Neurological History Taking and Examination of the Peripheral Nervous System

Neurological History Taking and Examination of the Peripheral Nervous System

TAKING A NEUROLOGICAL HISTORY

In addition to the normal history presenting complaint, there are specific closed questions that form a neurological systems review. These questions do not take the place of the detailed history you learned to take in semester one but rather add extra information specific to the neurological system. You should ask the patient if they have experienced the following:

Seizures or fits (convulsions)

- Partial seizure: Partial consciousness

Fainting

- Syncope

- Can be due to hypotension, hyperglycemia, excessive bleeding

Dizziness

- Vertigo / near syncope

- A defense mechanism: More blood flow to the brain when you lie down

Headache

- Can be common, tension, cluster or pre-menstrual headache

- Could be aggravated by chocolates or caffeine

- Hemiplegic migraine

- Left hemipligia, pathology appears to be on the right

- Medial cerebral artery affected

- In the morning: Could be due to raised intracranial pressure

- Tension Headache : After work

- Quality: Burst (Hemorrhage) , Throbbing ( Migraine/ Tension)

Paraesthesia (abnormal sensation) / Anesthesia ( Total loss of sensation)

Weakness

- Could be due to

- Vascular

- Stroke

- Metabolic

- Diabetes, Hypoglycaemia

- Polio

Gait or movement problems

Visual Disturbance

- Diplopia, blurred vision, Tunnel vision, Bitemporal hemianopia

Neck stiffness

- Could be due to inflamed meninges which cause headache

- Sinusitis

Head Injury with loss of consciousness (LOC)

- Subdural hematoma

- When someone is old, it could be caused by personality change

RISK FACTORS FOR PERIPHERAL NEUROLOGICAL DISEASE

Smoking

- Cerebroascular disease

Diabetes

- Neuropathy

Alcohol

- Tremors, Delirium tremens, Dementia myopathy, Subdural hematoma

Diet

- Pellagra, Peripheral neuropathy

Malabsorption

- Niacin deficiency, Thiamine deficiency

GENERAL PRINCIPLES OF PERIPHERAL NEUROLOGICAL EXAMINATION

LOOK

Muscle bulk, Wasting, Fasciculation (Sign of LML), Tremor, Spasm, Abnormal Movements, Skin Changes ( Hemifibronulus, cutaneous anglomata)

Tremor

- Described according to speed (fast/slow) and amplitude (fine/course)

-Physiological

- Pathological

- If slower, indication of liver, thyroid, neurological disease

-Parkinsonian

- slow and course