Neuro Histories Flashcards
What red flags should you ask about in a collapse/seizure history? (6)
Chest pain/SOB/palpitations Collapse when exercising FH of sudden cardiac death Weight loss, headaches Neuro symptoms Head injury
What are the red flags for a head injury? (4)
Loss of consciousness
>1 episode vomiting
Amnesia
Anti-coagulants
What questions should you ask about what happened before a collapse/seizure? (3)
What were you doing?
Preceding symptoms
Witness
What questions should you ask about what happened during a collapse/seizure? (6)
How did you fall? Seizure: describe Loss of consciousness Tongue biting: side/front Incontinence Hit head?
What questions should you ask about what happened after a collapse/seizure? (3)
Post ictal state
- how did you feel, confusion, drowsy, aching muscles
Todds paralysis: weakness
Previous episodes
What differentials would you think about for a collapse/seizure? (6)
Vasovagal syncope Cardiogenic syncope Seizure Situational syncope Carotid sinus syncope Postural hypotension
What should you ask in a systems review in a patient with a headache? (8)
Trauma Constitutional Meningism NS - weakness, vision, sensory disturbance Aura Previous seizures/blackouts Sentinel headache - recent less severe headache Pain on combing/chewing
What red flags should you ask about in a headache history? (7)
Meningism Non-blanching rash Systemically unwell Weight loss Neuro symptoms Seizures >65y + unilateral
What differentials would you think about for a first headache? (10)
Meningitis Extradural headache Subdural headache Subarachnoid headache Raised ICP Temporal arteritis Acute sinusitis Angle closure glaucoma Medications Trigeminal neuralgia
What differentials would you think about for recurrent headaches? (3)
Migraines
Cluster
Tension
What red flags should you ask about in a weakness history? (5)
Progression of Sx New onset incontinence Weight loss Headaches Seizures
What should you ask in a systems review in a patient with weakness? (9)
Numbness/tingling Muscle wasting Balance, Speech Headaches, Seizures/blackouts Pain Incontinence Constitutional
What differentials would you think about for weakness? (muscles) (3)
Muscular dystrophy
- Duchennes/Beckers
Polymyositis/dermatomyositis
Muscle wasting from disuse
What differentials would you think about for weakness? (neuromuscular junction) (2)
Myaesthenia gravis
Lambert-eaton myasthenic syndrome
What differentials would you think about for weakness? (peripheral nerves) (3)
Peripheral neuropahy
Mononeuropathy
Mononeuritis multiplex
What differentials would you think about for weakness? (Spinal cord) (4)
Radiculopathy/plexopathy
Cervical spondylosis
Syringomyelia
Spinal stenosis
What differentials would you think about for weakness? (central) (4)
Stroke/TIA
MS
Tumour/abscess
Motor neuron disease
What red flags should you ask about in an altered sensation history? (7)
Progression of symptoms Motor symptoms Other sensory symptoms New onset incontinence Weight loss Headaches Seizures
What should you ask in a systems review in a patient with altered sensation? (11)
Changes in vision/hearing/taste/smell Weakness, Balance, Speech Headaches Seizures/blackouts Pain Incontinence Constitutional Anxiety Vascular
What differentials would you think about for altered sensation? (central)
MS
Stroke/TIA
Tumour/abscess
What differentials would you think about for altered sensation? (spinal cord)
Radiculopathy/plexopathy
Cervical spondylosis
Spinal stenosis
Syringomyelia
What differentials would you think about for altered sensation? (peripheral neuropathy)
Mononeuropathy
Mononeuritis multiplex
Polyneuropathy
What differentials would you think about for altered sensation? (Non-neurological)
Anxiety +/- hyperventilation
Raynaud’s
What are the causes of mononeuropathy? (3)
Trauma
Carpal tunnel syndrome
Infection
What are the causes of mononeuritis multiplex? (3)
Diabetes
Autoimmune infections
Amyloidosis
What are the causes of polyneuropathy? (5*)
Alcohol B12 deficiency Chronic renal failure Diabetes Everything else: MS, cancer, amyloidosis
