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:
- 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:
- Pre-synaptic neuromuscular disorders, including:
- Lambert–Eaton myasthenic syndrome
Conditions – peripheral nerves
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Entrapment neuropathies
- Guillain–Barré syndrome
- Neuropathy:
- Other acquired and inherited peripheral neuropathies
- Plexopathies
- Radiculopathies
Conditions – psychological
Conditions – spinal cord
- Motor neurone disease
- CNS inflammatory disease, including:
- 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:
- Paroxysmal weakness disorders, such as:
- 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:
- 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
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:
- 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
