20 things we now know for certain about the Zika virus

Zika virus exploded into the news with striking images of children born with small heads in Brazil. This was at a time the country was struggling to plan for the Rio Olympics, and also embroiled in political turmoil. These all helped to embed the virus firmly in the public’s mind.

rio-1512643_1920

Events have unfolded very rapidly, with shifting certainties and swirling speculations. The storm is however now settling, and a clearer picture emerging. And neurology is right at the centre of this viral catastrophe. What is the current state of play? Here are 20 things we now know about the Zika virus.

1. Zika is an arbovirus of the family Flaviviridae

By Manuel Almagro Rivas - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=47941048
By Manuel Almagro RivasOwn work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=47941048

2. Zika was first identified in Uganda in 1947

 

By User TShilo12 on en.wikipedia, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1155428
By User TShilo12 on en.wikipedia, Public Domain, https://commons.wikimedia.org/w/index.php?curid=1155428

3. Zika was first isolated from a Rhesus macaque monkey

Rhesus Macaque. Robert Martinez on Flikr. https://www.flickr.com/photos/madrerik/16328787935
Rhesus Macaque. Robert Martinez on Flikr. https://www.flickr.com/photos/madrerik/16328787935

4. The first human cases were reported from Nigeria

Nigeria flag. Global Panorama on Flikr. https://www.flickr.com/photos/121483302@N02/13777960823
Nigeria flag. Global Panorama on Flikr. https://www.flickr.com/photos/121483302@N02/13777960823

5. Outbreaks of Zika have ocurred in BrazilMicronesia, and French Polynesia

French Polynesia Grunge Flag. Nicholas Raymond on Flikr. https://www.flickr.com/photos/80497449@N04/7384286938
French Polynesia Grunge Flag. Nicholas Raymond on Flikr. https://www.flickr.com/photos/80497449@N04/7384286938

 

6. Zika is mainly transmitted by Aedes mosquitoes

By Rafaelgilo - Praca własna, Domena publiczna, https://commons.wikimedia.org/w/index.php?curid=40189440
By RafaelgiloPraca własna, Domena publiczna, https://commons.wikimedia.org/w/index.php?curid=40189440

7. Zika virus is transmitted perinatally

By Øyvind Holmstad - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34796811
By Øyvind HolmstadOwn work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34796811

The Centre for Disease Control (CDC) recommendations for pregnant women are

  • To avoid travel to affected countries
  • To be tested if they travel to affected countries
  • To have 3–4 weekly foetal ultrasound if they test positive for the virus
  • To have their babies tested at birth if they were infected

8. Zika virus is also sexually transmitted 

gender-23777

9. Zika virus is most likely transmissible through the skin

223 [Pocari Sweat]. Evan Blaser on Flikr. https://www.flickr.com/photos/evanblaser/6032270876
223 [Pocari Sweat]. Evan Blaser on Flikr. https://www.flickr.com/photos/evanblaser/6032270876
  • fatal case report of Zika infection from the New England Journal of Medicine strongly suggests Zika may be transmitted through sweat or tears

10. Zika virus primarily infects neural stem cells

Adult neural stem cells. California Institute for Regenerative Medicine on Flikr. https://www.flickr.com/photos/cirm/3289062760
Adult neural stem cells. California Institute for Regenerative Medicine on Flikr. https://www.flickr.com/photos/cirm/3289062760

11. Zika infection usually only causes mild and self-limiting symptoms

By Beth.herlin - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46867814
By Beth.herlinOwn work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46867814

The typical symptoms of Zika virus infection are

  • Fever
  • Skin rash
  • Conjunctivitis
  • Joint pains
  • Muscle aches
  • Headache

12. Microcephaly is the striking feature of congenital Zika

By Centers for Disease Control and Prevention - http://www.cdc.gov/ncbddd/birthdefects/images/microcephaly-comparison-500px.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=46674502
By Centers for Disease Control and Prevention – http://www.cdc.gov/ncbddd/birthdefects/images/microcephaly-comparison-500px.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=46674502

 

13. Zika infection causes several other brain abnormalities

By Ralphelg - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16057859
By RalphelgOwn work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16057859

Brain abnormalities with congenital Zika infection include:

  • Calcification of the brain’s white matter
  • Cerebellar dysgenesis: abnormal development of the cerebellum
  • Craniosynostosis: premature closure of the bones of the brain
  • Lissencephaly: an abnormal shape of the brain 
  • Ventriculomegaly: enlargement of the brain’s fluid-containing spaces

These abnormalities may be seen on brain imaging

14. Adult Zika infection causes Guillain Barre syndrome (GBS)

 

By Doctor Jana - http://docjana.com/#/gbs; http://www.patreon.com/posts/guillain-barre-4374004, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=46847816
By Doctor Jana – http://docjana.com/#/gbs; http://www.patreon.com/posts/guillain-barre-4374004, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=46847816

15. Zika virus infection causes other neurological diseases

Knitted Neurology. estonia76 on Flikr. https://www.flickr.com/photos/estonia76/6453525355
Knitted Neurology. estonia76 on Flikr. https://www.flickr.com/photos/estonia76/6453525355

There are other neurological diseases associated with Zika virus such as

 

16. Zika virus infection causes many eye abnormalities

By JDrewes - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=3117810
By JDrewesOwn work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=3117810

Eye abnormalities reported with Zika virus infection include

  • Mottling and atrophy of the retina
  • Abnormalities of the optic nerve
  • Coloboma (defects) of the iris
  • Subluxation (dislocation) of the lens

 

17. Zika virus may cause impairments in other organ systems

By Mikael Häggström - Image:Respiratory system complete numbered.svg (Public domain licence), Public Domain, https://commons.wikimedia.org/w/index.php?curid=5806243
By Mikael HäggströmImage:Respiratory system complete numbered.svg (Public domain licence), Public Domain, https://commons.wikimedia.org/w/index.php?curid=5806243

Other organs affected by Zika virus lead to disorders such as

  • Pulmonary hypoplasia, or underdeveloped lungs
  • Severe thrombocytopaenia, or low platelet counts
  • Urinary and genital symptoms

18. Zika virus infection is confirmed by laboratory tests

CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=340018
CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=340018
  • rRT-PCR (real time reverse transcriptase polymerase chain reaction) is the best test for the Zika virus
  • This is done on urine and blood samples collected within 2 weeks of infection

19. There is an experimental human vaccine trial for the Zika virus

 

 

 

20. There are promising antiviral treatments for Zika virus

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Want to explore more? You may check out the following:

What are the most iconic neurological disorders?

Neurology is a broad specialty covering a staggering variety of diseases. Some neurological disorders are vanishingly rare, but many are household names, or at least vaguely familiar to most people. These are the diseases which define neurology. Here, in alphabetical order, is my list of the top 60 iconic neurological diseases, with links to previous blog posts where available.

 

1. Alzheimer’s disease

By uncredited - Images from the History of Medicine (NLM) [1], Public Domain, https://commons.wikimedia.org/w/index.php?curid=11648572
By uncredited – Images from the History of Medicine (NLM) [1], Public Domain, https://commons.wikimedia.org/w/index.php?curid=11648572

2. Behcet’s disease

By Republic2011 - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=17715921
By Republic2011Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=17715921

3. Bell’s palsy

By http://wellcomeimages.org/indexplus/obf_images/69/f2/8d6c4130f4264b4b906960cf1f7e.jpgGallery: http://wellcomeimages.org/indexplus/image/M0011440.html, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=36350600
By http://wellcomeimages.org/indexplus/obf_images/69/f2/8d6c4130f4264b4b906960cf1f7e.jpgGallery: http://wellcomeimages.org/indexplus/image/M0011440.html, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=36350600

4. Brachial neuritis

5. Brain tumours

6. Carpal tunnel syndrome

7. Cerebral palsy (CP)

8. Cervical dystonia

9. Charcot Marie Tooth disease (CMT)

By http://wellcomeimages.org/indexplus/obf_images/66/09/4dfa424fe11bb8dc56b2058f04ba.jpgGallery: http://wellcomeimages.org/indexplus/image/V0026141.html, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=36578490
By http://wellcomeimages.org/indexplus/obf_images/66/09/4dfa424fe11bb8dc56b2058f04ba.jpgGallery: http://wellcomeimages.org/indexplus/image/V0026141.html, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=36578490

10. Chronic inflammatory demyelinating polyneuropathy (CIDP)

11. Cluster headache

12. Creutzfeldt-Jakob disease (CJD)

By Unknown - http://www.sammlungen.hu-berlin.de/dokumente/11727/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4008658
By Unknownhttp://www.sammlungen.hu-berlin.de/dokumente/11727/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4008658

13. Duchenne muscular dystrophy (DMD)

By G._Duchenne.jpg: unknown/anonymousderivative work: PawełMM (talk) - G._Duchenne.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9701531
By G._Duchenne.jpg: unknown/anonymousderivative work: PawełMM (talk) – G._Duchenne.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9701531

14. Encephalitis

15. Epilepsy

16. Essential tremor

17. Friedreich’s ataxia

By Unknown - http://www.uic.edu/depts/mcne/founders/page0035.html, Public Domain, https://commons.wikimedia.org/w/index.php?curid=3960759
By Unknownhttp://www.uic.edu/depts/mcne/founders/page0035.html, Public Domain, https://commons.wikimedia.org/w/index.php?curid=3960759

18. Frontotemporal dementia (FTD)

19. Guillain-Barre syndrome (GBS)

By Anonymous - Ouvrage : L'informateur des aliénistes et des neurologistes, Paris : Delarue, 1923, Public Domain, https://commons.wikimedia.org/w/index.php?curid=28242077
By Anonymous – Ouvrage : L’informateur des aliénistes et des neurologistes, Paris : Delarue, 1923, Public Domain, https://commons.wikimedia.org/w/index.php?curid=28242077

20. Hashimoto encephalopathy

21. Hemifacial spasm

22. Horner’s syndrome

By Unknown - http://ihm.nlm.nih.gov/images/B15207, Public Domain, https://commons.wikimedia.org/w/index.php?curid=19265414
By Unknownhttp://ihm.nlm.nih.gov/images/B15207, Public Domain, https://commons.wikimedia.org/w/index.php?curid=19265414

23. Huntington’s disease (HD)

https://en.wikipedia.org/wiki/George_Huntington#/media/File:George_Huntington.jpg
https://en.wikipedia.org/wiki/George_Huntington#/media/File:George_Huntington.jpg

24. Idiopathic intracranial hypertension (IIH)

25. Inclusion body myositis (IBM)

26. Kennedy disease

27. Korsakoff’s psychosis

28. Lambert-Eaton myasthenic syndrome (LEMS)

29. Leber’s optic neuropathy (LHON)

30. McArdles disease

31. Meningitis

32. Migraine

33. Miller-Fisher syndrome (MFS)

By J3D3 - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34315507
By J3D3Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34315507

34. Motor neurone disease (MND)

35. Multiple sclerosis (MS)

36. Multiple system atrophy (MSA)

37. Myasthenia gravis (MG)

38. Myotonic dystrophy

39. Narcolepsy

40. Neurofibromatosis (NF)

41. Neuromyelitis optica (NMO)

42. Neurosarcoidosis

43. Neurosyphilis

44. Parkinson’s disease (PD)

45. Peripheral neuropathy (PN)

46. Peroneal neuropathy

47. Progressive supranuclear palsy (PSP)

48. Rabies

49. Restless legs syndrome (RLS)

50. Spinal muscular atrophy (SMA)

51. Stiff person syndrome (SPS)

52. Stroke

53. Subarachnoid haemorrhage (SAH)

54. Tension-type headache (TTH)

55. Tetanus

56. Transient global amnesia (TGA)

57. Trigeminal neuralgia

58. Tuberous sclerosis

59. Wernicke’s encephalopathy

By J.F. Lehmann, Muenchen - IHM, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9679254
By J.F. Lehmann, Muenchen – IHM, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9679254

60. Wilson’s disease

By Carl Vandyk (1851–1931) - [No authors listed] (July 1937). "S. A. Kinnier Wilson". Br J Ophthalmol 21 (7): 396–97. PMC: 1142821., Public Domain, https://commons.wikimedia.org/w/index.php?curid=11384670
By Carl Vandyk (1851–1931) – [No authors listed] (July 1937). “S. A. Kinnier Wilson“. Br J Ophthalmol 21 (7): 396–97. PMC: 1142821., Public Domain, https://commons.wikimedia.org/w/index.php?curid=11384670

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The Neurology Lounge has a way to go to address all these diseases, but they are all fully covered in neurochecklists. In a future post, I will look at the rare end of the neurological spectrum and list the 75 strangest and most exotic neurological disorders.

10 bizarre things neurologists do to their patients

This is a follow-up to my previous blog post, So what is remarkable about neurology anyway? That post reviewed the challenging tasks neurologists face everyday. How do they go about it? How do they evaluate their patients with suspected neurological disorders?

Neurology by MV Maverick on Flikr. https://www.flickr.com/photos/themvmaverick/11396461045
Neurology by MV Maverick on Flikr. https://www.flickr.com/photos/themvmaverick/11396461045

 

For the uninitiated, the process of the neurological assessment must seem like an outlandish ritual. Unlike cardiologists who approach patients with the familiar stethoscope, neurologists come armed to the hilt with an arsenal of threatening equipment. Patients are often bewildered, and occasionally irritated, with the neurological exam. Admitted, they sometimes, they sometimes emerge from the assessment feeling battered and bruised-all for a good cause of course!

So what are these bizarre deeds that marks the neurological consultation?

1. Neurologists welcome you with an overly firm handshake 

By liftarn (http://openclipart.org/media/files/liftarn/2604) [Public domain], via Wikimedia Commons
By liftarn (http://openclipart.org/media/files/liftarn/2604) [Public domain], via Wikimedia Commons

The handshake is a valuable neurological tool. It tells the neurologist right from the beginning if there is any weakness or if there is a form of muscle stiffness called myotonia. Therefore avoid the neurologist’s handshake if you suffer with arthritis or other painful hand conditions.

2. Neurologists make you do the catwalk 

The way you walk, the gait, may show the neurologist a variety of clues or signs. There are a variety of abnormal gaits that often point to a diagnosis even before the consultation actually begins. Examples include the shuffling gait in Parkinson’s disease, the hemiparetic gait in Stroke, and the waddling gait in diseases that give rise to hip girdle weakness. More embarrassing for some patients is that the neurologist may actually ask them to do a catwalk, all for the sake of making a diagnosis you must understand!

Other bizarre associated tests are walking an imaginary tightrope, standing on one leg, standing on tip toes and then on the heels, and marching in one spot with eyes shut

3. Neurologists stare intently at you 

"Thisisbossi Symmetry" by Andrew Bossi - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Thisisbossi_Symmetry.JPG#/media/File:Thisisbossi_Symmetry.JPG
“Thisisbossi Symmetry” by Andrew Bossi – Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:Thisisbossi_Symmetry.JPG#/media/File:Thisisbossi_Symmetry.JPG

 

The face often give the neurologist the clue to many diagnoses. Conditions such as Bell’s palsy and Stroke are evident from the face as are Parkinson’s disease, myotonic dystrophy and facio-scapulo-humeral muscular dystrophy (FSHD). There’s no need to blush therefore when the intent gaze seems to go on endlessly.

4. Neurologists come up very close- to peer into your soul

If the eyes are the windows to the soul, then neurologists are second only to ophthalmologists in recognising this nebulous entity. The back of the eye, or retina, holds a variety of valuable clues for many neurological diseases. The neurologist typically looks for signs of increased pressure in the head and this may occur with brain tumours, meningitis, encephalitis, This may also occur without any obvious cause in a condition called idiopathic intracranial hypertension (IIH). Other eye signs such as cataracts and pigmented retina seen with disorders for example mitochondrial diseases. 

To peer into the soul, the neurologist may come very uncomfortably close, (hoping the aftershave isn’t too strong and that the morning deodorant has lasted till then). Don’t hold your breath however, as this gazing into the soul may take longer than you anticipate.

5. Neurologists ask you to roll your eyes-in all sorts of directions

Muscles of the eye, circa 1900 by Double-M on Flikr. https://www.flickr.com/photos/double-m2/5551619158
Muscles of the eye, circa 1900 by Double-M on Flikr. https://www.flickr.com/photos/double-m2/5551619158

 

Abnormal eye movements are key pointers to many neurological disorders. There are six muscles that move each eyeball, and these are under the control of three pairs of cranial nerves-the oculomotor, the trochlear, and the abducens nerves. These nerves in turn are coordinated by complex nerve cell bodies or nuclei in the brain stem.The eyelids and pupils are also muscles under control of nerves.

These cranial nuclei coordinate a symphony of unparalleled and unimaginable complexity. This allows us to focus on moving objects without any hinderance. Things may go wrong with this symphony, and this typically results in double vision (diplopia) and droopy eyelids (ptosis). Diseases that cause these symptoms include brain aneurysms, myasthenia gravis (MG), and brainstem stroke. Some diseases may cause the eyeballs to move in uncontrollable and chaotic ways called nystagmus, oscillopsia, and opsoclonus (neurologists love these names!) 

Don’t be shocked therefore when your neurologist asks you to look up, look down, look to the right and left; to follow this or the other hand; to look at this fist then at these fingers…. It’s all a helpful game-honest!

6. Neurologists ask you to pretend to brush your teeth 

 

"Marcel Marceau - 1974" by press photo - ebay. Licensed under Public Domain via Commons.
Marcel Marceau – 1974” by press photo – ebay. Licensed under Public Domain via Commons.

 

Your neurologist may request you to brush your teeth or hair with an imaginary brush, or ask you to do victory sign or the thumbs-up sign (never thumbs-down mind you). Almost verging on the comedic, this is a serious test because these simple tasks are impaired in many diseases. The difficulty in performing tasks one has previously been proficient at is called dyspraxia, or apraxia if the ability is completely lost. Without any weakness or numbness, people with dyspraxia are unable to use common tools and equipment, reporting that they have no idea how to manipulate them. This could be seen in some forms of stroke and some dementias. Do decline however if she asks you to mimic the great mime Marcel Marceau.

7. Neurologists ask you to wiggle your tongue and poke it out 

New Zealand Maori culture 009 by Steve Evans on Flikr. https://www.flickr.com/photos/babasteve/5418324230
New Zealand Maori culture 009 by Steve Evans on Flikr. https://www.flickr.com/photos/babasteve/5418324230

 

The tongue is a very important muscle and holds countless clues for the neurologist. It is innervated by the last of the 12 cranial nerves, the hypoglossal nerve. which may be paralysed by a very localised stroke and this is often in the context of a condition called cervical artery dissection. This is a tear in one of the big arteries in the neck which take blood to the brain. The tear may arise from trivial neck movements and manipulations such as look up for a long time or staying too long on the hairdressers couch. A clot then forms at the site of the tear, and this then migrates to block a smaller blood vessel supplying the brainstem where the hypoglossal nerve sets off from…phew! Anyway, when this kind of stroke occurs, the tongue deviates to the the weaker side when it is poked out.

The more general weakness of the tongue is seen in conditions such as motor neurone disease (MND), in which the tongue also quivers at rest-something neurologists call fasciculations. The cheeky neurologist (pun intended) will ask you to push against her finger through your cheek to test its full strength.

Another problem that may affect the tongue is myotonia, a condition in which he tongue and other muscles are stiff and relax very slowly after they are activated. To test this, your neurologist may actually tap on your tongue, and then watches in fascination as it stiffens and then relaxes very slowly. Strong but slow moving tongues may be seen in Parkinson’s disease (PD). So, when next your neurologist says ‘open up’, he really means business.

8. Neurologists flex their muscles against yours

 

"FreestyleWrestling2" by Staff Sergeant Jason M. Carter, USMC - Defenseimagery.mil, VIRIN 040307-M-RS496-226. Licensed under Public Domain via Commons - https://commons.wikimedia.org/wiki/File:FreestyleWrestling2.jpg#/media/File:FreestyleWrestling2.jpg
“FreestyleWrestling2” by Staff Sergeant Jason M. Carter, USMC – Defenseimagery.mil, VIRIN 040307-M-RS496-226. Licensed under Public Domain via Commons – https://commons.wikimedia.org/wiki/File:FreestyleWrestling2.jpg#/media/File:FreestyleWrestling2.jpg

 

OK, she will not literally wrestle you to the ground but it may appear so at times. Pushing against your head, pressing down against your elbows, leaning hard against your leg-she will do everything to show she is stronger than you. Only if she fails will she score your power as grade 5/5-the best you can get. If you do not score full marks however you place the neurologist in a bit of a quagmire; a score between 0-5 is not always easy to allocate, and the obsessive neurologist may get in a bind and may give you marks such as 3+ or 4-. Just for fun let her win, and see her consternation!

9. Neurologists hit you with a hammer-in all sorts of places

Lego man and reflex hammer by Dr. Mark Kubert on Flikr. https://www.flickr.com/photos/clearpathchiropractic/7590265518
Lego man and reflex hammer by Dr. Mark Kubert on Flikr. https://www.flickr.com/photos/clearpathchiropractic/7590265518

 

The reflex hammer is perhaps the most well-recognised tool of the neurologist. These hammers come in all shapes and sizes, and some are really quite scary. People expect to have their knees tapped and look forward to what they have seen many times on TV-the leg kicking out. Most patients find this amusing. They are however often surprised  when the neurologist proceeds to use the hammer on their jaw, elbow, wrist and ankles. The then often bristle at having the soles of their feet stroked by the end of the hammer’s handle, a sharp uncomfortable end it is. All the hammer does is to stretch the tendons of muscles, and this elicits a reflex that causes the muscle to contract or tighten up. This response may be exaggerated (hypereflexia) if there is any problem in the central nervous system. Conversely the reflex response may be diminished (hyporeflexia) with problems of the peripheral nervous system.  Stroking the foot is called the Babinski response and gives a similar form of information to the neurologist. But beware the neurologist who then proceeds to stroke the side of your foot or squeeze your shins, all in an effort to get the same information-it is really an unnecessary and uncomfortable duplication of tests.

10. Neurologists prick and prod you with a sharp pin

Now this must take the cake, and quite rightly often comes at the end of the neurological examination. As threatening as this tests appears, this is probably the neurologist at his most acute. Using a sterile pin, the neurologist asks you to respond ‘yes’ if the sensation you perceive is sharp, and ‘no’ if it is dull. He then carefully proceeds to map out areas of reduced sensation or feeling, frowning as he struggles to keep track of your responses in his mind. He tries to establish if you have a glove and stocking pattern of sensory loss seen in peripheral neuropathy (nerve end damage). It may also be a dermatomal pattern seen with radiculopathy (trapped nerve in the spine). Unfortunately for the neurologist however many patients do not understand the rules of the game and give all sorts of unimaginable responses; not surprising when one is under the threat of a sharp pointy object!

"User-FastFission-brain". Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:User-FastFission-brain.gif#/media/File:User-FastFission-brain.gif
“User-FastFission-brain”. Licensed under CC BY-SA 3.0 via Wikimedia Commons – https://commons.wikimedia.org/wiki/File:User-FastFission-brain.gif#/media/File:User-FastFission-brain.gif

 

These are but a few of the bizarre doings of neurologists.  Seeing a neurologist soon? Be prepared-you have been warned!

PS. Images used in this blog post are for illustration purposes only and do not necessary depict the actual equipment used by neurologists. The examination steps described are however a good reflection of actual neurological practice.