History Taking In Neurology

Question 1

How do you take a history of presenting symptoms?

Answer 1

For presenting symptoms, you look at:
1. Duration of symptoms, and any previous episodes
2. Pattern - constant, intermittent, progressive
3. Onset - sequence of events when symptoms first began, or each time they recur
4. Triggers - warm baths may worsen symptoms caused by demyelination; sensory stimuli can trigger epilepsy; dietary stimuli, tiredness or stress can trigger migraines

Question 2

What screening aspects do you look at that may be indicative of a neurological disorder?

Answer 2

1. Systemic symptoms - fever (may suggest infection), weight loss and anorexia (may suggest malignancy with paraneoplastic neurological phenomena)
2. Raised intracranial pressure symptoms - headaches worse on waking and on lying flat, vomiting, diplopia
3. Visual symptoms - blurring, diplopia, flashing lights
4. Bulbar symptoms - changes in speech and difficulties swallowing
5. Motor symptoms - weakness, stiffness, abnormal gait
6. Sensory symptoms - loss of sensation, neuropathic ( ‘tingling’ or ‘electric’ ) pain
7. Loss of coordination - dizziness, staggering gait, loss of fine motor control, altered speech
8. Autonomic symptoms - postural dizziness, faecal incontinence, urinary retention
9. Loss of consciousness - features suggesting a neurological cause include aura, muscle jerking, tongue biting, incontinence and
   drowsy post-ictal phase.
10. Disturbance of higher functions - personality change, cognitive decline, loss of executive control, disinhibition, psychiatric symptoms

Question 3

What past medical history is important to take note of?

Answer 3

• Atherosclerotic risk factors - hypertension, diabetes, other cardiovascular disease
• Risk factors for embolic disease - atrial fibrillation, patent foramen ovale
• Diabetes - time since diagnosis, degree of glycaemic control, presence of other complications
• Malignancies, systemic inflammatory disorders, immunosuppressive
  conditions, e. g. HIV

Question 4

What medication history is important to take note of?

Answer 4

Use of neuroactive medications e.g antipsychotics

Question 5

What family history should be noted down?

Answer 5

History of inherited neurological disorders such as Huntington’s chorea, myotonic dystrophy and Charcot - Marie - Tooth disease in close relatives

Question 6

What risk factors for functional disease should be noted down?

Answer 6

Employment status, job security, stress at work, relationships with colleagues
Family circumstances, relationship status, conflict, bereavement

Question 7

What lifestyle factors do you assess?

Answer 7

Smoking
Alcohol consumption
Use of illegal drugs

Question 8

How do you assess for safety?

Answer 8

Do they drive?
What is their employment? Might their illness pose a risk to themselves or others?
Do they take baths or go swimming alone? Any other potentially risky leisure activities?