Rankin listed a series of ominous clinical findings in patients after stroke.


Clinical signs seen in stroke patients associated with poor prognosis:

(1) coma, with gravity proportional to the depth of the coma

(2) pupillary abnormalities

(2a) fully contracted pupils

(2b) widely dilated pupils

(2c) unequal pupils in the presence of bilateral extensor plantar responses

(2d) unequal pupils with the larger pupil on the same side as the stroke, and especially if pupil does not react to light (immobile)

(3) conjugate deviation of the eyes

(4) bilateral extensor plantar responses

(5) certain abnormalities of body temperature

(5a) pyrexia (> 99°F)

(5b) subnormal temperatures (< 97°F)

(6) respiratory embarrassment

(6a) stertorous respirations (snoring or sonorous)

(6b) Cheyne-Stokes respirations (rhythmic waxing and waning in depth, with regularly recurring periods of apnea)

(7) signs of meningeal irritation

(7a) neck rigidity

(7b) positive Kernig's sign (unable to completely extend the flexed thigh when sitting or lying, but able to do so when in the dorsal decubitus position)



• The presence of multiple findings suggests a poor outcome.

• If a finding was transient, then recovery may occur.


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