Social history

The patient's occupation may he relevant in the causation or triggering of neurological disorders, e.g.:

• exposure to toxic chemibals (neuropathies and encephalopathy)

• recurrent overuse of certain joints predisposing to entrapment neuropathy (e.g. carpal tunnel syndrome)

• prolonged visual work, particularly with visual display units or under artificial tight (tension headache and migraine).

Marital status and household dynamics and any change of lifestyle should be ascertained. Marriage, divorce, hereave-ment and change of occupation are important factors in

TABLE 6,1 Summary of neurological history-taking

Presenting complaint

Time relationships Localisation Trigger factors Associated features

Past medical history


Head/spine injury

Infections (meningitis/encephalitis)

Surgical procedures

Drug therapy

Family history

Epilepsy, migraine, multiple sclerosis, stroke, cerebral aneurysm, muscle disorders, dementia, spinocerebellar degenerations and neuropathies

Social history

Occupation Marital status Smoking habits Alcohoi consumption Use of recreational drugs Sexual orientation and habits

emotionally based symptoms, particularly tension bead-ache. migraine and depression, and may also trigger attacks of multiple sclerosis and epilepsy. Smoking habits both past and present should be elicited, as should the use and possible abuse of alcohol or other drugs. It may be appropriate to ask about the patient's sexual orientation and any possibility of exposure to sexually transmitted diseases including syphilis and HIV.

A summary of the information that should be obtained from patients presenting with neurological symptoms is given in Table 6.1.

Two of the commonest categories of symptom reported by patients seen in clinical neurology are:

• attacks of altered consciousness - 'fits, faints and funny turns'.

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