Loss of coordination Ask the patient to explain what they mean. Is it difficulty walking? Is it being clumsiness? Is it problems with fine motor skills? Is the problem withstanding up, walking or both? Are there any specific movements or tasks that are particularly difficult? Is the coordination loss affecting arms, legs or both? Is one side of the body affected more than the other or are both evenly affected? Time questions Onset Offset Constant or episodic? If episodic: How often does it happen? How long does it last for? Progression Anything like this before? Can you think of might have caused it? Did anything in your life around that time change? How has it been affecting your life? Does anything make it better? Does anything make it worse? Associated features: Speech issues Weakness Numbness or tingling Dizziness and fainting Vertigo Tremors or involuntary movements Visual changes Speech issues Swallowing issues Any falls as a result Generalised fatigue or tiredness? Medications history Prescription Non-prescription Medical history Allergies and vaccinations Surgical history Family history Social history Diet Smoking Alcohol Recreational drugs Occupational Under stress Recent travel Differentials Cerebellar ataxia Unsteady gait Truncal ataxia Limb ataxia with dysmetria Intention tremor Dysdiadochokinesia Dysarthria Oculomotor dysfunction including nystagmus GBS Bilateral (usually) limb involvement Paraesthesia -> stocking glove distribution Hyporeflexia Back and limb pain Cardiac arrythmias -> fluctuating blood pressure Urinary retention Intestinal dysfunction Respiratory failure (if respiratory muscles are involved) Cranial nerve involvement -> facial diplegia. Bilateral facial nerve involvement. Stroke Heavy metals E.g. lead. Alcohol abuse Hypothyroidism Diabetes MS Optic neuritis Usually unilateral Painful Impaired vision and colour blindness Demyelination of spinal cord tracts: Sensory loss. Cerebral involvement Poor postural control Scanning speech Nystagmus Intention tremors CN palsies Diplopia Fascial palsy Trigeminal neuralgia (bilateral). Autonomic dysfunction Bowel and bladder neurogenic disorders Urinary incontinence Impaired sexual function Changes in mental state Depression Emotional changes Memory deficits Impaired concentration. Uthoff phenomenon Reversible exacerbation of neurological symptoms following an increase in body temperature e.g. physical excretion, warm bath and fever. Brain tumours Vestibular causes Hepatic encephalopathy Uraemia Friedreich’s ataxia Progressive ataxia Nystagmus Dysarthria Dysphagia Hypertrophic cardiomyopathy Personality changes DM ALS Asymmetric limb weakness. Often beginning with weakness in the hands and feet. Fasciculation Cramps Muscle stiffness Split hand sign Pseudobulbar palsy with pseudobulbar affect may develop Respiratory failure Dysphagia Neurosyphilis Subacute stroke Paretic neurosyphilis Chronic Progressive meningoencephalitis -> widespread cerebral atrophy and major neurocognitive disorder. Bilateral miosis -> argyll Robertson pupil Tabes dorsalis -> demyelination of the dorsal columns and dorsal root ganglia Impaired proprioception Absent deep tendon reflexes. Dysesthesias: Loss of sensations -> mainly at the lower extremities Sharp and shooting pain Charcot’s joint ->joint pain due to bone degeneration that is precipitated by conditions results in loss of sensation