Self Test/Neurological Questionnaire

Self Test for Neurological Problems

Below are various regions of the brain. Listed under each region are physicial and/or behavioral problems caused by a malfunction in that region of the brain.

More than one region of the brain may be malfunctioning at a time.

PLEASE CHECK those symptoms you currently have or have experienced, possibly warning of brain or complex neurological problems?

FRONTAL CORTEX

Problems urinating more or less frequentlyNoticed an change in ability to concentrate or personalityExperienced blurred or double vision when reading or with eye movementsProblems with hand dexterity, writing, and holding on to objects, etc.

ANTERIOR CINGULATE: Neurobehavioral

(HIGH): (All ANS regulation)Patient demonstrated anxiety type personality or disordersPost traumatic syndrome disorder (PTSD) historyOCD ( obsessive-compulsive disorder ) spectrum historyPatient presents with abnormal eating habits or eating disorder

BASAL GANGLIA: Neurobehavioral

(HIGH)Increase in anxiety or panic in the patientPatient avoids conflict in life excessivelyPatient is pessimistic and always predicts worse scenarios in lifePatient presents with excessive motivation personality

(LOW)ADHD (attention deficit-hyperactivity disorder ) type syndromesDecreased motivation personalityMovement disorders such as Parkinsonism

PARIETAL CORTEX: sensory perception problems

Experiencing numbness in the upper or lower extremitiesNotice chronic area(s) of pain in body not leaving, fibromyalgia syndromesNeurobehavioral: poor sense of direction. Eyes do not track objects (double vision)

TEMPORAL CORTEX: loss of smell or taste on one or both sides

Patient noticed a ringing or hum in the ear(s) or decreased hearingPatient noticed a decrease in short or long term memory functionAny changes in speech such as slowness, “tongue tied”, slurred speech

Neurobehavioral: (HIGH)Prone to seizuresMysticism type behavior or experiencesPerverted religious or sexual experiences or behaviorHallucinations or illusions

Neurobehavioral: (LOW)Difficulty learning or retaining informationVarious dementias noticedEpilepsy type seizures of any magnitudeAggressive behavior actions on the riseSuicidal thoughts or behavioral tendencies

DEEP LIMBIC SYSTEM/THALMUS: Neurobehavioral

(HIGH)Frequently or always in a sad mood or experiencing negative thoughtsYou have little or no motivation in lifePerson is “a loner”. They isolate themselves from family, no friendsLoss of libido or sexual arousalMultiple areas of pain in body such as seen in fibromyalgia

(LOW)Presents with decrease in reaction timesContinually depressedDemonstrates cyclic mood swings such as seen in PMSADD (attention deficit disorder) or ADHD (attention deficit-hyperactivity)

OCCIPITAL CORTEX:

any changes in vision, ability to see, spots or sparklers in eyes (note if white or colored sparklers)

CEREBELLUM:

Patient having postural compromise, slumped over, unable to rise from chair with ease, difficulty going up and down stairsChronic pain in the neck, mid or lower back regions, may be accompanied by antalgic lean. Tremors in hands or feet, or numbness in hands, feet or bothCold hands or feet those are constant or worsen at a certain time of dayDecrease in coordination, stumps toe, bumps into walls going down hallDizziness, intermittent or constant loss of balance that will not subside for prolonged periods of time

Neurobehavioral:Impulse control problemsOrganizational skills are decreasedSpeed of thought is compromised, learning, memory, etcVery refined peripheral movements are compromised, especially in hands and feet

BRAINSTEM: (highway between brain, cerebellum and body)

IF YOU HAVE "CHECKED" ANY OF THE ABOVE SYMPTOMS or SIGNS, PLEASE CALL MY OFFICE or submit this information through this form IMMEDIATELY.
Call 502-296-3581 OR EMAIL ME AT drbrentfurnish@gmail.com to make an appointment to EVALUATE YOUR BRAIN. REMEMBER…… BETTER BRAIN, BETTER LIFE

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FACTS:

50% of all people over 60 will have Alzheimer’s or dementia in the next 5 years
90% of all people in nursing homes are there due to neurological problems
50% of all people on disability are due to neurological problems.
80% of all people over 65 have a major undiagnosed brain dysfunction (problem)

References:
Neurology in Clinical Practice; Bradley, Darhoff, Fenichel, Marsden M.D.
Neurology Differential Diagnosis, 2nd Ed. John Patten M.D.
Change Your Brain; Change Your Life, Daniel Amen M.D.