Table 1Review questions on category 2 symptoms

ChapterType of reviewReview questionsOutcomes
5.2.1 Dizziness and vertigo in adultsDiagnostic and clinical predictionIn adults and young people who present with dizziness or vertigo, what is the accuracy of accompanying signs and symptoms to support non-specialists in identifying neurological conditions?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
Other outcomes:
  • Adjusted odds ratios for the presence of the following conditions:
    • central nervous system causes such as posterior circulation strokes and other (migraines, tumours)
    • peripheral vestibular disorders, including posterior semi-circular canal dehiscence, BPPV, and labyrinthitis
    • cardiovascular disorders (presyncope, postural hypotension)
    • functional disorders
    • vertebrobasilar insufficiency.
5.2.2 Dizziness and vertigo in adultsDiagnosticIn people with suspected (or under investigation for) new onset of vertigo or dizziness, is the HINTS (Head-Impulse—Nystagmus—Test-of-Skew) test effective in identifying whether there is a central nervous system cause, as indicated by the reference standard, MRI?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
5.3 Atraumatic facial pain in adultsDiagnostic and clinical predictionIn adults who present with atraumatic facial pain, what is the accuracy of accompanying signs and symptoms to support non-specialists in identifying suspected neurological conditions?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
Other outcomes:
  • Adjusted odds ratios for the presence of the following conditions:
    • carotid and vertebral artery dissection
    • cluster headache
    • dental pain
    • max sinusitis
    • migraine facial pain
    • occipital neuralgia
    • temporal arteritis
    • tension headache
    • TMJ dysfunction
    • trigeminal neuralgia.
5.8.2 Memory tests in adultsDiagnosticIn adults under 40 with suspected (or under investigation for) memory failure, what is the negative predictive value of neuropsychological assessments in ruling out organic memory failure?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
5.10 Sensory symptoms such as tingling or numbnessDiagnostic and clinical predictionIn people (adults, young people and children) who present with tingling or altered sensation in the body, what is the accuracy of accompanying signs and symptoms to support non-specialists in identifying suspected neurological conditions?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
Other outcomes:
  • Adjusted odds ratios for the presence of the following conditions:
    • compression neuropathy (for example, carpal tunnel syndrome and Meralgia parasthetica)
    • demyelination
    • drug toxicity – chemotherapy, alcohol, platinum-based drugs
    • functional (hyperventilation)
    • mononeuropathy multiplex
    • peripheral neuropathy
    • radiculopathy
    • seizures
    • small fibre neuropathy
    • TIAs
    • tethering of the spinal cord.
5.15 Tremor in adultsDiagnostic and clinical predictionIn adults and young people who present with tremor, what is the accuracy of accompanying signs and symptoms to support non-specialists in identifying neurological conditions?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
Other outcomes:
  • Adjusted odds ratios for the presence of the following conditions:
    • cerebellar tremors
    • drug-related tremors
    • dystonic tremor (task-specific tremor)
    • essential tremor
    • neuropathic tremor
    • parkinsonism
    • physiological tremor
    • primary orthostatic tremor
    • psychogenic tremors
    • thyroid disorder.
7.2 Blackouts and paroxysmal events in childrenDiagnostic and clinical predictionIn children and babies who present with paroxysmal events, what is the accuracy of accompanying signs and symptoms to support non-specialists in identifying suspected neurological conditions?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
Other outcomes:
  • Adjusted odds ratios for the presence of the following conditions:
    • behavioural (that is, temper tantrums, breath-holding attacks and emotional disorders)
    • cardiac disorders – long QT, left ventricular outflow obstruction
    • epilepsy
    • reflex anoxic seizures
    • vasovagal syncope or postural hypotension.
7.5 Headaches in childrenDiagnostic and clinical predictionIn children under 12 who present with headache, what is the accuracy of accompanying signs and symptoms to support non-specialists in identifying suspected neurological conditions?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
Other outcomes:
  • Adjusted odds ratios for the presence of the following conditions:
    • brain tumour
    • chronic daily headaches
    • hydrocephalus
    • idiopathic intracranial hypertension
    • intracranial infection
    • migraine
    • nocturnal hypoventilation
    • raised intracranial pressure
    • sinusitis
    • venous sinus thrombosis.
7.6 Head shape or size abnormalities in childrenDiagnostic and clinical predictionIn children and babies who present with abnormal head shape or size, what is the accuracy of accompanying signs and symptoms to support non-specialists in identifying neurological problems?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value
Other outcomes:
  • Adjusted odds ratios for the presence of the following conditions:
    • microcephaly
    • familial macrocephaly
    • hydrocephalus
    • positional plagiocephaly
    • single suture synostosis
    • multiple suture synostosis
    • syndromic synostosis
    • growing skull fracture.
7.9.2 Motor developmental delay in childrenDiagnosticIn children and infants under 10 years of age who present with motor developmental delay, is a creatine kinase (CK) test accurate in identifying whether muscular dystrophy is present as compared to no test (and as indicated by the reference standard, diagnosis at follow-up)?Main outcomes:
  • Sensitivity (%) and specificity (%)
  • Area under the ROC curve (AUROC) – measure of predictive accuracy
  • Positive/negative predictive value

From: 4, Methods

Cover of Suspected neurological conditions
Suspected neurological conditions: recognition and referral.
NICE Guideline, No. 127.
National Guideline Centre (UK).
Copyright © NICE May 2019.

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