Neurological Examination - Patient's History

Patient's History

A patient's history is the most important part of a neurological examination and must be performed before any other procedures unless impossible (i.e. the patient is unconscious Certain aspects of a patient's history will become more important depending upon the complaint issued). Important factors to be taken in the medical history include:

• Time of onset, duration and associated symptoms (e.g. is the complaint chronic or acute)
• Age, gender, and occupation of the patient
• Handedness (right- or left-handed)
• Past medical history
• Drug history
• Family and social history

Handedness is important in establishing the area of the brain important for language (as almost all right-handed people have a left hemisphere which is responsible for language). As patients answer questions, it is important to gain an idea of the complaint thoroughly and understand its time course. Understanding the patient's neurological state at the time of questioning is important, and an idea should be obtained of how competent the patient is with various tasks and their level of impairment in carrying out these tasks. The interval of a complaint is important as it can help aid the diagnosis. For example, vascular disorders (such as strokes) occur very frequently over minutes or hours, whereas chronic disorders (such as Alzheimer's disease) occur over a matter of years.

Carrying out a 'general' examination is just as important as the neurological exam as it may lead to clues to the etiology of the complaint. This is shown by cases of cerebral metastases where the initial complaint was of a mass in the breast.