Reader response: The neurologic exam: Is it extinct?

Abstract

I read with interest the essay by Dr. Aghajan1; I agree, but I call it “reverse neurology.” Often neuroimaging is evaluated first and then, if needed, history-taking and clinical examination is contemplated. Reverse neurology is increasingly rampant in India. I recall a young female patient who presented with paraparesis with urinary retention of 8-hour duration. The doctor on emergency duty got an MRI of the thoracic region, which was reported normal. Later, many other investigations, including CSF examination, were found normal. Considering a possible diagnosis of transverse myelitis, the patient was administered IV methylprednisolone. There was no improvement, so residents were asked to re-evaluate. Neurologic examination was normal and plantar reflex was downgoing. A relative of the patient disclosed the patient's history of sexual abuse by another relative. The patient had conversion reaction. Neurologic deficits, seizures, and pain that cannot be explained by a systemic disease are frequently referred to as conversion reaction.2,3 A genuine neurologic disorder, but misdiagnosis is common. The only remedy for such errors lies in proper clinical examination. Diagnostic techniques only play a supportive role.