Neurological History Taking Flashcards
What things should you do to optimise communication before or at the start of a patient interview?
- Quiet environment minimise distractions
- Is hearing aid working or in?
- Are you speaking clearly & articulately
- Can the patient see you & your mouth (masks/clear visors)
- Do you need a pen and paper
- Is carer available ?
Online;
- Can you see/hear me
- Who else is in room, is that ok?
- Professional setting plain wall, lighting
- Confirm patient ID
What is dysarthria and dysphasia?
Dysarthria - Articulation of speech
Dysphasia - Difficulty to use or understand words
Why would asking what hand write with be useful in a neurological history?
Can show what hemisphere you have speech issues in
Although some left handed people use left side of brain so not always accurate, and 90% population right handed
What is benign positional vertigo?
Inner ear pathology where the room is physically spinning for someone (different to light headed)
Position it happens in is important as well
SOCRATES
What common neurological presentations do we usually see? The negatives are as important as the positives!
Altered cognitive ability - Confusion or memory loss (has carer noticed?)
Fits, faints and funny turns
Headache
Dizziness
Weakness or movement disorders affecting motor
Numbness or sensory disorders
Visual impairments (sight, smell, hearing) - affecting cranial nerves
What are some important questions asked in the presenting complaint ?
- Increased difficultly in doing up buttons? (fine motor skills - could be Parkinson’s)
- Have you noticed any changes in your writing?(Micrographia - small clustered writing that trails off at end)
- Any differences in the way you walk?
What is important in taking a history of fainting from a patient?
You need to work out if it is cardiovascular, endocrine or neurological so you can ask associated questions
What is important in taking a history of epilepsy from a patient?
Epilepsy is recurrent seizures so we need to do a series of tests, CT, MRI, EEG, ECG (heart) and bloods (electrolyte disturbance) to try and confirm which system is causing it
- even if these are all fine can still be epilepsy as reoccurring
How his epilepsy described?
An abnormal, excessive paroxysmal discharge of cerebral neurons
If possible what can be handy to get a patient to do when they are experiencing episodes?
Record it or write it down, more info the better!
- What happened before
- What factors might have lowered the seizure threshold
- What position was patient in
- Any proximal symptoms
- What happened during episode
- What happened after?
What questions would we ask around headache ?
SOCRATES
Site - show me where?
Onset - When did start?
Character - What kind of pain?
Radiation - Does it go anywhere else?
Associated symptoms ?
Timing
Exacerbates or reliving factors ?
Severity - Pain scale
What would a headache described as a sudden thunder clap be?
Subarachnoid haemorrhage - Send to hospital as have to rule out
What would a headache described as recurrent (but well between episodes) be?
Tension headache over stressful times
What would a headache described as gradually getting worse be?
Tumours cause headaches to get worse
What questions would we ask about the timing and evolution of symptoms ?
- Sudden e.g thunder clap headache?
- Recurrent (but well between episodes)
- Deterioration over hours
Relapsing/remitting - Deterioration over weeks/months
