Chapter 6: Common Neurological Complaints

Common Neurological Complaints systematically addresses the evaluation and management of five major neurological complaints encountered in clinical practice. Confusion, a symptom rather than a diagnosis, requires differentiation between delirium, which presents acutely with fluctuating consciousness and inattention often reversible upon treatment of underlying causes such as infection or medication toxicity, and dementia, which represents a chronic progressive decline in cognitive function. Dizziness and vertigo, though often conflated by patients, have distinct origins: dizziness emerges from systemic causes producing cerebral hypoperfusion including orthostatic changes and anemia, while vertigo involves a false sensation of movement originating from either peripheral vestibular structures like those affected in benign paroxysmal positional vertigo and Ménière's disease, or central nervous system lesions in the brainstem and cerebellum distinguished by characteristic nystagmus patterns and additional neurological deficits. Headaches divide into primary presentations including tension-type headaches producing bilateral band-like pressure, migraines causing unilateral throbbing pain potentially preceded by aura and managed through trigger avoidance and preventive medications, and cluster headaches marked by severe periorbital pain with autonomic accompaniments, alongside secondary headaches that demand urgent evaluation such as subarachnoid hemorrhage and temporal arteritis. Paresthesia and paresis describe abnormal sensations and weakness respectively, arising from acute vascular events like transient ischemic attacks, chronic peripheral neuropathies particularly from diabetes presenting in stocking-glove distributions, and nerve compression syndromes. Tremors, classified by occurrence patterns, include essential tremor as an action tremor frequently familial and responsive to propranolol, parkinson's disease presenting with characteristic resting tremor alongside bradykinesia and rigidity, and enhanced physiological tremor triggered by anxiety, stimulants, or metabolic derangement. The chapter emphasizes geriatric considerations including heightened confusion risk from polypharmacy, temporal arteritis in older adults threatening vision loss, and increased prevalence of movement disorders in aging populations.