What does a neurological examination include?

Neurological symptoms are not always specific and often occur in other diseases. History and neurologic examination findings usually identify disorders that require urgent intervention. At the same time, the bet on the results , and laboratory research instead of a thorough objective examination is fraught with errors and unreasonable costs. The main tasks of the neurological examination are to determine the level of the lesion and its pathophysiological nature.

Diagnosis of a neurological patient

Some neurological symptoms are functional or hysterical and are associated with mental disorders patient. Complaints presented by an overly depressed or frightened patient, as well as symptoms, are variable and subjective and often do not fit into the anatomical and physiological framework. At the same time, one should remember about the possibility of the coexistence of "psychogenic", i.e. functional, disorders with organic changes, and their differentiation will always be a difficult task for the doctor.

Neurological examination

A neurological examination begins with a careful observation of the patient: when the patient enters the office and sits on a chair, the doctor already evaluates the speed, symmetry and coordination of movements, the patient's posture and gait. The manner of behavior, appearance and answers to questions allow us to judge the mental state and social adaptation of the patient. Disturbances in speech or praxis, spatial orientation or posture, or other movement disorders may appear at any time during the examination. Information obtained before the objective examination, together with knowledge topographic anatomy and pathophysiology allows experienced doctor to somewhat reduce the program of further examination already at this stage. It is useful for a novice doctor to conduct a complete examination in order not to miss any violation.

mental status. First, the level of attention of the patient is assessed: an inattentive patient cannot adequately interact with the doctor and interferes with the examination. Any signs of cognitive dysfunction require assessment of intellectual functions, including orientation to person, time and place, assessment of memory, speech and ability to calculate, the ability to adequately assess the situation and abstract thinking. Loss of orientation in personality occurs only in a state of stun, with severe delirium or, but how isolated symptom indicates, most likely, a simulation. They analyze the patient's assessment of his condition and the total amount of knowledge based on the level of his education, evaluate the emotional status and mood.

The patient is asked to perform complex commands, involving three parts of the body and requiring the correct distinction between right and left. The patient is asked to name simple objects and body parts, read, write and repeat simple phrases, and in case of errors, additional tests for aphasia are performed. Spatial perception can be tested by asking the patient to fold their fingers into complex shapes, draw a clock, a cube, a house, or connected pentagons. The effort with which a patient performs a task is often more informative than the end result. At this stage of the examination, attention disorders, perseveration, micrography and spatial orientation disorders can be detected. To test for praxis, the patient can be asked to show how to brush their teeth, comb their hair, or snap their fingers.

cranial nerves. The sense of smell, a function of a pair of cranial nerves, is usually assessed either only after traumatic brain injury or when there is suspicion of involvement of the anterior cranial fossa, or when the patient reports a disturbance in smell or taste. The patient is asked to identify the smells brought to each nostril in turn. Alcohol, ammonia and other stimuli acting on the nociceptive receptors of the fifth pair of cranial nerves are used only when there is a suspicion of simulation.

For evaluation, the 4th and 5th pairs of cranial nerves examine visual function and eyeball range of motion. To examine a pair of cranial nerves, visual acuity is determined using a Snellen table for assessing distance vision and a portable table for assessing near vision, for each eye separately, covering the second. Color perception evaluated by pseudo-isochromatic Ishihara or Hardy-Rand-Ritter maps, where numbers and images are embedded in a field with numerous specifically colored dots. The boundaries of the visual fields are determined by four visual quadrants. Determine direct and friendly response

Mental status assessment

Estimate mental status start with an assessment appearance the patient, his behavior, mood, disturbances of perception and evaluation of cognitive functions.

Mental status assessment is mandatory in the elderly and in patients with traumatic brain injury or episodes of impaired consciousness in history. Standardized screening methods are used, more often the Folstein test. Initial data are recorded, repeated studies are carried out at a frequency of once a year or more often with the progression of the disease. The patient should be explained that mental status assessment is a routine procedure.

The study is carried out in a calm environment, the doctor must make sure that the patient hears well and understands his questions.

Mental status assessment includes assessment of a number of cognitive parameters. To do this, the doctor must make sure that the patient is attentive by asking him, for example, to quickly repeat three words. Otherwise testing is pointless.

Cognitive function parameters to be tested include the following. pupils. The condition, V and V pairs of cranial nerves are judged by the symmetry of eye movements, the position of the eyeballs, asymmetry or omission upper eyelids, as well as twitching of the eyeballs or eyelids. To determine the range of motion of the eyeballs, the patient is asked to follow a moving object in all four quadrants, which reveals nystagmus and paralysis. eye muscles. Then assess the synchronism and vivacity of the reaction of the pupils to light and examine the fundus.

To study the three sensory branches of the V pair of cranial nerves, the sensitivity of the skin of the face is determined using a needle or brush; the corneal reflex is checked by touching a piece of cotton wool on the border of the cornea and conjunctiva. If there is a violation of the sensitivity on the face, you should check the sensitivity in the corner mandible; its preservation confirms the defeat trigeminal nerve. Decrease or absence of the corneal reflex should be differentiated from weakened blinking due to paresis of the facial muscles. With damage to the muscles of the face, sensitivity to the touch of a piece of cotton on both sides remains. To assess the motor function of the trigeminal nerve, palpate chewing muscles with tightly clenched jaws, and also ask the patient to open his mouth, overcoming external resistance. With weakness of the pterygoid muscle, the jaw deviates towards the lesion.

When checking the V pair of cranial nerves, first of all, facial hemiparesis should be excluded. Facial asymmetry is usually noticeable during conversation, especially when the patient smiles or grimace in response to painful stimuli in the stunned state. On the affected side, there is a smoothing of the nasolabial fold and expansion palpebral fissure. If the patient has weakness only lower section facial muscles and he can wrinkle his forehead and close his eyes, then paresis of facial muscles is more likely central origin than peripheral. Taste sensitivity in the anterior two-thirds of the tongue is determined by applying a sweet, sour, salty, and bitter solution on both sides of the tongue. Hyperacusia is detected by bringing a sounding tuning fork to the ear.

Since the 5th cranial nerve carries signals from the organ of hearing and balance, their assessment includes an examination of hearing and balance.

The 9th and 10th pairs of cranial nerves are usually examined together. During phonation, the movements of the soft palate should be symmetrical, touching each side of the posterior pharyngeal wall with a spatula causes a gag reflex. Bilateral absence of the gag reflex occurs in healthy people and has no diagnostic value. In a patient in a coma, when mucus is sucked through the endotracheal tube, it should normally occur. If dysphonia is present, examine vocal cords. Isolated dysphonia may indicate the presence of formations that compress the recurrent laryngeal nerves.

The X pair of cranial nerves is evaluated by examining the muscles they innervate. The function of the sternocleidomastoid muscle is examined by turning the head against the resistance provided by the doctor's hand; With his free hand, the doctor palpates the active muscle. To evaluate the upper trapezius muscle, the patient is asked to raise their shoulders against resistance provided by the physician.

The X pair of cranial nerves innervates the musculature of the tongue, the examination of which can reveal atrophy, fasciculations and weakness; when the nerve is damaged, the tongue deviates towards the lesion.

Study of motor function. The limbs and shoulder girdle should be fully exposed, examined, and palpated for atrophy, hypertrophy, asymmetric development, fasciculations, myotonia, tremor, and other involuntary movements, including chorea, athetosis, and myoclonus. Muscle tone examined by passive flexion and extension of the limbs in a completely relaxed patient. decline muscle mass indicates atrophy, but bilateral atrophy or atrophy of large or deeply located muscles may not be noticeable. In the elderly, some loss of muscle mass - common occurrence. Hypertrophy occurs when one of the muscles has to perform the function of the affected, and pseudohypertrophy - when muscle replaced by growing fibrous or adipose tissue.

Fasciculations are relatively common. Fasciculations are sometimes observed in the norm, in particular, in calf muscles in the elderly, but usually indicate peripheral motor neuron involvement, degeneration or injury, and nerve regeneration. Myotonia indicates myotonic dystrophy, myotonia can also be identified by the inability to quickly unclench a clenched fist. Increased resistance to passive movements, followed by rapid relaxation, and spasticity indicate damage to the central motor neuron. Rigidity with a cogwheel phenomenon indicates damage to the basal ganglia.

Muscle strength study

A patient's complaint of muscle weakness may include fatigue, awkwardness in movement, or muscle weakness itself. Thus, the clinician must determine the nature of the symptoms, including the exact location, time of onset, aggravating and attenuating factors, and associated symptoms. Examine the limbs to determine muscle strength, identify tremors and other hyperkinesias. Strength different groups muscles are determined by their ability to overcome the additional resistance provided by the doctor; the strength of the right and left limbs is examined symmetrically in comparison. Pain in the muscles or joints can limit the force of muscle contraction, which affects the correct assessment. In hysterical paralysis, at the beginning of the study, the doctor feels normal resistance, then it suddenly disappears.

Mild paresis may be manifested by decreased arm sway when walking, a tendency to pronate the outstretched arm, sparing of the affected limb, external rotation of the foot, slowness in rapid exercise, or loss of dexterity.

Various scales are used to quantify paresis. In the most common 0 points means complete absence movements, 1 - very slight movements, 2 - movements outside the action of gravity, 3 - movements that can overcome gravity, but not the resistance of the doctor, 4 - movements that overcome the resistance of the doctor and 5 - normal muscle strength. Difficulties in using this and similar scales are due to a significant range of values muscle strength between scores of 4 and 5. The strength of the hands can be semiquantitatively determined with a hand dynamometer or by the degree of compression by the patient of the inflated cuff of the tonometer.

A clearer idea of the severity of movement disorders is given by functional tests. The patient is asked to perform one or another movement that reveals a specific motor defect, which in some cases can also be quantified. Getting up from a squat and sitting on a chair determines the strength of the thigh muscles; walking on heels and toes determines the strength of the muscles of the lower leg and foot. Pushing with your hands when getting up from a chair indicates weakness of the quadriceps femoris. Swinging movements of the body to move the arms to another position indicate paresis of the muscles of the shoulder girdle. Patients with weakness of the muscles of the pelvic girdle are forced to get up from a prone position in a certain sequence: first they turn over from their back to their stomach, then they kneel, straighten their legs with separate pushes and gradually straighten up from an anterior tilt position, climbing their hips with their hands.

Study of gait, statics and coordination of movements. Confident gait, static balance and good coordination of movements require coherence in the work of motor, vestibular and proprioceptive pathways. Damage to any of the pathways causes characteristic syndromes: at cerebellar ataxia the patient needs to spread his legs wide for stability when walking; with paresis of the extensor of the foot, the patient is forced to raise the leg higher so as not to cling to the surface with the hanging foot; with paresis of the muscles of the pelvic girdle, a waddling gait may appear; with spastic paresis, the leg describes a semicircle on the side of the lesion. If proprioception is impaired, the patient is doomed to constant visual control of his legs so as not to stumble or fall. Coordination is tested with finger-to-nose or genu-calcaneal tests, which help to identify atactic syndrome.

Sensitivity study. Violation pain sensitivity are detected by examining symmetrical areas of the face, torso and limbs with a safety pin, asking the patient whether he feels the same injections on both sides, blunt injections or sharp ones. The pin is thrown away after the study to avoid transmission and. To check the preservation of the somatosensory functions of the cerebral cortex, it is necessary to ask the patient to find out with eyes closed a familiar object placed in the hand, or a number drawn on the palm, as well as to determine the ability to separately perceive the simultaneous irritation of two close points on the finger or palm. temperature sensitivity checked with a cold tuning fork, one leg of which is warmed by the palm of your hand, or test tubes containing warm and cold water. Joint-muscular feeling is assessed using passive movements of the terminal phalanges of the fingers and toes up and down. If the patient does not perceive these movements with closed eyes, examine the more proximal joints. With gross disorders of the joint-muscular feeling, pseudo-athetoid movements are often noted, with intact motor pathways and basal ganglia. The patient is not able to determine the position of his limbs in space without the help of vision and makes all movements under visual control. With a violation of proprioception, the patient is not able to maintain balance in the Romberg position - with feet brought together and eyes closed. To check vibration sensitivity, the doctor puts his finger under the patient's distal interphalangeal joint and touches the back surface of the patient's finger with a tuning fork at 128 Hz, vibrating after a slight click. Normally, the patient and the doctor mark the end of the vibration at about the same time. A piece of cotton wool is used to evaluate the tactile sensation.

If sensitivity disorders are detected, it is necessary to establish anatomical localization defeat, i.e. make a topical diagnosis and find out if we are talking about damage to several nerves - polyneuropathy; or about the defeat of individual nerves or nerve roots in case of violation of the sensitivity of the podudermatome; or the spinal cord with a decrease in sensitivity below a certain level; or the trunk - with a cross decrease in sensitivity on the face and body; or large hemispheres with hemihypesthesia. To confirm the topical diagnosis, it is determined whether movement disorders and changes in reflexes are consistent with it. Spotted sensory, motor, and reflex changes in the limb suggest involvement of the brachial or pelvic plexus.

Study of reflexes. By checking deep tendon reflexes, you can get information about the state of the afferent nerve, synaptic connections in spinal cord, motor nerves and descending motor conductors. The defeat of the peripheral motor neuron causes a decrease in reflexes; damage to the central motor neuron causes an increase in reflexes.

Neurological diseases

Symmetry and strengthening/weakening of reflexes from the biceps muscle, brachioradialis, triceps, quadriceps femoris and Achilles reflex are assessed. Any asymmetric increase or decrease in reflexes is noted. In the absence of a reflex, the Jendrassik technique is used: to obtain a knee reflex, the patient grabs his hands in the lock and vigorously pulls them to opposite sides during the reflex test.

Slight streak irritation of any of the 4 quadrants of the anterior abdominal wall causes superficial abdominal reflexes. The extinction of the reflex is observed with most lesions of the central nervous system, obesity or flabbiness of the muscles of the abdominal wall; its absence may indicate a lesion at the level of the spinal cord.

Pathological reflexes- this is a return to more primitive reactions due to the loss of cortical inhibition. Reflexes Babinski, Chaddock and Oppenheim - plantar. At healthy person in response to the applied irritation, flexion is observed thumb legs, and in the case of pathology - slow extension with a fan-shaped dilution of the remaining toes, often accompanied by flexion in the hip and knee joints. Such a reaction indicates a loss of control on the part of the central motor neuron and a transition to the level of spinal reflexes. To induce the Babinski reflex, irritation is applied along the outer edge of the foot; displacement in the medial direction can cause a simple protective reflex. In patients with hypersensitivity a quick voluntary withdrawal of the leg is possible, which does not interfere with the assessment of the Chaddock or Oppenheim reflexes. The Chaddock reflex is the extension of the big toe in response to irritation of the skin below the outer ankle. Oppenheim reflex - extension of the big toe with a fan-shaped divergence of the remaining fingers in response to holding the knuckles of the hand along the ridge tibia top down.

proboscis reflex considered positive when fast easy a blow with a spatula on the lips causes a contraction of the circular muscle of the mouth and the extension of the lips with the proboscis. The sucking reflex is considered positive when, in response to a dashed irritation of the mucous membrane of the lips, sucking movements occur. The palmo-chin reflex is an involuntary contraction of the muscles of the chin in response to dashed skin irritation on the same side of the body. Hoffman's sign is considered positive when tapping on nail phalanges or V fingers causes involuntary flexion of the distal phalanx of the thumb and forefinger.

The glabellar reflex is considered positive when percussion of the forehead causes blinking. Typically, a blink accompanies approximately each of the first 5 taps, after which the reflex is exhausted. Its persistence is characteristic of diffuse brain damage.

Clonus is a rhythmic, rapidly alternating contraction and relaxation of a muscle caused by a sudden passive stretch of a tendon. Prolonged clonus indicates damage to the central motor neuron.

Sphincter reflexes are examined in the process rectal examination. Slight irritation of the perianal region normally causes contraction of the external sphincter, the absence of a reflex does not always indicate pathology. The bulbospongiosus reflex normally consists of contraction of the bulbospongiosus muscle in response to stimulation of the dorsal surface of the penis. The cremaster reflex is a contraction of the muscle that lifts the testis on the side of irritation in response to trichia irritation of the skin of the inner surface of the thigh.

Study of the autonomic nervous system. The study is aimed at identifying orthostatic hypotension, changes in heart rate in response to the Valsalva test, decreased or absent sweating, and Horner's syndrome. It is necessary to find out if there are disorders of the function of the intestines, bladder, genital area, as well as hypothalamic disorders.

Study of cerebral vessels. The risk is increased in elderly patients against the background of arterial hypertension, hypercholesterolemia, coronary and peripheral vessels. To exclude aortic dissection, which can cause impaired blood flow through the carotid artery, which is fraught, compare the pulse and arterial on both hands. Carefully examine the skin, sclera, fundus, oral mucosa and nail beds for hemorrhage and signs of cholesterol or septic embolism. Auscultation of the heart is performed to detect murmurs and arrhythmias.

Noises from vessels in the head area may indicate an arteriovenous malformation, a fistula, and sometimes retrograde blood flow along the circle of Willis due to occlusion of the carotid artery. Carotid auscultation may reveal bifurcation murmurs; rough palpation of this area should be avoided. By moving the head of the stethoscope down along the neck towards the heart, it is possible to differentiate intermittent vascular murmurs from cardiac systolic murmurs. Decrease in strength pulse wave above carotid artery indicates a stenosing lesion. To identify the pathology of peripheral vessels, the peripheral pulse is examined. Thickening or tenderness of the temporal arteries on palpation is indicative of temporal arteritis.

Even in children of the first year of life, a pathology of the nervous system can be detected, the causes of which are disturbances in the period of intrauterine development of the fetus (infections, fetal hypoxia) or a difficult course of childbirth. The consequences of damage to the nervous system can be a delay in mental and physical development child, speech impairment, etc. Observation of a neurologist, thus, is shown to each child with a certain frequency. In this article, we will answer possible questions from parents and eliminate their concerns about what a neurologist looks at in children.

Damage to the nervous system in infants is quite common. But these diseases can have a latent form, so in the first year of life, babies are repeatedly examined by a neurologist: at birth, at 1 month, at 3, 6, 9 months. and upon reaching the year. Sometimes doctors prescribe more frequent monitoring of the baby according to an individual schedule. Special attention given to premature babies.

Neurologist's examination...

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An examination by a pediatric neurologist is very important for babies. Most parents of infants are waiting for the diagnosis of this doctor with bated breath. This specialist is visited by children at the age of 1, 3, 6, 9 and 12 months.

Don't skip inspections! This will avoid many problems.

Pediatric neurologist appointment.

the main task neurologists - to diagnose and treat diseases of the nervous system in your baby. And also evaluate functional states, which may appear in the first months of the baby and require correction. Diseases of the nervous system, unfortunately, today are quite common in babies. They may be associated with severe course pregnancy, intrauterine infectious diseases, complicated childbirth, trauma at birth. Special control over the neurological status is required by those babies who were born prematurely.

Primary examination by a pediatric neurologist of newborns.

The first examination of a newborn by a neurologist takes place in the maternity hospital, in the same place ...

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An examination by a neurologist for infants is mandatory at 1, 3, 6, 9, and 12 months of life. What a pediatric neurologist looks at at an appointment is a question that interests every mother. Neurologist examinations for infants are required even if they are absolutely healthy. Such frequent monitoring is not at all unreasonable, the neurological status of the baby changes every three months. It is during these periods that the intensive growth of the baby takes place and the formation of certain skills in him, so any deviations will be visible.

Before discharge from maternity hospital babies undergo neurosonography (or ultrasound of the brain). Sometimes when this survey babies have brain cysts. The causes of cysts in babies are still not well understood. Presumably they appear due to hypoxia ( oxygen starvation). If the size of the cyst is not more than 3-4 mm, then by 3 months they resolve without a trace. If a brain cyst is found in an infant, neurosonography is shown in dynamics.

Diseases of the nervous...

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A neurologist is a doctor who must monitor the health of your child at every stage of development, give advice on how to properly care for the baby, treat if the child is sick. A visit to the doctor is necessary almost every month.

An examination is mandatory even if the baby is absolutely healthy, especially since this may not be the case. Only a specialist can identify deviations from the norm. An examination is carried out once a quarter, since the status of a newborn changes almost every month. Each segment is marked by the formation of any skills, this happens due to the continuous growth and development of the body.

in the maternity hospital

When the mother and baby are discharged from the hospital, the baby is given an ultrasonography of the brain. A brain cyst is a common diagnosis in newborns. Why does this pathology medicine is not completely known. If the tumor size is not more than 5 mm, then there is no cause for concern, and the tumor will resolve by three months. If a...

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Neurology is that branch of medicine, the main principles of which are focused on the study of the causes and mechanisms that contribute to the development of diseases of the central nervous system and the peripheral nervous system. Naturally, this also includes the development of appropriate methods for the treatment of this type of disease. As for the doctor who treats diseases of this group, then, you guessed it, he is a neuropathologist (or neurologist). It should be noted that this discipline is in close connection with neurosurgery, psychiatry and pediatrics.

What does a neurologist treat?

A neurologist (aka neuropathologist) is a doctor who has received a higher medical education, as well as trained in the relevant specialization in this area (that is, in neurology). Delving deeper into the specialization in question, or rather, into the possibility of realizing oneself as a specialist...

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A neurologist is engaged in determining the signs of diseases of the nervous system (peripheral and central), their treatment, prevention. What diseases does a neurologist treat? Strokes (cerebral hemorrhage, cerebral infarction), transient cerebral ischemia, organic lesions brain, dystrophic changes pathways of the brain, brain injury (treatment is carried out jointly with traumatologists), osteochondrosis and radicular syndromes, diseases peripheral nerves(damage, inflammatory changes) - the treatment and diagnosis of all these and many other conditions is within the competence of a neurologist.

Sometimes patients are interested in what is the difference between a neurologist and a neuropathologist? So, nothing. A neuropathologist (until 1980) was a doctor who had specialized in nervous diseases. Now there is no such specialty, there is only a “neurologist”. Although the first option is used in print and in colloquial speech, it is gradually falling out of use.

Find out which doctor to contact for a headache: how ...

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A qualified pediatric neurologist should not only know the functions and dynamics of the formation of the child's nervous system from birth, but also understand all related medical areas - mother's health during pregnancy, intrauterine development and the process of childbirth, genetic pathologies, endocrinology, orthopedics, infectious diseases, psychology, psychiatry, etc. When working with a child under one year old, a neurologist assesses the state of the central nervous system (central nervous system). How does it develop and how is it affected? adverse factors. Let's look at the main questions pediatric neurologist from the parents of the baby and what the doctor pays attention to when examining at each appointment.

Heredity, unfavorable course of pregnancy and childbirth can cause pathologies in the development of the fetus. Physician examinations reveal dangerous deviations in the work of the nervous system at the earliest possible time and to cure them in a timely manner before the onset irreversible consequences.

Why do you need a planned...

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Neurological examination of the patient - what and how does the neurologist check during the examination

Neurology is a branch of medicine that studies the human nervous system, its structure and functions in normal conditions and in the development of a neurological disease.

Neurology is divided into general and particular. The general division is based on the study of the functions and structure of the nervous system, as well as diagnostic methods. Private neurology deals with certain diseases nervous system.

The central system is represented by the spinal cord and brain. peripheral system includes all kinds of structures that connect the central nervous system and other organs and tissues of the human body.

The nervous system is responsible for normal functioning of the whole organism and the reaction to changes from the external and internal environment.

How is a diagnosis made?

A neurological examination for the purpose of making a diagnosis is based on three diagnostic ...

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In the first year of life, the child develops especially actively. Therefore, it is necessary constant control specialists. Problems identified early on big chance for a successful fix. 3 months - important age. At this time, doctors can draw the first conclusions about how the baby meets the standards, whether he has any hidden diseases.

Examination at the pediatrician

If the question arises of which specialists you need to go through, then the first thing you need to do is go to the pediatrician. It is he who will issue referrals for visiting other doctors and prescribe tests.

Visits to the pediatrician should be monthly until the child is one year old. After discharge from the maternity hospital, the doctor himself comes to the house, and starting from 1 month, you need to go to the clinic on your own. At each examination, the height of the baby, its weight and head circumference are necessarily measured. They do this in order to see the development of the baby in dynamics. Comparison with other children and norm tables is not very revealing. But...

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The first visit to a neurologist is always exciting for new parents and grandparents. Understanding this is quite simple - why would anyone meticulously study a child and question the health of the world's most beloved baby? And, nevertheless, this is really important - you have to gather your strength and entrust the little one to a neurologist. Qualified and timely medical examination often a guarantee good health your child.

How to prepare for the first visit to a neurologist?

If there is no urgent recommendation from a pediatrician, then the first visit to a neurologist usually occurs at the age of one month. Also at 1 month, the child should be examined by an orthopedic traumatologist and an ophthalmologist. It is advisable to prepare well for the visit in order to provide the specialist with as much information about the child as possible. Be prepared to talk about how the pregnancy proceeded and the birth itself, what grade the newborn received on the Apgar scale. Take with you outpatient card baby and everything he has...

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Very often, after birth or at http://crazymama.ru/razvitie.php, the baby is given a lot of incomprehensible and frightening neurological diagnoses. In addition, parents are scared dire consequences these diagnoses and write out a large number of rather serious drugs and various other methods of treatment, quite often not so cheap. Let's try to understand the mysterious abbreviations of diagnoses and clarify the situation a little in this material.

About diagnoses...

Pediatric neurology is one of the most complex branches of pediatrics - there is still a lot of overdiagnosis (many overdiagnosis) and unexplored processes. Research methods are constantly being improved, so every year there is a constant revision of approaches to the diagnosis of its treatment. Many diagnoses that were made 20 years ago are now not deviations or do not exist at all. These include the mysterious abbreviation PEP.

PEP or...

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Neurological examination

Neurological diseases are sometimes incredibly complex combinations of the action of various pathological factors, different levels of damage to the nervous system, violations of both organic and functional plans.

At the same time, at different pathology the patient's complaints will be similar. The most common are headaches, dizziness, weakness, back pain, sensory disturbances, memory loss, etc. Whereas the level of damage to the nervous system, as well as the leading pathological factor remains unknown.

What to do? Conduct expensive neuroimaging studies (MRI, MSCT)? Use other research methods? But in some diseases, no changes can be found, and the initial stages of the disease are sometimes difficult to detect.

That is why the beginning of the examination of a neurological patient always begins with the oldest and, perhaps, the most exact method research - neurological ...

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The very first acquaintance of a newborn with a doctor occurs immediately after birth, when examined by a neonatologist. Meetings with other specialists in white coats, in the absence of other indications, take place according to the inspection calendar. And one of the first in it is a neurologist (neuropathologist).

A pediatric neurologist (or neuropathologist) is a specialist who carefully monitors the development and maturation of the baby's nervous system. The state of the human nervous system is one of the main indicators of the state of the whole organism. And if with early age do not give to the nervous system and pathological manifestations on her part of due attention, this can lead to a delay in the psychomotor development of the baby, violations of his behavior and many other "diseases from the nerves."

Medical examination: when, why and why?

Every child, even an absolutely healthy one, should be observed by a neurologist. The doctor, together with the parents, will monitor the compliance of the psychomotor development of the baby ...

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Neurology deals with the treatment of diseases of the central and peripheral nervous system.

This branch of medicine is closely related to psychiatry, neurosurgery, and pediatrics. A neurologist treats diseases of this group.

Some patients think that this specialist treats psychiatric illnesses. But in fact, the activity of this doctor is in no way connected with helping patients with pathological changes psyche.

What diseases does a neurologist treat?

Neurological diseases are diverse, they occur when nerve cells and connections between them are disrupted, inflammation of a different nature in nerve fibers, spinal cord and brain.

A neurologist should be consulted for the following conditions:

Headache and facial pain (tics, tremors, Bell's palsy, migraines); Parkinson's disease; Alzheimer's disease; epileptic seizures and convulsions (loss and impairment of consciousness); consequences of a stroke; back pain (hernias,...

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Neurologist examination is the main stage in the examination of a patient with symptoms and complaints characteristic of diseases of the nervous system. An experienced, highly qualified neuropathologist, based on the information received during the examination, will develop a scheme for further examination: conducting TC, MRI, EEG, REG, and analyzes.

Due to the fact that the symptoms of internal diseases have a number of similar manifestations, the task of a neurologist is to identify the affected area of the central nervous system and determine the causes of the disease.

What is a neurological examination like?

AT paid multidisciplinary clinics Moscow consultation with a neurologist takes place in stages:

questioning and examination of the patient,
appointment of hardware and laboratory examinations
follow-up visit, at which an individual treatment regimen is prescribed

The neuropathologist, asking about what the patient complains about, when these symptoms appeared, what chronic diseases he suffers from, what infections he has suffered and injuries, conducts an examination. With a trained eye, the doctor evaluates the gait, the timbre of the voice, the intelligibility of words, facial expressions, involuntary movements, the severity of the nasolabial fold, the state of the muscles of the eyelids.

Starting the examination, the neuropathologist examines the function of the cranial nerves with the help of a needle and hammer. Evaluating the test with a hammer, when the patient follows the instrument with his eyes, the neuropathologist draws a conclusion about the quality of the functions. oculomotor nerves.

The doctor's suggestion to bare the teeth, show the tongue, wrinkle the forehead and nose, helps to identify pathologies facial nerve. When assessing pain sensitivity, a neuropathologist applies symmetrical injections with a needle at several points on the face, arms, legs, and body. At this point, the quality of the test depends on the patient's attentiveness, it is he who must assess the severity of pain. If necessary, apply tests for the severity of tactile sensitivity using cold or hot temperature object (tube).

The next stage of examination by a neurologist is an assessment motor ability. The doctor evaluates the strength, muscle tone, offering to shake hands. During the examination, the neuropathologist reveals physiological and pathological reflexes by tapping the tendons with a hammer.

Coordination of movements is assessed after the patient, having stood in the Romberg position for a couple of seconds, reaches out with his finger to his nose.

Examination by a neurologist spinal column allows you to characterize the tone and symmetry of the muscles, pain points.

The assessment of memory and intelligence is carried out during the entire period of communication between the doctor and the patient, goes unnoticed by the second.

Advantages of paid clinics

In many cases, neurological symptoms require prompt evaluation and treatment. Benefits of seeing a neurologist paid clinic undeniable:

admission is by appointment - there is no need to sit in line;
examination by a neurologist lasts as long as necessary, rush is excluded, the number of patients is calculated in advance;
the “call a doctor at home” service allows a neurologist to examine even those patients who cannot move independently. Examination by a neurologist at home is no different in quality medical care, there is a small surcharge in the price of the service;
the ability to choose the time and day of the consultation, the most convenient for the patient.

The Vash Doctor Help Desk website offers a wide range of private clinics Moscow, in which you can call a doctor at home or get checked neuropathologist for a fee, in short time.

Concluding the book, the authors hope that the information presented in it can serve as a basis for mastering the knowledge necessary for a neurologist. However, the book on general neurology brought to your attention should be considered only as an introduction to this discipline.

The nervous system ensures the integration of various organs and tissues into a single organism. Therefore, a neurologist requires broad erudition. It should be oriented to one degree or another in almost all areas. clinical medicine, since he often has to participate in the diagnosis of not only neurological diseases, but also in determining the essence pathological conditions which doctors of other specialties are recognized as beyond their competence. Neurologist

in everyday work, he must also show himself as a psychologist who is able to understand the personal characteristics of his patients, the nature of the exogenous influences affecting them. From a neurologist to a greater extent than from doctors of other specialties, it is expected to understand the mental state of patients, the characteristics of the social factors influencing them. The communication of the neurologist with the patient should, as far as possible, be combined with elements of psychotherapeutic influence.

The scope of interests of a qualified neurologist is very wide. It must be borne in mind that lesions of the nervous system are the cause of many pathological conditions, in particular, violations of the functions of internal organs. In the same time neurological disorders, manifested in a patient, are often a consequence, a complication of his somatic pathology, common infectious diseases, endogenous and exogenous intoxications, pathological effects on the body of physical factors, and many other reasons. Thus, acute disorders of cerebral circulation, in particular strokes, as a rule, are caused by a complication of diseases of the cardiovascular system, the treatment of which before the onset of neurological disorders was carried out by cardiologists or general practitioners; chronic renal failure is almost always accompanied by endogenous intoxication leading to the development of polyneuropathy and encephalopathy; many diseases of the peripheral nervous system are associated with orthopedic pathology, etc.

The boundaries of neurology as a clinical discipline are blurred. This circumstance requires a special breadth of knowledge from a neurologist. Over time, the desire to improve the diagnosis and treatment of neurological patients led to a narrow specialization of some neurologists (vascular neurology, neuroinfections, epileptology, parkinsonology, etc.), as well as to the emergence and development of specialties that occupy a border position between neurology and many other medical professions (somato-neurology). , neuroendocrinology, neurosurgery, neuroophthalmology, neurootiatry, neuroradiology, neuropsychology, etc.). This contributes to the development of theoretical and clinical neurology, expands the possibilities of providing the most qualified assistance to neurological patients. However, the narrowed profile of individual neurologists, and even more so the presence of specialists in disciplines related to neurology, is possible only in large clinical and research institutions. As practice shows, every qualified neurologist should have broad erudition, in particular, be oriented in the problems that are studied and developed in such institutions by specialists of a narrower profile.

Neurology is in a state of development, facilitated by advances in various areas science and technology, the improvement of the most complex modern technologies, as well as the success of specialists in many theoretical and clinical medical professions. All this requires from a neurologist continuous improvement level of knowledge, in-depth understanding of the morphological, biochemical, physiological, genetic aspects of the pathogenesis of various diseases of the nervous system, awareness of the achievements in related theoretical and clinical disciplines.

One of the ways to improve the qualifications of a doctor is periodic training in advanced courses, conducted on the basis of the relevant faculties of medical universities. However, the first

foamy meaning independent work with special literature, in which you can find answers to many questions that arise in practice.

To facilitate the selection of literature that may be useful to a novice neurologist, we have provided a list of some books published over the past decades in Russian. Since it is impossible to embrace the immensity, not all literary sources reflecting the problems that arise before a neurologist in practical work are included in it. This list should be recognized as conditional, indicative, and as necessary, it can and should be replenished. Particular attention is recommended to be paid to new domestic and foreign publications, while it is necessary to follow not only monographs that are published, but also journals that are relatively quickly brought to the attention of physicians. latest achievements in various fields of medicine.

We wish readers further success in mastering and improving knowledge that contributes to professional development, which will undoubtedly have a positive impact on the effectiveness of work aimed at improving the health of patients.

Konotopskaya Tatiana

20 reasons to visit a neurologist:

and 5 do it urgently

Peculiarities neurological examination.

An appointment with a neurologist, as in principle, and with a doctor of any other specialty, is divided into several stages. These include clarifying complaints, clarifying the history of the present disease, the characteristics of the patient's life, and, of course, conducting objective research. Since the last point is extremely specific in neurological practice, it should be considered in more detail.
As always, it all starts with an inspection. Right from the doorstep with a trained eye, the doctor will assess your gait and posture, changes that can indicate a lot. Then you will be closely examined for asymmetry of the face and body, the presence of atrophic or hypertrophic changes in the skin and muscles, hand tremors and other important symptoms. Next stage - research functions of cranial nerves (12 pairs). As the name implies, they exit the cranial cavity and provide innervation to the head. Thus, all sensitivity, as well as all motor functions(facial expressions and chewing) are carried out with their direct participation. During the examination, the neurologist uses special tools - a hammer and a needle. First you need to follow the hammer with your eyes, without turning your head - up, down, to the sides and to the tip of the nose. This is how the functions of the oculomotor nerves are studied. For some reason, this part of the program usually brings a smile to young patients. Then relax - the doctor will check the vivacity of normal reflexes on the face and make sure that there are no pathological ones. Now work hard again - you must follow commands like the following: "wrinkle your forehead, raise your eyebrows, wrinkle your nose, bare your teeth, show your tongue, say "A". These tasks serve mainly to establish the volume of functioning of the main motor nerve of this area - the facial one. To study pain sensitivity on the face, the neurologist will prick with a needle in symmetrical zones.At this time, you will focus on the sensations and will report whether you feel the same intensity of the injections.In some cases, the neurologist examines taste, smell, and also general views sensitivity on the face, which will be discussed below.

Further events - a revision of the motor sphere. Includes the study of muscle strength, tone and reflexes. To determine the strength, the doctor will ask you to perform some active action- such as shaking hands with him or resisting hip flexion. For these actions, you will receive a score from 1 to 5 points (the more, the better). Muscle tone is examined on completely relaxed limbs using passive movements. Also, the result is translated into numbers. Then the reflexes are evoked with the help of a hammer. Deep reflexes are checked from the arms and legs, including from the feet. To do this, the doctor strikes with a hammer on certain tendons. Induction of the knee jerk is the most well-known part of the neurological examination. Of the superficial reflexes, the neurologist is most often interested in the abdominal reflexes (a needle is applied with a dashed irritation on the skin of the abdomen). By the way, the anal and cremasteric (testicular) reflexes, which are not caused for obvious reasons, are superficial.

Sensitivity testing is now waiting for you. It is carried out in the same way as on the face: pain - with the help of a needle in symmetrical parts of the trunk and limbs. In some cases, they additionally study tactile sensitivity with the help of cotton wool, temperature - with test tubes different temperatures. All these are types of superficial sensitivity. The study of deep (muscular-articular, vibrational, as well as complex types) is carried out as follows. The doctor will offer to close your eyes and indicate in which direction he takes your finger. This is a test of musculo-articular feeling. Vibration sensitivity is examined with the help of tuning forks, but more often otolaryngologists do this.
The three-dimensional-spatial sense is studied as follows: a neurologist draws figures, numbers, etc. on your skin, and you tell what exactly with your eyes closed. If necessary, you will be checked for paravertebral (paravertebral) pain points and symptoms of root tension spinal nerves. For back pain, this is a must.
The next issue of the program is the study of coordination of movements. For a few seconds you will stand in the Romberg position - heels and toes together, hands forward, eyes closed. Ideally, you stand straight, without deviating or staggering. Then the doctor will ask you to put your index finger into the tip of the nose slowly (in turn with both hands) - the so-called finger-nose test. If meningitis is suspected, meningeal signs are checked. The final stage- search for violations of intelligence and memory (if there is a reason for such).
And finally, the doctor will make a preliminary diagnosis and prescribe examinations if necessary. If the diagnosis is clear, you will immediately receive recommendations for treatment. We wish you health!