What initial investigations should be considered for a patient presenting with unexplained neurological symptoms?

Initial investigations for a patient presenting with unexplained neurological symptoms should include a thorough clinical history and focused neurological examination to assess cognitive function, mobility, hand function, and relevant neurological signs. A urine dipstick test should be performed to check for infection or other abnormalities. Blood tests may be considered based on clinical suspicion, including inflammatory markers if temporal arteritis is suspected, thyroid function, vitamin B12 and folate levels, and serological testing for gluten sensitivity in cases of progressive gait ataxia. Neuroimaging should be arranged urgently if there are focal neurological signs, facial numbness, or suspicion of serious conditions such as subarachnoid haemorrhage or cancer. In cases suggestive of functional neurological disorder, referral to neurology for specialist assessment and confirmation is recommended, with neurophysiological testing and structural imaging as needed to exclude other diagnoses. If Lyme disease is suspected due to neurological symptoms and relevant exposure history, serological testing combined with clinical assessment should guide diagnosis and treatment. Immediate referral to emergency services is warranted if subarachnoid haemorrhage is suspected based on history and examination.