ROCHESTER, MN – Researchers at Mayo Clinic completed analysis of a 4-year prospective study comparing detailed neurologic examination versus magnetic resonance imaging (MRI) of the brain to localize neurologic dysfunction. The findings, which will be published in this month’s prestigious journal Academic Observations, 3rd edition (A&Ox3), demonstrated MRI’s superior performance to the clinical exam.
Lead researcher, Dr. Frank Babinski was astonished by the findings. “Using the systematic neurologic exam created by Jean-Martin Charcot over 130 years ago, we have been correlating clinical signs with specific lesions. It is completely maddening to think we can just get a damn MRI scan instead.”
Current neurology residents breathed a sigh of relief when the results were revealed. “We have been lugging around these ridiculous bags filled with reflex hammers (Queen square hammer and Troemner), 256 Hz tuning fork, pen light, ophthalmoscope, visual acuity card, OKN tape, red lens, safety pins, cotton swabs, and pocket smell test,” Dr. Sarah Bellum explained. “And now there is a more reliable way to localize our patients’ symptoms? *Beep* that!”
An even more surprising result of the analysis was that an MRI brain could be completed in a more timely manner than the neurology consult/exam, 26 minutes vs 783 minutes, respectively (p value <0.01).
The study found limitations in localization with neuroimaging if the lesion was outside the central nervous system (CNS). Reviewers of the publication, including an internist and ER physician, were surprised to discover that there were any neurological systems outside the CNS.
In the cases of peripheral localization, researchers concluded that electromyography (EMG) and nerve conduction velocity (NCV) testing are also more sensitive than performing a neurological exam.
The findings of this pivotal study were summarized in the following flow chart, outlining the recommended sequential evaluation of patients presenting with a neurologic symptom: