1. Headache, face pain
2. Faints, seizures
3. Dizziness, gait, deafness
4. Limb sensation, weakness
5. Tremor, speech
6. Past medical, surgical history
7. Family, social, drug history
8. Systems

Headache

• Unilateral, photophobia, preceded by flashing lights (classical migraine).
• Photophobia, fever, stiff neck (meningitis).
• Supraorbital, rhinorrhea, lacrimation, in bouts, flushing (cluster headache).
• Occiput, neck stiffness (spondylosis).
• Worse in morning, drowsy, vomit (raised ICP).
• Over temporal artery, blurred vision (temporal arteritis).
• Over cheeks or forehead (acute sinusitis).
• Thunderclap then later diffuse (SAH).
• Bilateral, recur often, tightness over an area (chronic tension headache).

Face pain

• SOCRATES (trigeminal neuralgia, temperomandibular arteritis, glaucoma, internal carotid aneurysm, superior orbital fissure syndrome).

Faints

• Blackouts, conscious (TIA).
• Sensations before fainting (hypoglycemia):
  • Sweating.
  • Weakness.
  • Confusion.

Seizures

• Abrupt loss of consciousness, preceded by aura, incontinent, tongue bitten (grand mal).
  • Epileptic attacks causes: lights, syncope, tumour, abscess.
  • Complex: unconscious. Simple: conscious.
• In children, idiopathic, no major movements, staring (petit mal).

Dizziness

• Deafness, tinnitus (ototoxic drugs).
• 50yo, triad of vertigo, tinnitus, deafness (Meniere's).
• Diplopia, atataxia (vertebrobasilar TIAs).

Gait

• See Gait.

Deafness

• See CN VIII.

Limb sensation, weakness

• Pins and needles in hands or feet (peripheral neuropathy):
  • Site: nerve distribution.
  • Timing: worse at night.
  • Alleviating: by dangling arm over bedside.
• Weakness (lesions). See UMNL vs. LMNL Reference.

Tremor

• Intention tremor (cerebellar).
• Resting tremor or chorea (Parkinson's).
• Action tremors (BAT:  Benign essential tremor syndrome, Anxiety, Thyrotoxicosis).

Speech

• See Speech.

Past medical, surgical history

• Meningitis, encephalitis.
• Spinal injury.
• Epilepsy, convulsions.
• Cerebrovascular dz risk factors.
• Depression [very common in chronic neurological dz]. See Depression.
• Prior operations.

Family history

• Similar symptoms in a family member (transmissible or neurotoxin).
• Huntington's.
• Other heritable neurological dz.

Social history

• Smoking: ever smoked, how many per day, for how long, type [cigarette, pipe, chew] (esp. cerebrovascular dz).
• Alcohol (Wernicke-Korsakoff).
• Occupation, exposure to neurotoxins (eg heavy metals).
• Who is with you there at home [important for neurological dz, since caregiver often needs to help significantly].
• Home: upper floor apartment, stairs, bath (mobility concerns).
• Assess ability to care for self.

Drug history

• Anticonvulsants.
• OCP.
• Anti-HTN.
• Steroids.
• Antiplatelets, anticoagulants.
• Anti-parkinsonism drugs.
• Cholinergics, anticholinergics.
• Recreational drugs [very important for neurological].
• Allergies. If allergic to drug, make sure not an allergy, not just a common side-effect.

Systems

• Difficulty eating (dysphagia).
• Cardiovascular symptoms (cerebrovascular dz).
• Back problems (spinal cord impingement).

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