Physical Examination

Prior to initiating a neurologic examination, a general physical examination should be completed. If a patient is febrile, the source of infection should be identified. An infection may be the cause of a patient's deterioration or may be a complication of the stroke (e.g., aspiration pneumonia). The skin should be examined for signs of emboli (e.g., Janeway lesions and Osler nodes) or bleeding dyscrasia (e.g., ecchymosis or petechiae). A funduscopic examination should be completed to identify signs of papilledema (suggesting a mass lesion or hypertensive crisis), preretinal hemorrhage (consistent with an SAH), or evidence of extensive hypertensive retinopathy. A history suggestive of possible cardiac disease such as myocardial infarction, angina, dysrhythmias, palpitation, or worsening of congestive heart failure should be investigated. Physical findings such as rales, an S3 gallop, or carotid bruit should be recorded.

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