Neurological Office Procedures

The goal of this issue of Seminars in Neurology is to provide a resource for the practicing neurologist to be able to take the journal off the shelf and review the "how-to" for the procedure they are performing in their office, the interpretation of the results, the indications, and the contraindications.

Omkar Markand, M.D., is Professor Emeritus in the Department of Neurology at Indiana University. He is our teacher and has set the standards of excellence for how electroencephalogram (EEG) is performed and interpreted at our medical center. He has published extensively on the interpretation of EEG and the management of epilepsy, including the management of seizures during pregnancy and status epilepticus, and he teaches students, residents, and faculty at Indiana University and on a national level at the American Academy of Neurology. He provides a review of the pearls, perils, and pitfalls in the use of EEG. This review is so comprehensive that it will never again be necessary to buy another EEG textbook if you keep this issue of Seminars in Neurology. In addition to his expertise in EEG, whenever I ask our residents "Who is the best attending on the Neurology Inpatient and Consultation services?" they always answer, "Dr. Markand." He has the admiration of everyone of us.

Scott Eggers, M.D., is a Clinical and Research Fellow with David Zee, M.D., in the Department of Neurology at Johns Hopkins University, and he is a Mayo Foundation Scholar. He will be joining the Mayo Clinic Faculty in Rochester in 2003. Dr. Zee is Professor of Neurology, Otolaryngology, Head and Neck Surgery, Ophthalmology and Neuroscience at Johns Hopkins. I asked Dr. Eggers to tell me about Dr. Zee. He told me that Dr. Zee is "the Master," that Dr. Zee's curriculum vitae of awards and publications is longer than War and Peace, and that Dr. Zee is an incredibly great guy. Drs. Eggers and Zee have provided an outstanding guide to the bedside examination and laboratory evaluation of the vestibular system.

John Ward, M.D., is Associate Professor of Clinical Anesthesia and Director of the Indiana University Chronic Pain Clinic. Dr. Ward describes the clinical presentation of occipital neuralgia and reviews the technique of occipital nerve block. All of his colleagues at Indiana University are tremendously grateful to him for his availability and for the service he provides in the care of patients with chronic pain.

James Corbett, M.D., is the McCarty Professor and Chairman of Neurology and Professor of Ophthalmology at the University of Mississippi. I have known Dr. Corbett since I was a resident, when he would come as a visiting professor to Charlottesville. We were always delighted when he would come to visit because he was very much like our beloved Chairman, T.R. Johns. He has been a neurologist in the very truest sense throughout his career, always reminding us that the answers we are looking for are with the patient, not in the Radiology Department, the computer, or anywhere else. He takes us through the neuro-ophthalmology examination at the bedside and in the office where our only limitations are our "gumption blocks."

Laurie Gutmann, M.D., is in the Department of Neurology at West Virginia University. She is the daughter of Lud Gutmann, M.D., and her choice of neurology as a career is a testimony to his love for neurology. Dr. Gutmann describes the usefulness and limitations of electrophysiologic testing. Dr. Gutmann reminds us that when a patient is referred to the EMG laboratory, a neurological examination is most helpful in allowing the electromyographer to decide what needs to be done for the patient to be of greatest service to the patient and referring physician.

Robert Pascuzzi, M.D., is Associate Chairman of Neurology at Indiana University and of course former Co-Editor in Chief of this journal, and my husband for 20 wonderful years. He reminds us how to do the edrophonium (Tensilon) test correctly.

Deborah Gelinas, M.D., takes us through pulmonary function screening for patients with neuromuscular weakness. She has earned a reputation for excellence in this area because she writes about what she does "with her hands on the patient" in the care of patients with neuromuscular disease.

Eelco Wijdicks, M.D., is one of the most published authors in the field of neurology. On a national and international level, he is foremost on everyone's list of experts to go to for advice on the care of critically ill neurological patients. Alejandro Rabinstein, M.D., was Dr. Wijdicks' fellow and is now Assistant Professor of Neurology at the University of Miami. They discuss the clinical signs, respiratory function tests, and management of respiratory insufficiency in patients with decreased central respiratory drive and patients with neuromuscular weakness from Guillain-Barré syndrome, myasthenia gravis, and amyotrophic lateral sclerosis.

I review the technique, contraindications, and complications of lumbar puncture. I have established a Lumbar Puncture Clinic to be of service to my colleagues and to assure that the Medicine and Pediatric Residents are comfortable with this procedure. When I initially finished this manuscript, I gave it to my husband to read and he had so many suggestions that my response was "holy cow." The fact that this expression comes readily to mind is evidence that I have been out here in the cornfields for a very long time. The sections on composition of normal cerebrospinal fluid (CSF), CSF analysis for meningitis and encephalitis, noninfectious CNS disorders, multiple sclerosis, and the immunoassay for the 14-3-3 protein were added at his request. Jeff Van Valer, M.D., took the photos for this manuscript. He is one of our senior residents. He works hard, he studies hard, he is genuinely interested in his patients, and his cup is always half full. He has an infectious enthusiasm for life. He will be missed when he completes his residency this June.

This issue of Seminars in Neurology is dedicated to our residents with admiration for the terrific physicians they are. The future of neurology is in very good hands.