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Neurological History-Taking

Presenting Complaints

Headache
Onset, severity, location, aggravating / relieving, prodromal symptoms
Seizure
Witnessed, duration, LOC, collateral
Presyncope / Syncope
Lightheadedness / loss of consciousness
Visual Changes
Blurring, diplopia, amaurosis fugax
Visual Blurring
Onset, use of glasses
Diplopia
Onset, associated symptoms
Amaurosis Fugax
Temporary visual loss without pain
Olfactory Changes
Loss of olfactory sensation, altered olfaction
Hearing Changes
Tinnitus, hearing loss
Tinnitus
Constant or intermittent, triggers
Hearing Loss
Degree of hearing loss, impact on function
Vertigo
Room spinning or patient spinning
Muscular Symptoms
Weakness, spasm, tremor, facial droop
Muscle Weakness
Proximal or distal
Muscle Spasm
Which muscles, situation
Tremor
Resting or with activity
Facial Droop
Onset, associated symptoms
Sensory Changes
Loss of sensation / tingling / burning
Numbness
Location, constant or intermittent
Paraesthesia
Pins & needles

Location, constant or intermittent
Neck Stiffness
Fevers, headache, photophobia
Dysarthria
Difficulty articulating

Onset, associated symptoms

Further History

Handedness
± Footedness
Description of a Single Episode
Before, during, after
Pattern of Events Over Time
First event, max frequency, Sx-free interval
Circumstances of Attacks
Precipitants, aggravators, alleviators

Systems Review

General
Appetite & weight, sleep
Bladder / Bowels
Potential sphincter disturbance
Psychological
Mood / depressive symptoms

Past Medical History

Neurological Disease
Diagnosis, symptoms, severity, functional impact, management
Cerebrovascular Events
TIA / stroke

How many, when, functional residual
Seizure Disorder / Epilepsy
Frequency / last seizure, type of seizures
Migraines
Frequency, severity, symptoms, impact
Vertigo
Meningitis
When, severity, management
Guillain Barre
Multiple Sclerosis
Alzheimer's Disease
Parkinson's Disease
Cerebral Palsy
Intellectual Disability
Neuromuscular Disorders
Myaesthenia gravis / ALS
Cerebrovascular Risk Factors
IHD, AF, HTN, lipids, Diabetes
Ischaemic Heart Disease
When diagnosed, symptoms, past coronary events, echo / angio results, management
Atrial Fibrillation
Paroxysmal / constant, CHADS2, anticoagulation, past TIA / stroke
Diabetes
Diagnosis, control, management, complications
Hyperlipidaemia
When diagnosed, lipid results, meds, diet
Hypertension
Latest BP readings, meds, complications
Trauma
Cerebral, neck or back

Medications

Family History

Known Family Neurological History
Family tree, age of onset

Social History

Education
Level of education attained
Vocation
Toxin exposure
Recent Travel
Where, when, how long
Degree of Support Available
Physically and psychologically
Impact of Presenting Complaint
On relationships, work etc.

Substance History

Alcohol
Average per day / week
Smoking
Pack-years, years since quitting
Recreational drugs
Acute intoxication
Illicit drug use, alcohol, opiates, methamphetamine etc
Withdrawal
Recently ceased drugs

Read More...

Hajat C, Dundas R, Stewart JA, Lawrence E, Rudd AG, Howard R, Wolfe CD. Cerebrovascular Risk Factors and Stroke Subtypes: Differences Between Ethnic Groups. Stroke. 2001; 32: 37-42. Link

Kennedy A, Zakaria R. Taking a Neurological History. Medicine. 2006; 36(10): 509-514. Link

Lima, Marco A. What is the essential neurological examination?. Arquivos de neuro-psiquiatria. 2012 Dec; 70(12): 939. Link

O'Brien MD. Taking a Neurological History. The Foundation Years. 2006; 2(1): 1-6. Link

Pearl PL. Neurological Problems of Jazz Legends. Journal of Child Neurology. 2009 Aug; 24(8): 1037-1042. Link