Kathryn Scott and Ellie Pilborough Neurological History Kathryn Scott and Ellie Pilborough

Know this structure like the back of your hand… Presenting Complaint History Presenting Complaint Systemic neurological enquiry- CARDINAL SYMPTOMS- Headache, Syncope, Seizures, Sensation, Vertigo, Vision. (HSSSVV) Past Medical History Drug History Allergies Family History Social History Ideas Concerns Expectations Paediatric history – Don’t forget to ask about: -Perinatal history -Nutrition, immunisations and developmental history.

1. Headache History INTRODUCTION: WASH HANDS “Good afternoon, I’m Eleanor Pilborough, I’m a Third Year Medical Student at Southampton University” “Please may I take a seat” “Please can I ask your name” “ Nice to meet you ………... I’m here to ask you some questions about what brought you to the surgery today, is that okay?”

PC and HPC SOCRATES SITE: “Where in the head do you feel the pain?” UNILATERAL- ……………………… BILATERAL- ………………………….. OCCIPITAL-……………………………..

ONSET/DURATION  “What were they doing when the headache occurred?” “Did it come on suddenly or gradually/ How long did it take for the headache to reach its peak intensity?”   Acute : mins – hours Vascular causes:……………or……………. ………………….. …………………… Subacute: Hours – days Infective/ inflammatory causes: ……………………… Chronic : Weeks to months ……………………….

CHARACTER “What type of pain is it?” RADIATION “Does the pain radiate anywhere else?” ASSOCIATED SYMPTOMS? Symptoms of meningism- neck stiffness, photophobia, headache. Fever, malaise, rash? Do your eyes water at the time of the headache? Do you feel you have a runny/blocked nose? ………………….. GI symptoms e.g. nausea and vomiting Visual symptoms –visual aura ……………….. Loss of consciousness? …………………. Scalp tenderness when brushing hair or pain on chewing? ……………….

TIME COURSE: “Does it follow any particular pattern?” Continuous, throughout the day with sharp exacerbations, often worse in the evenings…………………. EXACERBATING/RELIEVING FACTORS  “Does anything make it better?” Sleep/ stress management? “Does anything make it worse?” Stress/ menstruation/ sleep deprived ……………….. Coughing, straining, bending forwards…………….

SEVERITY: “How severe is the headache on a scale of 1-10?” “How does the headache compare in severity to previous headaches?” 10/10, worst headache they’ve ever had……………………………

Cardinal symptoms: Ensure you haven’t missed: Headache, Syncope ( including falls), Seizures, Sensation, Vertigo, Vision. (HSSSVV)

PMH “ Aside from this, are you otherwise well?” “ Do you suffer from any long term health problems or have you had any health problems in the past?” Hypertension Kidney disease- Polycystic kidney disease is linked to………………. Migraines/Tension headaches

DH “Do you take any regular medication?” Anticoagulants Oral contraceptive pill OTC medications and herbal remedies ( for extra brownie points) ALLERGIES! And type of allergic reaction?

FH (ask the same as SH) “ Has anyone in your family ever suffered from anything similar to this?” Headaches Migraines Kidney disease Hypertension

SH Smoker? “Have you ever smoked? How many a day? For how long?” Alcohol? “How much do you drink in a typical week?” Occupation? Stresses?

ICE “Have you got any idea what could be causing these headaches?” “Is there anything about these headaches that is particularly concerning you?” “What were you hoping the doctor could do for you today?”

Safety net “ Do you feel that I haven’t asked you something that might be relevant or important?” “Thank you very much for your time, I will pass on everything we have discussed to the doctor, is that okay with you?”

Back pain Exactly the same – SOCRATES. RED FLAGS: ……………………… ………………………. ………………………..

RED FLAGS Bladder retention or incontinence Faecal incontinence Saddle anesthesia Unexplained weight loss Lower limb weakness <20 or >55 years Structural deformity Non-mechanical pain PMH- Cancer

Other conditions to look up… 1. Stroke 2. Seizure History- pre-ictal, seizure, post-ictal period.