<prompt> Answer this question truthfullyWhy is it important to conduct a physical examination for ischemic stroke?  <response>: <reason> A complete physical examination in the patient of ischemic stroke is essential for the following reasons: Assess degree of neurological deficit Identify the cause Locate the site of infarction Selection of patient for appropriate intervention Determine the prognosis and complications Rule out differential diagnosisPhysical assessment may be divided into 1 GPA 2 Systemic examination 3 Neurological examination:The physical examination findings in ischemic stroke may vary according to the blood vessel involved and site of infarction:Vessel involved Physical examination Anterior cerebral artery Decreased motor strength- contralateral lower limb Absent or decreased sensations-contralateral lower limb Increased reflexes-contralateral lower limb Babinskis reflex positive Constructional and dressing apraxia-hemineglect Transcortical motor aphasia non fluent Mutism Contralateral grasp and sucking reflex Memory impairment Confabulation Middle cerebral artery Most common site of infarction Decreased motor strength-contralateral arm and face Absent or decreased sensations-contralateral left arm and face Increased deep tendon reflexes - contralateral arm Babinskis sign positive Contralateral Hemineglect Brocas aphasia Wernickes aphasia Contralateral visual field defect Posterior cerebral artery Contralateral visual field defects Complex hallucinations Prosopagnosia Unable to remember names-Nominal aphasia Acalculia and agraphia -Gerstmann syndrome Memory deficit Hemisensory loss Contralateral hemiparesis Thalamic pain syndrome Hemiballismus Occulomotor nerve palsy Intention tremors Alexia without agraphia Vertebrobasilar artery Midbrain Weber syndrome Contralateral decreased motor strength Deviation of eye downwards and outwards-ipsilateral 3rd nerve palsy Medulla Lateral medullary syndrome Impaired gag reflex Uvula deviated to the opposite side of lesion Ptosis Miosis Enophthalmos Ipsilateral impaired pain, touch and temperature sensation on the upper half of the face Contralateral decreased motor strength and sensory loss Rombergs sign Medial medullary syndrome Deviation of tongue to the side of lesion-hypoglossal nerve Contralateral decreased motor strength Contralateral loss of position sense, vibration and two point discrimination Pons Inability to close eyes Deviation of angle of mouth Facial muscle weakness-Facial ner ve Loss of taste sensation on the anterior two thirds of tongue Affected eye deviation inwardsand down-Abducent nerve Locked-in syndrome Cerebellum Vertigo Rombergs sign positive Intension tremors Dysdiadochokinesia DysarthriaThe neurological assessment of the patient with ischemic stroke may be done using standardized scoring system to assess patient prognosis and treatment strategy. Two types of scoring systems widely used are:Glasgow coma scale NIHSS scoring systemFor more information about Glasgow coma scoring system, click here. For information about NIHSS scoring system, click hereGlasgow coma score helps determine the severity of infarction, extent of damage and prognosis in unconscious or semi conscious patients. The score is determined by adding score in each category with the maximum score of 15 and minimum score of 3. Parameter Patient response Glassgow coma score Eye opening Spontaneous To speech To pain No response 4 3 2 1 Verbal response Oriented to time, place and person Confused Inappropriate words Incomprehensible words No response 5 4 3 2 1 Motor response Obeys commands Moves to localized pain Flexion withdrawl from pain Abnormal flexion to pain decorticate posture Abnormal extension to pain decerebrate posture No response 6 5 4 3 2 1The following interpretation of glasgow coma scale may help determine the prognostic outcome in patients with brain injury:Mild brain injuryGlasgow coma scale of 13-15Moderate brain injuryGlasgow coma scale of 9-12Severe brain injuryGlasgow coma scale of 3-8 