Neurology is a wonderful specialty for students interested in combining a slick physical examination with the latest advances in medical diagnostics. Neuro-imaging and neurophysiologic studies are essential to the practice of contemporary neurology. A skilled neurologist can evaluate sophisticated radiological tests, such as magnetic resonance imaging (MRI), magnetic resonance angiography
(MRA), computed tomography (CT), and cerebral angiograms. The ability to do so rapidly and precisely is crucial for patient outcome. For instance, neurologists must distinguish intracranial bleeds from benign calcifications, strokes from cancers, and swelling caused by head trauma from infectious or autoimmune processes. These clinicians often consult with their colleagues in radiology to narrow their list of differential diagnoses further.
Unlike other fields of medicine, neurology has immense potential for amazing advances in diagnostic technology. Every day, there are new breakthroughs in neuroimaging modalities. Neurologists are now using tools that allow them to specify further the nature of a lesion. As a result, fewer invasive biopsies are performed. These advances include positron emission tomography (PET), single photon emission computed tomography (SPECT), and MRI spectroscopy. In the research labs, neuroscientists and neurologists are joining forces to perfect the use of functional MRI, which may be used in the future to determine which parts of the brain light up when stimulated by certain movements, thoughts, experiences, or substances.
For a neurologist, making use of the latest advances in medical technology involves more than just a trip to the radiology department. Their diagnostic repertoire also consists of many tools unique to the practice of neurology, all of which fall under the domain of electrophysiology. The most common is electroencephalography (EEG), a test that evaluates the electrical activity of the brain by placing electrodes on the head. The electrical discharges detected by these electrodes determine whether or not a patient has epilepsy and decipher the type and location of seizure activity. This test can also quantify cognitive function, determine brain death, and aid in the detection of difficult-to-diagnose disorders like Creutzfeldt-Jakob disease (mad cow disease). Neurologists specializing in epilepsy often send their patients for long-term video EEG monitoring in the hospital. Here, they record seizure activity to determine the patient's candidacy for neurosurgery or implantation of a vagal nerve stimulator (a pacemaker-like device designed to activate the vagal nerve and stop seizures from occurring).
Whereas the EEG evaluates neural discharges within the brain, electromyography (EMG) analyzes the electrical activity of the peripheral nerves and muscles. In the first part of this test, known as the nerve conduction study, neurologists apply small shocks via electrodes to determine the strength of stimulus conduction by sensory nerves. During the actual EMG, the physician inserts small needles into different muscles of the patient's neck, back, arms, and legs. By introducing electrical stimuli, it becomes possible to detect abnormalities in neuromuscular conduction. This test enables neurologists to evaluate a patient for peripheral nerve and muscle disorders as well as radiculopathies (pinched nerves due to a slipped disk within the spine). Debilitating diseases such as myasthenia gravis are picked up by special EMG studies that make use of repetitive stimuli and single-fiber stimulation. By guiding the physician specifically to the affected muscle, the EMG allows for more effective treatment of patients with dystonia and severe muscle spasms.
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