Neurological history and examination Flashcards
What does a medical history entail?
PC, HPC, PMH, DH and allergies, SH, FH, RoS
Parts to a neurological history
- Patient +/- relative
- Impact of consciousness, speech or memory
- Age, gender, headedness, profession
- Pattern of progression important
- Impact, function, QoL
- Expectations, understanding, information
PC headache questions
Acute/chronic
speed of onset
single/recurrent
unilateral/bilateral/worsening features [e.g. waking/coughing]
relivieng features [e.g. sleep/rest]
associated features [e.g. aura, LOC]
red flags: new headache, over 60 years old, thunderclap, infective Sx, Hx of malignancy, etc.
Give examples of red flag Sx for a headache
New headache, over 60 years, thunderclap, infective Sx, Hx of malignancy etc.
Questions for weakness
- Onset gradual or sudden
- Rate of progression
- Muscle groups affected.
- pattern: symmetrical, asymmetrical
- associated sensory loss
pain - red flags [sphincter control, sudden onset, progressive, resp/swalloing problems]
What are red flag Sx for weakness?
loss of sphincter control
sudden onset [stroke]
progressive
resp. or swallowing problems
Questions for visual disturbances
"blurring" visual loss [monocular vs binocular] double vision [diplopia] photophobia speed of onset pain [in the eye, eye movements?] any other Sx [e.g. headache and visual loss in older person, acute onset]
Speech problems questions
“confusion”
comprehension? [recpetive/Wernicke’s dysphasia]
speech production? [expressive/broa’s]
repetition [conductive dysphasia, arcuate fasciculus]
articulation/slurred speech [dysarthria]: cerebellar, bulbar, pseudo-bulbar [“Donald duck” speech]
Phonation [dysphonia] e.g. laryngeal pathology, resp. muscle weakness
Questions for dysphagia
Is it neurological or mechanical?
Solids, liquids, or both?
Pain [odynophagia], things getting stuck?
Nasal regurgitation
associated coughin
speed of onset
mechanical causes incl. stricture and achalasia
neuro causes: bulbar and pseudoulbar palsy [brainstem pathology, MG, MND, etc.]
Sensation questions
positive or negative [numbness, pins and needles, para-dysaesthesia]? Pain, odd sensations "squeezing"? Distribution? Speed of onsety Ass. weakness/clumsiness
Blackout/fits/faints/funny turns questions
Detailed history important The way the patient tells it Eye witness account was there loss of consciousness? 3 Ps: posture, provokation, prodome? Frequency, duration Tongue biting, incontinence, cyanosis, post-event confusion shaking chest pain, palpitation, FHx driving
Compare epilepsy/non-epileptic attack/vasovagal syncope/cardiac syncope for situation/before/recovery/additional features/incontinence
slides
Obsrevaiton in the Dx of dementia
how many people come? Who gives the history? head turn sign detail of events, account of Hx Sx of depression and anxiety fluctuating, stepwise, progressing
Functional neurological disorders
Do the Sx add up
Do they fit into an appropriate anaotmical patterna
How does the person tell the story
what other Sx do they have
What are their ideas, concerns, and expectations
… and past past psychaitric hsitor yand social hsitory
PMH important qs
Similar/related Sx in past
DM and other vascualr RFs
AF
DH questions
Focus depends on presentation Peripheral neruopathy, Parkinsonism Now and in the past OTC recreational drugs alleergies and intolerance
Sh questions
Alcohol [seizures, neuropahy, ataxia, Wernicke-Korsakoff syndrome] Smoking Activities of daily living Family support Accomodation Driving
Tools in neuro exam
Fundoscope, tendon hammer, tuning fork, other
Main parts to neuro exam
Gen app, arms, legs, tone/power/reflexes/coordination/sensation, CN, [cognition, movement disorder, cortical signs etc.]
Signs of movement disorder PD
slides
inspection elements
well or unwell, thin or fat walking into clinic, tranferring, getting dressed and undressed PEG, catheters weakness, wasting, fasciculations Abnormal movements: tremor, chorea, tics, hemiballismus speech cognition interaction
Ways of testing cognitive state
AVPU, AMT [10], MMSE [30], MOCA [better - 30], ACE-R [better still - 100], neurophysiology
AMT parts
- recall address
- age
- time [nearest hour]
- year
- recognize two people [doctor, nurse etc.]
- DOB
- Date WW2
- Name present monarch
- name of hospital
- Count backwards from 10
briefly summarise anatomically where the CNs come out from the brain
slides
