The neurological consultation

Correct neurological diagnosis requires a combination of careful history taking and neurological examination.

History

I like to begin by introducing myself, learning a little about you, and establishing why you have come to see me. I will then ask about any previous significant medical or neurological problems, find out if there is any relevant family history, and check what medicines you are taking. Once I have done this, I like to establish the nature and development of your current neurological symptoms, and to find out what has been causing you concern. To avoid forgetting to tell me anything important on the day, you may find it helpful to bring some short notes with you, to serve as an aide memoire. If you have experienced an episode of loss of consciousness, please come with someone who witnessed you having the episode or, if this is not possible, please ask them to provide a written eye witness account which you can bring to your appointment.

Neurological examination

For the unitiatated, a neurological examination may seem an unusual process. I will watch you walking, assess your balance, look into the back of your eyes, observe your eye and facial movements, listen to your speech and finish by assessing the strength, reflexes, coordination and sesnation of your limbs. This helps me to establish whether your nervous system is working normally or whether there are any clues as to your diagnosis.

Diagnosis and investigations

I will conclude the consultation by summarising my findings and, wherever possible, by communicating your diagnosis. If your diagnosis remains unclear, or requires confirmation, I will arrange relevant investigations including blood tests, brain/spine/body scans (MRI, CT, DAT or PET),  brain wave recordings (EEG) and/or electrical tests of your nerves and muscles (NCS/EMG/evoked potentials).

Treatment and prognosis

Once your diagnosis has been established, we will discuss treatment options and prognosis.