以神經學定位導向的臨床推理教學

The Teaching of Clinical Reasoning Guided by Neurological Localization

神經學疾病因為涉及複雜的中樞神經及周邊神經控制，較難根據局部症狀來推理可能的診斷。因此，必須先讓學生熟悉神經學診斷的兩部曲:先有「定位性診斷」才能有「病因性診斷」。透過臨床案例中病史詢問及神經學檢查結果，以功能性神經解剖學知識下推理出一個精準的臨床定位，之後再根據VINDICATE來推理可能的病因。本文根據相同主訴的兩個案例，來說明臨床定位的重要性及臨床推理的思路過程。

The diagnosis of neurological disorders is rarely based on local symptom or signs due to the complexity of both central and peripheral nerve system control. Therefore, students must first familiarize themselves with the two-step rule of neurological diagnosis: the first 'localization' and the second 'etiological diagnosis.' The students have to localize the disease based on the reasoning skills with the help of background knowledge of functional neuroanatomy, and then speculate an etiological diagnosis using a VINDICATE approach to analyze the clinical profiles. In this paper, we illustrate the importance of clinical localization by stepwise analysis of the clinical reasoning process on two cases with similar chief complaint.