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We have instruments of precision in increasing numbers with which we and our hospital assistants at untold expense make tests and take observations, the vast majority of which are but supplementary to, and as nothing compared with, the careful study of the patient by a keen observer using his eyes and ears and fingers and a few simple aids.

—Harvey Cushing (1869–1939)


After completing the history and neurologic examination (NE) and proposing a tentative diagnosis, the examiner (Ex) has to decide whether further studies are required. Table 13–1 reviews the array of standard diagnostic tests. The goal is to choose the one or two safest, least invasive, and most economical procedures that will best confirm or refute the tentative diagnosis. Do not order every conceivable test to cover every diagnostic possibility. Go for the jugular. If you fail initially to secure the diagnosis, select successive tests in a logical order. In this section we will discuss the clinical use of lumbar puncture and neuro-imaging studies.

Table 13-1.Ancillary Neurodiagnostic Procedures


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