Neurological history taking

Question 1

3 key questions to ask when doing a ‘neuro clerking’?

Answer 1

• is there a lesion/pathology (structural vs functional; onset + course)
• where is the pathology/lesion
• what is the lesion/pathology

Question 2

How to check for spasticity in the upper and lower limb?

Answer 2

Spasticity is velocity dependent -> need to perform QUICK movements to detect it

A. Upper limb -> quickly shake hand (few times - passive movement of pt’s hand)

B. Lower limb quickly check knee -> ‘throw that on bed’

Question 3

Where is the weakness in Guillan Barre syndrome?

Answer 3

Bi-lateral + distal or proximal

Question 4

What’s the weakness pattern following the stroke?

Answer 4

Unilateral

(not to the lesion but for example weakness in limbs + eyes homologous hemianopia)

Question 5

3 main features of Parkinson’s

Answer 5

• Rigidity
• Resting tremor
• Bradykinesia

Question 6

Tremor - possible types (3)

Answer 6

Tremor:

• cerebellar -> essential tremor
• extra- pyramidal
• resting tremor -> Parkinson’s

Question 7

What may be meant by ‘blackout’?

Answer 7

• LOC
• loss of vision
• loss of memory

Question 8

A patient comes and says they have got e.g. dizziness (or any other symptom), what do we need to ask?

Answer 8

Make sure you know exactly what they mean by the symptoms e.g. what happens when you feel dizzy?

Question 9

What is onset?

What is course?

Answer 9

It’s extremely important to ask about the onset and course

• Onset - when it started
• Course - what has happened between the start of the symptoms and until now

Question 10

What to ask in pt with TIA in terms of PMH/risk factors?

Answer 10

• AF
• hypertension
• high cholesterol
• CVD

Question 11

What is Hoover’s sign in neurology? (in context of leg paresis = weakness)

(just what does it test for)

Answer 11

Hoover’s test -> help to distinguish between organic and non-organic (functional) nature of paresis

• it depends on synergistic contraction principle

Question 12

How to perform Hoover’s test?

Answer 12

Patient lies on their back -> examiner holds and lifts (slightly) their heels

Ask patient to straight afected leg (lift it) and if we cannot feel a downwards pressure on the leg that is not lifted -> pt is not ‘trying’ -> functional weakness

(if we cannot feel the pressure = positive test)

If we can feel downward pressure on the opposite leg -> organic cause of weakness

Question 13

Functional weakness

• causes
• management

Answer 13

• past trauma
• dissociation at brain level
• somatic symptoms

Management:

• CBT -> for cause/psychotherapy
• Physiotherapy -> for physical symptoms

Question 14

Optic neuritis - what happens?

Management

Answer 14

Optic neuritis

Inflammation or compression of an optic nerve

Management: steroids -> to speed up the recovery

Question 15

Characteristics of demyelination symptoms?

Answer 15

Sx worsen over days/ hours -> plateau for days -> spontaneously improve

Question 16

What causes an abrupt/sudden onset of a symptom? (in general)

Answer 16

Vascular cause

Question 18

Red flags from meningismus symptoms

Answer 18

• fever
• rash
• neck stiffness

Question 19

Red flags for temoporal arteritis (symptoms)

Answer 19

Temporal arteritis

• visual problems
• jaw claudication
• scalp tenderness

Question 20

Red flags for glaucoma

Answer 20

• red eye
• visual problems
• halos around lights

Question 21

What neurological questions to ask in RoS

Answer 21

A. General: fits, falls, LOC, memory loss, dizziness, visual/hearing changes, neck stiffness, photophobia

B. Motor: weakness, wasting, incontinence

C. Sensory: pain, numbness

Question 22

Questions in Hx related to ENT?

Answer 22

E - Ear: pain (otalgia), hearing changes, tinnitus

N - nose: rhinorrhoea and epistaxis

T - Throat - sore throat, epistaxis

Question 23

3 categories of questions to ask when someone presents with either: fit, seizure in syncope

Answer 23

What happened:

• before
• during
• after