Adams and Victor's Principles of Neurology

parts of the examination cannot be carried out in a coma-
tose patient; also, infants and small children, as well as
patients with psychiatric disease, must be examined in
special ways.
Certain portions of the general physical examination
that may be particularly informative in the patient with
neurologic disease should be included. For example,
examination of the heart rate and blood pressure, as well
as carotid and cardiac auscultation, are essential in a
patient with stroke. Likewise, the skin can reveal a num-
ber of conditions that pertain to congenital, metabolic, and
infectious causes of neurologic disease.
 
EXAMINING PATIENTS WHO PRESENT 
WITH NEUROLOGIC SYMPTOMS 
Numerous guides to the examination of the nervous
system are available (see the references at the end of
this chapter). For a full account of these methods, the
reader is referred to several of the many monographs
on the subject, including those of Bickerstaff and Spill-
ane, Campbell (
 
DeJong’s Neurological Examination
), and

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C
HAPTER
 
1
Approach to the Patient with Neurologic Disease
 
 7
of the staff members of the Mayo Clinic, each of which
approaches the subject from a somewhat different point
of view. An inordinately large number of tests of neuro-
logic function have been devised, and it is not proposed
to review all of them here. Some are described in subse-
quent chapters dealing with disorders of mentation,
cranial nerves, and motor, sensory, and autonomic func-
tions. Many tests are of doubtful value or are repeti-
tions of simpler tests and thus should not be taught to
students of neurology. Merely to perform all of them on
one patient would require several hours and, in most
instances, would not make the examiner any the wiser.
The danger with all clinical tests is to regard them as
indisputable indicators of disease rather than as ways
of uncovering disordered functioning of the nervous
system. The following approaches are relatively simple
and provide the most useful information.