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Curriculum standards

Knowledge guides

LG21: Weakness and sensory change - central and peripheral disorders

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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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.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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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.

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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.

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Presentations
  • Breathing difficulties / Shortness of breath
  • Cardiac arrhythmia
  • Confusion
  • Fatigue
  • Headaches
  • Muscle cramps, spasms, and/or twitches
  • Muscular difficulties, such as:
    • aching
    • coordination problems
    • difficulty walking
    • paralysis
    • stiffness
    • swelling
    • weakness
  • Nausea and/or vomiting
  • Numbness
  • Pain
  • Sciatica
  • Sensory loss / sensitivity
  • Vertigo
  • Violaceous skin rash
  • Vision problems, including:
    • pain
    • vision loss
  • Weakness
Conditions – brain and brain stem
  • Bell’s palsy
  • Central nervous system (CNS) inflammatory disease, including:
    • multiple sclerosis (MS)
    • myelin oligodendrocyte glycoprotein (MOG)
    • neuromyelitis optica spectrum disorder (NMOSD)
  • Stroke
Conditions – muscle
  • Dermatomyositis
  • Myotonic dystrophy
  • Polymyositis
  • Rhabdomyolysis
Conditions – neuromuscular junction
  • Botulism
  • Post-synaptic neuromuscular disorders, including:
    • myasthenia gravis
  • Pre-synaptic neuromuscular disorders, including:
    • Lambert–Eaton myasthenic syndrome
Conditions – peripheral nerves
  • Chronic inflammatory demyelinating polyneuropathy (CIDP)
  • Entrapment neuropathies
  • Guillain–Barré syndrome
  • Neuropathy:
    • nutritional
    • toxic
  • Other acquired and inherited peripheral neuropathies
  • Plexopathies
  • Radiculopathies
Conditions – psychological
  • Conversion disorder
Conditions – spinal cord
  • Motor neurone disease
  • CNS inflammatory disease, including:
    • MOG
    • MS
    • NMOSD
  • Spinal cord compression

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
Presentations
  • Rapid fluctuation in weakness
  • Sporadic weakness
Conditions
  • Metabolic disorders, such as:
    • metabolic myopathies
  • Paroxysmal weakness disorders, such as:
    • periodic paralysis
  • Tetanus

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
  • Neuroanatomy and neurophysiology of the sensory pathways and peripheral nerves
  • Neuroanatomy, neuropharmacology, and neurophysiology of the:
    • motor pathways
    • neuromuscular junction
    • peripheral nerves
    • somatic musculature
Cerebrospinal fluid (CSF) procedures and investigations
  • Lumbar puncture (LP) and interpretation of investigation results, such as:
    • basic CSF analysis:
      • autoimmune and paraneoplastic antibodies
      • cell count
      • cytology / flow cytometry
      • glucose level
      • microbiological tests
      • protein level
      • xanthochromia
    • opening pressure
    • special tests:
      • oligoclonal bands
      • spectrophotometry
Clinical neurophysiology investigations
  • EEG:
    • sleep-deprived EEG
    • standard EEG
    • video EEG
  • Electromyography (EMG):
    • needle EMG
    • single-fibre EMG
  • Evoked potentials:
    • brainstem
    • somatosensory
    • visual
  • Nerve conduction studies (NCS):
    • motor and sensory studies
    • repetitive nerve stimulation
    • single fibre EMG
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
  • 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
  • Myelography
  • Vascular imaging:
    • catheter angiography
    • Doppler ultrasound
Neuroimmmunology investigations
  • Autoantibody measurement:
    • anti-aquaporin 4 antibodies and MOG
    • autoantibodies associated with myasthenia gravis, such as:
      • anti-acetylcholine receptor antibodies
    • paraneoplastic antibodies
  • Referral to a neuroimmunologist
Neuropathology investigations
  • Biopsy:
    • muscle
    • nerve
Other investigations
  • Cardiac investigations:
    • 24-hour electrocardiography monitoring
    • bedside spirometry
    • lung function tests
    • transoesophageal / transthoracic echocardiogram
    • vital capacity
  • Serum tests:
    • acanthocytes
    • autoimmune panel
    • fasting lipid profile
    • HbA1c
    • heavy metals and other toxins
    • infective screen
    • myositis panel
    • paraneoplastic autoantibodies
    • serum angiotensin converting enzyme
    • serum free light chains
    • thrombophilia screen
    • urinary porphyrins
    • vasculitis panel
    • vitamin levels, including, but not limited to:
      • B1
      • B6
      • B12
      • vitamin E
  • Overlap with other allied health and medical specialties, such as geriatrics, immunology, medical genetics, physiotherapy, rehabilitation medicine, and speech pathology, and when it is appropriate to refer
  • Prognosis and implications of these disorders