The Neurological Examination (with an Emphasis on Its Historical Underpinnings)

I am grateful to Dr. Pascuzzi and Dr. Roos for the opportunity to organize and edit this issue of Seminars in Neurology. In this issue, we deal with the history of the neurological examination. The idea for this issue came after a course I had organized on this topic at the American Academy of Neurology Meeting in 2001 in San Diego. This issue of Seminars in Neurology is designed to serve as an introduction to the historical underpinnings of the neurological examination. The events of the past are more numerous than those of the present, and it is always a challenge to keep one's comments focused on a particular thread through time. With this in mind, I am indebted to the guest authors, recognized leaders in the history of the neurosciences, who took the time to participate in this project and to share and organize some of their wealth of knowledge in their respective areas of interest.

The neurological examination is perhaps the one thing that defines all of us as neurologists, and for many students, it is one of the fascinations that lured us into this specialty. The examination is a curious compendium of maneuvers; many of these are named, some have multiple names, and many are not named. One wonders how these maneuvers came about. How have they evolved over time from their first use? Even more interesting, what was the scientific basis for the development of these maneuvers? This issue of Seminars in Neurology is meant to carry you backward through time, allowing you to peer in on the originators of the neurological examination. Their attention to detail and logical approach is often remarkable. However, understanding their ideas about the function of the nervous system can be a challenge, as their language is often framed within the intellectual and scientific constructs of their times. This is where the authors will serve as our interpreters.

The issue is organized in the same fashion as is the neurological examination, starting with the higher functions (especially language) and moving down through the cranial nerves, motor testing, the cerebellar examination, testing of deep tendon reflexes and the cerebellar signs, the sensory examination, and testing of gait and balance. Many of the founders of neurology, such as Broca, Babinski, Chaddock, Erb, Holmes, Hughlings Jackson, Romberg, Wernicke, and Westphal, are represented in these pages, including some of the controversies that their work both solved and engendered. It is hoped that an understanding of the forces that molded our current neurological examination will better position us to look at this examination more critically. Also, it can be surprising, refreshing, and empowering to realize that entities that seem to be part of the bedrock of current knowledge were considered controversial in the not too recent past.