neurological history taking W1

Question 1

anatomical localisation - where is the lesion? (options)

Answer 1

central - brain, spinal cord
peripheral - nerve root, nerve, neuromuscular junction, muscle

Question 2

first question to ask?

Answer 2

what main symptoms are in their own words

Question 3

general questions about the patient?

Answer 3

age, handedness, occupation

Question 4

why ask about handedness?

Answer 4

indicates dominant hemisphere

Question 5

why ask about occupation

Answer 5

indicates level of physical/cognitive function
educational attainment
impact of symptoms on life

Question 6

common neurological presenting symptoms?

Answer 6

headache
loss of awareness/consciousness (fits/faints)
memory problems/change in behaviour
visual disturbance (blurred/double)
speech problems
change in sense of smell
weakness, tremor / involuntary movements
numbness, tingling
hearing changes (loss, tinnitus)
imbalance/falls

Question 7

questions about history of presenting complaint?

Answer 7

when did it start?
acuity of onset? (sudden/subacute/chronic)
episodic/fluctuating or persistent, progressive?
exacerbating/relieving factors?
impact of symptoms on daily life? (home/education/employment?)

Question 8

how to break down description of single episode? (eg headache, seizure, syncope, presyncope)

Answer 8

before episode
during episode
after episode

Question 9

questions about before the episode?

Answer 9

palpitations, light-headedness, visual changes, other sensory changes

Question 10

questions about during the episode?

Answer 10

length, loss of consciousness, limb/eye movement, tongue biting

Question 11

questions about after the episode?

Answer 11

focal limb weakness, fatigue, confusion

Question 12

questions about patter of events over time?

Answer 12

are events the same/similar?
when first event was
when latest event was
approximate frequency
normal between events?

Question 13

sudden onset meaning?

Answer 13

seconds/minutes

Question 14

subacute meaning?

Answer 14

hours/days

Question 15

chronic meaning?

Answer 15

months/years

Question 16

severity pattern of stroke?

Answer 16

sudden onset / subacute?, gradual decrease in severity over time

Question 17

severity pattern of Alzheimer disease/brain tumour

Answer 17

slow onset, gradual increase in severity over time

Question 18

severity pattern of MS?

Answer 18

subacute onset (?), fluctuates over time with multiple peaks, increasing severity between episodes

Question 19

severity pattern of migraine and epilepsy?

Answer 19

sudden onset, returns to low severity between episodes

Question 20

questions to ask about past medical history?

Answer 20

history of chronic neurological disease
medical conditions that may predispose to neurological problems
developmental history
previous head injury or neurological infections

Question 20

what to ask about when discussing history of chronic neurological disease?

Answer 20

management, complications:
stroke, epilepsy, migraine, MS, neuropathies, muscle disease, dementia, Parkinson’s, MND, myasthenia gravis, autoimmune neuro disease

Question 21

what medical conditions may predispose to neurological problems?

Answer 21

atrial fibrillation, diabetes, hypertension, rheumatoid arthritis, GI problems, cancer, HIV, blood disorders

Question 22

what to ask about developmental history?

Answer 22

prematurity, developmental milestones, schooling

Question 23

neurological infections?

Answer 23

meningitis, encephalitis

Question 24

what neurological symptoms can medications cause?

Answer 24

confusion, altered conscious level, headache, ataxia, neuromuscular disorders, neuropathy, seizures

Question 25

what to ask about family history?

Answer 25

anyone in family have neuro problems?
see if there’s a pattern of transmission (autosomal dominant/recessive or X-linked)

Question 26

inherited neurological disorders?

Answer 26

ataxias, hereditary neuropathies, muscular dystrophies, dementias, spinal muscular atrophy, forms of epilepsy, hereditary spastic paraplegia, Huntington’s disease, neurofibromatosis, tuberous sclerosis, mitochondrial

Question 27

what may weight/appetite suggest and what is this relevant to

Answer 27

malignancy
paraneoplastic syndrome

Question 28

what symptoms may suggest systemic inflammatory disorder?

Answer 28

skin rash
joint pain
breathing difficulties

Question 29

social history questions?

Answer 29

occupation
who is at home
what type of accommodation
do they drive
smoking history
alcohol intake
recreational drugs