74. Two-Point Discrimination Test

As in other parts of the exam, the patient’s deficits, as well as the anatomy of the nerves, nerve roots, and central pathways, should be used to guide the exam (see Chapters 7, 8, and 9 in Neuroanatomy through Clinical Cases 3e). Comparisons should be made from one side of the body to the other and from proximal to distal on each extremity. Note especially if there is a sensory level corresponding to a particular spinal segment (see Figure 8.4 in Neuroanatomy through Clinical Cases 3e) below which sensation abruptly changes, since such a change may indicate a spinal cord lesion requiring emergency intervention. Whenever there are uncertainties in the sensory exam or other parts of the neurologic exam, a good strategy is to repeat the relevant portions of the exam several times.