Taking a neurological history

A detailed neurological history allows the physician to determine where the lesion is within the nervous system, the nature of the pathological process, and which physical signs to look for when examining the patient. Taking a good history requires a basic knowledge of the hierarchical organization of the nervous system and the principles of functional localization. Characterizing the pattern of neurological disease over time is important: episodic, fluctuating and progressive courses of symptoms are the most common. A clear description of events before, during and after an episode (from an eyewitness if necessary) is essential. Different symptom complexes may point the clinician towards cortical, extrapyramidal, spinal, radicular, peripheral nerve and neuromuscular pathologies. These presentations are discussed.