1

Name/Age/Sex/Occupation/Address/handedness
Presenting Complaints:
H/o weakness / inability to use limbs
H/o mouth angle defect
H/o speech defect
History of Presenting complaints:
Weakness/ inability:
o Sequence of events in patients own words which includes
Duration
Onset sudden / insidious
Time of occurence sleep / work
Progression
Tone flaccid / rigid
Weakness of
Upper limb
o Proximal: H/o combing hair, lifting hand
o Distal: H/o mixing food, buttoning shirt, writing
Lower limb
o Proximal: H/o standing, climbing stairs
o Distal: H/o slippers slipping
Trunk
o H/o turning from side to side
Neck
o H/o difficulty to lift head from bed
H/o fasciculation / atrophy
H/o sensory loss
o Temperature sense: warm / cold water
o Touch sense: feeling shirts, dresses
o Pain sense: pinching
o Others: tingling, numbness, root pain
H/o loss of consciousness
o Duration
o Complete / partial
o Aura +/-
o Associated with (to rule out odds palsy)
o Bowel / Bladder disturbance
o Recovery period
o Frequency of occurence

2

History suggestive of etiology
H/o thrombus
Vomiting, diarrhoea (calf tenderness)
H/o embolism
Chest pain, palpitation, fever with meningitis, TB
H/o haemorrhage
Trauma, headache, projectile vomitting, blurring of vision, convulsions, bleeding
diathesis
Level of lesion
o H/o cortex
Aphasia
Bladder involvement
Convulsion
o H/o corona radiata
o H/o Internal capsule
o H/o brain stem
Cranial nerves
o I : H/o loss of sense of smell / altered
o II : H/o disturbance of vision
o III, IV, VI : H/o diplopia, difficulty in eye movements
o V : H/o sensory loss over face, chewing disturbances
o VII : H/o loss of taste, salivation, angle deviation, drooling of saliva from mouth
o VIII : H/o hearing loss, vertigo, tinnitus
o IX, X : H/o nasal regurgitation, nasal twang, dysphagia, hoarseness of voice
o XII : H/o dysarthria
ANS history:
o H/o bowel:
Constipation / loss of control
o H/o bladder:
Difficulty in feeling the filling / Difficulty in initiating / Difficulty in controlling /
Difficulty in complete evacuation / Dribbling
o Impotence:
o Sweating:
Past History:
o H/o previous episodes
o H/o TIA, RIND (Reversible Ischemic Neurological Deficit)
o H/o DM, TB, HT, STD
o H/o recurrent headache, vomiting, diarrhoea, fever
o H/o cardiac disease, epilepsy, trauma
o H/o CSOM, ARV, dogbite
3

o H/o drugs, surgery, OCPs, poisoning
Family History:
o Consanguinity
o Siblings
o Any similar episodes
Personal History:
o Smoking
o Alcohol
o Diet --> lathyrism, SACD
o STD history
Treatment History:
Summary:
Age/sex/name ? Handedness ? Personal H/o ? Family H/o ? PC ? other relevant positive findings
Probable system involved ? CNS
History Diagnosis:
Acute CVA, which is probably due to ...................... which is.........................(progression) in
nature, with associated cranial nerve involvement and ...........(no) sensory loss. The probable site of
lesion is ...........................
Examination of CNS case:
General Examination:
o comfortable
o cooperative
o conscious
o oriented
o built
o nourishment
o febrile / afebrile
o pallor / not anemic
o Icteric / not
o Clubbing
o Cyanosis
o Pedal oedema
o Significant lymphadenopathy
4

Neurocutaneous markers:
o Adenoma sebaceum
o Ash leaf patches
o Shagreen patches
o Cafe au lait spots
o Multiple neurofibromas
o Tuft of hair in the back spina bifida
o Capillary haemangioma Sturge weber syndrome
(port wine stain)
o Conjunctival haemangioma Von Hippel Lindau syndrome
o (with cerebellar haemangioma)
o Pes cavum Friedreichs ataxia
Markers of HIV
Markers of TB
Markers of FF syphilis
o peripheral nerve thickening
o spine angulation
Vital signs:
o Pulse: rate, rhythm, volume, character, PV, RF, vessel wall
o BP
o RR
o Temperature
o JVP
Local Examination of CVS:
A. Higher Function:
a. Consciousness
b. Orientation time, place, person
c. Memory short, place, person
d. Intelligence
e. Speech
f. Handedness
g. Emotion
B. Cranial nerves:
I. Olfactory nerve:
a. Clove - +/- (Rt & Lt)
b. Oil of peppermint - +/-
c. Asafoetida - +/-
II. Optic nerve:
a. Visual acuity
5

i.
Gross vision
Distant vision
Near vision
b. Field of vision
c. Colour vision
d. Fundoscopy

III, IV, VI Occulomotor , Trochlear, abducent
Extra ocular movements
Pupil
o Size
o Reflexes
Direct
Consensual
Accommodation
Nystagmus
Ptosis
V Trigeminal
Sensory sensation over face and buccal mucosa
Motor Clenching of teeth ( masseter, temporalis, pterygoids)
Reflex
o Corneal
o Conjunctival
o Jaw jerk
VII Facial nerve
Motor
o Wrinkling of forehead
o Closing of eyelids
o Showing teeth
o Blowing of cheeks, whistling
o Nasolabial folds
o platysma
o Hyperacusis (Stapedius)
Sensory
o Taste of Ant. 2/3 of tongue
(Sugar, salt, vinegar)
o Sensation over tongue
Reflex
6

o Corneal
o Conjunctival
Secretomotor
o Salivation
o Lacrimation(Shirmers tear)
VIII Vestibulocochlear nerve
Cochlear
o Rinnes test
o Weber test
Vestibular
o Caloric test
IX X Glossopharyngeal, Vagus
Taste (posterior 2/3 of tongue) IX
Gag reflex
Palatal reflex
XI Spinal accessory nerve
Shrugging of shoulders
Turning head against resistance
XII Hypoglossal nerve
Tongue protrusion
Fibrillation
Wasting
Power
C. Motor System:
Bulk
o Inspection
o Palpation
UL 10 cm from acromion
10 cm below olecranon process
LL 18 cm from upper end of patella
- 10 cm lower end of patella
Tone
o UL N / clasp knife spasticity in flexors
o LL N / clasp knife spasticity in extensors
Power
o UL
Shoulder
Flexion extension
7

Abduction adduction
Rotation
Elbow
Flexion extension
Wrist
Flexion extension
pronation Supination
Adduction Abduction
Fingers
Flexion extension
Abduction Adduction
Thumb
Flexion extension
Abduction Adduction
Opposition
o Lower Limb
Hip Jt
Flexion extension
Abduction adduction
Rotation
Knee Jt.
Flexion Extension
Ankle Jt
Dorsal plantar flexion
Inversion Eversion
Toes
Flexion extension
Adduction Abduction
Coordination:
o Upper limb
Finger nose test
Finger finger nose test
Disdiadochokinesia
o Lower limb
Knee heel test
Drawing circle
Gait
o In hemiplegia Adducted shoulder, Flexed elbow, Flexed and semipronated
wrist, Flexion at MP jts, extension at IP jts
Involuntary movements
Reflexes
8

o Superficial reflexes
Corneal (CN 5, 7)
Conjunctival (CN 5,7)
Pharyngeal (CN 9, 10)
Abdominal (T8 T12)
Cremasteric (L1, L2)
Plantar ( L5, S1)
o Deep reflexes
Jaw jerk (CN 5)
Biceps (C5, C6)
Triceps (C6, C7, C8)
Supinator (C5, C6)
Knee jerk (L3, L4) clonus
Ankle jerk (S1, S2) clonus
D. Sensory System:
a. Superficial
Touch
Pain
Temperature
b. Deep
Pressure
Deep pain
Vibration sense
Position sense
c. Cortical sense
Tactile localisation
Two point discrimination
Stereopsis
Graphesthesia
d. meningeal irritation:
Neck rigidity
Kernigs sign
Brudzinskis sign
Diagnosis:
...............................(Lt/Rt) sided hemiplegia .............................(with / without Lt/Rt) UMN facial
palsy with lesion at .............................. (Rt/Lt) Internal capsule in the ..................................(Rt/Lt MCA
territory) probably due to .........................(thrombosis / embolism / haemorrgage)