In writing a book devoted to neurological signs and their meaning, it is not my
intention to undervalue in any way the skill of neurological history taking. This
remains the key element of the doctor-patient encounter both in the neurological
clinic and on the ward, and is clearly crucial in order to formulate diagnostic
hypotheses, guide clinical examination, and help decide on the nature of the
pathological process (if one is present). However, having sat through several
thousand neurological consultations, I do not subscribe to the view that all one need
do is listen carefully and the patient will “tell you the diagnosis”, although this may
happen on rare (and often memorable) occasions. Clearly, history taking is not
simply a passive recording of symptoms (“what the patient complains of”), but also
an active process of seeking information of possible diagnostic significance through
appropriate questions; this might be called the “historical examination”. This latter
facet of history taking, much the more difficult skill to learn, may disclose certain
neurological signs which are not available to physical examination (principally in the
sensory domain, but also intermittent motor phenomena). Hence, my use of the term
“sign” in this book is a broad one, encompassing not only findings in physical
examination (its traditional use) but also from focused history taking. My operational
definition of sign is therefore simply a “signifier”, in the sense of phenomena of
semiologic value, giving information as to anatomical location and/or pathological
cause.
Download here: A Dictionary of Neurological Signs
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