Presentations – hearing and balance
- Ataxia
- Auditory hallucinations / Aura
- Hearing loss
- Loss of balance and/or coordination
- Nausea and/or vomiting
- Tinnitus
Presentations – smell and taste
- Behavioural / Mood / Personality changes
- Difficulties with vision and/or speech
- Gustatory / Olfactory aura
- Loss of smell
- Loss of taste
- Memory loss
Presentations – vision
- Anisocoria
- Binocular visual loss
- Bi-temporal hemianopia
- Blurry vision
- Difficulty reading
- Diplopia / Double vision
- Headache
- Hemianopia
- Jaw claudication
- Light sensitivity
- Loss of depth perception
- Monocular visual loss
- Muscular difficulties:
- coordination problems
- stiffness
- weakness and/or paralysis
- Myalgia
- Nausea and/or vomiting
- Nystagmus
- Pain
- Partial visual loss
- Photopsia
- Ptosis and/or exotropia
- Quadrantinopia
- Red eye
- Seizures
- Transient visual loss
- Visual hallucinations
Conditions – double vision
- Internuclear ophthalmoplegia
- Myasthenia gravis
- Ocular motor nerve palsies
Conditions – hearing
- Acoustic neuroma
- Raised intracranial pressure
- Seizures
- Stroke
Conditions – papilloedema / optic disc swelling
- Cerebral venous thrombosis
- Idiopathic intracranial hypertension
- Intracranial space-occupying lesions
Conditions – positive visual phenomena
- Charles Bonnet syndrome
- Dementia with Lewy bodies
- Migraine
- Occipital epilepsy
- Parkinson disease
Conditions – smell / taste
- Neurodegenerative conditions
- Orbitofrontal tumours
- Seizures
Conditions – vision loss
- Anterior pathway:
- anterior ischaemic optic neuropathy
- giant cell arteritis
- optic neuritis
- Chiasmal compression
- Demyelinating disease, such as:
- multiple sclerosis (MS)
- neuromyelitis optica spectrum disorder (NMOSD)
- Diabetes with microvascular ischaemic complications
- Posterior pathway:
- migraine
- occipital seizures
- posterior cortical atrophy
- stroke
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:
- disorders of the special senses
- double vision
- papilledema
- visual loss
- Methods of assessing automated and confrontation perimetry, pupillary function, visual acuity, and visual fields, and performing a direct ophthalmoscopy
- Neuroanatomy and neurophysiology of the auditory, oculomotor, olfactory, pupillary, and visual systems
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- immunological tests
- microbiological tests
- protein level
- sugar level
- xanthochromia
- opening pressure
- special tests:
- 14-3-3 protein
- oligoclonal bands
- spectrophotometry
Clinical neurophysiology investigations
- EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
- Electromyography (EMG):
- needle EMG
- single-fibre EMG
- Evoked potentials:
- repetitive nerve stimulation
- visual
- Vestibular function tests
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
- Single photon emission computed tomography (SPECT)
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- anti-aquaporin 4 antibodies
- autoantibodies associated with myasthenia gravis, such as anti-acetylcholine receptor antibodies
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
Neuropsychological investigations
- Cognitive screening:
- Mini-Mental State Examination
- Montreal Cognitive Assessment
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
- Other laboratory tests:
- C-reactive protein (CRP)
- B12 level
- erythrocyte sedimentation rate (ESR)
- fasting lipids
- HbA1c
- serum angiotensin converting enzyme
- thrombophilia screen
- Overlap with other medical specialties, such as ophthalmology and otolaryngology / ear, nose, and throat (ENT) surgery, and when it is appropriate to refer
- Prognosis and implications of these disorders
