e-book
How to Examine the Nervous System
Technical advances have made diagnoses quicker, safer, and more accurate.
Sometimes it appears that careful history taking and examination are
less important than knowing which test to order.
However, the technology is expensive and access is limited. As medical
costs are increasingly scrutinized by the paying agencies, private or public,
there will be limitations on both diagnostic investigations and hospital admissions.
For patients and doctors in smaller centers, limitations already exist. These
conditions make a careful history and examination essential to the intelligent
care of the sick and prerequisites for ordering tests. The practice of diagnostic
medicine is not simply ‘scene’ recognition plus knowing where to point
the technology. If it ever becomes this, a clerk—and eventually a machine—
will be able to do it. Therefore, I suggest that you learn how to listen to and
examine patients thoroughly and confidently. It is the most precious and
durable skill you have; the more you use it, the better it becomes. It is
unique.
In the examination of sick people a technique that elicits physical signs,
and the ability to interpret those signs, are required.
Interpreting physical signs is one of the interesting parts of neurology. The
process will not work if abnormal signs have been missed because of faulty
technique, or if minor variations within the limits of normal are considered
as firm abnormalities. Each year more students must be taught more subjects
as the knowledge explosion continues. Only a small amount of time can be
spent on the method of any physical examination. Therefore, learn a reliable
technique quickly.
This book offers some anatomical and a smaller number of pathological
possibilities that may explain a physical sign. It does not consist of a list of,
for example, all the possible causes of an absent corneal reflex, and is not a
small textbook of neurological diseases.
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