Numbness may rank as one of the emergency physician's least favorite chief complaints, situated somewhere between generalized weakness and prolapsed recta. Is the numbness in the 26-year-old woman just from anxiety causing hyperventilation or is it a small acute infarct from her oral contraceptives (rightfully causing her to be anxious and hyperventilate)? Is there a single lesion that would explain why her right-sided extremities are numb and her left arm is weak? Does she need an MRI of her head or cervical spine?
And you only have about 45 seconds to figure it out because the patient's family is staring you down, standing there with arms crossed.
To the rescue of bewildered emergency physicians come Drs. Zachary London, Douglas Gelb, and James Burke from the University of Michigan Department of Neurology. Their free iOS app, Neuro Localizer HD, is a fantastic tool to help diagnose neurologic symptoms.
Choose individualized body parts and associated signs (numbness, weakness) on the anthropomorphized gingerbread man, and the app draws the neural circuitry for each finding over a graphical representation of the spinal cord and brain. The app consolidates the localizations that are common to all the findings the user has chosen to quickly determine if a single lesion could cause all of the findings. The app even has beautiful interactive diagrams of peripheral nerves (e.g., brachial plexus) to help determine exactly which nerve roots may be causing the patient's presentation.
The app is beautiful and easy to use. Until Star Trek's tricorders become real, this app is the next best tool to help differentiate the neurologic zebra from the hyperventilating horse.
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