Neuro & Back History

Question 1

Cardinal neuro symptoms

Answer 1

Headache
Syncope
Seizures
Falls
Dizziness/vertigo
Visual disturbances
Altered sensation
Aura

Question 2

Classic subdural haemorrhage

Answer 2

Recent head injury
Gradual onset headache
Fluctuating level of consciousness
Elderly and alcoholics

Question 3

Classic extradural haemorrhage

Answer 3

Recent head injury
Gradual onset headache
Fluctuating level of conciousness
Young and alcoholics

Question 4

Classic intracerebral heamorrhage

Answer 4

Sudden onset severe headache
Raised ICP (waking up with headache, vomiting without nausea)
Focal neurology

Question 5

Classic subarachnoid haemorrhage

Answer 5

Sudden onset severe headache
Meningism (neck stiffness, photophbia, headache)
Drowsiness/loss of conciousness
Focal neurology

Question 6

Classic meningits/encephalitis

Answer 6

Fever, non blanching rash
Meningism (neck stiffness, photophobia, headache)
Infective (sweating, malaise, joint pain, diarrhoea)
N&V
Drowsiness/loss of conciousness

Question 7

PMH for headache

Answer 7

Hypertension/kidney disease
TIAs/strokes
Migraines
Tension headaches

Question 8

Action for suspected intracranial bleed

Answer 8

CT head
LP at 12hrs: Xanthochromia, spectrophotometry for bilirubin
Referral to neurosurgeons?

Question 9

Space occupying lesion headache history

Answer 9

Older age
Focal neuro signs and symptoms
Headache on waking
Vomiting without nausea

Question 10

Temporal arteritis history

Answer 10

Over 60yrs
frontal/occipital
Jaw pain/scalp tenderness/visual disturbance
Malaise
Proximal muscle weakness

Question 11

Classic cluster headache

Answer 11

Localised around one eye
Associated autonomic lacrimation and nasal congestion
Occurs for 15mins-2hrs daily for 6-8weeks then subsides for months

Question 12

Classic migraine

Answer 12

Chronic/recurrent headaches
Prodrome/aura
Trigger (cheese/chocolate/stress)
Oral contraceptive pill?
Photophobia/visual disturbance (zigzag lines)
N&V
FH

Question 13

Classic tension headache

Answer 13

Band-like dull ache
Scalp not cranium
Last throughout day, worsens in evening
Tired/dizzy

Question 14

11 Red flags for back pain

Answer 14

Onset 55
Constant/progressive/nocturnal pain
History of cancer
Progressive neurological deficit
Disturbed gait/saddle anaesthesia
Leg claudication
Morning stiffness
Current/recent infection
Bladder/bowel dysfunction
Immunosuppression
Fevers/unexplained weight loss

Question 15

Causes of back pain in 15-30yr olds

Answer 15

Trauma
fracture
prolapsed disc
ankylosing spondylitis

Question 16

Classic inflamm back pain

Answer 16

Morning stiffness>30mins
Gradual onset, progressive
Increased pain with rest
Disturbs sleep
Stiff spine/sacroiliac joint stiffness

Question 17

Classic cauda equina syndrome

Answer 17

Persistent and progressive bilateral leg pain
Normal leg pulses
Eased by leaning forward
Stiff spine
Bladder/bowel dysfunction

Question 18

Classic sciatica

Answer 18

Buttock->back of leg->foot

Parasthesia and pain