Presentations
- Ataxia / Imbalance / Incoordination
- Disequilibrium
- Dizziness
- Hearing problems, such as:
- ear pressure
- loss
- tinnitus
- Vertigo
Conditions – brain
- Cerebral palsy
- Cerebrovascular disease
- Demyelination
- Drugs and toxins
- Functional neurological disorder
- Gait apraxia
- Genetic causes, such as:
- Migraine
- Neoplasm
- Normal pressure hydrocephalus
- Progressive supranuclear palsy
Conditions – labyrinthine, peripheral nerves, spinal cord, and vestibular pathways
- Benign positional vertigo
- Labyrinthitis, acute
- Menière’s disease
- Neurofibromatosis:
- Peripheral nerve diseases, such as:
- Spinal cord neoplasm
- Transverse myelitis
- Vestibular causes
Conditions – non-neurological causes
- Cardiac arrythmia
- Syncope
Conditions – psychological
- Anxiety syndromes
- Conversion disorder
- Hyperventilation
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 – labyrinthine, peripheral nerves, spinal cord, and vestibular pathways
- Cerebellar ataxia neuronopathy vestibular areflexia syndrome (CANVAS)
- Hereditary ataxias, including:
- Mal de debarquement syndrome
- Superior canal dehiscence syndrome
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:
- disequilibrium
- disorders of gait and balance
- dizziness
- vertigo
- Neuroanatomy and neurophysiology of the:
- neurological pathways involved in gait and balance
- vestibular and cerebellar systems
Assessments
- Audiogram
- Caloric testing
- Dix–Hallpike manoeuvre
- Head impulse test
- Rotatory chair vestibulo-ocular reflex testing
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- cytometry
- immunological tests
- microbiological tests
- protein level
- sugar level
- xanthochromia
- opening pressure
- special tests:
- 14-3-3 protein
- oligoclonal bands
- spectrophotometry
Clinical neurophysiology investigations
- Evoked potentials:
- brainstem
- somatosensory
- visual
- Nerve conduction studies (NCS):
- motor and sensory studies
- repetitive nerve stimulation
- 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
- Myelography
- PET
- Single photon emission computed tomography (SPECT)
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- anti-aquaporin 4 (AQP-4) and myelin oligodendrocyte glycoprotein (MOG) antibodies
- testing for:
- angiotensin converting enzyme (ACE)
- antinuclear antibodies (ANA)
- anti-neutrophil cytoplasmic antibodies (ANCA)
- double-stranded DNA (dsDNA)
- extractable nuclear antigens (ENA) testing
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
Neuropsychological investigations
- Referral to a neuropsychologist
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
- Other laboratory tests:
- acanthocytes
- B12 level
- fasting lipid profile
- serum angiotensin converting enzyme
- thrombophilia screen
- urinary porphyrins
- Overlap with other allied health and medical specialties, such as ear, nose, and throat specialists, neurosurgery, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer
- Prognosis and implications of these disorders
