Discrepancies in Recorded Results from Duplicate Neurological History and Examination in Patients Studied for Prognosis in Cerebrovascular Disease

Abstract

Histories were taken and neurological examinations performed according to a carefully standardized protocol by two neurologists on 28 patients with histories of probable transient cerebrovascular insufficiency. Duplicate examinations were performed within a short interval of the initial examinations. Comparison of the findings on the two examinations showed extreme discrepancies in recording of presence or absence of specific symptoms and of signs on the neurological examination, including signs considered "objective"— for example, reflex asymmetry. Discussion between the examiners followed by another set of duplicate examinations reduced the discrepancies on the findings of neurological examination, but did very little to the discrepancies in the history. The necessity of realizing the variability of the history and examination in evaluating the course of, and therapy for, transient cerebrovascular ischemic attacks is emphasized.