Encephalopathy physical examination
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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]
Overview
Physical Exam
Appearance of the Patient
The appearance is mainly depends upon the severity of the condition and the cause. The patient is often confused. The patient may appear anxious and may have difficulty in breathing. There may be quite to a few signs of injury which may be due to trauma.
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
Head
- No obvious signs on head.
- Skull fractures may be evident in cases of trauma
Eyes
- Icteric sclera may be present
- Nystagmus may be seen in a few cases of cranial nerve disease
- Papilledema seen in hypertensive encephalopathy
Ears, Nose, Throat (ENT)
- No significant findings
- Injuries if trauma
Nose
Throat
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
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
Extremities
Neurologic
Complete physical examination may not be possible in a few cases of severe complications.
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.