Assessment of the Patient with Acute Sensory Symptoms - Flowchart

Assessment of the Patient with Acute Sensory Symptoms - Flowchart

Assessment of the Patient with Acute Sensory Symptoms - Flowchart Assessment of the Patient with Acute Sensory Symptoms Assessment of the Patient with Acute Sensory Symptoms

Flowchart

Acute sensory symptoms

Acute sensory symptoms

Acute sensory symptoms

Urgent CT +/– CT-A
Consider thrombolysis
See stroke (Ch. 65)

Urgent CT +/– CT-A
Consider thrombolysis
See stroke (Ch. 65)

Urgent CT +/– CT-A
Consider thrombolysis
See stroke (Ch. 65)

Ch. 65

End

End

End

Key observations and appropriate assessment. Obtain history and perform focused examination

Key observations and appropriate assessment. Obtain history and perform focused examination

Key observations and appropriate assessment. Obtain history and perform focused examination

Acute stroke possible?

Acute stroke possible?

Acute stroke possible?

Yes

Yes

Yes

No

No

No

Acute polyradiculopathy/neuropathy with weakness?

Acute polyradiculopathy/neuropathy with weakness?

Acute polyradiculopathy/neuropathy with weakness?

Yes

Yes

Yes

No

No

No

Likely diagnosis is GBS (Ch.70)
Monitor closely
Obtain neurological opinion

Likely diagnosis is GBS (Ch.70)
Monitor closely
Obtain neurological opinion

Likely diagnosis is GBS (Ch.70)
Monitor closely
Obtain neurological opinion

Contact ITU

Contact ITU

Contact ITU

VC < 1.5 L or < 80% predicted?

VC < 1.5 L or < 80% predicted?

VC < 1.5 L or < 80% predicted?

Yes

Yes

Yes

No

No

No

Urgent MRI spine

Urgent MRI spine

Urgent MRI spine

Acute spinal cord (or cauda equina) syndrome?

Acute spinal cord (or cauda equina) syndrome?

Acute spinal cord (or cauda equina) syndrome?

Yes

Yes

Yes

No

No

No

Neurosurgical opinion
See spinal cord compression

Neurosurgical opinion
See spinal cord compression

Neurosurgical opinion
See spinal cord compression

spinal cord compression

Compression/tumour?

Compression/tumour?

Compression/tumour?

Stroke?

Stroke?

Stroke?

Yes

Yes

Yes

Consider aspirin
See stroke (Ch.65)

Consider aspirin
See stroke (Ch.65)

Consider aspirin
See stroke (Ch.65)

Ch.65

Yes

Yes

Yes

Inflammatory?

Inflammatory?

Inflammatory?

Yes

Yes

Yes

Neurology opinion
Consider CSF analysis and steroids

Neurology opinion
Consider CSF analysis and steroids

Neurology opinion
Consider CSF analysis and steroids

^* - Typically multiple, painful, mononeuropathies

^* - Typically multiple, painful, mononeuropathies

^* - Typically multiple, painful, mononeuropathies

^*

^** - May require conservative management only

^** - May require conservative management only

^** - May require conservative management only

^**

Urgent vasculitic screen (see Ch.99)
Consider steroids

Urgent vasculitic screen (see Ch.99)
Consider steroids

Urgent vasculitic screen (see Ch.99)
Consider steroids

Ch.99

Acute vasculitis possible^*?

Acute vasculitis possible^*?

Acute vasculitis possible^*?

^* *

Yes

Yes

Yes

No

No

No

Resolved or recurrent?

Resolved or recurrent?

Resolved or recurrent?

Yes

Yes

Yes

No

No

No

Soon MRI

Soon MRI

Soon MRI

Mononeuropathy?

Mononeuropathy?

Mononeuropathy?

Subacute CNS syndrome?
Monoradicular^** syndrome?

Subacute CNS syndrome?
Monoradicular^** syndrome?

Subacute CNS syndrome?
Monoradicular^** syndrome?

^** **

Yes

Yes

Yes

No

No

No

Inflammatory?

Inflammatory?

Inflammatory?

Yes

Yes

Yes

Acute admission and investigation may not be required if systemically well, non-progressive and benign cause apparent

Acute admission and investigation may not be required if systemically well, non-progressive and benign cause apparent

Acute admission and investigation may not be required if systemically well, non-progressive and benign cause apparent

Consider TIA (Ch.66)

Consider TIA (Ch.66)

Consider TIA (Ch.66)

Consider migraine (P.130 Table 19.4)

Consider migraine (P.130 Table 19.4)

Consider migraine (P.130 Table 19.4)

Consider seizures (Ch.16)

Consider seizures (Ch.16)

Consider seizures (Ch.16)

Onset?

Onset?

Onset?

Instant

Instant

Instant

Over seconds

Over seconds

Over seconds

Over minutes

Over minutes

Over minutes