What is the essential neurological examination?

Abstract

Many clinicians consider the neurological examination (NE) the most difficult and intriguing aspect of semiology. A common complaint is how to perform an excessive number of complex maneuvers in order to obtain clinical relevant information.In 2009, Frazer Moore and Colin Chalk 1 published the results of an interesting study called "The Essential Neurological Examination". In an early part of their work, they elected to investigate how neurologists use NE when faced with a common clinical situation: a patient referred with a potential neurological complaint in which the history suggests that a neurological problem is in fact unlikely, and the NE is being used to confirm that the patient is neurologically normal. Such researchers asked 19 McGill University neurologists to consider this scenario, and then asked them to state how likely they would be to use each of the 46 items of a reasonably complete NE. As an external validation, 38 neurologists across Canada and 168 students from McGill Medical School in a range of practice settings were asked to rate the 46 NE elements, using the same scenario and rating scale. This study sought to evaluate how a group of neurologists based in Rio de Janeiro, Brazil, would use NE in the same scenario by Moore and Chalk's study. METHODSIn order to investigate how experienced neurologists use the NE, we hypothesized a common clinical scenario: a patient referred with a potential neurological complaint, but the history suggests that a neurological problem is in fact unlike, and the NE is being used to confirm that the patient is neurologically normal. ABSTRACTIn order to determine which aspects would be essential to the neurological examination (NE) in a given specific situation (a patient referred with a potential neurological complaint, but the history suggests that a neurological problem is unlikely), we presented the same questionnaire used by Moore and Chalk in Canada to 19 neurologists in Rio de Janeiro, Brazil. We considered significant aspects of NE, whose average responses were greater than or equal to 3.5: visual fields, fundoscopy, pursuit eye movements, facial muscle power testing, gait, pronator drift or rapid arm movement in upper limbs, finger-nose, tone in arms and legs, five tendon reflexes, and plantar responses. We concluded that, despite geographical and economical differences between Brazil and Canada, neurologists from both countries agree about the essential NE in the proposed scenario.Key words: neurologic examination, neurosemiology, neurological complaint. RESUMOVisando determinar quais aspectos do exame neurológico (EN) seriam essenciais em uma situação específica (paciente com queixa neuroló-gica, mas cuja história sugere ser improvável um problema neurológico), apresentou-se o mesmo questionário utilizado por Moore e Chalk no Canadá a 19 neurologistas do Rio de Janeiro, Brasil. Foram considerados os aspectos significativos do EN com pontuação igual ou superior a 3,5: campo visual, fundoscopia, movimentos de perseguição ocular, mímica facial, marcha, ...

The essential neurological examination of the unconscious patient in the emergency room

“…In addition, although the use of the Delphi method (de Villiers, de Villiers, & Kent, 2005) could have strengthened the results, the standard deviations of the vast majority of examination steps achieved by single questioning were comparable to those of Moore et al., who did apply the Delphi method (Moore & Chalk, 2009). All of these limitations could be overcome by repeating this study at other clinical locations, as conducted for the “essential neurological examination” (Lima & Maranhão‐Filho, 2012; Moore & Chalk, 2009). Another limitation relates to the method of selecting the steps from a given list, which might result in a higher number of essential steps compared to actively listing the steps used.…”

“…As the voting process for these guidelines is (Moore & Chalk, 2009). All of these limitations could be overcome by repeating this study at other clinical locations, as conducted for the "essential neurological examination" (Lima & Maranhão-Filho, 2012;Moore & Chalk, 2009). Another limitation relates to the method of selecting the steps from a given list, which might result in a higher number of essential steps compared to actively listing the steps used.…”

Teaching the Neurological Examination in a Rapidly Evolving Clinical Climate

“…This study was used as the basis for a study in Brazil with similar results. 40 The main focus for medical students should be learning and performing the core components of a neurological examination, 41 although they may then adapt it and add in new components. In doing so, the examination changes from being a step-by-step screening examination to one that is hypothesis driven and situation dependent.…”

Clinical neurology: why this still matters in the 21st century

“…First, where the history suggests that the patient is unlikely to have findings on examination, a Canadian group provided some very useful data, 12 which was then replicated by a Brazilian group. 14 Essentially, using the Delphi method (a methodology for reaching a consensus as objectively as possible on a complex problem), they asked neurological colleagues (24) and medical students (168) to list the essential aspects of the neurological examination from a list of 44 items that they would use in such a patient at least 80% of the time. To assess whether the results were more generalisable, they solicited the views of 38 other Canadian neurologists for validation.…”