neurologic disorders
Approach to the Neurologic Patient
History
The history is the most important part of the neurologic evaluation. Patients should be put at ease and allowed to tell their story in their own words. Usually, a clinician can quickly determine whether a reliable history can be obtained or whether a family member should be interviewed instead. History of present illnessshould include asking the patient about the following: The quality, intensity, distribution, duration, and frequency of each symptom (questions should be specific) The duration of symptoms to differentiate between acute, subacute, and chronic (including congenital) conditions The circumstances that aggravate and attenuate the symptom The effectiveness of past treatments The order in which symptoms occur to help identify the cause Symptoms not directly related to the nervous system, which suggest a generalized or systemic condition Specific disabilities, described quantitatively (eg, walking at most 7.6 meters [25 feet] before needing to stop to rest) and their effect on the patient's daily routine. are essential because neurologic complications are common in other disorders, especially Alcohol Use Disorder and Rehabilitation , Family historyis important because migraine and many metabolic, muscle, nerve, and neurodegenerative disorders are inherited. Social, occupational, and travel historyprovides information about unusual infections and exposure to toxins and parasites. Sometimes neurologic symptoms and signs are functional, reflecting a psychiatric disorder. Typically, such symptoms and signs do not conform to the rules of anatomy and physiology, and the patient may be depressed or unusually frightened. However, functional and physical disorders sometimes coexist, and distinguishing them can be challenging. 