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