神経診断学を極める―自著症例報告を深掘りして―

抄録

The secret to neurological diagnosis does not lie in the examination technique. Of course, you need to be able to use a hammer properly and examine eye movements, but the secret lies in thinking through the symptoms in front of you and their medical history. I would like to explain this secret through an explanation of my own case reports. Observation is the most important, and not thinking in terms of theory is the way to improve neurodiagnostic skills.

A patient is in front of you, presenting with certain symptoms and talking about the progression of those symptoms. At that time, you start to put together thoughts in your head as follows : (1) What on earth is it? : Is it an already well–known neurological symptom? (2) Where/in which nervous system is the lesion? (3) What kind of lesion is it? : It is important always to think pathologically, and I consider in terms of VITAMINS (Vascular, Infectious/Inflammatory, Traumatic/Toxic, Autoimmune, Metabolic, Idiopathic/Iatrogenic, Neoplastic, Structural).

Topics covered include hematomyelia due to von Willebrand disease ; conjugate deviation of the eyes due to a small hematoma in the left capsular genu ; auditory illusions due to a right medial geniculate body lesion ; bilateral chronic subdural hematomas in a young woman ; headache due to manganese poisoning ; spondylitis after prostate surgery ; and susceptibility to motion sickness due to a small hematoma in the right supramarginal gyrus.