Neurology for the Internist

Neurology at a glance.

History.

Taking a history from a patient with a neurologic complaint is fundamentally the same as taking any history.

• Age 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.

• Chief Complaint 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.

A. Confusion

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.