You are seeing Ms. Richards, a 75 year old female, in the ER. She is distraught because she is presenting with a two hour history of complete left leg paralysis. Please perform a focused history and physical examination.
History
- Onset and duration of paralysis
- Associated sensory loss
- History of trauma to leg
- Leg swelling
- Pain in leg
- Parasthesias in leg
- Numbness in leg
- Shortness of breath
- Chest pain
- Head trauma
- Weakness elsewhere in the body
- Sensory loss elsewhere in the body
- Vision or speech changes
- Personal history of myocardial infarction and stroke
- Peripheral vascular disease
- Diabetes
- Dyslipidemia
- Hypertension
- Smoking history (quantity in pack-years)
- Medications/Allergies
- Family history of cardiac or cerebrovascular events
Physical Examination
Inspection
- Comments on color of affected limb (pale)
- Inspects for hair loss/lack of oil on affected limb
- Inspects for arterial and diabetic ulcers on feet bilaterally (small ulcer on bottom of 1st toe)
- Inspects for leg swelling
Palpation
- Palpates affected limb for tenderness
- Compares temperature in lower limbs
- Assesses sensation in both lower limbs
- Assesses power in both lower limbs
- Assesses capillary refill in affected limb
Auscultation
- Auscultates bilaterally for femoral and popliteal bruits
- Auscultates abdomen for aortic aneurysm
Case 1 – Acute Paralysis