neuro exam

Question 1

what are the neuro questions?

Answer 1

headache, facial pain; neck or back pain; fits/faints/funny turns (including blackouts); dizziness/vertigo; disturbances of 5 senses inc. vision, hearing, touch, taste, smell; gait disturbances; loss of/disturbed sensation - numbness ‘pins and needles’; weakness in face or limbs; involuntary movements or tremors; speech disturbance; swallowing disturbance; altered cognition; disturbance of bladder or bowel; trauma

Question 2

questions for headache?

Answer 2

description, when, activity when it started, did it come on gradually, did you notice anything else

Question 3

questions for fits/ faints/ dizziness or blackouts recently?

Answer 3

vertigo: do you feel like your surroundings are moving?; experienced any nausea, vomiting, incontinence, sweating, headache, hearing loss; how long does the dizziness last?

Question 4

questions for visual disturbances?

Answer 4

double vision (diplopia), blurred vision (amblyopia), light intolerance (photophobia), visual loss

Question 5

questions for tremor and involuntary movements?

Answer 5

rhythmic? (tremor)
involuntary, small, jerky, rapid movements? (chorea)
motor restlessness? (akithesia)
sustained muscle contractions? (dystonia)
one sided chorea? (hemiballismus)
brief, purposeless limb muscle jerk? (myoclonic jerk)
repeated contraction of a small muscle group? (myokymia)
repetitive irresistible movement? (tic)

Question 6

risk factors for neurological disease?

Answer 6

• cerebrovascular disease: hypertension, smoking, diabetes, hyperlipidaemia; emboli - AF, bacterial endocarditis, AMI; haematological disease, family history of stroke

Question 7

past history questions?

Answer 7

meningitis/encephalitis, head/spinal injuries, epilepsy/convulsions, operations, STIs

Question 8

drug side effects?

Answer 8

• antihypertensives: reduce risk of stroke. ADEs are postural dizziness, syncope, depression (methyldopa)
• anticoagulants: reduce risk of stroke. ADEs are cerebral haemorrhage.
• statins: reduce stroke risk. ADEs are myopathy.
• major tranquillisers: treatment of psychoses. ADEs are ataxia, sedation, Parkinsonian tremor
• bronchodilators: ADEs are non-Parkinsonian tremor
• nitrates: ADEs are headache.

Question 9

family history?

Answer 9

muscular dystrophies, Huntington’s chorea, Alzheimer’s, cerebrovascular accidents