Case 1 – Acute Paralysis

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.


  • 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


  • 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


  • 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


  • Auscultates bilaterally for femoral and popliteal bruits
  • Auscultates abdomen for aortic aneurysm
Case 1 – Acute Paralysis