Neuro histories Flashcards
Give the SOCRATES for a HEADACHE
Site:
-> Ask the patient to point.
-> Unilateral / bilateral / in specific part (occipital? / over eye?)
Onset:
-> Sudden or gradual?
-> Thunderclap?
Character:
-> Throbbing?
-> Like a tight band?
-> Worst ever?
Radiation:
-> Does the pain radiate?
Asso Sx:
-> Nausea/vomiting
-> altered conscious level,
-> rash,
-> fever
-> neck stiffness
-> light sensitivity
-> visual loss,
-> blurred vision
-> aura
-> tender scalp
-> malaise
-> nasal discharge
Timing:
-> Constant/intermittent?
-> Single/recurrent?
-> Duration of episodes.
-> Worse at certain times of day/month/year?
E /R factors:
(E) —-> Triggers? noise, stress, bending, standing up,
coughing, sneezing, blowing nose, eating,
combing hair, bright or flashing lights, certain
foods/drugs, dehydration?
(R) —-> Analgesia, dark environment, lying down, rest
Severity:
-> Scale (1-10; 10 being the most severe)
What can cause headaches?
SAH
Meningitis
Trigeminal neuralgia
Acute closed-angle glaucoma
What do headaches worse in the morning indicate?
Raised ICP
What can the following R/E factors be associated with?
a) coughing , lying flat (E) +standing up (R)
b) standing up (E) + lying down (R)
a) Raised ICP
b) Low ICP
What key associated sx do you want to ask about?
What do they indicate?
Raised ICP ? SAH ? Space occupying lesion
Nausea/vomiting
visual loss / disturbance / blurred vision
Altered conscious level,
Photophobia
Meningitis
Rash
Fever
Neck stiffness
light sensitivity (photophobia)
Temporal arteritis
tender scalp - temporal region
Migraine
Photophobia
Aura
What RED FLAGS presentation are there in a HEADAHCE HISTORY?
A headache of sudden onset, reaching maximum intensity by five minutes (suggestive of subarachnoid haemorrhage).
Worsening headache associated with fever, meningeal irritation (i.e. neck stiffness) and altered mental status (suggestive of bacterial, viral or fungal meningitis).
New onset focal neurological deficit, personality change or cognitive dysfunction (e.g. intracranial haemorrhage, space-occupying lesion, encephalitis, meningitis).
Decreased level of consciousness (e.g. raised intracranial pressure).
Recent head trauma within the last 3 months (e.g. subdural haemorrhage).
Headache which is posture dependent (e.g. a headache worse on lying down and when coughing is suggestive of raised ICP).
Headache associated with tenderness in the temporal region (unilateral or bilateral) and jaw claudication (e.g. temporal arteritis).
Headache associated with severe eye pain, reduced vision, nausea and vomiting (e.g. acute angle-closure glaucoma).
When taking a hx w/ a PC of ALTERED CONSCIOUSNESS / TRANSIENT LOC what do you want the patient to do first?
Describe the episode in their own words
When taking a hx w/ a PC of ALTERED CONSCIOUSNESS / TRANSIENT LOC what do you want to pay attention to?
what happened before, during and after
What questions do you want to ask in a LOC hx?
Onset (gradual/sudden?)
Time of the day
What they were doing at the time?
Any pain / injections/ hot crowded rooms / emotional stress / prolonged standing,
How they felt before the episode
Asso sx:
Dizziness, nausea, vertigo, aura, palpitations,
sweating, weakness, sensory symptoms,
slurred speech, headache, tongue biting or
incontinence, stiffening\jerking of limbs,
awareness and responsiveness during the
episode, eyes-open or closed? Groans, crying?
How long did it take to recover?
Any amnesia / aggression / crying or weakness after the episode?
Previous episodes?
If so whether they are like the current one?
Was the episode witnessed?
If so what did the witness say?
Can we contact them to get a description?
With other neuro sx what do you want to ask abt?
Important to note the course:
-> is it sudden in onset,
-> how long did it take to reach the peak of the
symptoms- Minutes, Hours, days, weeks or
months?
-> Getting better or worse?
-> Static/progressive/relapsing and remitting?
? Previous attempts to diagnose the condition and responses to any previous therapeutic interventions.
What specific neuro risk factors do you want to ask about in the PMH?
Head/spinal trauma
Metabolic/endocrine disorders e.g. diabetes
Cancer (metastases?)
Epilepsy
HTN
AF
Heart diseases
What do you want to ask about in the DHx part of a neuro hx?
ALLERGIES
Any meds? Adherent? SE? OTC? HERBAL? OCP? HRT?
Anticonvulsants
Drugs that interact with anticonvulsants / lower the seizure threshold
Anticoagulants and anti-platelet drugs
Analgesics
Antihypertensives
Antidepressants
Insulin
Recreational drugs
What do you want to ask about in the FHx part of a neuro hx?
DM / Cerebral haemorrhage / CVA (Stroke / TIA) / CVD / IHD / Migraine / Epilepsy
What do you want to ask about in the SHx part of a neuro hx?
ADLS / mood
Alcohol consumption
Smoking
Recreational drugs
Occupation
Social activities/hobbies
Home circumstances, level of independence, mobility aids
