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
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
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:
- 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
- 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
