Cranial Nerve History

Question 1

What must you ask in a specific neurological review?

Answer 1

1. ‘Faints, fits or funny turns’ (seizures, LOC)
2. Previous headaches
3. Mood
4. Cognition
5. Senses – hearing, taste, smell, numbness, vision (inc diplopia)
6. Speech and swallowing problems
7. Weakness
8. Numbness or tingling
9. Balance
10. Bladder and bowel

Question 2

What general things must you ask in cranial nerve history?

Answer 2

1. Malaise / lethargy
2. Appetite change / weight loss
3. Fevers / night sweats
4. Rashes / skin changes

Question 3

What risk factors do you need to ask about?

Answer 3

1. Immunocompromised e.g. IVDU, HIV status
2. Old age
3. Previous history of cancer
4. Pregnancy (3rd trimester and postpartum)
5. Recent trauma, head injury

Question 4

What red flags for headache in cranial nerve history must be asked about?

Answer 4

1. Abrupt, severe (Thunderclap) headache
2. Age of onset >50 yrs old (GCA)
3. Progressively severe or worsening frequency of headache
4. Significant change in pattern of headache
5. Triggers posture (worse lying down), straining coughing suggests raised ICP
6. Any neurological signs – meningism (stiff neck), confusion, reduced LOC,
   neurological symptoms or focal signs
7. Secondary risk factors (see above)

Question 5

What PMHx must be enquired about in cranial nerve history?

Answer 5

1. Hypertension
2. Heart disease
3. Stroke or TIA (transient ischaemic attack) Diabetes
4. Cancer

Question 6

What FHX and DHx needs to be touched on?

Answer 6

1. medication can cause

2. pertinent medical or neurological disease

Question 7

What SHx do you need to ask about in cranial nerve history?

Answer 7

1. Hand dominance?
2. Does patient drive or not (DVLA aware?)? Smoking history
3. Alcohol history
4. Illicit drug use

Question 8

What sensory changes do you enquire about?

Answer 8

1. hearing
2. taste
3. smell
4. numbness
5. tingling
6. vision (including diplopia)
7. weakness
8. balance

Question 9

What do you ask about in fits faints or funny turns?

Answer 9

1. seizures
2. loss of consciousness
3. Any evidence of pre-warning / preceding symptoms
4. any witnesses to the event
5. what the recovery period was like after regaining consciousness
6. important to note if the patient has an occupation / hobby where a sudden syncopal episode would be especially dangerous e.g. diving / swimming / driving