Seizure physical examination: Difference between revisions
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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=== | ||
| Line 31: | Line 13: | ||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Vital signs]] are usually normal | *[[Vital signs]] are usually normal once baseline is reached. However, it should be monitored. | ||
*[[Oxygen saturation]] should be assessed. | *[[Oxygen saturation]] should be assessed. | ||
===Skin=== | ===Skin=== | ||
| Line 38: | Line 20: | ||
*[[Signs]] of a [[neurocutaneous syndrome]] associated with [[epilepsy]] on the [[skin]] (such as [[neurofibromatosis]], [[tuberous sclerosis]], and [[Sturge-Weber syndrome]]) may be observed. | *[[Signs]] of a [[neurocutaneous syndrome]] associated with [[epilepsy]] on the [[skin]] (such as [[neurofibromatosis]], [[tuberous sclerosis]], and [[Sturge-Weber syndrome]]) may be observed. | ||
===HEENT=== | ===HEENT=== | ||
*Lateral tongue bites | *Lateral [[tongue]] bites | ||
**Observed in 22% of patients with all types of epileptic seizures, but not observed in patients with [[psychogenic]] nonepileptic seizures. | **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.<ref name="pmid7487261">{{cite journal |author=Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F |title=Value of tongue biting in the diagnosis of seizures |journal=Arch. Intern. Med. |volume=155 |issue=21 |pages=2346-9 |year=1995 |pmid=7487261 |doi=}}</ref> | **A small study found that finding a bite to the side of the [[tongue]] was very helpful when present in diagnosing seizure.<ref name="pmid7487261">{{cite journal |author=Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F |title=Value of tongue biting in the diagnosis of seizures |journal=Arch. Intern. Med. |volume=155 |issue=21 |pages=2346-9 |year=1995 |pmid=7487261 |doi=}}</ref> | ||
***[[sensitivity (tests)|Sensitivity]] of 24% | ***[[sensitivity (tests)|Sensitivity]] of 24% | ||
***[[specificity (tests)|Specificity]] of 99% | ***[[specificity (tests)|Specificity]] of 99% | ||
===Neck=== | ===Neck=== | ||
*[[Nuchal rigidity]] or [[asterixis]] | *[[Nuchal rigidity]] or [[asterixis]]: May suggest an underlying systemic [[disorder]] | ||
===Lungs=== | ===Lungs=== | ||
| Line 51: | Line 33: | ||
===Heart=== | ===Heart=== | ||
* [[Cardiovascular examination]] of [[patients]] with seizure is usually normal. | * [[Cardiovascular]] [[examination]] of [[patients]] with seizure is usually normal. | ||
===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with | * [[Abdominal examination]] of [[patients]] with seizure is usually normal. | ||
===Back=== | ===Back=== | ||
* Back examination of patients with | * [[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=== | ||
* Genitourinary examination of patients with | * [[Genitourinary]] [[examination]] of [[patients]] with seizure is usually normal. [[Patient]] may have had [[urinary incontinence]] during the episode. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with | * [[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=== | ||
* Extremities examination of | * [[Extremities]] [[examination]] of [[patients]] with seizure may show [[signs]] of [[trauma]] due to fall. | ||
==References== | ==References== | ||
Latest revision as of 00:44, 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
The physical examination of patients with seizure may reveal:[1][2][3][4][5]
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 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.