Neurological History

Principles of Neurological History Taking – 1
Ideally, in most fields of medicine, following proper history

taking
and performing proper clinical examination, the clinician should
be able to answer the following questions:
The usual approach to a clinical problem is to ask the following:
• Where is the lesion?(brain, spinal cord, anterior horn cell,

peripheral nerve, neuromuscular junction, muscle)
• What is the aetiology?(vascular, degenerative, toxic,

infective, genetic, inflammatory, neoplastic, functional)
• What is the most likely diagnosis?
• What is the differential diagnosis?
• Is treatment possible?
• What is the prognosis?
A clinical fact:
• A detailed history usually will yield more information than the

neurological examination and ancillary tests.
Sources of history:
• The patient.
• Family members and eyewitness accounts are essential.
• A review of the “case notes” , if available, is very useful.
1
The “Case Notes”
Personal data.
The presenting complaint (s).
History of present illness.
Review of system(s)
Past medical (including surgical) history
Family history
Social history
Drug History
Allergy
Clinical examination (general examination, vital signs, regional lymph nodes,

examination of central and peripheral nervous system, examination of other
systems)
Provisional diagnosis
Differential diagnosis
Investigation(s)
Treatment (both medical and surgical options)
Follow-up
2
The “Case Notes”
Personal data: name, age, sex (gender), occupation, ethnic group, religion,
address, next of kin, date of admission, date of discharge, diagnosis, further
follow-up appointments, etc…
The presenting complaint (s) “in patient’s colloquial language”.
History of present illness “in medical terms; it contains details about the
presenting complaint(s) or symptom(s)”.
Analysis of symptoms will follow a similar plan:
o time relationships: date/week/month/year of onset;
o character and severity;
o location and radiation;
o time course;
o associated features and symptoms;
o trigger, aggravating and alleviating factors;
o previous treatments;
o remissions and relapses.
3
HEADACHE
• Onset (sudden, gradual)
• Frequency
• Duration
• Severity
• Timing (e.g. morning)
• Character (aching, throbbing)
• Precipitating factors (stooping, coughing)
• Relieving factors (analgesia)
• Site
• Associated features (vomiting, visual disturbance)
VISUAL DISORDER
• Frequency
• Duration
• Precipitating factors
• Impairment : one / both eyes; Total / partial visual loss; Whole

/ partial field loss
• DIPLOPIA – gaze direction where maximal
• Hallucination – false sensations, without stimulus; Formed – real

images; Unformed – shapes and colours
• Illusions – stimulus that is misperceived
4
LOSS OF CONSCIOUSNESS
• Frequency
• Duration
• Precipitating factors
• TONGUE BITING; INCONTINENCE; LIMB TWITCHING
• ALCOHOL / DRUG ABUSE
• HEAD INJURY
• CARDIVASCULAR or RESPIRATORY symptoms
SPEECH DISORDER
• Frequency
• Duration
• Difficulty in ARTICULATION
• Difficulty in EXPRESSION
• Difficulty in UNDERSTANDING
5
MOTOR DISORDER
• Frequency
• Duration
• Precipitating factors (e.g. walking)
• Relieving factors (e.g. rest)
• LACK OF CO-ORDINATION – Balance
• WEAKNESS – Progressive / Static; Distal / Proximal; Painful /

Painless
• INVOLUNTARY MOVEMENT
SENSORY DISORDER
• Frequency
• Duration
• Precipitating factors (e.g. walking, neck movement)
• Relieving factors (e.g. rest)
• PAIN
• NUMBNESS / TINGLING
• Site
6
SPHINCTER DISORDER
• Frequency
• Duration
• Difficulty in CONTROL (INCONTINENCE, RETENTION)
• Bladder
• Anal
LOWER CRANIAL NERVE DISORDER
• Frequency
• Duration
• Precipitating factors (e.g. neck movement, head position)
• DEAFNESS / TINNITUS – uni / bilateral
• VERTIGO – rotation of surroundings
• BALANCE / STAGGERING – direction
• SWALLOWING difficulty
• VOICE change
7
MENTAL DISORDER
• Frequency
• Duration
• MEMORY
• INTELLIGENCE
• PERSONALITY
• BEHAVIOUR
Past medical history
• Do not always accept the patients diagnostic terms.
• Enquires into
- birth / pregnancy;
- head / spine injury;
- infections (meningitis / encephalitis);
- surgical procedures;
- specific symptoms, e.g., 'migraine', seizure', 'stroke';
- drug therapy.
Family history
• Draw a family tree. Document a specific illnesses and cause of

death if known. In certain communities enquire about
consanguinity (‫ قرابة‬،‫) صلة عصب‬
• Enquires into: epilepsy, migraine, multiple sclerosis, stroke,

cerebral aneurysm, muscle disorders, dementia, spinocerebellar
degeneration, and neuropathies.
8
Social history
This should include:
 occupation;
 marital status;
 alcohol consumption;
 smoking habbits;
 recreational drug use;
 risk factors for HIV;
 detailed travel history;
 dietary habbits;
 sexual orientation and habbits.

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Principles of Neurological History Taking – 1

Ideally, in most fields of medicine, following proper history

and performing proper clinical examination, the clinician should

be able to answer the following questions:

The usual approach to a clinical problem is to ask the following:

• Where is the lesion?(brain, spinal cord, anterior horn cell,

• What is the aetiology?(vascular, degenerative, toxic,

• What is the most likely diagnosis?

• What is the differential diagnosis?

• What is the prognosis?

• A detailed history usually will yield more information than the

• Family members and eyewitness accounts are essential.

• A review of the “case notes” , if available, is very useful.

The presenting complaint (s).

History of present illness.

Past medical (including surgical) history

Clinical examination (general examination, vital signs, regional lymph nodes,

Treatment (both medical and surgical options)

The presenting complaint (s) “in patient’s colloquial language”.

Analysis of symptoms will follow a similar plan:

o time relationships: date/week/month/year of onset;

o character and severity;

o location and radiation;

o associated features and symptoms;

o trigger, aggravating and alleviating factors;

o remissions and relapses.

• Onset (sudden, gradual)

• Timing (e.g. morning)

• Character (aching, throbbing)

• Precipitating factors (stooping, coughing)

• Relieving factors (analgesia)

• Associated features (vomiting, visual disturbance)

• Onset (sudden, gradual)

• Impairment : one / both eyes; Total / partial visual loss; Whole

• DIPLOPIA – gaze direction where maximal

• Hallucination – false sensations, without stimulus; Formed – real

• Illusions – stimulus that is misperceived

• Onset (sudden, gradual)

• TONGUE BITING; INCONTINENCE; LIMB TWITCHING

• ALCOHOL / DRUG ABUSE

• CARDIVASCULAR or RESPIRATORY symptoms

• Onset (sudden, gradual)

• Onset (sudden, gradual)

• Precipitating factors (e.g. walking)

• Relieving factors (e.g. rest)

• LACK OF CO-ORDINATION – Balance

• WEAKNESS – Progressive / Static; Distal / Proximal; Painful /

• Onset (sudden, gradual)

• Precipitating factors (e.g. walking, neck movement)

• Relieving factors (e.g. rest)

• Onset (sudden, gradual)

• Difficulty in CONTROL (INCONTINENCE, RETENTION)

LOWER CRANIAL NERVE DISORDER

• Onset (sudden, gradual)

• Precipitating factors (e.g. neck movement, head position)

• DEAFNESS / TINNITUS – uni / bilateral

• VERTIGO – rotation of surroundings

• BALANCE / STAGGERING – direction

• Onset (sudden, gradual)