Obtaining a history
Obtaining a concise and thorough current and pertinent past medical history is an important first step when presented with a patient that might have neurologic disease. The owner should be allowed to give you their version of the history in their own words. Try your best to interrupt only to guide the discussion back to relevant information or to clarify their comments. I recommend waiting to ask questions until the owner has finished their account of their pet’s history. Discourage the owner from telling you what the breeder or another veterinarian thinks is going on so that you can form your own opinion. Ask the owner to provide a detailed description of what they are observing in their pets at home, rather than stating a conclusion. For example, many owners come in thinking their pet is having seizures, but there are many episodic events that are frequently mistaken for seizures, such as syncope, narcolepsy-cataplexy, vestibular episodes, and others. The owner should also be discouraged from providing every minute detail about every disease the dog has ever had over the course of its entire life unless it’s relevant to the current clinical signs. For example, it’s important to know that a patient has been vomiting recently if the patient has a head tilt, but you don’t need to know about its episode of gastroenteritis 8 years ago.
Questions to ask the owner
- What are you seeing at home in your pet? Have the owner describe their pet’s clinical signs and not a possible diagnosis (e.g., seizure).
- When did the clinical signs start?
- Sudden or gradual onset?
- Progression of clinical signs?
- Speed of progression?
- Any trauma at onset of clinical signs?
- Has your pet ever had clinical signs like this before?
- Does your pet seem painful?
- Any exposure to toxins, human or pet medications, human food, plants, chemicals, insecticides/pesticides?
- Any recent travel history? Infectious organisms are frequently found more often in specific regions (e.g., Coccidioides immitis in the southwestern USA vs. Cryptococcus neoformans in the northeastern USA).
- Any other pets at home and are they showing similar clinical signs?
- If possible seizures or hereditary disorder, are there any similar clinical signs in the littermates or the line?
- What diagnostics have already been performed?
- What medications does your pet currently take (including doses and frequency)?
- What medications have you tried already for this condition? Did they help?
- What do you feed your pet? Toxoplasma, Neospora, Salmonella and other organisms can be transmitted through raw food.
- Any difficulty eating or drinking, such as gagging, retching, food falling out of the mouth, etc.?
- Any change in loudness or pitch of your pet’s voice?
- Is your cat indoors-only or indoor/outdoor? Indoor-only cats are less likely to have an infectious process than an indoor/outdoor cat, while indoor/outdoor cats are more likely to suffer a traumatic event.
- Is your pet up-to-date on vaccines? When were they most recently vaccinated?
- Is your pet eating, drinking, or urinating more or less often than normal? Pituitary and diencephalic disorders may cause these clinical signs.
- Any coughing or sneezing beyond an occasional recently?
- Any regurgitation, vomiting or diarrhea recently?
Important questions for possible seizures:
- Obtain a complete & accurate description of episode
- Have the owner describe the events in detail
- Frequency & duration
- Time of day
- Focal or lateralizing signs?
- Abnormalities after episode?
- Separates seizures from other paroxysmal episodes
- Abnormalities between episodes?
- Abnormalities between seizures indicate disease other than Idiopathic Epilepsy