SYMPTOMS AND SIGNS OF NEUROLOGIC DISEASES

In taking a history and examining the patient, the neurologic clinician elicits both symptoms and signs. Symptoms are subjective experiences resulting from the disorder (ie, "I have a headache"; "The vision in my right eye became blurry a month ago"). Signs are objective abnormalities detected on examination or via laboratory tests (eg, a hyperactive reflex or abnormal eye movements). The history provide crucial information about diagnosis. For example, a patient was admitted to the hospital in a coma. His wife told the admitting physician that "my husband has high blood pressure but doesn't like to take his medicine. This morning he complained of the worst headache in his life. Then he passed out." On the basis of this history and a brief (but careful) examination, the physician rapidly reached a tentative diagnosis of subarachnoid hemorrhage (bleeding from an aneurysm, ie, a defect in a cerebral artery into the subarachnoid space). He confirmed this diagnostic impression with appropriate (but focused) imaging and laboratory tests and instituted appropriate therapy. The astute clinical observer may be able to detect signs of neurologic disease by carefully observing the patients'spontaneous behavior as they walk into the room and tell their story. Even before touching the patient, the clinician may observe the "festinating" (shuffling, small-stepped) gait of Parkinson's disease, hemiparesis (weakness of one side of the body) resulting from a hemispheric lesion such as a stroke, or a third nerve palsy suggesting an intracranial mass. The way patients tell their story also may be informative; for example, it may reveal aphasia (difficulty with language), confusion, or