Presentations
- Ataxia
- Back / Limb pain, acute
- Breathlessness
- Difficulties with speech and/or swallowing
- Double vision
- Dizziness
- Falls
- Fatigue
- Fever
- Headache
- Hearing loss
- Lethargy
- Limp, acute
- Loss of bladder / bowel control and/or urinary urgency
- Lower limb(s) weakness, acute
- Migraine
- Motor regression
- Non-weight bearing child, acute
- Nystagmus
- Palpitations
- Paroxysmal torticollis
- Poor feeding
- Syncope
- Tinnitus
- Toe walking
- Tremor
- Vertigo
- Vomiting
- Weakness
Conditions – central nervous system (CNS)
- Acute disseminated encephalomyelitis (ADEM) and other inflammatory encephalitis
- Brainstem encephalitis
- Cerebellar ataxia, acute
- Cerebellitis, acute
- Cerebral or brainstem / posterior circulation vascular event
- Cerebral palsy (CP)
- Channelopathies causing periodic paralysis
- Chiari malformation
- Drugs and toxins
- Epilepsy:
- atonic
- autonomic seizures
- drop attack
- Episodic ataxia
- Gait apraxia
- Glucose transporter defects
- Hydrocephalus
- Multiple sclerosis (MS)
- Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
- Neurodegenerative conditions
- Normal pressure hydrocephalus
- Oncological conditions – acoustic neuroma / other CNS malignancy
- Opsoclonus myoclonus ataxia syndrome
- Spinocerebellar atrophy
- Traumatic brain injury, such as:
- concussion
- inflicted injury
Conditions – muscle, peripheral nerves, and spinal cord
- Ataxia telangiectasia
- Autonomic ganglionopathy
- Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)
- Friedrich ataxia
- Guillain–Barré syndrome
- Hereditary spastic paraplegia
- Medication-related peripheral neuropathy
- Myositis
- Neuromuscular conditions
- Oncological conditions
- Peripheral nerve diseases, such as:
- Charcot–Marie–Tooth disease
- riboflavin transporter deficiency
- vitamin B12
- Spinal hematomas / collections
- Transverse myelitis
- Traumatic injury
Conditions – other
- Anxiety syndromes
- Functional neurological disorder
- Infections
- Labyrinthitis / Vestibulitis, acute
- Medication or drug toxicity
- Migraine with brainstem aura and vestibular migraine
- Persistent postural-perceptual dizziness
- Postural orthostatic tachycardia syndrome (POTS) and postural hypotension
- Recurrent vertigo of childhood and related 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
- 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
- Neurodevelopmental features and examination findings of normal preterm and term infants
- Time-course importance and the associated clinical features in reaching a diagnosis
Assessments
- Caloric testing
- Dix–Hallpike manoeuvre
- Head impulse test
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
- paired lactate
- paired glucose level
- protein level
- xanthochromia
- opening pressure
- special tests:
- amino acids
- neurotransmitters
- oligoclonal bands
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
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:
- Functional imaging:
- functional MRI (fMRI)
- PET
- single photon emission computed tomography (SPECT)
- Magnetic resonance:
- angiography (MRA)
- spectroscopy (MRS)
- venogram (MRV)
- MRI
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- anti-acetylcholine receptor antibodies
- anti-aquaporin 4 antibodies
- anti-muscle-specific kinase (MuSK)
- anti-myelin oligodendrocyte glycoprotein (MOG)
- Referral to a neuroimmunologist
Neuropathology investigations
Neuropsychological investigations
- Cognitive screening:
- Mini-Mental State Examination
- Referral to a neuropsychologist
Other investigations
- Cardiac investigations:
- 24-hour electrocardiogram monitoring
- ECG
- echocardiography
- Lung function tests:
- formal lung function tests
- vital capacity
- Other laboratory tests:
- 24-hour urinary catecholamines
- calcium, magnesium, and phosphate
- creatine kinase
- drug levels
- liver function tests
- thyroid function
- ultrasound:
- vitamins:
- Overlap with other allied health and medical specialties, such as:
- ear, nose, and throat (ENT) surgery
- physiotherapy
- rehabilitation medicine
- Prognosis and implications of these disorders
