Consultation

Most of the information necessary to localize a lesion in patients with Neurologic complaints can be obtained by taking a careful history. This is the extremely very important first step. The rights questions will usually point towards the correct diagnosis even before starting the Neurologic examination. Furthermore, right questions and answers can be considered examination findings. As an example, to examine the temperature sensation, patients can be asked whether they have any problems detecting water temperature. Additionally, to investigate for fine touch discrimination, patients can be asked whether they have problems pulling the correct coin or other objects out of their pockets. 

Nevertheless, the most important information will be learned by a thorough Neurologic examination. 

In some situations, such as episodes of loss of consciousness, it is always very important to attend the consultation with a witness who observed the episode and can provide crucial information to establish the accurate diagnosis, a good example of this situation is Epilepsy.

The complete Neurologic examination is a thorough examination of the central and peripheral nervous system. This can be quite long, and it is usually guided by the complaints of the patient and by certain components of the history. Again, the right questions answered by the patient will allow the Neurologist to focus on the parts of the Neurologic examination that will establish the accurate diagnosis. However, all important main functions of the Nervous system must be examined to ensure that no significant pathology was missed. 

The Neurologic examination doesn't cause any pain or major discomfort to the patient, it is almost always very well tolerated by the patients. As the examination is a multistep exam, and the Neurologist should inform the patient about what every step involves, this will avoid any discomfort or misunderstanding. 

In a nutshell, the Neurologic examination will assess the following functions of the Nervous system: 

• Mental status: Patient`s orientation to person, place and time. 
• Cranial nerves: Visual fields, response of pupils to light, eye movements, strength of muscles of the face and tongue, swallowing, speech and hearing.
• Motor system: Muscle strength of upper and lower extremities. 
• Reflexes
• Sensation

The examination can be expanded when an asymmetry or other abnormality is found.   

After obtaining the careful history and conducting the proper Neurologic examination, diagnostic and treatment plan will be discussed with the patient and family. 

There is a variety of investigations that can be arranged to help establishing the correct diagnosis behind the Neurologic complaints. These include:

• Special Laboratory testing
• MRI exam of the head, spine or both
• Neurophysiologic testing: Nerve Conductions studies (NCS) or Electromyography (EMG), whether separately or combined, depending on the diagnosis. 
• Electroencephalograph (EEG)
• Genetic testing
• Lumbar puncture, CSF testing
• And many others