The general physical examination should be directed toward discovering any injuries, especially head or spine, that might have resulted from the seizure. Seizures may cause injuries such as fractures, sprains, and bruises; posterior dislocations of the shoulder are common and may be overlooked. Tongue lacerations and aspiration are frequent sequelae. A search for any systemic illness that may have caused the attack should be undertaken. Temperature should be noted, and a bedside glucose determination should be obtained.
A directed neurologic examination should be performed with follow-up serial exams. Level of consciousness and mentation should be followed closely. Profound obtundation that improves steadily is likely benign; however, progressive deterioration requires prompt intervention. Signs of increased intracranial pressure should be sought. Any focal neurologic deficit should be noted. A transient focal deficit following a simple or complex focal seizure is referred to as Todd's paralysis, and should resolve within 48 hours.
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