Neurology

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Neurology

Neurology is a branch of medicine dealing with disorders of the nervous system. Physicians specializing in the field of neurology are called neurologists and are trained to diagnose, treat, and manage patients with neurological disorders. Most neurologists are trained to treat and diagnose adults. Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children.

Field of work

Neurological disorders are disorders that affect the central nervous system (brain, brainstem and cerebellum), the peripheral nervous system (peripheral nerves - cranial nerves included), or the autonomic nervous system (parts of which are located in both central and peripheral nervous system). Neurologists also diagnose and treat some conditions in the musculoskeletal system.

Major conditions include:

headache disorders such as migraine, cluster headache and tension headache
epilepsy and seizure disorders
neurodegenerative disorders, the most common class being dementias, including Alzheimer's disease
cerebrovascular disease, such as transient ischemic attacks, and strokes (ischemic or hemorrhagic)
sleep disorders
cerebral palsy
infections of the central nervous system (encephalitis), brain envelopes (meningitis) and peripheral nerves (neuritis), such as brain abscess, herpetic meningoencephalitis, aspergilloma, cerebral hydatic cyst
some infections of the peripheral nervous system, such as tetanus and botulism
neoplasms - tumors of the brain and its envelopes (brain tumors), spinal cord tumors, tumors of the peripheral nerves (neuroma)
movement disorders such as Parkinson's disease, chorea, hemiballismus, tic disorder, and Gilles de la Tourette syndrome
demyelinating diseases of the central nervous system, such as multiple sclerosis, and of the peripheral nervous system, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP)
spinal cord disorders - tumors, infections, trauma, malformations (e.g., myelocele, meningomyelocele, tethered cord)
disorders of peripheral nerves, muscle (myopathy) and neuromuscular junctions
traumatic injuries to the brain, spinal cord and peripheral nerves
altered mental status, encephalopathy, stupor and coma

Clinical tasks

General caseload

Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a neurosurgeon, an interventional neuroradiologist, or a neurointerventionalist. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient is deceased. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Other neurologists may develop an interest in particular subfields, such as movement disorders, headaches, epilepsy, sleep disorders, multiple sclerosis or neuromuscular diseases.

The core neurological diseases that are the primary domain of neurologists are:

demyelinating diseases of the central nervous system.
the epilepsies
headache and migraine
movement disorders
polyneuropathies
spinal cord disorders
genetic diseases with a primarily neurologic manifestation

Overlapping areas

There is some overlap with other specialties, varying from country to country and even within a local geographic area. Many stroke patients are seen only by specialists in internal medicine. Whether stroke patients should be seen primarily by neurologists is contested. Acute head trauma is most often treated by neurosurgeons, whereas sequela of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Some cases of nervous system infectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by general practitioners, at least the less severe cases. Similarly, most cases of sciatica and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or orthopedic surgeons). Sleep disorders are also treated by pulmonologists. Cerebral palsy is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age.

Relationship to clinical neurophysiology

In some countries, e.g. USA and Germany, neurologists may specialize in clinical neurophysiology, the field responsible for EEG, nerve conduction studies, EMG and evoked potentials. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).

Overlap with psychiatry

Although many mental illnesses are believed to be neurological disorders affecting the central nervous system, traditionally they are classified separately, and treated by psychiatrists. In a 2002 review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)

There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, bipolar disorder and schizophrenia. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-stroke depression, depression and dementia associated with Parkinson's disease, mood and cognitive dysfunctions in Alzheimer's disease, to name a few. Hence, there is no sharp distinction between neurology and psychiatry on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of Freud's psychoanalytic theory in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on neurosciences - aided by the tremendous advances in genetics and neuroimaging recently.)

External links

American Academy of Neurology
brainblog: news about our knowledge of the brain and behavior.
Neuroscience News: Neuroscience research news, neuroscience jobs, neuroscience forum, neuroscience bookstore and links.
On Line Neurology Journal Club (via JournalReview.org)