Neurological history taking(+ how to write a helpful letter)

Dr Naomi Warren

Consultant neurologist

RVInaomi.warren@nuth.nhs.uk

History Key to diagnosis Essential skill Key areas in brief appt:

Main symptoms Previous neurological events Relevant PMH and Ix Relevant medication

Main Symptoms Onset – how + when Progression Details of symptoms

Eg site/character headache Funny dos – before/during/after

Relevant associated features Important negatives

Eg visual symptoms with headache Stiffness/slowness with tremor

Previous neurological events Headache

Any headaches when younger ?Multiple sclerosis

Any previous episodes visual loss/vertigo Blackouts

Any febrile seizures/HI? Previously seen by neuro + why?

Investigations/Meds Investigations

Scans/eeg/ncs – esp if many years ago Medication

With doses of relevant drugs Previous meds eg failed drugs in headache, antipsychotics

if parkinsonism

Letters to Neurology

History as described Relevant examination What question are you asking us? Patients expectations/worries

Good: Clear description events, Relevant Ix,Not included: relevant PMH + meds, question?

Good: description,previous meds + mgmt, relevant PMH and examination, relevant Ix, question.

Summary Detailed history is key to diagnosis Time course and pattern Communicate relevant background What is the question?