THE NEUROLOGIC METHOD AND LOCALIZATION

THE NEUROLOGIC METHOD AND LOCALIZATION is a topic covered in the Harrison's Manual of Medicine.

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The clinical data obtained from the neurologic examination coupled with a careful history are interpreted to arrive at an anatomic localization that best explains the clinical findings (Table 180-2), to narrow the list of diagnostic possibilities, and to select the diagnostic tests most likely to be informative.

TABLE 180-2: FINDINGS HELPFUL FOR LOCALIZATIONS WITHIN THE NERVOUS SYSTEM
 Signs
CerebrumAbnormal mental status or cognitive impairment
 Seizures
 Unilateral weaknessa and sensory abnormalities including head and limbs
 Visual field abnormalities
 Movement abnormalities (e.g., diffuse incoordination, tremor, chorea)
BrainstemIsolated cranial nerve abnormalities (single or multiple)
 “Crossed” weaknessa and sensory abnormalities of head and limbs, e.g., weakness of right face and left arm and leg
Spinal cordBack pain or tenderness
 Weaknessa and sensory abnormalities sparing the head
 Mixed upper and lower motor neuron findings
 Sensory level
 Sphincter dysfunction
Spinal rootsRadiating limb pain
 Weaknessb or sensory abnormalities following root distribution (see Figs. 180-1 and 180-2)
 Loss of reflexes
Peripheral nerveMid or distal limb pain
 Weaknessb or sensory abnormalities following nerve distribution (see Figs. 180-1 and 180-2)
 “Stocking or glove” distribution of sensory loss
 Loss of reflexes
Neuromuscular junctionBilateral weakness including face (ptosis, diplopia, dysphagia) and proximal limbs
 Increasing weakness with exertion
 Sparing of sensation
MuscleBilateral proximal or distal weakness
 Sparing of sensation
aWeakness along with other abnormalities having an “upper motor neuron” pattern, i.e., spasticity, weakness of extensors > flexors in the upper extremity and flexors > extensors in the lower extremity, and hyperreflexia.
bWeakness along with other abnormalities having a “lower motor neuron” pattern, i.e., flaccidity and hyporeflexia.

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TY - ELEC T1 - THE NEUROLOGIC METHOD AND LOCALIZATION ID - 623457 Y1 - 2017 PB - Harrison's Manual of Medicine UR - https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623457/all/THE_NEUROLOGIC_METHOD_AND_LOCALIZATION ER -