Introduction

!DOCTYPE html PUBLIC “-//W3C//DTD XHTML 1.1//EN” “http://www.w3.org/TR/xhtml11/DTD/xhtml11.dtd”>

SECTION A	Introduction
CHAPTER	1

Introduction

The importance of the neurologic examination in the diagnosis of diseases of the nervous system cannot be overemphasized. In no other branch of medicine is it possible to build up a clinical picture so exact—with regard to localization and pathologic anatomy—as it is in neurology. This requires not only diagnostic acumen but also a thorough knowledge of the underlying anatomy and physiology of the nervous system, vascular supply, neuropathology, psychology, psychiatry, neuropharmacology, and related disciplines. In addition, neurologic practice demands knowledge of neuroradiology, electroencephalography, electromyography, neurochemistry, microbiology, genetics, neuroendocrinology, neurotransmitters, immunology, epidemiology, and an understanding of the neuromuscular system.

Neurologic diagnosis is a correlation of data in the study of the human nervous system in health and disease—a synthesis of all the details obtained from the history, examination, and ancillary studies. Nervous tissue makes up about 2% of the human body, and yet it is supplied to all portions of the body. Should the rest of the body tissues be dissolved, there remains an immense network of fibers in addition to the brain, brainstem, and spinal cord. This network is the great receptor, effector, and correlating mechanism of the body. It acts in response to stimuli, acclimates the individual to his environment, and aids in defense against pathologic changes. To understand man, one must first understand the nervous system. Since the nervous system governs the mind and mental operations, one cannot study psychology without knowledge of it. Since the nervous system regulates and controls all bodily functions, one cannot study disease of any organ or system of the body without a comprehension of neural function. Since the nervous system relates man to his environment and to others, one cannot study psychiatry or social pathology without first understanding nervous integration. We are interested, however, not in studying the nervous system and related disease alone, but in studying the person whose nervous system is diseased. The formulation of a case in terms of the relationship of the individual to his disease and the relationship of the patient to his associates and his environment is as important as providing a precise diagnosis. If we bear this in mind, we can most effectively aid our patients, treat their illnesses, restore them to health, reestablish their personal equilibrium, and aid them in regaining their place in society.

Neurologic diagnosis is often considered difficult by the physician who does not specialize in clinical neurology. Most parts of the nervous system are inaccessible to direct examination, and its intricate organization and integrated functions are difficult to comprehend on superficial observation. Many practitioners feel all neurologic matters belong to the realm of the specialist. Consequently, they make little attempt at neurologic diagnosis. However, many neurologic disorders come within the everyday experience of most practitioners; they should know how to examine the nervous system, when additional studies might be helpful, and how to use the data collected. Furthermore, neurologic dysfunction is the first manifestation of many systemic diseases. Medical diagnosis cannot be made without some knowledge of neurologic diagnosis. True, there are certain rare conditions and diagnostic problems that require long experience in the field of diseases of the nervous system for adequate appraisal. However, the majority of the more common neurologic entities could and should be diagnosed and treated by the physician in general practice. Not all neurologic questions are complex and esoteric, but an understanding of certain fundamentals is necessary.

The neurologic examination requires skill, intelligence, and patience. It requires accurate and trained observation, performed—in most instances—with the help and cooperation of the patient. The examination should be carried out in an orderly manner, and adequate time and attention are necessary if the details are to be appreciated. Each clinician eventually works out a personal method based on experience, but the trainee should follow a fixed and systematic routine until he is very familiar with the subject. Premature attempts to abbreviate the examination may result in costly errors of omission. A systematic approach is more essential in neurology than in any other field of medicine, because the multiplicity of signs and variations in interpretation may prove confusing. The specific order that is followed in the examination is not as important as the persistence with which one adheres to this order.

Only gold members can continue reading. Log In or Register to continue