Summary MRCP Neurology History Taking

Neurology General

 Intro + Name/Age/Occupation

 Special senses (cranial nerves) – any change in:
o Sight
o Smell
o Hearing
o Taste
o Sensation

 Brain:
o General
 Seizures
 Fainting/LoC
 Headache
 Head trauma

o Cerebellar  Balance, coordination, speech difficulty, (blurry vision – in special senses)

 Neck
o Neck stiffness
o Trouble swallowing

 Limbs:
o Pins and needles/numbness OR pain
o Weakness or difficulty walking

 Spinal cord  Bowel/bladder

 ROS
 ICE
 PMH, PSurgHx, FH, DH, SH
 Summary

 Request: Full neuro Hx, Exam (upper + lower limb, cranial nerves)




DANISH
Dysdiadokineia (trouble with rapid movement)
Ataxia (off balance)
Nystagmus (blurred vision)
Intention tremor
Speech (slurred)
Hypotonia

,Memory Loss History

 Dementia history:
o Core symptoms:
 Memory loss  “tell me more” + when did it start
 Gradual, rapid or step-wise deterioration; coming/going or constant (delirium)
 Short-term vs long-term memories (LT intact), can he make new memories
 Loss of cognition
 Aphasia  Trouble understanding or finding words?
 Apraxia  Trouble carrying out basic tasks?
 Agnosia  Trouble identifying people or objects?
 Higher dysfunction  Slowness of thinking and problem solving

o Disease specific questioning (if none present, likely Alzheimer’s):
 Cardiac risk factors?  HTN, Cholesterol, Diabetes, Smoking, FH (Multi-infarct)
 Hallucinations/delusions? Slow movement? (Lewy-Body or Parkinson’s dementia)
 Inappropriate behaviour (e.g. sexual)? (Frontotemporal degeneration e.g. Pick’s)
 Incontinence or unsteadiness on feet? (NPH)

o Effect on patient + partner/carer: Swamp
 Sleep?
 Wandering or getting lost?
 ADL?
 Mood?
 Partner/carer coping? Stress?

o ROS, ICE, PMH, PSurgHx, FH, DH, SH
o Summary

o Request: Full neuro + CVS history and examination

o DDx: Alzheimer’s, Vascular, LBD, Pick’s, Depression, Hypothyroidism, Anemia
o Ix:
 AMT, MMSE (20-26, 15-19, <15), Barthel, PHQ-9
 Urine
 Blood
 CT

o Rx  Conservative (social packages, OT, physio, MDT, geriatricians, donepizil, memantine)

, Headache History (inc red flags)

 SOCRATES
o Site  Bilateral (tension)? Unilateral (migraine)? Behind eye (cluster)? Occipital (SAH)?
o Onset  Sudden or Gradual? Had similar before? Worsening? Any head injury?
o Character
o Radiation
o Associated symptoms?
 SAH
 Feel like something hit you in back of head?
 LoC, Weakness, loss of sensation/pins and needles?
 Meningitis:
 Neck stiffness?
 Rash?
 SOL:
 Had headaches before? Worsening?
 Woken from sleep?
 Any seizures
 TA:
 Visual disturbance?
 Tenderness on scalp?
 Pain in jaw on chewing?
o Timing  Any diurnal variation i.e. better or worse in morning/as day goes on?
o Exacerbating
o Soothing?  Any pain killers?
o Severity?  Rate out of 10

 Specific questions if serious disease ruled out:
o Tension  Any stresses in life?
o Migraine:
 Aura? (NB: classify migraine as WITH or WITHOUT aura)
 Visual disturbances?
 N+V? (also SOL)
o Cluster:
 Pain behind eye?
 Tearing?
o Sinusitis:
 Tenderness of face?

Red Flags  SNOOP (NB: LP, MRI may be necessary if these are present)
Systemic illness (e.g. fever, stiff neck, rash, persistent vomiting, immunocompromised, warfarin)
Neurologicals (e.g. altered mental status, focal neurology, seizures, papilloedema)
Onset (new OR sudden, esp if >50 or <10)
Other associated conditions (e.g. headache from trauma, wakes from sleep)
Prior headaches different (e.g. worsening or different pattern), Progressive