Neuro histories

Question 1

Presenting complaints for neurology?

Answer 1

LOC, headache, acute confusion, numbness/ pins and needles, weakness, visual disturbance, nausea/ vomiting

Question 2

Acronym for presenting any history?

Answer 2

AT MIST

Age, timing, mechanism e.g. hazard/ risk factor, injury, symptoms, treatment

Question 3

Issues with articulation called? Phonation? With language function? All due to what?

Answer 3

Dysarthria- weakness/ incoordination of the orolingual muscles
Dysphonia- laryngeal problems, can cause voice hoarseness, may be reduced speech volume
Dysphasia- due to a lesion in the language areas of the dominant hemisphere

Question 4

As well as speech, what to look for?

Answer 4

Evidence of involuntary problems e.g. tremor, tics, chorea, hemiballismus/ orofacial dyskinesias

Question 5

General things to ask about general PC?

Answer 5

What, which part of the body affected, localised/ more widespread, when did they start, how long do they last for, sudden/ rapid/ gradual in onset, history of trauma, symptoms static/ deteriorating- exacerbations and remissions, triggering factors, associated symptoms, how ADLs are affected

Question 6

Past medical hx?

Answer 6

Head/ spinal trauma, metabolic/ endocrine disorders e.g. diabetes, cancer, epilepsy, HTN, AF, heart diseases

Question 7

Drug hx and allergies?

Answer 7

Anticonvulsants, drugs that lower the seizure threshold, anticoagulants and anti-platelets, analgesics, antihypertensives, antidepressants, insulin, recreational drugs

Question 8

Social hx?

Answer 8

Smoking and drinking habits, drugs- OTC and illicit, complementary and alternative medicines, occupation, marital status- bereavement/ divorce, sexual orientation- STIs, social activities/ hobbies, home circumstances, level of independence

Question 9

Family hx?

Answer 9

Diabetes, cerebral haemorrhage, cerebrovascular disease/ stroke, IHD, migraine, epilepsy, Huntingdon’s, muscular dystrophy, neuropathies, vascular disease

Question 10

Systematic enquiry?

Answer 10

Weight loss, appetite, weight gain- diabetes mellitus, polyuria

Question 11

Causes of generalised seizures?

Answer 11

Metabolic disturbances, space-occupying lesions, head trauma, stroke, medication, epilepsy

Question 12

To ask before a LOC?

Answer 12

Possible triggers e.g. vasovagal- emotional distress, orthostatic, situational- cough, sneeze, defecation, carotid sinus hypersensitivity- shaving, tight-fitting collars, CV= physical exertion
Prodromal symptoms e.g. vasovagal- light-headed, sweating, nausea, tinnitus, CV= lose suddenly/ chest pain/ palpitations, epileptic auras- olfactory hallucinations, deja-vu, sensory disturbances, motor weakness

Question 13

To ask during LOC?

Answer 13

Motor symptoms- stiff/ flaccid muscles, jerking movements e.g. initial tonic stiffening–> jerking= tonic-clonic
Duration- syncope< 20 secs, seizures> 20 seconds
Collateral- tongue biting= tonic-clonic, incontinence= seizures

Question 14

After LOC?

Answer 14

Collateral- how long to regain consciousness/ confused initially- syncope= 20-30 seconds
Seizure= post-ictal period, can be minutes- hours, often not remembered

Question 15

Relieving factors for LOC? From collateral?

Answer 15

Orthostatic= laid flat, seizures= administration of a benzodiazepine
Any injuries, head trauma and airway issues

Question 16

What to ask about for stroke hx?

Answer 16

When did symptoms first start
Severity- paralysis, loss of sensation, how much of visual field affected, receptive and expressive dysphasia, dysarthria
Course- have symptoms improved/ when at their worst
Precipitating factors
Ass symptoms- headache, neck stiffness, vomiting, unilateral headache, fevers, dizziness, palpitations- AF
Previous episodes
Dominant hand

Question 17

Key TIA/ stroke symptoms?

Answer 17

Weakness, sensory disturbance, visual disturbance, speech, ataxia, dysphagia, reduced LOC, pain

Question 18

Qs for stroke weakness?

Answer 18

Distribution, severity, onset and duration, course of weakness

Question 19

Qs for sensory disturbance?

Answer 19

Distribution, severity, onset and duration

Question 20

Qs for visual disturbance?

Answer 20

Type e.g. vertigo, hemianopia, quadrantanopia, amaurosis fugax, severity, onset and duration

Question 21

Qs for ataxia?

Answer 21

Issues with balance/ coordination- impact, associated

Question 22

Qs for speech issues?

Answer 22

Slurring, issues understanding/ getting words out

Question 23

Qs for swallowing?

Answer 23

Difficulties with swallowing solid/ liquid foods

Question 24

Qs for LOC stroke? Also?

Answer 24

When became more drowsy?, head trauma, headache, nausea, vomiting, jerking movements
PAIN

Question 25

Important TIA/ stroke RFs?

Answer 25

IHD, HTN, AF, hypercholesterolaemia, diabetes, previous, smoking, excessive alcohol, hyper coagulable diseases, prosthetic heart valves, carotid stenosis, poor ventricular function, migraine w/aura, combined pill, family hx in 1st degree

Question 26

Past medical hx for strokes?

Answer 26

How well controlled conditions are, previous surgery, previous stroke/ TIA- when, deficits, investigations and what txs, allergies