A

• Altered Level of Consciousness (ALOC)

  • Definition: Any deviation from normal alertness, ranging from lethargy to coma.

  • Causes: Metabolic (hypoglycemia, hepatic encephalopathy), infections (meningitis, encephalitis), structural (stroke, trauma), toxins.

  • Clinical tip: Document onset, progression, associated symptoms, and response to stimuli.

• Ataxia

  • Definition: Lack of voluntary coordination of muscle movements.

  • Causes: Cerebellar lesions, vestibular disorders, sensory neuropathies, intoxications.

  • History point: Onset (acute vs chronic), progression, associated dizziness or weakness.

B

• Bell’s Palsy

  • Definition: Acute unilateral facial nerve (CN VII) paralysis.

  • History features: Sudden onset facial weakness, inability to close eye, loss of taste anterior 2/3 tongue.

  • Important: Differentiate from stroke by involvement of forehead muscles.

• Babinski Sign (History relevance)

  • Note: While a physical exam finding, ask about symptoms suggesting upper motor neuron lesions like spasticity or weakness.

C

• Cranial Nerve Deficits

  • History clues: Diplopia, facial numbness, hearing loss, dysphagia, hoarseness.

  • Common causes: Stroke, multiple sclerosis, tumors, infections.

• Confusion

  • Definition: Disorientation to time, place, or person.

  • Causes: Delirium (infections, metabolic derangements), dementia, intoxication.

• Convulsions (Seizures)

  • History: Type (generalized vs focal), aura, duration, post-ictal state, triggers.

  • Differential: Epilepsy, metabolic disturbances, structural brain lesions, infections.

D

• Dizziness

  • Definition: Sensation of spinning (vertigo) or lightheadedness.

  • Vertigo causes: Vestibular neuritis, Meniere’s disease, stroke.

  • Presyncope causes: Cardiac arrhythmias, orthostatic hypotension.

• Diplopia

  • Definition: Double vision.

  • Causes: Cranial nerve palsies, myasthenia gravis, brainstem lesions.

• Dysarthria

  • Definition: Difficulty articulating speech due to motor dysfunction.

  • Associated disorders: Stroke, Parkinson’s disease, motor neuron disease.

• Dysphagia

  • Definition: Difficulty swallowing.

  • Neurological causes: Stroke, myasthenia gravis, ALS, brainstem lesions.

E

• Extrapyramidal Symptoms

  • History clues: Tremors, rigidity, bradykinesia, postural instability.

  • Common diseases: Parkinson’s disease, drug-induced parkinsonism.

• Emotional Lability

  • Description: Involuntary or inappropriate emotional expression.

  • Seen in: Stroke, traumatic brain injury, pseudobulbar palsy.

F

• Fasciculations

  • Definition: Involuntary muscle twitches.

  • Significance: Suggest lower motor neuron disease (e.g., ALS).

• Focal Weakness

  • History: Onset, progression, associated sensory or cranial nerve symptoms.

  • Causes: Stroke, tumor, demyelination.

G

• Gait Disturbance

  • Types: Ataxic, spastic, parkinsonian, hemiplegic.

  • History points: Duration, progression, associated symptoms like falls or sensory loss.

H

• Headache

  • History: Onset (sudden vs gradual), quality, location, duration, frequency, associated symptoms (visual changes, nausea, neurological deficits).

  • Red flags: Thunderclap headache, worsening pattern, neurological signs (may indicate hemorrhage, tumor, meningitis).

• Hemiparesis

  • Definition: Weakness affecting one side of the body.

  • Common causes: Stroke, brain tumors, multiple sclerosis.

• Hypoesthesia

  • Definition: Reduced sensation.

  • Causes: Peripheral neuropathy, spinal cord lesions.

I

• Involuntary Movements

  • Types: Tremor, chorea, athetosis, myoclonus.

  • Disorders: Huntington’s disease, Parkinson’s disease, metabolic causes.

• Imbalance

  • Distinguish: Vestibular vs proprioceptive causes.

L

• Lethargy

  • Definition: Decreased alertness and energy.

  • Causes: Infection, metabolic disorders, CNS injury.

• Lightheadedness

  • Often due to cardiovascular causes but may overlap with neurological dizziness.

M

• Memory Loss

  • History: Onset, progression, types of memory affected (short-term vs long-term).

  • Causes: Alzheimer’s disease, vascular dementia, depression.

• Muscle Weakness

  • Details: Distribution (proximal/distal), symmetry, associated muscle pain or wasting.

N

• Numbness

  • Description: Loss of sensation or abnormal sensations like tingling.

  • Causes: Peripheral neuropathy, radiculopathy, CNS lesions.

• Nystagmus

  • History: Onset, triggers (head movement), associated vertigo.

  • Causes: Vestibular disorders, brainstem pathology.

P

• Paresthesia

  • Definition: Abnormal sensations such as tingling or pins and needles.

  • Causes: Peripheral nerve injury, vitamin deficiencies, multiple sclerosis.

• Paralysis

  • Complete loss of muscle function.

  • Differentiate upper vs lower motor neuron signs.

• Personality Changes

  • Associated with: Frontal lobe lesions, dementia, psychiatric disorders.

• Photophobia

  • Light sensitivity, common in meningitis and migraine.

R

• Restlessness

  • May indicate discomfort, medication side effects, or neurological agitation.

• Rigidity

  • Increased muscle tone seen in extrapyramidal disorders.

S

• Seizures

  • See convulsions.

• Syncope

  • Transient loss of consciousness due to cerebral hypoperfusion; neurological vs cardiac causes.

• Speech Disturbances

  • Includes aphasia (language impairment), dysarthria.

• Sensory Loss

  • Complete or partial loss; important to localize lesion.

T

• Tremor

  • Types: Resting (Parkinsonian), intention (cerebellar), essential.

  • History: Onset, progression, family history.

• Transient Ischemic Attack (TIA)

  • Brief neurological dysfunction without infarction.

  • History: Sudden onset focal symptoms resolving within 24 hours.

V

• Vertigo

  • See dizziness.

• Visual Disturbances

  • Types: Blurring, diplopia, vision loss.

  • Causes: Optic neuritis, stroke, increased intracranial pressure.

Additional History Tips

• Chronology: Onset (sudden vs gradual), progression, frequency (episodic vs continuous).

• Triggers and Relievers: Physical activity, stress, medications.

• Associated systemic symptoms: Fever, weight loss, rash (may indicate infections or autoimmune).

• Functional impact: Falls, difficulties with daily activities, cognitive changes.