A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin, mucous membranes, and sclerae (white part of the eye) [tremor (muscle tremors); myoclonus (involuntary muscle twitching); paralysis; incoordination]
- Inspection (viewing) and palpation (palpation) of the thyroid gland [due todifferential diagnosis: Hashimoto’s encephalopathy (form of brain change caused by thyroid hormones]
- Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?) [Hepatic encephalopathy – central nervous system (CNS) dysfunction caused by acute or chronic liver disease (differential diagnosis)]
- Inspection (viewing).
- Neurologic examination – including reflex testing, motor/sensory examination, and cranial nerve testing. [due tosymptoms:
- Akinetic mutism (inhibition of all motor functions including speech).
- Ataxia (disturbance in the sequence of movement).
- Chorea (involuntary rapid sweeping movements).
- Coordination disorders
- Paralysis
- Myoclonus (involuntary muscle twitching).
- Painful dysesthesias (sensory disturbances)]
[due todifferential diagnoses:
- Alcoholism
- Dementias of all kinds
- Encephalitis (inflammation of the brain)
- Alzheimer’s disease
- Parkinson’s disease
- Multisystem atrophy (degenerative neurological disease similar to Parkinson’s disease, but much more severe and rapid).
- Normal pressure hydrocephalus (“hydrocephalus”, which does not lead to an increase in pressure due to a simultaneous reduction in brain tissue).
- Progressive multifocal leukoencephalopathy (demyelinating disease of the brain).
- Progressive myoclonic epilepsy (progressive form of epilepsy).
- Psychiatric disorders]
Square brackets [ ] indicate possible pathological (pathological) physical findings.