Evaluation of Neurotoxic Syndromes

Abstract

Diagnosis and management of patients with neurotoxic syndromes can best be carried out by a specialized team of health care professionals. The respective contributions from physicians and neuropsychologists will obviously depend on the circumstances of toxic exposure. Individuals exposed to high concentrations of acutely toxic materials require immediate medical management to sustain life and, if possible, eliminate the toxicant from the body. In such a situation, neuropsychological evaluation can be a valuable follow-up procedure to assess recovery of cortical function. Alternatively, when the diagnostic issue is one of subclinical effects and/or low-level, chronic exposure, then neuropsychological evaluation can proceed in tandem with medical tests and become an important initial contribution to final diagnosis and subsequent management. In either case, the ideal strategy for either clinical or research evaluation of patients with claimed neurotoxic exposure is a multidisciplinary one (e.g., Becking, Boyes, Damstra, & MacPhail, 1993). A diagnostic decision tree of the typical sequence of clinical evaluation for neurotoxic syndromes at Cook County Hospital, Chicago, Illinois, is illustrated in Fig. 2.1. While the flowchart is specific to industrial neurotoxicity assessment, the flow of multidisciplinary, cooperative effort should be applicable to diagnosis of other types of neurotoxic syndromes.