History Taking in CVA (HOPI Dr Chandra)

History Taking in CVA [ Dr Chandra] Chief complaint: Presenting with weakness (commonly) Identify risk factors -

Hypertensive Diabetic bese !eta !etabo boli lic c syndr yndro ome Chronic sm smoker H" of of st stroke pr prior

#eakness -

$tate $tate the the onset onset - e"act e"act time of occ%r occ%rance ance and not time arriving arriving at the the hosp hosp ( for thrombolysis p%rposes) #het #hethe herr it is pr progr ogressi essive ve or or s%d s%dde den n #hich ich lim limb b a&e a&ect cted ed 'rs 'rst ny spec speci'c i'c dist distrib rib%ti %tion on ne%r ne%rolo ologic gical al de'cit de'cits s (dista (distall  pro"imal s%ggestive of !*) Descr Descript iption ion +weakn +weakness ess,,  painf% painf%l. l. Heav Heavine iness ss. . $eve $everi rity ty  able able to to move move a bit/ bit/no nott at at all all Is it e0%a e0%all lly y a&e a&ect cted ed amon among g lim limbs bs ny evol%t evol%tion ion  progre progressiv ssively ely worsen worsening ing ne%rolog ne%rological ical de'cit de'cit after after onset onset ssoc ssoc with with sensor sensory y dist%rb dist%rbance ances s  co%ld co%ld the the patient patient feel the the clothes clothes that they they are wearing/ feel hot cold or to%ch Is ther there e any any wast wasting ing prior prior (s% (s%gge ggest stive ive of !*) !*) Is there there any abnor abnormal mal movement movements s ie fasic fasic%lat %lations ions (!*)1 (!*)1 any discoor discoordina dination tion (cerebellar (cerebellar involvement) 2pisode . 3st. rec%rrent. 

ssociation -

ssoc ssoc with with any C  if ther there e is ask ask whethe whetherr the head was in4%red in4%red d%ring d%ring fall fall ssoc ssoc with with change changed d behavior behavior11 abnorm abnormal al behavi behavior or loss loss of of memory memory (short/l (short/long) ong) ssoc ssoc with with any any sei5% sei5%re re  ask ask for 4erky 4erky movement movement/%pr /%prolli olling ng the the eyebal eyeballl incontinence/a%ra ssoc ssoc with menings meningsm m symtom symtoms: s: headache headache11 photo photophob phobia1 ia1 vomiting vomiting ny assoc assoc with with headac headaches hes  if there there is describe describe according according to $C6 $C672$ ssoc ss oc with with fever fever  high high g gra rade de chil chills ls and rigor rigors s ny n yh hyp yper er or hypo hypogl glyc ycem emic ic symp sympto toms ms Cortical sy symptoms pha p hasi sia a and and dysa dysart rthe heri ria a o #as it comprehensible #as it sensible o o #as it appropriate

Cranial *erves -

I 8ask whether pt has anosmie/ smell dist%rbances9 II 1 III1 I1 I8 any vis%al prob1 bl%rring or do%ble vision or loss of vis%al 'eld9 1 II1 ;1 ;II 8 can the patient masticate1 swallow/eat or any drooling of saliva9  sensory 8 cn % still feel hot and cold9 III  any hearing problem ie tinnit%s/red%ction or ;I  can he/she t%rn their heads left to right

%tonomic nervo%s system -

sk for post%ral hypotension
History -

6ecent fever/ infection (!* post viral /meningitis encephalitis ) History of recent tra%ma (IC<) Previo%s history of C 6ecent !I  risk n any coag%lation dr%gs/coag%lation disorder (liver fail%re).  bleeding tendancies= 2asily br%ising.
-

$ystemic review (look for signs on new onset HP7 and also symptoms of D!)

Cardiology

ook for > ne%rysm alv%lar problems (that co%ld be form as embol%s) ook for cardiac complications of HP7

6enal

6enal fail%re (pt m%ngkin have %ndiagnosed HP7 kan present renal fail%re

Palpitations Chest pain $< P*D rthopnea
ethargy nemia  $<1 di55iness1 pale 6ed%ce %rine o%t p%t Pathological fract%re

2ndorcrine

Hypergylcemia *ew onset diabetes

Polyphagia Polydypsia Poly%ria *oct%ria

ddition $ocial s%pport -

cc%pation Income Children Ho%sing 8type: do%ble storey terres/single storey terres9 6ooms. ny in gro%nd ?oor. Is it e0%ipt with a toilet How many people are living in the ho%se n%clear family. 2"tended family nyone smoking in the ho%se Is the ho%se near to a main road/ factory (independent factor)

Diet History