Ischemic stroke physical examination
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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
| 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 |
|
++ | ++ | ++ | + | + | ++ | + | + |
| Cerebellum | Community-acquired, ingestion of undercooked poultry | ++ | + | ++ | + | + | ++ | + | + |
| "Central pathway involved" |
|
± | + | ++ | ++ | + | ++ | + | + |
Glassgow coma score
Glassgow coma score helps determine the severity of infaction, extent of damage and prognosis in unconscious or semi conscious patients. The score is determined by adding score in each category with the maximum score of 15 and minimum score of 3.[2][3][4][5][6][7]
| Parameter | Patient response | Glassgow coma score |
|---|---|---|
| Eye opening |
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| Verbal response |
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| Motor response |
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Appearance
The patient may appear confused.
Eye
- Vision problems may be present.
- Drooping of eyelid (ptosis) and weakness of ocular muscles
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
- ↑ 1.0 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. - ↑ Sternbach GL (2000). "The Glasgow coma scale". J Emerg Med. 19 (1): 67–71. PMID 10863122.
- ↑ Reith FC, Van den Brande R, Synnot A, Gruen R, Maas AI (2016). "The reliability of the Glasgow Coma Scale: a systematic review". Intensive Care Med. 42 (1): 3–15. doi:10.1007/s00134-015-4124-3. PMID 26564211 : 26564211 Check
|pmid=value (help). - ↑ Gabbe BJ, Cameron PA, Finch CF (2003). "The status of the Glasgow Coma Scale". Emerg Med (Fremantle). 15 (4): 353–60. PMID 14631703.
- ↑ Tsao JW, Hemphill JC, Johnston SC, Smith WS, Bonovich DC (2005). "Initial Glasgow Coma Scale score predicts outcome following thrombolysis for posterior circulation stroke". Arch Neurol. 62 (7): 1126–9. doi:10.1001/archneur.62.7.1126. PMID 16009770.
- ↑ Haug RH, Picard U, Matejczyk MB, Indresano AT (1989). "The infected prosthetic total temporomandibular joint replacement: report of two cases". J Oral Maxillofac Surg. 47 (11): 1210–4. PMID 2509651.
- ↑ Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA (1993). "Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study". Crit Care Med. 21 (10): 1459–65. PMID 8403953.