Tailoring the Neurologic History and Examination to the Clinical Scenario

Ovid: Field Guide to the Neurologic Examination

Authors: Lewis,
Steven L.

Title: Field
Guide to the Neurologic Examination, 1st Edition

> Table of Contents > Section 3 –
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


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.


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.


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.


  • 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


    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.

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