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  1. I Bone,
  2. G N Fuller
  1. Dr GN Fuller, Department of Neurology, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK geraint{at}

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Patients with sleepiness may be referred to neurology outpatients for assessment, yet most neurologists have limited training in this area. There are an increasing number of interventions to help these patients. Neil Douglas, professor of respiratory medicine with a particular interest in sleep, outlines the approach to the sleepy patient in the first article of this issue.

In in-patient practice, few problems are more difficult to assess and manage than the patient with an altered mental state. Such patients are often seen in the intensive care unit with great expectation placed upon the neurologist to “sort out what is going on” or what to expect. Many of these patients have general medical problems so neurologists must consider the possibility of metabolic, infective, or drug induced disorders and not focus solely on the nervous system. A team approach to such patients is imperative in maximising chances of good outcome. We have …

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