Presentations – hearing
- Dysphagia
- Ear:
- Fever
- Headache
- Hearing loss
- Hyperacusis
- Loss of balance
- Nausea
- Rash
- Tinnitus
- Vertigo
- Vomiting
Presentations – smell and taste
- Change or loss in taste
- Drooling
- Headache
- Loss of smell
- Parosmia
- Seizure
Presentations – vision
- Decreased visual acuity
- Double vision
- Drooping of eyelids
- Dysmorphism
- Falls
- Fever
- Hallucinations
- Headache / Periorbital pain
- Microcephaly
- Microphthalmia
- Migraine
- Motor delay
- Night blindness
- Nystagmus
- Opsoclonus
- Pain on eye movement
- Papilloedema
- Photophobia
- Poor depth perception
- Poor fixation
- Seizures
- Speech delay
- Vertigo
- Visual hallucinations / auras
- Visual loss
Conditions – hearing
- Acoustic neuroma and other brainstem tumours
- Congenital deafness
- Medication-related
- Post-infection / Post-meningitis
Conditions – smell / taste
- Bell’s palsy
- Neurodegenerative conditions
- Orbitofrontal tumours
Conditions – vision
- Achromatopsia
- Acute demyelinating encephalomyelitis
- Cataracts
- Cerebral / Cortical visual impairment
- Epilepsy
- Functional neurological disorder
- Idiopathic intracranial hypertension (pseudotumor cerebri)
- Infections
- Leber congenital amaurosis
- Leber hereditary optic neuropathy
- Medication-related
- Migraine
- Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)
- Multiple sclerosis (MS)
- Neuromuscular conditions
- Neuromyelitis optica
- Ocular motor nerve palsies
- Oncological conditions, such as:
- Optic nerve hypoplasia
- Optic neuritis
- Raised intracranial pressure secondary to intracranial space-occupying lesion or cerebral venous thrombosis
- Retinal dystrophies
- Retinopathy of prematurity
- Septo-optic dysplasia
- Stargardt disease
- Trauma affecting vision
- Vascular event resulting in sudden vision loss
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
- Congenital myasthenic syndromes
- Other iatrogenic / hypertensive / toxic / traumatic occurances
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
- Causes of visual disturbance and eye movement abnormalities
- Methods of assessing automated and confrontation perimetry, pupillary function, visual acuity, and visual fields, including non-organic presentations
- Neuroanatomy and neurophysiology of the auditory, oculomotor, olfactory, pupillary, vestibular, and visual systems
- Neurodevelopmental features and examination findings of normal preterm and term infants
Cerebrospinal fluid (CSF) procedures and investigations
- Fundoscopy – normal versus abnormal
- Lumbar puncture (LP) and interpretations results of investigations, such as:
- basic CSF analysis:
- cell count
- cytology
- immunological tests
- lactate
- microbiological tests
- protein level
- glucose 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
- Electroretinogram
- Evoked potentials:
- Nerve conduction 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
Neuroimmunology investigations
- Autoantibody measurement:
- anti-acetylcholine receptor antibodies
- anti-aquaporin 4 antibodies
- anti-myelin oligodendrocyte glycoprotein (MOG) antibodies
- paraneoplastic antibodies
Neuropathology investigations
Neuropsychological investigations
- Autoimmune work up
- Mini-Mental State Examination
- Referral to a neuropsychologist
- Routine bloods including inflammatory markers
- Overlap with other medical specialties, such as ophthalmology and otolaryngology / ear, nose, and throat (ENT) specialties
- Prognosis and implications of these disorders
