Difficulty in Diagnoses?

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Is there a lot of thinking that goes into making a diagnosis?

Do you think there's a big separation between good neurologists and great neurologists? What makes up the separation?

Originally Posted by JP2740

Is there a lot of thinking that goes into making a diagnosis?

Do you think there's a big separation between good neurologists and great neurologists? What makes up the separation?

What's the difference between a good neurologist and a great neurologist? Oh, about 1.5 tesla, I'd say.

Originally Posted by phenylacetone

What's the difference between a good neurologist and a great neurologist? Oh, about 1.5 tesla, I'd say.

I appreciate your comment, which I take to mean that modern neuroimaging techniques are the be all and end all when it comes to neurodiagnosis. It is true that MRI and related neuroimaging technology is important in neurodiagnosis. These modern imaging techniques have definitely had an impact on our ability to diagnose CNS disorders...

But the fact is that neuroimaging technology, by itself, is no substitute for a clinical assessment by a competent neurologist. The neurologic method of diagnosis is a potent diagnostic technique...

What's the difference between a good neurologist and a great neurologist? The ability to detect Internet sarcasm.

I think the difference is being able to know with confidence when NOT to get imaging, I'm always depressed when someone says they have an awful headache (while talking on their cell phone) with no neurologic signs and all of a sudden there's an unneccessary NCHCT

Great neurologists have killer good looks. Good neurologists are only "average." Hate the game, not the playa.

from experience i would say a Great neuro listens to their patients....an average neuro blows off half of what is said and acts like god and all shall listen ....some of the info a pt. gives may be relevant in a diagnoses further down the track but not caring enough to listen means that has been omitted.

when i was 17 i had a massive accident that caused a epidural bleed and it took 4 different neuros to listen to what i was saying about my headache before a scan was done....most of the injuries were internal (compound fracture of L tib/fib, ruptured spleen, R femur punctured my femoral artery, lost a kidney and had a mooshed L lobe of my liver removed) they were so focused on everything else that a headache seemed like nothing.

Originally Posted by neurodoc

I appreciate your comment, which I take to mean that modern neuroimaging techniques are the be all and end all when it comes to neurodiagnosis. It is true that MRI and related neuroimaging technology is important in neurodiagnosis. These modern imaging techniques have definitely had an impact on our ability to diagnose CNS disorders...

But the fact is that neuroimaging technology, by itself, is no substitute for a clinical assessment by a competent neurologist. The neurologic method of diagnosis is a potent diagnostic technique...

This is what I'm worried about. Is the field mainly based on diagnostics not done by the neurologist?

Originally Posted by JP2740

This is what I'm worried about. Is the field mainly based on diagnostics not done by the neurologist?

No. Imaging alone means nothing without a history, examination, and synthesis of all of the above. This is where the great are separated from the good.

Originally Posted by JP2740

This is what I'm worried about. Is the field mainly based on diagnostics not done by the neurologist?

Absolutely not.

All joking aside, the ability to do a proper neurologic exam, take a detailed history, and generate an appropriate differential diagnosis separates the mediocre neurologists from the better ones. Just as in many medical specialites.

The exam and history matter perhaps more in neurological medicine because often "the devil is in the details" for our specialty, and the neurological examination is often performed incorrectly.

Pathology and radiology are parts of all of medicine. And we do our own spinal taps, PSG's, EEG's, and EMG's.

Originally Posted by JP2740

This is what I'm worried about. Is the field mainly based on diagnostics not done by the neurologist?

You will see many many brain MRIs/CTs that basically say "we found something not totally normal that needs some kind of clinical correlation because it's either an incindentaloma or its a stroke/met/etc" You also need to know where you're performin your imaging as doing a brain MRI isn't that useful for a peripheral nervous issue. You will also need the clinical judgement to have a good idea what these studies will show and to know when not to order them if it will change nothing about yor clinical management.

Originally Posted by Mattchiavelli

You will see many many brain MRIs/CTs that basically say "we found something not totally normal that needs some kind of clinical correlation because it's either an incindentaloma or its a stroke/met/etc."

You will also see some brain imaging studies that are read by general radiologists as "normal" that are in fact not. For example, I've had several cases (three just in the past two years) where my exam was definite for things like Huntington's Disease and Frontotemporal Dementia and I specifically asked that the radiologist who read the scans address my diagnosis. In two of these (HD) prior scans were avialable for review. All three were interpreted as "normal." They weren't. The HD cases showed definite caudate atrophy on axial and coronal cuts (progressive from the priors). The FTD case clearly showed frontal atrophy (even my med students could see it when directed to look for it).

Genetic testing confirmed HD in the two suspect cases. This is not to say that neuroimaging is worthless, but its value depends on the skill of the interpreter. Perhaps a specialy trained neuroradiologist would have done better than the radiologists who interpreted these three studies. I suppose that the point I'm trying to make is that there is some value in having a clinical neurologist who also knows how to read MRI's, or a radiologist who has a good knowledge of both MRI brain anatomy and functional neuroanatomy...

4 years ago my dad had an mri and the neurologists missed about 4 lesions saying that it was inconclusive for MS. i got diagnosed earlier this year and so my dad brought his mri from 4 years ago to my neurologist and he pointed each lesion out.

the point is, you cant just rush through things if you want to be a great neurologist.