Taking a history from a patient with a neurologic complaint is fundamentally the same as taking any history.
Age can be a clue to the cause of a neurologic problem. 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 chief complaint should be defined as clearly as possible, because it will guide evaluation toward—or away from—the correct diagnosis. The goal is for the patient 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 clarify what the patient is trying to convey.
Confusion may be reported by the patient or by family members. Symptoms can 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, so specific examples should be sought.
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 use 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 cuts.
Spells imply episodic and often recurrent symptoms such as in epilepsy or syncope (fainting).
History of Present Illness
The history of present illness should provide a detailed description of the chief complaint, including the following features.