Diagnostic Cardiovascular Ultrasound

Is the office “Accredited”?

• Our office Ultrasound Lab is accredited by the American College of Radiology (ACR).
• Such an accreditation implies that we meet a high standard of proficiency in performing these tests, by qualified and certified technicians.
• Our office is the only Neurology office in Middle Georgia to be fully accredited by the ACR.

What is an “Ultrasound”?

• An Ultrasound test is a non-invasive test used to visualize organs or blood flow inside the body.
• There are no needles involved.
• You will be fully awake and alert during the test.
• Ultrasound tests are NOT painful.

How is an ultrasound test performed?

• An “ultrasound probe” takes “real time” pictures of objects inside your body.
• The probe is moved on the surface of your skin, over the part of the body we are trying to visualize. The other end of the probe is connected to a computer.
• As the probe “sees” the objects inside your body, the computer records these images for later analysis.

Who performs the Ultrasound test?

• Any ultrasound examination done in our office is performed by a Board Certified Ultrasonographer.
• Our lead Ultrasonograher is Mike T, who has been performing ultrasound studies for over 15 years.

What is an Echocardiogram or Echo?

• An Echocardiogram, also called an “Echo”, is an ultrasound test of your heart. It visualizes the beating heart, the pumping blood, and the valves inside your heart.

What is a Carotid Doppler study?

• A Carotid Doppler study is to visualize the blood flow in the major blood vessels going to your brain, including the internal carotid arteries and the vertebral arteries.

Why is an Echo or Carotid Doppler study ordered?

• An Echo and Carotid Doppler tests are typically ordered as part of a “stroke work up”, looking for various causes for strokes.

EEG – Electrencephalogram

What is an Electroencephalogram (EEG)?

• An Electroencephalogram or EEG is a diagnostic test which examines the “brain waves”, using electrodes placed on the scalp. These electrodes are connected to a computer, which records your brain waves.

What is the difference between a “routine” and “ambulatory” EEG?

• Routine EEG
  • • A “routine” EEG is performed in the office, which takes approximately 30-45 minutes to perform.
    • This type of study only records your “brain waves” for about 20 minutes.
• Ambulatory EEG
  • • For an “ambulatory” EEG, the electrodes are connected to your scalp in the office, but we then send you home with these electrodes, along with a small hand-held computer.
    • This will record your brain waves for 3 or 4 full days, while you are leading a “normal life”.
    • Such EEGs are more accurate in that they are able to pick up abnormal brain waves while you are at work or while sleeping.
    • At the end of the 4 days, you will return the equipment to our office, which will then be analyzed and interpreted by Dr. Athni.
• Please discuss which type of EEG is appropriate for your situation

Which type of EEG is most ideal?

• Each type of EEG is used for different purposes.
• Which EEG is best for you will depend on your individual clinical situation.
• Dr. Athni will discuss these options with you during your office visit.

How is the EEG procedure performed?

• An EEG is a painless procedure, which involves attaching numerous electrodes to your scalp. These electrodes are connected to a computer, which will record your “brain waves’ during the duration of the study.
• These brain wave recordings are reviewed and interpreted by Dr. Athni.
• A certified EEG technician will attach the electrodes and perform the study, while being overseen by Dr. Athni.

Will an EEG always diagnose a seizure?

• A normal EEG does NOT mean there is “nothing wrong with you”.
• It also does NOT absolutely exclude a seizure or any other disease.
• The results of the EEG are used in conjunction with your clinical symptoms and other diagnostic tests, to make a final diagnosis and conclusion.

How do you prepare for the EEG test?

• For the test, PLEASE do the following:
  • • go to bed at 1 AM, and get up at 5 AM
    • wash your hair in the morning
    • NO hair spray, NO gel, NO mouse, NO oil
    • DO NOT style your hair: NO braids, NO ponytails
    • Wear a button down shirt or blouse
    • NO perfumes or body lotions (you MAY wear deodorant
• The EEG tech will remind you about your appointment and answer any questions you may during the test.

When will you get the results of the test?

• After the completion of the test, Dr. Athni will review the recorded “brain waves” and put together an analysis or “report”.
• This will be reviewed with you on your next office visit.

eVOX – Quantitative EEG

What is it?

• eVox uses quantitative EEG technology along with various brain health biomarkers to aid in the diagnosis of cognitive disorders.

What is a Head Map?

• Computational EEG head maps are a visual representation of the difference in activity between a patient’s brain and a standardized database.

What are Brain Biomarkers?

• Objective metrics derived from computational EEG data provide insight into how the brain is functioning. Peak Alpha Frequency (PAF) reflects cognitive capacity and physiological aging3,4. Theta/Beta Ratio reflects inattention and is FDA cleared to aid in the diagnosis of various cognitive disorders.

What is an Event Related Potential (ERP)?

• ERPs measure brain processing speed and efficiency7. They are highly sensitive biomarkers that have been shown to reflect functional abnormalities even prior to symptom onset

What is a “Go-No-Go” Task?

• Performance during a go/no-go task reflects a patient’s ability to perform daily tasks effectively. Reaction time, reaction time variability, omission errors, and commission errors give insight to cognitive status and behavioral functioning

How do you prepare for the eVox test?

• For the test, PLEASE do the following:
  • wash your hair in the morning
  • NO hair spray, NO gel, NO mouse, NO oil
  • DO NOT style your hair: NO braids, NO ponytails
  • Wear a button down shirt or blouse
  • NO perfumes or body lotions (you MAY wear deodorant
• The tech will remind you about your appointment and answer any questions you may during the test.

When will you get the results of the test?

• After the completion of the test, Dr. Athni will review the recorded “brain waves” and the associated Brain Biomarkers, all of which will be put together in the form of a “report”.
• This will be reviewed with you on your next office visit.

NeuroTrax Test

What is a “NeuroTrax” Test?

• A NeuroTrax test is a computerized test to assess whether you have any cognitive impairment caused by your medical / neurological conditions.
• It is an office based NeuroPsychology test.

How is it performed?

• The test is performed on a computer, although you do NOT have to know how to use a computer to take this test.
• The test takes approximately 30-45 minutes to complete.

What will the results reveal?

• The results will tell us what type of cognitive impairment you may have.
• It will give is a “score” which can be tracked over time to look for any worsening or improvement.

How often is the NeuroTrax test performed?

• If abnormal, we typically repeat this test every 6 months to look for any changes.

Autonomic Nervous System test (ANS)

What is the “Autonomic Nervous System” (“ANS”) ?

• Your autonomic nervous system (ANS) is the part of your nervous system that functions to sustain your life by controlling your heart, lungs, digestive system, blood pressure, immune system, certain of your reflexes, fluid balance, pupil diameter, sweating, and sexual function.
• There are two parts (or branches) of your ANS: the sympathetic branch and the parasympathetic branch. Generally, the sympathetic branch is more in control when you are stressed, ill, or injured, while the parasympathetic branch is more in control when you are relaxing, sleeping, or recovering from an illness or injury.
• In fact, most illnesses and injuries cause or result from an imbalance between these two branches. An imbalance in your ANS can tell your doctor many things about how healthy you are, as well as what can be done to keep you as healthy as possible.

What is an ANS Test?

• We perform three (3) independent clinical ANS tests (or studies) designed to determine the ability of both branches of the autonomic nervous system (ANS) to respond to and relax from a challenge.
• The two branches that make up the ANS are the sympathetic and parasympathetic (SNS and PSNS, respectively).

What are the different components of the ANS test?

The ANS test consists of 3 components or challenges.

The challenges are:

• deep breathing to challenge the PSNS,
• valsalva to challenge the SNS, and
• standing from a seated position to challenge both systems

How long does it take?

• A study takes approximately 25 minutes to complete.

What results will be obtained from this test?

• The ANS test will tell us whether your sympathetic and parasympathetic nervous system are “in balance” or “out of balance”.
• These results will help guide Dr. Athni in formulating a treatment plan to try to bring the ANS back “in balance”.

How often is the ANS test performed?

• If your ANS test is “normal”, we will not have to repeat the study at any set interval.
• But, if it is abnormal, we will probably repeat the study in 4-6 months to see if our therapeutic intervention is resulting in any ANS improvement.

Consent – Who Can Accompany Patient Into Exam Room

• If you are being seen thru Worker’s Comp, we will only allow the patient in the exam room.  If a NCM or Adjustor wants to meet with Dr. Athni, they will need to schedule a separate appointment with the front office.
• If you are an adult and are being seen thru your private insurance or Medicare or Tricare, we will allow your spouse into the exam room.
• BUT, for anyone else, we will need a Medical Power-of-Attorney (Medical POA) or a Notorized letter stating the third-party is allowed to be involved in the patient’s care.  This would include friends or a parent of a patient or an adult child of a patient.
• This is a standard practice in Psychiatric offices.  Although we are not treating Psychiatric illnesses, many of our patients have cognitive issues.  To make sure decisions are being made in the best interest of the patient, we require such a POA.  Even if you do not have any issues which involve your cognitive abilities, we have one policy for all patients.
• We hope you understand the rationale for this policy.  We are merely trying to make sure unauthorized people (who may not have the patient’s best interest) are not involved in medical decisions.

Scheduling Appointments

• We are a “referral only” office.  We require a referral from your primary care physician.
• As soon as our office receives your referral, we will first verify your insurance benefits to make sure we are part of your insurance network. (Please look at “Insurance Networks” on the web site to see our network affiliation.)
• We request you forward a copy of your medical records prior to scheduling your initial appointment.  We will review your medical records before an appointment is given.  We reserve the right to NOT schedule an appointment – after reviewing your medical records, we may decide we will not be able to participate in your medical care.
• Our office staff will then contact you directly to schedule the initial appointment.
• We try to see patients within 2 weeks of receiving the referral, but sometimes new appointments can delayed upto 8-12 weeks.
• We normally see new patients on Thursdays, all day.
• If the appointment involves a Work-Comp issue, we must obtain a written approval from the WC adjuster prior to scheduling the appointment.
• We request ALL new patients to arrive at the office at least 1 hour BEFORE their scheduled appointment.
• This will ensure that all paperwork issues are completed before your scheduled appointment time. Otherwise, your consultation time will be delayed.
• Be prepared to spend 2-3 hours in the office as we conduct a very detailed neurological evaluation, consisting of:
  • (1) an initial evaluation with an upper level medical student or medical resident, followed by
  • (2) a prolonged private discussion (sometimes 45 min to 1 hour) between Dr. Athni and the student / resident, followed by
  • (3) another detailed assessment by Dr. Athni.

Medication Refills

What medications will be refilled?

• Our office will only refill those medications we have prescribed, AND only if you are an active patient in our practice.

How many refills will be prescribed?

• During your office visit, we will try to prescribe medications with enough refills to last you until your next office visit
• If you cancel your follow up appointment, we will NOT refill your medications until you are re-evaluated by Dr. Athni
• If you choose not to re-schedule your appointment, you should consider obtaining all further refills thru your primary care physician

How are refills processed??

• We normally refill medications during the office visit
• We send all medication refills thru eRx (electronic prescribing system)
• The eRx system minimizes human error, and reduces prescription filling time
• Once we send an eRx prescription, an eRx is typically processed and filled within 1 hour by most pharmacies

“Calling in” prescriptions

• To minimize errors, we will NOT “call in” a refill medications
• If your pharmacy does not accept electronic prescriptions, we will give you a hand-written prescription during your office visit for you to hand-carry

Narcotics Pain Medications and Controlled Medications

• Many pain medications are “controlled” and monitored by the DEA (Drug Enforcement Agency) to minimize fraud and abuse
• We will NOT prescribe or refill any controlled narcotic pain medications
• We WILL prescribed non-narcotic, controlled medications.
• These medications will ONLY prescribed and refilled during a face-to-face office visit

Auto Accident Evaluations

• If your medical issues are related to a recent motor vehicle accident, we will not wait for payment from your auto insurance or from your attorney.
• You will be responsible for full payment of any and all charges incurred at our office.
• You can file the claim with your auto-insurance company.
• We will NOT accept a delayed payment from “3rd party liability” benefits as a result of any auto accidents.
• We will NOT accept any “liens” or “promissory notes” from your attorney.

Expected Payments

If you are a Work Injury or IME patient – No payment is required at time of office visit

• If you are being seen as an authorized Work Injury patient or as an authorized IME, you will NOT be asked to pay anything. All your bills will be handled through your Worker’s Compensation Insurance Company or your attorney.

What is your payment if you have Medicare?

• If Medicare is your primary insurance, then we expect 20 percent of your “Medicare allowable charges” and any deductible required for the calendar year.
• Per federal regulations, the Medicare deductible for calendar year 2022 is $226.

What is your payment if you have commercial (PPO or HMO) insurance?

• We will typically verify your insurance before you arrive at our office.
• If we are a “participating provider” for your insurance plan, then we will only collect the co-pay (either a set dollar amount or percentage).
• You may also be asked to pay any deductible that may not have been met for the calendar year.

What if we are NOT in your insurance network?

• If we are not in your insurance network, you may be asked to pay your bill in-full.
  Please discuss this with our office manager prior to your office visit.

What if you have NO insurance?

• If you are a NEW patient without a valid verifiable insurance, we will NOT be able to see you as a patient
• If you are an existing patient and have lost your insurance or we are no longer in your insurance network, then we expect full payment at the time of service.

Insurance Verification:

• We will verify your insurance PRIOR to your office visit.
• This verification will inform us of your insurance contract stipulations, including any co-pays you are required to pay.

WHEN to Pay:

• We expect payment at the time of service.

TYPE of Payment:

• Our office prefers cash or credit card (MC, Visa, Discover, and Amex).
• You may also pay On-Line thru this web site. We offer a Secure Payment process, powered by Pay-Pal.
• Due to the high number of “bounced checks”, we do NOT accept checks as a form of payment.

Filing Insurance Claims

What insurance claims do we file?

• We will file all Primary insurance claims.

How do we file insurance claims?

• If your insurance company is setup for electronic filing, we will file this claim electronically through our computer system.

When do we file the insurance claims?

• Typically, we file your claim within 7 days after the office visit.

NOTE: Although we may file your claim, it is quite common for insurance companies to “lose” and “not process” the claims. They commonly state that they did “not receive” our claims.

• Hence, it can sometimes take a few months for your claim to be processed properly.
• If we have not received payment within 45 days, we will re-file your claim.

Do we file Secondary insurance claims?

• Although we file all Primary insurance claims, we generally do NOT file Secondary insurance claims.
• Some insurance companies will transfer your claim automatically to the Secondary carrier, in which case it will get processed without any further intervention.
• Else, you will be required to submit the claim to your Secondary carrier after you receive the EOB (Explanation of Benefits) from your Primary insurance company.

Monthly Statements

When do we mail account statements?

• We mail account statements only AFTER the insurance has paid their portion.
• We will wait for payment from your insurance company before we send you a “Payment Due” bill. Sometimes, it may take up to 6 months (or longer) for us to receive the initial payment from your insurance company, so don’t be surprised if you receive a statement from us many months after services are rendered.
• If your insurance does not pay us anything, you will receive a bill for the full amount.
• We normally mail account statements once a month.

What if there is a zero balance?

• If your insurance company pays “in-full”, and there is NO balance due, you will NOT receive a statement.

What if there is a “balance due” on your account?

• If your insurance company only pays us a partial amount, and there is a remaining balance, we will send you a statement during the first week of the month following payment from the insurance company, and each month there-after until the balance is paid.

How many statements are mailed?

• You will receive a total of 3 statements from our office before sending your account over to a Collections Agency.

What if NO payment is made towards an open balance?

• If no payment is made towards your open balance after 3 monthly statements, your account will be sent to a local Collections Agency for further legal action.
• A separate “collections fee” will also be assessed above and beyond your open balance to cover the cost of the collections process.

Methods of Payment

• You may pay all or part of your open balance at any time. As long as there is an open balance, you will receive a monthly statement from our office. You may mail us your payment or stop by the office to pay.
• We accept cash, credit cards (Visa, MC, Discover, Amex), or debit cards.
• You may also pay on-line using our secure payment method powered by Pay-Pal.

On-Line Payment

• If you would like to pay a portion or all of your open balance, please use the form below.
• We use a Secure Payment process, powered by Pay-Pal. Please enter your Name and Birth Date so we can credit the correct account with your payment.
• After you click on the “Pay Now” button, you will be taken to a secure PayPal driven web site, where your payment will be processed.
• After the payment process, you will have a chance to enter any “comments or instructions” regarding your payment.

IME – Independent Medical Examination

WHAT is an IME?

• An Independent Medical Exam, commonly referred to as an “IME”, is a legal evaluation, usually requested by an insurance company, attorney, or some other involved 3rd party. These evaluations are strictly confidential, and the records are NOT released to any other requesting party.
• As an IME Physician, we fully understand that we are NOT developing any doctor-patient relationship. We will NOT prescribe any medications, and we will NOT make any formal treatment recommendations to the patient.
• Some diagnostic testing may be ordered to properly complete the IME, but these tests are scheduled and performed only with pre-approval from the insurance company or attorney.

HOW to schedule an IME:

• Independent Medical Examinations (IME) must be scheduled by the employer, attorney, or insurance company. Prior to scheduling the appointment, please call our office and talk with the office manager to discuss our IME financial policy. We typically request pre-payment for the IME.

WHEN are IMEs scheduled, and how long does it take?

• IMEs are scheduled at a mutually convenient time, and as quickly as possible.
• A typical IME can take 60 to 90 minutes with the patient. This is followed by an additional 3-4 hours of medical records review and case analysis.

What questions are answered during the IME?

• Typically, the IME-requesting party will ask a series of questions to be answered during the IME. All of these questions will be answered by Dr. Athni.
• If additional testing is necessary to properly answer these questions, we will recommend any necessary diagnostic tests. If approved, we will schedule and coordinate these diagnostic tests.
• Once the IME is completed, and if requested or necessary, Dr. Athni will call the IME-requesting party to discuss the case.

IME records are confidential:

• As noted above, we fully understand the legal implications of an IME, and hence we will release the report only to the IME-requesting party. These records are kept in strict confidence, and will NOT be released to anyone else.

Objectivity:

• All cases are handled objectively without being influenced by any outside party. Dr. Athni will “call it like he sees it”.
• For over 25 years, we have regularly seen patients referred by insurance companies (handling life insurance policies, disability insurance policies, workers compensation policies, etc), attorneys (representing both patients and employers), and directly from employers.

Oue experience with IMEs:

• Dr. Athni has been performing IMEs for over 25 years. On average, we complete 10 Independent Medical Evaluations per year.

Questions?

• If there are any questions or concerns regarding IMEs, please call our office and speak with our office manager. If they cannot answer your questions, then Dr. Athni will speak with you directly.

Records Review

• If an insurance company or attorney is involved in a legal case which requires a Neurological opinion, we will be happy to review the records and answer any pending questions.
• The Medical Records Review will be purely objective, regardless of who is requesting the Records Review.

• After the Records Review, Dr. Athni will be available to discuss the findings with the requesting attorney or insurance company.
• A report of the Records Review will be generated and faxed to the requesting party.
• Depending on the volume of the medical records, the review can take 1-2 weeks after receiving the medical records.

• We expect pre-payment for these services.
• The cost will be based on services requested, such as the volume of medical records, whether any imaging films need to be reviewed, and whether a telephone conference is also being requested.

• Please contact our office to discuss these fees.

Concussion Assessment

• Most people are familiar with football related concussions, but they are also quite common after work injuries.
• Concussions occur after a closed head injury, such as can occur after a fall or car accident or some other accident.  It is very important to have such head injuries evaluated quickly and aggressively, and as soon as possible after the accident.
• The symptoms associated with a concussion can be quite varied and unusual.
• Some diagnostic tests we perform in the evaluation of a concussion include: an MR brain, EEG, and Neurotrax test.
• Depending on the results of these tests, various treatment options will be discussed and recommended.

YouTube Educational Videos

Dr. Athni has created educational videos hosted by YouTube, and have also been posted on this page for convenience.  The YouTube channel is called “NeuroEd – Neurology Education Made Easy.”

These videos are separated into various “playlists” – primarily based on “type of video” and suitable audience.  Each playlist is displayed separately on the various tabs on this page.

This list of videos will be slowly expanded over the next few weeks to months.  Subscribe to Dr. Athni’s Channel to view the latest videos.

If you have a specific topic that you want Dr. Athni to discuss, please let him know on your next office visit.

“The Brain Doc” – a Podcast series

Dr. Athni is in the process of creating a Podcast series entitled “The Brain Doc”. In the Podcast, Dr. Athni will interview various specialists, medical students, as well as discuss various medical topics.

You can find all the episodes on this website or on your favorite Podcast Player.

For Spotify, search “Brain Doc Athni”

For all other Podcast players, search “Brain Doc”.

If you find the podcast enjoyable and educational, please leave a positive review.  Thank you.

The Neuro Axis video-series (8 total videos) will teach you how to “localize the lesion” using a simple approach. Great tool for medical students and residents. If you follow the methodology in this video series, you will markedly improve your clinical neurology skills, improve your Shelf and Step scores. More importantly, you will be a “star” on rounds!

Introduction 00:00 — Disclaimer 00:17 — Start of video 00:56

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Neuro Axis: Overview

Neuro Axis: Muscle Disorder

Neuro Axis: NeuroMuscular Junction Dysfunction

Neuro Axis: Peripheral Nerve Disorders

Neuro Axis: Nerve Root Disorders

Neuro Axis: Spinal Cord Disorders

Neuro Axis: Brainstem Disorders

Neuro Axis: Subcortical & Cortical Disorders

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The Medical Student Success video-series aims to give you important tips and tricks to succeed in medical school.  During your clinical years, you have to not only get good grades, but you have to also learn how to be a successful clinician.  Watch these videos, and learn how to succeed in “the game” and learn how to be a “star” on rounds!

Introduction 00:00 — Disclaimer 00:17 — Start of video 00:56

Other Information

• Park at LEFT side of building, in covered parking area
• Please ONLY use the SIDE DOOR to come in-out of the office
• If you have Orientation, you can use our conference room (remember to ask Dr. Athni for office Wi-Fi password).
• You can also use our conference room to attend your weekly “Academic Day” and “Grand Rounds” meetings.
• After completion of the webinar / meeting, you are expected to return to clinic.
• Wear comfortable shoes

Technology

• Bring your laptop, tablet, iPad, or cell phone with internet browsing capability (we have wifi in the office)
• Please keep cell phone on “vibrate” mode
• DO NOT use your device to play games or “shop” or socialize with your friends while in clinic
• DO NOT use your cell phone or tablet in front of patients – this would be very rude, and disrespectful to the patient

Neuro Tools

• The only tool you would need would be a neuro hammer, but do not buy one.
• Most students & residents purchase the wrong type of hammer. I will show you which one to purchase.

Rotation Expectations

• This is an out-patient rotation, with no call and no weekend responsibilities.
• This is not a physically-challenging rotation (no sleep deprivation, no excessive walking, no after hours, etc).
• If you have a lecture commitment, just let me know, and you can break away for the lecture and return when you are done.
• We have a conference room where you can watch your lectures and grand rounds.
• I will assign reading and “homework” during the rotation – you are an adult, so I expect you to keep up with these assignments.
• Your typical workweek in the clinic will be around 30-35 hours.
• Since this is not a very time-demanding or physically demanding rotation, I EXPECT you to read and learn Neurology when not in clinic.
• There should be absolutely no excuses for not reading neuro related material during the rotation.
• You will be working with Dr. Athni, directly – so please leave any “laziness” at home.
• REMEMBER:  You will get out of this rotation what you put into it.
• This might be your only exposure to Neuro, so take advantage of the rotation.
• The more you learn, the more you demonstrate an interest to learn, the more you ask, the more I will teach.

How to Assess Progress

• You will be required to take a “Neurology Pre-Clinic Quiz” PRIOR to the first day of the rotation (available on the NOCG Education portal).
• Try taking this test without studying to assess your baseline neuro knowledge.
• I do NOT expect you to “ace” this test.  Rather, it will assess your level of Neurology knowledge at the beginning of the rotation.
• You will be required to take another “Quiz” at the end of the rotation.
• Part of your “clinic” grade and assessment will be based on how you have progressed during your Neurology rotation.
• These quizzes are NOT meant to be stressful.  Rather, they are meant to demonstrate your academic growth and help build your confidence in clinical Neurology.

Teaching and Learning Process

• Many students and residents are “afraid” of Neuroscience and Neurology.
• One of the best ways to learn Neurology is to understand the pathology and pathophysiology, instead of memorizing random facts.
• To accomplish this, I use the Socratic method of teaching – so, be prepared to be challenged academically.
• You will quickly realize, and hopefully appreciate, the importance of critical analysis and reasoning (remember CARS on the MCAT?).
• Come with an open mind, and you will quickly find that Neurology is a lot of fun.
• Don’t stress over this rotation.
• Bring your “A” game, and you will learn more than enough to earn an “A” on your shelf exam, while also becoming well prepared for the Neurology component of the Step 1 and Step 2 exams.

Things to Study – BEFORE Rotation Starts

• Since you only have 3 to 4 weeks on the neurology rotation, I have found that most students / residents lose a lot of time trying to “re-learn” the fundamentals of neurology (information that should have been learned during basic sciences).
• Review basic neuro-anatomy (cortical lobes, detailed anatomy of brainstem and spinal cord, etc).
• Review the sensory and motor pathways.
• We will review this information during the rotation.  But, without this basic knowledge, your experience in neurology will be limited and constrained.
• SIDE NOTE:  Chapters 5 (Weakness) and chapter 6 (Sensory system) of Blueprints has a nice overview of the above information.  Pay special attention to how to properly “localize the lesion.”

Educational Videos – Watch BEFORE Rotation Starts

• All students and residents rotating through our office are expected to watch the “How To Localize The Lesion” video series (i.e. NeuroAxis) BEFORE starting the rotation.
• No excuses.  Without a clear understanding of the information provided in this video-series, you will find your first few days of neurology to be very painful!
• Also listen to the “FDA” podcast
• The Videos and Podcasts are located on the https://nocg.org web site

NOTE:   “BEFORE STARTING THE ROTATION” means BEFORE THE FIRST MONDAY OF THE ROTATION

Topics to study DURING the rotation

• There are a handful of topics which are very common in Neurology – very frequently appearing on your various exams (Shelf, Step, Specialty Boards)
• I encourage you to study and try to understand the clinical relevance of these topics, not just memorize the core information
• We will be discussing these topics at random times during the month.

Difficult Topics – Learn Big Concepts

• Synucleinopathies
• Epilepsy classification and treatment (including status)
• Multiple Sclerosis
• Myasthenia Gravis
• Concussion vs. TBI vs. Closed Head Injury vs. Post-concussive Syndrome
• How to analyze CSF results
• Stroke Management – acute vs. long term .. surgical vs. non-surgical … etc
• Spinal cord compression
• Classification of peripheral neuropathy
• “AIDP” vs. “CIDP”

Not So Difficult – Quickies – Easy To Learn

• Different types of hydrocephalus
• Bell’s Palsy
• Trigeminal Neuralgia
• Scheduling of medications
• Types of headaches
• Chronic pain vs. acute pain
• Aphasia vs. Dementia vs. Delirium
• Intracranial bleeds (5 types !!)
• Side effects of common medications

Try To Learn, Else Just Memorize

• Visual field defects
• Muscular Dystrophies
• Metabolic Syndromes