Pre PACES Podcast #54 Hemiparesis (part 2)
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Feb 12, 2023 Dr. Paul Sellors, a Consultant in Stroke Medicine at Southmead Hospital, dives deep into the intricacies of hemiparesis and stroke management. He shares essential tips for neurological examinations and highlights the importance of temperature testing in diagnosing posterior strokes with an innovative water-filled glove technique. The discussion also covers coordination tests, documenting incomplete exams, and essential imaging strategies. As a fun twist, Paul engages in a light-hearted Metallica quiz, balancing serious medical insights with memorable trivia.
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Temperature Trumps Proprioception In Posterior Stroke
- Proprioception tests are less useful in stroke, but pain and temperature can be crucial for posterior circulation strokes.
- Dr Paul Sellors tests temperature clinically (e.g., a water-filled glove) to detect crossed pain–temperature loss.
Sequence Cortical Tests By Lateralizing Deficit
- If right-sided weakness present, assess speech next; if left-sided weakness, assess neglect next, then test visual fields.
- Use quick bedside confrontation and simple tasks (name items, sight and sensation checks) to pick up cortical signs.
Practical Rapid Tests For Neglect
- Use quick neglect tests when time is limited: finger confrontation, simultaneous touch, line bisection or clock drawing.
- Point out obvious neglect (e.g., head turned away from one side) and use simple bedside demonstrations to prove cortical involvement.