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These authors investigated the reliability of the neurologic examination in detecting focal cerebral hemispheric lesions. They recruited 46 patients who lacked obvious neurologic impairments but, after an initial evaluation, had focal lesions revealed by CT, MRI, or both (20 frontal, 13 temporal, and 16 parietal); most lesions were tumors. Seventeen patients had focal neurologic symptoms on presentation, whereas 28 had headaches, nonfocal seizures, light-headedness, blurring of vision, or changes in cognition (one had no neurologic symptoms).
Neurologists who lacked access to patients' histories gave them a one-time, comprehensive, uniform panel of bedside tests of cognitive, cranial-nerve, motor, sensory, and reflex functions, as well as ga…