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{{Epilepsy}}
{{Epilepsy}}


{{CMG}}; {{AE}} {{Fs}}
{{CMG}}; {{AE}} {{Fs}}
==Overview==
==Overview==
Common physical examination findings of epileptic [[seizure]] include: [[Automatic behavior]]<nowiki/>s, upward eye rolling, [[unconsciousness]], [[drooling]], [[cyanosis]], post-ictal drowsiness, [[fever]], [[tachycardia]], [[hypertension]], [[mydriasis]], [[nystagmus]], [[Urinary incontinence|urine]] and [[fecal incontinence]], [[Disorientation|disorientation]] to persons, place, and time, altered mental status, [[Automatic behavior|automatic behaviors]] (repetitive muscle movement), [[Muscle rigidity]] and [[Hyperreflexia|hyper-reflexia]].
==Physical Examination==
==Physical Examination==
Physical examination of patients with epilepsy is usually remarkable for:
Physical examination of patients with epilepsy is usually remarkable for:


===Appearance of the Patient===
===Appearance of the Patient===
*Patients with epilepsy usually appear normal between the seizures.   
*Patients with epilepsy usually appear normal between the [[Seizure|seizures]].   
*During an epileptic seizure, based on seizure type they present with signs such as:
*During an epileptic [[seizure]], based on [[seizure]] type they present with [[signs]] such as:
**Automatic behaviors  
**[[Automatic behavior|Automatic behaviors]]
**Upward eye rolling  
**Upward eye rolling  
**Unconsciousness  
**[[Unconsciousness]]
**Drooling  
**[[Drooling]]
**Cyanosis  
**[[Cyanosis]]
*After an epileptic seizure, based on seizure type the can present with signs such as Drowsiness and confusion or no sign at all.<ref>{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref>  
*After an epileptic [[seizure]], based on [[seizure]] type the can present with signs such as [[drowsiness]] and [[confusion]] or no [[Sign (medical)|sign]] at all.<ref name=":0">{{cite book | last = Mattle | first = Heinrich | title = Fundamentals of neurology : an illustrated guide | publisher = Thieme | location = Stuttgart New York | year = 2017 | isbn = 9783131364524 }}</ref>  


===Vital Signs===
===Vital Signs===


*Fever may be present during the seizure or in the post-ictal phase.
*[[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.
*[[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.<ref name="pmid27549906">{{cite journal |vauthors=Hampel KG, Jahanbekam A, Elger CE, Surges R |title=Seizure-related modulation of systemic arterial blood pressure in focal epilepsy |journal=Epilepsia |volume=57 |issue=10 |pages=1709–1718 |date=October 2016 |pmid=27549906 |doi=10.1111/epi.13504 |url=}}</ref>
*[[Hypertension]] may be present during the [[seizure]] which mostly come back to normal value few minutes after [[seizure]].<ref name="pmid27549906">{{cite journal |vauthors=Hampel KG, Jahanbekam A, Elger CE, Surges R |title=Seizure-related modulation of systemic arterial blood pressure in focal epilepsy |journal=Epilepsia |volume=57 |issue=10 |pages=1709–1718 |date=October 2016 |pmid=27549906 |doi=10.1111/epi.13504 |url=}}</ref>


===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.
* Based on the etiology of epilepsy, physical examination of HEENT can be remarkable for:
OR
* Evidence of [[trauma]]<ref name="pmid11034867">{{cite journal |vauthors=Annegers JF, Coan SP |title=The risks of epilepsy after traumatic brain injury |journal=Seizure |volume=9 |issue=7 |pages=453–7 |date=October 2000 |pmid=11034867 |doi=10.1053/seiz.2000.0458 |url=}}</ref>
* Abnormalities of the head/hair may include ___
* [[Mydriasis]]<ref name="pmid6167689">{{cite journal |vauthors=Gadoth N, Margalith D, Bechar M |title=Unilateral pupillary dilatation during focal seizures |journal=J. Neurol. |volume=225 |issue=3 |pages=227–30 |date=1981 |pmid=6167689 |doi= |url=}}</ref>
* Evidence of trauma
* [[Nystagmus]]<ref name="pmid26550287">{{cite journal |vauthors=Ma Y, Wang J, Li D, Lang S |title=Two types of isolated epileptic nystagmus: case report |journal=Int J Clin Exp Med |volume=8 |issue=8 |pages=13500–7 |date=2015 |pmid=26550287 |pmc=4612972 |doi= |url=}}</ref>
* Icteric sclera
* [[Jaundice|Icteric]] [[sclera]]<ref name="pmid24348646">{{cite journal |vauthors=Mokhtarifar A, Mozaffari H, Afshari R, Goshayeshi L, Akavan Rezayat K, Ghaffarzadegan K, Sheikhian M, Rajabzadeh F |title=Cholestasis and seizure due to lead toxicity: a case report |journal=Hepat Mon |volume=13 |issue=11 |pages=e12427 |date=2013 |pmid=24348646 |pmc=3860072 |doi=10.5812/hepatmon.12427 |url=}}</ref>
* [[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".)
* [[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 but they are in increased risk of [[aspiration]] and sometimes can present with [[Sign (medical)|sign]] and [[Symptom|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>
OR
** Physical [[signs]]
* Asymmetric chest expansion OR decreased chest expansion
** [[Respiration rate]] >20/min
*Lungs are hyporesonant OR hyperresonant
** Percussion dullness
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
** Auscultation abnormality
*Rhonchi
** Bronchial breathing
*Vesicular breath sounds OR distant breath sounds
** [[Crackles]]  
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
** Temperature
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Tachycardia]] before, during and after seizure<ref name="pmid30024401">{{cite journal |vauthors=Behbahani S |title=A review of significant research on epileptic seizure detection and prediction using heart rate variability |journal=Turk Kardiyol Dern Ars |volume=46 |issue=5 |pages=414–421 |date=July 2018 |pmid=30024401 |doi=10.5543/tkda.2018.64928 |url=}}</ref>
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]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|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===
===Abdomen===
* Abdominal examination of patients with epilepsy is usually normal.
* Abdominal examination of patients with epilepsy is usually normal.
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* 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.
*[[Urinary incontinence|Urine]] and [[fecal incontinence]] may be present during a seizure attack.<ref name="pmid23142708">{{cite journal |vauthors=Brigo F, Nardone R, Ausserer H, Storti M, Tezzon F, Manganotti P, Bongiovanni LG |title=The diagnostic value of urinary incontinence in the differential diagnosis of seizures |journal=Seizure |volume=22 |issue=2 |pages=85–90 |date=March 2013 |pmid=23142708 |doi=10.1016/j.seizure.2012.10.011 |url=}}</ref>
OR
*A pelvic/adnexal mass may be palpated
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with epilepsy is usually normal.
OR
* During a [[seizure]] attack:
*Patient is usually oriented to persons, place, and time
**Patient is usually [[Disorientation|disoriented]] to persons, place, and time.
* Altered mental status
** Altered mental status
* Glasgow coma scale is ___ / 15
** [[Automatic behavior|Automatic behaviors]] (repetitive muscle movement).<ref name=":0" />
* Clonus may be present
** [[Muscle rigidity]]
* Hyperreflexia / hyporeflexia / areflexia
** [[Hyperreflexia|Hyper-reflexia]] can occur in [[stroke]] induced epilepsy patients.<ref name="OlsenHogenhaven1987">{{cite journal|last1=Olsen|first1=T. S.|last2=Hogenhaven|first2=H.|last3=Thage|first3=O.|title=Epilepsy after stroke|journal=Neurology|volume=37|issue=7|year=1987|pages=1209–1209|issn=0028-3878|doi=10.1212/WNL.37.7.1209}}</ref>
* 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===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with epilepsy is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity
 
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Pediatrics]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]

Latest revision as of 21:37, 29 July 2020

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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

Common physical examination findings of epileptic seizure include: Automatic behaviors, upward eye rolling, unconsciousness, drooling, cyanosis, post-ictal drowsiness, fever, tachycardia, hypertension, mydriasis, nystagmus, urine and fecal incontinence, disorientation to persons, place, and time, altered mental status, automatic behaviors (repetitive muscle movement), Muscle rigidity and hyper-reflexia.

Physical Examination

Physical examination of patients with epilepsy is usually remarkable for:

Appearance of the Patient

Vital Signs

Skin

HEENT

Neck

  • Neck examination of patients with epilepsy is usually normal.

Lungs

Heart

Abdomen

  • Abdominal examination of patients with epilepsy is usually normal.

Back

  • Back examination of patients with epilepsy is usually normal.

Genitourinary

Neuromuscular

Extremities

  • Extremities examination of patients with epilepsy is usually normal.

References

  1. ↑ 1.0 1.1 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. ↑ Annegers JF, Coan SP (October 2000). "The risks of epilepsy after traumatic brain injury". Seizure. 9 (7): 453–7. doi:10.1053/seiz.2000.0458. PMID 11034867.
  5. ↑ Gadoth N, Margalith D, Bechar M (1981). "Unilateral pupillary dilatation during focal seizures". J. Neurol. 225 (3): 227–30. PMID 6167689.
  6. ↑ Ma Y, Wang J, Li D, Lang S (2015). "Two types of isolated epileptic nystagmus: case report". Int J Clin Exp Med. 8 (8): 13500–7. PMC 4612972. PMID 26550287.
  7. ↑ Mokhtarifar A, Mozaffari H, Afshari R, Goshayeshi L, Akavan Rezayat K, Ghaffarzadegan K, Sheikhian M, Rajabzadeh F (2013). "Cholestasis and seizure due to lead toxicity: a case report". Hepat Mon. 13 (11): e12427. doi:10.5812/hepatmon.12427. PMC 3860072. PMID 24348646.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ Behbahani S (July 2018). "A review of significant research on epileptic seizure detection and prediction using heart rate variability". Turk Kardiyol Dern Ars. 46 (5): 414–421. doi:10.5543/tkda.2018.64928. PMID 30024401.
  11. ↑ Brigo F, Nardone R, Ausserer H, Storti M, Tezzon F, Manganotti P, Bongiovanni LG (March 2013). "The diagnostic value of urinary incontinence in the differential diagnosis of seizures". Seizure. 22 (2): 85–90. doi:10.1016/j.seizure.2012.10.011. PMID 23142708.
  12. ↑ Olsen, T. S.; Hogenhaven, H.; Thage, O. (1987). "Epilepsy after stroke". Neurology. 37 (7): 1209–1209. doi:10.1212/WNL.37.7.1209. ISSN 0028-3878.

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