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1 THE NEUROLOGIC EXAMINATION Raymond A. Martin, MD Houston Neurology Associates Houston, TX Eun-Kyu Lee, MD Associate Professor, Department of Neurology University of California, Davis Sacramento, CA Edward L. Langston, MD, RPh. American Health Network Board of Directors, ACGME Council on Medical Education, AMA Lafayette, IN
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2 Section One The Neurologic History As family practitioners you will see patients with complaints that cover the full spectrum of medical practice. Many of these patients, present with symptoms of pain, dizziness, forgetfulness, numbness, weakness and difficulty speaking or comprehending as their primary complaint, or as a portion of their history. In addition to a full medical evaluation, accurate assessment of these neurological complaints will be of increasing importance in our current health care environment. Since up to 10 to 15% of a family practitioner’s workload consists of neurological problems, it is the goal of this program to provide an effective and efficient means of gaining this knowledge. As a first step in evaluating the patient with a neurological problem the practitioner must obtain an accurate history . A good history alone will often suggest the correct diagnosis and the examination can be tailored to specifically search for corroborating physical signs. Patients with neurological disease may have impairments that make it difficult to elicit accurate information and the diligent examiner may need to spend extra time questioning the patient or obtaining information from family or friends. While this may seem tedious, time spent obtaining an accurate history often brings a rapid, correct diagnosis, thereby saving time and reducing health care costs. An important consideration in history taking is to not only record the patient&s complaint, eg, dizziness, but to question exactly what the patient means by that complaint. The symptom ±dizziness² often has different meanings to the lay public and the term could be used to connote lightheadedness, vertigo, tiredness, or malaise. If the examiner assumes it means vertigo then needless time and resources may be wasted in pursuing a non-existent complaint. Another example is ±weakness² which to many patients may mean fatigability or lack of energy rather than loss of strength in specific muscle groups. The history should be recorded in chronological order and in a systematic manner , noting the date of onset of symptoms and developing the story in sequence. Symptoms should be characterized and described in terms of severity, location, temporal profile, as well as aggravating and ameliorating factors. Any relation to the past history should be established and noted. Certain questions may be specific to certain disease processes; in other diseases, symptoms will be similar but the diagnosis may be established by a difference in temporal profile, ie, whether it is acute, subacute or chronic. For example, numbness and weakness of
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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