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History taking in CNS
- 1. History taking in CNS Case Dr Isha Deshmukh Asst. Professor- Pediatrics GMC Mumbai
- 2. • Name • Age • Gender • Place • Informant • Reliability • Presenting complaints – Altered sensorium Convulsions / paucity of movements/ abnormal movements/ posture/ delayed milestones/ neuroregression/ headache/ vomiting
- 3. History of presenting illness • Onset --- Acute- head injury / stroke / acute infections • Subacute – infections with low virulence • Chronic – neoplastic disorders , degenerative disorders, demyelinating disorders • Paroxysmal – epilepsy, migraine, multiple sclerosis, periodic paralysis
- 4. Precipitating factors When did it start? What was the child doing when it started? • During sleep – cerebral thrombosis • Exertional activity – Embolism • Strain / stress – Hemorrhage • Following seizures- Todd’s palsy
- 5. Course Of Illness • Improves with time Thromboembolic manifestations • Static cerebral palsy • Deterioration Degenerative disorders / tumours • Total paralysis cerebral hemorrhage • Severity at onset • Ascending or descending paralysis
- 6. Associated Complaints • Fever • Convulsions History related to higher functions : Level of consciousness Recognition, whether recovered / deterioration Orientation – TPP Behaviour – change in behavior, interest in surroundings, physical activity, sleeping well Cognitive Functions- speech, language, intelligence Memory Emotional disturbances – incoherent talks, violent / apathetic behaviour, picking at clothes, abnormal movements
- 7. History related to sleep Sleep pattern H/o insomnia, excessive sleepiness h/o handedness H/O Cranial nerve Involvement : • Abnormal smell • Blurring of vision • h/o double vision • Drooling of saliva • Collection of food in cheeks • h/o deviation of angle of mouth • h/o tinnitus/ vertigo • h/o nasal regurgitation • h/o change in voice
- 8. History related to Motor system • Nutrition – h/o wasting/ thinning of muscles • h/o child being stiff / flaccid • h/o weakness – proximal / distal • h/o lack of co-ordination • h/o swaying or abnormal gait • h/o involuntary movements – slow or fast • h/o fasciculations
- 9. Increased tone • h/o stiffness • h/o difficulty in wearing diapers • h/o difficulty in holding the child on hip • h/o toe walking • h/o scissoring
- 10. Decreased tone • h/o floppiness • h/o slipping between mother’s hands • h/o increased range of movements in joints
- 11. h/o alterations in power Upper limbs Proximal – • h/o difficulty in lifting the arm above the head • h/o difficulty i combing the hair • h/o difficulty in taking objects from a height Distal h/o difficulty in writing h/o difficulty in buttoning h/o difficulty in dressing h/o difficulty with holding the spoon
- 12. • Neck whether child lifts head from bed • Trunk – roll over / getting up from supine position Lower limbs –proximal • h/o difficulty in getting up from supine position • h/o difficulty in climbing stairs Distal • Difficulty in holding slippers • Dragging of foot / tripping of toes
- 13. Sensory system • h/o root pain • h/o alteration in sensations • Cortical sensations • Lateral column sensations - crude touch, pain and temperature • Posterior column sensations – h/o altered sensation while walking on a cotton wool, h/o fall, h/o appreciation of joint movements
- 14. Cerebellar symptoms • h/o hypotonia • h/o ataxia • Titubation • Nystagmus • Staccato speech • Intention tremors • Change in hand writing • Tendency to fall
- 15. Autonomic system • h/o bladder and bowel disturbances • h/o skin flushing/ oedema/ pallor/ numbness/ coldness • h/o giddiness while getting up from sitting position • h/o palpitations • h/o salivary disturbances • h/o wheezing
- 16. Spine and cranium / complications: • h/o pain in back • h/o spinal deformities • h/o painful spinal movements • h/o increase or decrease in head size • h/o bedsores • h/o contractures
- 17. • H/O raised intracranial tension • Headache • Vomiting • Visual disturbances • Convulsions/ coma
- 18. Aetiological history • h/o diarrhoea / dehydration • h/o associated facial weakness • h/o trauma • h/o infections • h/o fever with convulsions • h/o painful neck movements • h/o delayed milestones • h/o regression or loss of milestones
- 19. History related to other systems • CVS – h/o palpitations, cyanosis, hypertension, fever • RS – h/o chronic cough, foul smelling sputum, respiratory distress, abnormal breathing pattern, paradoxical respiration • GIT – diarrhoea, dysentery, vomiting • Hematology – h/o bleeding, bony tenderness, fever, pain in fingers, hematuria • Musculoskeletal system – h/o wasting of muscles, loss of function
- 20. History of past illness • h/o similar illness in past • h/o TIA • h/o convulsions • h/o head injury • h/o ear infections • h/o rheumatic fever • h/o hypertension • h/o CVS disorders
- 21. • Treatment history – h/o repeated blood transfusions, h/o surgery, h/o cranial irradiation • h/o contact • Antenatal history – intrauterine infections, motor neuron diseases, prolonged labour • Birth history – nature of delivery , instrumental , h/o BA, h/o birth injury
- 22. Neonatal history • Fever , rash, petechial hemorrages,jaundice , cataract • h/o umbilical cord catheterisation, sepsis • h/o cyanosis, resp distress • h/o jaundice • h/o neonatal seizures • Poor feeding, decreased activity , lethargy
- 23. • Developmental history • Nutritional history • Immunization history • Personal history – sedentary habits, sports , activities • Family history – seizure disorder, neurologicsl degeneration, death , metabolic disorders, hypertension, migraine, stroke • Environmental h/o – viral encephalitis, lead poisoning
- 24. THANK YOU !!!!!