What is Neurology? and Neurosurgery?
- Strokes
- Multiple Sclerosis
- Headaches
- Brain Trauma
- Parkinsons
- Vertigo and Dizziness
- Epilepsy
- Memory loss
- Spine, Nerve, Muscle
- Numbness and burning
- Weakness
- Vision, hearing, speech, swallow
- Neurologic bowel or bladder
- Neuropathic pain
- Brain tumours
- Subdural Haematoma release
- Aneurysms clipped
- Spinal cord decompressions
- Spinal nerve root decompressions
- Shunts for hydrocephalus
- Shunts for Idiopathic Intracranial Hypertension
- Biopsies of lesions found on scans
- Epilepsy surgery
- Carpal tunnel and Ulnar nerve decompressions
Neurology
The Neurosciences incorporate all almost aspects of medicine focused on the brain (the grey matter cortex, the deeper white matter connections, the basal ganglia the cerebellar coordination, and the brianstem with all its cranial nerves and automatic functions), spinal cord, nerve roots in the spine, then the meshing of nerves (plexus) leaving the spine out into the limbs (brachial plexus in arms, lumbosacral plexus in legs), the peripheral nerves or the trunk and limbs, the neuro-muscular junction (where nerves meet muscle), and muscle disorders.
Interestingly we do not specifically manage psychiatric disorders, although will often treat depression, anxiety and other psychiatric symptoms when they arise as part of a brain disorder. Psychiatry is a separate branch of medicine although as science advances, the biologic nature of such diseases of the brain becomes more and more convincing as a concept.
The mechanisms by which the neurologic system can be affected are, similar to most specialties of medicine, varied. The most exciting breakthroughs are already arriving in the immunologic attacks of any part of the neurologic system that can be seen as an overflow from the immune system trying to fight off cancer (called paraneoplastic disorders) and alternatively, seemingly spontaneous attacks of the immune system on a specific tissue. Whlts we ahve been able to fight such "autoimmune" diseases with prednisone (steroids) for decades, we are increasingly able to modify such devastating diseases using IVIG, a human protein from blood donations, or Rituximab (attacks the B-cell lymphocytes, or Natalizumab (attacks the T-cell lymphocytes). These treatments are very expensive as they are so new, but will become routine over time as the price drops and PHARMAC allows access. For example, in Multiple Sclerosis, the commonest immune disorder of the brain, spinal cord and optic nerves, often affecting young women with progressive and devastating attacks of neurologic failure, there are now 7 disease modifying medications ranging in power from 30% reduction in attacks to 75% reduction in attacks, and able to "switch off" the disease in up to 40% of patients. Finally some of the recently funded medications are oral tablets with mild to moderate strength against the disease. These exciting innovations are changing the face of neurology.
Stroke (and "ministroke" or TIA (transient ischaemic sttack) is probably the most common neurologic problem. It is generally sudden in onset and varies of minor and reversible to devastatingly disabling or death. It affects all ages, but particularly older folk. In Maori and Pacifika it occurs about 10 years younger than Pakeha. It is a collection of diseases of the blood vessels and can be 1) clot floating up from the heart to the brain, 2) clot in, or floating up from the large arteries of the neck or brain, 3) blockage in the small blood vessels of the brain, 4) bleeding strokes from popped arteries in the brain. Each has its own different lifestyle and genetic factors predisposing a person to stroke, but the central single factor is Blood Pressure. Over the last 30 years we have reduced the average risk of recurrent stroke after a first-ever stroke from what used to be 30% to current 8%. This 3/4s reduction in risk is due to medications for blood pressure, for cholesterol, for blood thinning, and also major lifestyle improvements. In the emergency setting stroke can now be reversed in many victims by a) clot busting intravenous medication, and b) invasive arterial devices to remove the large clot blocking arteries. Such treatments are extremely effective in the right scenario, but only if we get in early. By this early means generally within 4.5 to 6 hours of stroke onset.We have a long way to go with making all of this available 24/7/365 throughout the Midlands and New Zealand.
The Neurodegenerative diseases are being researched intensively worldwide, including in New Zealand. The three big ones are Alzheimers Disease, Parkinsons Disease and Motor Neurone Disease. At present each has medications which improve matters a little but nothing to definitely change the disease from progressing. We now have Nuclear Medicine DAT scans to show the level of Dopamine in the brain, and PET scans to show the accumulation of Amyloid deposits in the brain in Alzheimers. These and markers in the lumbar puncture fluid are beginning to teach us more about the diseases and to generate ideas about how they will in future be treatable.
There are so many more developments across the areas of Neurologic sciences that there is certainly no room to discuss them all in this site.
We find the free Emedicine website to be a detailed and accurate and very helpful place to take this further for the inquisative person. For example, in google type "emedicine epilepsy" and start learning.
Interestingly we do not specifically manage psychiatric disorders, although will often treat depression, anxiety and other psychiatric symptoms when they arise as part of a brain disorder. Psychiatry is a separate branch of medicine although as science advances, the biologic nature of such diseases of the brain becomes more and more convincing as a concept.
The mechanisms by which the neurologic system can be affected are, similar to most specialties of medicine, varied. The most exciting breakthroughs are already arriving in the immunologic attacks of any part of the neurologic system that can be seen as an overflow from the immune system trying to fight off cancer (called paraneoplastic disorders) and alternatively, seemingly spontaneous attacks of the immune system on a specific tissue. Whlts we ahve been able to fight such "autoimmune" diseases with prednisone (steroids) for decades, we are increasingly able to modify such devastating diseases using IVIG, a human protein from blood donations, or Rituximab (attacks the B-cell lymphocytes, or Natalizumab (attacks the T-cell lymphocytes). These treatments are very expensive as they are so new, but will become routine over time as the price drops and PHARMAC allows access. For example, in Multiple Sclerosis, the commonest immune disorder of the brain, spinal cord and optic nerves, often affecting young women with progressive and devastating attacks of neurologic failure, there are now 7 disease modifying medications ranging in power from 30% reduction in attacks to 75% reduction in attacks, and able to "switch off" the disease in up to 40% of patients. Finally some of the recently funded medications are oral tablets with mild to moderate strength against the disease. These exciting innovations are changing the face of neurology.
Stroke (and "ministroke" or TIA (transient ischaemic sttack) is probably the most common neurologic problem. It is generally sudden in onset and varies of minor and reversible to devastatingly disabling or death. It affects all ages, but particularly older folk. In Maori and Pacifika it occurs about 10 years younger than Pakeha. It is a collection of diseases of the blood vessels and can be 1) clot floating up from the heart to the brain, 2) clot in, or floating up from the large arteries of the neck or brain, 3) blockage in the small blood vessels of the brain, 4) bleeding strokes from popped arteries in the brain. Each has its own different lifestyle and genetic factors predisposing a person to stroke, but the central single factor is Blood Pressure. Over the last 30 years we have reduced the average risk of recurrent stroke after a first-ever stroke from what used to be 30% to current 8%. This 3/4s reduction in risk is due to medications for blood pressure, for cholesterol, for blood thinning, and also major lifestyle improvements. In the emergency setting stroke can now be reversed in many victims by a) clot busting intravenous medication, and b) invasive arterial devices to remove the large clot blocking arteries. Such treatments are extremely effective in the right scenario, but only if we get in early. By this early means generally within 4.5 to 6 hours of stroke onset.We have a long way to go with making all of this available 24/7/365 throughout the Midlands and New Zealand.
The Neurodegenerative diseases are being researched intensively worldwide, including in New Zealand. The three big ones are Alzheimers Disease, Parkinsons Disease and Motor Neurone Disease. At present each has medications which improve matters a little but nothing to definitely change the disease from progressing. We now have Nuclear Medicine DAT scans to show the level of Dopamine in the brain, and PET scans to show the accumulation of Amyloid deposits in the brain in Alzheimers. These and markers in the lumbar puncture fluid are beginning to teach us more about the diseases and to generate ideas about how they will in future be treatable.
There are so many more developments across the areas of Neurologic sciences that there is certainly no room to discuss them all in this site.
We find the free Emedicine website to be a detailed and accurate and very helpful place to take this further for the inquisative person. For example, in google type "emedicine epilepsy" and start learning.
Neurosugery
The Neurosurgeon and the Neurologist work very closely together, both highly educated within the Neurosciences but the Neurologist has a focus on Diagnosis, Investigations, Medications,Support, whereas the Neurosurgeon has a focus on the Neurologic diseases which require an operation to diagnose or to treat.
For example, the Neurosurgeons tend to manage acute head injury inpatients, because of the risk of needing surgical intervention, but the Neurologist is more often involved in the later phase of care. The Neurosurgeon may remove a benign tumour in the brain that was only discovered because of epileptic seizures, but then ongoing seizures would continue to be managed by the Neurologist with medication if not completely stopped.
In other conditions the Neurologist may detect the Neurosurgical problem, refer on to the Neurosurgeon, but the ongoing surgery and monitoring are done by the Neurosurgeon, eg low grade brain tumours, or followup of spinal decompression.
For example, the Neurosurgeons tend to manage acute head injury inpatients, because of the risk of needing surgical intervention, but the Neurologist is more often involved in the later phase of care. The Neurosurgeon may remove a benign tumour in the brain that was only discovered because of epileptic seizures, but then ongoing seizures would continue to be managed by the Neurologist with medication if not completely stopped.
In other conditions the Neurologist may detect the Neurosurgical problem, refer on to the Neurosurgeon, but the ongoing surgery and monitoring are done by the Neurosurgeon, eg low grade brain tumours, or followup of spinal decompression.