Neurology

The goal for the neurology rotation is to learn a good neuro exam. All of neurology involves "localizing the lesion" and apart from expensive imaging studies, the exam is the best way to solve these puzzles. Is the weakness peripheral in a proximal distribution (myopathy) or central in a pyramidal distribution (stroke)? Where would a stroke have to be to mimic this set of symptoms? Neurology is highly intellectual and requires a lot of critical reasoning. Over the past week, I've become better at remembering, performing, and reporting the clinical exam but it's still very difficult to figure out how the findings fit together.

Our inpatient service is busy and involves a number of strokes as well as a few "zebras" such as neurosyphilis and primary CNS lymphoma. It's a little disappointing and depressing that recovery is unlikely for many of our patients. One is nearly locked in and can only move his eyes; a few may be good rehab candidates. Neurology is a field in which the therapeutics are limited.

Clinic occurs twice a week and I really enjoy it. Students see only one patient but we do a pretty thorough history and physical. The complaints are outpatient based such as vertigo, headache, medication management, seizure, and movement disorders. It reminds me of family medicine. On the last clinic, I saw my first inmate patient, complete with handcuffs and shackles in an orange jumpsuit followed by an officer. He was complaining of amaurosis fugax, an eye finding in possible stroke. Surprisingly, it was a very normal interaction and I felt no conscious difference between seeing him and any other patient.