Introduction to the Neurological Exam

Introduction to the Neurological Exam

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The neurologic exam as a diagnostic tool gained mythical proportions in the pre-CT/MRI era, when great clinicians could pinpoint a lesion in the nervous system with often astounding accuracy. Decisions for surgery and other interventions were frequently made entirely on the basis of the neurologic history and physical findings. Today, with the availability of modern imaging techniques, the neurologic exam takes on a new and equally important role in diagnosis and management. Rather than serving as an end in and of itself, the neurologic exam today is a critical way station in the clinical decision-making process. Does the patient who just collapsed on the street have cardiac disease or an intracranial bleed? Is the patient with leg weakness and numbness suffering from degenerative joint disease or from impending spinal cord compression? Does the patient with nausea and vomiting need a gastroenterology consult, a head CT, or emergency interventions to lower dangerously elevated intracranial pressure? These—and many similar questions that frequently arise for health care providers in all subspecialties—can quickly be answered by a carefully performed neurologic exam.

On this website, we outline the main components of the neurologic exam. The goal will be to demonstrate through streaming video segments how each step of the neurologic exam is performed. In addition, we will briefly discuss which neuroanatomic systems are tested by each part of the neurologic exam, so that its functional and practical relevance will be better appreciated. For a more detailed discussion of the neurologic exam, as well as a clinically oriented approach to neuroanatomy with over 100 real clinical cases presented in an interactive format, please see Neuroanatomy through Clinical Cases, Third Edition.

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