Hard At Work.And Normally, Hardly Noticeable.
Neurology Workshop with Dr. Robert Kriel, MD, Pediatric Neurologist
Your brain is always on, and in ways you most likely don’t think about. But as the command center for your central nervous system, the brain is key to your health. On March 1, Dr. Robert Kriel spoke about the key concepts, most common conditions, and the different treatments for neurological disorders. Dr. Kriel, a recognized expert in the field, is a graduate of John Hopkins University. He has been a professor in the Pediatrics and Neurology departments of the Medical School and the College of Pharmacy at the University of Minnesota since 1991 and his clinical experience includes having led Pediatric Neurology at St. Paul Ramsey and Gillette Children’s Hospitals, as well as Hennepin County Medical Center.
In a very real sense, the most important functions of the central nervous system are the ones we least associate with the brain. All of our autonomic functions--our beating heart, our breathing, even our ability to sweat--are under the brain’s control. Luckily, life- threatening autonomic nervous system disorders are extremely rare. Neurologists are much more likely to deal with headaches, paralysis, seizures, memory loss, or mental delays or outright deterioration than patients who need to think about taking a breath so their lungs can fill up with air. On the other hand, the more common neurological disorders are much more difficult to diagnose. As a matter of fact, patients rarely book appointments with neurologists without a referral from a primary care provider. Neurologists often serve as consultants who first diagnose the problem, then advise on treatment plans.
Since diagnosis is so difficult, it may come as a surprise that there is no standard neurological exam. A neurologist will cover several general tests, ranging from the patient’s motor skills, coordination, and balance to sensory perception and deep tendon reflexes. But the key to diagnosis is collecting the patients history. Every question the neurologist asks during the exam is based on the patient’s key complaint. The answer to “why are you here?” allows the neurologist to tailor follow-up questions, and there is a huge chasm between “I’m slurring my words” and “my doctor sent me.” It’s only when you consider that LEP patient interviews take longer to conduct but still have the same amount of time allotted to them as those of a native speaker and that many times LEP patients defer to their primary care providers without understanding why they are being referred to other providers that the magnitude of the challenges a neurologist faces working with our patient population becomes obvious. Once a neurologist has a potential diagnosis, there are many tests that can be used to confirm it. These range from CT scans and MRIs to ultrasounds, electroencephalograms, and electromyograms. But without a detailed, successful patient interview, any test performed amounts to nothing more than a wild goose chase. Tests and scans only serve to confirm or disprove the educated assumptions the neurologists makes.
When everything is working right, it’s easy to forget the central nervous system. Given all the autonomic functions it controls, that’s a definite plus. But if something isn't quite right, it becomes impossible to forget how important your brain -- and every single nerve in your body -- really is. And that is a rather sobering thought.
Alfredo Lorente, CMI-Spanish