Evaluation of Neurologic Disorders

Palliative or Provocative Factors
Quality
Region/Radiation
Severity
Timing

• What is the patient’s current medication list?
• Dose
• Dosing schedule (times, relationship to other medications, relationship to meals)
• Duration
• Adherence
• Has the patient experienced adverse drug reactions
• What medications have been used in the past or recently discontinued? Why were they discontinued?
• Could the symptoms be drug-induced?

• Allow the child to provide as much history as they are developmentally able
• History may be obtained from the patient's guardians or caretakers rather than the child in most cases
• History should include
• Family history
• History of the pregnancy
• Details of labor and delivery
• Compare the child’s developmental stage to standard age-related developmental milestones

1. Higher Cortical Function (Mental Status)
2. Cranial Nerves
3. Motor Function
4. Reflexes
5. Cerebellar Function
6. Sensory Function
7. Gait

• Adapt for age and developmental stage
• Ex. Observe walking and playing for cerebellar and motor function
• Ex. Observe facial expressions, withdrawal, and responses to tactile sensory stimulation to assess sensory function

• Assess weight, height, and head circumference
• In infants, assess fontanels for size and note if they are open or
closed

• Diagnostic reasons:
• CNS infections
• Inflammatory processes
• Subarachnoid hemorrhage

• Therapeutic reasons:
• Relieve symptoms from increased intracranial pressure
• Deliver medications

Local Skin Infection over the site
Suspected intracranial or spinal cord lesion
Raised intracranial pressure (ICP) with signs of impending herniation
Bleeding diathesis
Uncontrolled coagulopathy

• Medications commonly administered via LP:
• Anesthesia
• Chemotherapy
• Antibiotics
• Contrast dye

• Fluoroscopic guidance or anesthesia IF:
• Patient is uncooperative
• Patient's cardiorespiration is compromised

• Start empiric antibiotics immediately IF strong clinical suspicion exists for:
• Bacterial infection
• Herpes meningoencephalitis

• Uses x-rays to produce images
• Highly availability
• Can be done rapidly (can be usedin urgent situations)
• Used to identify strokes, tumors, hemorrhages, infarctions, hydrocephalus, atrophy
• IV contrast can aid in imaging of vessels to identify breakdown of blood-brain barrier

• Uses magnetic properties of hydrogen atom to produce computer-processed scans

• Used to identify lesions in white matter (e.g., plaques in multiple sclerosis, lesions in posterior fossa,
tumors, very early ischemic stroke

• Used to evaluate cerebral circulatory system
• Used to identify local arterial stenosis, aneurysms, vascular malformations

• Considered tests of brain function
• Studied extensively in epilepsy, cerebrovascular disorders, cerebral tumorsmovement disorders, and dementia

• Records electrical activity of the brain
• Record is interpreted by observing the basic rhythms and waveforms, the symmetry of the recording, and abnormal electrical discharges
• Primarily used in diagnosis of seizures
• Most are about 30 minutes in length; however, long duration (>24 hours) are sometimes used

• Measures response to electrical signals sent along sensory pathways
• Examines conduction along pathways
• Helpful for localizing lesions and evaluating hearing problems and multiple sclerosis

• Measured by stimulating the nerve and recording the speed and amplitude of conduction of the impulse
• Used to detect presence of localized peripheral injuries, diffuse neuropathies, and neuromuscular junction disorders

• A needle is placed in the muscle to measure its resting and contractual electrical activity
• Used to diagnose peripheral neuropathies, amyotrophic lateral sclerosis, radiculopathies and muscle disease