Neurological Flashcards
Symptoms to screen for in a neurological history?
Headache/ facial pain, weakness, numbness, collapse, confusion, gait change, tremor, vertigo/ dizziness, visual change
Red flags for headache?
Thunderclap headache, focal neurological signs(haemorrhage, stroke, abscess, change in mental state(raised ICP, encephalitis, meningism, worse on lying down/ coughing
Useful Qs to differentiate between secondary headaches?
Fever- infective/ inflammatory causes, head injury/ fall- more likely to be bleeding, speed of onset= gives clues too
Causes of raised ICP and extra symptoms?
Tumour= weight loss, abscess= fever, intracranial bleed= trauma
Worse lying down/ coughing
Differentials for visual disturbance? Descriptions?
Migraine, MS, GCA, raised ICP, myasthenia gravis
Spot of flickering light in centre vision which enlarges, loss of central colour vision, vision is blurry, seeing double
If had visual disturbance before? Associated? Presentation of MS?
Recurring issue e.g. MS, migraine
Weakness, numbness, headache
Optic neuritis, pain on eye movement, reduction in central vision, reduction in colour vision
Other Qs for visual disturbance?
Weakness, sensory disturbance, had before, where, fatigue, worse in warm bath?
Main differential for facial pain?
Trigeminal neuralgia- sharp, intense pain, triggers= chewing, any contact, a breeze
Causes of weakness?
TIA/ stroke, mononeuropathies, nerve compression, MND/ALS, myasthenia gravis, Gullian-Barre, SOLs, MS, peripheral neuropathies
Differentials for numbness/ tingling?
Peripheral neuropathy-mono/ poly Stroke Nerve root lesions(radiculopathy) Spinal cord lesions(myelopathy) MS Cauda equina
Red flags for numbness/ tingling?
Weakness- pattern and timing of onset will give you clues, incontinence- cauda equina, saddle anaesthesia, numbness after head, neck/back injury- spinal injury–> cord compression/ cauda equina/ nerve root compression from prolapsed disc, confusion/ drowsiness- stroke/ brain
Areas of numbness and differentials?
Dermatomal- peripheral nerve(mononeuropathy)/ nerve root lesion, non-dermatomal area, sensory level- spinal cord lesion, one side of body- stroke/ other brain lesion, hands and feet= peripheral neuropathy
Features/ Qs for distal axonopathies?
Diabetes, toxins- alcohol abuse, kidney failure, vitamin deficiencies- malabsorption sx
Gradual sensory disturbance
Qs for collapse?
When? What were they doing at the time? How many times? Did anyone see it? LOC? Pre-collapse= aura, light-headed, during= tongue biting, foaming, incontinence, post-collapse= rapid recovery
Precipitating events for generalised seizures? Signs preceding? Symptoms present? Duration of main phase of episodes? Signs following?
Usually none; can occur during sleep
Relating to the prodrome+ aura phases
Motor activity- tonic-clonic, jaw and facial movements, urination and/or defecation, hypersalivation, unconsciousness, usually >1minute, signs related to post-ictal phase, slow recovery
Precipitating events for syncope? Signs preceding? Symptoms present? Duration of main phase of episodes? Signs following?
Stress, exercise, excitement
Usually none, rarely acute weakness, ataxia, vocalisation, urination and defecation may occur
Usually flaccid collapse; can be rigid sometimes
Urination and/or defecation, hypersalivation occur less commonly, usually retains but may lose consciousness, usually shorter, usually no events after; rapid recovery
Features differentiating NEAD from epilepsy?
Long duration> 2 mins, prolonged period of unresponsiveness, gradual onset of seizure, closed eyes(with resistance,) side to side head movements, biting of tip of tongue, fluctuating course, may talk during seizure
Differentials for tremor?
Parkinson’s, benign essential tremor, drug-induced tremor, alcohol withdrawal, hypoglycaemia, thyrotoxicosis
History for tremor?
Gait change, balance/ coordination
Onset- gradual in organic disease, patients age
Drug hx- antipsychotics, social- amphetamines, family- essential tremor
Specific risk factors for neuro history?
Head/ spinal trauma, metabolic/ endocrine disorders e.g. diabetes, cancer, epilepsy, HTN, AF, heart disease
Drug hx for neuro?
Anticonvulsants, drugs that interact, anticoagulants and anti-platelets, analgesics, antihypertensives, antidepressants, insulin, recreational drugs
Family hx?
Diabetes, cerebral haemorrhage, cerebrovascular disease/ stroke, IHD, migraine, epilepsy
