 Welcome back to intracranial bleed part three. In this section, we will discuss the history and physical examination in a patient with a potential intracranial bleed. The patients can have various presentations. They can have headaches, neck pain, seizures, focal neurological symptoms, or decreased level of consciousness. Depending on the presenting complaint, you will want to get the timeline of the events, what has happened when, and whether there are any other associated symptoms. Let's go into the details for the specific diagnosis. Epidural, subdural hematoma, and traumatic cyber-recanoid and traumatic parenchymal bleed are from trauma. And therefore, we will need to find out whether there is a history of trauma. What mechanism is involved, whether this is a fall or in a motor vehicle collision. We will want to find out whether the event was witnessed and therefore get more information about the event itself, such as gathering information from EMS personnel, family member, or other personnel from nursing home facilities. Remember that for subdural bleed, the trauma might have been remote. And therefore, any change in personality or increased fall will increase our suspicion. As we discussed before, we need to find out the mechanism of the injury from collateral sources. In particular, we need to know about the level of consciousness of the patient since the time of injury, especially if there has been a change. As with all bleeding, we need to find out if the patient has a coagulopathy. It can be a congenital reason such as hemophilia, or acquired for medications such as anticoagulants. If the patient has either of these, that would change our management. Once we ask all the questions about trauma, we'll now focus on non-traumatic cyber-recanoid hemorrhage. If we're able to speak to the patient, we need to know about the headache, the onset, what it feels like, and specifically how it peaked. Whether it is a gradual onset and from onset to peak, it is over hours or days. Or, did the headache peak instantly? That is, from the onset to the worst part of the headache, it is over seconds or minutes. Also known as a thunder-clap headache. The history of the onset of the headache is the most important in determining whether we need to worry about cyber-recanoid hemorrhage that's non-traumatic. After we get the history of the onset of headache, we need to know whether there is a history of similar headaches and what workup has been done. We also want to know about family history of cyber-recanoid bleeds, aneurysms, and polycystic kidney disease. For non-traumatic parankamal bleeds, we need to know something about the headaches, the onset and associated symptoms, and in particular, focal neurological deficits affecting vision, motor, sensory, or balance. As these bleeds are usually due to hypertension, we need to know about history of hypertension, whether there are any medication for it, and whether they have taken any medication that might increase the blood pressure. On physical examination, we will look at the vital signs, the GCS, and focus on the neurological exam. For the vital signs, we will look at all of it, including temperature, blood pressure, heart rate, breast rate, and O2SAT. We would also calculate their Glasgow-Koma scale. A full neurologic examination should be done. We would check the pupils for reactivity, symmetry, and do a fundoscopy exam to look at papillodema. We will also look for visual field deficits and neglect. We will examine for any deficits or asymmetry in motor or sensory symptoms. We will also check for reflexes. We will also do cerebellar testing. If it is possible, their gait should be examined. As we have described before, the patient's neurological status might change with time. Therefore, the time of the examination should be documented. In instances if the patient has changed, we need to repeat at least part of the neurological exam. In summary, we discussed the history of physical examination that we would do on a patient with a potential intracranial bleed. In the next part, we would discuss investigation and treatment. Thank you for watching.