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History taking in CNS Case:

History taking in CNS Case Dr Isha Deshmukh Asst. Professor- Pediatrics GMC Mumbai

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Name Age Gender Place Informant Reliability Presenting complaints – Altered sensorium Convulsions / paucity of movements/ abnormal movements/ posture/ delayed milestones/ neroregression / headache/ vomiting

History of presenting illness:

History of presenting illness Onset --- Acute- head injury / stroke / acute infections Subacute – infections with low virulence Chronic – neoplastic disorders , degenerative disorders, demyelinating disorders Paroxysmal – epilepsy, migraine, multiple sclerosis, periodic paralysis

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Precipitating factors When did it start? What was the child doing when it started ? During sleep – cerebral thrombosis Exertional activity – Embolism Strain / stress – Hemorrhage Following seizures- Todd’s palsy

Course Of Illness:

Course Of Illness Improves with time  Thromboembolic manifestations Static  cerebral palsy Deterioration  Degenerative disorders / tumours Total paralysis  cerebral hemorrhage Severity at onset Ascending or descending paralysis

Associated Complaints:

Associated Complaints Fever Convulsions History related to higher functions : Level of consciousness Recognition, whether recovered / deterioration Orientation – TPP Behaviour – change in behavior , interest in surroundings, physical activity, sleeping well Cognitive Functions- speech, language, intelligence Memory Emotional disturbances – incoherent talks, violent / apathetic behaviour, picking at clothes, abnormal movements

History related to sleep:

History related to sleep Sleep pattern H/o insomnia, excessive sleepiness h/o handedness H/O Cranial nerve Involvement : Abnormal smell Blurring of vision h/o double vision Drooling of saliva Collection of food in cheeks h/o deviation of angle of mouth h/o tinnitus/ vertigo h/o nasal regurgitation h/o change in voice

History related to Motor system:

History related to Motor system Nutrition – h/o wasting/ thinning of muscles h/o child being stiff / flaccid h/o weakness – proximal / distal h/o lack of co-ordination h/o swaying or abnormal gait h/o involuntary movements – slow or fast h/o fasciculations

Increased tone:

Increased tone h/o stiffness h/o difficulty in wearing diapers h/o difficulty in holding the child on hip h/o toe walking h/o scissoring

Decreased tone:

Decreased tone h/o floppiness h/o slipping between mother’s hands h/o increased range of movements in joints

h/o alterations in power:

h/o alterations in power Upper limbs Proximal – h/o difficulty in lifting the arm above the head h/o difficulty i combing the hair h/o difficulty in taking objects from a height Distal h/o difficulty in writing h/o difficulty in buttoning h/o difficulty in dressing h/o difficulty with holding the spoon

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Neck  whether child lifts head from bed Trunk – roll over / getting up from supine position Lower limbs –proximal h/o difficulty in getting up from supine position h/o difficulty in climbing stairs Distal Difficulty in holding slippers Dragging of foot / tripping of toes

Sensory system:

Sensory system h/o root pain h/o alteration in sensations Cortical sensations Lateral column sensations - crude touch, pain and temperature Posterior column sensations – h/o altered sensation while walking on a cotton wool, h/o fall, h/o appreciation of joint movements

Cerebellar symptoms:

Cerebellar symptoms h/o hypotonia h/o ataxia Titubation Nystagmus Staccato speech Intention tremors Change in hand writing Tendency to fall

Autonomic system:

Autonomic system h/o bladder and bowel disturbances h/o skin flusing / oedema/ pallor/ numbness/ coldness h/o giddiness while getting up from sitting position h/o palpitations h/o salivary disturbances h/o wheezing

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Spine and cranium / complications: h/o pain in back h/o spinal deformities h/o painful spinal movements h/o increase or decrease in head size h/o bedsores h/o contractures

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H/O raised intracranial tension Headache Vomiting Visual disturbances Convulsions/ coma

Aetiological history:

Aetiological history h/o diarrhoea / dehydration h/o associated facial weakness h/o trauma h/o infections h/o fever with convulsions h/o painful neck movements h/o delayed milestones h/o regression or loss of milestones

History related to other systems:

History related to other systems CVS – h/o palpitations, cyanosis, hypertension, fever RS – h/o chronic cough, foul smelling sputum, respiratory distress, abnormal breathing pattern, paradoxical respiration GIT – diarrhoea, dysentery, vomiting Hematology – h/o bleeding, bony tenderness, fever, pain in fingers, hematuria Musculoskeletal system – h/o wasting of muscles, loss of function

History of past illness:

History of past illness h/o similar illness in past h/o TIA h/o convulsions h/o head injury h/o ear infections h/o rheumatic fever h/o hypertension h/o CVS disorders

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Treatment history – h/o repeated blood transfusions, h/o surgery, h/o cranial irradiation h/o contact Antenatal history – intrauterine infections, motor neuron diseases, prolonged labour Birth history – nature of delivery , instrumental , h/o BA, h/o birth injury

Neonatal history:

Neonatal history Fever , rash, petechial hemorrages,jaundice , cataract h/o umbilical cord catheterisation, sepsis h/o cyanosis, resp distress h/o jaundice h/o neonatal seizures Poor feeding, decreased activity , lethargy

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Developmental history Nutritional history Immunization history Personal history – sedentary habits, sports , activities Family history – seizure disorder, neurologicsl degeneration, death , metabolic disorders, hypertension, migraine, stroke Environmental h/o – viral encephalitis, lead poisoning

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