Neurology

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Neurology is the medical specialty concerned with diagnosis and treatment of diseases of the nervous system; a specialist in the field is a neurologist. It is often considered one of the more intellectually challenging fields of medicine, due to the complexity of the nervous system, the wide range of neurological disease, and the specialized examinations involved.

One standard text decries that poor teaching of neurology turns the examination "the ritual they they then witness of putting the patient through a series of maneuvers designed to evoke certain mysterious signs, the names of which are difficult to pronounce (e.g., Kernig's and Brudzinski's signs), is hardly reassuring; in fact the procedure often appears to conceal the very intellectual process by which neurologic diagnosis is obtained."[1] The authors hasten to add that using a clinical method makes this diagnostic task less daunting than it otherwise might seem. It often surprises learners that many of the seemingly exotic signs can be evoked simply by positioning the patient, or using instruments as simple as a reflex hammer, cotton-tipped wooden swab, and small vials of ammonia and ground coffee.

The field deals with the central nervous system (i.e., the brain and spinal cord), the peripheral nervous system and autonomic nervous system, the specialized blood supply to these body parts, to the way in which the nervous system causes changes in the state of muscles and glands.

Training

Basic specialty training takes four years. This can be followed by additional subspecialty work either in pure neurologic subspecialties, or interdisciplinary subspecialties to which neurology is one of the pathways.

In the United States, as in many countries, the specialty certification board covers the joint fields of neurology and psychiatry, which have different but highly complementary, and indeed sometimes overlapping, views of nervous system function. [2]

Clinical Neurophysiology

This subspecialty is concerned with specialized methods for diagnosing and monitoring nerve and muscle disorders, using electrical, functional imaging, and other techniques including electroencephalography (EEG), electromyography (EMG), nerve conduction studies (NCS), etc. They may treat disorders of altered neurotransmission.

Neurodevelopmental Disabilities

Subspecialists in this area are involved with inappropriate childhood develop of nervous structures, as well as chronic conditions resulting from such deveopment, including cerebral palsy, mental retardation and behavioral disorders with an organic cause.

Neuromuscular Medicine

Sensory nerves sense signals from muscles and motor nerves control muscle movement. Subspecialists herre deal with conditions including amyotrophic lateral sclerosis, peripheral neuropathy, muscular dystrophies, myopathies, and neuromuscular transmission disorders

Vascular Neurology

As mentioned in the introduction, neurology includes blood supply to the nervous system. The subspecialty deals with the effects of hemorrhage in structures of the nervous system; ischemia caused by thrombi, atherosclerosis and other interference with blood flow including congenital narrowing; and vasculitic inflammation of blood vessels in the brain or supplying nerves.

Interdisciplinary specialties

Neurologic diagnosis

In suspected neurologic disorders, neurologists often perform extended medical history taking and physical examination. A surprising number of meaningful neurologic results can be determined quite quickly within the scope of a regular physical examination.[3]

Supplementary neurological examination involves a wide range of specialized maneuvers, many not requiring specialized equipment but demanding a sophisticated knowledge of the effects, on sensation and motion, of various disorders. Often, this analysis recognizes a related group of symptoms and signs, called a syndromic diagnosis.

From the syndromic diagnosis, the neurologist uses knowledge of neuroanatomy, as well as instrumented tests, and possibly sampling of parts of the nervous system through lumbar puncture or biopsy, to localize to the affected parts of the nervous system. This is the anatomic or topographic diagnosis.

Given the anatomic and syndromic diagnosis, as well as the history and the results of evaluation by other pertinent medical specialties, the physician determines the nature of the disorder, or pathologic diagnosis. The pathologic diagnosis deals with manifestation; determining causation is the result of the etiological diagnosis. As the final input into the treatment plan, the neurologist assesses the impact of the disorder on the patient and the expected duration, or functional diagnosis. The prognosis defines the chance of restoration of function.

References

  1. Victor, Maurice (2001), Adams and Victor's Principles of Neurology, McGraw-Hill, at 3
  2. American Board of Psychiatry and Neurology
  3. Goldberg, Stephen (1987), The Four-Minute Neurologic Exam, Medmaster