This on-demand teaching session, "Neuro History Taking," offers critical insights into how to effectively collect and understand a patient's neurological history. Through this engaging session, medical professionals will learn to identify the main symptom and its onset, progression, and duration. This session delves into the SOCRATES method for pain tracking and discusses critical symptoms that should be noted, from motor and sensory symptoms to cognitive, psychiatric, and autonomic symptoms. The course is designed to help practitioners check for red flag symptoms and aims to enhance the overall process of past medical history taking. The session also sheds light on crucial elements of drug history and offers critical insights into a patient's living situation, lifestyle factors, and family history. The course also provides engaging case examples to aid learning. Medical professionals dealing with neurological cases can greatly benefit from this comprehensive session.
Understand the process of taking a thorough neurological history from a patient, including key elements such as presenting complaint, history of presenting complaint, past medical history, drug history, social history and family history.
Distinguish between neurological symptoms, able to accurately describe and classify them using terms such as acute, sub-acute, chronic, and using tools such as the SOCRATES pain scale.
Identify 'red flag' symptoms that may indicate a serious underlying condition, such as sudden "thunderclap" headache, seizures, altered consciousness, or sudden onset of weakness.
Understand the importance of discussing patients' ideas, concerns and expectations (ICE) during consultations and appropriate methods for addressing them.
Apply knowledge to interpret case studies and formulate differential diagnoses and management plans. For example, they should be able to handle a case of a patient presenting with headache or transient weakness and slurred speech.
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The following transcript was generated automatically from the content and has not been checked or corrected manually.
Neuro History Taking Emilia and MartinaPresenting Complaint + History of Presenting Complaint Presenting Complaint (PC) - What is the main symptom? (E.g., headache, weakness, dizziness) - Duration, onset (sudden vs. gradual), progression History of Presenting Complaint (HPC) - SOCRATES for pain (e.g., headache) - Time course (acute, subacute, chronic) - Associated symptoms (e.g., visual changes, speech difficulty, seizures) - Red flag symptoms (e.g., sudden "thunderclap" headache → SAH)SOCRATES ▶Site - location ▶Onset - hyperacute, acute, chronic ▶Character - sharp, dullm, burning ▶Radiation - does it move anywhere ▶Associated Symptoms ▶Time course - has it changed over time, diurnal variation, different episodes ▶Exacerbating/relieving factors ▶Severity - rate pain from 0-10KEY NEURO QUESTIONS Motor Symptoms – Weakness, coordination issues, tremors Sensory Symptoms – Numbness, tingling, pain Cranial Nerves – Vision changes, double vision, facial droop, hearing loss Speech and Swallowing – Dysarthria, dysphagia Cognitive/Psychiatric – Memory loss, confusion, mood changes Autonomic – Bladder/bowel dysfunction, syncopeRED FLAG SYMPTOMS Sudden onset symptoms eg. thunderclap headache Headache + neck stiffness + photophobia Altered consciousness Seizures Vision changes Weakness eg. unilateral limb weakness Urinary retention/incontinence Dysphagia Facial drooping/asymmetryICE Ideas “What do you think might be going on?” Concerns “What is your biggest worry at the moment?” Expectations “What do you hope to get from the consultation?” Past Medical History Ask patient for any other medical conditions. ● Hypertension (risk factor for stroke and vascular dementia) ● Diabetes mellitus (associated with peripheral neuropathy and stroke) ● Trauma (e.g. head injury leading to subdural hematoma or chronic traumatic encephalopathy) ● Hyperlipidaemia (increased risk of stroke and vascular dementia) ● Atrial fibrillation (risk factor for embolic stroke) ● Thyroid disorders (e.g. hypothyroidism causing myopathy or neuropathy; hyperthyroidism causing tremors or agitation) ● Autoimmune diseases (e.g. multiple sclerosis, myasthenia gravis) ● Infections (e.g. meningitis, encephalitis, HIV-encephalopathy) ● Chronic kidney disease (linked to uraemic neuropathy or encephalopathy) ● Vitamin deficiencies (e.g. vitamin B12 deficiency leading to subacute combined degeneration of the spinal cord) ● Cancer (e.g. paraneoplastic syndromes causing neurological dysfunction) ● Alcohol use disorder (associated with Wernicke’s encephalopathy, Korsakoff syndrome, and peripheral neuropathy) ● Obstructive sleep apnoea (related to cognitive impairment, stroke, and excessive daytime sleepiness) ● Psychiatric conditions (e.g. depression often overlaps with cognitive neurological disorders such as dementia and Parkinson’s disease) ● Haematological conditions (e.g. hypercoagulable states increasing risk of thrombosis and stroke)Drug History and Drug Allergies Key Points to Cover in Drug History: - Current Medications (Prescription, OTC, supplements) - Recent Medication Changes - Adherence (Regular use vs. occasional) - Side Effects : any neuro-related adverse effects (e.g., dizziness, neuropathy, confusion) ⚠ Allergies - Drug Allergies – Type of reaction (rash vs. anaphylaxis) - Food & Environmental Allergies – Some can trigger neurological symptoms (e.g., migraines, anaphylaxis)FAM HISTORY Any family history of neurological disease? At what age did this develop? Any other diseases that run in the family? If one of the patient’s close relatives is deceased, sensitively determine the age at which they died and the cause of deathSOCIAL HISTORY Living Situation - Support system, ability to perform daily activities Occupation & Driving - Exposure to toxins, heavy metals, repetitive trauma - Impact of symptoms on work and ability to drive safely Lifestyle Factors - Alcohol & Smoking (risk factors for stroke, peripheral neuropathy) - Recreational Drug Use – Cocaine (stroke risk), heroin (infectious risks) Family History - Neurological conditions (stroke, epilepsy, dementia, movement disorders) Systems Inquiry Brief screen for symptoms in other parts of the body. Some examples of symptoms you could screen for in each system include: ● Systemic: fevers, weight change, fatigue ● Cardiovascular: chest pain, palpitations, oedema, syncope, orthopnoea ● Respiratory: dyspnoea, cough, sputum, wheeze, haemoptysis, pleuritic chest pain ● Gastrointestinal: dyspepsia, nausea, vomiting, dysphagia, abdominal pain ● Genitourinary: oliguria, polyuria ● Musculoskeletal: chest wall pain, trauma ● Dermatological: rashes, ulcersEXAMPLE CASE 1 - HEADACHE James presents to the GP with complaints of excruciating headaches that have been occurring for the past two weeks. Patient Details: ● Name: James Carter ● Age: 38 ● Sex: Male ● Occupation: Construction worker ● Medical History: Smoker (10 pack-years), occasional alcohol use, no known allergies ● Family History: No known history of migraines or neurological disorders SOCRATES - Site: Unilateral, usually around or behind one eye - Onset: sudden - Character: Severe, stabbing, burning, or drilling pain - Radiation: may spread to the temple, forehead, or cheek, but remains mostly unilateral - Associated symptoms: lacrimation, redness of eye, congestion, sweating - Time course: last 15 min to 3 hours, multiple times a day for weeks, can occur at night - Exacerbating: alcohol, heat, stress, relieving: nothing works - Severity: 9/10 What are your main differentials? CASE EXPLANATION Management - Cluster Headache ● NICE recommend seeking specialist advice from a neurologist if a patient develops cluster headaches ● Acute ○ 100% oxygen (80% response rate within 15 minutes) ○ Subcutaneous triptan (75% response rate within 15 minutes) ● Prophylaxis ○ Verapamil is the drug of choice ○ There is also some evidence to support a tapering dose of prednisoloneCASE 2 Case Presentation: 70-year-old male patient presents to A&E after having had a 10-minute episode of left arm weakness and slurred speech. Symptoms have resolved completely before arrival. Patient Details: - Name: James Carter - Age: 70 - Sex: Male - Occupation: Retired teacher - Family History: Father had a stroke at age 72, T2DM, no known allergies SOCRATES - Site: Right side of body (arm and face) - Onset: Suddenly while watching TV - Character: Weakness and numbness - Radiation: No spread - seizuresed Symptoms: Slurred speech, transient confusion, but no headache or - Time Course: Symptoms lasted for 10 minutes before resolving completely - Exacerbating Factors: None - Relieving Factors: Resolved spontaneously - Severity: Mild initially but noticeable loss of coordinationCASE EXPLANATION: TIA (Transient Ischaemic Attack) General Immediate Management: - Give 300 mg aspirin - Refer urgently (within 24 hours) to a stroke specialist clinician → they will then make a decision about whether imaging is necessary (MRI, CT) Further Management: + High Intensity Statins: atorvastatin 20-80 mg daily + Carotid Imaging - ex. carotid duplex ultrasound (only for candidates of carotid intervention) Key Points: - High risk of stroke – needs urgent assessment (ABCD² score sometimes used) - Common mimics: Migraine aura, focal seizures, hypoglycemia, ICH - Importance of early intervention (antiplatelets, BP control, lifestyle changes)QUESTIONS?Feedback Please take a minute now before you leave to fill in a quick feedback form! https://app.medall.org/feedback/feedback- flow?keyword=cf72c2d3320f449e64a53676&organisation=accessibil ity-in-medicineThank you for coming! If you have any more questions, feel free to email me us at s2018968@ed.ac.uk (Martina) or s2022461@ed.ac.uk (Emilia) or email accessibilityinmedicine@gmail.com Give our Facebook page a like for updates and opportunities, just search @AIMEdinburghSign up to the mailing list ▶ Sign up to the AIM mailing list to be the first to hear about tutorials, discounts, and opportunities! ▶ https://forms.gle/q JNyeoFzA9B5urND7Thank you to our sponsors
