This is the seventh edition of Dr. DeMyer's textbook on The Neurologic Examination. It is the second under the stewardship of the current authors. When first published in 1994, Dr. DeMyer hoped it would fill a gap and function as a self-learning tool that combined with feedback from experienced clinicians and practice at the bedside, would improve the diagnostic skills of a student. It was never meant to be read, but in many respects it was a "to-do" book. It was the active doing or practicing the techniques that Dr. DeMyer felt would engage the student and facilitate learning rather than promote memorization. As bedside examination skills improve, ultimately patients would come to benefit.
Currently there is a tendency to undermine the benefits of the physical examination as a foundational skill in clinical diagnosis. Various explanations are given that include limitations of time, increased sensitivity of diagnostic tools or the fact that some physical examination skills or findings, have been shown to not be diagnostic at all. It is certainly true that there are some physical examination practices of only historical interest, but most of the skills in eliciting a history and a relevant physical examination remain critical to proper diagnosis. When properly performed, they provide valuable information to an underlying disease and interpretation of abnormal diagnostic test results often relies on physical examination findings. Finally, the physical examination is of enormous benefit in the effective use of these diagnostic tests and the elimination of unnecessary ones. So, far from being relegated to historical interest, these skills are as important in the development of a clinician as they are for the patients under their care.
We want to end this preface by again acknowledging Dr. William E. DeMyer as an esteemed colleague who demonstrated the highest qualities of a physician, master clinician, and teacher. The origin of this book, and the current authors' intention, is to promote the value of a thoughtful physical examination and interpretation of those findings. We hope this book will fill such a role by becoming a virtual mentor that facilitates learning, through performing and interpreting physical examination findings. If the directions within this book are followed, not only will you benefit, but so will your patients and that is an ultimate responsibility that society expects of us. We hope you enjoy this excursion and we wish you the best as your careers unfold.
José Biller, MD
Gregory Gruener, MD
Paul W. Brazis, MD