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 and mucous membranes
- Auscultation (listening) of the heart [due todifferential diagnoses: chronic heart failure (chronic heart failure), cardiac arrhythmias].
- Auscultation (listening) of the lungs [due todifferential diagnoses: chronic obstructive pulmonary disease (COPD), pulmonary insufficiency (inability of the lungs to provide sufficient oxygen)]
- Inspection (viewing).
- If necessary, ophthalmological examination – eye test.
- If necessary, ENT medical examination – hearing test.
- Neurologic examination – including motor and sensory function testingNote: Axial rigor (muscle rigidity), clinging, small-step gait, disturbances in vertical oculomotor function (eye movement), dystonic movement disorders, and myoclonias (brief involuntary twitching of single muscles or muscle groups) are indicative of a primary neurodegenerative disease.[due toDifferential diagnoses:
- Alzheimer’s dementia
- Chorea-Huntington’s disease (genetic neurological disease with increasing brain mass loss).
- Encephalitis (inflammation of the brain)
- Brain tumors
- Gerstmann-Sträussler-Scheinker disease (disease affecting the brain and associated with BSE).
- Hallervorden-Spatz syndrome (genetic neurological disorder with mental retardation and early death).
- Brain abscess (encapsulated collection of pus in the brain).
- Brain metastases
- Leigh encephalomyelopathy (genetic neurological disorder of early infancy).
- Leukodystrophy (disease of the central nervous system characterized by metabolic disorders).
- Meningoencephalitis (combined inflammation of the brain (encephalitis) and meninges (meningitis)).
- Parkinson’s disease
- Multi-infarct dementia (dementia due to brain damage after multiple strokes).
- Multiple sclerosis (MS) (neurological disease that can lead to paralysis).
- Multisystem atrophy (neurological disease associated with parkinsonism).
- Normal pressure hydrocephalus (brain changes due to a decrease in brain matter and a simultaneous increase in cerebrospinal fluid (nervous fluid)).
- Progressive multifocal encephalopathy (brain changes caused by papovavirus).
- Progressive supranuclear palsy (neurological disease associated with dementia).
- Subacute sclerosing panencephalitis (generalized encephalitis (inflammation of the brain) usually caused by measles infection).
- Wernicke’s encephalopathy (synonyms: Wernicke-Korsakow syndrome; Wernicke’s encephalopathy) – degenerative encephaloneuropathic disease of the brain in adulthood; clinical picture: brain-organic psychosyndrome (HOPS) with memory loss, psychosis, confusion, apathy, as well as gait and stance unsteadiness (cerebellar ataxia) and eye movement disorders / eye muscle paralysis (horizontal nystagmus, anisocoria, diplopia)); vitamin B1 deficiency (thiamine deficiency)]
- Psychiatric examination[due todifferential diagnoses:
- Alcohol dependence
- Depression
- Neuroses
- Schizophrenia]
[due topossible sequelae:
- Depression
- Hallucinations
- Insomnia (sleep disturbances)
- Delusions]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.