Study Guidelines 1. Be able to contrast the structure of the dura mater with that of the pia–arachnoid. 2. Be able to follow a drop of venous blood from the superior sagittal sinus to the internal jugular vein and from an ophthalmic vein to the sigmoid sinus. 3. Name the nerves supplying (a) the supratentorial dura and (b) the infratentorial dura. 4. Identify the different vessels…
Study Guidelines 1. On simple outline drawings of the lateral, medial, and inferior surfaces of a cerebral hemisphere, learn to shade in the territories of the three cerebral arteries. 2. Identify the main sources of arterial supply to the internal capsule. 3. Become familiar with carotid and vertebral angiograms. 4. Be able to list the territories supplied by the vertebral and basilar arteries. 5. Identify the…
Study Guidelines 1. Be able to recognise and label the locations of the ascending and descending pathways in the horizontal sections of the brainstem and spinal cord. 2. Be able to describe or trace the four decussations that occur as part of a simple motor action. ( Box 3.1 deserves special attention because it indicates why certain pathways cross the midline and others do not. The…
Study Guidelines 1. The most important objective is that you become able to recite all the central nervous system items identified in the magnetic resonance images without looking at the labels. 2. Try to get the nomenclature of the component parts of the basal ganglia into long-term memory. Not easily done! 3. Because of its clinical importance, you must be able to pop up a mental…
Study Guidelines This chapter aims to give you sufficient insight into the embryologic development of the brain and spinal cord to account for the arrangement of structures in the mature nervous system. If not already familiar with adult brain anatomy, we suggest you read this chapter again following your study of Chapter 2, Chapter 3 . For descriptive purposes, the embryo is in the prone (face-down)…
Telemedicine (also known as telehealth, as will be used interchangeably in this chapter) is the remote provision of health care using any variety of telecommunication tools, wearable devices, computing technology, and/or robotic technology. Telecommunication tools can include smartphones, mobile devices, tablets, and telephones, with or without a video connection. Telemedicine usage has grown rapidly in response to the COVID-19 pandemic, as social distancing and quarantine have…
Background Traditional medical practice is not always the most efficient or convenient way to provide care to our neurology patients. With an increasing demand for neurologic services in a growing population, technology can be one way to extend our reach to our patients. As technologies develop, it is paramount that practitioners maintain high-quality care, equivalent to traditional in-person visits. Information and communication technologies (ICTs) have great…
Introduction The legal, regulatory, and reimbursement aspects of incorporating telehealth into a neurological practice are likely the aspects of this technology that have been the source of the most trepidation for neurologist and other practitioners. The novelty of this modality of practice has led to an ever-changing legal landscape over recent years. Prior to March 6, 2020, one may argue that progress being made in creating…
Introduction to virtual care within graduate medical education Virtual platforms as a means for graduate medical education have existed for many years prior to the forced use during the COVID-19 pandemic. Many programs allowed for live two-way audio-visual software for academic conferences, particularly in those programs were trainees rotate in multiple clinical settings. In fact, a number of primary care and specialty affiliate organizations at a…
In this chapter, we explore the concept of a system of care for telemedicine through three cases that illustrate the challenges of expansion. Whether virtual or traditional, a system of care is necessary to provide comprehensive services throughout a health care setting. But what is a system of care? A system of care is the whole environment of individuals and resources that surround a patient and…
Introduction Telemedicine has traditionally been utilized for remote consultations in areas of medicine such as trauma, neurology, and psychiatry. However, with the 2020 COVID-19 pandemic, multiple disciplines of medicine quickly learned the utility of this modality of providing health care to our patients. This became necessary in order to deliver health care during this pandemic while reducing staff exposure to ill persons, reducing the burden of…
Introduction A thorough yet focused neurological examination of a patient has been the cornerstone of any neurosurgery clinician’s training. Although the value of the human touch and in-person evaluation of a patient at the bedside or in a clinic setting cannot be understated, an effective neurosurgical examination can be performed via telemedicine, specifically by use of interactive video calls. In fact, many neurosurgeons were forced to…
The history of telemedicine Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. However, this simple definition does not reflect the history of its development, which has been integrated with technology, and innovation. Like many technological advances that are now common to our daily lives and professions, telemedicine was birthed alongside the birth and growth of the internet in the 1960s.…
Overview In part due to the limited access and capability of sleep centers, the field of sleep neurology is in a suitable position for real-time, interactive, audio-video telecommunications (telemedicine). The American Academy of Sleep Medicine’s (AASM) Taskforce on Sleep Telemedicine supports telemedicine as a means of advancing patient health, by improving access to the expertise of Board-Certified Sleep Medicine Specialists. From the use of sleep home…
Tele-technology has been around for a long time. The earliest use of tele-technology in the United States was smoke signals by Native Americans. The use of the telegraph and the invention of the telephone are all examples of tele-technology. The use of telehealth technology has steadily increased over the past several years. However, the recent severe acute respiratory system corona virus-2 (SARS-CoV-2) pandemic hurdled telehealth technology…
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Introduction Since its branching from internal medicine few decades ago, of which neurology once was a subspecialty itself, subspecialization of neurology has been marching forward at a great pace. As a result, today there are more than two dozen neurology subspecialties and up to three-quarters of graduating neurology residents continue to complete a clinical fellowship program in one of those subspecialties. One of those subspecialties is…
Introduction As technological advances allow greater virtual connectivity for many aspects of business and social life, the medical field is also developing innovative ways to extend our care. Certain specialties lend themselves more easily to this form of care. Neuro-ophthalmology relies heavily on in-person physical exam with specialized equipment and diagnostic testing that cannot be fully replicated in the home setting. Yet, some providers use a…
Introduction A comprehensive ophthalmic exam can be critical to the diagnosis and management of neurological conditions. Composed of eight different parts, certain components of a complete ophthalmic exam are easily adapted to telemedicine and others are quite challenging. In this chapter, we will discuss the current options available to the clinician as it relates to examining the eye, current practices, and future adaptions specific to ophthalmology.…
Introduction Epilepsy management encompasses a spectrum of disease acuity and locations. Whether providing chronic disease management in the outpatient setting, acute consults in the hospital for new onset or breakthrough seizures, or critical care management of status epilepticus, there are now opportunities for this care to occur virtually rather than in-person. Technology to facilitate video-enabled communication between provider and patient has been available for some time,…