Ischemic stroke physical examination: Difference between revisions

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{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Site of Infarction}}
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Specific area involved}}
! style="background: #4479BA; padding: 5px 5px;" colspan=8 | {{fontcolor|#FFFFFF|Physical exam findings}}
|-
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Motor strength}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Reflexes}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Cranial nerves involved}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Sensations}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Coordination}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Babinski's sign}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Pupils}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Pupillary reflex}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Cerebral cortex''
| style="padding: 5px 5px; background: #F5F5F5;" | Frontal lobe
Perietal lobe
temporal lobe
Occipital lobe
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Brain stem''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Midbrain
*Pons
*Medulla
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''Cerebellum''
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, ingestion of undercooked poultry
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | "Central pathway involved"
| style="padding: 5px 5px; background: #F5F5F5;" |
*Spinothalamic tract
*Corticospinal tract
*Medial leminscus
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|}
|}
===Appearance===
===Appearance===

Revision as of 20:18, 5 November 2016

Stroke Main page

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]

Overview

A systematic review found that acute facial paresis, arm drift, or abnormal speech are the best findings.[1]

Physical Examination

Glassgow coma score

Glassgow coma score helps determine the severity of infaction and extent of damage.

Parameter Patient response Glassgow coma score
Eye opening
  • Frontal lobe
  • Temporal
  • Parietal
  • Occipital
  • A
  • B
  • C
Motor response
  • Midbrain
  • Pons
  • Medulla

A B C

Verbal response
  • A
  • B
  • C
  • D
  • A
  • B
  • C
  • D
Site of Infarction Specific area involved Physical exam findings
Motor strength Reflexes Cranial nerves involved Sensations Coordination Babinski's sign Pupils Pupillary reflex
Cerebral cortex Frontal lobe

Perietal lobe temporal lobe Occipital lobe

++ + ++ + + ++ + +
Brain stem
  • Midbrain
  • Pons
  • Medulla
 ++ ++ ++ + + ++ + +
Cerebellum Community-acquired, ingestion of undercooked poultry ++ + ++ + + ++ + +
"Central pathway involved"
  • Spinothalamic tract
  • Corticospinal tract
  • Medial leminscus
 ± + ++ ++ + ++ + +

Appearance

The patient may appear confused.

Eye

Ear

  • Altered hearing may be present.

Extremities

Neurologic

  • Abnormal speech
  • Acute facial paresis
  • Decreased reflexes: gag, swallow, pupil reactivity to light
  • Disorganized thinking, confusion, hypersexual gestures (with involvement of frontal lobe)
  • Hemineglect (involvement of parietal lobe)
  • Loss of co-ordination
  • Memory deficits (involvement of temporal lobe)
  • Numbness
  • Reduction in sensory or vibratory sensation

References

  1. ↑ 1.0 1.1 Goldstein L, Simel D (2005). "Is this patient having a stroke?". JAMA. 293 (19): 2391–402. doi:10.1001/jama.296.16.2012 url=http://jama.ama-assn.org/cgi/content/full/296/16/2012 Check |doi= value (help). PMID 15900010.

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