neurology
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Neurology. Dr Chris Derry Consultant Neurologist Department of Clinical Neurosciences WGH, Edinburgh. Outline. What is neurology? What is a neurologist? Elements of neurological diagnosis History Examination Demonstration Signs/ videos Laboratory tests Final diagnosis. - PowerPoint PPT PresentationTRANSCRIPT
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NeurologyDr Chris Derry
Consultant NeurologistDepartment of Clinical
NeurosciencesWGH, Edinburgh
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Outline• What is neurology?• What is a neurologist?• Elements of neurological diagnosis
– History– Examination
• Demonstration• Signs/ videos
– Laboratory tests– Final diagnosis
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What is Neurology?• The medical specialty concerned with the
diagnosis, investigation and management of disorders of the nervous system.
• Clinical neurosciences vs basic neurosciences
• Nervous system– Central Nervous System (CNS)– Peripheral Nervous System (PNS)– Autonomic nervous system (ANS)
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What does a neurologist do?• Diagnostics of nervous system disease
– Traditional role
• Management of acute neurological conditions– Status epilepticus, encephalitis, acute stroke etc
• Management of chronic neurological diseases– Epilepsy, parkinsons disease, multiple sclerosis
• Research
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Other nervous system specialists…
• Neurosurgeon– Surgical treatment of neurological disease. Open and
stereotactic procedures
• Neuroradiologist– Neuroimaging. Interventional neuroradiology
• Neurophysiologist– EEG, NCV/EMG, evoked potentials
• Neuropathologist– Biopsy analysis, autopsy
• Psychiatrist– Mental illness
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Why are patients referred to aNeurologist?
• GP– Neurological symptoms worrying patient/ doctor – headache/ numbness/ weakness
• Other specialists– Neurological complications of other diseases– Confusing clinical pictures
– Many tests not definitive– Some invasive/expensive
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Example…• 32 year old female.• Background of
migraine
• Persistent daily headache for 1/12
• Worsening headache, presented to A&E
• Admitted, MRIDoes she have MS?
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Making a neurological diagnosis
1. Where is the problem?• CNS (brain/ spinal cord)• Nerves• Muscle
2. What is the nature of the problem?• ‘vascular’• ‘inflammatory’• ‘infection’• ‘neoplastic’ etc..
3. What is the definitive diagnosis?
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How are those stages reached?
1. History• 80% of diagnostic information• Particularly useful for localisation and
mechanism
2. Examination• Can confirm localisation
3. Investigations• Can help with pathological/ definitive diagnosis
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The neurological history• Presenting complaint
– Headache, blackouts, dizziness, weakness, sensory symptoms, memory difficulties etc etc etc
– Evolution of symptoms– Acute, subacute, chronic– Episodic, persistent
– Systematic review– Additional neurological symptoms. ?Focal,
multifocal or systemic disorder
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The neurological history• Previous medical history
– Earlier neurological symptoms, including symptoms seemingly unconnected
• Family history– Many neurological disorders have a genetic basis
• Social history– Consequences for job, family, driving, hobbies, sport,
recreation– Smoking, alcohol– Drug history
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Neurological examination• After the history, you usually have a fair idea of:
– Where the lesion is – Type of lesion
– And you may also know the final diagnosis…
• Examination serves several purposes– Confirm localisation/ hypothesis testing
• e.g Spinal cord vs peripheral nerve– Screening for unsuspected abnormalities– Closely observe patient behaviours– Reassure patient– Think!
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Neurological examination• Cognition (Addenbrooke’s Cognitive Examination)• Cranial nerves• Limbs
– Inspection (wasting etc)– Tone– Power– Co-ordination– Reflexes– Sensation
• Romberg’s/ Unterberger’s/ Hallpike’s• Gait
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1. Cranial nerves
– ‘Head’ functions (including special senses)
• Smell• Sight• Facial sensation• Facial movements• Taste• Hearing• Tongue movements• Swallowing
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Cranial nerve II (optic nerve)
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Cranial nerves II, IV, VI
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Cranial nerves II, IV, VI
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Cranial nerve VII
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Cranial nerve XII
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Limb Examination• UPPER LOWER
EXTREMITIES• Neck movement and
strength• Motor function• Muscle bulk• Tone• Power• Reflexes• Co-ordination• Sensory examination
• AXIAL EXAMINATION
• Shoulder girdle muscles
• Curvature• Rise from supine• Abdominal reflexes
• Unterberger’s• Romberg’s • Hallpike’s
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Some “Spot” diagnoses
• Parkinson’s Disease• Huntingdon’s Chorea
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Investigations
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CT (computed tomography)
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CT (computed tomography)
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Magnetic Resonance (MR) imaging
• Similar looking machinery to CT– No radiation source– Works via powerful magnets
• Very high definition of anatomy – eg white matter v grey
• Better than CT for detecting most brain pathology, particularly small/subtle abnormalities
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MRI
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Nuclear medicine
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Lumbar puncture
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Electroencephalography (EEG)
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Case• 32 year old female.• Background of
migraine
• Persistent daily headache for 1/12
• Worsening headache, presented to A&E
• Admitted, MRIDoes she have MS?
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Assessment• Full history
– Remote neurological episodes (even minor)– Family history
• Examination findings suggestive of previous neurological events
• Consider investigations– repeating MRI– lumbar puncture
• Uncertainty may persist…
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