Epilepsy physical examination: Difference between revisions

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===Skin===
===Skin===
*[[Cyanosis]]  
*[[Cyanosis]]  
*[[Jaundice]]
* 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>
* [[Pallor]]
* Bruises
 
 


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* 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".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
===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 [disease name] is usually normal.
* Pulmonary examination of patients with epilepsy is usually normal.
OR
* 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>
* Asymmetric chest expansion OR decreased chest expansion
** Physical signs
*Lungs are hyporesonant OR hyperresonant
** Respiration rate >20/min
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
** Percussion dullness
*Rhonchi
** Auscultation abnormality
*Vesicular breath sounds OR distant breath sounds
** Bronchial breathing
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
** Crackles
*[[Wheezing]] may be present
** Temperature
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===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===
* Genitourinary examination of patients with [disease name] is usually normal.
*Urine and fecal incontinence may be present during a seizure attack.
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===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

  • Cyanosis
  • Bruises (result of sudden falls or loss of consciousness)[3]

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

  1. Mattle, Heinrich (2017). Fundamentals of neurology : an illustrated guide. Stuttgart New York: Thieme. ISBN 9783131364524.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

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