Neurology
Overview
Neurology encompasses the prevention and management of disorders of the central and
peripheral nervous systems. Other conditions, such as headache, may be caused by non-neural
dysfunction but are often considered under the category of neurology.
The general internist should possess a broad range of competency in neurology. He or she should
be able to perform and interpret a detailed neurologic examination; should be competent in the
primary and secondary prevention of neurologic diseases; and should be familiar with the
presenting features, diagnosis, and treatment of common neurologic disorders.
The general internist may encounter neurologic disorders in various settings, including
ambulatory care, hospital, long-term care, and home care. In communities where a neurologist is
not available, the general internist may be a consultant for some complex neurologic disorders
(for example, control of status epilepticus).
Common Clinical Presentations
·
Abnormal speech·
Abnormal vision·
Altered sensation·
Confusion·
Disturbed gait or coordination·
Dizziness, vertigo·
Headache·
Hearing loss·
Localized pain syndromes: Facial pain, radiculopathy·
Loss of consciousness·
Memory impairment·
Seizure·
Sleep disorder·
Tremor·
Weakness/paresis (generalized, localized)Procedure Skills
·
Caloric stimulation test·
Tensilon (edrophonium chloride) test (optional)Ordering and Understanding Tests
·
Anticonvulsant drug levels·
Carotid Doppler echo scans·
Computed tomography, magnetic resonance imaging of central nervous system·
Digital intravenous angiography·
Electroencephalography, evoked potentials (visual, auditory, sensory)·
Electromyography, nerve conduction studies·
Muscle biopsy·
Myelography·
Screen for toxins, heavy metals·
Sleep study