So what is so remarkable about neurology anyway?

There is an astounding variety of reasons why a patient may be referred to a neurologist. The neurologist is easily identified as a brain doctor, and the patient may, after all, just have some tingling in the feet or some flickering of the muscles. Many patients may only have heard of prominent neurologists such as Oliver Sacks.

9.13.09 Oliver Sacks By Luigi Novi
9.13.09 Oliver Sacks By Luigi Novi

 

Or perhaps that man Sigmund Freud-or was he a psychoanalyst?

"Sigmund Freud LIFE" by Max Halberstadt - http://politiken.dk/kultur/boger/faglitteratur_boger/ECE1851485/psykoanalysen-har-stadig-noget-at-sige-i-noejagtigt-betitlet-bog/. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:Sigmund_Freud_LIFE.jpg#/media/File:Sigmund_Freud_LIFE.jpg
“Sigmund Freud LIFE” by Max Halberstadt – http://politiken.dk/kultur/boger/faglitteratur_boger/ECE1851485/psykoanalysen-har-stadig-noget-at-sige-i-noejagtigt-betitlet-bog/. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:Sigmund_Freud_LIFE.jpg#/media/File:Sigmund_Freud_LIFE.jpg

 

Apart from the fact that both are bearded, there is absolutely nothing similar to the practice of Sacks and Freud. You may refer to my post on the 100 all-time most influential neurologists for a flavour of the diverse and prominent neurologists.

By Joaquín Sorolla (1863 - 1923) ([1]) [Public domain or Public domain], via Wikimedia Commons
Santiago Ramon y Cajal By Joaquín Sorolla (1863 – 1923) ([1]) [Public domain or Public domain], via Wikimedia Commons

And this is what baffles patients; their inability to pigeon-hole a neurologist. Most medical specialists are easily identified by the restricted range of patients they see but neurology has a bewildering diversity of specialties. A cardiologist or a nephrologist comes with a clear label on the box, but the neurologist deals with conditions that extend from the top of the head to the tips of the toes.

"Components of the Nervous System" by Jenna Fair - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Components_of_the_Nervous_System.png#/media/File:Components_of_the_Nervous_System.png
“Components of the Nervous System” by Jenna Fair – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Components_of_the_Nervous_System.png#/media/File:Components_of_the_Nervous_System.png

 

Neurological conditions are broadly defined as either affecting the central nervous system (brain and spinal cord) or the peripheral nervous system. Each of these then has several subspecialties that are mind-boggling.

Charis Tsevis Wired Nerves for Harrison & star. Flikr. https://www.flickr.com/photos/tsevis/8043450564
Charis Tsevis on Flikr. Wired Nerves for Harrison & Star. https://www.flickr.com/photos/tsevis/8043450564

 

The peripheral nervous system for instance consists of a diversity of motor and sensory nerves, and these communicate with organs, muscles and tissues all over the body. And there is an overwhelming array of things that can go wrong at each point of the nervous system, resulting in a myriad of nervous system diseases.

 

Gontzal García del Caño on Flikr. Spinal cord and spinal nerves. https://www.flickr.com/photos/euskalanato/2056232391
Gontzal García del Caño on Flikr. Spinal cord and spinal nerves. https://www.flickr.com/photos/euskalanato/2056232391

 

Peripheral nerve dysfunction may therefore give rise to disorders of the anterior horn cell, the nerve root, the ganglion, the neuromuscular junction, muscles, small and large nerve fibers. Each of these are further subclassified, a reflection of the diversity of neurological disorders. Take a look for example at the complex neuromuscular junction below, and you will appreciate the literally countless things that may go amiss.

"Synapse diag4". Licensed under CC BY-SA 3.0 via Commons - https://commons.wikimedia.org/wiki/File:Synapse_diag4.png#/media/File:Synapse_diag4.png
“Synapse diag4”. Licensed under CC BY-SA 3.0 via Commons – https://commons.wikimedia.org/wiki/File:Synapse_diag4.png#/media/File:Synapse_diag4.png

 

The diversity of neurological problems was brought home to me when I took up the task of compiling a database of neurology checklists. I blame Atul Gawande‘s Checklist Manifesto for this excursion on my part. The process was like opening up a can of worms; below is the broad range of major neurological disease categories I found:

  • Epilepsy
  • Disorders of Cranial Nerves
  • Disorders of Cognition
  • Disorders of Consciousness
  • Neurological Infections
  • Neurological Toxicity
  • Sleep disorders
  • Developmental Disorders
  • Parkinsonism
  • Other movement Disorders
  • Neuro-inflammatory Disorders
  • Headache Disorders
  • Metabolic disorders
  • Autoimmune Disorders
  • Anterior Horn Cell disorders
  • Radicular disorders
  • Plexus Disorders
  • Peripheral Nerve Disorders
  • Neuromuscular Junction (NMJ) disorders
  • Muscle Disorders
  • Spinal Cord Disorders
  • Nervous System Tumours
  • Stroke
  • Other Vascular Disorders

Neurology also has significant overlaps with other specialties, and neurologists often have to deal with:

  • Disorders of Allied Neurological Specialties
  • Neurological Disorders and General Medicine

What is so remarkable about neurology? It encompasses an unimaginable diversity of diseases. Many such as as migraine, Parkinson’s disease (PD) and peripheral neuropathy are common. For a taste of the diversity of these common diseases, see my previous blogs on neurology guidelines and neurology review articles. Many neurological diseases are however rare and complicated; for a flavour of the rarer diseases, take a look at my previous blog post on the most esoteric neurological conditions.

Typhoon at English Wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons
Typhoon at English Wikipedia [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

These are the remarkable things neurologist try to sort out. But how do they do it? How do they go about teasing out what is what? What is in the neurological toolbox? The key is the neurological consultation, an assessment so alien, using tools so scary, that it takes many patients aback: watch out for my future blog on The 20 Bizarre Things Neurologists Do To Their Patients.

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