Nervous System Systematic Enquiry

Question 1

What are the common presenting nervous system symptoms?

Answer 1

• Headache
• Balance
• Dizziness/ vertigo
• Vision
• Hearing
• Speech disturbance
• Cogntive impairment (use MSQ)
• Faints/fits/ loss of consiousness
• Weakness
• Numbness/ tingling/ paraesthesia

Question 2

Headache Questions:

Answer 2

SOCRATES + Other questions

• Sight (unilateral/bilateral)
• Onset (How fast/slow did it come on?)
• Character (descirbe the headache/pain
• Radiation (does the pain go anywhere)
• Assosiated symptoms (systematic enquiry - LATER)
• Timing (how long did the headache last)
• Exacebating and relieving factors (worse on waking/ getting up suggests increased ICP. Worse with lighting and sounds suggests migraine)
• Severity (scale the pain 1 to 10, 10 being worst)
• Single/recurrent
• Different to usual headaches

Question 3

Seizure/ Syncope/ Loss of Consciousness Questions:

Answer 3

• Ask about what happened during the event (ask about duration: Syncope < 60s. Seizure = 1-2 mins. Ask about convulsions/ ireegular movements during event. Syncope = brief myoclonic jerks. Seizure = Usual, tonic- clonic 1-2 mins)
• Before the event, “did anything bring it on” AND “any syomptoms before the event” (ask about triggers: Syncope = pain, illness, emotion. Seizure = often none. Ask about prodromal symptoms: Syncope = feeling faint, light headed, nausea. Seizure = Focal onset)
• Ask about face colour: Syncope = pale/grey. Seizure = cyanosis
• Ask about injurys: Syncope = Uncommon. Seizure = TONGUE BITING, headache, generalsied myalgia, back pain)
• Ask about urinary incontinence
• After the event: “Can you descibe how he was after the event. Did he recover well?” (Syncope = rapid recovery, no confusion. Seizure = gradual recovery, often confused)

Other possible questions:

Cardio:

• Chest pain?
• Palpitations?

Neuro systematic enquiry

General systematic enquiry

Question 4

Limb Weakness/ Numbness Questions:

Answer 4

• Duration (consistent. intermittent)
• Any pain? (SOCRATES)
• Speed of onset
• (Which muscle groups are affected HOWEVER probably already told by the patient)
• Any sensory loss/disturbance/alteration (“have there been any changes to the sensation in your limbs)
• “Any bowel problems”
• “Any loss of balance”
• Neuro systematic enquiry
• General systematic enquiry

Question 5

Vision loss history taking: