| Yes No Disorder | Duration month |
| ☐ ☐ Migraine Headache |
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| ☐ ☐ Other types ofHeadaches |
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| ☐ ☐ Ischaemic Stroke Image Findings…………………………………………………….. |
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| ☐ ☐ Haemorrhagic Stroke Image Findings…………………………………………………….. |
|
| ☐ ☐ CVT Image Findings…………………………………………………….. |
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| ☐ ☐ Retinal vein occlusion Image Findings…………………………………………………….. |
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| ☐ ☐ Generalized epilepsy Image Findings…………………………………………………….. |
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| ☐ ☐ Focal epilepsy Image Findings…………………………………………………….. |
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| ☐ ☐ Non-epileptic attacks |
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| ☐ ☐ Dementia ☐ Alzheimer’s disease ☐ Vascular dementia ☐ FTLD ☐ Other states............................. Image Findings…………………………………………………….. |
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| ☐ ☐ DMD Aetiology ☐ ☐ Multiple Sclerosis ☐ ☐ Monophasic transverse myelitis ☐ ☐ Neuromyelitis Optica Spectrum ☐ ☐ MOG Image Findings…………………………………………………….. |
|
| ☐ ☐ Idiopathic Parkinson’s Disease |
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| ☐ ☐ Parkinson Plus Disease PSP |
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| ☐ ☐ Parkinson Plus Disease MSA |
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| ☐ ☐ Parkinson Plus Disease CBS |
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| ☐ ☐ Parkinson Plus Disease DLB |
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| ☐ ☐ Essential Tremors |
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| ☐ ☐ Cranial Neuropathy ☐ ☐ Idiopathic Bell’s Palsy ☐ ☐ Trigeminal neuralgia (TN) ☐ ☐ AbducensN ☐ ☐ Oculomotor N ☐ ☐ Others |
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| ☐ ☐ Spastic paraplegia Aetiology…………………………………………………………….. Image findings……………………………………………………… |
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| ☐ ☐ Flaccid paraplegia Aetiology…………………………………………………………….. Image findings……………………………………………………… |
|