Seizure physical examination

The physical examination of patients with seizure may reveal: lateral tongue bites, nuchal rigidity or asterixis, bruises or scrapes on the body after falls, signs of a neurocutaneous syndrome associated with epilepsy on the skin, back pain, transient or persistent focal weakness or asymmetry, and urinary incontinence.

The physical examination of patients with seizure may reveal:^{[1][2][3][4][5]}

• Patients with seizure may appear completely normal or may have signs of trauma or other findings specific to the underlying etiology.

• Vital signs are usually normal once baseline is reached. However, it should be monitored.
• Oxygen saturation should be assessed.

• Skin examination of patients with seizure is usually normal. There may be bruises or scrapes on the body after a fall due to seizure.
• Signs of a neurocutaneous syndrome associated with epilepsy on the skin (such as neurofibromatosis, tuberous sclerosis, and Sturge-Weber syndrome) may be observed.

• Lateral tongue bites
  • Observed in 22% of patients with all types of epileptic seizures, but not observed in patients with psychogenic nonepileptic seizures.
  • A small study found that finding a bite to the side of the tongue was very helpful when present in diagnosing seizure.^[6]
    • Sensitivity of 24%
    • Specificity of 99%

• Nuchal rigidity or asterixis: May suggest an underlying systemic disorder

• Pulmonary examination of patients with seizure is usually normal.

• Cardiovascular examination of patients with seizure is usually normal.

• Abdominal examination of patients with seizure is usually normal.

• Back examination of patients with seizure is usually normal. Some patients may complain of back pain, it may suggest a vertebral compression fracture

• Genitourinary examination of patients with seizure is usually normal. Patient may have had urinary incontinence during the episode.

• Neuromuscular examination of patients with seizure should include assessment of orientation to persons, place, and time and altered mental status.
• Transient or persistent focal weakness or asymmetry. May suggest abnormality in the area of the brain affected.

• Extremities examination of patients with seizure may show signs of trauma due to fall.