From the Guidelines
A comprehensive physical examination for patients with suspected acute stroke should include vital signs, neurological assessment, and head and neck examination, as outlined in the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, update 2018 1.
Vital Signs
Vital signs involve measuring:
- Blood pressure
- Temperature
- Heart rate
- Oxygen saturation
- Hydration status These provide baseline information about a patient's physiological status and can indicate various conditions when abnormal.
Neurological Exam
The neurological exam begins with:
- Mental status assessment, evaluating orientation, memory, and cognition
- Cranial nerve examination tests all 12 cranial nerves for proper function, including vision, eye movements, facial sensation, hearing, swallowing, and tongue movement
- Motor function assessment evaluates strength, coordination, and reflexes
- Sensory testing checks for response to touch, temperature, and vibration A standardized stroke scale, such as the National Institutes of Health Stroke Scale (NIHSS), should be used to assess stroke severity 1.
Head and Neck Examination
The head and neck examination includes:
- Inspection for abnormalities
- Palpation of the scalp for tenderness or masses
- Examination of neck muscles for stiffness, spasm, or tenderness
- Assessment of the carotid arteries for bruits
- Checking of lymph nodes for enlargement This systematic approach helps identify neurological disorders, infections, vascular issues, and other conditions affecting the head and neck region, as recommended by the American Heart Association/American Stroke Association guidelines for the early management of patients with acute ischemic stroke 1.
From the Research
Vital Signs
- Blood pressure: a crucial indicator of a patient's condition, with abnormal readings often associated with poor clinical outcomes 2
- Temperature: an essential vital sign that can indicate infection or other underlying conditions
- Other vital signs, such as heart rate and respiratory rate, also provide valuable insight into a patient's condition
Neurological Exam
- Assessment of mental status: evaluating a patient's level of consciousness, confusion, and ability to respond to stimuli
- Cranial nerves: examining the function of cranial nerves to identify any deficits or abnormalities
- Motor and sensory function: assessing a patient's strength, reflexes, and sensation to identify any neurological deficits
Examination of the Head and Neck
- Palpation of the scalp: examining the scalp for any signs of trauma, infection, or other abnormalities
- Palpation of the neck muscles: assessing the neck muscles for any signs of tension, trauma, or other abnormalities
- Other aspects of the head and neck exam, such as examining the eyes, ears, and throat, can also provide valuable information about a patient's condition
Relationship to Meningitis and Stroke
- Acute bacterial meningitis can cause serious neurological adverse effects, including stroke 3
- The inflammatory response triggered by meningitis can cause damage to the blood-brain barrier, leading to cerebral ischemia and stroke
- Early recognition and treatment of meningitis are critical to preventing long-term neurological damage and improving patient outcomes 4
Assessment and Management
- The assessment of vital signs and neurological function is critical for safe, high-quality care 2
- A comprehensive examination of the head and neck can help identify signs of meningitis, stroke, or other neurological conditions
- Prompt treatment, including antimicrobial therapy and supportive care, is essential for managing meningitis and preventing complications 4