neuro hx

Question 1

mj pres symptoms

Answer 1

headaches, seizures, loc/altered conc, motor/sens dysfunction, mental/cognitive decline, incontence

Question 2

types of headache

Answer 2

1’- pain that occurs in absence exact cause. migraine, tension, cluster

2’- known cause. trigem, sinnusitis etc

Question 3

inc icp headache

Answer 3

dull ache
worse on waking in morning, improves throughout day
worse by coughing/sneezing, bending, lying down
assoc with morning vom

Question 4

subarachnoid haem headache

Answer 4

sudden onset (thunderclap)
irritability, photosenstivity
altered mental state, syncope

Question 5

meningitis symo

Answer 5

headache
neck stiff - meningism
fever nausea
photophobia
drowsiness
confusion

Question 6

acute headache

Answer 6

min to hours- vascular problem eg haem or mig

Question 7

subacute headache

Answer 7

hours to days- infective/inflam cause eg mening, abcess

Question 8

chronic headache

Answer 8

weeks to months- neoplastic
months to years- degen process

Question 9

seizures cause

Answer 9

abn elect dishcarge
epilepsy is recurrent seizure

Question 10

risk factors of seizures

Answer 10

electrolyte abnormalities, brain infection, congenital/peri-partum abnormalities, drug abuse, smoking (tumours) etc

Question 11

seizures classification

Answer 11

localized- partial seizures
generalized seizures- all inclusde loc

Question 12

types of localized seizures

Answer 12

Simple partial - if consciousness not affected
Complex partial - if consciousness is affected

Question 13

types of generalizedf seizures

Answer 13

divided according to the effect on the body -include absence, myoclonic, clonic, tonic, tonic–clonic, and atonic seizures.

Question 14

gen seizures symptoms

Answer 14

Tonic-clonic phases
Cry and fall
Tongue biting
Frothing at the mouth during the clonic phase
Cyanosis
Urinary/faecal incontinence
Rhythmic jerking movements of limbs
LOC (+ drowsiness + post-ictal confusion, amnesia and headache)

Question 15

tonic phase

Answer 15

extension of body
30 sec
may have apnea

Question 16

clonic phase

Answer 16

alternating muscles cont and rel
30-60 sec
tongue biting
sphincter rel

Question 17

recovery phase

Answer 17

neuro normal
30 min headache and confusion
transient weakness

Question 18

typical absence attack (petit mal)

Answer 18

childhood
activity ceases
staring + pallor
eyelid twitch
brief and may be frequent

Question 18

Vaso-vagal syncope

Answer 18

provoked by emotionally charged event e.g venepuncture

Question 18

Cardiac syncope

Answer 18

sudden decline in cardiac output and hence cerebral perfusion e.g severe aortic stenosis or heart block

Question 18

temp lobe seizure

Answer 18

simple or complex seizures
may prod aura - olfactory - unsual smell
may loc
tingling limbs
may be assoc with confusion and drowsiness

Question 18

cranial nerve dysfunction symp

Answer 18

Loss of vision, smell, taste
Alteration in facial feeling
Double vision / visual symptoms
Problems with swallowing / chewing
Speech alterations
Vertigo / hearing abnormalities
Bulbar dysfunction
Pain / difficulty with neck movements

Question 18

hx of seizures qs

Answer 18

description of seizure, feeling before during after
From patient and witness (NB blackouts, faints, fits, loss of consciousness)
What happens at the onset of the fit?
What happens during the fit?
Does the patient fall or remain standing or sitting?
How does the fit end?
Confusion or other post-ictal symptoms?
Is there incontinence, any injury or tongue biting?
Frequency of seizures?
When do the seizures occur?
What medication is taken?
Low glucose levels/Diabetes?
History of past/ current medication, compliance and response to medication
Change in seizure pattern
Family history of seizures
Head trauma or brain illness
(especially in adult-onset epilepsy)
Birth history
(especially in early onset seizures)

Question 19

Symptoms of Motor Dysfunction

Answer 19

Weakness – ask about ability to lift arms / objects, grip strength, getting up from a chair / bed, going upstairs
Wasting / loss of muscle bulk
Stiffness of limbs
Gait abnormalities - limping or dragging of legs

Question 19

CEREBROVASCULAR DISEASE types

Answer 19

Ischaemic -e.g blockage of blood flow as in cerebral venous thrombosis, cerebral arterial embolism Haemorrhagic - accumulation of blood in the brain tissue (intraparenchymal or intraventricular haemorrhage) or between the brain and the skull vault (epidural haematoma, subdural haematoma and subarachnoid haemorrhage)

Question 20

Signs/symptoms of stroke

Answer 20

Acute onset of focal neurologic deficits Symptoms vary by the area of circulation affected Visual, language, motor/sensory disturbances CN deficits, co-ordination, drop attacks, altered consciousness

Question 21

Lesion in cerebral hemisphere -

Answer 21

unilateral motor deficit (hemiplegia), higher cerebral function deficit (aphasia or neglect), hemisensory loss or a visual field defect.

Question 22

Carpel Tunnel syndrome

Answer 22

The carpal tunnel, a narrow, rigid passageway of ligament and bones in the wrist, houses the median nerve and tendons. Swelling of structures within this tunnel causes median nerve compression and CTS results. It is characterised by pain, weakness and numbness in the wrist and hand.

Question 22

Lesion in brain stem or cerebellum -

Answer 22

ataxia, diplopia, vertigo and/or bilateral weakness

Question 23

Symptoms of changes in mental state or cognitive decline - dementia

Answer 23

hanges in memory State of alertness / drowsiness Changes in mood and affect, loss of spontaneity Loss of spatial orientation Language changes Diminished ability to carry out routine activities of daily living

Question 23

Large volume lesion in cerebral hemisphere

Answer 23

reduced level of consciousness

Question 23

Symptoms of Co-ordinatory Dysfunction or Balance disturbance

Answer 23

Difficulty in walking Unsteadiness Falls Staggering Loss of balance in the dark

Question 23

Symptoms of Bladder Dysfunction

Answer 23

Urinary retention (spinal cord compression or trauma) Loss of awareness of bladder distension (damage to the frontal lobe as in frontal tumours, bifrontal subdural haematomas) Frequency, urgency and urge incontinence (damage to the pons or spinal cord resulting in an upper motor neuron lesion) Overflow incontinence (damage to the pudendal nerve leading to flaccid paralysis of the detrusor muscle of the bladder, resulting in a lower motor neurone lesion)

Question 24

summary

Answer 24

Demographics Presenting complaint and duration Most likely diagnosis/system involved Any underlying condition causing the disease * Can include any important associated symptoms * Risk factors for that particular system involved