ABNORMAL STROKE EXAM FINDINGS:
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1 Stroke Assessment Scenario Case Information PATIENT INFORMATION: 68-year-old male patient complaining of left sided weakness and an unsteady gait. Reported last normal time 3 minutes prior to EMS arrival on scene. ABNORMAL STROKE EXAM FINDINGS: Moderate left arm drift. Unable to maintain extension for secs. Moderate decrease left leg motor function. Unable to maintain leg raise for 5 secs. EXPECTED OUTCOME: CPSS positive, suggesting possible ischemic event. EMS should transport to the nearest primary stroke center; onset < 3 hours. mrace exam should be completed en route to the primary center. mrace of, not indicative of a large vessel occlusion.
2 Item Exam Abnormal Points mrace. Speech Repeat: The sky is blue in Pittsburgh. Normal (speech with correct words and no slurring) Abnormal (slurs words, says wrong words, or unable to speak). Facial Palsy Ask patient to smile / show teeth Absent (symmetric movement) Mild facial palsy (slightly asymmetrical) Moderate-severe facial palsy (completely asymmetric) 3. Arm Motor Ask patient to raise both arms, palms up, for secs No or mild drift of either arm (limb held > secs) Moderate drift of either arm (limb held < secs) Severe weakness of either arm (no movement Presence of Stroke Cincinnati Prehospital Stroke Score Positive (any yes above): 4. Leg Motor Ask patient to raise each leg for 5 secs No or mild drift of either leg (limb held > 5 secs) Moderate drift of either leg (limb held < 5 secs) Severe weakness of either leg (no movement 5. Head and Gaze Deviation Ask patient to move head and eyes horizontally and assess gaze deviation Absent (eye movements to both sides possible and no head deviation) Present (eyes and head deviation to one side) 6. Commands Ask the patient to close your eyes and make a fist Normal (performs both tasks) Moderate (performs one task) Severe (performs no tasks) 7. Agnosia Ask patient while showing the affected arm: Whose arm is this? Ask patient to lift both arms and clap (evaluate if patient recognizes functional impairment) Normal (recognizes his/her arm and Moderate (does not recognize his/her arm or Severe (does not recognize his/her arm nor Stroke Severity Serum Glucose: mrace Score:
3 Stroke Assessment Scenario Case Information PATIENT INFORMATION: 83-year-old female patient experiencing an altered level of consciousness. Last normal time approximately 5 hours prior. ABNORMAL STROKE EXAM FINDINGS: Slurred speech. Unable to move right arm against gravity. Unable to move right leg against gravity. Unable to make a fist with her left hand. Unable to close her eyes. Does not recognize deficit. Is not able to clap. EXPECTED OUTCOME: CPSS positive, suggesting possible ischemic event. mrace exam should be completed on scene. mrace of 8, suggestive of a large vessel occlusion. EMS should consult medical command for interventional center; onset 3- hours.
4 Item Exam Abnormal Points mrace. Speech Repeat: The sky is blue in Pittsburgh. Normal (speech with correct words and no slurring) Abnormal (slurs words, says wrong words, or unable to speak). Facial Palsy Ask patient to smile / show teeth Absent (symmetric movement) Mild facial palsy (slightly asymmetrical) Moderate-severe facial palsy (completely asymmetric) 3. Arm Motor Ask patient to raise both arms, palms up, for secs No or mild drift of either arm (limb held > secs) Moderate drift of either arm (limb held < secs) Severe weakness of either arm (no movement Presence of Stroke Cincinnati Prehospital Stroke Score Positive (any yes above): 4. Leg Motor Ask patient to raise each leg for 5 secs No or mild drift of either leg (limb held > 5 secs) Moderate drift of either leg (limb held < 5 secs) Severe weakness of either leg (no movement 5. Head and Gaze Deviation Ask patient to move head and eyes horizontally and assess gaze deviation Absent (eye movements to both sides possible and no head deviation) Present (eyes and head deviation to one side) 6. Commands Ask the patient to close your eyes and make a fist Normal (performs both tasks) Moderate (performs one task) Severe (performs no tasks) 7. Agnosia Ask patient while showing the affected arm: Whose arm is this? Ask patient to lift both arms and clap (evaluate if patient recognizes functional impairment) Normal (recognizes his/her arm and Moderate (does not recognize his/her arm or Severe (does not recognize his/her arm nor Stroke Severity Serum Glucose: mrace Score: 8
5 Stroke Assessment Scenario 3 Case Information PATIENT INFORMATION: 74-year-old male patient complaining of a headache and increased weakness. Residual left sided deficits from a prior CVA in 7. Last normal time approximately 9 minutes ago. ABNORMAL STROKE EXAM FINDINGS: Mild left-sided facial droop. Moderate left arm drift. Unable to maintain extension for secs. Moderate decrease left leg motor function. Unable to maintain leg raise for 5 secs. Unable to clap and recognizes the deficit. EXPECTED OUTCOME: CPSS positive, suggesting possible ischemic event. EMS should transport to the nearest primary stroke center; onset < 3 hours. mrace exam should be completed en route to the primary center. mrace of 3, not indicative of a large vessel occlusion.
6 Item Exam Abnormal Points mrace. Speech Repeat: The sky is blue in Pittsburgh. Normal (speech with correct words and no slurring) Abnormal (slurs words, says wrong words, or unable to speak). Facial Palsy Ask patient to smile / show teeth Absent (symmetric movement) Mild facial palsy (slightly asymmetrical) Moderate-severe facial palsy (completely asymmetric) 3. Arm Motor Ask patient to raise both arms, palms up, for secs No or mild drift of either arm (limb held > secs) Moderate drift of either arm (limb held < secs) Severe weakness of either arm (no movement Presence of Stroke Cincinnati Prehospital Stroke Score Positive (any yes above): 4. Leg Motor Ask patient to raise each leg for 5 secs No or mild drift of either leg (limb held > 5 secs) Moderate drift of either leg (limb held < 5 secs) Severe weakness of either leg (no movement 5. Head and Gaze Deviation Ask patient to move head and eyes horizontally and assess gaze deviation Absent (eye movements to both sides possible and no head deviation) Present (eyes and head deviation to one side) 6. Commands Ask the patient to close your eyes and make a fist Normal (performs both tasks) Moderate (performs one task) Severe (performs no tasks) 7. Agnosia Ask patient while showing the affected arm: Whose arm is this? Ask patient to lift both arms and clap (evaluate if patient recognizes functional impairment) Normal (recognizes his/her arm and Moderate (does not recognize his/her arm or Severe (does not recognize his/her arm nor Stroke Severity Serum Glucose: mrace Score: 3
7 Stroke Assessment Scenario 4 Case Information PATIENT INFORMATION: 8-year-old male patient experiencing frequent falls over the past 8 hours. Last normal time approximately 8 hours prior, difficult to determine. ABNORMAL STROKE EXAM FINDINGS: Moderate right arm drift. Unable to maintain extension for secs. Moderate decrease right leg motor function. Unable to maintain leg raise for 5 secs. EXPECTED OUTCOME: CPSS positive, suggesting possible ischemic event. mrace exam should be completed on scene. mrace of, not indicative of a large vessel occlusion. EMS should consult medical command for appropriate receiving facility.
8 Item Exam Abnormal Points mrace. Speech Repeat: The sky is blue in Pittsburgh. Normal (speech with correct words and no slurring) Abnormal (slurs words, says wrong words, or unable to speak). Facial Palsy Ask patient to smile / show teeth Absent (symmetric movement) Mild facial palsy (slightly asymmetrical) Moderate-severe facial palsy (completely asymmetric) 3. Arm Motor Ask patient to raise both arms, palms up, for secs No or mild drift of either arm (limb held > secs) Moderate drift of either arm (limb held < secs) Severe weakness of either arm (no movement Presence of Stroke Cincinnati Prehospital Stroke Score Positive (any yes above): 4. Leg Motor Ask patient to raise each leg for 5 secs No or mild drift of either leg (limb held > 5 secs) Moderate drift of either leg (limb held < 5 secs) Severe weakness of either leg (no movement 5. Head and Gaze Deviation Ask patient to move head and eyes horizontally and assess gaze deviation Absent (eye movements to both sides possible and no head deviation) Present (eyes and head deviation to one side) 6. Commands Ask the patient to close your eyes and make a fist Normal (performs both tasks) Moderate (performs one task) Severe (performs no tasks) 7. Agnosia Ask patient while showing the affected arm: Whose arm is this? Ask patient to lift both arms and clap (evaluate if patient recognizes functional impairment) Normal (recognizes his/her arm and Moderate (does not recognize his/her arm or Severe (does not recognize his/her arm nor Stroke Severity Serum Glucose: mrace Score:
9 Stroke Assessment Scenario 5 Case Information PATIENT INFORMATION: 58-year-old female patient reported with abnormal behavior and weakness. Last normal time reported 9 minutes prior. ABNORMAL STROKE EXAM FINDINGS: Slurred speech. Severe left facial palsy. Unable to move left arm against gravity. Unable to move left leg against gravity. Right gaze deviation. Unable to identify left arm. Unable to clap and does not recognize impairment. EXPECTED OUTCOME: CPSS positive, suggesting possible ischemic event. EMS should transport to the nearest primary stroke center; onset < 3 hours. mrace of 9, suggestive of a large vessel occlusion. mrace exam should be completed en route.
10 Item Exam Abnormal Points mrace. Speech Repeat: The sky is blue in Pittsburgh. Normal (speech with correct words and no slurring) Abnormal (slurs words, says wrong words, or unable to speak). Facial Palsy Ask patient to smile / show teeth Absent (symmetric movement) Mild facial palsy (slightly asymmetrical) Moderate-severe facial palsy (completely asymmetric) 3. Arm Motor Ask patient to raise both arms, palms up, for secs No or mild drift of either arm (limb held > secs) Moderate drift of either arm (limb held < secs) Severe weakness of either arm (no movement Presence of Stroke Cincinnati Prehospital Stroke Score Positive (any yes above): 4. Leg Motor Ask patient to raise each leg for 5 secs No or mild drift of either leg (limb held > 5 secs) Moderate drift of either leg (limb held < 5 secs) Severe weakness of either leg (no movement 5. Head and Gaze Deviation Ask patient to move head and eyes horizontally and assess gaze deviation Absent (eye movements to both sides possible and no head deviation) Present (eyes and head deviation to one side) 6. Commands Ask the patient to close your eyes and make a fist Normal (performs both tasks) Moderate (performs one task) Severe (performs no tasks) 7. Agnosia Ask patient while showing the affected arm: Whose arm is this? Ask patient to lift both arms and clap (evaluate if patient recognizes functional impairment) Normal (recognizes his/her arm and Moderate (does not recognize his/her arm or Severe (does not recognize his/her arm nor Stroke Severity Serum Glucose: mrace Score: 9
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