Diagnosis

PCP Evaluation/Management Options

PCP Guide for Referral Specialist

Cerebral Ischemic Symptoms

1. Consider consultation whether transient, reversible, or persistent.
2. Seek immediate consultation for consideration of thrombolytic therapy.

Degenerative Neurological Disorders

Diagnose with respect to the patient’s general medical care.

Coordinate general medical care.

1. Seek initial consultation for confirmation of the diagnosis.
2. Ongoing consultation for medication adjustment may also be appropriate.

Headaches

Evaluate acute headaches, namely those of sudden onset with severe persistent pain, whether traumatic or atraumatic, with or without altered mental state, and focal neurological findings.

Consider imaging as appropriate.

Diagnose episodic cluster headaches, migraines, and tension type headaches.

1. Seek immediate referral for acute headaches if there is suspicion of hemorrhage, meningitis or other life threatening processes.
2. Consult for a change in headache pattern, altered mental state, focal findings, if the diagnoses us unclear or if there is an unsatisfactory response to treatment.

Neurological Assessment

Perform neurological history and examination including mental status examination, evaluation of cranial nerves, motor and sensory function, coordination, gait, and reflexes.

1. Refer if neurological exam is abnormal or questionable.

Neuropathies, Radiculopathies, Myelopathies and Myopahties

1. Consult if the cause is unclear or if there is an unsatisfactory response to treatment.
2. Clinically symptomatic condition should be referred to neurologist.

Other Neurological Disorders

Provide B12 injections in the office.

1. Consider Consultation for:

Dementia

Intention tremor

Tic douloureux

Intractable neurological symptoms, or

Undiagnosed neurologic problem.

Diagnosis

PCP Evaluation/Management Options

PCP Guide for Referral Specialist

Seizures

Provide anticonvulsant treatment per established care plan if the disorder is controlled

1. If a seizure disorder is suspected, consider initial consultation for conformation of the diagnosis and establishment of a treatment plan.
2. Consult if:

Seizures are recurrent or refractory,

There are concerns of drug toxicity, or

Discontinuance of anticonvulsants is being considered.

Syncope

Evaluate syncope with history, physical examination, EKG and CXR

1. Consider consult to cardiologist if patient has known heart disease or if a transient cause has not been identified and episodes are recurrent.
2. Consider referral to neurology if suggest seizure of TIA.