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Good papers are those that alter your practice or change your understanding of a clinical problem. Great papers are those that transform neurological practice. Somehow it is all the more impressive if they do so without resorting to complicated technology. Here are two outstanding examples.
The first, by Lempert, Bauer and Schmidt,1 concerns the diagnosis of blackout – and was a wonderfully simple study that simply videoed 56 volunteers who induced syncope by squatting and hyperventilation, followed by Valsalva (the ‘Mess Trick’). They demonstrated the range features that can be associated with syncope – in particular multifocal jerks, head turns and other brief motor movements – and transformed the clinical assessment of patients with blackouts as many of these were previously supposed to be highly specific for seizures. This paper must have prevented many patients with syncope being misdiagnosed as having had a seizure. Equipment used – two video cameras and a mattress to break the volunteers' falls.
The second, by Halmagyi and Curthoys,2 is the description of an original clinical sign that is very useful in patients with dizziness and vertigo. They described and validated the head thrust test the first bedside test that demonstrates unilateral canal paresis. In patients with vertigo this is a reliable test that can help distinguish central from peripheral vertigo. Equipment used – clinical acumen.
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