Neurological examination

Craig JJ, McConville JP, Patterson VH, Wootton R. Neurological examination is possible using telemedicine. J Telemed Telecare 1999 5 177-181. 

Neurologic examination Usually, the neurologic physical examination is completely normal. Any neurologic deficits that are identified should be fully investigated, because seizures do not usually cause permanent, detectable neurologic deficits. 

Monitor for acute and chronic adverse effects of AEDs. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, carbamazepine, and valproate. 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

Neurological examinations, physical examinations, white blood cell counts, and blood cholinesterase measurements made several times during a 3- to 4-month operation period failed to detect differences between the exposed men and a group of eight nonexposed men from the same ship. 

Morphine can cause constipation, spasms of the sphincter of Oddi, urinary retention, and pruritus (secondary to histamine release) (see Table 54-4). In head trauma patients who are not ventilated, morphine-induced respiratory depression can increase intracranial pressure and cloud the neurologic examination results. 

Neurological examinations of humans with M-hexanc-induced peripheral neuropathy have not shown clinical signs of central nervous system toxicity (Herskowitz et al. 1971 Yamamura 1969). There have been reports of altered evoked potentials recorded in the brain (increased latency, decreased amplitude) in humans occupationally exposed to -hexane (Mutti et al. 1982c Seppalainen et al. 1979). There has been one report of an individual occupationally exposed to -hexane for 38 years who developed Parkinsonism (Pezzoli et al. 1995), although the etiology of this case is complicated by the fact that the patient had a sister who was probably affected by Parkinsonism. Further studies, particularly prospective... 

At scheduled intervals during BZ testing, the physician conducts a brief neurological examination of each subject... 

A 68-year-old woman complains of chronic fatigue that bas worsened over tbe past month. She has experienced recent bouts of nausea and diarrhea. History indicates that she changed her diet in order to lose some weight 3 months before she started experiencing these symptoms. Blood work reveals a macrocytic anemia. Neurologic examination is within normal limits. 

Denckla, M. (1989) Neurological examination. In Rapoport, J., ed. Obsessive-Compulsive Disorder in Children and Adolescents. Washington, DC American Psychiatric Press, pp. 107-115. 

Cummings, J.L. and Cunningham, K. (1992) Obsessive-compulsive disorder in Huntington s disease. Biol Psychiatry 31 263-270. Denckla, M.B. (1989) Neurological examination. In Rapoport, J.L., ed. Obsessive-Compulsive Disorder in Children and Adolescents. Washington, DC American Psychiatric Press, pp. 107-118. Douglass, H.M., Moffit, T.E., Dar, R., McGee, R., and Silva, P. (1995) Obsessive-compulsive disorder in a birth cohort of 18 year olds prevalence and predictors. / Am Acad Child Adoles Psychiatry 34 1424-1431. 

A physical examination (including checking of vital signs) and a neurological examination (including a complete, formal mental stams examination) should be performed. 

Phencyclidine All Abnormal neurologic examination, poor suck reflex and feeding... 

Some information on health effects of PBBs in children is available from studies of the Michigan contamination episode. Symptoms of ill health were not associated with increased exposure to PBBs and general neurological examinations did not show any abnormalities. More detailed... 

---