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Dermatological clues to neurological diagnoses
  1. Katharine L Warburton1,
  2. Benjamin Wakerley2
  1. 1Senior House Officer, Department of Neurology, John Radcliffe Hospital, Oxford, UK
  2. 2Specialist registrar, Department of Neurology, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr B Wakerley, Department of Neurology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX39DU, UK; benwakerley{at}fastmail.fm

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Many neurological conditions are accompanied by skin changes, which frequently appear before the onset of the neurological symptoms. In some cases a rash may herald the start of an infectious process. In others, skin changes may mirror pathological processes that are also occurring in the brain or peripheral nerves. Careful examination of the skin can therefore provide important clues when making a neurological diagnosis, allowing early treatment and avoiding unnecessary tests. Instead of presenting an exhaustive list of cutaneous manifestation of every neurological condition, we aim to provide practical knowledge for the non-dermatologist to aid neurological differential diagnosis. We highlight the more common skin changes that occur in association with stroke, peripheral neuropathy, meningitis, encephalitis, malignancy and HIV. In addition, we cover the most frequently encountered neurocutaneous conditions and finally, we will remind the reader of skin changes associated with adverse reactions to drugs commonly used by neurologists.

Introduction

How often do you purposefully examine a patient's skin to guide your neurological differential diagnosis? Are you confident at identifying a rash or skin lesion and relating it to the neurological diagnosis of your patient? This article aims to cover the most important and meaningful dermatological disorders that you may encounter within neurology. An exhaustive list of all potential cutaneous findings would not necessarily be useful in diagnosis and management; rather, we aim to provide a practical selection of management altering dermatological signs within the context of common neurological presentations. We also review some commonly encountered neurocutaneous disorders, skins lesions at different stages of HIV/AIDS and remind the reader of important drug reactions.

Stroke

In young patients, the skin can provide important clues as to the cause of stroke. Is there a bleeding tendency or underlying hyperviscosity syndrome? Are blood vessels inflamed or fragile and prone to rupture? Can you identify any risk …

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