Approach to the Patient with Potential Acute Neurological Disease - Flowchart

Approach to the Patient with Potential Acute Neurological Disease - Flowchart

Approach to the Patient with Potential Acute Neurological Disease - Flowchart Approach to the Patient with Potential Acute Neurological Disease Approach to the Patient with Potential Acute Neurological Disease

Flowchart

Neurological presentation

Neurological presentation

Neurological presentation

Check blood glucose
Obtain venous sample (if no delay) and treat if low (see Chapter 81)

Check blood glucose
Obtain venous sample (if no delay) and treat if low (see Chapter 81)

Check blood glucose
Obtain venous sample (if no delay) and treat if low (see Chapter 81)

81

End

End

End

Assess and stabilize airway, breathing and circulatin. Briefly review presentation

Assess and stabilize airway, breathing and circulatin. Briefly review presentation

Assess and stabilize airway, breathing and circulatin. Briefly review presentation

^* seizures/reduced conscious level/focal deficit

^* seizures/reduced conscious level/focal deficit

^* seizures/reduced conscious level/focal deficit

^*

^** reduced conscious level/hypoventilation/pin-point pupils +/– hx of use/abuse

^** reduced conscious level/hypoventilation/pin-point pupils +/– hx of use/abuse

^** reduced conscious level/hypoventilation/pin-point pupils +/– hx of use/abuse

^**

^† for example possible stroke/status epilepticus/bacterial meningitis

^† for example possible stroke/status epilepticus/bacterial meningitis

^† for example possible stroke/status epilepticus/bacterial meningitis

^†

Potential hypoglycaemia?^*

Potential hypoglycaemia?^*

Potential hypoglycaemia?^*

^* *

Yes

Yes

Yes

No

No

No

Treat with naloxone and assess response (p.233-234)

Treat with naloxone and assess response (p.233-234)

Treat with naloxone and assess response (p.233-234)

Potential opiate toxicity?^**

Potential opiate toxicity?^**

Potential opiate toxicity?^**

^** **

Yes

Yes

Yes

No

No

No

Manage as appropriate

Manage as appropriate

Manage as appropriate

Other syndrome requiring immediate investigation and/or management?^†

Other syndrome requiring immediate investigation and/or management?^†

Other syndrome requiring immediate investigation and/or management?^†

^† †

Yes

Yes

Yes

No

No

No

Obtain more detailed history (see text)
Consider using third party sources if appropriate

Obtain more detailed history (see text)
Consider using third party sources if appropriate

Obtain more detailed history (see text)
Consider using third party sources if appropriate

Consider potential localizations and causes in a systematic manner (Table 14.1, 14.3)

Consider potential localizations and causes in a systematic manner (Table 14.1, 14.3)

Consider potential localizations and causes in a systematic manner (Table 14.1, 14.3)

Table 14.1 14.3

Is there a differential diagnosis?

Is there a differential diagnosis?

Is there a differential diagnosis?

Yes

Yes

Yes

No

No

No

Further diagnostic possibilities raised?

Further diagnostic possibilities raised?

Further diagnostic possibilities raised?

Yes

Yes

Yes

No

No

No

Neurology opinion likely to be required

Neurology opinion likely to be required

Neurology opinion likely to be required

Does a non-directed examination help?

Does a non-directed examination help?

Does a non-directed examination help?

Yes

Yes

Yes

No

No

No

Obtain required tests (prioritize as per Table 14.5)

Obtain required tests (prioritize as per Table 14.5)

Obtain required tests (prioritize as per Table 14.5)

Are investigations required to further confirm?

Are investigations required to further confirm?

Are investigations required to further confirm?

Yes

Yes

Yes

No

No

No

Therapy, monitoring and follow-up as directed by diagnosis

Therapy, monitoring and follow-up as directed by diagnosis

Therapy, monitoring and follow-up as directed by diagnosis

Diagnosis made?

Diagnosis made?

Diagnosis made?

Yes

Yes

Yes

No

No

No

Focused examination to confirm/support/refute differentials (Table 14.1)

Focused examination to confirm/support/refute differentials (Table 14.1)

Focused examination to confirm/support/refute differentials (Table 14.1)

Could the pathology be localized elesewhere?

Could the pathology be localized elesewhere?

Could the pathology be localized elesewhere?

Yes

Yes

Yes

No

No

No