Neurology is a branch of medicine dealing with disorders of the nervous system. Physicians specializing in the field of neurology are called neurologists and are trained to diagnose, treat, and manage patients with neurological disorders. Most neurologists are trained to treat and diagnose adults. Pediatric neurologists, nearly always a subspecialty of pediatrics, treat neurological disease in children.

Field of work

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

Major conditions include:

• headache disorders such as migraine, cluster headache and tension headache
• epilepsy and seizure disorders
• neurodegenerative disorders, the most common class being dementias, including Alzheimer's disease
• cerebrovascular disease, such as transient ischemic attacks, and strokes (ischemic or hemorrhagic)
• sleep disorders
• cerebral palsy
• infections of the central nervous system (encephalitis), brain envelopes (meningitis) and peripheral nerves (neuritis), such as brain abscess, herpetic meningoencephalitis, aspergilloma, cerebral hydatic cyst
• some infections of the peripheral nervous system, such as tetanus and botulism
• neoplasms - tumors of the brain and its envelopes (brain tumors), spinal cord tumors, tumors of the peripheral nerves (neuroma)
• movement disorders such as Parkinson's disease, chorea, 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

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Archives of Neurology recent issues

Effects of Intensive Medical Therapy on Microemboli and Cardiovascular Risk in Asymptomatic Carotid Stenosis [Original Contribution]
Spence, J. D., Coates, V., Li, H., Tamayo, A., Munoz, C., Hackam, D. G., DiCicco, M., DesRoches, J., Bogiatzi, C., Klein, J., Madrenas, J., Hegele, R. A.Objective  To assess the effect of more intensive medical therapy on the rate of transcranial Doppler (TCD) microemboli and cardiovascular events in patients with asymptomatic carotid stenosis (ACS).Design  A prospective study.Setting  A teaching hospital.Patients  Four hundred sixty-eight patients with ACS greater than 60% by Doppler peak velocity.Main Outcome Measures  We compared (1) the proportion of ACS patients who had microemboli on TCD, (2) cardiovascular events, (3) rate of carotid plaque progression, and (4) baseline medical therapy, before and since 2003.Results  Among 468 ACS patients, 199 were enrolled between January 1, 2000, and December 31, 2002; and 269 were enrolled between January 1, 2003, and July 30, 2007. Microemboli were present in 12.6% before 2003 and 3.7% since 2003 (P < .001). The decline in microemboli coincided with better control of plasma lipids and slower progression of carotid total plaque area. Since 2003, there have been significantly fewer cardiovascular events among patients with ACS: 17.6% had stroke, death, myocardial infarction, or carotid endarterectomy for symptoms before 2003, vs 5.6% since 2003 (P < .001). The rate of carotid plaque progression in the first year of follow-up has declined from 69 mm2 (SD, 96 mm2) to 23 mm2 (SD, 86 mm2) (P < .001).Conclusions  Cardiovascular events and microemboli on TCD have markedly declined with more intensive medical therapy. Less than 5% of patients with ACS now stand to benefit from revascularization; patients with ACS should receive intensive medical therapy and should only be considered for revascularization if they have microemboli on TCD.Published online December 14, 2009 (doi:10.1001/archneurol.2009.289).
Infectious Burden and Risk of Stroke: The Northern Manhattan Study [Original Contribution]
Elkind, M. S. V., Ramakrishnan, P., Moon, Y. P., Boden-Albala, B., Liu, K. M., Spitalnik, S. L., Rundek, T., Sacco, R. L., Paik, M. C.Objective  To determine the association between a composite measure of serological test results for common infections (Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus 1 and 2) and stroke risk in a prospective cohort study.Design  Prospective cohort followed up longitudinally for median 8 years.Setting  Northern Manhattan Study.Patients  Randomly selected stroke-free participants from a multiethnic urban community.Main Outcome Measure  Incident stroke and other vascular events.Results  All 5 infectious serological results were available from baseline samples in 1625 participants (mean [SD] age, 68.4 [10.1] years; 64.9% women). Cox proportional hazards models were used to estimate associations of each positive serological test result with stroke. Individual parameter estimates were then combined into a weighted index of infectious burden and used to calculate hazard ratios and confidence intervals for association with risk of stroke and other outcomes, adjusted for risk factors. Each individual infection was positively, though not significantly, associated with stroke risk after adjusting for other risk factors. The infectious burden index was associated with an increased risk of all strokes (adjusted hazard ratio per standard deviation, 1.39; 95% confidence interval, 1.02-1.90) after adjusting for demographics and risk factors. Results were similar after excluding those with coronary disease (adjusted hazard ratio, 1.50; 95% confidence interval, 1.05-2.13) and adjusting for inflammatory biomarkers.Conclusions  A quantitative weighted index of infectious burden was associated with risk of first stroke in this cohort. Future studies are needed to confirm these findings and to further define optimal measures of infectious burden as a stroke risk factor.Published online November 9, 2009 (doi:10.1001/archneurol.2009.271).
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