Authors: Lewis,
Steven L.
Steven L.
Title: Field
Guide to the Neurologic Examination, 1st Edition
Guide to the Neurologic Examination, 1st Edition
Copyright ©2004 Lippincott Williams &
Wilkins
Wilkins
> Table of Contents > Section 3 –
Neurologic Examination in Common Clinical Scenarios > Chapter 41 – Tailoring
the Neurologic History and Examination to the Clinical Scenario
Neurologic Examination in Common Clinical Scenarios > Chapter 41 – Tailoring
the Neurologic History and Examination to the Clinical Scenario
Chapter 41
Tailoring the Neurologic History and Examination to the Clinical
Scenario
Scenario
GOAL
The goal of tailoring the history and examination to the clinical
scenario is to obtain the information that’s needed to help figure out what’s
wrong with your patient.
scenario is to obtain the information that’s needed to help figure out what’s
wrong with your patient.
PATHOPHYSIOLOGY
In each of the following chapters of this section, the basic
relevant pathophysiology underlying various common symptoms or syndromes is
discussed as a background to the appropriate historical and examination
procedures and findings helpful in diagnosis.
relevant pathophysiology underlying various common symptoms or syndromes is
discussed as a background to the appropriate historical and examination
procedures and findings helpful in diagnosis.
TAILORING THE HISTORY TO THE CLINICAL SCENARIO
Although a thorough neurologic history should be attempted in all
patients, there are pieces of information that are of particular interest in
some clinical scenarios more than others. These discriminating historical
features are reviewed throughout the chapters that follow.
patients, there are pieces of information that are of particular interest in
some clinical scenarios more than others. These discriminating historical
features are reviewed throughout the chapters that follow.
HOW TO TAILOR THE EXAMINATION TO THE CLINICAL SCENARIO
In all patients with neurologic symptoms, an appropriately
thorough neurologic examination should be attempted, as discussed in Chapter 40, Performing a Complete Neurologic Examination.
Depending on the clinical scenario, however, some examination elements are
likely to be more helpful than others in getting you to the diagnosis, and you
should concentrate particularly on these during the examination. For example,
in a patient who presents with diplopia, the examination of eye movements is
most likely to be the most telling examination procedure diagnostically. In
the following chapters, the importance of specific examination procedures and
findings in various common clinical syndromes is discussed.
There are clinical situations in which the neurologic examination
is necessarily limited, often because of the neurologic symptoms themselves,
such as the acutely confused patient or the comatose patient; in situations
such as these, important diagnostic information can be learned if you
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know what clues are most important and how
they should be found. These examination findings are discussed in the relevant
chapters that follow.
Certain examination procedures can be helpful in specific
clinical settings but are unnecessary at other times. Examples include
oculocephalic testing in coma, the Dix-Hallpike maneuver in patients with
positional vertigo, and testing for meningismus in patients with acute
headache; syndrome-specific tests such as these are discussed in the relevant
chapters of this section.