GEM - Curriculum statement 15.7 neurological problems
Knowledge Base for the nMRCGP
Curriculum Statement 15.7 Neurological Problems
Symptoms:
- Headache
- Vertigo/dizziness (neurological, otological, psychological and cardiovascular causes)
- Tremor
- Neuropathies
- Abnormal movements/chorea
- Seizures
- Drowsiness
- Loss of consciousness and coma
Common and/or important conditions:
- Epilepsy
- Common causes of headache – tension headache, migraine, cluster headache, cervical neuralgia, sinusitis, dental pain, drug rebound headache
- Important causes of headache – raised intracranial pressure, thunderclap headache (subarachnoid haemorrhage, enlarging aneurism or migraine), temporal arteritis, trigeminal neuralgia, herpes zoster, cancers
- Brain infections – meningitis, encephalitis, brain abscess, tuberculosis, HIV
- Neurological causes of vertigo – stroke (brainstem and cerebellar haemorrhage/infarction), multiple sclerosis, trauma and concussion, acoustic neuroma, brain tumours
- Mononeuropathies – trigeminal neuralgia, Bell’s palsy, carpal tunnel syndrome, nerve entrapments, e.g. ulnar, sciatic and femoral nerves
- Polyneuropathies – metabolic causes (diabetes, alcohol, vitamin B12 and folate, porphyria, uraemia, infectious causes (e.g. Guillain-Barré, post viral, HIV), drugs induced neuropathy
- Multiple sclerosis
- Amyotrophic lateral sclerosis
- Essential tremor
- Parkinson’s disease
- Congenital conditions, e.g. cerebral palsy, spina bifida
- Genetic conditions, e.g. Huntingdon’s disease.
Investigation:
- Knowledge of secondary care investigations and treatment including: electroencephalography (EEG), computerised tomography (CT) and magnetic resonance imaging (MRI), nerve conduction studies.
Treatment:
- Understand principles of treatment for common conditions managed largely in primary care – epilepsy, headaches, vertigo, neuropathic pain, mononeuropathies, essential tremor and Parkinson’s disease
Emergency care:
- Acute management of meningitis and meningococcal septicaemia
- Acute management of people presenting with collapse, loss of consciousness or coma
- Understand indications for emergency referral of people with stroke, intra-cranial haemorrhage, raised intracranial pressure and temporal arteritis
Prevention:
- Health education and accident prevention advice for people with epilepsy
- Vaccination for meningococcal disease
- Understand avoidance of triggers and prophylaxis for migraine
- Investigation of people with family history of genetic neurological disease, e.g. Berry aneurysm.
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