Presentations – disorders of consciousness
- Anxiety
- Confusion or somnolence
- Dizziness
- Fainting / Loss of consciousness
- Fever
- Hallucinations
- Headache
- Heart palpitations and/or shortness of breath
- Muscular difficulties:
- coordination problems
- stiffness
- weakness and/or paralysis
- Nausea and/or vomiting
- Pain
- Pins and needles and/or sensory loss
- Seizures
- Shakiness
- Speech and/or swallowing difficulties
Presentations – disorders of sleep
- Concentration / Memory impairment
- Episodes of incomplete awakening and limited responsiveness
- Excessive daytime sleepiness, narcolepsy, and sleep attacks
- Insomnia
- Loud snoring
- Morning headaches
- Sleep paralysis
- Waking gasping or choking during the night
Conditions – cognition
- Delirium
- Metabolic and inherited disorders
- Neurodegeneration
Conditions – inflammatory and infectious
- Demyelinating disease
- Encephalitis:
- autoimmune
- infective
- vasculitis
- Meningitis
- Systematic inflammatory disorders
- Systemic infection
Conditions – metabolic and toxic
- Hepatic
- Hypoglycaemia
- Kidney failure
- Prescribed and illicit drugs
Conditions – other
- Epilepsy, especially sudden unexpected death in epilepsy (SUDEP)
- Obstructive sleep apnoea
- Syncope
- Traumatic brain injury, including:
Conditions – structural
- Raised intracranial pressure
- Space-occupying lesions:
- abscess
- haemorrhage
- tumour
- Stroke
- Subarachnoid haemorrhage
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
- Non-rapid eye movement (REM), such as:
- confusional arousal
- night terrors
- sleep talking
- somnambulism
- REM sleep behaviour disorder (RBD)
- Sleep attacks
Conditions
- Sleep disorders, such as:
- hypersomnia
- narcolepsy
- parasomnia
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 required for brain death diagnosis
- Neuroanatomy, neuropharmacology, and neurophysiology of brain and brainstem mechanisms involved in the maintenance of normal consciousness
- Neuroanatomy, neuropharmacology, and neurophysiology of normal sleep function
- Pathological mechanisms that result in decreased consciousness
- Pathological mechanisms that result in disturbed sleep and describe the way disorders of sleep can present
Assessments
- Epworth Sleepiness Scale
- Glasgow Coma Scale
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- CSF analysis:
- cell count
- cytology
- immunological tests, including:
- encephalitis panel
- paraneoplastic
- microbiological tests
- oligoclonal bands
- protein level
- sugar level
- xanthochromia
- opening pressure
Clinical neurophysiology investigations
- EEG:
- sleep-deprived EEG
- standard EEG
- video EEG
- Evoked potentials:
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
Neuropsychological investigations
- Cognitive screening:
- Addenbrooke’s Cognitive Examination
- Mini-Mental State Examination
- Referral to a neuropsychologist
Other investigations
- Cardiac investigations:
- 24-hour ECG monitoring
- ECG
- echocardiography
- Lung function tests:
- formal lung function tests
- vital capacity
- Other laboratory tests, such as:
- autoimmune serology
- B12 level
- electrolytes
- full blood count and inflammatory markers
- hepatic and renal function
- metabolic testing, including:
- glucose level
- heavy metal and other toxins, including:
- alcohol
- ammonia levels
- drugs
- micronutrients
- Multiple Sleep Latency Test (MSLT)
- Polysomnography
- Conditions that mimic disturbance of consciousness, such as:
- acute aphasia
- functional disorders, including:
- non-epileptic status epilepticus
- locked-in syndrome
- stroke
- Conditions that result in prolonged disturbance of consciousness, such as persistent vegetative state and minimally conscious state
- Overlap with specific neurological syndromes, such as Parkinson disease and REM sleep behavioural disorders
- Prognosis and implications of sleep disorders, such as driving
- Role of neurologist in neuroprognostication for serious intercranial injury, including hypoxic ischaemic encephalopathy and subarachnoid haemorrhage
