ERDoc Posted December 8, 2008 Share Posted December 8, 2008 You are called to the residence of a 27y/o male who tells you, "Dude! I think I'm having a stroke. I've been dragging my foot and I have some numbness in it too." Link to comment Share on other sites More sharing options...
mobey Posted December 8, 2008 Share Posted December 8, 2008 Events leading up to present illness? Drug/alcohol use? Past med Hx? Sudden/slow onset? pins & Needles feeling? Pain? assess usual stroke stuff Trouble speaking grip strengths shrug shoulders pupils etc etc As for the leg: Color? Temp? Look for trauma (including needle marks) any decreased ROM Strength? Any meds? seen the Doc lately? for what? Link to comment Share on other sites More sharing options...
ERDoc Posted December 8, 2008 Author Share Posted December 8, 2008 Whoa! Mobey, save some of the scenario for the others. The pt states he noted some numbness through the day while he was at work but didn't think much about it. He says when he was walking to his car after work he noticed his right foot was dragging. No PMH, but doesn't go to the doctor. No drug or alcohol use. Says he can't feel anything over the side of the shin going to the foot. No trouble speaking, equal hand grips, shoulders are equal. PERRLA. Leg has normal color and temperature. No signs of trauma. The pt has difficulty with dorsiflexion of the foot, especially the great toe. You have him walk and notice that he drags the foot because he does not seem to be able to dorsiflex while he is taking a step. Link to comment Share on other sites More sharing options...
Timmy Posted December 8, 2008 Share Posted December 8, 2008 I take it he hasn't no cervical pain or spinal related complaints? Does he take any medication? Does he have lower back pain? What's our neurological observations looking like? No blurry vision, balance problems? Has he been overseas? Any past family history of cerebral or spinal tumours? Can I get a BP and Pulse please? Has he been playing sport, climing stairs ect? Any funny sensations on movement of limb suggesting a STI or ?# Does the limb actually have weakness/ loss of motor function or is he favouring it because it feels uncomfortable? Peadal Pulse? Link to comment Share on other sites More sharing options...
AZCEP Posted December 8, 2008 Share Posted December 8, 2008 What kind of work does he do? Pulses in all extremities? Cap refill? Temp.? Vital signs? Point discrimination in the effected limb? Link to comment Share on other sites More sharing options...
Timmy Posted December 8, 2008 Share Posted December 8, 2008 What does point discrimination entail? I've never heard of it. Link to comment Share on other sites More sharing options...
ERDoc Posted December 8, 2008 Author Share Posted December 8, 2008 No neck pain. No meds, no lower back pain. No vision changes, he says he does not feel like he is off balance but says he does have trouble walking because of the foot dragging. Family history in noncontributory. BP is 124/72, P 82. No sports or stair climbing. No funny sensations with movement (not sure what STI and ?# mean). Good DP/PT pulses. Cap ref <2 sec in all toes. He has the weakness noted above. I take it he hasn't no cervical pain or spinal related complaints? Does he take any medication? Does he have lower back pain? What's our neurological observations looking like? No blurry vision, balance problems? Has he been overseas? Any past family history of cerebral or spinal tumours? Can I get a BP and Pulse please? Has he been playing sport, climing stairs ect? Any funny sensations on movement of limb suggesting a STI or ?# Does the limb actually have weakness/ loss of motor function or is he favouring it because it feels uncomfortable? Peadal Pulse? Link to comment Share on other sites More sharing options...
AZCEP Posted December 8, 2008 Share Posted December 8, 2008 What does point discrimination entail? I've never heard of it. Basically, it's a fancy term for sharp and dull sensation. You take a paperclip and open it up so you have two pointy and one dull end. Then you start poking around until the patient can tell the two apart. There is ton more to the testing, but this works in a pinch. It will tell you the degree of nerve involvement, and the level it starts/stops. Link to comment Share on other sites More sharing options...
Timmy Posted December 8, 2008 Share Posted December 8, 2008 Sweet, thanks for that. I've completed simliar assessments with a pen just never had a name for it. Link to comment Share on other sites More sharing options...
ERDoc Posted December 8, 2008 Author Share Posted December 8, 2008 He is a tree cutter and is the guy that climbs them. Good pulses in all extremities. Cap ref<2sec in all extremities. Temp 98.2. 2 point discrimination is decreased over the lateral aspect of the shin from just below the head of the fibula down to the dorsum of the foot. What kind of work does he do? Pulses in all extremities? Cap refill? Temp.? Vital signs? Point discrimination in the effected limb? Link to comment Share on other sites More sharing options...
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