Curriculum standards
Knowledge guides
LG19: Paroxysmal disorders, including seizures, syncope, and stroke
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Confusion
- Dyskinetic movement disorders
- Epilepsy
- Fainting / Loss of consciousness
- Fatigue
- Headaches
- Jerky, rhythmic, or twitching motions
- Light-headedness and/or dizziness
- Muscular difficulties:
- coordination problems
- stiffness
- weakness and/or paralysis
- Nausea and/or vomiting
- Reduced level of consciousness
- Seizures
- Sensory disturbances
- Speech difficulties
- Staring
- Stroke
- Sweating
- Syncope
- Unresponsiveness
Conditions – epileptic
- Lesion-related epilepsies
- Metabolic disturbance
- Primary generalised epilepsies
- Status epilepticus
Conditions – haemorrhagic
- Cerebral amyloid angiopathy
- Primary intracranial haemorrhage
- Subarachnoid haemorrhage
- Venous infarction
Conditions – ischaemic
- Amaurosis fugax
- Cervical arterial dissection
- Ischaemic stroke:
- acute thromboembolic
- arterial
- Lacunar stroke
- Transient ischaemic attacks
- Venous sinus thrombosis
- Watershed infarcts
Conditions – non-epileptic
- Non-epileptic pseudo-status
- Non-epileptic seizures
Conditions – stroke mimics
- Conversion disorder
- Migraine
- Mitochondrial disorders
Conditions – syncope
- Autonomic failure
- Cardiac arrhythmias
- Carotid sinus hypersensitivity
- Dehydration
- Vasovagal syncope
Other episodic conditions
- Movement disorders
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Neuromuscular paroxysmal disorders
- Paroxysmal movement disorders
- Posterior reversible encephalopathy syndrome (PRES)
- Reversible cerebral vasoconstriction syndrome (RCVS)
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Arterial blood supply, vascular anatomy, and venous drainage of the brain and spinal cord
- Causes of stroke syndromes, ischaemic and haemorrhagic diseases, and mimics, including those listed above
- Classification and clinical features of the different types of epileptic seizure and epilepsy syndromes
- Evidence-based pharmacological therapy and other forms of management of stroke and related syndromes, in relation to the acute situation, rehabilitation, and prophylaxis
- Neuroanatomy, neuropharmacology, and neurophysiology involved in the generation of epilepsy and syncope
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- glucose level
- immunological tests
- microbiological tests
- protein level
- xanthochromia
- opening pressure
- basic CSF analysis:
Clinical neurophysiology investigations
- Autonomic testing
- EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
- Electromyography (EMG) / Nerve conduction studies (NCS)
Neurogenetic investigations
- Genetic testing, including, but not limited to:
- chromosomal testing, such as:
- karyotype
- microarray
- genomic testing, including whole exome or genome sequencing
- mitochondrial genome sequencing
- targeted panel testing
- chromosomal testing, such as:
- Referral to a neurogeneticist
Neuroimaging investigations
- CT, including:
- CT angiography
- perfusion
- venography
- MRI, including:
- functional (fMRI)
- magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- with contrast
- PET
- Referral to a neurointerventionalist or vascular surgeon
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- autoimmune
- paraneoplastic
- Referral to a neuroimmunologist
Neuropsychological investigations
- Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
- Referral to a neuropsychologist
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
- Other laboratory tests:
- acanthocytes
- alcohol
- B12 level
- creatine kinase (CK)
- electrolytes
- fasting lipid profile
- full blood count (FBC)
- lactate
- thrombophilia screen
- troponin
- urine drug screen
- Polysomnography
- Overlap with other allied health and medical specialties, such as occupational therapy, physiotherapy, rehabilitation medicine, and speech pathology, and when it is appropriate to refer
- Overlap with other medical conditions, such as:
- cardiac disorders
- depression
- non-epileptic disorders
- syncope
- Prognosis and implications of seizures, stroke, and syncope, such as driving and pregnancy
- Prognosis, implications, and management strategies for stroke, such as:
- acute management
- impact on the family
- rehabilitation
- secondary prevention
- Risk factors and comorbidities in stroke