Clinical Neurology in General Practice

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Clinical Neurology in General Practice

• Dr. Owen Powell
• Fforestfach Medical Centre

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Aims

• To be able to diagnose and manage common
  neurological presentations in General Practice
• To be aware of Guidelines on best practice
• To be aware of local resources and care pathways

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Case 1

• Donna, a 24 year old secretary is brought to
  surgery by her mother. Her mother thinks she may
  have had a fit the day before. She says that she
  was watching TV and suddenly started shaking for
  1 -2 minutes. This has never happened before and
  she is normally well.
• What aspects do you need to know in the history?
• What investigations should you arrange?
• What is your diagnosis and management plan and
  how do you explain this to Donna?

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Resources

• Differentiating factors
• Differential diagnosis
• Risk of recurrence
• NICE http//www.nice.org.uk/Guidance/CG20/Guidanc
  e/pdf/English
• Patient information Epilepsy action
  http//www.epilepsy.org.uk/
• http//www.epilepsyandpregnancy.co.uk
• DVLA http//www.dvla.gov.uk/media/pdf/medical/aa
  gv1.pdf

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• Differentiating seizure from syncope helpful and
  unhelpful featuresUnhelpful featuresoften
  mistakenly thought to indicate seizure but can
  occur in syncope
• Twitching and jerking
• Incontinence (reflects a full bladder at the time
  of the event)
• Pallor
• Bitten tip of tongue
• Fatigue after the event
• Helpful featuresindicate a seizure
• Confusion after the event lasting gt2 minutes
• Deeply bitten lateral border of the tongue
• Tonic then clonic movement lasting gt1 minute
• Deep cyanosis

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• Reported risk factors for seizure recurrence
• Remote symptomatic aetiology (pre-existing static
  brain abnormalities that are, by implication,
  causative)
• Focal neurological findings
• Focal seizure phenomenology (including Todd's
  paresis)
• Focal or generalised epileptiform activity on
  EEG
• Tumours or other progressive lesions as the
  underlying pathology
• Status epilepticus
• Family history of epilepsy
• Previous febrile seizures

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• Mr. Palmer is a 56 year old pharmacist who
  complains of tiredness and pain in his right
  shoulder. Work is becoming difficult. His wife
  has said he is slow doing everything.
• He has a past history of vertigo and hypertension
• Medication-lisinopril 5mg daily
• What else do you want to know from the history?
• How would you examine this man?
• What is your management plan and explanation?

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Resources

• Parkinsons Treatment Centre, Gorseinon
• NICECG35 Parkinson's disease full guideline.mht
• Patient and doctor information Parkinson's
  Disease Society - Resources for GPs.mht

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• Sarah, a 25 year old teacher, complains of
  headaches. She describes a pain on the right side
  of her head, mostly around the eye. The pain is
  severe and makes her feel sick or vomit. She has
  had three of these headaches in the last 6 weeks.
  She is worried she may have a brain tumour.
• What important factors do you need to elicit from
  the history?
• What examination would you perform?
• What is your management plan?

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Resources

• Bandolier IHS criteria for migraine
• British Association for the Study of Headache
  Diagnosis and Management of Headache

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