Common cerebral histories

• Bilateral tight band sensation
• Recurrent
• Occurs late in day
• Association with stress

• Short painful attacks around one eye-Last between 30 minutes – 3 hours
• Occur multiple times a day for 1-3 months
• May have lacrimation and flushing

• Unilateral throbbing headache in trigeminal nerve distribution
• Last between few hours – days
• May have aura (usually visual)
• Need to lie down in dark room (photophobia)

• • 2 second paroxysms of stabbing pain in unilateral trigeminal nerve distribution

• Photophobia
• Neck stiffness
• Systemic symptoms, e.g. fever, non-blanching rash

• Very sudden onset severe headache
• ‘Like someone hit me with a brick over the head’
• Meningism

Many causes, e.g. tumour, idiopathic intracranial hypertension

• Worse in morning and with coughing and bending
• Vomiting and reduced GCS
• May have neurological symptoms/seizures
• History of malignancy/immunocompromise

• Venous sinus thrombosis
• Intracranial haemorrhages (intracerebral, subarachnoid, subdural)
• Infections (abscess, encephalitis, meningitis, viraemia)
• Spontaneous intracranial hypotension
• Pituitary apoplexy

• Unilateral throbbing pain
• Scalp tenderness and jaw claudication
• >55 years
• May have visual involvement

• Pain around one eye
• Swollen red eye
• Visual blurring and halos

• Facial pain exacerbated by leaning head forward
• Rhinorrhoea

• Hypertensive headache
• Hypoxia/hypercapnia
• Cervical spondylosis
• Pre-eclampsia
• Drugs (e.g. nitrates, PPI, caffeine, analgesia overuse, hormones)

• Attacks of sudden rotational vertigo
• Evoked by head turning
• Lasts ~30 seconds

• Often preceded by URTI
• Sudden rotational vertigo and vomiting
• Lasts several days but imbalance may persist
• May re-occur several times per year

• Often preceded by URTI
• Severe vertigo and hearing disturbance
• May have tinnitus, otalgia, nausea, fever

• TRIAD: vertigo + tinnitus + hearing loss
• Attacks last minutes-hours

• Acoustic neuroma (vestibular schwannoma)
• Chronic otitis media
• Eustachian tube dysfunction
• Ramsay-Hunt syndrome (vertigo, facial palsy, otalgia, zoster rash)
• Cholesteatoma

• Sudden onset
• Other neurological symptoms

• Sudden onset
• Other cerebellar symptoms

• Momentary vertigo attacks precipitated by neck extension
• Elderly with cervical osteoarthritis

• Neurological conditions (e.g. MS, epilepsy, brain tumour, migraine)
• Head injury
• Drugs, e.g. alcohol, salicylates, quinine, aminoglycosides, metronidazole, co-trimoxazole, diuretics

• Fall after transient arrhythmia
• May have had palpitations or felt strange before collapse
• Cardiac history or family history of sudden death
• May have occurred during exercise or when supine

• Collapse on exertion
• SOB worse on exertion

• Structural, e.g. hypertrophic obstructive cardiomyopathy, arrhythmogenic right ventricular dysplasia
• PE 
• Vertebrobasilar insufficiency (elderly with cervical osteoarthritis)

• Partial

  • Simple partial: focal motor seizure, no LOC
  • Complex partial (e.g. temporal lobe epilepsy): strange actions with impaired awareness

• • Tonic-clonic (grand mal): sudden LOC, limbs stiff then jerk, may become incontinent, bite tongue, feel awful with myalgia and confusion afterwards
  • Absence (petit mal): unresponsively stare into space for ~5 seconds (in childhood)
  • Atonic: all muscles relax and drop to floor
  • Tonic: all muscles become rigid
  • Myoclonic: involuntary flexion

TETRAD = rigidity + tremor + bradykinesia + postural instability

• Neurological symptoms, e.g. limb/face weakness, slurred speech, hemianopia
• LOC/syncope very uncommon

• Neuropathy e.g. MS
• Intracranial haemorrhage (extradural, subarachnoid, subdural)
• Drop attack (sudden leg weakness without warning/LOC/confusion)

• Occurs in response to specific stimuli, e.g. emotion/pain/fear/heat/dehydration/ prolonged standing
• Preceding nausea, feeling pale and sweaty
• Narrowing visual fields
• Then LOC for brief period

• Dizziness ± LOC on standing from lying
• Recently medication changes (e.g. antihypertensives)

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