Neurological examination - nervous diseases. Examination by a neurologist (primary)

The skull develops from life
All over the forehead - from temple to temple. . .
O. Mandelstam

Your baby will soon be or has already turned 1 month old!

One of the most difficult periods in a newborn’s life is behind us. After all, the first month of a child’s life becomes his first critical period after birth: it is characterized by the intense work of all organs and systems of the body, “responsible” for the adaptation (adaptation) of the newborn to environmental conditions that are fundamentally new for him. By the end of this period, all transition processes should be completed, but under the influence of unfavorable conditions external environment, with aggravated pregnancy and childbirth, natural adaptation processes for a newborn can take on a pathological direction and lead to a neurological disease of the child.

It is at this time that it is necessary to visit a neurologist for the first time - usually just to make sure that everything is fine with the baby; but if this is not the case, in order to identify and “capture” the pathology at the very beginning, to prevent the disease from developing. To determine the level of development of the child and exclude neurological pathology, it is important not only to assess the formed reactions to light, sound, motor and psycho-emotional activity of the newborn, but also his appearance (in fact, it is this last topic that my article will mainly be devoted to).

So, what will a neurologist first of all pay attention to when examining a one-month-old baby? On the shape and size of his skull, facial expression, posture, appearance skin. Why is this so important? Why are our worries and experiences often associated with the presence of deviations from the outside? appearance child, especially if it is a change in the shape and size of the skull? This is primarily due to the fact that such changes can be a diagnostic sign of serious diseases - and microcephaly.

Skull shape and size

Deviation from the norm is a possible pathology. . .

Hydrocephalus- this is an excessive increase in the size of the skull, fontanelles, caused by an increase in the number cerebrospinal fluid in the cranial cavity. With this disease, the shape of the skull also changes - its cerebral part significantly predominates over the facial part, frontal part protrudes sharply forward, a pronounced venous network is observed in the area of ​​the temples and forehead.

Microcephaly- this is a reduction in the size of the skull and early closure of the fontanelles. With congenital microcephaly, the size of the skull is small from birth, the cranial sutures are narrowed, or closed, or small in size. Subsequently, a slow rate of growth in head circumference is noted, so that sometimes a 2-3 year old child’s skull size is almost the same as at birth. With microcephaly, the skull has a specific shape: the cerebral part of the skull is smaller than the facial part, the forehead is small, sloping, the line of the forehead and nose is sloping.

Conditions such as hydro- and microcephaly further lead to mental and mental retardation. physical development and therefore require correction from the very beginning early age!

. . .or a reason for further examinations?

But should every deviation from the norm clearly indicate a pathological condition? Of course not! Clinical observations show that there are many factors that influence the shape and size of the head. Of course, even a slight increase or decrease in the circumference of the skull in a newborn compared to age norm can be considered a risk factor for the development of hydrocephalus or microcephaly, but you should not panic when you discover that the baby’s head is slightly larger or smaller than normal: this circumstance should first of all become a signal for the need for additional examinations to exclude pathological conditions. What kind of examinations are these?

• An absolutely safe and reliable method is neurosonography ( ultrasonography brain through the large fontanelle). This study will help not only to see changes in the structure of the brain and signs of increased intracranial pressure, but also to evaluate blood flow through the main vessels of the brain.
• An even more reliable method is brain nuclear magnetic resonance (NMR), however this study for children it is carried out under general anesthesia, so it is performed only for sufficiently compelling indications.
• In this case, consultations with an ophthalmologist and a neurosurgeon are also necessary.

"Homework" for parents

In addition, right from birth, you can independently monitor the growth of the child’s head circumference, which is one of the main indicators of normality and pathology. How to do this correctly?

• Measure the child's head circumference weekly and record the resulting numbers in a specially kept notebook.
• When measuring, place the measuring tape at the most protruding points of the skull (frontal and occipital protuberances).
• To avoid misunderstandings, the measurement must be carried out by the same person.

In addition to the increase in head circumference, you can monitor the increase in chest circumference, which is one of the general anthropometric indicators of child development. For this:

• measure your circumference weekly chest on the same day you measure your head circumference;
• Place the measuring tape at the level of the baby's nipple line.

Why is such “amateur activity” needed? By taking these simple measurements, you will help the doctor draw up an objective picture of the child’s development, and you yourself can have peace of mind, excluding the possibility of developing serious diseases (normally, the monthly increase in head circumference in the first three months of a full-term baby should not exceed 2 cm per month; up to a year, the circumference The chest is approximately 1 cm larger than the child’s head circumference).

Well, now a few words about what can and should be normal and what is pathological. I tried to frame the conversation on this topic in the form of answers to questions that most often concern young parents.

What determines the shape of the skull?

Normally, as a child passes through the birth canal, the bones of the skull overlap each other. Features of the course of the birth process affect changes in the shape of the skull. In the event of a complicated birth, a sharp juxtaposition of the skull bones may occur on top of each other, and this will lead to its deformation, which will persist for quite a long time.

A change in the shape of the skull can be expressed in the persistence of swelling of the soft tissues of the head in the place where the child moved forward along the birth canal. The swelling disappears within the first 2-3 days. (hemorrhage under the periosteum) also changes the shape of the skull. It resolves more slowly than swelling, and this process requires the supervision of specialists (neurologist, surgeon).

Changes in the shape of the skull are also associated with age-related characteristics. In a newborn, the skull is elongated in the anteroposterior direction, and after a few months the transverse size of the skull will increase and its shape will change.

Some change in the shape and size of the skull may also occur with normal development in premature babies, or when the child is often placed on the same side, or when the child lies on his back for a long time.

How does the head grow?

The average head circumference of a newborn is 35.5 cm (the range of 33.0-37.5 cm is considered normal). The most intensive increase in head circumference in full-term babies is observed in the first 3 months - on average, 1.5 cm for each month. Then the growth decreases slightly, and by the age of one year the child’s head circumference is on average 46.6 cm (normal limits are 44.9-48.9 cm).

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Discussion

We have had this for 16 years now. Any emotions - positive or negative, or anticipation of something, be it a holiday, tests or a trip to the doctor, everything causes a gag reflex, it “burps”, calms down, and we move on. It happened in the store, at a party, and at school. She was angry, screamed, scolded - only worse. She stopped paying attention, she’s trying to cope on her own. The diagnosis was Moebius syndrome, we tried everything we could to treat it, but there was no result. We had consultations both at Taldomsky and Odessa, everything that could be avoided, everyone unanimously said that you need to learn to live with this and with age you yourself will learn to restrain your emotions. Now he goes to a psychologist once a week. But it's a little expensive here. You should see a neurologist, an examination, genetics if indicated, more communication with children to distract you from addiction. Breast - obsessive movements, most likely, Good luck to you and don’t panic - this is the main thing.

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Discussion

At this age, they look at distant large stationary objects for a long time. My one month old loved the closet. She stares at him and lies there looking. So this is normal)) If the tone is reduced, then the child will do the head and everything else later. Nothing wrong with that. U. Because of this, my eldest did everything very late and in general was physically poorly developed for a very long time - she was clumsy, but her mental and psycho-emotional development was always ahead of her peers, and even now, compared to many, she is very different from many, but physically she has caught up . So don't worry ahead of time. As for the eye, I would show it to the ophthalmologist just in case.

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A neurological examination begins with the identification of general cerebral symptoms (dizziness, headache, nausea, vomiting) and meningeal symptoms (headache, vomiting, general hyperesthesia, meningeal posture, rigidity occipital muscles, symptoms of Kernig, Brudzinski, etc.).

What does a neurological examination include?

During a neurological examination, the patient’s consciousness, the presence of psychomotor agitation are assessed, speech functions and their impairment are examined. Speech disorders associated with paralysis or paresis of the muscles involved in articulation (anarthria) may indicate bulbar and pseudobulbar lesions, and are expressed in the form of alalia, tongue-tiedness, and some forms of stuttering. Aphasia, which occurs when the function of the speech apparatus (tongue, palate, lips, larynx) is preserved, is caused by damage to the speech zones of the cerebral cortex or their pathways.

With dysarthria, there is difficulty in pronouncing speech sounds as a result of paresis, spasm, hyperkinesis or ataxia of the speech muscles. The cause of dysarthria can be vascular, degenerative or inflammatory diseases of the brain, in which the pyramidal and extrapyramidal systems or pathological changes in the cranial nerves and their nuclei in the brain stem innervating the speech muscles.

Neurological examination of cranial nerves

Then they begin to examine the cranial nerves.

The first pair of cranial nerves is the olfactory nerve.

The function of this nerve is studied using a special set of odorous substances.

Impaired sense of smell may indicate damage to various parts of the central nervous system (frontal, temporal lobes, base of the brain - the anterior cranial fossa).

Smell disorders:

1) anosmia – complete loss of sense of smell;

2) hyposmia – impaired sense of smell in the form of decreased perception of smell;

3) parosmia - a violation of the sense of smell in the form of a perversion of perception;

4) hyperosmia – disturbances of the sense of smell in the form of exacerbation.

Smell disorders, which are symptoms of pathological processes of the nervous system, should be differentiated from smell disorders that occur during inflammatory and atrophic processes in the nasal mucosa and olfactory hallucinations in some forms of mental disorders.

The second pair of cranial nerves is the optic nerve.

Studies of visual acuity, visual field, and fundus

They conduct a study of visual acuity and field, color vision characteristics, and fundus examination. Oculomotor nerves:

III pair – oculomotor nerve;

IV pair – trochlear nerve; VI pair – abducens nerve.

During a neurological examination, first of all, a simple examination determines the size and shape of the pupils. The patient should be positioned opposite the light source.

At the same time, unequal pupil size as a single symptom cannot indicate an organic lesion of the nervous system (should be differentiated from congenital characteristics, unevenness sympathetic innervation and various eye diseases). But a change in shape during a neurological examination of the pupils is a more important prognostic sign of organic changes in the nervous system. This symptom deserves special attention when there is a change in the reaction of the pupils to light and the reaction to accommodation with convergence.

Methodology for studying the reaction of pupils to light

The doctor tightly covers both eyes of the patient with his palms, which should be wide open at all times. Then, one by one, the doctor quickly moves his palm away from each eye, noting the reaction of each pupil.

Another option for studying this reaction is to turn on and off an electric lamp or a portable flashlight, brought to the patient’s eye, the patient tightly covers the other eye with his palm.

The study of pupillary reactions should be carried out with the utmost care using a sufficiently intense light source (poor illumination of the pupil may either not constrict at all or cause a sluggish reaction).

Methodology for studying the reaction to accommodation with convergence

The doctor asks the patient to look into the distance for a while, and then quickly move his gaze to fixate an object (finger or hammer) brought close to the eyes. The study is carried out separately for each eye. In some patients, this method of studying convergence is difficult and the doctor may have a false opinion about convergence paresis. For such cases, there is a “testing” version of the study. After looking into the distance, the patient is asked to read a small written phrase (for example, a label on a matchbox) held close to the eyes.

It must be recalled that the doctor must pay attention not only to pronounced disturbances in pupillary reactions, but also to the characteristics of the reactions of each pupil separately, examine both the reaction of the pupils to light and the reaction of accommodation with convergence, noting any combinations of changes in pupillary reactions.

For example, Argyll-Robertson syndrome is characterized by reflex immobility of the pupils to light stimulation while maintaining the reaction to convergence. And the consequence of epidemic encephalitis is often convergence paresis and sluggish constriction of the pupils during accommodation with a live reaction to light, although other combinations of changes in pupillary reactions are not uncommon. By amount visual signs a preliminary diagnosis can be made. In this case, you should carefully study the patient's motor skills. Hypomimia, mask-like face, monotonous voice, deepening motor activity, slight tremor of the distal parts of any limb, in combination with complaints of drooling, periodically appearing “rolling” of the eyes (at the same time, a tendency to pester, importunity is noted in the behavior) allows the doctor to assume that this patient has light form parkinsonism.

Most often, changes in pupillary reactions are symptoms of syphilitic damage to the nervous system, epidemic encephalitis, less often - alcoholism and organic pathologies such as damage to the stem region, cracks in the base of the skull.

Study of position and movements eyeballs

With pathology of the oculomotor nerves (III, IV and VI pairs), convergent or divergent strabismus, diplopia, limited movements of the eyeball to the sides, up or down, drooping are observed upper eyelid(ptosis).

It should be remembered that strabismus can be a congenital or acquired visual defect, but the patient does not experience double vision. When one of the oculomotor nerves is paralyzed, the patient experiences diplopia when looking towards the affected muscle.

More valuable for diagnosis is the fact that when clarifying complaints, the patient himself declared double vision when looking in any direction. During the survey, the doctor should avoid leading questions about double vision, because a certain contingent of patients will answer in the affirmative even in the absence of data for diplopia.

To find out the causes of diplopia, it is necessary to determine the visual or oculomotor disorders present in a given patient.

The method used for the differential diagnosis of true diplopia is extremely simple. If there are complaints of double vision in a certain direction of gaze, the patient should close one eye with the palm of his hand - true diplopia disappears, but in the case of hysterical diplopia, the complaints remain.

For accurate diagnosis For diplopia, the patient is referred to an ophthalmologist.

The technique for studying eye movements is also quite simple. The doctor asks the patient to follow the moving person. different directions object (up, down, to the sides). This technique allows you to detect damage to any eye muscle, gaze paresis, or the presence of nystagmus.

The most common horizontal nystagmus is detected when looking to the sides (the abduction of the eyeballs should be maximum). If nystagmus is a single identified symptom, then a clear sign organic damage it cannot be called the nervous system. In completely healthy people, examination may also reveal “nystagmoid” eye movements. Persistent nystagmus is often found in smokers, miners, and divers. There is also congenital nystagmus, characterized by rough (usually rotatory) twitching of the eyeballs that persists with a “static position” of the eyes.

The diagnostic technique for determining the type of nystagmus is simple. The doctor asks the patient to look up. At congenital nystagmus its intensity and character (horizontal or rotatory) are preserved. If nystagmus is caused by an organic disease of the central nervous system, then it either weakens, becoming vertical, or completely disappears.

If the nature of the nystagmus is unclear, it is necessary to examine it by moving the patient to a horizontal position, alternately on the left and right side.

Symptoms of Multiple Sclerosis

If nystagmus persists, abdominal reflexes should be examined. The presence of nystagmus and extinction of abdominal reflexes in total are early signs multiple sclerosis. The symptoms that confirm the presumptive diagnosis of multiple sclerosis should be listed:

1) complaints of periodic double vision, fatigue of the legs, urination disorders, paresthesia of the limbs;

2) detection during examination of increased unevenness of tendon reflexes, the appearance of pathological reflexes, intentional trembling.

V pair of cranial nerves – trigeminal nerve.

To study the trigeminal nerve, the functional activity of the anatomical and physiological elements located in the innervation zone corresponding to its branches is determined. The functions of the masticatory muscles, the degree of mouth opening (jaw mobility), and the conjunctival and corneal reflexes are determined. The sensitivity of the points - the exit points of the branches of the trigeminal nerve (Vallée's points) in the supraorbital, infraorbital and mental areas is studied.

VII pair of cranial nerves - facial nerve.

Thank you

Make an appointment with a Neurologist

Neurologist consultation

Consultation neurologist represents one of the stages of diagnosis. In most cases, patients are referred to this specialist by other doctors, suspecting neurological disorders. The duration of the consultation may vary depending on the symptoms and medical history.

In general, the consultation includes the following stages:

• Anamnesis collection. At this stage, the doctor simply asks the patient about his symptoms and complaints. For example, if there is pain, a neurologist clarifies its nature, frequency, duration, and connection with certain stimuli.

• Genetic predisposition. Many neurological diseases (Parkinson's disease, Huntington's chorea, epilepsy, etc.) have a genetic predisposition. The neurologist usually asks the patient if he has direct relatives with a similar diagnosis or at least with similar symptoms. Therefore, it is advisable to collect such information before the consultation.
• Reflex assessment. A person has many unconditioned reflexes that reflect the efficiency of the nervous system. The most common are the knee and elbow. Children have their own research criteria, since each age has its own normal limits.
• Specific tests. There are other ways to examine the nervous system that your doctor may suggest. As a rule, they concern the study of vision, smell, motor coordination or speech skills. These tests are painless and not too tiring. The neurologist selects those in which he expects certain deviations.

As a rule, the consultation ends with the appointment of tests or examinations that will confirm or refute the doctor’s preliminary assumptions. The patient comes for a follow-up appointment with test results. If treatment has been prescribed, it is advisable to see a doctor after the course to evaluate the results.

Can I make an appointment by phone or online? electronic recording)?

Most clinics and treatment centers They give you the opportunity to make an appointment with specialists online or by phone. Currently, this practice exists not only in private, but also in many public institutions.

Is it possible to ask a neurologist a question online?

Many sites provide the opportunity to consult with various specialists on the Internet. Unfortunately, a consultation with a neurologist in this format will be ineffective. This doctor must evaluate many indicators himself ( reflexes, patient movements, facial expressions, etc.). Therefore, all advice from a neurologist on the Internet will be of a general nature, but to prescribe treatment you will still have to go to an appointment.

Does a neurologist come to your home for examination?

Some private clinics can send a neurologist to patients’ homes for consultation. Also in many major cities You can find neurologists with private medical practice. As a rule, such visits are more expensive and less effective, since the doctor at home does not have all the necessary tools and devices at hand.

What does a neurologist look for and check during a consultation?

Survey different patients can happen in different ways. There are many different neurological tests and other criteria that reflect the functioning of a particular part of the nervous system. At the appointment, the doctor selects those research methods that can help make a diagnosis for a particular patient. There is usually simply not enough time to carry out all the tests. The specialist will proceed from the patient’s symptoms and complaints.

Most often, during a consultation, a neurologist does the following checks:

• eye movements ( amplitude, uniformity, synchronous head rotation, etc.);
• facial expression ( symmetry of muscle contraction);
• sensitivity ( by tingling in different areas);
• coordination of movements with open and closed eyes ( for example, putting your finger to your nose or standing on one leg);
• muscle tone ( passive and active movements limbs);
• spatial sensations ( perform various actions with your eyes closed);
• study of thinking and memory ( memorizing pictures, logic puzzles, etc.).

During the consultation, the neurologist closely monitors the patient, since even small things can indicate violations. For example, if one half of the face turns redder, or one half of the body sweats more. To an experienced doctor The patient's gait or posture can also tell a lot.

For children, there are other examination criteria, many of which are known and applied by the pediatrician or family doctor during a preventive examination.

What complaints and symptoms should you see a neurologist for?

There are quite a lot various symptoms, which indicate probable problems with the nervous system. But most of them are quite rare. More often, such diseases cause disturbances in the functioning of other organs, and the patient is first referred to other specialists. The safest thing to do if you have any health problems is to consult a general practitioner, family doctor, or simply call ambulance if the patient's condition is alarming. These specialists will refer the patient to a neurologist if necessary.

The following symptoms clearly indicate disturbances in the functioning of the central nervous system:

• Convulsive seizures. Even one attack is enough to refer the patient to a neurologist for preventive examination (rule out epilepsy).
• Double vision or other distorted image perception. Typically, patients consult an ophthalmologist, but clear double vision usually indicates that the brain is not correctly processing information received from the eyes.
• Asymmetrical muscle work. If the muscles of one half of the body are tense and the other is relaxed, this often indicates problems with the brain. In addition, pay attention to facial asymmetry, which is controlled by facial muscles.
• Memory losses. Memory is controlled directly by the brain, so any problems with remembering or processing information ( logical thinking, etc.) indicate neurological problems.
• Sleep disorders. Neurologists are the ones who treat insomnia, since sleep is controlled by the brain.
• Paralysis. If a patient loses control of a limb or limbs, the problem most often lies at the level of the brain or spinal cord.
• Coordination problems. A wobbly gait or uncertain limb movements are a clear neurological symptom. They are explained by the fact that the brain poorly controls the position of the body in space.
• Muscle weakness. If weakness is not associated with a long-term illness, hunger or other objective reason, the problem may lie in the innervation of the muscles.
• Headache. Of course, in the vast majority of cases, this symptom is not neurological in nature. But if there are no visible reasons, and the pain is severe, you need to contact a neurologist.

There are other neurological symptoms related to unusual changes in vision, hearing, smell or skin sensitivity. Some people, for example, lose the ability to speak ( alexia) or write ( agraphia). However, even in the practice of a neurologist, such violations are very rare.

Which doctor gives a referral for examination to a neurologist?

Disturbances in the functioning of the nervous system can mimic the symptoms of the most various diseases. Subject matter specialists, having not found the expected diagnosis, often refer the patient to an appointment with a neurologist.

Most often, the following doctors give a referral to a neurologist:

• therapist;
• traumatologist;
• neonatologist;
• family doctor.

Sometimes, in the presence of severe neurological symptoms, the patient can be taken directly to the neurological department by ambulance.

How many times a month ( in year) should I visit a neurologist?

A neurologist is a specialist with a fairly narrow profile, so healthy adults do not regularly consult him. For prevention, routine medical examinations or consultations with a general practitioner are sufficient ( therapist, family doctor, etc.). They refer patients to a neurologist only when they suspect certain problems. But patients suffering from chronic neurological diseases ( Huntington's chorea, Parkinson's disease, etc.) or those who have had a stroke, consultations are necessary frequently and within long period time.

• at 1 month;
• at 3 months;
• at 6 months;
• at 1 year;
• further as necessary ( The doctor will tell you how often you need to see him).

For children, consultation with a neurologist is important, as he can determine the level of development of the child, which sometimes helps to detect hidden pathologies. However, in the absence of any violations, the doctor usually himself says that consultations are no longer required in the near future.

Do pregnant women need a medical examination by a neurologist?

Most pregnant women do not require a mandatory medical examination by a neurologist. Symptoms such as headache or nausea are usually explained not by problems with the nervous system, but by hormonal changes or moderate intoxication of the body. In the absence of serious neurological problems, timely completion of all tests is quite sufficient. necessary tests and observation by the attending physician.

A mandatory consultation with a neurologist during pregnancy may be necessary in the following cases:

• if you have had a history of traumatic brain injury;
• when typical neurological symptoms appear ( severe sleep disturbances, sensory disturbances, paralysis, etc.);
• in the presence of chronic neurological diseases ( epilepsy, multiple sclerosis, migraine, etc.).

Pain in the lower back or back, which also often bothers women during pregnancy, is also usually not a neurological problem. They arise due to mechanical stress on the spine ( shift of the body's center of gravity as the fetus grows).

Do they undergo a medical examination by a neurologist at the military registration and enlistment office?

A medical examination at the military registration and enlistment office is a mandatory procedure, but a neurologist is usually not a mandatory member of the commission. The main doctors in this case are a therapist, a surgeon, a dermatologist, an otolaryngologist, a psychiatrist and an ophthalmologist. They may suspect some neurological pathologies and give a referral for a separate examination by a neurologist. For many diseases of the central or peripheral nervous system, they are not taken into the army, as this can aggravate the patient’s condition.

Do they undergo a medical examination by a neurologist in kindergarten and school?

Medical examinations in kindergartens and schools almost always include an examination by a neurologist. Unfortunately, while examining a large number of children for a short time, even a good specialist cannot always identify hidden pathologies. If a child has any problems, it is better to report them to kindergarten teachers or teachers at school. They will be able to alert the doctor, and the child will be given more attention during the examination.

During medical examinations in educational institutions they do not conduct diagnostic measures and do not prescribe treatment. The neurologist performs a standard battery of tests to look for certain symptoms. When they are detected, he simply gives a direction for a more thorough examination.

How does a neurologist make a diagnosis?

Diagnosing neurological diseases is very difficult due to the wide variety of symptoms and similarity of manifestations. This is why neurologists must be highly qualified specialists. Making a diagnosis begins with collecting information about the patient's illness. To confirm, there are various laboratory and instrumental studies.

The neurologist most often does not perform all diagnostic procedures himself. He decides what tests a particular patient needs and then refers him to the appropriate specialists. After the examination, the doctor evaluates the results and decides whether they confirm the previously assumed diagnosis. It should be noted that the diagnosis of some neurological diseases can take a long time ( weeks and months).

Diagnostic methods

Conventionally, diagnostic methods are usually divided into several groups. The first is aimed at visualizing various structural abnormalities. The second is for functional problems ( for example, studying the speed of impulse conduction, etc.). The third group includes various laboratory research, in which the blood or tissue of the patient’s body is taken as the test material.

The following diagnostic procedures are most often used in neurology:

• Electroencephalography. This method involves recording the electrical activity of the brain. For some diseases ( epilepsy, migraine, etc.) are characterized by certain changes in the results of the study, which makes it possible to confirm the diagnosis.
• Electroneuromyography. This method is aimed at studying peripheral nerves. With its help, the doctor evaluates the speed at which the impulse travels along the nerve and its transmission to the muscle. Electroneuromyography is important in the diagnosis of myodystrophy and diseases accompanied by paralysis.
• X-ray. Using X-rays, doctors can roughly examine the structure of the skull and brain. This study is especially often prescribed after traumatic brain injury.
• CT scan. This method, like x-rays, involves the use of x-rays to obtain an image. However, the accuracy of a CT scan increases significantly, and the doctor can recognize smaller defects.
• Magnetic resonance imaging. In neurology, this research method is considered one of the most accurate. In addition to providing a clear picture of the fabrics, it helps you see how they work. various departments cerebral cortex ( in functional MRI mode). This makes the diagnosis of various brain lesions much easier.
• Dopplerography. This method uses ultrasound beams to evaluate the speed of blood flow in the vessels of the brain. This helps to detect cerebral aneurysms, atherosclerotic processes, various congenital anomalies vascular development.
• Lab tests. The functioning of the nervous system can be influenced by the most different substances. Biochemical research methods help detect hormones or abnormal proteins in the blood. Microbiological methods important when infectious lesions nervous system.

Thus, in the arsenal of a neurologist there are many different diagnostic methods. Of course, for individual patients I prescribe only those examinations that can help confirm their diagnosis. Sometimes the doctor asks the patient to undergo the same test several times ( for example, before, during and after the end of treatment) to assess the effectiveness of treatment or the rate of disease progression.

X-ray

X-ray examination is the most common method aimed at detecting various structural damage. Best seen on x-ray thick fabrics, skull bones. Sometimes injected into the bloodstream of patients contrast agents so that one or another vessel is clearly visible in the picture. This makes it possible to detect cerebral aneurysms. In general, in neurology, x-rays are not very informative. MRI is much more reliable for studying soft tissues.

Magnetic resonance imaging ( MRI)

Magnetic resonance imaging is one of the most informative methods research in neuroscience. It allows you to accurately examine the structure of brain tissue, see the vessels and membranes of the brain. Neurologists often prescribe MRI to detect small brain tumors and assess damage from traumatic brain injuries. This research method is also very expensive, and it is not possible to undergo it in all hospitals. MRI is contraindicated for patients with metal implants, since the strong magnetic field inside the machine heats up the metal and can be attracted to it.

What tests and examinations can a neurologist prescribe?

Exist various ways to assess the state of the nervous system. Almost all patients with suspected serious pathologies will be mandatory a blood test and a urine test are prescribed, as they provide information about the functioning of the body as a whole. There are also many specific tests. For example, it may be necessary to determine the level of certain hormones in the blood, isolate proteins characteristic of certain pathologies, etc. Most often, blood is taken for analysis, but the most informative material for research in neurology is cerebrospinal fluid.
To obtain it, patients undergo a puncture - the disc between the vertebrae in the lumbar region is pierced with a special needle. The procedure is quite painful and may have a number of side effects after ( dizziness, nausea, etc.).

A spinal tap provides the following information important for diagnosis:

• indirectly shows the level of intracranial pressure;
• allows you to detect bleeding in the brain ( then red blood cells are found in the liquid);
• allows you to detect infections of the central nervous system during microbiological analysis ( encephalitis, meningitis, etc.);
• In the cerebrospinal fluid, substances specific to certain neurological diseases can be isolated.

A study of cerebrospinal fluid is more informative, since the blood does not come into direct contact with the brain matter. It does not include all substances or microorganisms that may be located under the meninges.

Why do you need an odorous neurologist kit?

In neurology, there are several studies aimed at examining the sensory organs. One of them is called olfactometry. It is aimed at assessing the patient's sense of smell. For examination, the doctor takes a special set of odorous substances. The patient smells them and chooses from several answer options which particular smell was offered to him. For the test, easily recognizable odors are usually taken ( mint, cinnamon, etc.). In some patients, due to injuries, tumors or other problems, the normal perception of smells is disrupted. They confuse the proposed smells or do not smell them at all. This test is diagnostic. If the ENT doctor does not find any abnormalities at the level of the nasal sinuses, the neurologist will examine in more detail the lobes of the brain responsible for the sense of smell.

How does a neurologist check reflexes and muscle tone?

Reflexes are the nervous system's response to external stimuli. During the examination, neurologists usually check tendon reflexes, which are manifested by contractions of various muscles. In healthy people, reflexes are present, and the procedure for checking them is completely painless.

The most common reflexes checked during examination are:

• Patella. A light blow with a hammer under the kneecap causes the leg to straighten slightly.
• Achilles tendon. A slight blow to the Achilles tendon results in slight deviation feet to the side.
• Biceps muscle. Tapping the biceps near the cubital fossa causes the muscle to contract and the arm to flex.

Children also have other reflexes. For example, tapping certain places on the abdomen can cause reflex emptying of the bladder or bowel. As the child grows up, these reflexes disappear.

Equipment for a neurologist's office

Currently, the minimum equipment for a neurologist's office is regulated by the relevant order of the Ministry of Health. Regulations may vary slightly from country to country, but basic set equipment and tools remain unchanged.

The neurologist's office must have the following furniture and equipment:

• cabinet for storing documents and equipment;
• patient examination couch;
• personal computer or laptop;
• thermometer and tonometer;
• neurological hammer;
• tuning fork ( for testing hearing and vibration sensitivity);
• standard set of odorants;
• negatoscope ( special screen on the wall for viewing x-rays).

Treatment by a neurologist

In neurology, doctors use various treatment methods. The most common is the so-called conservative treatment, treatment with various medications. Many patients are also prescribed physical therapy. In cases of severe structural abnormalities, surgical intervention on the spinal cord or brain may be necessary.

The treatment tactics are always chosen by a neurologist after confirming the diagnosis. Self-treatment of neurological pathologies usually not only does not give a positive result, but can be simply dangerous. Moreover, even general practitioners family doctors and other general specialists most often do not undertake to make prescriptions for patients with neurological disorders. This is explained by some isolation of neurology from other areas of medicine.

What does a neurologist treat in adults?

Each age is characterized by certain neurological pathologies. In adults, various neuroses and degenerative diseases of the central nervous system are very common. In addition, among adults, various injuries accompanied by damage to the central nervous system are more common ( industrial accidents, car accidents, etc.).

The most common neurological problems in adults are:

• epilepsy;
• Huntington's chorea;
• Parkinson's disease;
• multiple sclerosis.

Many of these diseases appear due to more intense stress, exposure to various harmful factors, and also against the background of age-related degenerative changes.

What drugs ( pills and injections) prescribed by a neurologist?

The range of drugs that a neurologist works with is very wide. In principle, many different substances are involved in the metabolic processes occurring in the brain and nervous tissue. Currently, almost all of them are synthesized artificially by pharmacological companies. Thanks to this, neurologists can influence the body in the necessary way.

The following groups of drugs can be used in neurology:

• Sedatives ( sedatives). Used for excessive psychomotor agitation, psychosis and neuroses. The most common benzodiazepines ( diazepam, lorazepam, phenazepam). They are also used to relieve seizures.
• Muscle relaxants. This group drugs help relax muscles. For example, they are prescribed for pinched spinal nerve roots to reduce pain. From this group, mydocalm and baklosan are often prescribed.
• Drugs that improve blood flow in the vessels of the brain. This group includes, for example, Cerebrolysin, Cavinton, Mexidol.
• Antidepressants. This group affects areas of the brain responsible for activity, positive thinking, pleasures, etc. They are prescribed to patients with signs of depression. The most commonly used are amitriptyline and cipralex.
• Antiepileptic drugs. These drugs are prescribed to patients with epilepsy to reduce the frequency of seizures and relieve symptoms. The most common drugs in this group are chloral hydrate, suxilep, finlepsin.
• Antiparkinsonian drugs ( DOPA system). This group of drugs is designed specifically for patients with Parkinson's disease. Taking them slows the progression of symptoms. Antiparkinsonian drugs include pronoran, requip, levodopa.
• Sleeping pills. This group of drugs is used for various sleep disorders. Patients with this problem may be prescribed phenobarbital, Reslip, Melaxen.
• Nootropic drugs. This group of drugs improves metabolism in brain tissue. They are often prescribed after strokes, for memory impairment and other functional disorders. TO nootropic drugs include, for example, piracetam, phenibut, vinpocetine, glycine.
• Vitamins. Basically, when neurological diseases as tonic B vitamins are prescribed ( neurobion, vitamin B12, etc.).

If necessary, patients may also be prescribed painkillers ( from non-steroidal anti-inflammatory drugs to morphine and its analogues). Also, in case of problems with the blood vessels of the brain, medications that thin the blood and prevent the formation of blood clots may be prescribed for preventive purposes.

All of the above groups of drugs have wide range various side effects. In this regard, many of them are issued in pharmacies only by prescription. Self-administration these funds are fraught with serious problems.

Why are blockades needed?

Blockades with painkillers are one of the methods of treating local pain syndrome. The procedure involves the injection of one or more drugs ( usually

By completing the book, the authors hope that the information presented in it can serve as a basis for mastering the knowledge necessary for a neurologist. However, the book on general neurology offered to your attention should be considered only as an introduction to this discipline.

The nervous system ensures the integration of various organs and tissues into a single organism. Therefore, a neurologist is required to have broad erudition. He must be, to one degree or another, oriented in almost all areas of clinical medicine, since he often has to participate in the diagnosis of not only neurological diseases, but also in determining the essence of pathological conditions that doctors of other specialties recognize as beyond their competence. Neurologist

in everyday work he must also prove himself as a psychologist who can understand the personal characteristics of his patients and the nature of the exogenous influences affecting them. A neurologist, to a greater extent than doctors of other specialties, is expected to understand the mental state of patients and the characteristics affecting them social factors. Communication between a neurologist and a patient should, whenever possible, be combined with elements of psychotherapeutic influence.

The scope of interests of a qualified neurologist is very wide. It must be borne in mind that damage to the nervous system is the cause of many pathological conditions, in particular dysfunction of internal organs. At the same time, neurological disorders that appear in a patient are often a consequence, a complication of his existing somatic pathology, common infectious diseases, endogenous and exogenous intoxications, pathological effects on the body of physical factors and many other reasons. Thus, acute cerebrovascular accidents, in particular strokes, are usually caused by complications of diseases of the cardiovascular system, the treatment of which was carried out by cardiologists or general practitioners before the onset of neurological disorders; chronic renal failure is almost always accompanied by endogenous intoxication, leading to the development of polyneuropathy and encephalopathy; many diseases of the peripheral nervous system are associated with orthopedic pathology, etc.

The boundaries of neuroscience as a clinical discipline are blurred. This circumstance requires a special breadth of knowledge from a neurologist. Over time, the desire to improve the diagnosis and treatment of neurological patients led to a narrow specialization of some neurologists (vascular neurology, neuroinfections, epileptology, parkinsonology, etc.), as well as to the emergence and development of specialties occupying a borderline position between neurology and many other medical professions (somatoneurology , neuroendocrinology, neurosurgery, neuroophthalmology, neurootiology, neuroradiology, neuropsychology, etc.). This contributes to the development of theoretical and clinical neurology and expands the possibilities of providing the most qualified care to neurological patients. However, a narrowed profile of individual neurologists and, even more so, the presence of specialists in disciplines related to neurology are possible only in large clinical and research institutions. As practice shows, every qualified neurologist must have broad erudition, in particular, be oriented in problems that in such institutions are studied and developed by specialists of a narrower profile.

Neurology is in a state of development, which is facilitated by achievements in various fields of science and technology, the improvement of the most complex modern technologies, as well as the successes of many theoretical and clinical specialists medical professions. All this requires from a neurologist constant increase level of knowledge, in-depth understanding of the morphological, biochemical, physiological, genetic aspects of the pathogenesis of various diseases of the nervous system, awareness of achievements in related theoretical and clinical disciplines.

One of the ways to improve the qualifications of a doctor is periodic training in advanced courses, conducted on the basis of the relevant faculties medical universities. At the same time, the first

Of particular importance is independent work with specialized literature, in which one can find answers to many questions that arise in practical activities.

To facilitate the selection of literature that may be useful to a novice neurologist, we have provided a list of some books published in Russian over the past decades. Since it is impossible to embrace the immensity, it does not include all literary sources reflecting the problems that arise for a neurologist in practical work. This list should be considered conditional, indicative, and as necessary it can and should be replenished. It is recommended to pay special attention to new domestic and foreign publications, and it is necessary to monitor not only published monographs, but also journals that relatively quickly bring to the attention of doctors the latest achievements in various fields of medicine.

We wish our readers further success in mastering and improving knowledge that will contribute to the improvement of professional qualifications, which will undoubtedly have a positive impact on the effectiveness of work aimed at improving the health of patients.