Curriculum

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Curriculum
15.7 – Neurological problems
KNOWLEDGE
Symptoms
Abnormal movements and chorea
Drowsiness and delirium
Headache
Loss of consciousness and coma
Memory loss and cognitive impairment
Neuropathies
Seizures
Tremor
Vertigo and dizziness (neurological, otological,
psychological and cardiovascular causes)
Conditions
Common causes of headache :
Tension headache
Migraine and cluster headache
Cervical neuralgia, sinusitis and dental pain
Drug rebound headache
Serious causes of headache :
Raised intracranial pressure, tumours
Thunderclap headache (eg subarachnoid
haemorrhage, enlarging aneurysm or migraine)
Temporal arteritis
Trigeminal neuralgia
Herpes zoster
Amyotrophic lateral sclerosis
Brain infections :
Meningitis and encephalitis
Brain abscess
TB and HIV
Congenital conditions (eg cerebral plasy, spina
bifida)
Epilepsy
Essential tremor
Genetic conditions (eg Huntington’s disease)
Mononeuropathies including trigeminal
neuralgia, Bell’s palsy, carpal tunnel syndrome
and other nerve entrapments (eg ulnar, sciatic
and femoral nerves)
Multiple sclerosis
Neurological causes of vertigo (eg stroke, MS,
trauma and concussion, acoustic neuroma,
brain tumours)
Parkinson’s disease
Polyneuropathies including metabolic causes
(diabetes, alcohol, B12 and folate, porphyria,
uraemia), infectious causes (eg Guillain-Barre,
postviral, HIV) and drug-induced neuropathy
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Curriculum
15.7 – Neurological problems
Speech disorders
Stroke (haemorrhage and infarction)
Investigation
Knowledge of secondary care investigations
and treatment including EEG, CT, MRI and
nerve conduction studies
Treatment
Understanding principles of treatment for
common conditions managed largely in primary
care – epilepsy, headaches, vertigo,
neuropathic pain, mononeuropathies, essential
tremor and Parkinson’s disease
Emergencies
Acute management of meningitis and
meningococcal septicaemia, collapse, loss of
consciousness or coma
Understand indications for emergency referral
of patients with :
Stroke
Intracranial haemorrhage
Raised intracranial pressure
Temporal arteritis
Prevention
Health education and accident prevention
advice for people with epilepsy
Vaccination for meningococcal disease
www.immunisation.nhs.uk
Understand avoidance of triggers and
prophylaxis for migraine
Investigation of people with family history of
genetic neurological disease (eg berry
aneurysm)
SKILLS
Consultation
skills
Communicating prognosis truthfully and
sensitively to patients with incurable / disabling
neurological conditions
Sharing uncertainty when required and
managing ‘difficult’ symptoms with multiple
causes (eg chronic headache, dizziness)
(Discuss strategies for tackling medically
unexplained symptoms)
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Curriculum
15.7 – Neurological problems
Psychomotor
skills
Examination of cranial nervous system
Examination of peripheral nervous system
Visual acuity
Visual fields
Fundoscopic examination
KNOW HOW
The indications for referral to a neurologist for ongoing specialist
management (eg MS, Parkinson’s disease) and for conditions that
may be irreversible without early treatment (eg ulnar nerve
entrapment)
The functional anatomy of the nervous system as required to aid
diagnosis
(This is very relevant to diagnosing common conditions such as
carpal tunnel syndrome and sciatica)
Epilepsy medication drug interactions and side effects, including
contraceptive and pregnancy advice, systems for ensuring regular
patient reviews and the issues around compliance
(The higher death rate amongst patients with epilepsy may be
related to poor seizure control)
The current DVLA medical standards of fitness to drive for
neurological conditions, in particular epilepsy
(www.dvla.gov.uk/medical/ataglance
The impact neurological conditions may have on an individual or
family’s social and economic wellbeing
The key national guidelines that influence healthcare provision for
neurological problems
NICE (www.nice.org.uk) has issued guidelines on epilepsy
diagnosis and management
Ethical principles involved when treating an incompetent patient
(eg unconsciousness) and when treating a patient who is unable to
communicate (eg dysphasia)
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Curriculum
15.7 – Neurological problems
RESOURCES
NICE (www.nice.org.uk) has guidelines on epilepsy, head injury, MS and
parkinson’s disease
SIGN (www.sign.ac.uk) has guidelines on epilepsy and early management of
head injury
RCP National Clinical Guidelines for Stroke (concise primary care version) :
www.rcplondon.ac.uk/pubs/books/stroke/stroke_primarycare_2ed.pdf.
British Association for the Study of Headache : www.bash.org.uk
The National Service Framework for long-term (neurological) conditions is
available at : www.library.nhs.uk
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