Neurological History Taking Flashcards
Presentation:
The dizziness started suddenly when I was in bed and rolled over…
Feels like I am on a roundabout…lasts a couple minutes then settles
OK if I keep my head still but if I look up suddenly it can start again
Benign positional vertigo
follow up questions for BPV?
- Duration of symptoms • Speed of onset
- Location
- Variation
- Intensity
shuffling gait
increasing difficulty going up buttons
Parkinsons Disease
three main origins of a collapse
- endocrine
- cardiovascular
- Neurological
sudden thunder clap headache
indicates bleeding in or around the brain, most common cause is a ruptured aneurysm
a headache which deteriorates over hours
most likely linked to infection
relapsing or remitting headaches
could indicate MS
If the headache deterioration is over weeks and months
this indicates chronic conditions such as Parkinson’s or a slow growing tumour etc.
neurological test for myasthenia gravis
the ice pack test
what does a focal weakness suggest
a neurological origin
if the problem is a proximal weakness what activities would the individual find difficult
rising from the sitting position
Drying their hair
if the problem is a distal weakness what activities would the individual find difficult
fine finger movements and standing on their tip toes
if there is too much movement in the body
Chorea – “fidgety jerks”
choreoathetosis..decreased tone…rapid, writhing changes in movement (consider over treatment of PD)
if there is too little movement in the body
E,g. Parkinson’s disease…slowing of movement, stiffness
Allodynia
chronic pain syndrome where even fine touch is perceived as painful
full sensory loss is almost always likely to be
functional origin
Presentation:
“Wake up in the middle of the night with ache and numbness in my thumb and first two fingers”
median nerve compression due to carpal tunnel syndrome
What chronic illnesses may result in neurological impairment?
diabetes (peripheral vascular disease)
alcohol related disease
hormonal conditions
Cranial Nerve screening questions
Change in your sense of smell? Vision? Double vision? Dry eyes? Dry mouth? Change in taste? Hearing? Dizziness? Change in voice? Articulation?
tests for cognitive assessment
- 4As test (rapid, initial screen for delirium)
- Montreal Cognitive Assessment (MOCA)
- Addenbrookes Cognitive examination (ACE III)
What is delirium?
Mental confusion that can happen if someone becomes medically unwell
triggers can be infection and hypoxia and even covid
good things about moca test
• Better at identifying mild levels of impairment • Less bias ethnicity / age/ education
ACE III
• Scored out of 100 • 5 cognitive domains: – Attention – Memory – Verbal fluency – Language – Visuospatial abilities
Confabulation
- Presenting false information
- Great authority, great certainty
- Often autobiographical in nature
- No intent to deceive
- Korsakoff’s syndrome
- Alzheimer’s dementia
