Box 1.

The principles of acute neurology

1 Use the history (direct and collateral) to establish a differential or working diagnosis. Be an active listener. Let the patient talk; they will often ‘tell’ you the diagnosis
2 Develop a routine to rapidly screen for neurological deficits.9 Where is the problem: brain, spinal cord, peripheral nerve etc? This should only take 4 to 5 minutes
3 Target investigations to define aetiology. Decide on the general underlying pathological process rather than a diagnostic label (eg inflammatory problem affecting the cervical cord to guide investigation10
4 Ensure the management plan is helpful to the patient (eg pain relief)
5 Involve the multidisciplinary team
6 Decide whether patient needs admission