Epilepsy physical examination: Difference between revisions
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===Skin=== | ===Skin=== | ||
*[[Cyanosis]] | *[[Cyanosis]] | ||
* Bruises (result of sudden falls or loss of consciousness)<ref name="pmid2030371">{{cite journal |vauthors=Hoefnagels WA, Padberg GW, Overweg J, van der Velde EA, Roos RA |title=Transient loss of consciousness: the value of the history for distinguishing seizure from syncope |journal=J. Neurol. |volume=238 |issue=1 |pages=39–43 |date=February 1991 |pmid=2030371 |doi= |url=}}</ref> | |||
* Bruises | |||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with [disease name] is usually normal. | * HEENT examination of patients with [disease name] is usually normal. | ||
* Evidence of trauma | * Evidence of trauma | ||
* Icteric sclera | * Icteric sclera | ||
| Line 44: | Line 38: | ||
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".) | *[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".) | ||
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".) | *[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".) | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with epilepsy is usually normal. | * Neck examination of patients with epilepsy is usually normal. | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with | * Pulmonary examination of patients with epilepsy is usually normal. | ||
* Patients with epilepsy are in increased risk of aspiration and sometimes can present with sign and symptoms of recurrent pneumonia such as:<ref name="pmid12830562">{{cite journal |vauthors=Hopstaken RM, Muris JW, Knottnerus JA, Kester AD, Rinkens PE, Dinant GJ |title=Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection |journal=Br J Gen Pract |volume=53 |issue=490 |pages=358–64 |date=May 2003 |pmid=12830562 |doi= |url=}}</ref><ref name="pmid15256199">{{cite journal |vauthors=DeToledo JC, Lowe MR, Gonzalez J, Haddad H |title=Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients |journal=Epilepsy Behav |volume=5 |issue=4 |pages=593–5 |date=August 2004 |pmid=15256199 |doi=10.1016/j.yebeh.2004.03.009 |url=}}</ref> | |||
* | ** Physical signs | ||
** Respiration rate >20/min | |||
** Percussion dullness | |||
* | ** Auscultation abnormality | ||
* | ** Bronchial breathing | ||
* | ** Crackles | ||
* | ** Temperature | ||
* | |||
* | |||
* | |||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with [disease name] is usually normal. | * Cardiovascular examination of patients with [disease name] is usually normal. | ||
| Line 86: | Line 69: | ||
* Back examination of patients with epilepsy is usually normal. | * Back examination of patients with epilepsy is usually normal. | ||
===Genitourinary=== | ===Genitourinary=== | ||
* | *Urine and fecal incontinence may be present during a seizure attack. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
Revision as of 19:24, 10 December 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
Physical Examination
Physical examination of patients with epilepsy is usually remarkable for:
Appearance of the Patient
- Patients with epilepsy usually appear normal between the seizures.
- During an epileptic seizure, based on seizure type they present with signs such as:
- Automatic behaviors
- Upward eye rolling
- Unconsciousness
- Drooling
- Cyanosis
- After an epileptic seizure, based on seizure type the can present with signs such as Drowsiness and confusion or no sign at all.[1]
Vital Signs
- Fever may be present during the seizure or in the post-ictal phase.
- Tachycardia is present during the seizure and sometimes continue to be high in post-ictal phase.
- Hypertension may be present during the seizure which mostly come back to normal value few minutes after seizure.[2]
Skin
HEENT
- HEENT examination of patients with [disease name] is usually normal.
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of ___
- Hearing acuity may be reduced
- Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
- Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
Neck
- Neck examination of patients with epilepsy is usually normal.
Lungs
- Pulmonary examination of patients with epilepsy is usually normal.
- Patients with epilepsy are in increased risk of aspiration and sometimes can present with sign and symptoms of recurrent pneumonia such as:[4][5]
- Physical signs
- Respiration rate >20/min
- Percussion dullness
- Auscultation abnormality
- Bronchial breathing
- Crackles
- Temperature
Heart
- Cardiovascular examination of patients with [disease name] is usually normal.
OR
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with epilepsy is usually normal.
Back
- Back examination of patients with epilepsy is usually normal.
Genitourinary
- Urine and fecal incontinence may be present during a seizure attack.
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity
References
- ↑ Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
- ↑ Hampel KG, Jahanbekam A, Elger CE, Surges R (October 2016). "Seizure-related modulation of systemic arterial blood pressure in focal epilepsy". Epilepsia. 57 (10): 1709–1718. doi:10.1111/epi.13504. PMID 27549906.
- ↑ Hoefnagels WA, Padberg GW, Overweg J, van der Velde EA, Roos RA (February 1991). "Transient loss of consciousness: the value of the history for distinguishing seizure from syncope". J. Neurol. 238 (1): 39–43. PMID 2030371.
- ↑ Hopstaken RM, Muris JW, Knottnerus JA, Kester AD, Rinkens PE, Dinant GJ (May 2003). "Contributions of symptoms, signs, erythrocyte sedimentation rate, and C-reactive protein to a diagnosis of pneumonia in acute lower respiratory tract infection". Br J Gen Pract. 53 (490): 358–64. PMID 12830562.
- ↑ DeToledo JC, Lowe MR, Gonzalez J, Haddad H (August 2004). "Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients". Epilepsy Behav. 5 (4): 593–5. doi:10.1016/j.yebeh.2004.03.009. PMID 15256199.