weakness, but exa m ination shows severe atrophy. Atrophy is a sign of lower
. motor neuron disease, but it is not present acutely. In this case, further questioning
would be necessary to try to elicit a more chronic (and perhaps subtle) history
of weakness (another possibility is a pre-existing chronic weakness with a
superim posed new, acute insult) .
From these examples you can see that the neurologic history and examination
are interrelated and that, while the history ohen suggests the diagnosis, it is important
to synthesize the information from both to come up with the correct answer.
In addition, realize that if a basic neurologic function is impaired, it is not easy to
reliably test higher neurologic functions; i . e . , if a patient's arm is paralyzed or
paretic, then fine motor coordination is difficult to assess; likewise, it would be unfair
to label a patient as having severely impaired memory if the patient is aphasic.