Approach to the Patient With a Neurologic Problem

Achieving an accurate diagnosis is crucial in reaching the goals of neurologic care: to alleviate signs and symptoms; to restore function; and to keep the patient in the best possible health. Experienced neurologists may approach the patient based on their extensive knowledge to establish the correct diagnosis by listening to the history, forming key hypotheses, narrowing the hypotheses based on the neurologic exam, ordering the key laboratory and neuroimaging tests, and initiating appropriate treatment. Forming the key hypotheses comes from clinical experience with pattern recognition, knowledge of the more likely diagnoses in the particular clinical situation, and the ability to order the appropriate tests to confirm the diagnosis. The challenge facing the medical student is to make an accurate diagnosis without the years of experience and extensive reading. This chapter outlines eight simple steps in diagnosing neurologic conditions and avoiding inappropriate care due to ordering inappropriate laboratory tests, establishing an incorrect diagnosis, and prescribing the wrong treatment. An important early step is to determine the most likely anatomic location for the patient’s problem. This chapter outlines the key clinical features for each anatomic location. The chapter finishes with a discussion of types of symptomatic treatment, etiologic treatment, prevention, and neurorehabilitation.