ABSTRACT
OBJECTIVE: To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond. METHODS: The full neurologic examination is described with attention to components that can be performed virtually. RESULTS: A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations). CONCLUSIONS: During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.
Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Neurologic Examination/standards , Pneumonia, Viral/therapy , Practice Guidelines as Topic/standards , Telemedicine/standards , Video Recording/standards , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Neurologic Examination/methods , Neurologists/standards , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/methodsABSTRACT
BACKGROUND AND OBJECTIVES: Epileptic seizures frequently occur in people with multiple sclerosis (MS) and are thought to represent a manifestation of cortical pathology. However, at present, seizures are not considered to be a typical clinical presentation of demyelination. METHODS AND RESULTS: In this case series, we identified four people, who presented with seizures as a sole presenting feature, with demyelinating imaging abnormalities that satisfy current diagnostic criteria for a clinically isolated syndrome (CIS) or early MS. CONCLUSION: Based on this case series, we propose that people presenting with de novo seizures, with concurrent radiological abnormalities suggestive of demyelination could potentially be considered to have a CIS.