Neurological History: symptoms • Headache • Fits, faints and funny turns Neurology teaching • Disturbance of higher mental function History taking and common presenting neurological symptoms • Visual, hearing disturbance • Speech difficulties • Dizzness • Swallowing difficulty Agata Plonczak Thursday Feb 21 st 2013 • Weakness, numbness, paraesthesia • Problems with sphincter control (bowel/bladder) HPC: syncope HPC: syncope • Syncope vs pre-syncope • Was the onset gradual or sudden? • Pre/peri/post-syncope history is essential and • How long was the LOC? should be supplemented by a collateral history • Any recall of the events • What was the patient doing at the time? • Routine investigations should always include: • Any warning symptms/aura? • ECG, • Any associated cardiac symptoms? (ie chest pain, • capillary blood glucose, palpitations, nausea, sweating ? Any relationsip • lying and standing blood pressures with the use of medication (ie antihypertensives and GTN spray) HPC: syncope HPC: headache • When the patient came round were there any other • Character: dull, severe, sharp symptoms? • Severity • Was there any tongue biting or urinary or faecal • Site incontinence ? • Duration and onset: sudden vs insiduous • Was there any motor activity during the • Frequency unconscious episodes? • Radiation • How long did it take for the patient to feel back to • Aggravating factors: early morning or after periods normal? of lying down, straining at stool, laughing, coughing • Facial appearance: cyanosed or pale? • Relieving factors: analgesia 1
HPC: headache Past Medical History • Precipitating factors: stress, OCP, specific foods, • Any previous neurological disorder? alcohol • Any systemic diseases, particularly cardiovascular • Associated factors: nausea and vomiting, conditions (stroke is a very common cause of photophobia, neck stiffness , fever , rashes, neurological deficit) pharyngitis, cough, sputum, myalgia, arthralgia, seizures , decreased level of consciousness , coma Drug History Family History • Consider both treatment of neurological disorders • Any family history of neurological disease? and medication that may be causing symptoms • There may be important hereditary neurological conditions such as Huntington’s chorea • Draw a family tree if appropriate Causes of collapse Social history • What are the patient’s disabilities? A. Acute myocardial infarction B. Cerebrovascular accident 1. A 45 year old woman collapses during • Any mobility aids? C. Dissecting aortic aneurysm a church service in summer. Her D. Drug allergy hisband states that she turned pale • Where does the patients live? Do they receive any and collapsed shortly after standing E. First-dose hypotension help? What support is available to them? up. She did not jerk or lose urinary F. Left ventricular failure continence. She denies chest pain, G. Ruptured Abdominal aortic aneurysm • Smoking, alcohol, drug misuse? shortness of breath and palpitations. H. Stable angina She recovered after 30 secs and now feels back to her usual self. All I. Stokes-Adams attack observations –including blood tests, J. Supraventricular tachycardia ECG and lying and standing BP are K. Vasovagal syncope normal L. Ventricular rupture M. Wolf-Parkinson-White syndrome 2
Causes of collapse Causes of collapse A. Acute myocardial infarction A. Acute myocardial infarction B. Cerebrovascular accident B. Cerebrovascular accident 1. A 25 year old woman collapses 1. A 75 year old woman is brought to the C. Dissecting aortic aneurysm C. Dissecting aortic aneurysm suddenly while visiting her A&E department after collapsing. On D. Drug allergy grandmother in hospital. There D. Drug allergy examination, her heart rate is 80 bpm appears to be no pulse. The crash and irregular with a BP of 150/90 E. First-dose hypotension E. First-dose hypotension team is called and manage to mmHg. She has difficulty moving her F. Left ventricular failure F. Left ventricular failure resuscitate her after identifying arm and leg . G. Ruptured Abdominal aortic aneurysm G. Ruptured Abdominal aortic aneurysm ventricular fibrillation on the cardiac H. Stable angina H. Stable angina monitor. The attending anaesthetist records a repeat ECG and notes that I. Stokes-Adams attack I. Stokes-Adams attack the QRS complexes are broad with J. Supraventricular tachycardia J. Supraventricular tachycardia slurred upstroke of R wave K. Vasovagal syncope K. Vasovagal syncope L. Ventricular rupture L. Ventricular rupture M. Wolf-Parkinson-White syndrome M. Wolf-Parkinson-White syndrome Causes of collapse Causes of collapse A. Acute myocardial infarction A. Acute myocardial infarction B. Cerebrovascular accident B. Cerebrovascular accident 1. A 67 year old man presents to the 1. A 57 year old man is found collapsed C. Dissecting aortic aneurysm C. Dissecting aortic aneurysm emergency department follwing a at work. On arrival at the emergency D. Drug allergy collapse. He has a history of ishaemic D. Drug allergy department, he is complaining of mild heart disease with hypertension epigastric discomfort that started at E. First-dose hypotension E. First-dose hypotension diagnosed only last week. He rest. He appears pale and sweaty and F. Left ventricular failure F. Left ventricular failure remembers feeling dizzy when he got has vomited once. He is on insulin for G. Ruptured Abdominal aortic aneurysm G. Ruptured Abdominal aortic aneurysm out of his chair to go to the toilet before type 1 diabetes mellitus. H. Stable angina H. Stable angina fainting. He regained consciousness I. Stokes-Adams attack almost immediately and had fully I. Stokes-Adams attack recovered within 5 minutes. J. Supraventricular tachycardia J. Supraventricular tachycardia K. Vasovagal syncope K. Vasovagal syncope L. Ventricular rupture L. Ventricular rupture M. Wolf-Parkinson-White syndrome M. Wolf-Parkinson-White syndrome 2- Seizures 2- Seizures A. Anoxic seizure A. Anoxic seizure B. Complex partial seizure B. Complex partial seizure 1. A 14 year old boy is playing football at 1. A 36 year old woman is found on the C. Febrile convulsions C. Febrile convulsions school when he suddenly falls to the street having a fit by passers-by. They D. Nacrolepsy floor. Soon after, his friends notice him D. Nacrolepsy stand close until she finished fitting, jerking around and unresponsive. and then try to rouse her. Before she E. Partial motor seizure E. Partial motor seizure During the episode, he is incontinent of regains consciousness, she starts F. Partial sensory seizure F. Partial sensory seizure urine and starts bleeding from his having another seizure. By the time G. Pseudo-seizure G. Pseudo-seizure mouth. When the boy finally regains the ambulance arrives 10 minutes H. Status epilepticus H. Status epilepticus consciousness he is confised and later, she is still fitting. sleepy. I. Tonic-clonic seizure I. Tonic-clonic seizure J. Tonic seizure J. Tonic seizure K. Versive seizure K. Versive seizure 3
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