19-Neurological signs (+/- Headache)

When results of neuro exam are clear:

• If symmetrical neuro signs, click here 19-§1
• If asymmetrical neuro signs, click here 19-§2

If you are not sure about your neuro exam:

• If paresis/paralysis, click here 19-§3
• If confusion/delirium, click here 19-§4
• If severe headache, click here 19-§5
• If convulsions, click here 19-§6

If you feel that the problem is psychogenic:

• Go to specific protocol for "Psychological Troubles 27"

Useful table

Important notes:

• Sometimes it is difficult to make the distinction between psychological and neurological problems… Experience helps.
• Health workers should be able to do at least this basic neuro examination including: bicep deep tendon reflex + patellar reflex + stiff neck + eye mobility (nxx001) + anisocoria (nxx005) + Babinski + paresis/paralysis (nxx002) (nxx006) + consciousness + confusion. The health worker should be able to differentiate symmetrical and asymmetrical neurology and/or disconnection with reality.
• Headaches can be so severe that we have to consider tramadol as curative treatment (even if it in fact does nothing to cure the disease).
• We presently have here curative medicine for only CRYPTO, TOXO and Cerebral TB… but diagnoses are rarely conclusive.  (TOXO or DEMENTIA?, TB or TOXO?, TOXO or LYMPHOMA? (...) Because we do not have a lab for blood tests/LP/etc, we sometimes have to give drugs as a "test" to make the diagnosis.  The "TOXO test" is the easiest (and cheapest!) and will give results quicker than the other tests.  Therefore if you are not confident of your diagnosis, try treating as TOXO first.  On the fifth day of this toxo treatment stop all painkillers and compare the strength of pain with the period before treatment.  (Some authors suggest to continue with the "TOXO test" longer before checking level of pain, but in practice, if a patient has continued to decline during the first 5 days, we prefer to start another test... death is not far off).  The "TB test" and the "CRYPTO test" take longer.  It takes 2 weeks or more without a discernible improvement before one may declare the test a failure and try another test.  This is why in a confused situation; it is often better first to try a "TOXO test".  If serious new neurological signs (like convulsions) appear during a test, we can surmise that the test is not effective, stop it and try another test immediately.
• One useful way to make a differential diagnosis between some brain diseases (lung diseases as well) is to distinguish between acute, sub acute and chronic evolution of the disease... Only experience will help to make these distinctions...
• With HIV terminal patient, urinary retention (sux002) is usualy a sign of neurologic lesion since the sphincter is close if no stimulation (unlike anal sphincter).