PHYSICAL EXAMINATION VIDEOS: Part 2

Cranial Nerves Examination:

Upper Limb Neurological Assessment:

Lower Limb Neurological Assessment:

(Source: Youtube, Credit: Geeky Medics)

Part 3 to follow......

Stroke/TIA: Scales & Recommendations

Rosier Scale:   Diagnoses Stroke
NIHSS:             Rates Severity of a stroke
ABCD2:           Predicts Stroke in TIA

Rosier Scale:

Negative Symptoms:
LOC/Syncope      -1
Seizures                 -1

Positive Symptoms: (FALSE Memonic)
Assymetric Weakness of Face     1
                                            Arms    1
                                            Legs     1
Disturbance in Speech                 1
                           Eyes (Vision)      1

Total Score -2 to 5
Score of > 0 is Stroke in absence of Hypoglycemia with a Sensitivity of 93% and Specificity of 83%

ABCD2 for TIA:

Age > 60                        1 point
BP   > 140/90                1 point
C/f
Unilateral Weakness   2 points
Slurred Speech only (no weakness)  1 point
Duration
> 60 minutes                      2 points
>10 minutes and < 60 minutes 1 point
<10 0="" minutes="" nbsp="" p="" points="">DM

Score: 0 to 7
< 4                   Aspirin and Secondary prevention
                        Imaging or Brain and carotids and consultation in 1 week

> 4                  Aspirin and Secondary prevention
                        Imaging or Brain and carotids and consultation in 24 hours

C/I to Thrombolysis in Stroke:

Age: <18 or="">80
BP: >185/110 or bleeding disorders
CNS: Neoplasm, AVM, Past Bleed, Recent Stroke
Duration: > 4.5 Hours
NIHSS: <5 or="">25

(Victoria Stacey 2012)

ABCD2 For TIA to determine the risk of stroke

ABCD2 Score for TIA

(Estimates risk of stroke after a TIA, according to patient risk factors)

Age > 60 Years                                                                     1

BP > 140/90 mm Hg at initial evaluation                    1

Clinical Features of TIA                 

            Unilateral Weakness                                              2

            Speech disturbance (no weakness)                    1

            Other Symptoms                                                      0

Duration of symptoms                                           

            Less than 10 minutes                                              0

            10 – 60 minutes                                                        1

            > 60 minutes                                                             2

Diabetes Mellitus                                                                 1

Total Score

Risk Score	% Stroke Risk 2 days	% Stroke Risk 7 days	% Stroke Risk 90 days
0 – 3 (Low)	1	1.2	2.1
4 – 5 (Moderate)	4.1	5.9	9.8
6 – 7 (High)	8.1	11.7	17.8

Recommendation:

 Scores < 4                             Aspirin and Prevention of secondary sequelae

                                                Neurology Opinion in a week

                                                Imaging within a week

Score > 4                                Aspirin and Prevention of secondary sequelae

                                                Neurology Opinion within 24 hours

                                                Imaging within 24 hours