The Neurologic History
As family practitioners you will see patients with complaints that cover the full spectrum
of medical practice.
Many of these patients, present with symptoms of pain, dizziness,
forgetfulness, numbness, weakness and difficulty speaking or comprehending as their primary
complaint, or as a portion of their history.
In addition to a full medical evaluation, accurate
assessment of these neurological complaints will be of increasing importance in our current
health care environment.
Since up to 10 to 15% of a family practitioner’s workload consists of
neurological problems, it is the goal of this program to provide an effective and efficient means
of gaining this knowledge.
As a first step in evaluating the patient with a neurological problem the practitioner must
A good history alone will often suggest the correct diagnosis and
the examination can be tailored to specifically search for corroborating physical signs.
with neurological disease may have impairments that make it difficult to elicit accurate
information and the diligent examiner may need to spend extra time questioning the patient or
obtaining information from family or friends.
While this may seem tedious,
obtaining an accurate history
often brings a rapid, correct diagnosis, thereby saving time and
reducing health care costs.
An important consideration in history taking is to not only record the patient&s complaint,
eg, dizziness, but to question exactly what the patient means by that complaint.
±dizziness² often has different meanings to the lay public and the term could be used to connote
lightheadedness, vertigo, tiredness, or malaise.
If the examiner assumes it means vertigo then
needless time and resources may be wasted in pursuing a non-existent complaint.
example is ±weakness² which to many patients may mean fatigability or lack of energy rather
than loss of strength in specific muscle groups.
The history should be recorded in
and in a
noting the date of onset of symptoms and developing the story in sequence.
be characterized and described in terms of
severity, location, temporal profile,
as well as
aggravating and ameliorating factors.
Any relation to the past history should be established
Certain questions may be specific to certain disease processes; in other diseases,
symptoms will be similar but the diagnosis may be established by a difference in temporal
profile, ie, whether it is
For example, numbness and weakness of