Neurological History

Question 1

Aims of a neuro history

Intro

Answer 1

Identify the location and pattern of the lesion

• focal/multifocal
• systemic disease?

Age, sex
Handedness, occupation - with an aim to return the patient to their environment

Can you tell me about why you’ve come in today?
-what’s your no 1 problem

Question 2

Possible presenting complaints

-review of neuro system

Answer 2

Behaviour
Seizures
Memory
Headache
Dizzy, syncope, balance
Vision, hearing, swallowing
Weakness, numbness
Bowels, bladder, sexual function

Question 3

Establishing the timeline of the presenting complaint

• frequency and distribution
• aggravating and precipitating factors common to all events

Distribution of events over time

Answer 3

Have you had this before?

• were past events more or less the same?
• 1st episode - distribution of events between - most recent (dated if possible)

Distribution of events
-clusters?
-longest free period?
-penultimate?
Ask in relation to patient's life events to help recall

Between events - do you return to normal between events?

Question 4

Before, onset, progression and recovery from event

-key questions

Answer 4

Before

• aggravating factors (related to time of day, activity, stress?)
• precipitators? (specific triggers)
• circumstances, time and place common to all events? (time of day, standing, sitting, lying?)
• how did you feel before the event
• did you know what was going to happen?

Onset

• what happened right before the event?
• can you recognise this as the start of the event (has this happened consistently?)

Speed of onset and progression => max deficit

• is there enough time to sit down?
• seconds => vascular?
• days => inflammatory
• months-years => degenerative, neoplastic?
• how long does it take for symptoms to be at their worst?

Recovery

• are they back to their normal? => if yes, you may not find anything in the physical examination
• what can they now not do?

Try to get a collateral

Question 5

Discrete similar events

Answer 5

Frequency, duration, severity - are they more or less the same?

Question 6

Neuro system review

Review of other systems

Answer 6

Systemic wellness

• changes in appetite?
• unintentional weight changes?
• sleep quality? changes in sleeping patterns?

CV, resp - chest pain, SOB, palpitations, syncope and falls
GI - N+V, dysphagia, dysphonia, C+D, pain
MSK - joint pain, rashes, back pain,
GU - hematuria, urgency, overflow, pain, stress, periods/menopause (is their PC related?)

Question 7

Past medical events
Medical history
Drug history
Allergies

Answer 7

Past hospital admissions, operations, serious illnesses, accidents?

Are you currently managing other health conditions?

• what medications are you currently taking
• dose, duration

Anything OTC, herbal, inhalers, health food preparations, contraceptives, recreational drugs?

Any allergies
Have you had any problems with certain medications in the past?
-common allergic medication - AEDs
Have you ever had asthma? - Bb, aspirin often used in neuro (strokes)

Question 8

Family history

Answer 8

Parents, siblings, children

• are they alive and well
• how old were they when they passed?

Question 9

Social history

Answer 9

Living conditions

• who is at home with you
• do you live in a house? apartment?
• are there stairs? can you manage them?

Occupation

• are you currently in work?
• how do you get to work?
• have you missed time from work due to your PC?

Alcohol, smoking

• how many, how long?
• max smoked in a day

Travel

• have you been abroad in the past year?
• prophylactic vaccines for malaria, dengue, HIV/AIDs, STD, TB

Driving

• do you drive?
• has it affected your ability to drive?

How has this condition affected your life?

Question 10

Wrapping up the history and examination

Answer 10

Is there anyone else you’d like to tell me?
Is there anything you’d like to ask?
What did you think it might be?