Essential Neurological Examination – Time for Change?

Česká verze

Authors: E. Růžička ¹; P. Marusič ²
Authors place of work: Neurologická klinika a Centrum klinických neurověd 1. LF UK a VFN v Praze ¹; Neurologická klinika 2. LF UK a FN Motol, Praha ²
Published in the journal: Cesk Slov Neurol N 2017; 80/113(1): 84-91
Category: Krátké sdělení
doi: https://doi.org/10.14735/amcsnn201784

Summary

In neurology, diagnosis has traditionally been based on detailed history taking followed by a highly structured clinical exam. However, considering advances in auxiliary diagnostic methods, such a complex and time-consuming approach may seem superfluous. We thus aimed to determine the components of the codified neurological assessment used by Czech neurologists during a screening neurological exam and to compare results with surveys performed in Canadian and Brazilian neurologists. Four groups including a total of 101 Czech neurologists and residents participated in an anonymous survey. In a questionnaire consisting of 47 components of the routine neurological exam, respondents were asked to rate each item on a 4-point scale, indicating how important they considered it to be for screening a patient with nonspecific symptoms. The Delphi Method was used to determine consensus. Our neurologists concordantly rated 21 items as essential. The content of the screening neurological exam does not essentially differ between Czech neurologists and trainees from different neurological departments. Accordingly, there were few differences between the screening neurological exam as performed by the Czech and Canadian or Brazilian neurologists. Examination of visual fields and fundoscopy are usually not performed by Czech neurologists. On the contrary, articulation, tongue movements, heel-to-knee and Romberg test were selected by Czech but not Canadian or Brazilian neurologists. After adjustments taking into account both local and foreign experiences and current needs, we propose a 22-item neurological examination as an essential tool to exclude or confirm significant nervous system affection. Specific medical history or abnormal findings of the initial assessment should be followed by specific targeted examinations and tests leading to timely diagnosis and effective treatment.

Key words:
neurological examination – surveys and questionnaires

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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