Comms: Neurology histories Flashcards
What questions should be asked in a CNS history?
Headache
Vision
Smell
Loss of consciousness
Vertigo
Weakness
numbness
Tremor
Fine motor control
Mobility
Memory
Concentration
Why is the time course of a neurological history important?
Onset - start
Duration - how long last
Frequency - how often
Sudden onset - vascular e,g stroke
10 days (acute) - subdural haematoma
4 months or chronic - malignant
What are the different terms used to describe a time course?
Acute - mins to hrs
Sub-acute - hours to days
Chronic - weeks to months
How can we differentiate between different headaches based on where they are?
Radiation out from between eyes - tension
Stipe across forehad - tension
One side of the head (unilateral) then spread - migraine
Spreading into the neck - cervicogenic headaches
Focused around the eye - cluster
What are some important characters of headaches?
What words would you use to describe your headache?
Throbbing
bang around the head
Shooting
Burning
What are the associated features with migraines?
Aura
Photophobia
Interference to life
Nausea
What is important to ask about the timing of headaches?
What brings headaches on?
Tirggers - caffeine, diet, lifestyle, alcohol
Associated with activity, time of day or seasons
Any other people in the household affected? - Co poisoning - nasuea, headache, tightness in chest, fatigue, dizziness.
What are some exacerbating/relieving factors around headaches?
Trauma
Posture
Valsalva manouvres
Fatigue or stress
Menstraul cycle
Medication change or withdrawal
Painkillers
What is the difference between a primary and a secondary headache?
Give some examples of each
Primary -no underlying pathology - migraine, tension type, cluster
Secondary - underlying pathology - subarachnoid haemorrhage, brain tumour, temporal arteritis
What are some red flags for headaches?
First or worst headache ver
New onset headache
Onset after age 50yrs
Worsening headahc
Acute or sudden onset
Sudden onset during exertion, with coughing, sneezing, sex related
Headache with postural link
Headache in setting of malignant or HIV
Systemic symptoms - fever, weight loss, cough
Neuologic signs or symptoms
What are some different speech difficulties and how can you ask about them in a history?
receptive dysphasia - problems understanding other people saying
Expressive - word finding difficulties
Dysarthita - comphrension and construction limited
Dysphonia - poor generation os sound through vocal cords - voice hoarseness or changes in volume
What is important to know about loss of consciousness?
Circumstances of event, prodromal symptoms
During - appearance eyes open or shut, presence or absence of movement, tongue biting, urinary incontinence
After - injuries, time to recover.
What is the key difference between syncope and seizures?
Syncope - triggered by pain, illness or emotion, often feel faint, nausea or visual problems before hand, last for less than 60s, tend to go pale, rapid recovery with no confusion, may have some brief myoclonic jerks whils unconscious
Seizures - no trigger (alcohol, drugs etc), focal onset, last 1-2mins, tonic-clonic 1-2ms convulsions are common, often bite tongue, headahcem back pain, generalised muscle pain, recovery takes a long time often 30mins, often confused when wake up.
What patterns of weakness can indicate a diagnosis?
What are the positive and negative symptoms of numbness?
positive - altered sensation - tingling, pins and needles
Negative - loss of sensation, usually noticed with inadvertently injure or touching that part.
