The document provides guidance on neurological history taking. It outlines the necessary prerequisites, proforma, goals, and descriptions for evaluating common neurological presentations such as headache, visual disturbances, loss of consciousness, seizures, speech and motor disorders, sensory changes, and alterations in mental state. Key areas of history include onset, duration, frequency and characteristics of symptoms, as well as family, personal, medical and medication histories. A thorough neurological examination aims to localize lesions in the nervous system and determine the nature of any pathology.

1. NEUROLOGICAL
HISTORY-TAKING
BY
DR. MANOJ KUMAR MAHATA
DM PDT NEUROLOGY

2. PRE-REQUISITE
Alertness of patient
Informant
Insight of patient regarding illness
Doctor-patient relationship
PROFORMA
Patient particulars ( name, age , sex, occupation,
area of residency, handedness)
Presenting illness
Past illness- medical/ surgical
Personal history- toxin exposure, birth history
Family history
Treatment history

3. GOAL OF HISTORY TAKING
First priority is to identify the region of nervous
system that is likely to be responsible for the
symptoms
Site of the lesion
Nature of the lesion
BASIC DESCRIPTION
Site
Severity
Onset ( acute, subacute, chronic )
Duration
Frequency
Precipitating/ Relieving factors
Time of occurrence

4. COMMON PRESENTATIONS
Headache
Visual disturbances
Loss of consciousness
Seizure
Speech disorder
Motor disorder
Sensory disorder
Cranial nerve disorder
Alteration of state of mind
Autonomic disorder
Sphincter disorder

5. HEADACHE
Site
Severity
Onset ( sudden/ gradual )
Frequency
Duration
Character
Time of occurrence ( e.g.morning )
Precipitating factors ( stooping / coughing )
Relieving factors
Associated features ( vomiting, visual
disturbances )

6. First attack or presence of previous attacks
- worst headache (SAH)
- persistent ( secondary headache)
Age of onset
- childhood to young adulthood ( primary
headache)
- older than 50 yrs ( secondary headache)
Activity at onset of headache
- Valsalva maneuver ( SAH, CSF leak)
- changes in posture (supine - ↑ICP , upright –
low CSF pressure headache)
- head trauma
- exercise – can precipitate migraine

7. Characteristics of headache
- severe headache : SAH
both primary & secondary HA may be
mild to severe
- timeframe : rapid onset – SAH, ICH
gradual onset – migraine(mins to days)
SDH, GCA(days to months)
- duration
- location
- quality : pounding/throbbing- migraine
boring sharp- cluster HA

8. - Associated symptoms :
• Fever , diaphoresis , chills & rigor
• nausea & vomiting – migraine, ↑ICP,
posterior fossa lesion
• Photophobia & phonophobia – migraine or
meningeal process
• Neck stiffness – meningeal process
• Changes in consciousness
• Focal neurological symptoms

9. VISUAL DISTURBANCES
Impairment of vision
Diplopia
Hallucinations ( formed / unformed)

10. IMPAIRMENT OF VISION
Maybe caused by problem in media or due to nerve
damage
Monocular
• acute transient – Amaurosis fugax
• subacute – maybe painful or painless
- optic neuritis
- AION – arteritic or non arteritic
- leber optic neuropathy
• Chronic – due to optic nerve compression
usually painless
Binocular
abrupt onset – ON – Devic’s disease, Foster
Kennedy syndrome
partial field loss – chiasmal damage, migraine,
degenerative disease

11. DIPLOPIA
MONOCULAR - due to aberration in ocular media
BINOCULAR – vertical/ horizontal diplopia
constant/ intermittent diplopia
ASSOCIATED SYMPTOMS
eye pain – orbital conditions
- distributed in V1 – cavernous
sinus / SOF
headache - ↑ICP, brainstem localisation
HALLUCINATIONS
due to migraines

12. LOSS OF CONSCIOUSNESS
Head injury – recent / previous
Sudden collapse – ICH , SAH
Limb twitching ,incontinence – epilepsy/post-
tictal
Alcohol/ drug abuse
Cardiovascular/ respiratory/ genitourinary
disorder
Acute/ gradual – mass lesion
Metabolic – diabetes
Psychiatric disorder - hysteria

13. HISTORY OF SEIZURES
• Obtain a description of the seizure/s:
• From patient and witness (NB blackouts, faints, fits,
loss of consciousness)
• What happens at the onset of the fit?
• What happens during the fit?
• Does the patient fall or remain standing or sitting?
• How does the fit end?
• Confusion or other post-ictal symptoms?

14. • Is there incontinence, any injury or tongue biting?
• Frequency of seizures?
• When do the seizures occur?
• What medication is taken?
• History of past/ current medication, compliance and
response to medication
HISTORY OF SEIZURES

15. • Change in seizure pattern
• Family history of seizures
• Head trauma or brain illness
(especially in adult onset epilepsy)
• Birth history
(especially in early onset seizures)
HISTORY OF SEIZURES

16. SYNCOPE
• Fainting or LOC resulting from recoverable loss of
adequate blood supply to the brain
• Vasovagal syncope - provoked by emotionally
charged event e.g venepuncture
• Cardiac syncope - sudden decline in cardiac output
and hence cerebral perfusion e.g severe aortic
stenosis or heart block

17. SEIZURE AND SYNCOPE
• Features helpful in distinguishing the two:
Seizure Syncope
1) Aura + -
2) Cyanosis + -
3) Tongue-biting + -
4) Post-ictal confusion,
headache and amnesia + -
5) Rapid recovery - +

18. SPEECH DISORDER
• Onset
• Frequency
• Duration
• Difficulty in articulation – dysarthria
• Difficulty in expression
• Difficulty in understanding

19. MOTOR DISORDER
 Lack of co-ordination – balance
 Weakness – unilateral / bilateral
- progressive/static
- distal/proximal(ability to lift
objects, grip strength, arising
from chair/bed, climbing stairs)
- painful/ painless
- diurnal variations
 Involuntary movements like twitching, jerks etc
 Wasting
 Limb stiffness
 Gait abnormalities – limping, leg dragging, waddling

20. SENSORY DISORDER
Pain
Tingling/ numbness
Loss of sensation
Trophic changes – ulcer/ neuropathic joint

21. CRANIAL NERVE DISORDER
 Loss of smell, vision, taste
 Difficulty in mastication , loss of sensation over face
 Deviation of angle of mouth; facial asymmetry;
epiphora
 Deafness/ tinnitus – unilateral/ bilateral
 Vertigo
 Balance/ staggering – direction
 Nasal intonation or regurgitation
 Difficulty in deglutition
 Change of voice
 Wasting of tongue / dysarthria
 Difficulty in neck movements

22. CHANGE IN MENTAL STATE
Changes in memory ( short / long term)
Alertness/ drowsiness
Loss of spatial orientation
Changes in mood, affect, loss of spontaneity
Ability to carry out daily routine activities

23. Autonomic disorder
• Palpitation
• Abnormal sweating
• Abnormal skin temperature
• Impotence
• Bladder dysfunction
• Nocturnal diarrhoea
• GI dysfunction- vomiting
• Orthostatic hypotension

24. SPHINCTER DISORDER
Difficulty in control – incontinence/ retention
Urinary retention ( spinal cord compression or
trauma)
Loss of awareness of bladder distension (
damage to frontal lobe)
Frequency, urgency, urge incontinence ( damage
to pons or spinal cord)
Overflow incontinence ( lmn)

25. Medical illnesses
• DM, hypertension, dyslipidemia
• Valvular heart disease
• Malignancy
• Coagulopathy
• Collagen vascular diseases
• Endocrinopathies
• Infectious diseases like HIV

26. FAMILY HISTORY
Hypertension , heart disease – stroke
Inherited disorder ( NF, Wilson’s Ds, CMT )
Detailed family history often necessary in
polygenic disorders such as MS, migraine, and
epilepsies.
PERSONAL HISTORY
Drug abuse – prescribed or illicit
Toxin exposure like alcohol, environmental or
industrial neurotoxins
Birth history

27. Drug history
• h/o sedatives, antidepressants and other
psychoactive medications in acute confusional
state
• Aminoglycosides use in neuromuscular disorder
• Anticancer drugs in peripheral neuropathy
• Immunosuppressive agents in encephalopathy
• Excessive vitamins uses
• OCPs, antihypertensives, anti-coagulants