Neurology

Neurology (from Greek: νεῦρον (neûron), "string, nerve" and

the suffix -logia, "study of") is the branch of medicine dealing Neurology
with the diagnosis and treatment of all categories of conditions
and disease involving the brain, the spinal cord and the
peripheral nerves.[1] Neurological practice relies heavily on the
field of neuroscience, the scientific study of the nervous system.

A neurologist is a physician specializing in neurology and

trained to investigate, diagnose and treat neurological
disorders.[2] Neurologists treat a myriad of neurologic conditions,
including stroke, seizures, movement disorders such as
Parkinson's disease, autoimmune neurologic disorders such as
multiple sclerosis, headache disorders like migraine and
A network of dendrites from neurons
dementias such as Alzheimer's disease.[3] Neurologists may also
in the hippocampus.
be involved in clinical research, clinical trials, and basic or
translational research. While neurology is a nonsurgical specialty, System Nervous system
its corresponding surgical specialty is neurosurgery.[2] Significant Neuropathy, dementia,
diseases stroke, encephalopathy,
Parkinson's disease,
epilepsy, meningitis,
Contents muscular dystrophy,
History migraine, attention
deficit/hyperactivity
Training disorder
Physical examination Significant Computed axial
tests tomography, MRI scan,
Clinical tasks
lumbar puncture,
General caseload
electroencephalography
Overlapping areas
Specialist Neurologist
Relationship to clinical neurophysiology
Glossary Glossary of medicine
Overlap with psychiatry
Neurological enhancement
See also
References

History
The academic discipline began between the 15th and 16th centuries with the work and research of many
neurologists such as Thomas Willis, Robert Whytt, Matthew Baillie, Charles Bell, Moritz Heinrich
Romberg, Duchenne de Boulogne, William A. Hammond, Jean-Martin Charcot, C. Miller Fisher and John
Hughlings Jackson. Neo-Latin neurologia appeared in various texts from 1610 denoting an anatomical
focus on the nerves (variably understood as vessels), and was most notably used by Willis, who preferred
Greek νευρολογία.[4][5]

Training
Many neurologists also have additional training or interest in one Neurologist
area of neurology, such as stroke, epilepsy, headache,
Occupation
neuromuscular disorders, sleep medicine, pain management, or
movement disorders. Names Physician, Medical
Practitioner
In the United States and Canada, neurologists are physicians who
Occupation Profession
have completed a postgraduate training period known as residency type
specializing in neurology after graduation from medical school.
This additional training period typically lasts five years, with the Activity Medicine
sectors
first year devoted to training in internal medicine.[9] On average,
neurologists complete a total of eight to ten years of training. This Description
includes four years of medical school, five years of residency and Education M.D. or D.O. (US),
an optional one to two years of fellowship. [10] required M.B.B.S. (UK), D.M.
(Doctorate of
While neurologists may treat general neurologic conditions, some
Medicine) (India),
neurologists go on to receive additional training focusing on a
particular subspecialty in the field of neurology. These training M.B. B.Ch. B.A.O.
programs are called fellowships, and are one to two years in (Republic of
duration. Subspecialties include brain injury medicine, clinical Ireland)[6][7]
neurophysiology, epilepsy, neurodevelopmental disabilities, Fields of Hospitals, Clinics
neuromuscular medicine, pain medicine, sleep medicine, employment
neurocritical care, vascular neurology (stroke),[11] behavioral
neurology, child neurology, headache, multiple sclerosis, neuroimaging,
neurooncology, and neurorehabilitation.

In Germany, a compulsory year of psychiatry must be done to complete a

residency of neurology.[12]

In the United Kingdom and Ireland, neurology is a subspecialty of general

(internal) medicine. After five years of medical school and two years as a
Foundation Trainee, an aspiring neurologist must pass the examination for
Membership of the Royal College of Physicians (or the Irish equivalent)
and complete two years of core medical training before entering specialist
training in neurology.[13] Up to the 1960s, some intending to become
neurologists would also spend two years working in psychiatric units
before obtaining a diploma in psychological medicine. However, that was Polish neurologist Edward
uncommon and, now that the MRCPsych takes three years to obtain, Flatau greatly influenced the
would no longer be practical. A period of research is essential, and developing field of
obtaining a higher degree aids career progression. Many found it was eased neurology. He published a
after an attachment to the Institute of Neurology at Queen Square, London. human brain atlas in 1894
and wrote a fundamental
book on migraines in 1912.
Some neurologists enter the field of rehabilitation medicine (known as
physiatry in the US) to specialise in neurological rehabilitation, which may
include stroke medicine, as well as traumatic brain injuries.

Physical examination
During a neurological examination, the neurologist reviews the patient's
health history with special attention to the patient’s neurologic complaints.
The patient then takes a neurological exam. Typically, the exam tests
mental status, function of the cranial nerves (including vision), strength,
coordination, reflexes, sensation and gait. This information helps the
neurologist determine whether the problem exists in the nervous system and
the clinical localization. Localization of the pathology is the key process by
which neurologists develop their differential diagnosis. Further tests may be
needed to confirm a diagnosis and ultimately guide therapy and appropriate Jean-Martin Charcot is
management. considered one of the
fathers of neurology.[8]

Clinical tasks
Neurologists examine patients who are referred to them by other physicians in both the inpatient and
outpatient settings. Neurologists begin their interactions with patients by taking a comprehensive medical
history, and then performing a physical examination focusing on evaluating the nervous system.
Components of the neurological examination include assessment of the patient's cognitive function, cranial
nerves, motor strength, sensation, reflexes, coordination, and gait.

In some instances, neurologists may order additional diagnostic tests as part of the evaluation. Commonly
employed tests in neurology include imaging studies such as computed axial tomography (CAT) scans,
magnetic resonance imaging (MRI), and ultrasound of major blood vessels of the head and neck.
Neurophysiologic studies, including electroencephalography (EEG), needle electromyography (EMG),
nerve conduction studies (NCSs) and evoked potentials are also commonly ordered.[14] Neurologists
frequently perform lumbar punctures to assess characteristics of a patient's cerebrospinal fluid. Advances in
genetic testing have made genetic testing an important tool in the classification of inherited neuromuscular
disease and diagnosis of many other neurogenetic diseases. The role of genetic influences on the
development of acquired neurologic diseases is an active area of research.

Some of the commonly encountered conditions treated by neurologists include headaches, radiculopathy,
neuropathy, stroke, dementia, seizures and epilepsy, Alzheimer's disease, attention deficit/hyperactivity
disorder,[15] Parkinson's disease, Tourette's syndrome, multiple sclerosis, head trauma, sleep disorders,
neuromuscular diseases, and various infections and tumors of the nervous system. Neurologists are also
asked to evaluate unresponsive patients on life support to confirm brain death.

Treatment options vary depending on the neurological problem. They can include referring the patient to a
physiotherapist, prescribing medications, or recommending a surgical procedure.

Some neurologists specialize in certain parts of the nervous system or in specific procedures. For example,
clinical neurophysiologists specialize in the use of EEG and intraoperative monitoring to diagnose certain
neurological disorders.[16] Other neurologists specialize in the use of electrodiagnostic medicine studies –
needle EMG and NCSs. In the US, physicians do not typically specialize in all the aspects of clinical
neurophysiology – i.e. sleep, EEG, EMG, and NCSs. The American Board of Clinical Neurophysiology
certifies US physicians in general clinical neurophysiology, epilepsy, and intraoperative monitoring.[17] The
American Board of Electrodiagnostic Medicine certifies US physicians in electrodiagnostic medicine and
certifies technologists in nerve-conduction studies.[18] Sleep medicine is a subspecialty field in the US
under several medical specialties including anesthesiology, internal medicine, family medicine, and
neurology.[19] Neurosurgery is a distinct specialty that involves a different training path, and emphasizes
the surgical treatment of neurological disorders.

Also, many nonmedical doctors, those with doctoral degrees (usually PhDs) in subjects such as biology and
chemistry, study and research the nervous system. Working in laboratories in universities, hospitals, and
private companies, these neuroscientists perform clinical and laboratory experiments and tests to learn more
about the nervous system and find cures or new treatments for diseases and disorders.

A great deal of overlap occurs between neuroscience and neurology. Many neurologists work in academic
training hospitals, where they conduct research as neuroscientists in addition to treating patients and
teaching neurology to medical students.

General caseload

Neurologists are responsible for the diagnosis, treatment, and management of all the conditions mentioned
above. When surgical or endovascular intervention is required, the neurologist may refer the patient to a
neurosurgeon or an interventional neuroradiologist. In some countries, additional legal responsibilities of a
neurologist may include making a finding of brain death when it is suspected that a patient has died.
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.
Some neurologists may develop an interest in particular subfields, such as stroke, dementia, movement
disorders, neurointensive care, headaches, epilepsy, sleep disorders, chronic pain management, multiple
sclerosis, or neuromuscular diseases.

Overlapping areas

Some overlap also occurs with other specialties, varying from country to country and even within a local
geographic area. Acute head trauma is most often treated by neurosurgeons, whereas sequelae of head
trauma may be treated by neurologists or specialists in rehabilitation medicine. Although stroke cases have
been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and
interventional neuroradiology has created a demand for stroke specialists. The establishment of Joint
Commission-certified stroke centers has increased the role of neurologists in stroke care in many primary, as
well as tertiary, hospitals. 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. Likewise, most cases of sciatica are treated by general practitioners, though they may be
referred to neurologists or surgeons (neurosurgeons or orthopedic surgeons). Sleep disorders are also
treated by pulmonologists and psychiatrists. Cerebral palsy is initially treated by pediatricians, but care may
be transferred to an adult neurologist after the patient reaches a certain age. Physical medicine and
rehabilitation physicians may treat patients with neuromuscular diseases with electrodiagnostic studies
(needle EMG and nerve-conduction studies) and other diagnostic tools. In the United Kingdom and other
countries, many of the conditions encountered by older patients such as movement disorders, including
Parkinson's disease, stroke, dementia, or gait disorders, are managed predominantly by specialists in
geriatric medicine.
Clinical neuropsychologists are often called upon to evaluate brain-behavior relationships for the purpose of
assisting with differential diagnosis, planning rehabilitation strategies, documenting cognitive strengths and
weaknesses, and measuring change over time (e.g., for identifying abnormal aging or tracking the
progression of a dementia)

Relationship to clinical neurophysiology

In some countries such as the United States and Germany, neurologists may subspecialize in clinical
neurophysiology, the field responsible for EEG and intraoperative monitoring, or in electrodiagnostic
medicine nerve conduction studies, EMG, and evoked potentials. In other countries, this is an autonomous
specialty (e.g., United Kingdom, Sweden, Spain).

Overlap with psychiatry

In the past, prior to the advent of more advanced diagnostic techniques such as MRI some neurologists
have considered psychiatry and neurologic to overlap. Although mental illnesses are believed by many 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, "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".[20]

Neurological disorders 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,
and Huntington disease, to name a few. Hence, the sharp distinction between neurology and psychiatry is
not always on a biological basis. The dominance of psychoanalytic theory in the first three-quarters of the
20th century has since then been largely replaced by a focus on pharmacology.[21] Despite the shift to a
medical model, brain science has not advanced to a point where scientists or clinicians can point to readily
discernible pathological lesions or genetic abnormalities that in and of themselves serve as reliable or
predictive biomarkers of a given mental disorder.

Neurological enhancement
The emerging field of neurological enhancement highlights the potential of therapies to improve such things
as workplace efficacy, attention in school, and overall happiness in personal lives.[22] However, this field
has also given rise to questions about neuroethics and the psychopharmacology of lifestyle drugs can have
negative and positive effects on neurology because different types of drugs can depend on people and their
lives [Cheyanne l.dorsey]

See also
Medicine portal
 American Board of Psychiatry and
Neurology
American Osteopathic Board of Neurology
and Psychiatry
Developmental Neurorehabilitation
List of neurologists
List of women neuroscientists
Neuroepigenetics
Neurohospitalist, a physician interested in
inpatient neurological care

References
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