Upon completion of the chapter, the reader will be able to:
- 1. Describe the importance of the neurologic examination in the diagnosis of neurologic diseases.
- 2. Determine when abbreviation of the neurologic examination is appropriate in a given patient.
- 3. Apply the results of a neurologic examination, as written in the patientsâ medical record, to the creation and monitoring of a pharmacotherapy plan.
- 4. Recognize the importance of lumbar puncture (LP), electroencephalograph (EEG), evoked potentials (EPs), electromyography (EMG), nerve conduction velocities (NCVs), carotid Doppler, magnetic resonance angiography (MRA), computed tomographic angiography (CTA), transcranial Doppler (TCD), computed tomography (CT), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), positron-emission tomography (PET), and single-photon emission computed tomography (SPECT) in the diagnosis of a patient with a neurologic illness.
- 5. Comment on the importance of symmetry in the evaluation of a patient with a neurologic illness.
- 6. Identify when a patient has a focal neurologic deficit by interpreting the results of the neurologic examination.
- 7. List the 12 cranial nerves.
To contribute most effectively to the care of patients with neurologic illness, one must understand the tools used in the diagnosis and management of these patients. In addition, clinicians must be able to gather their own data through a targeted neurologic examination and history taking to ensure optimal pharmacotherapy in neurologic patients. Despite technologic advances that have led to the development of sensitive diagnostic tests in neuroscience, the clinical neurologic history and examination are still the cornerstones of the neurologic diagnosis and management.1
As in all of medicine, obtaining an accurate and complete history is of utmost importance in the evaluation of neurologic diseases. In many instances, the diagnosis can be made on the basis of the history, and the neurologic examination can be tailored to optimally evaluate the patient and confirm the diagnosis. The clinician depends on the patient or family for the details of the illness. Care must be taken to avoid “leading” the patient. Obtaining an accurate history may be difficult because a number of neurologic diseases may affect patients' speech and memory. Through the patient's history one can determine the main symptoms, the mode of onset (gradual or sudden), progression over time (maximal at onset or steadily gaining intensity), and associated illnesses/risk factors (recent head injury from a motor vehicle accident). ...