neurological history taking W1 Flashcards
anatomical localisation - where is the lesion? (options)
central - brain, spinal cord
peripheral - nerve root, nerve, neuromuscular junction, muscle
first question to ask?
what main symptoms are in their own words
general questions about the patient?
age, handedness, occupation
why ask about handedness?
indicates dominant hemisphere
why ask about occupation
indicates level of physical/cognitive function
educational attainment
impact of symptoms on life
common neurological presenting symptoms?
headache
loss of awareness/consciousness (fits/faints)
memory problems/change in behaviour
visual disturbance (blurred/double)
speech problems
change in sense of smell
weakness, tremor / involuntary movements
numbness, tingling
hearing changes (loss, tinnitus)
imbalance/falls
questions about history of presenting complaint?
when did it start?
acuity of onset? (sudden/subacute/chronic)
episodic/fluctuating or persistent, progressive?
exacerbating/relieving factors?
impact of symptoms on daily life? (home/education/employment?)
how to break down description of single episode? (eg headache, seizure, syncope, presyncope)
before episode
during episode
after episode
questions about before the episode?
palpitations, light-headedness, visual changes, other sensory changes
questions about during the episode?
length, loss of consciousness, limb/eye movement, tongue biting
questions about after the episode?
focal limb weakness, fatigue, confusion
questions about patter of events over time?
are events the same/similar?
when first event was
when latest event was
approximate frequency
normal between events?
sudden onset meaning?
seconds/minutes
subacute meaning?
hours/days
chronic meaning?
months/years
severity pattern of stroke?
sudden onset / subacute?, gradual decrease in severity over time
severity pattern of Alzheimer disease/brain tumour
slow onset, gradual increase in severity over time
severity pattern of MS?
subacute onset (?), fluctuates over time with multiple peaks, increasing severity between episodes
severity pattern of migraine and epilepsy?
sudden onset, returns to low severity between episodes
questions to ask about past medical history?
history of chronic neurological disease
medical conditions that may predispose to neurological problems
developmental history
previous head injury or neurological infections
what to ask about when discussing history of chronic neurological disease?
management, complications:
stroke, epilepsy, migraine, MS, neuropathies, muscle disease, dementia, Parkinson’s, MND, myasthenia gravis, autoimmune neuro disease
what medical conditions may predispose to neurological problems?
atrial fibrillation, diabetes, hypertension, rheumatoid arthritis, GI problems, cancer, HIV, blood disorders
what to ask about developmental history?
prematurity, developmental milestones, schooling
neurological infections?
meningitis, encephalitis
what neurological symptoms can medications cause?
confusion, altered conscious level, headache, ataxia, neuromuscular disorders, neuropathy, seizures
what to ask about family history?
anyone in family have neuro problems?
see if there’s a pattern of transmission (autosomal dominant/recessive or X-linked)
inherited neurological disorders?
ataxias, hereditary neuropathies, muscular dystrophies, dementias, spinal muscular atrophy, forms of epilepsy, hereditary spastic paraplegia, Huntington’s disease, neurofibromatosis, tuberous sclerosis, mitochondrial
what may weight/appetite suggest and what is this relevant to
malignancy
paraneoplastic syndrome
what symptoms may suggest systemic inflammatory disorder?
skin rash
joint pain
breathing difficulties
social history questions?
occupation
who is at home
what type of accommodation
do they drive
smoking history
alcohol intake
recreational drugs
