Knowledge guides

LG15: Scientific foundations of neurology

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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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, management and outcomes.

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Central and peripheral nervous system
  • Anatomy and physiology of the nervous system, including neuroembryology
  • Fundamental principles of neurophysiology
  • Mechanisms by which underlying neuroanatomical, neuropathological, and neurophysiological processes result in neurological symptoms and abnormal neurological signs
  • Microanatomy and histology of brain, meninges, and peripheral nerves
Neuropsychiatry
  • Diseases which present as, and can be confused with, neurological conditions, such as weakness due to conversion disorder and non-epileptic seizures
  • Pharmacological and behavioural treatment of neuropsychiatric illnesses
  • Psychological aspects of illnesses and their management, such as:
    • anxiety
    • conversion
    • depression
    • psychosis
Neurorehabilitation
  • Formulate a prognosis based on an understanding of the natural history of the relevant condition coupled with clinical assessment of the relevant markers for recovery
  • Neurorehabilitation, including:
    • goal setting
    • indications for referral
    • setting realistic outcome expectations
    • the techniques employed
  • Recovery from neurological illness and/or injury, including the natural history and neuronal plasticity
  • Referral to rehabilitation physicians and/or allied health professionals involved in rehabilitation, including:
    • continence advisors
    • occupational therapists
    • physiotherapists
    • social workers
    • speech pathologists
Therapeutic interventions
  • Devices used in the specialist management of neurological diseases, such as implantable brain stimulators and focused ultrasound:
    • common and uncommon adverse effects
    • indications
    • monitoring requirements
    • neuroanatomy, neurophysiology, and neuropathology, where relevant
    • safe and rational use
  • Endovascular procedures, including, but not limited, to thrombectomy / therapy (EVT) for stroke
  • Immunotherapy and cytotoxic drugs
  • Management strategies for drug-resistant conditions, such as drug-resistant epilepsy, including surgical management
  • Medication to treat acute and chronic neurological illness:
    • common and uncommon adverse effects
    • indications
    • monitoring requirements
    • potential drug interactions
    • safe and rational use
  • Neuropharmacology drug interactions, metabolism, pharmacodynamics, and pharmacokinetics, along with the potential role of pharmacogenomics
  • Pharmacological therapy and other forms of management for various diseases and disorders
  • Plasmapheresis:
    • common and uncommon adverse effects
    • indications
    • monitoring requirements
    • safe and rational use
Cerebrospinal fluid (CSF)
  • Abnormalities seen on lumbar puncture (LP)
  • Interpret CSF results, including:
    • opening pressure
    • special tests:
      • amino acids
      • antibodies:
        • autoimmune
        • paraneoplastic
      • CSF cytology
      • glucose ratio
      • neurotransmitters
      • oligoclonal bands
      • polymerase chain reaction (PCR) for viruses
    • standard tests:
      • cell counts
      • culture
      • glucose
      • gram stain
      • protein
      • xanthochromia
  • Limitations of interpretation, and the implications for formulating diagnoses
  • LP:
    • contraindications
    • limitations to interpretation
    • requests
    • urgent investigation
  • Neuroanatomy and neurophysiology of CSF, including the pathological mechanisms that underlie abnormalities of pressure and CSF constituents
  • Normal ranges of CSF opening pressure and the various laboratory measurements
  • Potential complications of LP and the management of post-LP symptoms, including the role of blood patch in treating post-LP headache
Clinical neurophysiology
  • Abnormalities on clinical neurophysiology investigations
  • Clinical neurophysiology modalities
  • Interpret and report EEG and evoked potentials results, including:
    • abnormal and normal EEG waveforms
    • EEG electrode placement and recording
    • localising focal epileptiform discharges and slow wave activity
    • physiological basis of EEG potentials and waveforms
    • reporting EEG studies, and interpret findings in clinical context
    • role and limitations of EEG in clinical neurology
    • skills and knowledge required to appropriately request studies and interpret reports as an informed consumer
    • technology used for EEG recording
    • the change in normal EEG patterns across the lifespan
  • Interpret and report electromyography (EMG) and nerve conduction study (NCS) results, including:
    • interpreting EMG and NCS reports
    • physiological basis of EMG and NCS potentials and waveforms
    • skills and knowledge required to appropriately request studies and interpret reports as an informed consumer
    • technology used for EMG and NCS recording
  • Interpret results of clinical neurophysiology tests, and synthesise these findings with other clinical data in the management of patients with neurological conditions
  • Neuroanatomy and neurophysiology of:
    • muscle
    • neuromuscular junction
    • peripheral nervous system
  • Neurophysiological investigations:
    • discuss the results with a neurophysiologist
    • limitations to interpretation
    • potential complications
    • questioning a formal report
    • requesting further test(s)
    • requests
    • urgent investigation
  • Role of evoked potentials
Neurogenetics
  • Abnormalities on neurogenetic testing in appropriate conditions
  • Genetics and the patterns of inheritance of inherited neurological conditions, including classifications of genetic syndromes
  • Limitations of interpretation, and the implications for formulating a diagnosis
  • Pre-test counselling and potential implications of a positive diagnosis for patients and families
  • Referral to neurogeneticist
  • Techniques used in neurogenetics laboratories, including limitations in interpretation of the results
  • Utility of genetic testing in neurological diagnosis, even in asymptomatic individuals
Neuroimaging
  • Abnormalities on neuroimaging investigations
  • Appearance of a normal brain and spinal cord on neuroimaging techniques, including vascular anatomy
  • Basic principles underlying the various imaging modalities
  • Considerations of performing neuroimaging, including radiation risks and technical difficulties
  • Limitations of interpretation, and the implications for formulating a diagnosis
  • Neuroimaging investigations:
    • limitations to interpretation
    • potential complications
    • questioning a formal report
    • requesting further test(s)
    • requests
    • urgent investigation
  • Pathological mechanisms that underlie imaging abnormalities
  • Recognise when to request further tests, and when to discuss the results with a neuroradiologist
  • Relevant neuroanatomy of the brain and spinal cord and their respective vascular supply
Neuroimmunology
  • Abnormalities seen on neuroimmunological testing in appropriate conditions
  • Immunology and the processes involved in the generation of immunologically mediated neurological conditions
  • Limitations of interpretation, and the implications for formulating a diagnosis
  • Neuroimmunologist referral
  • Pharmacology management of neuroimmunology disease
  • Techniques used in the neuroimmunology laboratory, including limitations to interpretation of the results
Neuropathology
  • Importance of communication with neuropathologists regarding suspected diagnosis and differential diagnosis
  • Limitations of interpretation, and the implications for formulating a diagnosis
  • Neuroanatomy of brain, muscle, and nerve, coupled with an understanding of the pathological mechanisms that underlie abnormalities seen on neuropathology
  • Neuropathology investigations, such as when to request them and what limitations there might be to interpretation
  • Potential complications of neuropathology investigations, and the management of these complications
Neuropsychology
  • Abnormalities detected in neuropsychological testing
  • Limitations of interpretation, and the implications for formulating a diagnosis
  • Neuroanatomy and cognitive functions of the brain, and broadly how the various neuropsychological domains are tested by the neuropsychologist
  • Role of the neurologist and neuropsychologist in assessing competence and determining patients’ decision-making and testamentary capacity
  • When to request neuropsychological testing, and what limitations there might be to interpretation
Neurosurgery, including vascular surgery and interventional radiology
  • Common techniques used by neurosurgeons, vascular surgeons, and interventional radiologists in the management of neurological conditions
  • Potential complications of procedures
  • Procedures:
    • brain tumour surgery, such as:
      • biopsy
      • debulking
      • excision
    • CSF shunting, CSF diversion procedures, and neuroendoscopy
    • emergency surgical procedures for the management of trauma, such as evacuation of intracranial haematoma and decompressive hemicraniectomy
    • functional neurosurgery, such as:
      • deep brain stimulation
      • movement disorders
      • procedures for epilepsy
      • spinal surgery, such as:
        • laminectomy
        • microdiscectomy
    • vascular surgery, such as:
      • aneurysm clipping and coiling
      • carotid endarterectomy
      • endovascular thrombectomy / therapy (EVT)
      • surgical procedures for treatment of moyamoya disease
  • When to refer to the:
    • neurointerventionalist
    • neurosurgeon
    • vascular surgeon
End-of-life (EOL) care
  • EOL issues and consulting with patients, families, and/or carers to determine management plans that prevent suffering
  • Manage symptoms, such as:
    • anxiety
    • dyspnoea
    • pain
  • Principles of the techniques used by palliative care physicians, along with the potential complications of any procedures involved
  • Prognosis and implications of these disorders
  • Role of the neurosurgeon and the intensive care unit, and when referral is appropriate
  • Role of the palliative care physician, and when referral is appropriate
Neurological emergencies
  • Evidence-based pharmacological therapy, potential complications, and other forms of management of various conditions presenting as emergencies, as well an ability to instigate appropriate treatment
  • Neuroanatomy, neuropathology, and neurophysiology relevant to the various conditions presenting as neurological emergencies
  • Rapid clinical assessment of patients with a neurological emergency
Patient-centred care
  • Impact and interrelationship of comorbidities and neurological conditions on each other, including:
    • clinical presentation
    • diagnostics
    • impact of illness
    • management
    • prognostics
  • Patient care considerations for specific patient groups and those with culturally diverse backgrounds, including:
    • Aboriginal and Torres Strait Islander peoples
    • adolescent
    • elderly
    • ethnic minorities
    • low socioeconomic background
    • Māori
    • non-English speaking background
    • overseas travellers
    • pregnant or peripartum state
    • refugees
    • religious ideologies, such as Jehovah’s Witness
Pregnancy
  • Collaborate with obstetricians on treatment and management plans
  • Impact and management of primary obstetric disorders, including eclampsia and epidural anaesthesia, and other obstetric issues with neurological sequalae
  • Impact of neurological disease and management on fertility, pregnancy, and the postpartum period, including breastfeeding, method of delivery, and teratogenesis
  • Neurological investigations and treatment in pregnancy with reference to:
    • limitations
    • potential hazards
    • safety issues
  • Pharmacological therapy and other forms of management for neurological conditions in pregnancy and when breastfeeding
  • Prognosis and longer-term implications of the various conditions