Encephalopathy physical examination

Encephalopathy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2]

Appearance of the Patient

The appearance is mainly depending upon the severity of the condition and cause. The patient is often confused. The patient may appear anxious and may have difficulty in breathing.

Vitals

Temperature

• Increased in infections, thyroiditis

• Decreased in severe sepsis

Pulse

Rate

• Tachycardia may be present in cases of thyroiditis and infections
• Bradycardia may be present in dehydration, loss of blood volume and severe sepsis

Rhythm

• The pulse is regular

Strength

• The pulse may be weak in cases of dehydration and hemorrhages

Symmetry

• The pulses are symmetric

Blood Pressure

• Hypotension may be present in cases of loss fluids , sepsis and low blood volume
• Hypertension may be present in cases of severe hypertensive encephalopathy

Respiratory Rate

• Tachypnea may be present in cases of pulmonary edema caused due to increase in blood pressure or due to multi organ failure

• Cheyne-Stokes respirations - an altered breathing pattern seen with brain damage and coma

Skin

• Cyanosis may be present in severe hypoxia and poisoning
• Jaundice may be present liver failure and in neonatal encephalopathy
• A rash may be present owing to a viral infection

Eyes

Icteric sclera may be present

Neck

• Jugular venous pressure may be elevated
• Carotid bruits may be present
• Lymph nodes may be present
• Thyromegaly may be present
• Hepatojugular reflux may be present

Lungs

• Pulmonary edema and rales may be present
• Wheezing may be present
• Consolidation may be present
• Egophony may be present

Heart

• A heave may be present
• A thrill may be present

Auscultation

• S1
• S2
• S3
• S4
• Gallops
• A systolic murmur best heard at the base may be present
• A systolic murmur best heard at the apex may be present
• A diastolic murmur may be present

Abdomen

• Abdominal distention may be present
• Abdominal tenderenss may be present
• Rebound may be present
• An acute abdomen may be present
• An abdominal mass may be present
• Hepatomegaly may be present
• Splenomegaly may be present

Neurologic

Complete physical examination may not be possible in a few cases of severe complications.

Vital signs

• Temperature -
• Blood pressure - very high blood pressure may be cause of encephalopathy, in a few cases like sepsis, dehydration it may be low
• Pulse -

General examination

• Myoclonus (involuntary twitching of a muscle or group of muscles)
• Nystagmus (rapid, involuntary eye movement)
• Tremor
• Muscle atrophy and weakness
• Dementia
• Seizure
• Loss of ability to swallow
• Loss of ability to speak

Complete physical examination may not be possible in a few cases of severe complications.

Vital signs

• Temperature - increased in infections, may be decreased in severe sepsis
• Blood pressure - very high blood pressure may be cause of encephalopathy, in a few cases like sepsis, dehydration it may be low
• Pulse - increase in rate but decrease in volume in dehydration, increase in rate and volume in thyroiditis

General examination

• Myoclonus (involuntary twitching of a muscle or group of muscles)
• Nystagmus (rapid, involuntary eye movement)
• Tremor
• Muscle atrophy and weakness
• Dementia
• Seizure
• Loss of ability to swallow
• Loss of ability to speak

Complete physical examination may not be possible in a few cases of severe complications.

Vital signs

• Temperature - increased in infections, may be decreased in severe sepsis
• Blood pressure - very high blood pressure may be cause of encephalopathy, in a few cases like sepsis, dehydration it may be low
• Pulse - increase in rate but decrease in volume in dehydration, increase in rate and volume in thyroiditis

General examination

• Myoclonus (involuntary twitching of a muscle or group of muscles)
• Nystagmus (rapid, involuntary eye movement)
• Tremor
• Muscle atrophy and weakness
• Dementia
• Seizure
• Loss of ability to swallow
• Loss of ability to speak

References

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