Neuro histories Flashcards
(26 cards)
Presenting complaints for neurology?
LOC, headache, acute confusion, numbness/ pins and needles, weakness, visual disturbance, nausea/ vomiting
Acronym for presenting any history?
AT MIST
Age, timing, mechanism e.g. hazard/ risk factor, injury, symptoms, treatment
Issues with articulation called? Phonation? With language function? All due to what?
Dysarthria- weakness/ incoordination of the orolingual muscles
Dysphonia- laryngeal problems, can cause voice hoarseness, may be reduced speech volume
Dysphasia- due to a lesion in the language areas of the dominant hemisphere
As well as speech, what to look for?
Evidence of involuntary problems e.g. tremor, tics, chorea, hemiballismus/ orofacial dyskinesias
General things to ask about general PC?
What, which part of the body affected, localised/ more widespread, when did they start, how long do they last for, sudden/ rapid/ gradual in onset, history of trauma, symptoms static/ deteriorating- exacerbations and remissions, triggering factors, associated symptoms, how ADLs are affected
Past medical hx?
Head/ spinal trauma, metabolic/ endocrine disorders e.g. diabetes, cancer, epilepsy, HTN, AF, heart diseases
Drug hx and allergies?
Anticonvulsants, drugs that lower the seizure threshold, anticoagulants and anti-platelets, analgesics, antihypertensives, antidepressants, insulin, recreational drugs
Social hx?
Smoking and drinking habits, drugs- OTC and illicit, complementary and alternative medicines, occupation, marital status- bereavement/ divorce, sexual orientation- STIs, social activities/ hobbies, home circumstances, level of independence
Family hx?
Diabetes, cerebral haemorrhage, cerebrovascular disease/ stroke, IHD, migraine, epilepsy, Huntingdon’s, muscular dystrophy, neuropathies, vascular disease
Systematic enquiry?
Weight loss, appetite, weight gain- diabetes mellitus, polyuria
Causes of generalised seizures?
Metabolic disturbances, space-occupying lesions, head trauma, stroke, medication, epilepsy
To ask before a LOC?
Possible triggers e.g. vasovagal- emotional distress, orthostatic, situational- cough, sneeze, defecation, carotid sinus hypersensitivity- shaving, tight-fitting collars, CV= physical exertion
Prodromal symptoms e.g. vasovagal- light-headed, sweating, nausea, tinnitus, CV= lose suddenly/ chest pain/ palpitations, epileptic auras- olfactory hallucinations, deja-vu, sensory disturbances, motor weakness
To ask during LOC?
Motor symptoms- stiff/ flaccid muscles, jerking movements e.g. initial tonic stiffening–> jerking= tonic-clonic
Duration- syncope< 20 secs, seizures> 20 seconds
Collateral- tongue biting= tonic-clonic, incontinence= seizures
After LOC?
Collateral- how long to regain consciousness/ confused initially- syncope= 20-30 seconds
Seizure= post-ictal period, can be minutes- hours, often not remembered
Relieving factors for LOC? From collateral?
Orthostatic= laid flat, seizures= administration of a benzodiazepine
Any injuries, head trauma and airway issues
What to ask about for stroke hx?
When did symptoms first start
Severity- paralysis, loss of sensation, how much of visual field affected, receptive and expressive dysphasia, dysarthria
Course- have symptoms improved/ when at their worst
Precipitating factors
Ass symptoms- headache, neck stiffness, vomiting, unilateral headache, fevers, dizziness, palpitations- AF
Previous episodes
Dominant hand
Key TIA/ stroke symptoms?
Weakness, sensory disturbance, visual disturbance, speech, ataxia, dysphagia, reduced LOC, pain
Qs for stroke weakness?
Distribution, severity, onset and duration, course of weakness
Qs for sensory disturbance?
Distribution, severity, onset and duration
Qs for visual disturbance?
Type e.g. vertigo, hemianopia, quadrantanopia, amaurosis fugax, severity, onset and duration
Qs for ataxia?
Issues with balance/ coordination- impact, associated
Qs for speech issues?
Slurring, issues understanding/ getting words out
Qs for swallowing?
Difficulties with swallowing solid/ liquid foods
Qs for LOC stroke? Also?
When became more drowsy?, head trauma, headache, nausea, vomiting, jerking movements
PAIN
