Neuro Examination and History Flashcards
How to take a Neuro History
History of presenting compliant
- What have you come to see us with today?
- Do you have any other symptoms?
- How are you feeling at the moment
- How long has it gone on for
- Has this happened before and when did it start
- was the start of this pain associated with a specific event
- What does it (pain) feel like
- Do it start suddenly or a gradual onset
- Where speficially is the pain and does it spread
- What is the character of the pain
– does anything make it better or worse
- What treatments has this responded to
- can you rate the pain on a scale of 0-10
- How are you generally – are you fit and well
Then go into more specific questions about symptoms:
- What were you doing before the blackout, can you remember what happened during the blackout and what happened after the blackout
- in what position was the patient - lying, standing, seated
- where you sleep deprived or have drunk a lot o alcohol
- have you had any recurrent episodes and what were you doing when it happened
- in the case of vertigo - is there recurrence on turn gin the head or sitting up from lying flat - indicate benign positional vertigo
- availability of thrombolysis for stroke means that the time of onset of symptoms need to be noted
- what are triggering factors
- patterns of episodes over time
Ideas Concerns Expectations
- Do you have any idea of what might be going on
- Is there anything that is worrying you specifically
- What were you hoping id be able to do for you today
Past Medical history - Do you have any medical conditions - Have you seen anyone for this before Specific questions - Have you had contact with those that are unwell recently -
Drug history and allergies
- What prescribed medication do you take
- What over the counter medication do you take
- Have you taken any illicit substances?
- Do you have any allergies?
Social history
- What do you do for a living
- Do you smoke – how long have you smoked, how many cigarettes do you smoke a day
- Do you drink
- Where do you currently live
- Do you have a support network that helps you
- Do you require any assistane in day to day life
- How much exercise do you do – how often and what type
Family History
- Has your family had any significant illness
- Are they well and still alive
Systematic review
Now just before we finish I just have some quick general questions to ask
- Have you had a fever
- Any weight changes
- Do you fill fatigued
- Have you had a cough?
- Do you get any stomach pain or nausea and vomiting
- Are you going to the toilet as usually?
- Have you had a headache, any visual changes, or motor and sensory disturbances
- Any chest wall pain, or trauma
- Do you have any rashes or other skin problems
Before I examine you is there anything else that you would like to add or think that I have missed
what should you seek to answer in a neurological history examination
- which part of the nervous system is affected and where is the lesion
- is it a single lesion or is there multiple lesion
- what is the underlying pathological process
- is this a purely neurological problem or a neurological manifestation of a systemic disease
what other history is good to have
- a collateral history from a caretaker should be sought
- but permission should be asked before hand
why is hardness important to know
- almost all right handed individuals and at least 3/4 of left handed ones are left hemisphere dominant for language
- this information is important when localising al lesion
the more left handed the patient the more likely they are to be …
- the more left handed the patient is the more likely they are to be right hemisphere dominan
why should you look at levels of severity
- MS - patterns and symptoms are important in determining the nature of the disease - e.g. primary progressive, relapsing remitting or secondary progressive
what suggests cortical pathology
- epileptic seizures
- disturbances of consciousness
- cognitive and psychiatric symptoms (e.g. dementia)
- organic psychoses
- hemiparesis
- hemisensory disturbance
- visual field deficits (homonymous hemianopia).
What are the pathological processes that commonly affect the cortex
- vascular disease
- tumour
- abscess
- trauma
- atrophy/infection of the temporal lobe
what are frontal lobes important for
- important for planning and executive function
what happens if there is damage to the frontal lobe
- may be disinhibited or flippant
- check there attention span - ask them to recall a string of numbers
- be ware that they may lack capacity and need a moral assessment of their ability to consent for investigation and treatment
- changes in personality, mood, insight and urinary incontinence
what happens if there is a lesion to the parietal lobe
- can be difficult to identify
- loss of function such as temperature or proprioception suggests a lesions low down the chain
- disorders such as agnosia and apraxia or inattention suggest cortical pathology
what happens if there is a lesion to the temporal lobe
- speech and language is affected if the left/dominant temporal lobe is involved
- memory (particularly episodic memory) is affected
- the hippocampus and temporal lobe are needed to form new memories and are sensitive to anoxia
- seizures that begin in the temporal lobe may be preceded by a sense of deja vu or a strange smell
- medial temporal lobe is commonly involved in viral encephalitis and acute temporal lobe symptoms associated with headache in young patients should suggest this diagnosis
How do you know of damage to the occipital lobe
- visual deficits
- scotoma
- ask western symtpoms are bilateral and in particular ask if there is any history of trauma - after sudden deceleration injury
- contra-coup injury may damage both occipital poles simultaneously
what is a scotoma
a scotoma is when there is a black spot in the visual field where the macula which is rich in photoreceptors is located
list some extrapyramidal disease characteristics
- parkinsons - stiffness and slow movement
- hypokientic syndromes due to lesions in the palladium or substantially nigra
- tremor
- putamen and caudate lesions can lead to hyperkinetic disorders in which tone tends to decrease
- sub thalamic damage - ballismus - more violent and less smooth involuntary movement
what does a transection of the cord in the cervical spine result in
- spastic paralysis of all four limbs (tetraplegia)
what does a transection in the thoracic or lumbar spine affect
- just the lower limbs - paraplegia
what indicates damage to the conus and caudal equine
involvement of the perineum with or without associated autonomic dysfunction (such as urinary retention) may indicate pathology in the conus or cauda equina
