Seizure physical examination: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
Zehra Malik (talk | contribs) (→Neck) |
||
| (24 intermediate revisions by 3 users not shown) | |||
| Line 2: | Line 2: | ||
{{Seizure}} | {{Seizure}} | ||
{{CMG}} {{AE}} {{SHA}} | {{CMG}} {{AE}} {{SHA}} | ||
==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== | ==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> | |||
===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=== | ||
*[[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.<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% | |||
***[[specificity (tests)|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== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Epilepsy]] | [[Category:Epilepsy]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 00:44, 22 April 2021
|
Seizure Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Seizure physical examination On the Web |
|
American Roentgen Ray Society Images of Seizure physical examination |
|
Risk calculators and risk factors for Seizure physical examination |
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.