Clinical History

For disorders of strength, as for other disorders of the nervous system, the clinical history is primarily important in defining the location and cause of the disorder. The onset (sudden or insidious), rate of progression (gradual or rapid), and temporal profile (intermittent, step-wise, or stable and chronic) help narrow the diagnostic possibilities. Precipitating elements associated with onset of the disorder, such as trauma, exposure to toxins, recent infections, or travel, provide important clues. Because the molecular and genetic natures of more and more neurological disorders are being defined, it is most important to take a careful family history. Other medical illnesses and the medications taken for them may be important determinants of the cause. Life style and habits, and drugs, both prescribed and illicit, including alcohol, vitamins, and special diets, are potential causes of weakness. Other neurological illnesses or features may also help in localizing the lesion and defining the cause of the weakness. For example, dementia or a speech and language disorder may localize the problem to the cortex; the distribution of numbness, pain, and other sensory symptoms helps to localize the lesion causing weakness. The phenomenon of fatigability typifies a lesion of the neuromuscular junction.

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