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, lifethreatening 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