Differential Diagnosis in Neurology

Background | Endorsements


My undergraduate training was at Harvard University and I attended medical school at the University of Pennsylvania. While in medical school, I was fortunate enough to work with Drs. John Liu, Melvin Levitt and William Chambers. They introduced me to the anatomy and neurophysiology of the nervous system. In my junior year I was fortunate to rotate with Dr. G. Milton Shy: he was an outstanding neurologist and educator whose unique ability was to bring the scientific basis of neurological disease to the bedside. He had the extraordinary ability to develop a differential diagnosis from the history, examination and probable physiology of the disease at hand. He was also one of the founding fathers of modern neurology. My internship and internal medicine training was completed at Duke University. I was fortunate enough to be grounded in internal medicine under the tutelage of Dr. Eugene Stead, who is now generally regarded as one of the great clinicians produced in America. His great abilities were to take a medical history, perform a medical examination and apply his incredible knowledge of the nuances of diseases. While he rarely got the correct answers in clinical pathological conferences, the way that he analyzed the clinical data was amazing and one knew that he could have been correct with his with his line of reasoning. Hopefully, this project has some of the nuances that tip the balance towards specific disease in the differentials that are discussed.

My neurology training was done under the direction of Dr. Lewis P. Rowland. He is a true academic scholar with an amazing breadth of knowledge of the literature in neuromuscular disease. He has the ability to apply this information to clinical situations. A neuromuscular fellowship under the direction of Dr. King Engel at NIH completed my formal neurology education. Dr. Engel is a superb neuromuscular clinician and neuropathologist. He demonstrated to me the power of muscle and nerve biopsy as well as translational medicine in the early days of clinical trials.

This project also grew out of the profound relationship I had with the residents that I taught in three institutions. I spent 35 years leading morning report, a conference with my residents, staff and students where all patients who were admitted to my neurology service were presented to me. Here the residents were required to relate the history and physical examination as well as the basis of their differential diagnosis. I directed the discussion and often examined the patients with the residents on general rounds or during grand rounds. Grand rounds were presented in the manner done so at Duke under the tutelage of Dr. Stead: I would take the history and did the neurological examination in front of the faculty, visitors, residents and medical students. I never called on residents but interacted with the faculty. Most of the time I had not seen the patients and while I was frequently wrong, I gave the residents and students the benefit of how to quickly develop a differential diagnosis similar to what transpires in a physician’s office. I also attended all stroke and neuroradiology conferences in an effort to keep them clinically relevant. This project grew from this background with the support and help of my neurological colleagues from various faculties, residents, students, faculty members from other departments and visiting neurologists from the community.

Robert Jay Schwartzman

Drexel University College of Medicine,
Philadelphia, PA, USA

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