Some common symptom patterns: NMJ Fatiguable weakness LMN Dysarthria, dysphagia Distal weakness (and numbness) UMN Dexterity, dragging foot, exertional worsening, clonus, spasms (and sphincter disturbance) Extrapyramidal Aching, slowing up, shuffling, dexterity, handwriting Cerebellar Slurring of speech, clumsiness, unsteadiness
Symptoms of Motor Dysfunction
- Weakness – ask about ability to lift arms / objects, grip strength, getting up from a chair / bed, going upstairs
- Wasting / loss of muscle bulk
- Stiffness of limbs
- Gait abnormalities - limping or dragging of legs
Symptoms of Co-ordinatory Dysfunction or Balance disturbance
- Difficulty in walking
- Unsteadiness
- Falls
- Staggering
- Loss of balance in the dark
Important points during the pre -weakness
Associated sensory symptoms: e.g. parasthesia, numbness, tingling, loss of awareness of the limb(s).
Current functional status of affected limb(s):
- UL: lifting objects, writing, dressing, ….etc;
- LL: walking independently or with aid, using wheelchair….etc.
Any history of headache, vomiting, dizziness, status of consciousness.
Facial deviation:
Ask to which side the angle of mouth/face is deviated, any history of slurred speech, drooling of saliva, difficulty in drinking liquids and regurgitation of food after the stroke attack.
Seizures: History of abnormal body movements, tongue biting, up rolling of eyes and frothy secretions from the mouth.
Embolic evidence – History of chest pain, dyspnea and palpitations.
Other:
- Incontinence of stools and urine.
- Blurring/loss of vision.
- Any history of recent head injury/trauma.
- Past history –episode of TIAs, Previous stroke: when, cause, course and outcome. Trauma (Subdural haematoma). RHD (MS & AF)
- Predisposing factors like Hypertension and Diabetes (duration, TTT, control, regular follow up), Smoking, and Alcohol.
- History of intake of drugs like OCPs, Aspirin, Warfarin, Hormones, etc.
- Family history of stroke.