1. Out-patient Management in Neurology
20/5/2015
Out-patient Management in Neurology
อ.ลักษนันท์ ชีวะเกรียงไกร
แผนกประสาทวิทยา กองอายุรกรรม
โรงพยาบาลพระมงกุฎเกล้า
อ.พาสิริ สิทธินามสุวรรณ

2. Common consultation Headache Numbness Weakness Seizures
Dizziness, vertigo
Ataxia
Ptosis
Diplopia
Visual failure
Memory impairment
Confusion
Dysphagia
Tremor, abnormal movement

3. Concepts of Neurology History: Physical examination: CC, PI, PH
Onset, chronological progression
Underlying, associated symptoms
Systemic review
Physical examination:
General medical examination
Neurological examination

4. Concepts of Neurology Anatomical localization Etiology
Where is(are) the lesion(s)?
Etiology
What is(are) the etiology?

5. Concepts of Neurology

6. Concepts of Neurology

7. Concepts of Neurology

8. Concepts of Neurology

9. Concepts of Neurology

10. Overview in Common Symptoms in Neurology
For OPD practice

11. Headache Anatomical localization Etiology Intracranial Extracranial
Primary headache
Secondary headache
SNOOP

12. Numbness Anatomical localization Etiology CNS PNS
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

13. Weakness Anatomical localization Etiology Upper motor neuron lesion
Lower motor neuron lesion
Etiology
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

14. Seizures Anatomical localization
Cortical lesion
Subcortical lesion
Focal/ multifocal/diffuse (generalized)
Etiology: provoked or unprovoked seizure
Genetics
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

15. Dizziness, vertigo Anatomical localization Etiology Central vertigo
Peripheral vertigo
Etiology
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

16. Ataxia Anatomical localization Etiology Cerebellar ataxia
Sensory ataxia
Etiology
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

17. Ptosis Anatomical localization Etiology 3rd nerve nuclei or true nerve
NMJ
Muscle
Etiology
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

18. Diplopia Anatomical localization Etiology
3rd, 4th, 6th, cranial nuclei or nerve
NMJ, muscles
Etiology
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

19. Visual failure Anatomical localization Etiology
Anterior visual pathway
Posterior visual pathway
Etiology
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

20. Memory impairment Anatomical localization Etiology Libic areas
Primary dementia
Alzheimer’s disease
Secondary dementia (treatable dementia)

21. Confusion Anatomical localization Etiology Intracranial cause
Extracranial cause (delirium)
Etiology
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

22. Dysphagia Anatomical localization Etiology Balbar palsy
Pseudobulbar palsy
Etiology
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

23. Tremor, abnormal movement
Anatomical localization
Extrapyramidal pathway
Parkinson or non-Parkinson
Etiology:
Congenital (inherited)
Trauma
Tumor, infection
Toxic, metabolic, endocrine
Inflammatory
Vascular
Degeneration
etc.

24. Work up Lab: Radiology Genetic testing Pathology Consultation
General medicine
CBC, UA, blood chemistry, septic work up, EKG
Radiology
Genetic testing
Pathology
Consultation

25. Neurological tests Lumbar puncture Prostigmine test
V-EEG: routine, long-term
Polysomnography
Carotid Doppler
EMG, NCV
Etc.

26. Imaging
CT brain
MRI brain, MRA, MRV
Angiogram +/- intervention

27. Management Pharmacologic Non-pharmacologic Counselling OPD ER, observe
Admission

28. Follow up plans
Depending on diagnosis, underlying disease, severity of illnesses

29. Thank You