Stroke (Apoplexy): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • Assessment of consciousness using the Glasgow Coma Scale (GCS).
  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Neck vein congestion?
      • Central cyanosis? (bluish discoloration of skin and central mucous membranes, e.g., tongue).
      • Abdomen (abdomen):
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
      • Extremities (palpation (feeling) of peripheral pulses, looking for edema/water retention).
    • Auscultation (listening) of the heart and central arteries (flow sounds?).
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
  • Neurological examination – including testing of reflexes (especially the biceps tendon reflex (BSR), triceps tendon reflex (TSR), radius periosteal reflex (RPR), patellar tendon reflex (PSR), and Achilles tendon reflex (ASR, also triceps surae reflex)), testing of sensitivity and motor function.
    • Babinski reflex – pressureful brushing of the lateral edge of the sole of the foot leads to an upward extension of the big toe
    • Cranial nerve involvement with corresponding symptoms, e.g., dysphagia (difficulty swallowing), deviation of the tongue when sticking it out, gaze paralysis
    • Further: see under symptoms – complaints

Square brackets [ ] indicate possible pathological (pathological) physical findings.

FAST test

With the help of the so-called FAST test, it is possible to quickly orient (even for medical laymen) to check the typical apoplexy symptoms:

  • F = Face (face paralyzed on one side? ); Test: ask the patient to smile.
  • A = Arms (arm movement restricted? ; Test: ask patient to raise both arms simultaneously, turning palms upward.
  • S = Speech (speech slurred? ); Have the patient repeat a simpler sentence.
  • T = Time (Do not waste time! Tel. 112).

Glasgow Coma Scale (GCS) – scale for the estimation of a disorder of consciousness.

Criterion Score
Eye opening spontaneous 4
on request 3
on pain stimulus 2
no reaction 1
Verbal communication conversational, oriented 5
conversational, disoriented (confused) 4
incoherent words 3
unintelligible sounds 2
no verbal reaction 1
Motor response Follows prompts 6
Targeted pain defense 5
untargeted pain defense 4
on pain stimulus flexion synergisms 3
on pain stimulus stretching synergisms 2
No response to pain stimulus 1

Assessment

  • Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
  • If the score is 8 or less, a very severe brain dysfunction is assumed and the there is a risk of life-threatening respiratory disorders.
  • With a GCS ≤ 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) must be considered.