Neurology

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Neurology (from the classical Greek νεῦρον neuron, 'nerve', and the suffix -λογία logy, 'study of') is the branch of medicine that studies the nervous system and its disorders. Specifically, it deals with the prevention, diagnosis, treatment, and rehabilitation of all diseases that involve the central nervous system, peripheral nervous system, and the autonomic nervous system. There are a large number of neurological diseases, which can affect the central nervous system (brain and spinal cord), the peripheral nervous system, or the autonomic nervous system.^{[citation needed]}

Diagnosis of the subject with neurological disease

Clinical method in neurology

The objective of the clinical method in neurology is to serve as a basis for the treatment or prevention of a neurological disease. In most cases the method consists of five stages, which are:

Steps to diagnose a neurological disease. Principles of Neurology for Adams and Victor.

Identification of symptoms and signs through interrogation and physical exploration.
The physical symptoms and signs that are considered important in relation to the problem in question are interpreted in physiological and anatomical terms: identification of disorders of function and the anatomical structure involved.
Anatomical/topographic diagnosis: Location of the pathological process (identification of the affected Nervous System parts), where a characteristic group of symptoms and signs is recognized, which constitute a syndrome, which helps us identify the place and nature of the disease. This is known as Syndrome diagnosis.
From the anatomical diagnosis and other medical data (mode, speed of initiation, evolution, course of the disease, condition of extraneurological organic systems, personal and family history and laboratory data) it is possible to deduce the pathological diagnosis. When the mechanism is identified and the causality of the disease can be determined etymological diagnosis.
Development Functional diagnosis. This last stage refers to the assessment of the degree of incapacity, where it is determined whether this is temporary or permanent. It is of great importance for the treatment of the disease and for the estimation of the potential for restoring the function, that is, the prognosis.

The above method for the diagnosis of neurological diseases can be seen summarized in the diagram placed in this section. This systematic approach makes it possible to reliably identify the location and often the precise diagnosis of the disease. It should be remembered that it is not always necessary to present the solution to a clinical problem in this way, since some neurological diseases have very characteristic clinical pictures.

Neurological examination

An investigation (1897), work of Joaquín Sorolla. The painting shows the inside of the laboratory of the neurologist Luis Simarro in the late nineteenth century.

During a neurological exam, the neurologist reviews the patient's medical history, with special attention to recent conditions. Then he performs a neurological exam. Typically, this neurological exam assesses mental status, cranial nerve functions, the motor system, and the sensory system. This information helps the neurologist determine if the problem is in the nervous system and its clinical location. The location of the pathology is the key to the process by which neurologists develop their different diagnoses. Further studies may be necessary to confirm the diagnosis, and finally appropriate guidance and therapy.

The neurological examination begins with the examination of the patient while the interrogation is carried out. The way in which the patient relates to her illness may manifest confusion or incoherence of thought, memory or judgment disorders, and even difficulties in understanding or expressing ideas. The remainder of the neurological examination should be performed as the last part of the general physical examination, beginning, as already mentioned, with examination of the cranial nerves, neck, and trunk, ending with tests of motor, reflex, and sensory functions of the upper and lower extremities.

This examination should be modified according to the patient's condition. Of course, many parts of the examination cannot be carried out in the comatose patient; young children and infants or patients with psychiatric conditions need to be explored in special ways.

Examination and diagnostic procedures

Cranial nerve tests: the function of cranial nerves should be investigated more complexly in patients with neurological symptoms than in those who do not experience them. If an injury from the previous pit is suspected, the sense of smell should be tested through each nostril, determining whether the patient can distinguish odors. The visual fields are traced through confrontation tests, in some cases by investigation of each eye separately looking for any anomaly. The sensitivity of the face is tested with a pin and a little cotton, the presence or absence of corneal reflexes must be determined. Facial movements are observed when the patient speaks and smiles as light weakness can be more evident in these circumstances. It is necessary to inspect the vocal cords with special instruments in case of suspicion of suffering from the raquid bulb or the vague nerve especially when there is a snorkel.
Motor function tests: the observations of the speed and strength of the movements, size, tone and muscle coordination should be taken into account.

Prona and supine positions.
It is essential that the patient fully expose the extremities to inspect them by atrophy and fasciculations as well as to observe them while retaining the arms stretched in the prone and supine positions; that the individual performed simple tasks such as alternating contact with his nose and with the finger of the examiner; make him perform rapid alterations, particularly those involving changes of direction, acceleration and deceleration;
Tests of the function reflect: the tests of the bicipital, tricipital, supinator, rotuliano, hereleo, abdominal cutaneous and planting reflexes allow to get an idea of how appropriate the activity reflects from the spinal cord. Trendy reflexes require the affected muscles to be relaxed; hypoactive or barely discarded reflexes are usually facilitated by voluntary contraction of other muscles. The presence of superficial skin reflexes of abdominal muscles, cremasterians and other types is often a basic test of great utility to identify corticosteroid injuries.
Sensitive function tests: this is the most complicated part of neurological exploration, is reserved for the final part of the exploration and should not be extended for more than a few minutes if the data is required to be reliable. Generally, differences are sought between both sides of the body, the level below which the sensation or existence of a relative or absolute anesthesia area is lost. Each test is explained to the patient quickly; speaking too much about these tests with a meticulous introspective patient can encourage him to notify minor variations regardless of the stimulus intensity. It is not necessary to explore all surface regions of the skin, quick research on the face, neck, hands, trunk and feet with a pin requires only a few seconds. Sensitive deficit regions may be subject to other tests. The discovery of some area with hyperesthesia leads attention to a superficial sensitivity disorder.
Exploring the station and the march: no exploration is complete but the patient is seen in an erect position. Perhaps the most outstanding neurological anomaly or the only one is the abnormality of bipedestation and march, as in some cerebelous disorders or the frontal lobe. In addition, an alteration of the posture and the movements of pure automatic adaptation when walking provides the most definitive path diagnosis in the initial stage of Parkinson's disease and progressive supranuclear paralysis.
The medical or surgical patient without neurological symptoms: for the upper extremities it is usually sufficient to observe the naked and stretched arms in search of atrophy, weakness (prontor impulse), trembling or abnormal movements; the verification of force, grip and dorsiflexion at the wrist level; to inquire about sensitive disorders and to trigger biantal and trivial reflexes. The triggering of the Rotulian reflexes, hereleum and plant; the vibration tests and sense of position on the fingers of the hands and feet, and the evaluation of coordination by making the patient touch his nose and finger of the examiner alternately, as well as by sliding the heel up and down the front of the opposite leg.
The comatose patient: careful examination of the patient in stupor or comatose provides considerable information regarding the function of the nervous system. The predominant positions of the extremities and the body should be recognized; the presence or absence of spontaneous movements on one side; the position of the head and eyes, the speed, depth and rhythm of the breath. The patient's reaction is valued when he hears his name, simple orders or harmful stimuli. It is usually possible to determine whether the coma is related to meninge irritation or focal brain disease or brain stem. In the less profound stages of the coma the Meningea irritation produces resistance to passive bending of the neck but not to the extension, rotation or inclination of the head.
Laboratory diagnosis: the description of the clinical method and its application evidences that rigorous clinical exploration must always precede the use of laboratory assistants, however in neurology the purpose of these is prevention. Therefore in preventive neurology the laboratory methodology can acquire priority on the clinical methodology. Genetic information allows the neurologist to identify patients in danger of developing certain diseases to immediately begin the search for biological markers before symptoms or signs appear. Biochemical research tests are applicable to a whole population and allow to identify in individuals who do not yet show symptoms, and in some of these diseases it is possible to apply a treatment before an injury to the nervous system occurs.

Clinical work

Cases in general

Neurologists are responsible for the diagnosis, treatment, and management of all of the conditions mentioned above. When surgical intervention is required, the neurologist may refer to the patient as a "neuropatient." In some countries, some of the legal responsibilities of a neurologist may include making a diagnosis of brain death if the patient dies. They usually treat people with congenital diseases if most of the manifestations are neurological. Lumbar punctures can also be performed by these professionals. Some neurologists develop an interest in particular subfields such as cerebrovascular diseases, movement disorders, epilepsy, headaches, behavioral neurology and dementias, sleep disorders, chronic pain management, multiple sclerosis, or neuromuscular diseases.

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There is overlap of other specialties, varying from country to country and even within a local geographic area. Acute traumatic brain injury (CTE) is most commonly treated by neurosurgeons, while sequelae of head trauma can be treated by neurologists or medical rehabilitation specialists. Although cerebrovascular accident (CVA) cases have traditionally been treated by internists or hospital physicians, the rise of vascular neurology and interventional neurologists have created a demand for stroke specialists.

The JHACO certified stroke center organization has increased the role of neurologists in the treatment of stroke in many primary care centers as well as in tertiary hospitals. Some cases of infectious diseases of the nervous system are treated by specialists in infectious diseases. Most headache cases are mainly diagnosed and treated by general practitioners, at least the less severe cases. Similarly, most cases of sciatica and other mechanical radiculopathies are cared for by general practitioners, although they may be referred to neurologists or surgeons (neurosurgeons or orthopedic surgeons). Sleep disorders are generally treated in multidisciplinary units involving neurologists, pulmonologists, and psychiatrists. Cerebral palsy is initially seen by pediatricians, but treatment can be transferred to an adult neurologist after the patient reaches a certain age.

Clinical neuropsychologists are usually consulted to perform a functional assessment of behavior and higher cognitive functions, related to assistance in differential diagnoses, planning rehabilitation strategies, recording cognitive strengths and weaknesses, and measuring changes in over time (for example, to identify abnormalities of aging or tracking the progress of dementia).

Relations to clinical neurophysiology

In some countries, such as the United States and Germany, neurologists can specialize in clinical neurophysiology, in electroencephalography, or in the study of nerve conduction, in electromyography and evoked potentials. In other countries, it is a separate specialty (for example in the UK and Sweden).

Overlap with psychiatry

Although mental illnesses are considered by some to be neurological disorders affecting the central nervous system, they are traditionally classified separately, and treated by psychiatrists. In a 2002 review in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by profession, wrote that: “The division into two categories is arbitrary, often influenced by beliefs rather than verifiable scientific observations. And the fact that the brain and the mind are one makes this division only artificial anyway. This perspective has led to a progressive rapprochement between both specialties in the last two decades, which finally materialized in 2004 with the recognition, in the United States, of the subspecialty in «Behavioral Neurology and Neuropsychiatry». Currently, doctors in this subspecialty are in charge of the study, diagnosis and treatment of behavioral disorders and mental disorders attributable to neurological diseases.

Neurological diseases often have psychiatric manifestations, such as psychosis, depression, mania, and anxiety. These neuropsychiatric syndromes are relatively common in patients with stroke, Huntington's disease, parkinsonism, Alzheimer's disease, Lewy body disease, Pick's disease, infectious encephalitis, autoimmune encephalitis, as well as some types of epilepsy, to name just a few.

Effects of aging on the nervous system

Old age, Emily Samson in the welcome to the new world.

Of all the changes associated with age, those of the nervous system are of enormous importance. Some neurological signs of aging are: neuro-ophthalmological signs, progressive perceptive hearing loss, decreased sense of smell and less extension of taste, reduction in speed and magnitude of motor activity, slow reaction time, coordination and agility disorders, reduced muscle strength and muscle wasting, changes in tendon reflexes and finally disturbances in the sense of vibration in the fingers of the fingers. feet and ankles.

Old couple. Roger Hsu.

Cosmetic Neurology

The emerging field of cosmetic neurology points to the potential for therapies to improve issues such as work efficiency, attention in school, and greater happiness in personal life. Despite everything, this field has also given rise to questions about neuroethics or psychopharmacology.

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