Mariam Al Hussona*1, MB, BCh, BAO (Hons), Monica Maher*1, MD, MSc, David Chan2, MD, MEd, FRCPC, Jonathan A. Micieli3, MD, FRCSC, Jennifer D. Jain MD, FRCPC4, Houman Khosravani5,6, MD, PhD, FRCPC, Aaron Izenberg5, MD, FRCPC, Charles D. Kassardjian^,2,6, MD, MSc, FRCPC, Sara B. Mitchell MD, MPH, FRCPC^,5,6,7

1 Division of Neurology, Department of Medicine, Postgraduate Medical Education, University of Toronto, Toronto, Ontario, Canada
2 Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
3 Department of Ophthalmology and Vision Sciences, and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
4 Florida Medical Clinic, Wesley Chapel, Florida, USA
5 Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
6 Neurology Quality and Innovation Lab (NQIL), University of Toronto, Toronto, Ontario, Canada
7 Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
*These authors contributed equally to the manuscript
^These authors are co-senior authors on the manuscript

Abstract:

Objective: To outline features of the neurologic examination that can be performed

virtually through telemedicine platforms (the virtual neurological examination), 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 virtual neurologic examination 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

disorders 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

virtual neurologic examination will be critical for neurologists, and this paper outlines a

practical approach to implementation.