Clinical assessment

The practical process of clinical assessment in modern neurosurgery is slightly different to the traditional model, and the history and examination provide the foundation stones on which all subsequent patient management is built. This chapter outlines the importance of the initial clinical encounter. History taking, including dealing with difficult consultations, is explored. The neurological examination pays particular attention to aspects relevant to neurosurgical practice from first impressions, assessment of the unconscious patient, speech and language, examination of individual lobes of the brain, cranial nerves including the eye examination, and limb examination. Finally, advice on how to pull this information together to make diagnostic conclusions and construct an appropriate management plan is provided.