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ⓘ स्नायुशास्त्र



स्नायुशास्त्र
                                     

ⓘ स्नायुशास्त्र

Neurology is a branch of medicine dealing with disorders of the nervous system. Physicians specializing in the field of neurology are called neurologists र are trained to diagnose, treat, र manage patients with neurological disorders. Most neurologists are trained to treat र diagnose adults. Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children. Neurologists are also involved in clinical research, clinical trials, as well as basic research र translational research.

                                     

1. Field of work

Neurological disorders are disorders that affect the central nervous system brain, brainstem र cerebellum, the peripheral nervous system peripheral nerves - cranial nerves included, or the autonomic nervous system parts of which are located in both central र peripheral nervous system. Neurologists also diagnose र treat some conditions in the musculoskeletal system.

Major conditions include:

  • traumatic injuries to the brain, spinal cord र peripheral nerves
  • sleep disorders
  • movement disorders such as Parkinsons disease, chorea, hemiballismus, tic disorder, र Gilles de la Tourette syndrome
  • some infections of the peripheral nervous system, such as tetanus र botulism
  • neurodegenerative disorders, including Alzheimers disease, Parkinsons disease, Lou Gehrigs disease र ataxia.
  • cerebrovascular disease, such as transient ischemic attacks, र strokes ischemic or hemorrhagic
  • infections of the central nervous system encephalitis, brain envelopes meningitis र peripheral nerves neuritis, such as brain abscess, herpetic meningoencephalitis, aspergilloma, cerebral hydatic cyst
  • epilepsy र seizure disorders
  • disorders of peripheral nerves, muscle myopathy र neuromuscular junctions
  • cerebral palsy
  • demyelinating diseases of the central nervous system, such as multiple sclerosis, र of the peripheral nervous system, such as Guillain-Barré syndrome र chronic inflammatory demyelinating polyneuropathy CIDP
  • altered mental status, encephalopathy, stupor र coma
  • Speech र language disorders
  • spinal cord disorders - tumors, infections, trauma, malformations
  • neoplasms - tumors of the brain र its envelopes brain tumors, spinal cord tumors, tumors of the peripheral nerves neuroma
  • headache disorders such as migraine, cluster headache र tension headache
                                     

2.1. Clinical tasks General caseload

Neurologists are responsible for the diagnosis, treatment, र 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. Other neurologists may develop an interest in particular subfields, such as movement disorders, headaches, epilepsy, sleep disorders, multiple sclerosis or neuromuscular diseases.

The core neurological diseases that are the primary domain of neurologists are:

  • the epilepsies
  • spinal cord disorders
  • polyneuropathies
  • movement disorders
  • demyelinating diseases of the central nervous system.
  • headache र migraine
  • genetic diseases with a primarily neurologic manifestation
                                     

2.2. Clinical tasks Overlapping areas

There is some overlap with other specialties, varying from country to country र even within a local geographic area. Most stroke patients are seen only by specialists in internal medicine. Whether stroke patients should be seen primarily by neurologists is contested. Acute head trauma is most often treated by neurosurgeons, whereas sequela of head trauma may be treated by neurologists or specialists in rehabilitation medicine. Some cases of nervous system infectious diseases are treated by infectious disease specialists. Most cases of headache are diagnosed र treated primarily by general practitioners, at least the less severe cases. Similarly, most cases of sciatica र 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.



                                     

2.3. Clinical tasks Relationship to clinical neurophysiology

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

                                     

2.4. Clinical tasks Overlap with psychiatry

Although many mental illnesses are believed to be neurological disorders affecting the central nervous system, traditionally they are classified separately, र treated by psychiatrists. In a २००२ review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School र 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 र mind are one makes the separation artificial anyway. Martin JB. The integration of neurology, psychiatry र neuroscience in the २१st century. Am J Psychiatry २००२; १५९:६९५-७०४

There are strong indications that neuro-chemical mechanisms play an important role in the development of, for instance, bipolar disorder र schizophrenia. As well, neurological diseases often have psychiatric manifestations, such as post-stroke depression, depression र dementia associated with Parkinsons disease, mood र cognitive dysfunctions in Alzheimers disease, to name a few. Hence, there is no sharp distinction between neurology र psychiatry on a biological basis - this distinction has mainly practical reasons र strong historical roots such as the dominance of Freuds psychoanalytic theory in psychiatric thinking in the first three quarters of the २०th century - which has since then been largely replaced by the focus on neurosciences - aided by the tremendous advances in genetics र neuroimaging recently.

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