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==Physical Examination== | ==Physical Examination== | ||
The [[physical examination]] of patients with seizure may reveal:<ref name="pmid28027373">{{cite journal| author=Gavvala JR, Schuele SU| title=New-Onset Seizure in Adults and Adolescents: A Review. | journal=JAMA | year= 2016 | volume= 316 | issue= 24 | pages= 2657-2668 | pmid=28027373 | doi=10.1001/jama.2016.18625 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28027373 }} </ref><ref name="pmid23041172">{{cite journal| author=Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG | display-authors=etal| title=Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. | journal=Epilepsy Behav | year= 2012 | volume= 25 | issue= 2 | pages= 251-5 | pmid=23041172 | doi=10.1016/j.yebeh.2012.06.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23041172 }} </ref><ref name="pmid11297707">{{cite journal| author=Browne TR, Holmes GL| title=Epilepsy. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 15 | pages= 1145-51 | pmid=11297707 | doi=10.1056/NEJM200104123441507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11297707 }} </ref><ref name="pmid15101468">{{cite journal| author=Ahmed SN, Spencer SS| title=An approach to the evaluation of a patient for seizures and epilepsy. | journal=WMJ | year= 2004 | volume= 103 | issue= 1 | pages= 49-55 | pmid=15101468 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15101468 }} </ref><ref name="pmid30743294">{{cite journal| author=Bank AM, Bazil CW| title=Emergency Management of Epilepsy and Seizures. | journal=Semin Neurol | year= 2019 | volume= 39 | issue= 1 | pages= 73-81 | pmid=30743294 | doi=10.1055/s-0038-1677008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30743294 }} </ref> | * The [[physical examination]] of patients with seizure may reveal:<ref name="pmid28027373">{{cite journal| author=Gavvala JR, Schuele SU| title=New-Onset Seizure in Adults and Adolescents: A Review. | journal=JAMA | year= 2016 | volume= 316 | issue= 24 | pages= 2657-2668 | pmid=28027373 | doi=10.1001/jama.2016.18625 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28027373 }} </ref><ref name="pmid23041172">{{cite journal| author=Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG | display-authors=etal| title=Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. | journal=Epilepsy Behav | year= 2012 | volume= 25 | issue= 2 | pages= 251-5 | pmid=23041172 | doi=10.1016/j.yebeh.2012.06.020 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23041172 }} </ref><ref name="pmid11297707">{{cite journal| author=Browne TR, Holmes GL| title=Epilepsy. | journal=N Engl J Med | year= 2001 | volume= 344 | issue= 15 | pages= 1145-51 | pmid=11297707 | doi=10.1056/NEJM200104123441507 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11297707 }} </ref><ref name="pmid15101468">{{cite journal| author=Ahmed SN, Spencer SS| title=An approach to the evaluation of a patient for seizures and epilepsy. | journal=WMJ | year= 2004 | volume= 103 | issue= 1 | pages= 49-55 | pmid=15101468 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15101468 }} </ref><ref name="pmid30743294">{{cite journal| author=Bank AM, Bazil CW| title=Emergency Management of Epilepsy and Seizures. | journal=Semin Neurol | year= 2019 | volume= 39 | issue= 1 | pages= 73-81 | pmid=30743294 | doi=10.1055/s-0038-1677008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30743294 }} </ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== |
Revision as of 00:42, 22 April 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Overview
The physical examination of patients with seizure may reveal: lateral tongue bites, nuchal rigidity or asterixis, bruises or scrapes on the body after falls, signs of a neurocutaneous syndrome associated with epilepsy on the skin, back pain, transient or persistent focal weakness or asymmetry, and urinary incontinence.
Physical Examination
Appearance of the Patient
- Patients with seizure may appear completely normal or may have signs of trauma or other findings specific to the underlying etiology.
Vital Signs
- Vital signs are usually normal after once baseline is reached. However, it should be monitored.
- Oxygen saturation should be assessed.
Skin
- Skin examination of patients with seizure is usually normal. There may be bruises or scrapes on the body after a fall due to seizure.
- Signs of a neurocutaneous syndrome associated with epilepsy on the skin (such as neurofibromatosis, tuberous sclerosis, and Sturge-Weber syndrome) may be observed.
HEENT
- Lateral tongue bites
- Observed in 22% of patients with all types of epileptic seizures, but not observed in patients with psychogenic nonepileptic seizures.
- A small study found that finding a bite to the side of the tongue was very helpful when present in diagnosing seizure.[6]
- Sensitivity of 24%
- Specificity of 99%
Neck
- Nuchal rigidity or asterixis: May suggest an underlying systemic disorder
Lungs
- Pulmonary examination of patients with seizure is usually normal.
Heart
- Cardiovascular examination of patients with seizure is usually normal.
Abdomen
- Abdominal examination of patients with seizure is usually normal.
Back
- Back examination of patients with seizure is usually normal. Some patients may complain of back pain, it may suggest a vertebral compression fracture
Genitourinary
- Genitourinary examination of patients with seizure is usually normal. Patient may have had urinary incontinence during the episode.
Neuromuscular
- Neuromuscular examination of patients with seizure should include assessment of orientation to persons, place, and time and altered mental status.
- Transient or persistent focal weakness or asymmetry. May suggest abnormality in the area of the brain affected.
Extremities
- Extremities examination of patients with seizure may show signs of trauma due to fall.
References
- ↑ Gavvala JR, Schuele SU (2016). "New-Onset Seizure in Adults and Adolescents: A Review". JAMA. 316 (24): 2657–2668. doi:10.1001/jama.2016.18625. PMID 28027373.
- ↑ Brigo F, Storti M, Lochner P, Tezzon F, Fiaschi A, Bongiovanni LG; et al. (2012). "Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective". Epilepsy Behav. 25 (2): 251–5. doi:10.1016/j.yebeh.2012.06.020. PMID 23041172.
- ↑ Browne TR, Holmes GL (2001). "Epilepsy". N Engl J Med. 344 (15): 1145–51. doi:10.1056/NEJM200104123441507. PMID 11297707.
- ↑ Ahmed SN, Spencer SS (2004). "An approach to the evaluation of a patient for seizures and epilepsy". WMJ. 103 (1): 49–55. PMID 15101468.
- ↑ Bank AM, Bazil CW (2019). "Emergency Management of Epilepsy and Seizures". Semin Neurol. 39 (1): 73–81. doi:10.1055/s-0038-1677008. PMID 30743294.
- ↑ Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F (1995). "Value of tongue biting in the diagnosis of seizures". Arch. Intern. Med. 155 (21): 2346–9. PMID 7487261.