RT Book, Section
A1 Amato, Anthony A.
A1 Russell, James A.
SR Print(0)
ID 1115656168
T1 Approach to Patients with Neuromuscular Disease
T2 Neuromuscular Disorders, 2e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 9780071752503
LK neurology.mhmedical.com/content.aspx?aid=1115656168
RD 2024/04/16
AB The  evaluation  of  patients  with  suspected  neurologic  disease  remains  first  and  foremost  a  bedside  exercise.  Accurate  diagnosis  requires  consideration  of  individual  patient  and  disease  differences.  Despite  the  benefits  of  evidence-based  medicine,  conclusions  are  more  relevant  to  populations  than  to  individuals.  Confounding  variables  that  are  part  of  the  human  experience  may  be  overlooked  or  overemphasized  by  testing  algorithms.  This  textbook  will  repeatedly  emphasize  the  strongly  held  philosophy  of  its  authors,  that  is,  patient  management  flows  from  an  accurate  diagnosis.  An  accurate  diagnosis  is  most  likely  to  be  obtained  based  on  a  differential  diagnosis  driven  by  clinical  assessment  and  hypotheses.  These  hypotheses  should  be  formulated  on  the  basis  of  the  principles  of  neurologic  localization,  the  correlation  of  the  chronologic  course  of  symptom  development  with  the  behaviors  of  differing  disease  conditions,  and  the  application  of  risk  factor  analysis.  Ideally,  the  tests  described  in  the  subsequent  two  chapters  and  throughout  the  text  would  be  utilized  with  the  primary  intent  of  resolving  a  clinically  established  differential  diagnosis  ideally  to  prove  a  working  diagnosis.  As  all  tests  are  potentially  fallible,  the  credibility  of  their  results  diminishes  when  they  are  used  as  screening  procedures.  A  laboratory  abnormality,  occurring  without  the  context  of  clinical  correlation,  fails  to  establish  the  desired  confidence  in  a  cause  and  effect  relationship  with  the  patient's  complaint(s).  Metaphorically,  laboratory  tests  are  analogous  to  a  carpenter's  tools.  They  are  of  great  value  when  placed  in  the  hands  of  a  skillful  artisan,  but  are  potentially  damaging  if  used  injudiciously.