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February 1989

Clinical Neuroepidemiology: III. Decisions

Author Affiliations

From the Departments of Radiation Oncology and Neurology, Hahnemann University, Philadelphia (Dr Koprowski); Division of Neurology, Department of Medicine, University of Washington, Seattle (Dr Longstreth); and Division of General Medicine, Department of Medicine, Cleveland Metropolitan General Hospital (Dr Cebul).

Arch Neurol. 1989;46(2):223-229. doi:10.1001/archneur.1989.00520380129027

AS we assemble clinical information on diagnosis and outcomes of neurologic conditions, we need to make decisions about further evaluation and treatment despite the existence of substantial uncertainty. We are all familiar with the uncertainty that surrounds clinical situations. Astute neurologists formulate a strategy based not only on data from the literature, but also on their own knowledge of basic science and clinical circumstances. The latter include not only an estimation of the likelihood of particular diagnosis, but also consideration of the patient's attitudes toward illness and death, the trade-off of high short-term risks with lower long-term risks, and a host of other factors. Most often neurologists attempt to analyze these factors intuitively and reach a decision about further evaluation or treatment based on as many relevant variables as possible.

Consider the patient who has experienced a transient ischemic attack.1 What is the best strategy for such a

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