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A series looking at aspects of clinical examination
A series devoted to the value of particular physical signs in neurological practice needs no apology. Though one suspects that succeeding generations of neurologists have bemoaned the lack of clinical expertise among their juniors there can be no doubt that the remarkable advance in neuroimaging and allied techniques that has been seen over the past 20 years has altered the delicate balance between clinical appraisal and investigation. An overreliance on sophisticated investigative techniques has a number of potential pitfalls. The interpretation of those investigations remains a highly skilled process and is prone to error. Some of these techniques are of such sophistication that abnormalities are frequently discovered that bear no relation to the clinical problem. Without an appropriate level of history taking and examination, such abnormalities may be misinterpreted as being relevant to the patient’s presentation. Indeed there remains as much skill in the decision not to investigate a particular patient as to do so. That decision rests at least in part on the ability to perform an adequate neurological examination and to be able to distinguish the normal from the abnormal. This series will look at nine aspects of the clinical examination that I felt merited discussion regarding their value in determining diagnosis or, at least, in the localisation of a neurological disorder. The list is subjective and to some extent perhaps arbitrary but I believe it embraces a number of areas where correct interpretation of an abnormal finding is of major value to the clinician in patient assessment. Individual contributors therefore have been asked where possible to look at issues such as specificity and sensitivity when discussing a particular physical sign. The series I trust will prove both informative and stimulating.
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