neurology - Education and Training Encyclopedia

neurology

Introduction (introduction)

Neurology is a part of neuroscience, and its development is closely related to the progress of many basic disciplines of neuroscience, which study the structure and function of nervous system, etiology and pathology. They permeate and promote each other. These basic disciplines include neuroanatomy, neurohistology and embryology, neurophysiology, neurobiochemistry, neuropathology, neurogenetics, neuroimmunology, neuroepidemiology, neuroimaging, neuropharmacology, neuroophthalmology, neurootology, neuropsychology, neuroendocrinology, neurooncology, experimental nerve planning, neurobiology and molecular biology. Neurosurgery has been separated from neurology for a long time and developed rapidly. Pediatric neurology, perinatal neurology, neonatal neurology and geriatric neurology have also developed or are developing into independent specialties. The new theories of any related basic disciplines and the invention of medical instruments have also brought revolutionary changes to the diagnosis and treatment of nervous system diseases. For example, 1979 Computed Tomography (cT) instrument designed by British scientist Hounsfield, winner of the Nobel Prize in Medicine, 1972 was applied in clinic, which completely changed the diagnosis of brain diseases. Swedish scientist cad Chang-son won the Nobel Prize in Medicine in 2000. He discovered that the signal transduction function of dopamine and dopamine deficiency in specific parts of the brain can cause Parkinson's disease, and promoted the development of effective therapeutic drug levodopa. There are many such examples. Flt~Pf shows that the research field of neurology is very broad and its development prospect is limitless.

The human brain and peripheral nervous system, which are composed of hundreds of billions of nerve cells and synapses over10/4, have extremely complex and delicate structures and functions. The central nervous system (cNs) composed of brain and spinal cord and the peripheral nervous system (PNS) composed of cranial nerve and spinal nerve form a complete, unified and harmonious whole, which commands and coordinates the body's motor, sensory and autonomic nervous functions, feels and responds to information from the internal and external environment of the body, and participates in people's consciousness, learning and memory. According to the different functions of its main parts, the fork can be divided into somatic nervous system and autonomic nervous system. The former mainly regulates the human body to adapt to changes in the external environment; The latter mainly regulates other systems and organs, that is, stabilizes the internal environment of the body. Hypothalamus is the autonomic nerve center regulated by cerebral cortex, which regulates the release of pituitary hormones.

The research contents of neurology include CNS disease, PNS disease and skeletal muscle disease, and the types of diseases include infection, vascular disease, tumor, trauma, autoimmune, degeneration, heredity, poisoning, congenital dysplasia, nutritional deficiency and metabolic disorder. Various diseases usually have their unique pathological changes and specific prone sites of nervous system (or muscle tissue). Therefore, when looking for the etiology of nervous system diseases, we must first find out the exact location of the lesions, and organically combine the localization and characterization of the diseases to make a complete diagnosis. It should be noted that the dysfunction of the nervous system can lead to the dysfunction of other system organs, such as thalamic hemorrhage, which often causes digestive tract ulcers, and severe encephalopathy can lead to arrhythmia. Other systemic diseases can also lead to nervous system dysfunction, such as hypertension, diabetes and hyperlipidemia, which can promote the occurrence of cerebral infarction. Hyperthyroidism can lead to hypokalemic periodic paralysis, hepatic encephalopathy, hepatic myelopathy, diabetic peripheral neuropathy and paraneoplastic neurological syndrome. Diseases such as bones, joints, peripheral blood vessels and connective tissue can also cause motor and sensory disorders, similar to nerve injury. Lesions in the frontal lobe and temporal lobe of the brain, such as viral encephalitis, often have mental symptoms, and epilepsy can be manifested as psychomotor seizures, which is different from mental diseases mainly characterized by cognitive, emotional, will and behavior disorders. Therefore, in the diagnosis of nervous system diseases, we must have a holistic concept and not be biased by the nervous system itself.

Symptoms of nervous system diseases can be divided into four categories according to their pathogenesis: ① defect symptoms: refers to the weakening or loss of normal nerve function caused by nerve tissue injury, such as hemiplegia, hemiparalysis and aphasia caused by cerebral infarction in the main hemisphere; Facial neuritis causes ipsilateral muscle paralysis. ② Stimulus symptoms: refers to the excessive excitement of nervous structure after stimulation, such as partial motor seizures caused by irritating lesions in motor area of cerebral cortex; Lumbar disc herniation causes sciatica; ③ Release symptoms: refers to the injury of the central nervous system, which weakens the control function of the lower central nervous system and embodies the function of the lower central nervous system. The pyramidal tract sign caused by upper motor neuron injury is characterized by increased muscle tone, hyperreflexia of tendon and positive Babinsky sign. ④ Shock symptoms: refers to acute local severe lesions of the central nervous system, causing short-term loss of nerve function in distant parts related to its function. For example, in the acute stage of massive cerebral hemorrhage, hemiplegic limbs show decreased muscle tone, disappearance of tendon reflex and negative babinski sign, which is called concussion; When acute transverse lesions occur in the spinal cord, flaccid paralysis, the so-called spinal cord shock, also occurs below the damaged plane. After the shock stage, symptoms of nerve defect and release gradually appeared.

In recent years, due to the great progress of science and technology, many advanced examination instruments and special examination methods have appeared, which provide powerful means and great convenience for clinical diagnosis. These inspection techniques can pull out a long list, and many of them are non-invasive inspections. Such as computed tomography (cT), CT angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), digital subtraction angiography (DSA), vision, brain stem hearing, somatosensory evoked potentials (VEP, BAEP, somatosensory evoked potentials), event-related potentials (ERP) and nerves. Electromyography (EMG), transcranial Doppler (TCD), single photon emission computed tomography (SPECT), positron emission tomography (PET), regional cerebral blood flow measurement (rCBF), muscle and nerve biopsy, detection of cerebrospinal fluid oligoclonal band (OB), cerebrospinal fluid cytology, detection of specific antibodies and cytokines. In addition, there are gene diagnosis techniques, such as gene mutation detection and gene linkage analysis. However, all these advanced technologies cannot replace basic clinical methods. The basic idea of clinical diagnosis must start with a complete and detailed medical history and careful and accurate neurological examination. After careful consideration and reasonable analysis, we can draw a clinical conclusion. Auxiliary examination can only provide evidence or corroboration for clinical diagnosis. In fact, the diagnosis of many neurological diseases in L clinic mainly depends on the medical history and its manifestations, such as trigeminal neuralgia, epilepsy, vascular headache, transient ischemic attack, syncope, neurogenic orthostatic hypotension, periodic paralysis and so on. The diagnosis of some diseases mainly depends on the signs of patients, such as Parkinson's disease, dystonia, chorea, cerebellar ataxia, cutaneous nerve syndrome, Raynaud's disease, erythema, progressive muscular dystrophy and so on. Cerebrospinal fluid examination, including routine examination, biochemistry, cytology, IgG index and oligoclonal bands, is still a routine examination of nervous system diseases, which plays an irreplaceable and sometimes decisive role in the diagnosis of many nervous system diseases.

In terms of treatment, nervous system diseases can be roughly divided into three categories: ① There are many common diseases that can be completely or basically cured, for example, most meningitis, encephalitis, nutritional deficiency diseases, benign tumors, idiopathic facial paralysis, Guillain-Barre syndrome, cerebral hemorrhage and cerebral infarction (mild cases), cerebral cysticercosis (mild cases), subacute combined degeneration of spinal cord (early cases) and so on. ② There are many common diseases that can't be cured, but the symptoms or conditions of patients can be completely controlled or alleviated by relieving therapy, such as various types of epilepsy, Parkinson's disease, Parkinson's syndrome, trigeminal neuralgia, multiple sclerosis, myasthenia gravis, migraine and periodic paralysis. Effective drugs and other measures should be taken to treat these diseases, control the progress of the disease as much as possible, and reduce the degree of disability of patients; Another disease. At present, there is no effective treatment, including malignant tumor, neurodegenerative diseases (such as Aker Harmo's disease, motor neuron disease, syringomyelia, etc.). ), hereditary diseases of nervous system (Friedreieh*** ataxia, spinocerebellar ataxia, peroneal muscular atrophy), prion diseases, nervous system damage caused by AIDS/EIIV, etc. Appropriate symptomatic and supportive treatment should be given to these diseases.

disturbance of consciousness

In medicine, consciousness refers to the degree of awakening of the brain, which is the function of the body's perception and understanding of itself and its surrounding environment, and is manifested through human language, body movements and behaviors. Or that it is the ability of the central nervous system (cNS) to respond to internal and external environmental stimuli. The decline or disappearance of this ability means different degrees of consciousness disorder (f∞nscloness).

The content of consciousness is higher nervous activity, including orientation, perception, attention, memory, thinking, emotion and behavior. The most important structure that affects consciousness is the ascending repetitive activation system of the brain. The excitement from the ascending repetitive activation system is transmitted to the non-specific nucleus of thalamus and then spread to the whole cerebral cortex, which is beneficial to the evoked potential of the cortex and keeps it awake, and the destruction of this structure will inevitably lead to consciousness disorder. Secondly, the central integration mechanism, diffuse cerebral cortex injury will cause the level of consciousness to decline.

It is a medical department specializing in dealing with nervous system and neurological disorders. An expert who specializes in neurology is called a neurologist. Neurosurgery is performed by doctors or even neuroradiologists trained in neurosurgery.

Neuropathy is a disease that affects the central nervous system, peripheral nervous system or autonomic nervous system located in the central and peripheral nervous systems. Common situations include:

1. Headache diseases, such as migraine and tension headache (group headache)

2. Diseases caused by epilepsy.

3. Neurodegenerative diseases, such as Alzheimer's disease, including Alzheimer's disease.

4. Cerebrovascular diseases, such as transient ischemic attack and stroke.

5. insomnia

6. Cerebral palsy

7. Central nervous system (encephalitis) bacterial, fungal, viral and parasitic infections, meningitis and peripheral nerves (neuritis)

8. Tumors-brain tumors, spinal cord tumor's and peripheral nerve tumors.

9. Dyskinesia, such as Parkinson's disease, chorea and hemimorphism.

10. necrotizing diseases of central nervous system, such as multiple sclerosis and peripheral nervous system.

1 1. Spinal nerve diseases-tumor, infection, trauma, deformity (i.e. spinal cord cells, meningeal spinal cord cells)

12. Peripheral nerve disorder, nerve disorder of muscle and nerve connection point

13. Brain injury, spinal cord and peripheral nerve injury

14. Coma and coma caused by various reasons

Neurologists are responsible for the diagnosis and treatment of all the above conditions. Apart from surgical intervention, it becomes the responsibility of neurosurgeons, and in some cases, it involves neuroradiologists. In some countries, other legal responsibilities of neuroscientists include finding evidence of brain stem death for suspected deceased patients and issuing death certificates.

Overlap with psychiatry

Although many mental diseases are considered as neurological disorders affecting the central nervous system, they have traditionally been classified separately and dealt with by psychiatrists, clinical psychologists and psychotherapists.

However, there are strong indications that neurochemical mechanisms play an important role in the development of bipolar disorder and schizophrenia (for example). Similarly, neurological diseases often have psychiatric manifestations (behavioral neurology and neuropsychiatry).

Clinical types and manifestations

1. Visual agnosia refers to the inability of patients to correctly identify, describe and name what they see and are familiar with. The patient's primary vision has not been lost, but he can see but doesn't know the meaning of the visual object. It is generally considered that the connection between the visual object itself and its concept is interrupted, including object agnosia, color agnosia, face blindness's disease, simple agnosia and simultaneous agnosia. It is more common in posterior occipital lobe, striatum and angular gyrus lesions.

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2. Hearing agnosia refers to the patient's normal hearing, but he can't distinguish another familiar voice. The lesions are mostly located in bilateral auditory contact cortex (such as mental deafness), bilateral superior temporal gyrus middle cortex and left temporal lobe subcortical white matter (such as pure word deafness).

3. Tactile agnosia refers to the fact that patients can't recognize familiar objects simply by touching them with their hands when their sense of touch, proprioception and temperature are normal. The lesions were mostly located in bilateral parietal angular gyrus and superior marginal gyrus.

Body image disorder means that patients have complete vision, pain, temperature and proprioception, but their understanding of the existence, spatial position and relationship of various parts of the body is impaired, which is more common in parietal lobe lesions in the non-dominant hemisphere (right side). It is characterized by agnosia, unilateral limb neglect, anomie, phantom limb disease and hemiamnesia.

5.Gerstmanri syndrome is characterized by bilateral finger agnosia, limb disorientation, agraphia and miscalculation. It is more common in angular gyrus lesions of parietal lobe in dominant hemisphere.

Visual impairment and eye movement disorder

The formation of clear vision requires the adjustment of pupil and lens, and the coordinated movement of eyeball due to different light and object distance, all of which require the participation of oculomotor nerves, so this section describes vision and eye movement disorders together. First, visual impairment.

Any damage in the transmission path from visual receptors (retinal cones, columnar cells) to occipital visual centers (cuneiform gyrus and lingual gyrus in striated areas) will lead to visual impairment or visual field defect. In this path, the optic nerve, optic bundle and optic radiation fibers originating from the lateral geniculate body neurons correspond to each point of the retina in strict order. The recombination of optic nerve fibers at optic chiasma becomes the basis of hemianopia or quadrant blindness.

Modern neurosurgery

The Open Journal of Modern Neurosurgery (OJMN) is an international open journal dedicated to publishing original articles related to the prevention, diagnosis, treatment and rehabilitation of diseases affecting any part of the nervous system, including the brain, spinal cord, peripheral nerves and extracranial cerebrovascular system. The goal of this journal is to provide a platform for scientists and scholars all over the world to promote, share and discuss the progress in neurosurgery. All manuscripts must be written in English and undergo strict and fair peer review. Accepted papers will appear on the Internet immediately, followed by printed hard copies. The magazine publishes original papers, including but not limited to the following fields:

Modern Open Source Journal of Neurosurgery is an original international open journal published by American Scientific Research Press. The parts that affect the nervous system include the prevention, diagnosis, treatment and rehabilitation of brain and spinal cord diseases, peripheral nerves and extracranial and cerebrovascular systems. The purpose of this magazine is to provide a platform for scientists and scholars from all over the world to share and discuss various advances in neurosurgery. The magazine publishes original papers, including the following fields:

Cerebrovascular surgery

Cervical and lumbar spinal stenosis

functional neurosurgery

Craniocerebral trauma

hydrocephalus

intracranial hemorrhage

minimally invasive surgery

dyskinesia

Moyamoya disease

Nerve trauma

Pediatric neurosurgery

Peripheral neuropathy