A thorough but directed history and neurologic examination are the keys to neurologic diagnosis and treatment. Laboratory studies, discussed in Chapter 2, can provide valuable additional information, but cannot replace the history and exam.
Taking a history from a patient with a neurologic complaint is fundamentally the same as taking any history.
The patient's age can be a major clue to the likely causes of a neurologic problem. For example, epilepsy, multiple sclerosis, and Huntington disease usually have their onset by middle age, whereas Alzheimer disease, Parkinson disease, brain tumors, and stroke predominantly affect older individuals.
The patient's problem (chief complaint) should be defined as clearly as possible, because it will guide subsequent evaluation toward—or away from—the correct diagnosis. In eliciting the chief complaint, the goal is to describe the nature of the problem in a word or phrase.
Common neurologic complaints include confusion, dizziness, weakness, shaking, numbness, blurred vision, and spells. Each of these terms means different things to different people, so it is critical to point evaluation of the problem in the right direction by getting as much clarification as possible regarding what the patient is trying to convey.
Confusion reported by the patient or family members may include memory impairment, getting lost, difficulty understanding or producing spoken or written language, problems with numbers, faulty judgment, personality change, or combinations thereof. Symptoms of confusion may be difficult to characterize, and asking for specific examples can be helpful in this regard.
Dizziness can mean vertigo (the illusion of movement of oneself or the environment), imbalance (unsteadiness due to extrapyramidal, vestibular, cerebellar, or sensory deficits), or presyncope (light-headedness resulting from cerebral hypoperfusion).
Weakness is the term neurologists use to mean loss of power from disorders affecting motor pathways in the central or peripheral nervous system or skeletal muscle. However, patients sometimes use this term when they mean generalized fatigue, lethargy, or even sensory disturbances.
Shaking may represent abnormal movements such as tremor, chorea, athetosis, myoclonus, or fasciculation (see Chapter 11, Movement Disorders), but the patient is unlikely to classify his or her problem according to this terminology. Correct classification depends on observing the movements in question or, if they are intermittent and not present when the history is taken, asking the patient to demonstrate them.
Numbness can refer to any of a variety of sensory disturbances, including hypesthesia (decreased sensitivity), hyperesthesia (increased sensitivity), or paresthesia ("pins and needles" sensation). Patients occasionally also use this term to signify weakness.
Blurred vision may represent diplopia (double vision), ocular oscillations, reduced visual acuity, or visual field ...