Click for pdf: neurological history
- Parents and guardians are often very worried about the seriousness of their child’s illness.
- It is important to put the child and caregiver at ease and present an empathetic demeanor.
- Establish expectations, understanding and fears regarding the child’s presentation.
- History is crucial for evaluation of a child with a suspected neurologic problem.
- Children 3 or older should be encouraged to participate in providing the history.
- History in children is always a composite of the parent/guardian and the child’s input.
- Be sure to confirm and clarify symptoms ie. dizziness could be lightheadedness, confusion, vertigo, weakness, etc.
- Elicit a succinct reason that prompted the parents and child to seek medical attention
|History of presenting illness
- detail the onset, duration, frequency, character, palliating and provoking factors, and associated symptoms
- Focused review of systems relevant to chief complaint
- Infection: fever, nuchal rigidity, rash, seizures
- Family history of muscular disorders, consanguinity
- Progressive hypotonia?
- Limbs affected
- Developmental milestones
- Duration, frequency
- Infection: Fever, rash, diarrhea, vomiting, sore throat, nasal discharge, cough
- Changes in consciousness, focal vs generalized
- Underlying medical conditions
- Timing of seizure relative to fever (if present)
- Presence of a postictal phase?
- Breathing difficulties
- Infection: fever, nuchal rigidity, rash, nausea, vomiting, diarrhea
- Severity and impact on function (absence from school?)
- Worst headache ever experienced?
- Migraine symptoms
- Presence of an aura
- Changes in consciousness
- Personality changes, visual disturbances,
- If seizure lasts > 30 minutes without child regaining consciousness = status epilepticus and should be managed accordingly
- Benign febrile seizures < 15 minutes
- try to obtain history of headache (especially pain) directly from child
- progressively worse headache may suggest increasing intracranial pressure/space-occupying mass
|General review of systems
- The review must include all of the organ systems because neurological function is adversely affected by dysfunction of many systems, including the liver, kidney, gastrointestinal tract, heart, and blood vessels
- Include sleep habits, diet, bowel and bladder habits, activity level, personality, and mood
- Failure to thrive
- Altered/decreased level of consciousness
- Weight loss
- Persistent vomiting
- Severe headache
- Muscular weakness
- Any focal neurological deficit
|Past medical history
- General medical conditions
- Past surgeries, emergency visits, hospitalizations
Review of pregnancy, labor and delivery
- Important – especially if congenital disorder is suspected
- Prenatal history
- Infections (rubella, HIV, syphilis)
- Comorbidities + complications (pregnancy-induced HTN, gestational diabetes)
- Screening test results (ultrasound, amniocentesis, etc)
- Toxin, alcohol, cigarette, illicit drug use, medication exposure
- Delivery and birth history
- Birth weight, length, head circumference, Apgar score, NICU stay, ventilator assistance, neonatal seizures, jaundice
Developmental History (see table)
- Assess presence of developmental delay
- Global or specific (ie. isolated motor delay)
- Onset, timing, progression of developmental delay
- Delay at birth or early in development
- Delay in infancy and childhood
- Personality before and after onset of symptoms
- Academic performance before and after onset of symptoms
- Loss of skills (regression) over time suggests an underlying degenerative disease
- Information from teachers or kindergarten staff may be helpful regarding academic performance and social skills
|Medications – dose, frequency, indication, response, side effectsAllergies – document nature of reaction
- Extremely important
- Parents may be unwilling to discuss neurological disorders that run in the family openly
- Neuromuscular diseases often have a strong familial component
- Living conditions (caregivers, neighborhood)
- Support system
- Exercise habits
TABLE Screening Scheme for Developmental Delay: Upper Range
|Supports weight on forearms
||Opens hands spontaneously
||Shows likes and dislikes
|Pulls to stand
||Plays pat-a-cake, peek-a-boo
|Walks with one hand held
||Releases an object on command
||Comes when called
||1–2 meaningful words
|Walks upstairs with assistance
||Feeds from a spoon
||Mimics actions of others
||At least 6 words
||Builds a tower of 6 blocks
||Plays with others
||2–3 word sentences
- Berstein D, Shelov SP, editors. Pediatrics. Baltimore: Williams and Wilkins;1996.
- Behrman RE, Jenson HB, Kliegman RM, Stanton BF. Nelson Textbook of Pediatrics. 18th ed. Elsevier; 2007.
- Bradley WG, Daroff RB, Fenichel G, Jankovic J. Neurology in Clinical Practice. 5th ed. Butterworth-Heinemann; 2008.
Written by: Bing Wei Wang
Edited by: Katherine Muir
Last updated on November 14, 2011 @2:09 pm