The Neurological Exam: Evaluating the Master Organ

Written by Gary Cordingley

Continued from page 1

I'll single out one item onrepparttar cranial nerve exam as deserving special mention, and that isrepparttar 148660 visual field exam. The visual fields are evaluated one eye at a time. Whilerepparttar 148661 patient stares at an unmoving object,repparttar 148662 doctor asks ifrepparttar 148663 patient can see objects (likerepparttar 148664 doctor's fingers) appearing in different locations ofrepparttar 148665 patient's peripheral vision. In order to detect objects inrepparttar 148666 four corners of each eye's vision,repparttar 148667 patient must have proper functioning of each of six lobes ofrepparttar 148668 brain—both parietal lobes, both temporal lobes and both occipital lobes. In fact, this isrepparttar 148669 only portion ofrepparttar 148670 entire neurological exam that checksrepparttar 148671 right temporal lobe. Despite its importance,repparttar 148672 visual field exam sometimes gets skipped by medical students (in which caserepparttar 148673 ones under this author's supervision must endure hearing an earful).

The motor exam includes some pretty obvious things like checkingrepparttar 148674 strength of different muscles inrepparttar 148675 arms and legs, but also includes less obvious components like muscle tone, coordination, andrepparttar 148676 presence of involuntary movements. It also includes an inspection of muscles for loss of size orrepparttar 148677 presence of spontaneous twitches. Additionally, this isrepparttar 148678 part ofrepparttar 148679 exam in whichrepparttar 148680 doctor pulls out his or her rubber hammer and checks reflexes inrepparttar 148681 arms and legs. The motor exam also includes a briefly painful maneuver—calledrepparttar 148682 Babinski test—in whichrepparttar 148683 bottom ofrepparttar 148684 foot is scraped with a metal object whilerepparttar 148685 doctor observes for a reflexive response in certain foot-muscles.

The sensory exam focuses onrepparttar 148686 processing of inputs from sensory nerve-endings inrepparttar 148687 patient's skin and joints. It can include awareness of light touch, pain, warmth, coldness and vibration. In addition,repparttar 148688 doctor examines position-sense by movingrepparttar 148689 patient's toes and fingers up or down and askingrepparttar 148690 patient to say, without looking, which way they moved.

Finally, we have those portions ofrepparttar 148691 exam related to stance and walking, but also includingrepparttar 148692 patients' ability to transfer in and out of their chair. While on their feet, patients are asked to walk in their usual fashion, as well as on tiptoes. They are also observed while doing a "tandem gait," known more commonly asrepparttar 148693 "state trooper test," in which they walk flat-footed in a straight line withrepparttar 148694 heel ofrepparttar 148695 leading foot touchingrepparttar 148696 toes ofrepparttar 148697 trailing foot. Last,repparttar 148698 doctor checksrepparttar 148699 patients' ability to remain standing after closing their eyes. This is calledrepparttar 148700 Romberg test.

That's about it. Inrepparttar 148701 hands of experienced cliniciansrepparttar 148702 neurological exam doesn't take much longer to perform than to describe, and yet provides a wealth of information aboutrepparttar 148703 functioning ofrepparttar 148704 patient's nervous system. In this age of high-tech imaging devicesrepparttar 148705 neurological exam might seem archaic or old-fashioned, but it is still indispensable, and provides diagnostic information that even a battery of CT or MRI scans might miss.

(C) 2005 by Gary Cordingley

Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles, see his website at:

Medical Tests: What Does a "Normal Range" Mean?

Written by Gary Cordingley

Continued from page 1

The next step is to decide how many standard deviations above and below average should be accepted as normal. A typical choice for a blood-test is two standard deviations in either direction. It is known that measurements falling withinrepparttar range of two standard deviations above and belowrepparttar 148659 average will include, on average, 95% ofrepparttar 148660 healthy people. It will also exclude or label as apparently abnormalrepparttar 148661 other 5% of healthy volunteers. So ifrepparttar 148662 "normal range" is generated in this fashion, one thing we already know is that it will be wrong 5% ofrepparttar 148663 time.

Another outcome of this statistical system is that if your doctor measures twenty different things in your bloodstream, then, on average, one of them will be outside its normal range—even if you are totally healthy!

Moreover,repparttar 148664 statistical method automatically generates a lower and an upper value. This is done without consideration of whether or not it means anything to be too high or too low. The normal range merely expresses typical values obtained in healthy volunteers. It is up to your doctor to determine whether or not a result outsiderepparttar 148665 normal range is clinically meaningful. The "normal range" is not a judgment; it is merely a statistical statement. You wantrepparttar 148666 judgment to come from a trained clinician.

Your doctor has special words that are useful in navigating this intersection between statistics and clinical meaning. One favorite word is "unremarkable." You might not likerepparttar 148667 idea of being described as unremarkable. But this is a handy term that your doctor uses to lump together your laboratory results that fell within their normal ranges with those that fell outside their normal ranges but were still considered benign. So in this case, "unremarkable" is a good thing to be.

(C) 2005 by Gary Cordingley

Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles see his website at:

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