Neurology Flashcards
what questions should be asked in the presenting complaint of a headache history relating to pain?
site; unilateral, bilateral, neck, eye
prodromal symptoms
character; sharp, dull, tight, throbbing
duration/timing
frequency; one off, intermittent/episodic, progressive, constant
onset; acute, gradual
severity
radiation; other parts of the head, eye, neck
aggravating factors; leaning forward, bright lights, sound, lying flat
relieving factors; standing, sitting, lying still
special times; mornings, menses, overtired, stressed
associated; vomiting, drowsiness, temperature, fever, rash
what questions should be asked in the presenting compliant of a headache history not relating to pain?
cognitive/higher function changes mood/mental state alteration visual disturbances speech alteration episodes of loss of consciousness seizures sensory symptoms; numbness, pins and needles motor symptoms; involuntary weakness, reduction of power
what are the symptoms of migraines?
unilateral headache attacks lasting from 4-72 hours pulsating moderate-severe aggravated by routine activities photophobia phonophobia visual upset nausea and vomiting sleepiness tingling aura; zigzag lines, scotoma, dizziness, numbness, word salading, cravings, lethargy postdrome; feeling washed out, hungover triggers; chocolate, coffee, menses
what are the symptoms of tension-type headaches?
mild-moderate bilateral non-pulsating tightness/squeezing associated with stress or worry
what are the symptoms of meningism?
pain at the back of the neck neck stiffness drowsiness movement aggravates symptoms lying still relieves symptoms
what are the symptoms of raised intercranial pressure?
increasing headache day by day
worse in the mornings
drowsiness
made worse by coughing, stooping, straining
what are the symptoms of subarachnoid haemorrhage?
described as the worst headache ever
usually sudden onset
neck stiffness; may take hours to develop
what questions should be asked in the presenting compliant of a collapse history?
witness account did the patient actually lose consciousness where did the event happen when did the event happen what were they doing at the time before during after history of similar episodes
what questions should be asked in the before section of a collapse history?
how did they feel before the event
chest pain
palpitations
dyspnoea
warning/prodrome; pins and needles, sleepiness
prolonged period of standing
change in posture
micturition
vigorous coughing
associated symptoms; nausea, vomiting, headache, photophobia, neck stiffness
precipitating factors; not eating, dehydration, emotion, pain, sleep deprivation
what questions should be asked in the during section of a collapse history?
how long was the LOC if no LOC, were they aware of their surroundings injuries convulsing/jerking of the arms and legs focal features; deviation of head, repetitive limb movement tongue biting urinary/faecal incontinence change in colour of patient did a witness take a pulse
what questions should be asked in the after section of a collapse history?
how long did they take to recover how did they feel after the event; confusion amnesia drowsiness muscle weakness limb weakness speech alteration associated symptoms; nausea, sweating, chest pain, back pain, dyspnoea
what conditions should be asked about in a collapse history?
previous head injury epilepsy ischaemic heart disease CVA pacemaker diabetes
describe the examination of the 1st cranial nerve
olfactory
test one nostril at a time with the opposite side occluded with a non-irritating stimulant
eyes closed
describe the examination of the 2nd cranial nerve
optic inspect eyes visual acuity; glasses on if applicable visual fields colour vision fundoscopy pupils; size, irregularities, asymmetry, reflexes, direct/consensual response to light, accommodation
describe the examination of the 3rd, 4th and 6th cranial nerves
oculomotor, trochlear, abducens extra ocular movements eyelid elevation pupils; sizes and reflexes presence of a squint or nystagmus
