History taking or collecting of subjective data in a patient with neurological illness

1. Subjective neurological Assessment
Rebecca

3. Introduction
• Have a basic knowledge of the hierarchical
organization of the nervous system.
• Systems review
• Time consuming
• Use SOLER technique
• Use open ended questions
• Ideas, beliefs, expectations and concerns
• Clarity, rephrasing and paraphrasing
• No prompting – patient’s own words
• Pediatric history (immunization, milestones)
• History taking is an art
• Handling unenthusiastic patients

4. History
• Personal, Socio-economic, Marital
• Past and Present history
• Drug history
• Toxins
• Travel
• Occupation
• History of illness
• Presenting Complaints

5. • Age and Gender
• Symptom onset (e.g., acute, subacute,
chronic, insidious)
• Duration (short / intermediate / long)
• Course of the illness (eg, static,
progressive, or relapsing and
remitting)
• Associated symptoms, such as pain,
headache, nausea, vomiting, vertigo,
numbness, weakness, and seizures

6. Neurological Symptoms
• Pain / Headache
• Vomiting
• Seizures
• Visual Disturbances (diplopia, ptosis, proptosis)
• Partial or complete paralysis
• Muscle weakness
• Partial or complete loss of sensation
• Difficulty reading and writing
• Poor cognitive abilities
• Unexplained pain
• Decreased alertness
• Others – speech, smell, taste, hearing, vertigo

7. Pain
• Pain is a common symptom
• Headache / backache / neck pain /
• Brain lack pain receptors
• Trigeminal nerve and upper cervical nerves
• Location (Ask the patient to point with one
finger)
• Radiation (Pay attention to any dermatomal
relationship.)
• Onset
• Intensity

8. • Trauma history
• Severity or quantity (Estimate functional
limitation.)
• Precipitating factors (stress, periods,
allergens, sleep deprivation, etc)
• Relieving factors (sleep, stress
management, etc)
• Diurnal or seasonal variation
• Quality (stabbing, stinging,
lightning like, pounding, etc)

12. Seizures
History:
• Onset
• Diurnal variation
• Post-ictal phase
• Drugs
• Trauma
• Perinatal history
• Febrile convulsions
• Family history or any infections
• Triggers

13. Type of seizure (semiology)
• Tonic
• Atonic
• Clonic
• Versive
• Autonomic
• Dialeptic
• Gelastic

14. Visual DisturbancesMay be due to ocular, neurologic and
systemic;
• Onset
• Side
• Duration
• How it was first noticed
• H/o of diplopia
• Diurnal variation
• Painful / painless
• Drugs / Nutrition
• Metabolic diseases
• Visual acuity
• H/o trauma

15. Muscle Weakness
• A motor deficit can be because of cortical,
spinal, peripheral nerve related, neuro-muscular
junction or muscular disorder.
• Progression – non progressive and progressive
• Which limb – mono, para and tetraplegia
• Spasticity / Flaccidity
• Endurance
• Bed ridden status
• Breathing difficulty
• Trauma
• Metabolic

16. Gait
• Both neurologic and orthopedic problems
may impair the gait of a person.
• Onset
• Stance
• Character
• Irregular surface – sensory problems
• Pain
• Drug intake
• Family history

18. Common Causes
FISH SHAPED
• F - Fainting
• I - Infantile convulsions
• S – Shock
• H – Head injury
• S – Stroke
• H – Heart attack
• A – Asphyxia
• P – Poison
• E – Epilepsy
• D - Diabetes

19. • Was it witnessed? Try to get answers
from a witness.
• When did this happen?
• • What happened beforehand?
• • Did you know you were going to lose
consciousness?
• • How long were you unconscious for?
• • Did you hurt yourself?
• Did you hit your head?

20. • What were you doing at the time?
• Were you watching TV or flashing lights?
• Were there any visual or sensory changes?
• Did you wet yourself? Did you bite your tongue?
Epileptic fit
• Were you coughing? Cough syncope
• Were you passing urine? Micturition syncope
• Were you turning your head? Carotid hypersensitivity
• Were you standing up? Postural hypotension
• Were you exerting yourself, e.g. climbing stairs?
Cardiac valve abnormality
• Did you have a warning? Any palpitations?
Arrhythmia

21. OTHERS
• Dysphagia
• Dysphasia
• Numbness / tingling
• Tremors / muscle twitching
• Vertigo / dizziness
• Sensory deficits (smell, hearing, taste,
touch)
• Unexplainable loss of weight, tiredness,
weakness)