Neurologists analyze information in two stages. First they discern where the problem is. Then they must consider what all the causes of disease are in that location. When several locations are involved, the list of possible diagnoses narrows.
To diagnose multiple sclerosis, the neurological evaluation must satisfy two clinical criteria: first, a course of attacks and remissions, and second, findings (either from the neurological examination or the patient's history) that suggest lesions in at least two of the main sites of the central nervous system - spinal cord, brain stem-cerebellum, optic nerve, or cerebrum.
The success of a diagnosis is, of course, highly dependent on the doctor's skill in observing and soliciting an accurate description of history and symptoms. The history begins with the present illness - when and how did it start? It's important to discuss each symptom - if it disappeared and when, if it still persists, if symptoms vary during the day, if it's constant or intermittent, what provides relief, if it's affected by heat from exercise or a hot bath, and so on. Then the patient's past history must be carefully reviewed, taking in any illnesses, injuries, operations, allergies, medications, pregnancies, or alcohol or drug abuse. The neurologist might also take a history from a parent, husband, wife, or other close family member. The family history will include serious medical problems, causes of death, and any other neurological disorders in parents, brothers, sisters, and children. The visit to the neurologist, including the history taking and neurological examination can take up to two hours. (It should be remembered that the neurologist may also suspect a stroke, a tumor, an adverse reaction to medication, or some other problem.)
More Answers from Louis Rosner