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    Geriatric OSCE Stroke Exam

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    Ami Febriza
    This document outlines the steps for assessing a patient who may have had a stroke. It involves a general assessment including motor function, facial appearance and speech. A neurological examination of facial movements, sensation, eyes, limbs and reflexes is then described. The patient's speech, actions and ability to perform tasks are evaluated. Possible interpretations are provided depending on the location of lesions in the brain, such as right or left hemisphere involvement. Common treatments, outcomes, prevention strategies and diagnostic findings for strokes are also reviewed.

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    Geriatric OSCE Stroke Exam

    Uploaded by

    Ami Febriza
    650 views2 pages
    This document outlines the steps for assessing a patient who may have had a stroke. It involves a general assessment including motor function, facial appearance and speech. A neurological examination of facial movements, sensation, eyes, limbs and reflexes is then described. The patient's speech, actions and ability to perform tasks are evaluated. Possible interpretations are provided depending on the location of lesions in the brain, such as right or left hemisphere involvement. Common treatments, outcomes, prevention strategies and diagnostic findings for strokes are also reviewed.

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    osce stroke

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    This document outlines the steps for assessing a patient who may have had a stroke. It involves a general assessment including motor function, facial appearance and speech. A neurological examination of facial movements, sensation, eyes, limbs and reflexes is then described. The patient's speech, actions and ability to perform tasks are evaluated. Possible interpretations are provided depending on the location of lesions in the brain, such as right or left hemisphere involvement. Common treatments, outcomes, prevention strategies and diagnostic findings for strokes are also reviewed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    650 views2 pages

    Geriatric OSCE Stroke Exam

    Uploaded by

    Ami Febriza
    This document outlines the steps for assessing a patient who may have had a stroke. It involves a general assessment including motor function, facial appearance and speech. A neurological examination of facial movements, sensation, eyes, limbs and reflexes is then described. The patient's speech, actions and ability to perform tasks are evaluated. Possible interpretations are provided depending on the location of lesions in the brain, such as right or left hemisphere involvement. Common treatments, outcomes, prevention strategies and diagnostic findings for strokes are also reviewed.

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    Geriatric OSCE: Stroke Assessment

    General assessment:
    -

    Assess the patient, their state, any aids / equipment etc.


    Motor function, standing / sitting / lying
    Facial appearance, speech

    Examination:
    -

    Facial movements:
    o Raise eyebrows
    o Scrunch eyes
    o Puff out cheeks and hold them out
    o Open mouth, and against resistance
    o Tongue in / out / left / right
    Facial sensation:
    o Ocular / maxillary / mandibular branches
    o Tongue
    Ocular:
    o PLRs
    o Movements: Double-H
    o Visual fields: seeing, and when movement stops
    Upper limbs:
    o Tone
    o Gross motor
    o Sensation
    o Reflexes: including grasping
    Lower limbs:
    o Tone
    o Gross motor
    o Sensation
    o Reflexes: including Babinski
    Speech:
    o Orientation in time / place / person
    o General use of words:
    o Stating names and purposes of finger / pen / watch, name things starting with F
    Nominal aphasia if cant name it
    Agnosia if cant identify purpose
    o Identify their ownership of left / right hands
    Hemi-neglect
    Actions:
    o Act as if youre brushing your teeth
    Dyspraxia if cant carry out actions
    o Draw a clock
    May detect hemi-neglect, impaired executive function,
    o Simple maths: 2+6 = 8
    May detect acalculia
    o Write their name
    May detect agraphia or dyspraxia

    Interpretation:
    -

    Dominant (Left) MCA lesion:


    o Right weakness / impaired sensation
    o Aphasia Wernickes or Brocas
    o Dysarthria distinguish from cerebellar speech
    o Right visual field deficit
    o Impaired reading / writing / calculating (acalculia, agraphia)
    Non-dominant (Right) MCA lesion:
    o Left weakness / impaired sensation
    o Spatial disorientation
    o Left visual field deficit
    o Dysarthria (distinguish from cerebellar speech)

    Brainstem lesion:
    o 4-limb weakness and sensory impairment
    o Ataxia
    o Nystagmus
    o Bilateral visual field deficits
    Anterior Cerebral Artery lesion
    o Slowed mentation, decreased executive function
    o Incontinence
    o Frontal release of primitive reflexes
    Lateral Medullary Syndrome:
    o Ipsilateral numbness, limb ataxia, Horners Syndrome, pain over eye
    o Contralateral loss of sensation (pin prick and hot-cold)
    o Vertigo, nausea, hoarseness, hiccups, dysphagia

    Questions:
    -

    Treatment for acute stroke:


    o Rule out intracranial haemorrhage first
    o Thrombolysis if less than 4hrs (exact timeframe of who benefits at what time is
    still unclear)
    o Rehabilitation: rehabilitation physician, physiotherapy, speech and occupational
    therapy
    Outcomes of stroke:
    o Majority of recovery occurs within first 3 months, minimal neuro improvement
    past 6 months
    o At 1 yr: 1/3 die, 1/3 permanently impaired, 1/3 minimally or no residual
    impairment
    o High rate of post-stroke depression
    Secondary prevention:
    o Anticoagulation (aspirin / clopidogrel / other antiplatelets, NOACs, warfarin)
    o Lipid, diabetes, HTN control
    o Carotid endarterectomy
    CT findings:
    o Haemorrhagic stroke:
    Hyperdense diffuse region of haemorrhage
    Mass effect, increased intracranial pressure, herniation / displacement
    o Ischaemic stroke:
    Loss of grey-white distinction
    Loss of clarity of basal ganglia
    MRI findings:
    o Haemorrhagic stroke:

    Poor for detection of subarachnoid haemorrhage


    o Ischaemic stroke:
    Loss of grey-white distinction
    Loss of clarity of basal ganglia
    Differentials:
    o Thromboembolic stroke
    o Haemorrhagic stroke
    o Mass lesion (+/- acute necrosis / haemorrhage within mass)
    o Hypoglycaemia
    o Electrolyte abnormalities, esp hyponatraemia +/- overly rapid correction
    o Delirium

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