History Taking in CVA [ Dr Chandra]

Chief complaint:
Presenting with weakness (commonly)
Identify risk factors
-

Hypertensive
Diabetic
Obese
Metabolic syndrome
Chronic smoker
Hx of stroke prior

Weakness
-

State the onset - exact time of occurance and not time arriving at the hosp
( for thrombolysis purposes)
Whether it is progressive or sudden
Which limb affected first
Any specific distribution neurological deficits (distal proximal suggestive of
LMN)
Description weakness painful? Heaviness?
Severity able to move a bit/not at all
Is it equally affected among limbs
Any evolution progressively worsening neurological deficit after onset
Assoc with sensory disturbances could the patient feel the clothes that they
are wearing/ feel hot cold or touch
Is there any wasting prior (suggestive of LMN)
Is there any abnormal movements ie fasiculations (LMN), any discoordination
(cerebellar involvement)
Episode ? 1st? recurrent?

Association
-

Assoc with any LOC if there is ask whether the head was injured during fall
Assoc with changed behavior, abnormal behavior loss of memory (short/long)
Assoc with any seizure ask for jerky movement/uprolling the eyeball
incontinence/aura
Assoc with meningsm symtoms: headache, photophobia, vomiting
Any assoc with headaches if there is describe according to SOCRATES
Assoc with fever high grade chills and rigors
Any hyper or hypoglycemic symptoms
Cortical symptoms
Aphasia and dysartheria
o Was it comprehensible
o Was it sensible
o Was it appropriate

Cranial Nerves
-

I [ask whether pt has anosmie/ smell disturbances]

II , III, IV, VI[ any visual prob, blurring or double vision or loss of visual field]
V, VII, X, XII [ can the patient masticate, swallow/eat or any drooling of
saliva]
V sensory [ cn u still feel hot and cold]
VIII any hearing problem ie tinnitus/reduction or
XI can he/she turn their heads left to right

Autonomic nervous system

-

Ask for postural hypotension

Bowel and bladder routine and control
Sweating

History
-

Recent fever/ infection (LMN post viral /meningitis encephalitis )

History of recent trauma (ICB)
Previous history of CVA
Recent MI risk
On any coagulation drugs/coagulation disorder (liver failure)? bleeding
tendancies. Easily bruising? Bleeding through gums - imp when to start
thrombolysis/ in case of heamorrahgic stroke

Systemic review (look for signs on new onset HPT and also symptoms of DM)
Cardiology

Look for AF
Aneurysm
Valvular problems
(that could be form as
embolus)
Look for cardiac
complications of HPT

Renal

Renal failure
(pt mungkin have
undiagnosed HPT kan
present renal failure

Palpitations
Chest pain
SOB
PND
Orthopnea
Bilateral ankle swelling
Stigmata of IE

Lethargy
Anemia SOB, dizziness, pale
Reduce urine out put
Pathological fracture

Endorcrine

Hypergylcemia
New onset diabetes

Polyphagia
Polydypsia
Polyuria
Nocturia

Addition
Social support
-

Occupation
Income
Children
Housing [type: double storey terres/single storey terres]
Rooms? Any in ground floor? Is it equipt with a toilet
How many people are living in the house nuclear family? Extended family
Anyone smoking in the house
Is the house near to a main road/ factory (independent factor)

Diet History