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KEY CONCEPTS

KEY CONCEPTS

  • image Accurate diagnosis of neurological disorders leads to effective pharmacotherapy.

  • image The clinical neurologic history and examination are the cornerstones of neurologic diagnosis and management.

  • image History and examination should be modified for the pediatric patient as appropriate.

  • image The neurologic history and examination are directed at localizing the disease process to derive a differential diagnosis.

  • image After forming the differential diagnosis, appropriate testing helps pinpoint the correct diagnosis.

  • image Accurate diagnosis leads to appropriate therapy and management of neurologic conditions.

  • image Specific neurologic history and examination are useful for monitoring and evaluating the pharmacotherapeutic plan.

  • image 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.

BEYOND THE BOOK

BEYOND THE BOOK

Watch the video entitled “The Neurologic Screening Exam” in AccessPharmacy by Daniel H. Lowenstein. https://accesspharmacy.mhmedical.com/MultimediaPlayer.aspx?MultimediaID=12986884

This nine-minute video provides a brief overview of the neurologic examination including all five components. This visual depiction will aid in student understanding of the examination. The information collected in the neurologic examination is used in the COLLECT and FOLLOW-UP steps in the patient care process.

INTRODUCTION

image image 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 patient history and targeted neurologic examination to ensure optimal pharmacotherapy. Despite technological advances and development of sensitive diagnostic tests, the clinical neurologic history and examination are still the cornerstones of diagnosis and management.1

SIGNS AND SYMPTOMS OF NEUROLOGIC DISORDERS

As in all of medicine, obtaining an accurate and complete history is of utmost importance in the evaluation of neurologic diseases. In many instances, the differential diagnosis can be made on the basis of the history, and the neurologic examination can be tailored to optimally evaluate the patient and confirm the diagnosis.1 Open-ended questions allow the patient to provide the salient history without leading the patient toward preconceived diagnoses. Obtaining an accurate history may be difficult because a number of neurologic diseases potentially affect communication and memory. The details obtained from family or other observers, support and further expand patient reported history; additionally, family medical history can be helpful in diagnosis.1 Through patient history, one can determine the main symptoms, location, onset (acute, subacute, or chronic), progression over time (maximal at onset or steadily gaining intensity), and associated illnesses or risk factors for neurologic disease.2 The history should also identify factors that might precipitate or ameliorate the symptoms.2 Each patient complaint should be thoroughly investigated while taking the history. See Table e72-1 for questions to assist the clinician ...

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