Foreword - Qpercom | Skills in Medicine

This program has been developed to supplement the teaching of neurology to medical students. Experience has shown that reading neurology handbooks does not provide the student with sufficient insight into how to carry out the neurological examination. Studying with this program alone is also insufficient to acquire the necessary skills in this examination. Demonstration and practice remain essential. Finally, it goes without saying that prior knowledge of neuroanatomy and neurophysiology is a prerequisite when carrying out a neurological examination.

The first section deals with the history-taking. This is only covered briefly as the history-taking for a patient with a symptom which may be based on a neurological condition is the same as for other patients. One exception is the history-taking in the case of patients with conditions involving the higher cerebral functions. This will be discussed in the section The higher cerebral functions.
The sections describing the examination have the same lay-out where possible. Following a short introduction, a detailed illustrated description of how to carry out the examination is provided. A number of possible abnormal findings are then listed and in a number of cases these are accompanied by an overview of the diseases which could fit these findings.
The sequence of the sections does not necessarily reflect the sequence of the examination. The sequence of the examination depends on the primary symptom. The sequence of the first nine sections was chosen because almost every consultation starts with a history-taking (section 1). During the history-taking, the patient’s voice, speech and language are assessed (section 2). You will immediately form an impression of the patient’s higher cerebral functions, clarity of thought, memory and judgement (section 3). You can investigate the cranial nerves while the patient, still dressed, sits beside your desk (section 4).

For the subsequent examination it is necessary for the patient to (partially) undress. You will then start to examine the gait and posture (section 5) and begin to focus more on the motor function, coordination, sensory function and reflexes (sections 6, 7, 8 and 9). In sections 10 and 11 the meningeal irritation tests and examination of the unconscious patient are discussed.
The neurological examination of newborns and examination of psychomotor development in infants, toddlers and pre-school children is discussed in sections 12 and 13.
Sections 14, 15 and 16 cover the neurological examination that may need to be carried out in the case of a number of complaints frequently seen in the general practice, in particular headache, sciatica and brachialgia.