Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!


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 (LP) and neuroimaging studies.

TABLE 13-1Ancillary Neurodiagnostic Procedures


A. Location, origin, and circulation of the cerebrospinal fluid

  1. Examination of the cerebrospinal fluid (CSF) dates to Heinrich Iraneous Quincke who introduced spinal puncture in 1891 for the treatment of hydrocephalus.

  2. Location of the CSF: The CSF occupies the ventricles and subarachnoid spaces. The total volume of ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.