++
Patient Care Process for Neurological Evaluation
Collect
Patient characteristics (e.g., age, sex, pregnant)
Patient medical history (personal, family, birth, and developmental) (see Signs and Symptoms of Neurologic Disorders section)
Social history (e.g. tobacco/ethanol use)
Current and previous medications including non-prescription medications, herbal products, and dietary supplements (see Signs and Symptoms of Neurologic Disorders section)
Objective data
Neurologic examination (i.e., higher cortical function, cranial nerves, motor function, reflexes, cerebellar function, sensory function, and gait) (see The Neurologic Examination section)
Blood pressure (BP), heart rate (HR), height, weight
Laboratory examinations as appropriate for the differential diagnosis and possibily including examination of the cerebrospinal fluid (CSF) (see Laboratory Findings for Neurologic Disorders and Their Interpretation section)
Imaging studies as appropriate (e.g., computed tomography (CT) of head) (see Diagnosing Neurologic Anatomic Abnormalities section)
Electrophysiology studies as appropriate (e.g., nerve conduction velocities (NCV), electromyography (EMG), and electroencephalogram (EEG) (see Assessing Neurologic Dysfunction section)
Assess
Results of history and neurological examination
Ability/willingness to obtain diagnostic testing (e.g., insurance coverage, travel, undergoing invasive testing)
Relative contraindications for lumbar puncture (see Laboratory Findings for Neurologic Disorders and Their Interpretation section)
Emotional status (e.g., presence of anxiety, depression)
Plan*
Order appropriate diagnostic regimen
With established diagnosis, develop therapeutic plan (see disease-specific chapters)
Monitoring parameters including efficacy and safety of any therapies; frequency and timing of follow-up
Patient education regarding testing and diagnosis
Referals to other neurology specialists when appropriate (e.g., memory disorders, stroke)
Implement*
Follow-up: Monitor and Evaluate
Resolution of neurologic symptoms
Presence of adverse effects of therapy
Patient adherence to treatment plan using multiple sources of information
Re-evaluate as needed
*Collaborate with patient, caregivers, and other health professionals
++
KEY CONCEPTS
Accurate diagnosis of neurological disorders leads to effective pharmacotherapy.
The clinical neurologic history and examination are the cornerstones of neurologic diagnosis and management.
The neurologic history and examination are directed at localization of the disease process so that evaluation and management may be planned appropriately.
Appropriate history taking and examination techniques are useful for monitoring and evaluating the pharmacotherapeutic plan.
After forming the differential diagnosis, appropriate testing helps pinpoint the correct diagnosis.
++
Accurate diagnosis of neurological disorders leads to effective pharmacotherapy. This diagnosis is built upon history, a detailed neurological examination, and appropriate testing. To contribute most effectively to the care of patients with neurologic illness, one must understand the tools used in the diagnosis and management of these patients. In addition, clinicians must be able to gather their own data through history taking and a targeted neurologic examination to ensure optimal pharmacotherapy in neurologic patients. Despite technologic advances that have led to the development of sensitive diagnostic tests in neuroscience, the clinical ...