Neurological

Question 1

Symptoms to screen for in a neurological history?

Answer 1

Headache/ facial pain, weakness, numbness, collapse, confusion, gait change, tremor, vertigo/ dizziness, visual change

Question 2

Red flags for headache?

Answer 2

Thunderclap headache, focal neurological signs(haemorrhage, stroke, abscess, change in mental state(raised ICP, encephalitis, meningism, worse on lying down/ coughing

Question 3

Useful Qs to differentiate between secondary headaches?

Answer 3

Fever- infective/ inflammatory causes, head injury/ fall- more likely to be bleeding, speed of onset= gives clues too

Question 4

Causes of raised ICP and extra symptoms?

Answer 4

Tumour= weight loss, abscess= fever, intracranial bleed= trauma
Worse lying down/ coughing

Question 5

Differentials for visual disturbance? Descriptions?

Answer 5

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

Question 6

If had visual disturbance before? Associated? Presentation of MS?

Answer 6

Recurring issue e.g. MS, migraine
Weakness, numbness, headache
Optic neuritis, pain on eye movement, reduction in central vision, reduction in colour vision

Question 7

Other Qs for visual disturbance?

Answer 7

Weakness, sensory disturbance, had before, where, fatigue, worse in warm bath?

Question 8

Main differential for facial pain?

Answer 8

Trigeminal neuralgia- sharp, intense pain, triggers= chewing, any contact, a breeze

Question 9

Causes of weakness?

Answer 9

TIA/ stroke, mononeuropathies, nerve compression, MND/ALS, myasthenia gravis, Gullian-Barre, SOLs, MS, peripheral neuropathies

Question 10

Differentials for numbness/ tingling?

Answer 10

Peripheral neuropathy-mono/ poly 
Stroke 
Nerve root lesions(radiculopathy)
Spinal cord lesions(myelopathy)
MS
Cauda equina

Question 11

Red flags for numbness/ tingling?

Answer 11

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

Question 12

Areas of numbness and differentials?

Answer 12

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

Question 13

Features/ Qs for distal axonopathies?

Answer 13

Diabetes, toxins- alcohol abuse, kidney failure, vitamin deficiencies- malabsorption sx
Gradual sensory disturbance

Question 14

Qs for collapse?

Answer 14

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

Question 15

Precipitating events for generalised seizures? Signs preceding? Symptoms present? Duration of main phase of episodes? Signs following?

Answer 15

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

Question 16

Precipitating events for syncope? Signs preceding? Symptoms present? Duration of main phase of episodes? Signs following?

Answer 16

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

Question 17

Features differentiating NEAD from epilepsy?

Answer 17

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

Question 18

Differentials for tremor?

Answer 18

Parkinson’s, benign essential tremor, drug-induced tremor, alcohol withdrawal, hypoglycaemia, thyrotoxicosis

Question 19

History for tremor?

Answer 19

Gait change, balance/ coordination
Onset- gradual in organic disease, patients age
Drug hx- antipsychotics, social- amphetamines, family- essential tremor

Question 20

Specific risk factors for neuro history?

Answer 20

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

Question 21

Drug hx for neuro?

Answer 21

Anticonvulsants, drugs that interact, anticoagulants and anti-platelets, analgesics, antihypertensives, antidepressants, insulin, recreational drugs

Question 22

Family hx?

Answer 22

Diabetes, cerebral haemorrhage, cerebrovascular disease/ stroke, IHD, migraine, epilepsy