Neurological History Taking

Question 1

In reference to taking a social history, when is a CAGE questionnaire relevant and what does CAGE mean?

Answer 1

Useful when asking about alcohol dependency. C - have you ever felt the need to Cut down on your alcohol intake? A - have you ever felt Annoyed when someone says you drink too much? G - have you ever felt Guilty about your alcohol use? E - have you ever needed an Eye-opener in the morning to feel better? >/= 2 positive answers indicates significant alcohol problem

Question 2

Give some examples of questions you might ask as part of a neurological review of systems?

Answer 2

Any history of seizures or unexplained loss of consciousness? Headache? Vertigo or dizziness? Loss of vision or diplopia? Tinnitus? Difficulties with speech or swallowing? Weakness, difficulty moving, abnormal movements? Numbness or tingling? Tremor, problems with gait, balance or coordination? Memory problems? Difficulties with sphincter control or sexual function? Problems sleeping or excessive sleeping?

Question 3

List some important points to cover in a patient with chronic headache?

Answer 3

Location of pain, pain intensity, pain quality, timing, duration, frequency, average daily caffeine intake, average daily analgesic intake, precipitating factors e.g. alcohol, bright light., alleviating factors e.g. rest, activity, medications., response to treatment, neurological accompaniments e.g. numbness, speech disturbance., visual accompaniments e.g. transient blindness., associated symptoms e.g. photophobia, tearing., any history of head trauma

Question 4

List some important points to take in the history from a patient with back and leg pain

Answer 4

Onset and duration, intensity, history of injury, past history of disc herniation, disc surgery, location of the worst pain, pain radiation pattern, relation of pain to body movement, weakness of the leg, foot or toes, numbness or paraesthesia of leg or foot, relieving factors, any associated bladder, bowel, or sexual dysfunction suggesting cauda equina syndrome, any associated fever, weight loss or morning stiffness

Question 5

List some important points to take from a history of a patient with episodic loss of consciousness

Answer 5

Timing of attack, patient’s recollection of events, circumstances of attack e.g. in the shower., events just prior to the attack, body position prior to attack, presence of prodrome or aura, any tonic or clonic activity, any suggestion of focal onset, any incontinence or tongue biting, symptoms following the event, time to complete recovery, witness description of events, drug, alcohol and medication exposure, family history

Question 6

List some important points to take from a history of a patient with memory loss

Answer 6

Duration of problem, getting worse, better or same? Examples of what is forgotten, is the patient still in control of own finances? Any tendency to get lost? Medication history, drinking habits, any difficulties with smell or taste? Headaches? Difficulties with balance, walking or bladder control? Depressive symptoms? Recent head trauma or vascular problems? Past history of thyroid disease, anaemia, low B12, any STD/risk factors for HIV, FH of dementia or Alzheimer’s