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PATIENT CARE PROCESS

Patient Care Process for Neurological Evaluation

Image not available.

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)

    • Relative contraindications for magnetic resonance imaging (MRI) (see Diagnosing Neurologic Anatomic Abnormalities 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*

  • Provide patient education regarding all elements of evaluation and treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence to any therapies

  • Schedule follow-up

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

KEY CONCEPTS

  • Image not available. Accurate diagnosis of neurological disorders leads to effective pharmacotherapy.

  • Image not available. The clinical neurologic history and examination are the cornerstones of neurologic diagnosis and management.

  • Image not available. The neurologic history and examination are directed at localization of the disease process so that evaluation and management may be planned appropriately.

  • Image not available. Appropriate history taking and examination techniques are useful for monitoring and evaluating the pharmacotherapeutic plan.

  • Image not available. After forming the differential diagnosis, appropriate testing helps pinpoint the correct diagnosis.

Image not available. 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. Image not available. Despite technologic advances that have led to the development of sensitive diagnostic tests in neuroscience, the clinical neurologic history ...

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