ppt

1. The Neurologic History
Presenter: Dr. Abebe Gelaw (NR-II)
Moderator: Dr. Guadie (Consultant Neurologist)

2. Outline
• Introduction
• Identification
• Chief complaint
• History of Present Illness
• Past medical History
• Family History
• Social History
• Review of System

3. Introduction
• The Neurologic history is the cornerstone of Neurologic diagnosis.
• A skillfully taken history will frequently indicate the probable diagnosis
• In many common neurologic disorders, the diagnosis rests almost entirely on the
history.
• The most important aspect of history taking is attentive listening.
• Ask open-ended questions and avoid suggesting possible responses.
• The physician should present a friendly and courteous attitude, center all his
attention on the patient, appear anxious to help, word questions tactfully, and ask
them in a conversational tone

4. cont…
• History taking is an opportunity to establish a favorable patient-
physician relationship
• It can be learned partly through reading and study, but it is honed only
through experience and practice.
• The history is best taken in private, with the patient comfortable and at
ease.

5. The clinical data obtained by a careful history and physical
examination are used to address three questions:
1. What anatomic structures of the nervous system are affected?
2. What is the nature of the neurologic disorder?
3. What are the most likely etiologies for the patient's illness?

6. Identification
• Name
• Age
• Gender
• Ethnicity
• Socioeconomic status
• Handedness

7. Present complaint and Present Illness
• The usual starting point of the diagnostic process
• The complaints serve to focus attention on the questions to be
addressed in taking the history and provide the first clue to the
anatomy and etiology of the underlying disease
• Record the chief complaint in the patient’s own words
• Establishing the temporal severity profile of each symptom reported
by the patient.

8. • Temporal course of illnesses and characterization of symptoms:
location, quality, duration, severity, frequency, inciting event,
associated symptoms, relieving factors, natural course/progression
• Corroboration of the history by others
• In neurologic patients, particular attention should be paid to
determining the time course of the illness, as this is often instrumental
in determining the etiology.

9. cont…
• An illness might be static, remittent, intermittent, progressive, or
improving.
• Trauma and vascular events-Abrupt onset followed by improvement with
variable degrees of recovery
• Degenerative diseases-have a gradual onset of symptoms and a variable rate of
progression
• Tumors-have a gradual onset and steady progression of symptoms

10. cont…
• Infections usually have a relatively sudden, but not precipitous, onset.
• Common or Concerning Symptoms
Headache
Dizziness or vertigo
Weakness (generalized, proximal, or distal)
Numbness, abnormal or absent sensation
Fainting and blacking out (near-syncope and syncope)
Seizures
Tremors or involuntary movements

11. cont…
• What brought you here today?
• What sort of problems are you having?
• When, where, and how did it start?
• What things worsen or relieve your symptoms?
• What associated symptoms do you have?
• How does it progress? Worsening, improving, similar, or episodic,
response to treatment?

12. Past medical History
• It is important because neurologic symptoms may be related to
systemic diseases.
• Any systemic disease in the patient's background.
• Common disorders, such as hypertensive vascular disease or
diabetes mellitus
• Hospitalizations

13. cont…
• Operations, accidents or injuries, particularly head trauma;
• Infectious diseases, venereal diseases
• Allergies and other drug reactions
• A history of Malignancy
• History of the patient’s birth and early development is pertinent,
including any complications of pregnancy
• Current medications patient taking

14. Family History
• Important for heredofamilial disorders
• Family size
• Carcinomas, DM, HTN, cardiovascular diseases
• Migraine, epilepsy, cerebrovascular diseases, movement disorders,
myopathy, and cerebellar diseases
• FH of alcoholism and other types of substance abuse

15. cont..
• It is sometimes necessary to inquire about the relationship between the
parents, exploring the possibility of consanguinity.

16. Social History
• Marital status
• Employment history
• A travel history is important
• A history of personal habits like alcohol,…

19. cont…
• Interpretation of AUDIT-C(3 components);
• 0- no alcohol use
• Positive: 4 or more in male and 3 or more in female
• Interpretation of AUDIT(10 components)

20. Review of System
• Detect symptoms involving other systems of that the patient may not
spontaneously complain but that provide clues to the diagnosis of the
presenting complaint.
• Useful after exploring the present illness to uncover relevant
neurologic complaints.
• Can be done by questionnaire in outpatients or during the physical
examination

21. Retaking The History
• whenever the diagnosis is in doubt
• The attending effect
• Forgetfulness during first encounter
• Sicknesses, in pain or inattention during first evaluation
• Detection of new symptoms developed

23. Reference
• DeJong The Neurologic Examination 8th ed
• Bradley Neurology in clinical Practice 7th ed
• Merritt Neurology 2016
• Harrison principles of Internal Medicine 20th ed

24. THANK U

25. Pedigree
•Ancestral line of descent especially as diagrammed on a chart to show
ancestral history used in genetics to analyze inheritance
• Should be centered on the patient.
• When the patient is an adult, it will extend upward to include parents,
aunts, uncles, and grandparents; laterally to include siblings and
cousins; and downward to include children and grandchildren.
• If the patient is a child, it usually extends upwards to the grandparents.

26. • Use of family history to assess genetic risk — Key factors that suggest the
presence of a genetic disorder include the following:
• Multiple affected individuals in multiple generations from either side of the
individual's family.
• Disease occurrence at an earlier age than usual.
• Close degree of relatedness (ie, first- or second-degree relative) between
affected relatives and the individual.

27. • Presence of associated conditions in the family. Examples include breast
and ovarian cancer or colorectal and endometrial cancer.
• Atypical presentations of common conditions. Frequently, this involves
greater severity than commonly seen, such as bilateral breast cancer or
breast cancer in a male relative.
• Presence of consanguinity. Conditions caused by rare recessive mutations
are more common in families in which related individuals such as first
cousins have children. Consanguinity is generally more relevant in prenatal
and pediatric evaluations than for adult-onset conditions