From the Guidelines
Common chief complaints in neurology include headache, dizziness, weakness, numbness, seizures, altered mental status, and gait disturbances, with headache being particularly prevalent, as seen in 80% of patients with aneurysmal subarachnoid hemorrhage 1.
Key Chief Complaints
- Headache: can be a symptom of various conditions, including aneurysmal subarachnoid hemorrhage, with a characteristic "thunderclap headache" described by patients 1
- Dizziness: encompasses vertigo, lightheadedness, and disequilibrium, often stemming from vestibular disorders or cerebrovascular issues, with a low positivity rate of head CT in the emergency department 1
- Weakness and numbness: may indicate stroke, peripheral neuropathy, or multiple sclerosis, requiring prompt evaluation 1
- Seizures: present as episodes of abnormal electrical activity in the brain, with a high incidence in patients with aneurysmal subarachnoid hemorrhage 1
- Altered mental status: can range from confusion to unconsciousness, potentially indicating encephalopathy, infection, or metabolic disturbances, with a yield of neuroimaging studies in patients with altered mental status being low 1
- Gait disturbances: often suggest Parkinson's disease, cerebellar dysfunction, or normal pressure hydrocephalus, with ataxia being a common symptom in various conditions, including spinocerebellar ataxias and fragile X-associated tremor/ataxia syndrome 1
Diagnostic Approach
The initial evaluation of these chief complaints should include a thorough history-taking, focused neurological examination, and appropriate diagnostic testing to determine the underlying cause and guide treatment. The choice of diagnostic test depends on the specific complaint and clinical presentation, with noncontrast head CT being the cornerstone of diagnosis for aneurysmal subarachnoid hemorrhage 1, and MRI being the preferred modality for initial assessment of ataxia and other conditions affecting the posterior fossa 1.
From the Research
Common Chief Complaints in Neurology
- Headache is a common complaint, often with a benign cause, such as a primary headache syndrome 2
- Other frequent neurological chief complaints include:
- In pediatric neurology, headache and seizures are two of the most common complaints, with headache being the most frequent 6
- The most common chief complaints in an emergency room setting are:
- Dizziness is a frequent neurological chief complaint in the emergency room, with benign paroxysmal positional vertigo and stroke being the two most frequent disorders 4