Exam:

• Neurologic Exam (Full exam always required for evaluation of a neurologic symptom or condition). Specific exam maneuvers relevant to the evaluation of this presenting symptom includes:

  • Mental status: Any abnormality may suggest a meningitic process

  • Cranial Nerves: Any dysfunction other than CN 7 broadens the differential to conditions that can cause multiple cranial neuropathies which would involve advanced imaging and analysis of CSF and additional serum studies.

  • Focal Deficit: Suggests a structural abnormality requiring advanced imaging

• Additional Exam

  • Examination of the external ear, ear canal, and ear drum looking for vesicles (assess for varicella zoster virus)

  • Examination of the oropharynx (assess for varicella zoster virus)

  • Palpation of the parotid glands and visual examination of face for swelling (assess for parotid gland tumor)

  • General skin exam to assess for skin changes suggestive of Lyme