Taking a Neurologic History
PURPOSE
The purpose of the neurologic history—the most important component of neurologic evaluation—is to obtain information helpful in determining the localization and the mechanism of the patient’s disease process.
WHEN TO PERFORM THE NEUROLOGIC HISTORY
A thorough neurologic history should be performed on all patients who present with symptoms suggestive of nervous system dysfunction. The history should always be taken before the examination is performed.
EQUIPMENT NEEDED TO PERFORM THE NEUROLOGIC HISTORY
None.
HOW TO PERFORM THE NEUROLOGIC HISTORY
Introduction
Greet the patient.
Sit down and make yourself—the examiner—comfortable. Don’t be hurried or cut corners; reserve enough time for this important part of neurologic evaluation (obviously in the rare, truly emergent situation, you need to make yourself less comfortable and take a rapid, pointed, judicious history).
Take the history from the patient first, if possible, before talking to family members or other witnesses.
Chief Complaint
Don’t assume that you know why the patient is seeing you or what the complaint or problem is.
After greeting the patient, discern the patient’s chief complaint by asking the patient a general question, such as “What brings you here today?” Listen carefully to the patient’s response.
History of Present Illness
Once you have an idea of what the main complaint is, take your time to define the specific details of the patient’s history.
Ask the patient to start at the beginning and tell you the story. If the problem began yesterday morning, ask the patient to tell you the details, starting perhaps with the night before. If the history is of recurrent events dating back weeks, months, or years, try to get the specific details of each episode starting from the initial one.
After listening to the patient tell the history, ask specific, clarifying questions so you can better understand the patient’s symptoms:
Elucidate the nature of the patient’s symptoms by asking the patient to describe them. Symptoms such as weakness, numbness, and dizziness can mean different things to different patients at different times. When necessary, clarify the patient’s symptom by asking something like, “What do you mean by … ?” Try not to put words into the patient’s mouth; however, if you still have a difficult time understanding the nature of the patient’s symptoms, you may have to give the patient multiple choices to define his or her symptoms.Related posts:
Role of the Neurologic History and Examination In Neurologic Diagnosis
Testing Orientation, Concentration, Knowledge, and Constructional Ability
Examination of the Sternocleidomastoid and Trapezius Muscles
Examination of Lower Extremity Muscle Strength
Performing a Complete Neurologic Examination
Examination of the Patient Without Neurologic Symptoms: the Screening Neurologic Examination
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
