Presentations
- Assess brain function, including:
- alterations in cognition
- suspected brain death
Conditions
- Brain death
- Brain tumours
- Cerebrovascular disease, including:
- chronic ischaemia
- moyamoya disease
- stroke
- Epilepsy:
- non-temporal lobe focal epilepsy
- temporal lobe
- Neurodegenerative disorders, including dementia, such as:
- Alzheimer disease
- dementia with Lewy bodies
- frontotemporal dementia
- vascular dementia
- Parkinson disease and other movement disorders
PCH
- Brain death
- Brain tumours and recurrence
- Epilepsy
- VP shunt dysfunction
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
- Encephalitis
- Suspected cerebrospinal fluid (CSF) shunt complications, such as obstruction or leak
- Suspected normal pressure hydrocephalus
Conditions
- CSF leak
- CSF shunt blockage
- Normal pressure hydrocephalus
PCH
- Vascular disorders, including moyamoya disease
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
- Anatomy of the brain and spinal cord, with particular emphasis on cross-sectional anatomy
- Cerebral arteries, the territories that they perfuse, and their relations to other cerebral structures
- Cerebral blood volume and luxury perfusion
- Cerebral veins and sinuses, and their relations to other cerebral structures
- Cerebral ventricles and their relations to other cerebral structures, including the spinal cord
- Describe the pathophysiology of:
- atherosclerosis
- cerebral atrophy and neurodegeneration
- cerebral ischaemia and infarction
- cerebral tumours – primary and secondary
- encephalitis
- Intracerebral structures of the brain in coronal, sagittal, and transverse planes
- Intracranial aneurysms and vascular malformations
- Pathophysiology and classification of dementias
- Pathophysiology and classification of seizures
- Pathophysiology of:
- CSF leaks
- non-obstructed hydrocephalus
- normal pressure hydrocephalus
- obstructed hydrocephalus
- Pathophysiology of acute and chronic cerebral ischaemia
- Pathophysiology of brain death
- Pathophysiology of Parkinson disease and other movement disorders
- Physiology of cerebral perfusion and autoregulation
- Physiology of CSF production and flow:
- types of CSF shunts and reservoirs that are typically used in management of obstruction, and how to access them
- Surface markings of the cerebral lobes
- The basic sciences related to radiotracers used in nuclear medicine imaging of the neural axis
- The relationship between cerebral perfusion and cerebral metabolism in health and disease
- The temporal effect of seizures on cerebral blood flow and metabolism
Investigations
- Incorporating complementary imaging techniques into the evaluation of impaired neurological function:
- carotid doppler ultrasound
- CT
- MRI
- PET brain imaging:
- PET tracers, including:
- amino acid tracers, such as F-18 FET
- beta amyloid tracers
- F-18 FDG
- Tau tracers
- Scintigraphic assessment of cerebral perfusion:
- SPECT brain imaging, including:
- ictal and interictal cerebral perfusion imaging
- Scintigraphic assessment of CSF circulation:
- CSF shunt studies, including:
- CSF leak study and pledget radioactivity
- radionuclide cisternography
- radionuclide shunt scintigram
Procedures
- Acetazolamide challenge in assessing cerebral perfusion reserve
- CSF shunt access / organising instillation of radiolabelled tracer into shunt reservoir
- Lumbar puncture, as per local practices
PCH
- Cerebral SPECT
- CSF shunt patency
- Epilepsy – ictal and interictal SPECT
- Epilepsy – PET / CT IM
- Patient demographics, including geographic location, socioeconomic status, ethnicity, and cultural background, and the considerations when managing and following up these patients, such as travel from rural to metropolitan areas
- Radiation protection, patient safety and consent
- Radioisotope decay and patient proximity to the procedure
