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Diagnostic Dilemmas

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The Neurologic Diagnosis

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Abstract

The majority of patients referred to neurologists and a large proportion of patients seen by primary care providers complain of headaches, dizziness or vertigo, episodes of loss of consciousness, sleep disorders and other transient symptoms such as confusion, amnesia, weakness, blurred vision, numbness or tingling sensations and muscle cramps or pain in the extremities. Since most residency programs focus on in-patient experience, the graduating resident is often unprepared for the deluge of patients with such complaints. He or she must be able to sift through the history to extract the critical information and, most important, to ask the pertinent questions which elicit diagnostic information. Lurking within this patient load are undoubtedly a significant number with serious illnesses which must be detected and treated promptly. Many of them either do not have abnormal laboratory values that easily facilitate making a diagnosis or they provide misleading neuroimaging data that, if totally relied upon, result in misdiagnosis.

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Notes

  1. 1.

    MIBG scintigraphy: 123I-metaiodobenzylguanidine. This test measures postganglionic sympathetic cardiac innervation. It shows damage to the postganglionic part of the autonomic nervous system in all patients with Parkinson’s disease.

  2. 2.

    DaTscan: Dopamine transporter single photon emission computerized tomography imaging technique. It provides visual evidence of nigrostriatal degeneration because of reduced density of dopamine transporters.

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Authors and Affiliations

  1. Department of Neurology, University of Texas Medical, School at Houston, Houston, TX, USA

    Jack N. Alpert

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  1. Jack N. Alpert
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Alpert, J.N. (2019). Diagnostic Dilemmas. In: The Neurologic Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-95951-1_12

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  • DOI: https://doi.org/10.1007/978-3-319-95951-1_12

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