Neurologic Exam Health Article

Preparation

The MSE is the first step in a continuous assessment to determine the diagnosis a psychotherapist should take a detailed medical history in the process of ruling out a general medical condition. If a general medical disease is suspected, referral is indicated to rule out this category. Once a medical condition has been fully excluded the therapist can then localize the components of an abnormal MSE to determine the underlying psychological disorder. Once this is determined treatment may included, but is not limited to therapy sessions and/or medication. For neurological diseases the clinician will use information gained from the NE for ordering further tests. These tests may include a complete blood analysis, liver function tests, kidney function tests, hormone tests, and a lumbar puncture to determine abnormalities in cerebrospinal fluid. In cases a trauma (car accident, sports injury) the NE is a quick and essential component of emergency assessment. One a diagnosis is determined emergency measures may include further tests and/or surgery.

Aftercare

Care is usually specific once the final diagnosis has been determined. In psychological cases the treatment may include therapy and/or medication. In causes of an acute insult such as stroke or trauma, the patient is usually admitted to the hospital for appropriate treatment. Some neurological diseases are chronic and require conservative (medical) treatment and frequent follow-up visits for monitoring and stability or progression of the disease state. The MSE and NE are good diagnostic tools. Further testing using advanced technological procedures are usually required for definitive diagnosis and initiation of disease-specific treatment.

The outcome depends ultimately on the final diagnosis. Neurological diseases typically follow a chronic course. Situations that present as trauma may require surgical intervention and intensive care with an outcome usually proportional to extent of injuries. Psychological disorders may require long term (chronic) treatment and/or medication(s). Most neurological conditions require follow-up and periodic monitoring.

BOOKS

Behrman, Richard E., et al, eds. Nelson Textbook of Pediatrics 16th ed. W. B. Saunders Company, 2000.

Goldman, Lee, et al. Cecil's Textbook of Medicine. 21st ed. W. B. Saunders Company, 2000.

Rosen, Peter. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby-Year Book, Inc., 1998.

PERIODICALS

Sturmann, K. "Neurologic Emergencies: The Neurologic Examination." Emergency Medicine Clinics of North America 15 (Aug. 1997).

Laith Farid Gulli, M.D.

Bilal Nasser, M.Sc.

KEY TERMS

Corticospinal tract—A tract of nerve cells that carries motor commands from the brain to the spinal cord.

Gait—Referring to walking motions.

Reflex—A response, usually a movement, elicited by tapping on the nerve with a special hammer-like instrument.

Thalamus—A part of the brain that filters incoming sensory information.