article : Neurology

Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle.^[1] Physicians who specialize in neurology are called neurologists, and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialize in the technical/laboratory aspects of one of neurology's subdisciplines.

Field of work

Neurological disorders are disorders that can affect the feet central nervous system (brain and spinal cord), the peripheral nervous system, or the autonomic nervous system.

Major conditions include:

• behavioral/cognitive syndromes
• headache disorders such as migraine, cluster headache and tension headache
• seizure disorders
• neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, Huntington's disease, and Amyotrophic lateral sclerosis (Lou Gehrig's disease).
• cerebrovascular disease, such as transient ischemic attack and stroke.
• sleep disorders
• cerebral palsy
• infections of the brain (encephalitis), brain meninges (meningitis), spinal cord (myelitis)
• infections of the peripheral nervous system
• neoplasms – tumors of the brain and its meninges (brain tumors), spinal cord tumors, tumors of the peripheral nerves (neuroma)
• movement disorders such as Parkinson's disease, Huntington's disease, hemiballismus, tic disorder, and Gilles de la Tourette syndrome
• demyelinating diseases of the central nervous system, such as multiple sclerosis, and of the peripheral nervous system, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP)
• spinal cord disorders – tumors, infections, trauma, malformations (e.g., myelocele, meningomyelocele, tethered cord)
• disorders of peripheral nerves, muscle (myopathy) and neuromuscular junctions
• exciting injuries to the brain, spinal cord and peripheral nerves
• altered mental higher status, encephalopathy, stupor and coma
• speech and language disorders

Educational requirements

A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after graduation from medical school.

Neurologists complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.

Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.

Testing examinations

During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the cranial nerves (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management. To become a neurologist it will take a total of about 8 to 10 years of school

Clinical tasks

General caseload

Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a neurosurgeon, an interventional neuroradiologist, or a neurointerventionalist. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient is deceased. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis or neuromuscular diseases.

Overlapping areas

There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute head trauma is most often treated by neurosurgeons, whereas sequela of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of JCAHO stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system infectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by general practitioners, at least the less severe cases. Similarly, most cases of sciatica and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or orthopedic surgeons). Sleep disorders are also treated by pulmonologists. Cerebral palsy is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age.

Clinical neuropsychologists are often called upon to evaluate brain-behavior relationships for the purpose of assisting with differential diagnosis, planning rehabilitation strategies, documenting cognitive strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal aging or tracking the progression of a dementia).

Relationship to clinical neurophysiology

In some countries, e.g. USA and Germany, neurologists may specialize in clinical neurophysiology, the field responsible for EEG, nerve conduction studies, EMG and evoked potentials. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).

Overlap with psychiatry

Further information: Psychoneuroimmunology and Neuropsychiatry

Although many mental illnesses are believed to be neurological disorders affecting the central nervous system, traditionally they are classified separately, and treated by psychiatrists. In a 2002 review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)

There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, bipolar disorder and schizophrenia. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-stroke depression, depression and dementia associated with Parkinson's disease, mood and cognitive dysfunctions in Alzheimer's disease, to name a few. Hence, there is no sharp distinction between neurology and psychiatry on a biological basis – this distinction has mainly practical reasons and strong historical roots (such as the dominance of Freud's psychoanalytic theory in psychiatric thinking in the first three quarters of the 20th century – which has since then been largely replaced by the focus on neurosciences – aided by the tremendous advances in genetics and neuroimaging recently.)

In Germany, a compulsory year of Psychiatry must be done to complete a residency of Neurology.

References

1. ^ http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf

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article : Neural development in humans

he study of neural development draws on both neuroscience and developmental biology to describe the cellular and molecular mechanisms by which complex nervous systems emerge during embryonic development and throughout life.

Some landmarks of embryonic neural development include the birth and differentiation of neurons from stem cell precursors, the migration of immature neurons from their birthplaces in the embryo to their final positions, outgrowth of axons from neurons and guidance of the motile growth cone through the embryo towards postsynaptic partners, the generation of synapses between these axons and their postsynaptic partners, and finally the lifelong changes in synapses which are thought to underlie learning and memory.

Typically, these neurodevelopmental processes can be broadly divided into two classes: activity-independent mechanisms and activity-dependent mechanisms. Activity-independent mechanisms are generally believed to occur as hardwired processes determined by genetic programs played out within individual neurons. These include differentiation, migration and axon guidance to their initial target areas. These processes are thought of as being independent of neural activity and sensory experience. Once axons reach their target areas, activity-dependent mechanisms come into play. Neural activity and sensory experience will mediate formation of new synapses, as well as synaptic plasticity, which will be responsible for refinement of the nascent neural circuits.

Embryonic stage

Neurulation

Main article: neurulation

See embryogenesis for understanding the animal development up to this stage.

Neurulation is the formation of the neural tube from the ectoderm of the embryo. It follows gastrulation in all vertebrates. During gastrulation cells migrate to the interior of embryo, forming three germ layers— the endoderm (the deepest layer), mesoderm and ectoderm (the surface layer)—from which all tissues and organs will arise. In a simplified way, it can be said that the ectoderm gives rise to skin and nervous system, the endoderm to the guts and the mesoderm to the rest of the organs.

After gastrulation the notochord—a flexible, rod-shaped body that runs along the back of the embryo—has been formed from the mesoderm. During the third week of gestation the notochord sends signals to the overlying ectoderm, inducing it to become neuroectoderm. This results in a strip of neuronal stem cells that runs along the back of the fetus. This strip is called the neural plate, and is the origin of the entire nervous system. The neural plate folds outwards to form the neural groove. Beginning in the future neck region, the neural folds of this groove close to create the neural tube (this form of neurulation is called primary neuralation). The anterior (front) part of the neural tube is called the basal plate; the posterior (rear) part is called the alar plate. The hollow interior is called the neural canal. By the end of the fourth week of gestation, the open ends of the neural tube (the neuropores) close off.^[1]

Formation of the spinal cord

Cross-section of a developing spinal cord.

The spinal cord forms from the lower part of the neural tube. The wall of the neural tube consists of neuroepithelial cells, which differentiate into neuroblasts, forming the mantle layer (the gray matter). Nerve fibers emerge from these neuroblasts to form the marginal layer (the white matter).

The ventral part of the mantle layer (the basal plates) forms the motor areas of the spinal cord, whilst the dorsal part (the alar plates) forms the sensory areas. Between the basal and alar plates is an intermediate layer that contains neurons of the autonomic nervous system.^[2]

Formation of the brain

The embryo's brain at four weeks.

The embryo's brain at six weeks.

Late in the forth week, the superior part of the neural tube flexes at the level of the future midbrain—the mesencephalon. Above the mesencephalon is the prosencephalon (future forebrain) and beneath it is the rhombencephalon (future hindbrain). The optical vesicle (which will eventually become the optic nerve, retina and iris) forms at the basal plate of the prosencephalon.

In the fifth week, the alar plate of the prosencephalon expands to form the cerebral hemispheres (the telencephalon). The basal plate becomes the diencephalon.

The diencephalon, mesencephalon and rhombencephalon constitute the brain stem of the embryo. It continues to flex at the mesencephalon. The rhombencephalon folds posteriorly, which causes its alar plate to flare and form the fourth ventricle of the brain. The pons and the cerebellum form in the upper part of the rhombencephalon, whilst the medulla oblongata forms in the lower part.

Human brain development

Highly schematic flowchart of human brain development.

Neuronal migration

Neuronal migration is the method by which neurons travel from their origin or birth place to their final position in the brain. There are several ways they can do this, e.g. by radial migration or tangential migration.

Radial migration

Neuronal precursor cells proliferate in the ventricular zone of the developing neocortex. The first postmitotic cells to migrate form the preplate which are destined to become Cajal-Retzius cells and subplate neurons. These cells do so by somal translocation. Neurons migrating with this mode of locomotion are bipolar and attach the leading edge of the process to the pia. The soma is then transported to the pial surface by nucleokenisis, a process by which a microtubule "cage" around the nucleus elongates and contracts in association with the centrosome to guide the nucleus to its final destination.^[3] Radial fibres (also known as radial glia) can translocate to the cortical plate and differentiate either into astrocytes or neurons. ^{[4][citation needed]} Somal translocation can occur at any time during development.^[5]

Subsequent waves of neurons split the preplate by migrating along radial glial fibres to form the cortical plate. Each wave of migrating cells travel past their predecessors forming layers in an inside-out manner, meaning that the youngest neurons are the closest to the surface.^[6][7] It is estimated that glial guided migration represents 80-90% of migrating neurons.^{[citation needed]}

Tangential migration

Most interneurons migrate tangentially through multiple modes of migration to reach their appropriate location in the cortex. An example of tangential migration is the movement of Cajal-Retzius cells from the ganglionic eminence to the cerebral cortex.

Others

There is also a method of neuronal migration called multipolar migration^[8][9]. This is seen in multipolar cells, which re abundantly present in the cortical intermediate zone. They do not resemble the cells migrating by locomotion or somal translocation. Instead these multipolar cells express neuronal markers and extend multiple thin processes in various directions independently of the radial glial fibers.^[10]

Neural development in the adult nervous system

Main article: Neuroregeneration

Neural development in the adult nervous system includes mechanisms such as remyelination, generation of new neurons, glia, axons, myelin or synapses. Neuroregeneration differs between the peripheral nervous system (PNS) and the central nervous system (CNS) by the functional mechanisms and especially, the extent and speed.

See also

• Time lapse seqeunces of radial migration (also known as glial guidance) and somal translocation.^[5]

• Axon guidance

• Neural Darwinism

• Pre- and perinatal psychology

References

1. ^ Fitzgeral, MJ Turlough; Gruener, Gregoery; Mtui, Estomih. (2007). Clinical Neuroanatomy and Neuroscience, pg 1. Elsevier Saunders. ISBN 1-4160-3445-5
2. ^ Atlas of Human Embryology, Chronolab. Last accessed on Oct 30, 2007.
3. ^ Samuels B, Tsai L (2004). "Nucleokinesis illuminated". Nat Neurosci 7 (11): 1169-70. PMID 15508010.
4. ^ Trends Neurosci. 2002 May;25(5):235-8. Radial glia: multi-purpose cells for vertebrate brain development. Campbell K, Götz M. PMID: 11972958
5. ^ ^{a b} Nadarajah B, Brunstrom J, Grutzendler J, Wong R, Pearlman A (2001). "Two modes of radial migration in early development of the cerebral cortex". Nat Neurosci 4 (2): 143-50. PMID 11175874.
6. ^ Nadarajah B, Parnavelas J (2002). "Modes of neuronal migration in the developing cerebral cortex". Nat Rev Neurosci 3 (6): 423-32. PMID 12042877.
7. ^ Rakic P (1972). "Mode of cell migration to the superficial layers of fetal monkey neocortex". J Comp Neurol 145 (1): 61-83. PMID 4624784.
8. ^ Tabata H, Nakajima K (2003). "Multipolar migration: the third mode of radial neuronal migration in the developing cerebral cortex". J Neurosci 23 (31): 9996-10001. PMID 14602813. Full text
9. ^ Nadarajah B, Alifragis P, Wong R, Parnavelas J (2003). "Neuronal migration in the developing cerebral cortex: observations based on real-time imaging". Cereb Cortex 13 (6): 607-11. PMID 12764035. Full text
10. ^ NCBI - Multipolar migration: the third mode of radial neuronal migration in the developing cerebral cortex. Tabata H, Nakajima K.

Source : http://en.wikipedia.org

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article :Nervous system in Human

This article needs additional citations for verification.

Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (November 2007)

Neuroscience Portal

The nervous system is a highly specialized network whose principal components are nerves called neurons. Neurons are interconnected to each other in complex arrangements, and have the property of conducting, using electrochemical signals, a great variety of stimuli both within the nervous tissue as well as from and towards most of the other tissues. Thus, neurons coordinate multiple functions in organisms. Nervous systems are found in many multicellular animals but differ greatly in complexity between species.

Nervous system in humans

The human nervous system can be observed both with gross anatomy, (which describes the parts that are large enough to be seen with the plain eye,) and microanatomy, (which describes the system at a cellular level.) At gross anatomy, the nervous system can be grouped in distinct organs, these being actually stations which the neural pathways cross through. Thus, with a didactical purpose, these organs, according to their ubication, can be divided in two parts: the central nervous system (CNS) and the peripheral nervous system (PNS).

Central nervous system

Main article: Central nervous system

See also: List of regions in the human brain

The central nervous system (CNS) represents the largest part of the nervous system, including the brain and the spinal cord. The CNS is contained within the dorsal cavity, with the brain within the cranial cavity, and the spinal cord in the spinal cavity. The CNS is covered by the meninges. The brain is also protected by the skull, and the spinal cord is also protected by the vertebrae. The nervous system can be connected into many systems that can function together. The two systems are central nervous system (CNS)and the peripheral nervous system (PNS).

Central nervous system	Brain	Prosencephalon	Telencephalon	Rhinencephalon, Amygdala, Hippocampus, Neocortex, Lateral ventricles
			Diencephalon	Epithalamus, Thalamus, Hypothalamus, Subthalamus, Pituitary gland, Pineal gland, Third ventricle
		Brain stem	Mesencephalon	Tectum, Cerebral peduncle, Pretectum, Mesencephalic duct
			Rhombencephalon	Metencephalon	Pons, Cerebellum,
				Myelencephalon	Medulla oblongata
	Spinal cord

Peripheral nervous system

Main article: Peripheral nervous system

The PNS consists of all the other nervous structures that do not lie within it. The large majority of what are commonly called nerves (which are actually axonal processes of nerve cells) are considered to be PNS.

Microanatomy

The nervous system is, on a small scale, primarily made up of neurons. However, glial cells also play a major role.

Neurons

Main article: Neuron

They are the core components of both the central nervous system & peripheral nervous system. Neurons are sensors that send electric messages to the Central Nervous System which send the electric messages back to the neurons telling them how to react, where the messages are finally sent back directly to the brain. These messages travel at a usual pace of 100 meters per second.

Glial cells

Main article: Glial cell

Glial cells are non-neuronal cells that provide support and nutrition, maintain homeostasis, form myelin, and participate in signal transmission in the nervous system. In the human brain, glia are estimated to outnumber neurons by about 10 to 1.^[1]

Glial cells provide support and protection for neurons. They are thus known as the "glue" of the nervous system. The four main functions of glial cells are to surround neurons and hold them in place, to supply nutrients and oxygen to neurons, to insulate one neuron from another, and to destroy pathogens and remove dead neurons.

Physiological division

A less anatomical but much more functional division of the human nervous system is that classifying it according to the role that the different neural pathways play, regardless whether these cross through the CNS or the PNS:

The somatic nervous system is responsible for coordinating the body's movements, and also for receiving external stimuli. It is the system that regulates activities that are under conscious control.

The autonomic nervous system is then split into the sympathetic division, parasympathetic division, and enteric division. The sympathetic nervous system responds to impending danger or stress, and is responsible for the increase of one's heartbeat and blood pressure, among other physiological changes, along with the sense of excitement one feels due to the increase of adrenaline in the system. The parasympathetic nervous system, on the other hand, is evident when a person is resting and feels relaxed, and is responsible for such things as the constriction of the pupil, the slowing of the heart, the dilation of the blood vessels, and the stimulation of the digestive and genitourinary systems. The role of the enteric nervous system is to manage every aspect of digestion, from the esophagus to the stomach, small intestine and colon.

In turn, these pathways can be divided according to the direction in which they conduct stimuli:

• Afferent system by sensory neurons, which carry impulses from a receptor to the CNS
• Efferent system by motor neurons, which carry impulses from the CNS to an effector
• Relay system by relay neurons (also called interneurons), which transmit impulses between the sensory and motor neurones.

A useful mnemonic to remember the nature of Afferent vs Efferent is SAME DAVE: Sensory Afferent, Motor Efferent; Dorsal Afferent, Ventral Efferent

However, there are relay neurons in the CNS as well.

The junction between two neurones is called a synapse. There is a very narrow gap (about 20nm in width) between the neurons - the synaptic cleft, where an action potential is transmitted from one neuron to a neighboring one. They do this by relaying the message with the use of neurotransmitters which the next neuron then receives the electrical signal, known as a nerve impulse. The nerve impulse is determined by the neurotransmitter to then carry the message to its appropriate destination. These nerve impulses are a change in ion balance in the nerve cell, which the central nervous system can then interpret. The fact that the nervous system uses a mixture of electrical and chemical signals makes it incredibly fast, which is necessary to acknowledge the presence of danger. For example, a hand touching a hot stove. If the nervous system was only comprised of chemical signals, the body would not tell the arm to move fast enough to escape dangerous burns. So the speed of the nervous system is a necessity for life.

Physiological division	Somatic nervous system	Afferent system
		Efferent system
	Autonomic nervous system	Sympathetic	Afferent system
			Efferent system
		Parasympathetic	Afferent system
			Efferent system

Development

Main article: Neural development in humans

Some landmarks of embryonic neural development include the birth and differentiation of neurons from stem cell precursors, the migration of immature neurons from their birthplaces in the embryo to their final positions, outgrowth of axons from neurons and guidance of the motile growth cone through the embryo towards postsynaptic partners, the generation of synapses between these axons and their postsynaptic partners, and finally the lifelong changes in synapses which are thought to underlie learning and memory.

Importance

Many people have lost basic motor skills and other skills because of spinal chord injuries. If this portion is damaged, the biggest nerve and the most important one gets damaged. This leads to paralysis or other permanent damages.

Abilities

The nervous system is able to make basic motor skills and other skills possible. The basic 5 senses of texture, taste, sight, smell,and hearing are powered by the nervous system. If disabled, basic motor skills may be lost.

Non-humans

Vertebrates

The nervous system of all vertebrate animals, is often divided into the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal cord.

Worms

Planaria, a type of flatworm, have dual nerve cords running along the length of the body and merging at the tail and the mouth. These nerve cords are connected by transverse nerves like the rungs of a ladder. These transverse nerves help coordinate the two sides of the animal. Two large ganglia at the head end function similar to a simple brain. Photoreceptors on the animal's eyespots provide sensory information on light and dark.

The nervous system of the roundworm Caenorhabditis elegans has been mapped out to the cellular level. Every neuron and its cellular lineage has been recorded and most, if not all, of the neural connections are known. In this species, the nervous system is sexually dimorphic; the nervous systems of the two sexes, males and hermaphrodites, have different numbers of neurons and groups of neurons that perform sex-specific functions. In C. elegans, males have exactly 383 neurons, while hermaphrodites have exactly 302 neurons [1]

Arthropoda

Arthropods, such as insects and crustaceans, have a nervous system made up of a series of ganglia, connected by a ventral nerve cord made up of two parallel connectives running along the length of the belly [2]. Typically, each body segment has one ganglion on each side, though some ganglia are fused to form the brain and other large ganglia [3].

The head segment contains the brain, also known as the supraesophageal ganglion. In the insect nervous system, the brain is anatomically divided into the protocerebrum, deutocerebrum, and tritocerebrum. Immediately behind the brain is the subesophageal ganglion, which is composed of three pairs of fused ganglia. It controls the mouthparts, the salivary glands and certain muscles.

Many arthropods have well-developed sensory organs, including compound eyes for vision and antennae for olfaction and pheromone sensation. The sensory information from these organs is processed by the brain.

Development

Main article: Neural development

Neural development in most species have many similarities neural development in humans.

Source : http://en.wikipedia.org

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article : Parkinson's Disease

Physician developed and monitored.

Original source: www.neurologychannel.com
Original Date of Publication: 02 Jan 2000
Reviewed by: Stanley J. Swierzewski, III, M.D.
Last Reviewed: 04 Dec 2007

Overview

Parkinson's disease is a chronic, progressive neurodegenerative movement disorder.

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article : Neurology and Human System

Neurology is a medical speciality dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle.^[1] Physicians who specialize in neurology are called neurologists, and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialise in the technical/laboratory aspects

Field of work

Neurological disorders are disorders that affect the central nervous system (brain and spinal cord), the peripheral nervous system, or the autonomic nervous system.

Major conditions include:

• behavioral/cognitive syndromes
• headache disorders such as migraine, cluster headache and tension headache
• seizure disorders
• neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, Huntington's disease, and Amyotrophic lateral sclerosis (Lou Gehrig's disease).
• cerebrovascular disease, such as transient ischemic attack and stroke.
• sleep disorders
• cerebral palsy
• infections of the brain (encephalitis), brain meninges (meningitis), spinal cord (myelitis)
• infections of the peripheral nervous system
• neoplasms - tumors of the brain and its meninges (brain tumors), spinal cord tumors, tumors of the peripheral nerves (neuroma)
• movement disorders such as Parkinson's disease, Huntington's disease, hemiballismus, tic disorder, and Gilles de la Tourette syndrome
• demyelinating diseases of the central nervous system, such as multiple sclerosis, and of the peripheral nervous system, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP)
• spinal cord disorders - tumors, infections, trauma, malformations (e.g., myelocele, meningomyelocele, tethered cord)
• disorders of peripheral nerves, muscle (myopathy) and neuromuscular junctions
• traumatic injuries to the brain, spinal cord and peripheral nerves
• altered mental status, encephalopathy, stupor and coma
• speech and language disorders

Educational requirements

A neurologist's educational background and medical training varies with the country of training. In the United States and Canada, neurologists are physicians who have completed postgraduate training in neurology after the completion of medical school and attainment of the allopathic (MD, MBBS, MBChB, etc) or osteopathic (DO) degree.

Neurologists complete a minimum of 10 years of postsecondary education and clinical training. In the majority of cases this training includes obtaining an undergraduate degree (a few medical schools will admit students with as little as two years of undergraduate education), a medical degree (4 years), and then completing a four-year residency in neurology. The four-year residency consists of one year of internal medicine training followed by three years of training in neurology.

Many neurologists also have additional subspecialty training (fellowships) after completing their residency in one area of neurology such as stroke, epilepsy, neuromuscular, sleep medicine, pain management, neuroimmunology, clinical neurophysiology, or movement disorders.

In INDIA the education neurology or related to whole body nervous system is given by NIMHANS, the dream institute of a neurologist.

Testing examinations

During a neurological examination, the neurologist reviews the patient's health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests mental status, function of the cranial nerves (including vision), strength, coordination, reflexes and sensation. This information helps the neurologist determine if the problem exists in the nervous system and the clinical localization. Localization of the pathology is the key process by which neurologists develop their differential diagnosis. Further tests may be needed to confirm a diagnosis and ultimately guide therapy and appropriate management.

Clinical tasks

General caseload

Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a neurosurgeon, an interventional neuroradiologist, or a neurointerventionalist. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient is deceased. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis or neuromuscular diseases.

Overlapping areas

There is some overlap with other specialties, varying from country to country and even within a local geographic area. Acute head trauma is most often treated by neurosurgeons, whereas sequela of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Although stroke cases have been traditionally managed by internal medicine or hospitalists, the emergence of vascular neurology and endovascular neurosurgery as disciplines has created a demand for stroke specialists. The establishment of JCAHO stroke centers has increased the role of neurologists in stroke care in many primary as well as tertiary hospitals. Some cases of nervous system infectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed and treated primarily by general practitioners, at least the less severe cases. Similarly, most cases of sciatica and other mechanical radiculopathies are treated by general practitioners, though they may be referred to neurologists or a surgeon (neurosurgeons or orthopedic surgeons). Sleep disorders are also treated by pulmonologists. Cerebral palsy is initially treated by pediatricians, but care may be transferred to an adult neurologist after the patient reaches a certain age.

Clinical neuropsychologists are often called upon to evaluate brain-behavior relationships for the purpose of assisting with differential diagnosis, planning rehabilitation strategies, documenting cognitive strengths and weaknesses, and measuring change over time (e.g., for identifying abnormal aging or tracking the progression of a dementia).

Relationship to clinical neurophysiology

In some countries, e.g. USA and Germany, neurologists may specialize in clinical neurophysiology, the field responsible for EEG, nerve conduction studies, EMG and evoked potentials. In other countries, this is an autonomous specialty (e.g. United Kingdom, Sweden).

Overlap with psychiatry

Further information: Psychoneuroimmunology and Neuropsychiatry

Although many mental illnesses are believed to be neurological disorders affecting the central nervous system, traditionally they are classified separately, and treated by psychiatrists. In a 2002 review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote that 'the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.' (Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704)

There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, bipolar disorder and schizophrenia. As well, 'neurological' diseases often have 'psychiatric' manifestations, such as post-stroke depression, depression and dementia associated with Parkinson's disease, mood and cognitive dysfunctions in Alzheimer's disease, to name a few. Hence, there is no sharp distinction between neurology and psychiatry on a biological basis - this distinction has mainly practical reasons and strong historical roots (such as the dominance of Freud's psychoanalytic theory in psychiatric thinking in the first three quarters of the 20th century - which has since then been largely replaced by the focus on neurosciences - aided by the tremendous advances in genetics and neuroimaging recently.)

References

1. ^ http://www.acgme.org/acWebsite/downloads/RRC_progReq/180neurology07012007.pdf

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