Neurology 21226 226054866 2008-07-16T17:00:17Z Dwayne Reed 7262504 added image {{redirect|Neurologist|the medical journal|The Neurologist}} [[Image:Structural.gif|thumb|[[Nuclear magnetic resonance imaging|MRI]] of the head is a nuclear medicine technique frequently used in the field of Neurology.]] '''Neurology''' is a [[medical]] specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the [[Central nervous system|central]], [[Peripheral nervous system|peripheral]], and [[autonomic nervous system]]s, including their coverings, blood vessels, and all effector tissue, such as muscle.<ref>http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf</ref> [[Physicians]] who specialize in neurology are called '''neurologists''', and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in [[clinical research]], [[clinical trials]], as well as [[basic research]] and [[translational research]]. In the United Kingdom, contributions to the field of neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialize in the technical/laboratory aspects of one of neurology's subdisciplines. ==Field of work== '''Neurological disorders''' are disorders that can affect the [[central nervous system]] ([[brain]] and [[spinal cord]]), the [[peripheral nervous system]], or the [[autonomic nervous system]]. Major conditions include: * [[behavioral neurology|behavioral/cognitive syndromes]] * [[headache|headache disorders]] such as [[migraine]], [[cluster headache]] and [[tension headache]] * [[epilepsy]] * [[traumatic brain injury]] * [[neurodegenerative disorder]]s, including [[Alzheimer's disease]], [[Parkinson's disease]], [[Huntington's disease]], and [[Amyotrophic lateral sclerosis]] ([[Amyotrophic lateral sclerosis|Lou Gehrig's disease]]). * cerebrovascular disease, such as [[transient ischemic attack]] and [[stroke]]. * [[sleep disorder]]s * [[cerebral palsy]] * [[infection]]s of the brain ([[encephalitis]]), brain meninges ([[meningitis]]), spinal cord ([[myelitis]]) * [[infections]] of the peripheral nervous system * [[neoplasm]]s{{ndash}} [[tumor]]s of the [[brain]] and its meninges ([[brain tumor]]s), [[spinal cord]] [[tumor]]s, [[tumor]]s of the peripheral [[nerves]] ([[neuroma]]) * [[movement disorder]]s such as [[Parkinson's disease]], [[Huntington's disease]], [[hemiballismus]], [[tic disorder]], and Gilles de la [[Tourette syndrome]] * [[demyelinating disease]]s 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{{ndash}} [[tumor]]s, [[infection]]s, [[Physical trauma|trauma]], malformations (e.g., myelocele, meningomyelocele, tethered cord) * disorders of peripheral [[nerve]]s, [[muscle]] ([[myopathy]]) and [[neuromuscular junction]]s * exciting injuries to the [[brain]], [[spinal cord]] and peripheral [[nerve]]s * altered mental higher status, [[encephalopathy]], stupor and [[coma]] * [[communication disorder|speech and language disorders]] == Educational requirements == A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after graduation from [[medical school]]. Neurologists complete, on average, 12 years of postsecondary education and clinical training. This training includes obtaining a four-year undergraduate degree, a medical degree, which is an additional four years, and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology. Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, [[interventional neurology]], epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders. In the United Kingdom and Ireland, neurology is a subspecialty of general (internal) medicine. After five or six years of medical school and a year as a pre-registration house officer (or two years on the new Foundation Programme) a would-be neurologist has to get enough training in internal medicine to pass the examination for [[Membership of the Royal College of Physicians]] (or the Irish equivalent) before entering specialist training in neurology. A generation ago some neurologists would also spend a couple of years working in psychiatric units and obtain a Diploma in Psychological Medicine, but that became uncommon and now that a basic psychiatric qualification takes three years to obtain it is no longer practical. A period of research is essential, and obtaining a higher degree aids career progression: many found it was eased after an attachment to the Institute of Psychiatry in London. Some neurologists enter the field of rehabilitation medicine (known as [[physiatry]] in the US) to specialise in neurological rehabiltation, which may include stroke medicine as well as brain injuries. == Testing examinations == During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the [[cranial nerves]] (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if 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 management. ==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]]. 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 ([[gene]]tic) diseases when the major manifestations are neurological, as is frequently the case. [[Lumbar puncture]]s are frequently performed by [[neurologists]]. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, [[headache]]s, [[epilepsy]], sleep disorders, chronic pain management, [[multiple sclerosis]] or neuromuscular diseases. ===Overlapping areas=== There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute [[head injury|head trauma]] is most often treated by [[neurosurgeon]]s, whereas [[sequelae]] of head trauma may be treated by neurologists or [[Physical medicine and rehabilitation|specialists in rehabilitation medicine]]. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and [[interventional neurologists]] has created a demand for stroke specialists. The establishment of [[JCAHO]] 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 disease]]s are treated by infectious disease specialists. Most cases of [[headache]] are diagnosed and treated primarily by [[general practitioner]]s, 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 surgery|orthopedic surgeons]]). [[Sleep disorders]] are also treated by [[Pulmonology|pulmonologists]]. [[Cerebral palsy]] is initially treated by [[Pediatrics|pediatricians]], but care may be transferred to an adult neurologist after the patient reaches a certain age. [[Clinical neuropsychology|Clinical neuropsychologists]] are often called upon to [[Neuropsychological assessment|evaluate]] [[brain]]-[[Human behavior|behavior]] relationships for the purpose of assisting with [[differential diagnosis]], planning [[Physical medicine and rehabilitation|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, e.g. USA and Germany, neurologists may specialize in [[clinical neurophysiology]], the field responsible for [[electroencephalography|EEG]], [[nerve conduction study|nerve conduction studies]], [[electromyography|EMG]] and [[evoked potentials]]. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden). ===Overlap with psychiatry=== {{see|Psychoneuroimmunology|Neuropsychiatry}} Although many [[mental illness]]es 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 neurochemical mechanisms play an important role in the development of, for instance, [[bipolar disorder]] and [[schizophrenia]]. Also, 'neurological' diseases often have 'psychiatric' manifestations, such as post-[[stroke]] [[clinical depression|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{{ndash}}; this distinction has mainly practical reasoning and strong historical roots (such as the dominance of [[Freud]]'s [[psychoanalysis|psychoanalytic theory]] in the first three quarters of the 20th century{{ndash}} which has since then been largely replaced by the focus on [[neurosciences]]{{ndash}} aided by the tremendous advances in [[genetics]] and [[neuroimaging]].) In Germany, a compulsory year of Psychiatry must be done to complete a residency of Neurology. == References == <references/> ==External links== * [http://www.efns.org European Federation of Neurological Societies] * [http://www.blackwell-synergy.com/loi/ene European Journal of Neurology] * [http://www.ninds.nih.gov National Institute of Neurological Disorders and Stroke (NINDS)] * [http://www.fastmag.info Fast-MAG] The Field Administration of Stroke Therapy – Magnesium Phase 3 Clinical Trial * [http://stroke.ahajournals.org/ Journal of The American Stroke Association] * [http://www.tg.com.au/?sectionid=46 Therapeutic Guidelines{{ndash}} Neurology] {{Medicine}} {{Neuroscience}} [[Category:Neurology]] [[Category:Subjects taught in medical school]] [[Category:Greek loanwords]] [[ar:طب الأمراض العصبية]] [[bn:স্নায়ুবিদ্যা]] [[bs:Neurologija]] [[bg:Неврология]] [[ca:Neurologia]] [[cs:Neurologie]] [[da:Neuromedicin]] [[de:Neurologie]] [[el:Νευρολογία]] [[es:Neurología]] [[eo:Neŭrologio]] [[eu:Neurologia]] [[fa:عصب‌شناسی]] [[fr:Neurologie]] [[ga:Néareolaíocht]] [[hr:Neurologija]] [[id:Neurologi]] [[it:Neurologia]] [[he:נוירולוגיה]] [[ku:Neurologî]] [[lt:Neurologija]] [[hu:Neurológia]] [[nl:Neurologie]] [[ne:स्नायुशास्त्र]] [[ja:神経学]] [[no:Nevrologi]] [[nn:Nevrologi]] [[pl:Neurologia]] [[pt:Neurologia]] [[ro:Neurologie]] [[ru:Неврология]] [[simple:Neurology]] [[sr:Неурологија]] [[fi:Neurologia]] [[sv:Neurologi]] [[th:ประสาทวิทยา]] [[tr:Nöroloji]] [[ur:اعصابیات]] [[zh:神經學]]