Curriculum standards
Knowledge guides
LG22: Disorders of gait and balance, including disequilibrium, dizziness, and vertigo
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
- Ataxia / Imbalance / Incoordination
- Disequilibrium
- Dizziness
- Hearing problems, such as:
- ear pressure
- loss
- tinnitus
- Vertigo
Conditions – brain
- Cerebral palsy
- Cerebrovascular disease
- Demyelination
- Drugs and toxins
- Functional neurological disorder
- Gait apraxia
- Genetic causes, such as:
- spinocerebellar atrophy
- Migraine
- Neoplasm
- Normal pressure hydrocephalus
- Progressive supranuclear palsy
Conditions – labyrinthine, peripheral nerves, spinal cord, and vestibular pathways
- Benign positional vertigo
- Labyrinthitis, acute
- Menière’s disease
- Neurofibromatosis:
- type 1
- type 2
- Peripheral nerve diseases, such as:
- vitamin B12 deficiency
- Spinal cord neoplasm
- Transverse myelitis
- Vestibular causes
Conditions – non-neurological causes
- Cardiac arrythmia
- Syncope
Conditions – psychological
- Anxiety syndromes
- Conversion disorder
- Hyperventilation
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 – labyrinthine, peripheral nerves, spinal cord, and vestibular pathways
- Cerebellar ataxia neuronopathy vestibular areflexia syndrome (CANVAS)
- Hereditary ataxias, including:
- episodic ataxias
- Mal de debarquement syndrome
- Superior canal dehiscence syndrome
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
- Acute, chronic, common, and rare diseases that cause:
- disequilibrium
- disorders of gait and balance
- dizziness
- vertigo
- Neuroanatomy and neurophysiology of the:
- neurological pathways involved in gait and balance
- vestibular and cerebellar systems
Assessments
- Audiogram
- Caloric testing
- Dix–Hallpike manoeuvre
- Head impulse test
- Rotatory chair vestibulo-ocular reflex testing
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- cytometry
- immunological tests
- microbiological tests
- protein level
- sugar level
- xanthochromia
- opening pressure
- special tests:
- 14-3-3 protein
- oligoclonal bands
- spectrophotometry
- basic CSF analysis:
Clinical neurophysiology investigations
- Evoked potentials:
- brainstem
- somatosensory
- visual
- Nerve conduction studies (NCS):
- motor and sensory studies
- repetitive nerve stimulation
- Vestibular function tests
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
- Myelography
- PET
- Single photon emission computed tomography (SPECT)
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- anti-aquaporin 4 (AQP-4) and myelin oligodendrocyte glycoprotein (MOG) antibodies
- testing for:
- angiotensin converting enzyme (ACE)
- antinuclear antibodies (ANA)
- anti-neutrophil cytoplasmic antibodies (ANCA)
- double-stranded DNA (dsDNA)
- extractable nuclear antigens (ENA) testing
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
- Biopsy:
- brain
- nerve
Neuropsychological investigations
- Referral to a neuropsychologist
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
- Other laboratory tests:
- acanthocytes
- B12 level
- fasting lipid profile
- serum angiotensin converting enzyme
- thrombophilia screen
- urinary porphyrins
- Overlap with other allied health and medical specialties, such as ear, nose, and throat specialists, neurosurgery, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer
- Prognosis and implications of these disorders