P year‎ > ‎Neurology‎ > ‎

12.10.30 Teaching notes

Headache Hx
  • How long have you had headaches?
  • How often do you have headaches?
    • Are they becoming more frequent?
    • If daily, how long have they happened every day?
  • Where in the head are they?
  • What quality do they have?
    • e.g. pressing, throbbing, pounding etc.
  • How long do they last?
  • Are there any visual or sensory symptoms, if so how long do they last?
  • Is the headache associated with nausea or aversion to light (photophobia)?
  • Do you take medications for the headaches including painkillers?
    • c.f. medication overuse

Blackout Hx
  • How many attacks have you had?
  • When did they start?
  • What were you doing when the attack started?
  • Where you standing or seated/ lying when the attack started?
  • Was there any warning, or did the attack come on suddenly?
  • What was the warning like?
  • What happened next?
  • Was there a witness?
    • Establish if the patient actually collapsed to the floor / lost consciousness
  • Did you shake? For how long?
  • How long did it take to recover?


  • Spasticity affects the agonist, Rigidity is in both
    • => Systematically check both directions at each joint
  • Pyramidal signs
    • Upper limb extensors
    • Lower limb flexors
  • Types of spasm
    • Adductor (cross legs)
    • Flexor (bend legs)
  • Corticospinal tract:
    • Goes through the internal capsule
    • Crosses at the medulla
  • Drugs linked to myopathy
    • Steroids
    • Statins
  • Myopathy tends to be proximal + symmetrical