Sleep clinicians, neurologists and generalists seeing unrefreshing sleep or daytime sleepiness get a more specialist sleep-medicine frame. It separates chronic insomnia from hypersomnolence, narcolepsy, parasomnias, REM sleep behaviour disorder and restless legs syndrome using history, timing and selected investigations.

Medication exposure with renal function belongs in first-seizure and breakthrough-seizure assessment. Posture or exertion-triggered limb shaking should lead to urgent vascular imaging, while apparent insomnia and optic neuritis need targeted assessment before hypnotics or special tests take over.

A new obsession with specific sounds is not just an eccentric hobby when it arrives with social disinhibition, reduced empathy, prosopagnosia or right temporal atrophy. Save this for neurology reasoning, especially if post-operative chorea and bilateral basal ganglia signal change also need a structured differential.

An incidental MRI with demyelinating features needs more than a quick label of radiologically isolated syndrome. It separates white matter hyperintensities from genuine demyelination, adds oligoclonal bands and spinal imaging to the conversation, and keeps misdiagnosis in view before treatment starts.

Fracture prevention belongs in routine neurology review, not after the first low-trauma injury. Use FRAX as a starting screen, remember recurrent falls, immobility and long-term antiseizure or corticosteroid exposure can make risk look lower than it really is, and use DEXA selectively.