Neurological History

Question 1

History: Questions to ask about headache?

Answer 1

SOCRATES:

Site: Ask the patient to point. Unilateral/bilateral?
Onset: Sudden or gradual? Thunderclap?
Character: Throbbing? Like a tight band? Worst ever?
Radiation: Does it radiate anywhere?
Associated Symptoms: Nausea/vomiting, altered conscious level, rash,
fever, neck stiffness, light sensitivity, visual loss,
blurred vision, aura, tender scalp, malaise, (nasal
discharge)?
Timing: Constant/intermittent? Single/recurrent? Duration
of episodes. Worse at certain times of
day/month/year?
Exacerbating factors: Triggers? noise, stress, bending, standing up,
coughing, sneezing, blowing nose, eating,
combing hair, bright or flashing lights, certain
foods/drugs, dehydration?
Alleviating Factors: analgesia, dark environment, lying down, rest
Severity: Scale (1-10; 10 being the most severe)

Question 2

History: Questions for altered consciousness or transient loss of consciousness?

Answer 2

Ask the patient to describe the episode in their own words.
Pay attention to what happened before, during and after:
Onset (gradual/sudden?),
Time of the day
What they were doing at the time?
Any pain, injections, hot crowded rooms, emotional stress, prolonged standing,
How they felt before the episode
Associated symptoms: Dizziness, nausea, vertigo, aura, palpitations, sweating, weakness,
sensory symptoms, slurred speech, headache, tongue biting or incontinence,
stiffening\jerking of limbs, awareness and responsiveness during the episode, eyes-open or
closed? Groans, crying?
How long did it take to recover? Any amnesia, aggression, crying or weakness after the
episode?
Previous episodes? If so whether they are like the current one?
Was the episode witnessed? If so what did the witness say? Can we contact them to get a
description?

Question 3

History: What are other neurological symptoms we are interested in?

Answer 3

With other neurological symptoms, it is important to note the course: is it sudden in onset,
how long did it take to reach the peak of the symptoms- Minutes, Hours, days, weeks or
months? Getting better or worse? Static/progressive/relapsing and remitting?
Also note the results of any previous attempts to diagnose the condition and responses to
any previous therapeutic interventions.

Question 4

What are the key parts of the PMH for neurology?

Answer 4

Specific risk factors include:
Head/spinal trauma
Metabolic/endocrine disorders e.g. diabetes
Cancer (metastases?)
Epilepsy
Hypertension
Atrial Fibrillation
Heart diseases

Question 5

What are the key parts of the Drug and allergy history for neurology?

Answer 5

Anticonvulsants
Drugs that interact with anticonvulsants / lower the seizure threshold
Anticoagulants and anti-platelet drugs
Analgesics
Antihypertensives
Antidepressants
Insulin
Recreational drugs

Question 6

What are the key parts of the social history for neurology?

Answer 6

Alcohol consumption
Smoking
Recreational drugs
Occupation
Social activities/hobbies
Home circumstances, level of independence, mobility aids

Question 7

What are the key parts of the family history for neurology?

Answer 7

Diabetes
Cerebral haemorrhage
Cerebrovascular disease / stroke
Ischaemic heart disease
Migraine
Epilepsy