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KEY CONCEPTS
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Accurate diagnosis of neurological disorders leads to effective pharmacotherapy.
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The clinical neurologic history and examination are the cornerstones of neurologic diagnosis and management.
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History and examination should be modified for the pediatric patient as appropriate.
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The neurologic history and examination are directed at localization of the disease process so that a differential diagnosis can be formed.
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After forming the differential diagnosis, appropriate testing helps pinpoint the correct diagnosis.
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Accurate diagnosis leads to appropriate therapy and management of neurologic conditions.
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Appropriate history taking and examination techniques are useful for monitoring and evaluating the pharmacotherapeutic plan.
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Lumbar puncture (LP) should only be performed when it can be done safely. Relative contraindications may include increased intercranial pressure, mass lesions, papilledema, and coagulopathies.
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Patient Care Process for Neurological Evaluation

Collect
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Patient characteristics (eg, age, sex, pregnant)
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Patient medical history (personal, family, birth, and developmental) (see section “Signs and Symptoms of Neurologic Disorders”; Table e70-1)
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Social history (eg, tobacco/ethanol use)
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Current and previous medications including nonprescription medications, herbal products, and dietary supplements (see section “Signs and Symptoms of Neurologic Disorders”)
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Objective data
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Neurologic examination (ie, higher cortical function, cranial nerves, motor function, reflexes, cerebellar function, sensory function, and gait) (see section “The Neurologic Examination”; Table e70-2)
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Blood pressure (BP), heart rate (HR), height, weight
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Laboratory examinations as appropriate for the differential diagnosis and possibly including examination of the cerebrospinal fluid (CSF) (see section “Laboratory Findings for Neurologic Disorders and Their Interpretation”; Table e70-3; Fig. e70-1)
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Imaging studies as appropriate (eg, computed tomography [CT] of head) (see section “Diagnosing Neurologic Anatomic Abnormalities”)
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Electrophysiology studies as appropriate (eg, nerve conduction velocities [NCV], electromyography [EMG], and electroencephalogram [EEG]) (see section “Assessing Neurologic Dysfunction”)
Assess
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Results of history and neurological examination
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Ability/willingness to obtain diagnostic testing (eg, insurance coverage, travel, undergoing invasive testing)
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Relative contraindications for lumbar puncture (see section “Laboratory Findings for Neurologic Disorders and Their Interpretation”)
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Emotional status (eg, presence of anxiety, depression)
Plan*
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Order appropriate diagnostic testing
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With established diagnosis, develop therapeutic plan (see disease-specific chapters)
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Monitoring parameters including efficacy and safety of any therapies; frequency and timing of follow-up
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Patient education regarding testing and diagnosis
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Referrals to other neurology specialists when appropriate (eg, memory disorders, stroke)
Implement
Follow-up: Monitor and Evaluate
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Resolution of neurologic symptoms
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Presence of adverse effects of therapy
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Patient adherence to treatment plan using multiple sources of information
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Reevaluate as needed
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Preclass Engaged Learning Activity
Watch the video entitled “The Neurologic Screening Exam” in AccessPharmacy by Daniel H. Lowenstein. https://accesspharmacy.mhmedical.com/MultimediaPlayer.aspx?MultimediaID=12986884
This 9-minute video provides a brief overview ...