Neurological examination - nervous diseases. Neurologist examination (primary)

The skull develops from life
Full forehead - from temple to temple. . .
O. Mandelstam

Your baby will soon be or already 1 month old!

Behind one of the most difficult periods of a newborn's life. After all, the first month of a child's life becomes for him the 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 fundamentally new environmental conditions for him. By the end of this period, all transient processes should be completed, however, under the influence of adverse environmental conditions, with a burdened course of pregnancy and childbirth, the adaptive processes natural for the newborn can take 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: the baby is all right; but if this is not so, in order to reveal, "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 its appearance (in fact, this last topic will be mainly devoted to my article).

So, what will the 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, type of skin. Why is it so important? Why are our worries and experiences often associated with the presence of deviations precisely from the appearance of the child, especially if this 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.

The shape and size of the skull

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 amount of cerebrospinal fluid in the cranial cavity. With this disease, the shape of the skull also changes - its brain section significantly predominates over the front, the frontal part sharply protrudes forward, a pronounced venous network is observed in the temples and forehead.

Microcephaly- this is a decrease in the size of the skull and early closure of the fontanelles. In congenital microcephaly, the size of the skull is small from birth, the cranial sutures are narrowed, or closed, or small in size. In the future, a slower rate of increase in head circumference is noted, so that sometimes in a child of 2-3 years old, the dimensions of the skull are almost the same as at birth. With microcephaly, the skull has a specific shape: the brain region of the skull is smaller than the front, the forehead is small, sloping, the line of the forehead and nose is oblique.

Conditions such as hydro- and microcephaly further lead to a delay in mental and physical development and therefore require correction from a very early age!

. . .or an occasion for the further inspections?

But is any deviation from the norm unambiguously indicative of 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 the age norm can be considered a risk factor for the development of hydrocephalus or microcephaly, but one should not panic when one finds that the baby’s head is slightly larger or smaller than normal: this circumstance should first of all, to become a signal for the need for additional examinations to exclude pathological conditions. What are these examinations?

• An absolutely safe and reliable method is neurosonography (ultrasound examination of the brain through a 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 assess blood flow through the main vessels of the brain.
• An even more reliable method is nuclear magnetic resonance of the brain (NMR), however, this study for babies is carried out under general anesthesia, therefore, it is carried out only for sufficiently strong indications.
• In this case, consultations of an oculist and a neurosurgeon are also necessary.

"Homework" for parents

In addition, right from birth, you can independently control the growth of the child's head circumference, which is one of the main indicators of the norm and pathology. How to do it correctly?

• Weekly measure the circumference of the child's head and record the figures obtained in a specially wound notebook.
• When measuring, place the centimeter tape along the most protruding points of the skull (frontal and occipital tubercles).
• To avoid misunderstandings, the measurement should be carried out by the same person.

In addition to the increase in head circumference, it is possible to control the increase in chest circumference, which is one of the general anthropometric indicators of a child's development. For this:

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

Why do we need such "initiative"? Carrying out these simple measurements, you will help the doctor to draw up an objective picture of the development of the child, and you yourself can be calm, eliminating the possibility of developing serious diseases (normally, the monthly increase in head circumference for the first three months in 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 circumference of the child's head).

Well, now a few words about what can and should be normal, and what is a pathology. I tried to present a 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, when a child passes through the birth canal, the bones of the skull overlap each other. Features of the course of the birth process affect the change in the shape of the skull. With a complicated birth act, a sharp finding of the bones of the skull on top of each other may occur, 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 preservation 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).

The change in the shape of the skull is also associated with age-related features. 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 can also occur during normal development in premature babies, or when the child is often laid on the same side, or when the child is lying on his back for a long time.

How does the head grow?

In a newborn, the average head circumference 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 children is observed in the first 3 months - on average, it is 1.5 cm for each month. Then the growth decreases slightly, and by the year the child's head circumference is on average 46.6 cm (normal limits 44.9-48.9 cm).

To date, diseases of the nervous system in children are among the most common. Often it is necessary to identify certain deviations of the nervous system, even among newborn children. First of all, this is due to pathology during pregnancy and childbirth: hypoxic, infectious processes transferred by the fetus in utero, feto-placental insufficiency (blood flow disorders in the "mother-child" system), group and Rh blood conflicts, stress factors, harmful ...

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Discussion

We have had this for 16 years. Any emotions - positive or negative, or the expectation of something, whether it's a holiday, control or going to the doctor, everything causes a gag reflex, "burps" calms down, and move on. It happened in the store, and at a party, and at school. Angry, screaming, scolding - only worse. She stopped paying attention, she tries to cope on her own. Diagnosis - Mobius syndrome, tried to treat as much as possible - there is no result. There were consultations on Taldomsky and Odessa, everything that could be avoided, everyone unanimously says that you need to learn to live with this and, with age, you will learn to restrain your emotions. Now she goes to a psychologist once a week. But it's too expensive for us. You are on the way to a neurologist, examination, genetics if it is shown, more communication with children, in order to distract from addiction. Chest - obsessive movements, most likely, Good luck to you and do not panic - this is the main thing.

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Discussion

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Discussion

At this age, they examine distant large stationary objects for a long time. My month was very fond of the closet. She stares at him and lies 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 in this, but physically caught up . So don't worry ahead of time. And about the eye, I would show the optometrist just in case.

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A neurological examination begins with the detection of cerebral (dizziness, headache, nausea, vomiting) and meningeal symptoms (headache, vomiting, general hyperesthesia, meningeal posture, neck stiffness, symptoms of Kernig, Brudzinsky, 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 violation 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-tied tongue, and some forms of stuttering. Aphasia, which occurs when the function of the speech apparatus (tongue, palate, lips, larynx) is preserved, is due to 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 are damaged or pathological changes in the cranial nerves and their nuclei in the brain stem that innervate the speech muscles.

Neurological examination of the cranial nerves

Then proceed to the examination of the cranial nerves.

I pair of cranial nerves - olfactory nerve.

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

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

Olfactory disorders:

1) anosmia - complete loss of smell;

2) hyposmia - a violation of the sense of smell in the form of a decrease in the perception of smell;

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

4) hyperosmia - impaired sense of smell in the form of exacerbation.

Olfactory disorders, which are symptoms of pathological processes of the nervous system, should be differentiated from olfactory 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 and field of view, fundus

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

III pair - oculomotor nerve;

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

In 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, the unequal size of the pupils as a single symptom cannot indicate an organic lesion of the nervous system (it should be differentiated from congenital features, uneven sympathetic innervation, and various eye diseases). But the 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 the reaction of the pupils to light changes and the reaction to accommodation with convergence.

Method for studying the reaction of pupils to light

The doctor with his palms tightly covers both eyes of the patient, which should be wide open all the time. Then, in turn, from each eye, the doctor quickly removes his palm, 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 closes 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 give constriction at all, or cause a sluggish reaction).

Methodology for studying the reaction to accommodation with convergence

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

It should be recalled that the doctor should pay attention not only to pronounced violations of pupillary reactions, but also to the characteristics of the reactions of each pupil separately, to investigate both the pupillary reaction to light and the reaction of accommodation with convergence, noting any combination 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 paresis of convergence and lethargy of constriction of the pupils during accommodation with a live reaction to light, although other combinations of changes in pupillary reactions are not uncommon. By the sum of the visual signs, a preliminary diagnosis can be judged. In this case, the patient's motor skills should be carefully examined. Hypomimia, mask-like face, monotony of voice, decrease in motor activity, slight tremor of the distal parts of any limb, in combination with complaints of salivation, periodically appearing “rolling” of the eyes (with a tendency to pestering, importunity is noted in the behavior) allows the doctor to assume this patient a mild form of parkinsonism.

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

Study of the position and movements of the eyeballs

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

It should be remembered that strabismus can be a congenital or acquired visual defect, while the patient does not have double vision. With paralysis of one of the oculomotor nerves, 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 interview, 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 that this patient has.

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

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

The technique for studying the movements of the eyeballs is also quite simple. The doctor offers the patient to follow the object moving in different directions (up, down, sideways). 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 side (abduction of the eyeballs should be maximum). If nystagmus is a single identified symptom, then it cannot be called a clear sign of an organic lesion of the nervous system. In perfectly healthy people, the examination may also reveal "nystagmoid" eye movements. Persistent nystagmus is often found in smokers, miners, divers. There is also congenital nystagmus, characterized by coarse (usually rotatory) twitching of the eyeballs, which persists with the "static position" of the eyes.

Diagnostic technique for determining the type of nystagmus is simple. The doctor asks the patient to look up. With congenital nystagmus, its intensity and character (horizontal or rotatory) is 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 nystagmus is unclear, it is necessary to investigate it by transferring 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 the extinction of abdominal reflexes in total are early signs of multiple sclerosis. Symptoms that support a presumptive diagnosis of multiple sclerosis should be listed:

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

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

The 5th pair of cranial nerves is the trigeminal nerve.

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

VII pair of cranial nerves - facial nerve.

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Neurologist's consultation

Consultation neurologist is 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 present and medical history.

In general, the consultation includes the following steps:

• Collection of anamnesis. At this stage, the doctor simply asks the patient about his symptoms and complaints. For example, in the presence of pain, the neurologist specifies their nature, frequency, duration, 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, before the consultation, it is desirable to collect such information.
• Assessment of reflexes. A person has many unconditioned reflexes that reflect the efficiency of the nervous system. The most common are knee and elbow. For children, there are their own research criteria, since each age has its own limits of the norm.
• specific tests. There are other ways to examine the nervous system that a doctor can suggest. As a rule, they concern the study of vision, smell, coordination of movements or speech skills. These tests are painless and not too tiring. The neurologist selects those of them 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 to the re-appointment with the results of the tests. 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 record)?

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

Can I ask a neurologist a question online?

Many sites provide an opportunity to consult with various experts on the Internet. Unfortunately, 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, and you still have to go to an appointment to prescribe treatment.

Does a neurologist come for a home visit?

Some private clinics may send patients a neurologist to their homes for consultation. Also in many large 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 at and check during a consultation?

Examination of different patients can be carried out in different ways. There are many different neurological tests and other criteria that reflect the work of a particular part of the nervous system. At the appointment, the doctor chooses those research methods that can help with the diagnosis of a particular patient. There is simply not enough time to conduct all the tests. The specialist will proceed from the symptoms and complaints of the patient.

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, put a finger to your nose or stand on one leg);
• muscle tone ( passive and active limb movements);
• spatial sensations do things with your eyes closed);
• study of thinking and memory ( memorization of pictures, logical puzzles, etc.).

During the consultation, the neurologist closely monitors the patient, as even little things can indicate violations. For example, if one half of the face is more reddened, or one half of the body is sweating more. An experienced doctor can also tell a lot about the gait or posture of the patient.

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

With what complaints and symptoms should I go to see a neurologist?

There are quite a few different symptoms that indicate probable problems with the nervous system. But most of them are quite rare. More often, such diseases cause disturbances in the work of other organs, and the patient first gets to other specialists. It is most reliable for any health problems to contact a therapist, a family doctor, or simply call an ambulance if the patient's condition is apprehensive. These specialists will refer the patient to a neurologist as needed.

The following symptoms clearly indicate disorders in the work of the central nervous system:

• Convulsive seizures. Even one attack is enough to refer the patient to a neurologist for a preventive examination ( rule out epilepsy).
• Double vision or other distorted image perception. Usually patients go to an ophthalmologist, but a clear double vision usually indicates that the brain does not correctly perceive the information received from the eyes.
• Asymmetric muscle work. If the muscles of one half of the body are tense and the other half are relaxed, this often indicates problems with the brain. In addition, attention is paid to the asymmetry of the face, which is controlled by facial muscles.
• Memory losses. Memory is controlled directly by the brain, so any problems remembering information or processing it ( logical thinking, etc.) indicate neurological problems.
• Sleep disorders. It is neurologists who treat insomnia, since sleep is controlled by the brain.
• Paralysis. If the patient loses control of a limb or limbs, the problem most often lies at the level of the brain or spinal cord.
• Coordination disorders. A wobbly gait or unsteady movements of the limbs is a clear neurological symptom. They are explained by the fact that the brain does not control the position of the body in space.
• Muscle weakness. If the weakness is not related to long-term illness, hunger, or another 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 of a neurological 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 disturbances 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 disorders are very rare.

Which doctor gives a referral for examination to a neurologist?

Disorders in the functioning of the nervous system can mimic the symptoms of a variety of diseases. Profile specialists, not finding 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 per month in year) Should I visit a neurologist?

A neurologist is a specialist with a rather narrow profile, so healthy adults do not regularly visit him for a consultation. 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 who have had a stroke, consultations are needed frequently and over a long period of time.

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

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 in the near future consultations are no longer required.

Do pregnant women need a medical examination by a neurologist?

Most pregnant women do not need 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, the timely delivery of all necessary tests and observation by the attending physician is quite sufficient.

Mandatory consultation of a neurologist during pregnancy may be necessary in the following cases:

• in the presence of a past traumatic brain injury;
• with the onset of typical neurological symptoms ( 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 occur due to the mechanical load on the spine ( shift in the center of gravity of the body as the fetus grows).

Do they undergo a medical examination by a neurologist in 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 the internist, surgeon, dermatologist, otolaryngologist, psychiatrist and optometrist. They may suspect some neurological pathologies and give a referral for a separate examination by a neurologist. With many diseases of the central or peripheral nervous system, they are not taken into the army, as this can aggravate the patient's condition.

Are there medical examinations by a neurologist in kindergarten and at school?

The medical board in kindergartens and schools almost always includes an examination by a neurologist. Unfortunately, examining a large number of children in a short time, even a good specialist cannot always reveal hidden pathologies. If the child has any problems, it is best to report them to kindergarten teachers or teachers at school. They will be able to warn the doctor, and the child will be given more attention during the examination.

During a medical examination, educational institutions do not carry out diagnostic measures and do not prescribe treatment. A neurologist performs a standard set of tests to look for certain symptoms. When they are found, he simply gives direction for a more thorough examination.

How does a neurologist make a diagnosis?

It is very difficult to diagnose neurological diseases due to the wide variety of symptoms and the similarity of manifestations. That is why neurologists must be highly qualified specialists. Diagnosis begins with the collection of information about the patient's disease. For confirmation, there are various laboratory and instrumental studies.

The neurologist most often does not conduct all diagnostic procedures himself. He decides which examinations are necessary for a particular patient, and then directs 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 one is aimed at visualization of various structural disorders. The second is for functional problems ( for example, the study of the speed of impulse conduction, etc.). The third group includes various laboratory studies in which blood or tissues of the patient's body are taken as the test material.

Most often in neurology resort to the following diagnostic procedures:

• Electroencephalography. This method consists in 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 allows you to confirm the diagnosis.
• Electroneuromyography. This method is aimed at the study of peripheral nerves. With its help, the doctor evaluates the speed of the impulse 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 examine the structure of the skull and brain in general terms. Especially often this study is 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 a clear image of tissues, it helps to see how different parts of the cerebral cortex work ( in functional MRI mode). This greatly facilitates the diagnosis of various brain lesions.
• Dopplerography. With this method, ultrasonic rays are used, with the help of which the speed of blood flow in the vessels of the brain is estimated. This helps to detect aneurysms of cerebral vessels, atherosclerotic processes, various congenital anomalies in the development of blood vessels.
• Laboratory tests. A variety of substances can affect the functioning of the nervous system. Biochemical research methods help to detect hormones or abnormal proteins in the blood. Microbiological methods are important in infectious lesions of the nervous system.

Thus, in the arsenal of a neurologist there are many different diagnostic methods. Of course, I prescribe to individual patients only those examinations that can help confirm their diagnosis. Sometimes the doctor asks the patient to undergo the same examination several times ( e.g. before, during and after the end of a course 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 lesions. Dense tissues, the bones of the skull, are best seen on an x-ray. Sometimes contrast agents are injected into the bloodstream of patients so that one or another vessel is clearly visible in the picture. This allows you to detect cerebral aneurysms. In general, in neurology, x-rays are not very informative. MRI is much more reliable than MRI for examining soft tissues.

Magnetic resonance imaging ( MRI)

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

What tests and examinations can a neurologist prescribe?

There are various ways to assess the state of the nervous system. Almost all patients with suspected serious pathologies will be required to have a blood test and urinalysis, as they provide information about the work of the body as a whole. There are also many specific analyses. For example, it may be necessary to determine the level of certain hormones in the blood, to 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 receive it, patients make a puncture - they pierce the disc between the vertebrae in the lumbar region with a special needle. The procedure is quite painful and may have a number of side effects after the procedure ( dizziness, nausea, etc.).

Spinal puncture provides the following information important for diagnosis:

• indirectly shows the level of intracranial pressure;
• allows detecting bleeding in the brain ( then erythrocytes are found in the liquid);
• allows microbiological analysis to detect CNS infections ( encephalitis, meningitis, etc.);
• in the cerebrospinal fluid, substances specific for certain neurological diseases can be isolated.

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

Why do you need an odorous neurologist kit?

In neurology, there are several studies aimed at examining the organs of perception. One of them is called olfactometry. It aims to evaluate the patient's sense of smell. For examination, the doctor takes a special set of odorous substances. The patient sniffs them and chooses from several response options what kind of 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 impaired. They confuse the proposed smells or do not feel them at all. This test is diagnostic. If the ENT doctor does not find abnormalities at the level of the sinuses, the neurologist will examine in more detail the parts of the brain responsible for smell.

How does a neurologist check reflexes and muscle tone?

Reflexes are the response of the nervous system to external stimuli. During the examination, neurologists usually check for 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.

Most often, during the examination, the following reflexes are checked:

• Patella. A light blow with a hammer under the patella causes the leg to straighten slightly.
• Achilles tendon. A light blow to the Achilles tendon leads to a slight deviation of the foot to the side.
• Biceps muscle. Tapping the biceps near the antecubital fossa leads to muscle contraction and flexion of the arm.

Children have other reflexes. For example, when tapping on certain places on the abdomen, you can cause a reflex emptying of the bladder or intestines. As the child grows older, these reflexes disappear.

Neurologist's office equipment

Currently, the minimum equipment of the neurologist's office is regulated by the relevant order of the Ministry of Health. Regulations may vary slightly in different countries, but the basic set of equipment and tools remains the same.

The office of a neurologist must have the following furniture and equipment:

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

Treatment by a neurologist

In neurology, doctors use a variety of treatments. The most common is the so-called conservative treatment, treatment with various medications. Many patients are also prescribed physiotherapy procedures. With severe structural disorders, surgical intervention on the spinal cord or brain may also be necessary.

The neurologist always chooses the tactics of treatment after confirming the diagnosis. Self-treatment of neurological pathologies usually not only does not give a positive result, but can simply be dangerous. Moreover, even general practitioners, family physicians and other general practitioners are often reluctant to make prescriptions for patients with neurological disorders. This is due to 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 are more common, accompanied by damage to the central nervous system ( industrial, car accidents, etc.).

The most common neurological problems in adults are:

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

Many of these diseases appear due to more intense loads, exposure to various harmful factors, as well as 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 the metabolic processes occurring in the brain and nervous tissue, in principle, many different substances are involved. Currently, almost all of them are synthesized artificially by pharmacological companies. Thanks to this, neurologists can influence the body in the necessary way.

In neurology, the following groups of drugs can be used:

• sedatives ( sedative). Used for excessive psychomotor agitation, psychosis and neurosis. The most common benzodiazepines ( diazepam, lorazepam, phenazepam). They are also used to relieve seizures.
• Muscle relaxants. This group of drugs helps to relax muscles. They are, for example, prescribed for infringement of the roots of the spinal nerve to reduce pain. From this group, midokalm, baclosan 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 the areas of the brain responsible for activity, positive thinking, pleasure, 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. Their intake slows down the progression of symptoms. Antiparkinsonian drugs include pronoran, requip, levodopa.
• Sleeping drugs. 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 tissues. They are often prescribed after strokes, memory impairment and other functional disorders. Nootropics include, for example, piracetam, phenibut, vinpocetine, glycine.
• Vitamins. Basically, in case of neurological diseases, vitamins of group B are prescribed as a general tonic ( 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 vessels of the brain, for prophylactic purposes, they can prescribe drugs that thin the blood and prevent the formation of blood clots.

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

What are blockades for?

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

Concluding 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 brought 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 requires broad erudition. He should be more or less focused 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 are recognized as beyond their competence. Neurologist

in everyday work, he must also show himself as a psychologist who is able to understand the personal characteristics of his patients, the nature of the exogenous influences affecting them. From a neurologist to a greater extent than from doctors of other specialties, it is expected to understand the mental state of patients, the characteristics of the social factors influencing them. The communication of the neurologist with the patient should, as far as 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 lesions of the nervous system are the cause of many pathological conditions, in particular, violations of the functions of internal organs. At the same time, neurological disorders that manifest in a patient are often a consequence, a complication of his somatic pathology, common infectious diseases, endogenous and exogenous intoxications, pathological effects on the body of physical factors, and many other reasons. Thus, acute disorders of cerebral circulation, in particular strokes, as a rule, are caused by a complication of diseases of the cardiovascular system, the treatment of which before the onset of neurological disorders was carried out by cardiologists or general practitioners; 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 neurology 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 that occupy a border position between neurology and many other medical professions (somato-neurology). , neuroendocrinology, neurosurgery, neuroophthalmology, neurootiatry, neuroradiology, neuropsychology, etc.). This contributes to the development of theoretical and clinical neurology, expands the possibilities of providing the most qualified assistance to neurological patients. However, the narrowed profile of individual neurologists, and even more so the presence of specialists in disciplines related to neurology, is possible only in large clinical and research institutions. As practice shows, every qualified neurologist should have broad erudition, in particular, be oriented in the problems that are studied and developed in such institutions by specialists of a narrower profile.

Neurology is in a state of development, which is facilitated by advances in various fields of science and technology, the improvement of the most sophisticated modern technologies, as well as the success of specialists in many theoretical and clinical medical professions. All this requires a neurologist to constantly increase the 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 the 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 of medical universities. However, the first

Of great importance is independent work with special 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 over the past decades in Russian. Since it is impossible to embrace the immensity, not all literary sources reflecting the problems that arise before a neurologist in practical work are included in it. This list should be recognized as conditional, indicative, and as necessary, it can and should be replenished. Particular attention is recommended to be paid to new domestic and foreign publications, while it is necessary to follow not only monographs that are published, but also journals that relatively quickly bring to the attention of physicians the latest achievements in various fields of medicine.

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