Eval Consider primary causes of sx and contributing factors based on hx s sx 3

By rray, 3 June, 2024
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Sx quality Review predisposing comorbidities prior neuro sx time course triggers impact on QOL etc Assess current vs pre COVID functional status 2 Assess for current prior EtOH substance use diet exercise physical and cognitive activity social determinant
If HA r o secondary causes by hx e g systemic sx hx of CA HIV immunosuppression TB neuro s sx thunderclap onset age 50 positional precipitated by Valsalva hx new onset in pregnancy 1
PMHx med review esp antihistamines anticholinergics antidepressant anxiolytic muscle relaxants that may contribute to neuro sx 1 COVID severity hospitalization2 e g post ICU syndrome
Use standardized assessments to evaluate and follow sx over time 2 nbsp nbsp Montreal Cognitive Assessment MoCA nbsp nbsp Mini Mental Status Examination MMSE nbsp nbsp Compass 31 for dysautonomia nbsp nbsp Neurobehavioral Symptom Inventory
Exam Perform complete neuro exam to identify focal deficits small loss of pin prick pain temp vs large loss of vibration position sense darr DTRs fiber neuropathies 1 screen for anxiety depression PTSD or other mental health dz if indicated 4
Labs CBC w differential CMP B12 thiamine folate homocysteine 1 25 dihydroxy vit D HbA1c magnesium eGFR uACR LFTs TSH free T3 free T4 CRP ESR 1 5 if high risk consider syphilis and HIV testing 5
Brain imaging Consider neuroimaging for new worsening focal neuro deficits cognitive sx 5
If neuropathy neuropathic pain consider CK ferritin HIV RPR serum protein electrophoresis w immunofixation methylmalonic acid EMG NCS MRI of spine if abnl EMG NCS 1
If muscle pain weakness tremor consider CK ANA LDH protein electrophoresis and immunofixation aldolase RF anticitrullinated peptide antibodies myasthenia gravis profile EMG NCS MRI to evaluate for myositis 1
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<b>Eval: Consider primary causes of sx and contributing factors based on hx, s/sx.<sup>3</sup></b>