Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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The workhorse of acute traumatic neurology is the Non-Contrast Head CT (NCCT). It is used to rapidly identify neurosurgical emergencies. Neurologists look for “midline shift” (the brain being pushed past the center line) and the effacement of the basal cisterns (crowding of the fluid spaces), which are signs of impending herniation.
Magnetic Resonance Imaging (MRI) is utilized once the patient is stable. Susceptibility Weighted Imaging (SWI) is a specific MRI sequence that is extremely sensitive to blood products. It is the gold standard for detecting Diffuse Axonal Injury, which appears as tiny black dots (microbleeds) scattered at the grey-white matter junction.
In comatose patients (GCS < 8), monitoring the pressure inside the skull is mandatory. An External Ventricular Drain (EVD) is a catheter inserted through the skull into the fluid-filled ventricles. It serves a dual purpose: it measures pressure (diagnosis) and allows drainage of CSF to lower pressure (treatment).
Alternatives include intraparenchymal fiber-optic bolts, which measure pressure inside the brain tissue but cannot drain fluid. The “waveform” of the ICP monitor provides neurological data; loss of distinct peaks in the waveform suggests the brain has lost its compliance (stiffness) and can no longer tolerate any volume increase.
Modern neurocritical care utilizes “multimodal monitoring.” Beyond just pressure, neurologists measure brain oxygen levels and metabolism. A probe measures brain tissue oxygen (PbtO2) to ensure the brain is not ischemic. Microdialysis catheters can sample the brain’s extracellular fluid to measure glucose, lactate, and pyruvate.
A high Lactate/Pyruvate ratio indicates “metabolic crisis”—the brain is starving even if blood flow looks normal. Continuous EEG (cEEG) is also standard to detect “subclinical seizures”—electrical seizures that happen without physical shaking, which occur in up to 20% of severe TBI patients.
The Glasgow Coma Scale remains the universal language for classifying severity. However, neurologists add specific assessments: the “pupillary reactivity” score and corneal reflexes. The presence of brainstem reflexes (doll’s eyes, gag, cough) helps localize the level of injury to the midbrain, pons, or medulla.
Serial examinations are crucial. A drop in GCS of 2 or more points is a sign of deterioration requiring immediate repeat imaging. Neurologists also look for the “focal motor exam”—testing for asymmetry in movement that points to a specific expanding lesion.
Diagnosis is moving towards blood-based biomarkers. Proteins like GFAP (Glial Fibrillary Acidic Protein) and UCH-L1 are released into the blood when brain cells die. These markers are FDA-cleared to help rule out the need for a CT scan in mild TBI. In severe TBI, markers like Neurofilament Light (NfL) correlate with the extent of axonal injury and long-term prognosis.
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An External Ventricular Drain (EVD) is a tube placed into the brain’s fluid cavities to measure pressure and drain fluid to relieve that pressure.
The blood oxygen from a finger probe tells us about the body, but the brain might be swelling and cutting off its own supply, so we measure directly inside the tissue.
These are “silent” seizures visible on EEG brain waves but showing no outward shaking; they damage the brain and require treatment just like convulsive seizures.
A drain (EVD) can remove fluid to lower pressure; a bolt is just a sensor that measures pressure but cannot remove fluid.
Yes, new tests measure specific proteins that leak out of broken brain cells into the bloodstream, helping doctors gauge the severity of the injury.
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