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How to decipher neurology: 5 easy steps
Learning neurology is challenging. Yet, it is a necessary hurdle for medical students, post-grad medical exams and some sub-specialties (e.g. psychiatry, ICU, general practice). Let's look at some...
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Keep calm and carry on: neurology
During our lifetime, data suggests that 1 in 3 of us will experience an anxiety disorder. This certainly matches day-to-day clinical practice. Our patients are often in the midst of an anxiety disorder...
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Parkinson's Law: does it apply to neurology?
In November 1955, The Economist published a fascinating article by Prof Cyril Northcote Parkinson. A naval historian, Dr Parkinson served as a professor of history in Singapore. The success of this...
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Erythema nodosum and neurology
A skin exam is often worthwhile in neurology. Many younger doctors with an interest in neurology would benefit from spending some time in a dermatology service. It can be quite eye-opening (e.g....
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Eastchester clapping sign: a novel screen for neglect
If you spend some time working in a stroke unit, you'll quickly notice that patients with left hemisphere strokes often display right hemiparesis and dysphasia. On the contrary, right hemispheric...
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TIA and stroke risk factors
Let's start with some terminology. Most would agree that a transient ischaemic attack (TIA) is a brief period of neurological dysfunction caused by focal brain, spinal cord or retinal ischaemia. TIAs...
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Pendular reflexes: rare but helpful
I learned the standard cerebellar signs in medical school. We all know these: gait ataxia, dysarthria, nystagmus, intention tremor, past pointing, rebound, dysdiadochokinesia and pendular reflexes....
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The Gordon reflex: an easy alternative to the Babinski reflex
The internet is a remarkable resource for those interested in medical history. Here is a nice quote from an article by Dr Alfred Gordon in 1906 : "In October 1904, I demonstrated before this Society a...
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Blepharoclonus
Blepharoclonus is an interesting clinical sign often omitted from the routine neurological examination. What is it? And what are the causes?
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Movement disorders: an important piece of the puzzle
Many neurology trainees feel compelled to pursue a subspecialty (e.g. epilepsy, stroke, neuroimmunology, neuromuscular, movement disorders). However, some of us prefer to remain in general neurology....
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Eye exam in neurology: keep it simple
Short cuts are necessary in clinical practice. However, one needs to take care not to skip too much of the physical examination. Yet, the complete omission of any eye exam is surprisingly common in...
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Surfer's myelopathy
Myelopathy refers to neurological deficits that arise from spinal cord dysfunction. The classical triad of signs indicating myelopathy is:
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Cerebral small vessel disease: surprisingly common
If you send elderly patients for an MRI brain, you will frequently encounter a report of cerebral small vessel disease. Often the non-specific finding of multiple small white matter hyperintensities is...
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Therapeutic trial: often worth a try in neurology
Older clinicians are adept at the art of the therapeutic trial. In day-to-day clinical medicine, this management option refers to the use of a treatment in a non-standard manner. For example, (a) where...
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Managing expectations: a 2-way street
As doctors or medical students, who we interact with professionally is worth considering for a moment: patients, admin staff, nurses, doctors, students, family members etc. However, it is much more...
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Internuclear ophthalmoplegia (INO): an acronym worth knowing
There are several potential causes of an internuclear ophthalmoplegia (INO). These include ischaemia, demyelination, tumour & inflammation. For those who work in a hospital environment, the two...
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On the importance of brevity
Are you guilty of talking too much? When you have a discussion with others, would it be better described as a lecture? And your patients and colleagues can't get a word in? While is it nice to have the...
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Doctors are bad at business: why?
Ask any accountant or financial planner: 'Which occupation is the least savvy when it comes to business?'. The answer is usually doctors and dentists. Let's first consider some of the many reasons for...
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Doctors are bad at business: 5 steps for success
For those who disagree with the claim that doctors are bad at business, take at look at why this is the case here. There are many advantages to being good at business:
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Palilalia in Parkinson's disease
Over time, patients with Parkinson's disease often display a softer voice (i.e. hypophonia). There are, however, several other speech-related manifestations of this condition. All in all, the...
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