Neurological Localisation in Clinical Practice

Abstract

Neurological localisation is dependent on history and physical examination and demands that the clinician is aware of those features, encompassed within the clinical setting, that define the neuroanatomy and neurophysiology that defines the focus of any neurological lesion. The paper to follow provides an approach to the neurological evaluation of patients that employs the traditional methods of history, stylised physical examination, incorporating: Higher centres; cranial nerves; and peripheral neurological evaluation, and offers important features that define the focus and potential nature of pathology and relies on traditional clinical assessment rather than being dependent on adjunctive investigations. It offers insight into techniques that not only discuss novel approaches, to such areas as higher centre function testing, but also provides explanations as to the interpretation of the findings from an anatomical perspective and offers normative data to help with interpretation of the findings. It explores the anatomy of cranial nerve abnormalities and differentiates some of the findings from peripheral neurological examination to discern upper motor neurone pathology from lower motor pathology and extrapyramidal features from cranial nerve dysfunction. The paper also provides signs of unequivocal features of non-organic presentations to enable the clinician to determine a provisional diagnosis, of non-organic pathology, rather than relying on a diagnosis that is dependent on investigations that showed no abnormality thus leaving non-organic illness as a diagnosis of exclusion, which tends to undermine patient confidence in a situation where the patient is already vulnerable from functional illness.