☐ ☐ Peripheral neuropathy Pattern:……………………………………………………………. ☐ ☐ Distal diabetic sensory peripheral neuropathy ☐ ☐ Carpal Tunnel Syndrome ☐ ☐ Axonal Sensory Motor Neuropathy ☐ ☐ CIDP |
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☐ ☐ Myasthenia Gravis (MG) |
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☐ ☐ cerebellar syndromes Aetiology: ............................................................................................... |
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☐ ☐ Muscular dystrophy Aetiology: ............................................................................................... |
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☐ ☐ Vertigo and other vestibular disorders Aetiology: ............................................................................................... |
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☐ ☐ Space occupying lesions ☐ ☐ Primary ☐ ☐ Secondary neoplasms ☐ ☐ Granulomas ☐ ☐ Abscesses ☐ ☐ Spinal metastasis |
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☐ ☐ Central nervous system infections, ☐ ☐ Meningitis ☐ ☐ Encephalitis ☐ ☐ Empyema ☐ ☐ Pott’s disease ☐ ☐ Leprosy |
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☐ ☐ Idiopathic intracranial hypertension |
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☐ ☐ NPH |
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☐ ☐ Hearing loss |
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☐ ☐ Benign Hereditary Chorea |
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☐ ☐ Sleep paralysis |
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☐ ☐ Lightheaded on standing |
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☐ ☐ Paget’s disease of bone |
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☐ ☐ Systemic lupus erythematosus (SLE) |
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☐ ☐ Rheumatoid Arthritis (RA) |
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☐ ☐ Temporal arteritis (GCA) |
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☐ ☐ The post-traumatic disorders |
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☐ ☐ Conversion syndrome |
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☐ ☐ Hyperactivity attention deficit disorder HAAD |
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☐ ☐ Anxiety |
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☐ ☐ Cerebral palsy |
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☐ ☐ Stiff person syndrome |
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☐ ☐ Other |
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State: |
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