1. Headacheface pain
2. Faintsseizures
3. Dizzinessgaitdeafness
4. Limb sensationweakness
5. Tremorspeech
6. Past medicalsurgical history
7. Familysocialdrug history
8. Systems

Headache

• Unilateralphotophobiapreceded by flashing lights (classical migraine).
• Photophobiafeverstiff neck (meningitis).
• Supraorbitalrhinorrhealacrimationin boutsflushing (clusterheadache).
• Occiputneck stiffness (spondylosis).
• Worse in morningdrowsyvomit (raised ICP).
• Over temporal arteryblurred vision (temporal arteritis).
• Over cheeks or forehead (acute sinusitis).
• Thunderclap then later diffuse (SAH).
• Bilateralrecur oftentightness over an area (chronic tension headache).

Face pain

• SOCRATES (trigeminal neuralgiatemperomandibular arteritisglaucomainternalcarotid aneurysmsuperior orbital fissure syndrome).

Faints

• Blackoutsconscious (TIA).
• Sensations before fainting (hypoglycemia):
  • Sweating.
  • Weakness.
  • Confusion.

Seizures

• Abrupt loss of consciousnesspreceded by auraincontinenttongue bitten(grand mal).
  • Epileptic attacks causes: lightssyncopetumourabscess.
  • Complex: unconscious. Simple: conscious.
• In childrenidiopathicno major movementsstaring (petit mal).

Dizziness

• Deafnesstinnitus (ototoxic drugs).
• 50yotriad of vertigotinnitusdeafness (Meniere's).
• Diplopiaatataxia (vertebrobasilar TIAs).

Gait

• See Gait.

Deafness

• See CN VIII.

Limb sensationweakness

• Pins and needles in hands or feet (peripheral neuropathy):
  • Site: nerve distribution.
  • Timing: worse at night.
  • Alleviating: by dangling armover bedside.
• Weakness (lesions). See UMNL vs. LMNL Reference.

Tremor

• Intention tremor (cerebellar).
• Resting tremor or chorea (Parkinson's).
• Action tremors (BAT:  Benign essential tremor syndromeAnxietyThyrotoxicosis).

Speech

• See Speech.

Past medicalsurgical history

• Meningitisencephalitis.
• Spinal injury.
• Epilepsyconvulsions.
• Cerebrovascular dz risk factors.
• Depression [very common in chronic neurological dz]. See Depression.
• Prioroperations.

Family history

• Similar symptoms in a family member (transmissible or neurotoxin).
• Huntington's.
• Other heritable neurological dz.

Social history

• Smoking: ever smokedhow many per dayfor how longtype [cigarettepipechew] (esp. cerebrovascular dz).
• Alcohol (Wernicke-Korsakoff).
• Occupationexposure to neurotoxins (eg heavy metals).
• Who is with you there at home [important for neurological dzsincecaregiver often needs to help significantly].
• Home: upper floor apartmentstairsbath (mobility concerns).
• Assess ability to care for self.

Drug history

• Anticonvulsants.
• OCP.
• Anti-HTN.
• Steroids.
• Antiplateletsanticoagulants.
• Anti-parkinsonism drugs.
• Cholinergicsanticholinergics.
• Recreational drugs [very important for neurological].
• Allergies. If allergic to drugmake sure not an allergynot just acommon side-effect.

Systems

• Difficulty eating (dysphagia).
• Cardiovascular symptoms (cerebrovascular dz).
• Back problems (spinal cord impingement).

Nervous Exam »

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