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To test lower- extremity strength, have the patient lie supine and raise their leg to an angle of about 30–35 degrees, then hold it there while you count to five. If the leg drifts downward, touches the bed or can't be raised, it is a positive test. Lew Steinberg 52 APRIL 2016 | EMSWORLD.com Risk factors include hypertension, anticoagulants, brain aneu- rysms, arteriovenous malformations and prior hemorrhagic strokes. Differential diagnosis: hypoglycemia, migraine headache, seizure (Todd's paralysis), vertigo, hypertensive encephalopathy, menin- gitis, head trauma. Bell's Palsy Bell's palsy is a common stroke mimic that presents with unilateral facial weakness or paralysis. This occurs when the seventh cranial nerve becomes compressed or inflamed, most likely due to a viral infection. With Bell's palsy, the patient will have unilateral facial drooping and not be able to raise the eyebrow or close the eyelid as strongly on the affected side. In contrast, only the lower facial muscles are affected in patients suffering from a stroke. Stroke patients will have no difficulty raising both eyebrows and closing both eyes. Associated symptoms of Bell's palsy may include facial paresthesia, increased sensitivity to sound and an altered taste on the affected side. If the patient presents with any other focal neurological deficits, such as weakness of the extremities or visual disturbances, consider it to be a stroke. Symptoms typically evolve over 48 hours, and recent viral ill- ness or pain behind the ear on the affected side may precede facial weakness. Differential diagnosis: stroke. Peripheral Vertigo (Dizziness) Vertigo is the sudden onset of the sensation of spinning. It is impor- tant to differentiate a chief complaint of dizziness between vertigo (a sense of motion or spinning), ataxia (loss of balance) and light- headedness (feeling faint), as they have different underlying causes. If not differentiated, the symptom of dizziness can lead you down the wrong diagnostic path. For patients with vertigo, movement of the head, especially in the supine position, may provoke symptoms, while remaining still may calm the spinning sensation. Patients with peripheral vertigo will generally have horizontal nystagmus. For More Information Circle 39 on Reader Service Card PREVENT MESSY BODILY FLUID CLEAN UPS. (A) Extra Wide Opening. 6" wide, rigid collar makes it easy to use, even with one hand. (B) Won't Leak or Spill. Inner-valve seals contents and odors in. Won't leak even if dropped. (C) Hand Protection. Outer sleeve protects against infectious splatter. Helps Comply with OSHA 29 CFR. Isolates Bloodborne Pathogens, in bloody body fluids. Disposable. No messy, contaminated clean ups. Made in U.S.A. for over 25 yrs. This is how we ensure our high quality standards, and customer satisfaction. CONVENIENCE BAG BRAND TM For a free sample contact: GKR Industries, Inc., 13653 S. Kenton Ave., Crestwood, IL 60445 or call 800 -526-7879 www.GKRindustries.com For Vomit and Urine Collection A C B O v e r 2 5 M i l l i o n S o l d TABLE 4: PHYSICAL FINDINGS Ischemic Stroke Positive fndings on stroke evaluation tool and/or abnormal visual, motor, sensation, cerebellar or speech exam. Hemorrhagic Stroke Positive fndings on stroke evaluation tool and/or abnormal visual, motor, sensation, cerebellar or speech exam; photophobia; may have altered LOC. TIA Positive fndings on stroke evaluation tool and/or abnormal visual, motor, sensation, cerebellar or speech exam. Bell's Palsy Weakness on afected side of face including the muscles controlling the eyebrow and eyelid. May have mild tenderness behind the ear on afected side. Drooling and tearing on afected side may be present. Mild sensory loss on afected side may be present in severe cases. Vertigo Absence of other stroke signs or symptoms. Horizontal nystagmus present, increased symptoms if changes position or turns head side to side. Absence of diplopia and slurred speech. Todd's Paralysis (seizure) Unilateral motor weakness/paralysis occurring after a stroke. Meningitis Fever, altered LOC, petechial rash may be present; nuchal rigidity.