Presentations
- Acute sensory loss
- Back pain
- Bulging fontanelle
- Dizziness
- Fatigue
- Headache – disturbed vision, nausea and/or vomiting
- Muscular difficulties, such as:
- coordination problems
- paralysis
- stiffness
- weakness
- Neuropathic pain
- Pain in head and/or face
- Pins and needles and/or sensory loss
- Reduced level of consciousness
- Sciatica
- Sensory or auditory aura
- Sensory sensitivity
- Speech and/or swallowing difficulties
- Vertigo
- Visual disturbance
Conditions – brain and spine
- Intracranial haemorrhage, such as:
- Meningitis and other central nervous system (CNS) infections
- Multiple sclerosis (MS) of brain or spinal cord
- Neuromyelitis optica
- Raised intracranial pressure, including from space-occupying lesions
- Spinal cord compression or ischaemia
- Traumatic brain injury, including:
- Vascular conditions, including:
- arteriopathy
- ruptured malformation
- stroke
- Vasculitis
Conditions – peripheral nerve disorders
- Botulism
- Entrapment neuropathies
- Guillain–Barré syndrome
- Other acquired and inherited peripheral neuropathies
- Plexopathies
- Radiculopathies
Conditions – primary headaches
- Migraine-like headaches
- Migraine with brainstem features
- Migraine with or without aura
- New persistent daily headaches
- Status migrainosis
- Tension type headaches
Conditions – secondary headaches
- Idiopathic intracranial hypertension
- Low pressure headaches
- Medication-overuse headache
Conditions – other
- Functional neurological disorders
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
- Cervicogenic headaches
- Cluster headaches and other trigeminal autonomic cephalalgias
- Glossopharyngeal neuralgia
- Headaches attributed to intracranial arterial disorder, such as:
- reversible cerebral vasoconstriction syndrome (RVCS)
- Myofascial pain syndrome
- Temporomandibular joint disorders
- Trigeminal neuralgia
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
- Current headache classification, such as International Classification of Headache Disorders (ICHD)
- Headache syndromes
- Identification of secondary headache from underlying causes
- Migraine, migraine equivalents, and migraine variants
- Neuroanatomy, neuropharmacology, and neurophysiology involved in the generation of headache and facial pain
- Neuroanatomy, neuropharmacology, and neurophysiology of the pain pathway, peripheral nerves, and sensory pathways
- Rational use of investigations for headache
- Recognition of tumours presenting without headache
Cerebrospinal fluid (CSF) procedures and investigations
- Lumbar puncture (LP) and interpretation of investigation results, such as:
- basic CSF analysis:
- cell count
- cytology
- glucose level
- immunological tests
- microbiological tests
- protein level
- xanthochromia
- fundoscopy
- opening pressure
- special tests:
- anti-myelin oligodendrocyte glycoprotein (MOG) antibodies
- oligoclonal bands
Clinical neurophysiology investigations
- Electromyography (EMG):
- needle EMG
- single-fibre EMG
- 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:
- MRI (and other specialised magnetic resonance techniques)
- Vascular imaging:
- catheter angiography
- Doppler ultrasound
Neuroimmmunology investigations
- Autoantibody measurement:
- anti-aquaporin 4 antibodies
- anti-MOG antibodies
- paraneoplastic antibodies
- Referral to a neuroimmunologist
Neuropathology investigations
- Importance of early diagnosis and treatment of acute conditions
- Knowledge and treatment strategies for psychosocial effects and drivers of pain
- Management strategies for the common types of headache:
- non-pharmaceutical interventions, such as:
- biofeedback
- psychological and relaxation therapies, such as:
- sleep hygiene
- yoga
- rational use of medications
- use of botulinum toxin and nerve blocks in the management of migraines
- Overlap with other allied health and medical specialties, such as pain services, physiotherapy, and rehabilitation medicine, and when it is appropriate to refer patients
- Overlap with other medical conditions, such as depression
- Prognosis and implications of these disorders
