Chapter 48 Assessment of a patient with stroke

The neurological examination is a time-honored physician skill that is honed by neurologists. It is a key component of the clinical assessment of a patient with suspected stroke. The emphasis of the neurological examination may vary among patients and differences in evaluation are influenced by the patient's history or other findings detected prior to the physical examination. Besides defining the neurological deficits, clinical issues that are addressed by the examination are also influenced by the time since the stroke. The initial examination helps localize the lesion and provides clinical–anatomical correlations. Because of its many attributes and clinical utility, the neurological examination remains the clinical standard to which other components of the evaluation of the patient are compared. Specific sections of the neurological examination are used to construct the various clinical rating instruments to assess patients with stroke. The components of the neurological examination are outlined in the chapter. This chapter focuses on the importance of the types of neurological impairments in predicting the location of an infarction. This localization is important for management, including decisions about evaluation, acute care, and long-term treatment.