History - Neurology

Neurology

·        UMN = Upper Motor Neuron, LMN = Lower Motor Neuron

History

·        Want to know the answer to two questions:

o  Where is the lesion (based on history and exam): Eg Weakness:

§  Upper motor neuron: motor cortex, internal capsule, brain stem or spinal chord

§  Lower motor neuron: nerve root, brachial/lumbosacral plexus, or peripheral nerve

§  Neuromuscular junction

§  Muscle

o  What is the lesion (based on history – mode of onset and progression)? Is it infarct, haemorrhage, inflammatory, tumour or degenerative

·        Differentials:

o  Inability to walk: Parkinson‟s, spinal chord (demyelination, compression, disease due to ¯B1₂ or syphilis), cervical spondylosis, polymyositis, myasthenia gravis, Guillain Barre, hereditary motor and sensory neuropathy, MS, diabetic neuropathy, motor neuron disease, alcoholic neuropathy

o  Brief loss of consciousness: Stokes Adams attacks, VT, postural hypotension, hysterical unconsciousness, vasovagal syncope (fainting), epilepsy, CVA

o  Coma and Stupor: hypoglycaemia, Wernicke‟s encephalopathy, sedative or narcotic drug overdose, post anoxic coma, CVA, status epilepticus, meningitis, encephalitis, delirium, coning.

o  Space occupying lesion: bleed, tumour, cyst, abscess, TB granuloma, AVMs, hydrocephalus