Subdural hematoma physical examination: Difference between revisions

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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Common physical examination findings of subdural hematoma include decreased level of consciousness, mental status abnormalities, abnormal gait, evidence of intracranial hypertension (papilledema), hemiparesis, and Parkinson like symptoms.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with subdural hematoma usually appear normal.  


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


*High-grade / low-grade fever
*Fever (in infected subdural hematoma)
*[[Hypothermia]] / hyperthermia may be present
*Vital signs in patients with subdural hematoma is usually normal.
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with subdural hematoma is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* Abnormalities of the head including evidence of head trauma
OR
* Extra-ocular movements are normal
* Abnormalities of the head/hair may include ___
*Pupils reactive to light and commodation
* Evidence of trauma
*Ophthalmoscopic exam may be abnormal with findings of papilledema (in case of intracranial hypertension)
* 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".)
* [[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 [disease name] is usually normal.
* Neck examination of patients with subdural hematoma is usually normal
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* Pulmonary examination of patients with subdural hematoma is usually normal.
OR
* Asymmetric chest expansion OR decreased chest expansion
*Lungs are hyporesonant OR hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds OR distant breath sounds
*Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
*[[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.
* Cardiovascular examination of patients with subdural hematoma 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]]
*[[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 [disease name] is usually normal.
* Abdominal examination of patients with subdural hematoma is usually normal.
OR
*[[Abdominal distension]]
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with subdural hematoma is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump
 
===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
* Genitourinary examination of patients with subdural hematoma is usually normal.
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.
OR
*Patient is usually oriented to persons, place, and time
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Altered mental status may be present in acute SDH
* Glasgow coma scale is ___ / 15
* Glasgow coma scale may be abnormal in acute SDH
* Clonus may be present
*Abnormal gait may be present
* Hyperreflexia / hyporeflexia / areflexia
*Negative Trendelenburg sign
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
*Unilateral/bilateral tremor may be present in chronic SDH mimicking Parkinson disease
* Muscle rigidity
*Bradykinesia may be present in chronic SDH mimicking Parkinson disease
* Proximal/distal muscle weakness unilaterally/bilaterally
*Absent dysdiadochokinesia (palm tapping test)
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
* Unilateral/bilateral upper/lower extremity weakness may be present in chronic SDH
*Unilateral/bilateral upper/lower extremity weakness
* Unilateral/bilateral sensory loss in the upper/lower extremity may be present in chronic SDH
*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 subdural hematoma 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}}

Latest revision as of 15:18, 10 June 2019

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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 subdural hematoma include decreased level of consciousness, mental status abnormalities, abnormal gait, evidence of intracranial hypertension (papilledema), hemiparesis, and Parkinson like symptoms.

Physical Examination

Appearance of the Patient

  • Patients with subdural hematoma usually appear normal.

Vital Signs

  • Fever (in infected subdural hematoma)
  • Vital signs in patients with subdural hematoma is usually normal.

Skin

  • Skin examination of patients with subdural hematoma is usually normal.

HEENT

  • Abnormalities of the head including evidence of head trauma
  • Extra-ocular movements are normal
  • Pupils reactive to light and commodation
  • Ophthalmoscopic exam may be abnormal with findings of papilledema (in case of intracranial hypertension)

Neck

  • Neck examination of patients with subdural hematoma is usually normal

Lungs

  • Pulmonary examination of patients with subdural hematoma is usually normal.

Heart

  • Cardiovascular examination of patients with subdural hematoma is usually normal.

Abdomen

  • Abdominal examination of patients with subdural hematoma is usually normal.

Back

  • Back examination of patients with subdural hematoma is usually normal.

Genitourinary

  • Genitourinary examination of patients with subdural hematoma is usually normal.

Neuromuscular

  • Patient is usually oriented to persons, place, and time
  • Altered mental status may be present in acute SDH
  • Glasgow coma scale may be abnormal in acute SDH
  • Abnormal gait may be present
  • Negative Trendelenburg sign
  • Unilateral/bilateral tremor may be present in chronic SDH mimicking Parkinson disease
  • Bradykinesia may be present in chronic SDH mimicking Parkinson disease
  • Absent dysdiadochokinesia (palm tapping test)
  • Unilateral/bilateral upper/lower extremity weakness may be present in chronic SDH
  • Unilateral/bilateral sensory loss in the upper/lower extremity may be present in chronic SDH

Extremities

  • Extremities examination of patients with subdural hematoma is usually normal.

References

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