Nervous: History
  1. Headache, face pain
  2. Faints, seizures
  3. Dizziness, gait, deafness
  4. Limb sensation, weakness
  5. Tremor, speech
  6. Past medical, surgical history
  7. Family, social, drug history
  8. Systems
Headache
  • Unilateral, photophobia, preceded by flashing lights (classical migraine).
  • Photophobia, fever, stiff neck (meningitis).
  • Supraorbital, rhinorrhea, lacrimation, in bouts, flushing (cluster headache).
  • Occiput, neck stiffness (spondylosis).
  • Worse in morning, drowsy, vomit (raised ICP).
  • Over temporal artery, blurred vision (temporal arteritis).
  • Over cheeks or forehead (acute sinusitis).
  • Thunderclap then later diffuse (SAH).
  • Bilateral, recur often, tightness over an area (chronic tension headache).
Face pain
  • SOCRATES (trigeminal neuralgia, temperomandibular arteritis, glaucoma, internal carotid aneurysm, superior orbital fissure syndrome).
Faints
  • Blackouts, conscious (TIA).
  • Sensations before fainting (hypoglycemia):
    Sweating.
    Weakness.
    Confusion.
Seizures
  • Abrupt loss of consciousness, preceded by aura, incontinent, tongue bitten (grand mal).
    Epileptic attacks causes: lights, syncope, tumour, abscess.
    Complex: unconscious. Simple: conscious.
  • In children, idiopathic, no major movements, staring (petit mal).
Dizziness
  • Deafness, tinnitus (ototoxic drugs).
  • 50yo, triad of vertigo, tinnitus, deafness (Meniere's).
  • Diplopia, atataxia (vertebrobasilar TIAs).
Gait
Deafness
Limb sensation, weakness
  • Pins and needles in hands or feet (peripheral neuropathy):
    Site: nerve distribution.
    Timing: worse at night.
    Alleviating: by dangling arm over bedside.
  • Weakness (lesions). See UMNL vs. LMNL Reference.
Tremor
  • Intention tremor (cerebellar).
  • Resting tremor or chorea (Parkinson's).
  • Action tremors (BAT:  Benign essential tremor syndrome, Anxiety, Thyrotoxicosis).
Speech
Past medical, surgical history
  • Meningitis, encephalitis.
  • Spinal injury.
  • Epilepsy, convulsions.
  • Cerebrovascular dz risk factors.
  • Depression [very common in chronic neurological dz]. See Depression.
  • Prior operations.
Family history
  • Similar symptoms in a family member (transmissible or neurotoxin).
  • Huntington's.
  • Other heritable neurological dz.
Social history
  • Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew] (esp. cerebrovascular dz).
  • Alcohol (Wernicke-Korsakoff).
  • Occupation, exposure to neurotoxins (eg heavy metals).
  • Who is with you there at home [important for neurological dz, since caregiver often needs to help significantly].
  • Home: upper floor apartment, stairs, bath (mobility concerns).
  • Assess ability to care for self.
Drug history
  • Anticonvulsants.
  • OCP.
  • Anti-HTN.
  • Steroids.
  • Antiplatelets, anticoagulants.
  • Anti-parkinsonism drugs.
  • Cholinergics, anticholinergics.
  • Recreational drugs [very important for neurological].
  • Allergies. If allergic to drug, make sure not an allergy, not just a common side-effect.
Systems
  • Difficulty eating (dysphagia).
  • Cardiovascular symptoms (cerebrovascular dz).
  • Back problems (spinal cord impingement).

Nervous Exam