Neurological

Question 1

HPC headache?

Answer 1

SOCRATES

• Point to the point, uni/bilateral?
• Sudden, gradual or thunderclap? Aura/warning?
• Throbbing or tight band?
• Radiation ie neck stiffness?
• N+V, altered consciousness, rash, pyrexia, neck stiffness, photophobia, visual loss or blurring, aura, tender scalp, malaise, rhinorrhoea/lacrimation, joint (shoulder/hip) pain, focal neurology, loss of sensation , seizure?
• Constant or intermittent? single or recurrent? Duration of episode? Worse at time of day/month/year?
• Brought on/exaccerbated by: noise/stress/bending/coughing/sneezing/blowing nose/eating/bright lights/food or drugs/dehydration? CHOCOLATE?
• Relieved by: analgesia/dark/rest?
• 1-10?

Question 2

HPC altered consciousness?

Answer 2

Describe in own words?
- Onset - gradual/sudden? what was happening? how they felt before? Recent trauma?
Associated symptoms - N+V/diziness/vertigo/aura/tachyc./sweating/weakness/speech change/headache/incontinence/tongue biting?
Felt after - duration to recovery/amnesia/post-ictal - drowsiness, confusion, headache, myalgia?
Previous episodes? Increasing level of severity?
Was it witnessed by anyone?
Hypoglycaemia screen
Cancer screen
Shock screen (temp, breathless)
Liver disease screen (yellowing, itching, bleeding/bruising, anorexia, alcohol/hep Hx)
(Postural drop - Hx hypotension/treatment for HTN; Vasovagal - seeing something bookey)

Question 3

PMH - name some specific risk factors for common neurological conditions?

Answer 3

Head/spinal trauma
Metabolic/endocrine disorders 
Cancer - mets? 
Epilepsy 
HTN
AF

Question 4

DH + allergies

Answer 4

• Anticonvulsants - carbamazepine, lamotrigine, sodium valproate, phenytoin, gabapentin etc
• Drugs that interact with anticonvulsants - metronidazole, prednisolone etc
• Anticoag + antiplatelet - heparin, warfarin; aspirin, clopidogrel
• Analgesics
• Antihypertensives - diuretics/CCBs/ACEis/ARBs etc
• Antidepressants - SSRIs, tricyclics
• Insulin
• Recreational drugs

Question 5

SH?

Answer 5

Alcohol consumption 
Smoking
Recreational drugs
Occupation 
Social activities/hobbies 
Home circumstance, level of independence

Question 6

FH?

Answer 6

DM
Cerebral haemorrhage 
Cerebrovascular disease/stroke
Ischaemic heart disease 
Migraine

Question 7

HPC vision loss?

Answer 7

Onset, duration, fields affected?
Previous episodes?
Associated features - red eye, discharge, pain
MS -sensory changes ie pins/needles, weakness/falls, bladder/bowel/sexual dysfunction, confusion, speech changes, worse in heat
Red flags - worse on coughing/bending/vomiting, LOC, recent trauma
Cancer screen
PMH/FH - DM? Stroke/TIA?

Question 8

HPC confusion?

Answer 8

Timing- rapid/slow onset? following trauma? Progressive?
Dementia - age, memory impairment, agitation
Hypoglycaemia - agitation, dizziness, hunger, sweating, shaking, PMH DM
Infection - respiratory or urinary symptoms, fever etc
Others - drug change or side effects, polypharmacy >5, drug/alcohol withdrawals/intoxication, pain, dehydration, retention or constipation

Question 9

HPC limb weakness?

Answer 9

Timing - rapid/slow? Following infection or trauma? Worse at end of day/after exertion? Progressive - how fast? Ascending?
MS - visual changes, pains/spasms, bladder/bowel/sexual dysfunction?
CVA - focal neurology, unilateral, speech disturbance?
Intracranial bleed - headache, seizure, stiff neck?
MND - UMN/LMN signs, no bladder/sensory/ocular muscle changes
Exact location - nerve palsys from spinal entrapment, carpal tunnel (median), foot drop (common peroneal) etc
Other - MSK = degenerative or trigger associated; infection - any can cause myalgia, chronic conditions that cause you to get fatigued ie anaemia, COPD