The Neurologic History Holds the Diagnostic Keys
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Obtaining a complete history by employing a methodical, unhurried approach is the key to an accurate diagnosis. The initial focus must be on the anatomic localization which invariably determines the differential diagnosis. Paresthesias of the left leg, for example, may indicate a compressive peroneal neuropathy, lumbar radiculopathy from a herniated disk, spinal cord disease, or a right cerebral lesion. This type of diagnostic dilemma is a frequent reason to request a neurologist’s opinion. An MRI scan of the lumbar spine may be completely normal, dumbfounding the patient’s physician. Conversely, a herniated disk with nerve root compression may be treated surgically without alleviation of the patient’s symptoms which are due to a brain tumor. Furthermore, it is quite common to find a herniated disk which is asymptomatic. Needless to say, technology with all of its benefits has major limitations. It resolves numerous difficulties of a differential diagnosis but can easily lead to inappropriate treatment by an unwary physician.