Assessment

HISTORY. Determine if the patient is on any medications or abuses intravenous drugs. Elicit a history of neurological deficits (Table 5). Determine if the patient has experienced an inability to recognize familiar objects or persons through sensory stimuli (agnosia) or any memory loss (amnesia). Elicit a history of speech difficulties such as an inability to understand language or express language (aphasia), poorly articulated speech (dysarthria), or any other form of speech impairment (dysphasia). Determine if the patient has lost the ability to comprehend written words (alexia), read written words (dyslexia), or write (agraphia). Establish a history of visual difficulties such as double vision (diplopia), defective vision, or blindness in the right or left halves of the visual fields of both eyes (homonymous hemianopia), lack of depth perception, color blindness, blindness, blurring on the affected side, or drooping eyelids (ptosis).

Elicit a history of motor difficulties such as the inability to move the muscles (akinesia), inability to perform purposeful acts or manipulate objects (apraxia), poor coordination, impairment of voluntary movement (dyskinesia), muscular weakness or partial paralysis affecting one side of the body (hemiparesis), or paralysis of one side of the body (hemiplegia). Ask if the patient has experienced numbness and ascertain the specific location. Determine if the patient has experienced headaches. Establish a history of personality changes such as flat affect or distractibility.

• TABLE 5 CVA Sites and Neurological Deficits
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