Simplifying Neurology Terms
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October 2006 640 The Journal for Nurse Practitioners - JNP JNP Neurology has many seemingly conflicting con- cepts. It is mostly because we use big words and confusing terms. Just when we know the defini- tions of the terms, the great neurology gods change them for better clarity. Examples of this are when the headache and seizure labels were changed (Table 1). Then there are those terms that are confusing because we call the same thing by several names: extensor plantar response and Babinski reflex are commonly referred to as the same thing. Then we use terms that are just plain confusing. For example, what exactly do we mean in neurolo- gy when we talk about cortical versus subcortical disease or use words like extrapyramidal? My favorite are the confounding phrases like “The Babinski is positive” or “The Romberg is nega- tive.” First, you have to remember what the test is, then you have to remember if positive or nega- tive is the normal response. In this article, I will attempt to simplify the cryp- tic nature of neurologic jargon and give practical solutions to reporting neurologic exams that every- one can understand. First, let’s take the example of verbiage changes (Table 1). Surprisingly, the new lingo makes more sense because it is more descriptive of the actual disease processes. For example, common migraine was changed to migraine without aura— very specific and concise and we know exactly what is occurring. A problem occurs when some folks use the old terminology (sometimes incor- rectly) and some folks use the new terminology, creating a hodge-podge in the patient’s chart and literature. Therefore, we have to know both the new and old terms to be able to easily translate between the new and old languages, so to speak. The solution is to always write what you see. In this case, the new terminology is the most correct because it explains most closely what is occurring with the patient and more accurately conveys the pathology between providers with less reliance on interpretation of “fancy” words. Second, let’s talk about the Babinski test, when the bottom of the foot is scratched and the toes either curl under (normal) or the big toe goes up and the other toes fan out (abnormal in an adult). The Babinski and the extensor plantar response are usually used interchangeably. I prefer the latter because it explains exactly what I am doing with the patient. Simplifying Neurology Terms Table 1. Terminology Changes Seizures Migraines Grand mal generalized tonic-clonic Common migraine migraine w/out aura Petit mal absences Classic migraine migraine w/aura Psychomotor complex partial Vascular headaches migraine w/ or w/out aura (be specific) Tension headache episodic or chronic tension-type headache (be specific) Old = new More descriptive of specific pathology experienced by the patient. Focal simple partial DIAGNOSTIC TIPS Barbara Bishop
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Transcript of Simplifying Neurology Terms
October 2006640 The Journal for Nurse Practitioners - JNP
JNP
Neurology has many seemingly conflicting con-cepts. It is mostly because we use big words andconfusing terms. Just when we know the defini-tions of the terms, the great neurology godschange them for better clarity. Examples of thisare when the headache and seizure labels werechanged (Table 1).
Then there are those terms that are confusingbecause we call the same thing by several names:extensor plantar response and Babinski reflex arecommonly referred to as the same thing.
Then we use terms that are just plain confusing.For example, what exactly do we mean in neurolo-gy when we talk about cortical versus subcorticaldisease or use words like extrapyramidal? Myfavorite are the confounding phrases like “TheBabinski is positive” or “The Romberg is nega-tive.” First, you have to remember what the testis, then you have to remember if positive or nega-tive is the normal response.
In this article, I will attempt to simplify the cryp-tic nature of neurologic jargon and give practical
solutions to reporting neurologic exams that every-one can understand.
First, let’s take the example of verbiage changes(Table 1). Surprisingly, the new lingo makes moresense because it is more descriptive of the actualdisease processes. For example, commonmigraine was changed to migraine without aura—very specific and concise and we know exactlywhat is occurring. A problem occurs when somefolks use the old terminology (sometimes incor-rectly) and some folks use the new terminology,creating a hodge-podge in the patient’s chart andliterature. Therefore, we have to know both thenew and old terms to be able to easily translatebetween the new and old languages, so to speak.
The solution is to always write what you see. Inthis case, the new terminology is the most correctbecause it explains most closely what is occurringwith the patient and more accurately conveys thepathology between providers with less reliance oninterpretation of “fancy” words.
Second, let’s talk about the Babinski test, whenthe bottom of the foot is scratched and the toeseither curl under (normal) or the big toe goes upand the other toes fan out (abnormal in an adult).The Babinski and the extensor plantar responseare usually used interchangeably. I prefer the latterbecause it explains exactly what I am doing withthe patient.
Simplifying Neurology Terms
Table 1. Terminology Changes
Seizures Migraines
Grand mal generalized tonic-clonic Common migraine migraine w/out aura
Petit mal absences Classic migraine migraine w/aura
Psychomotor complex partial Vascular headaches migraine w/ or w/out aura (be specific)
Tension headache episodic or chronic tension-type headache (be specific)
Old = newMore descriptive of specific pathology experienced by the patient.
Focal simple partial
DIAGNOSTIC TIPS
Barbara Bishop
640-641_YJNP292_Bishop_CP 9/29/06 10:37 AM Page 640
www.npjournal.org The Journal for Nurse Practitioners - JNP 641
How to properly record a Babinski response getsmore confusing and is often recorded incorrectly,as positive or negative. The correct way to recordit is to state whether the response is absent(meaning the toes are down) or present (meaningthe toes are up). The easiest way to record thisresponse is to write what you see (toes up ordown). Record the responses specifically for boththe left and right side.
What exactly do we mean when we refer to cor-tical versus subcortical? The cortical region is thearea of the brain encompassing the cerebral cor-tex, its pathways, and the integration of its struc-tures. The major areas include the prefrontal andpremotor regions; motor and sensory pathways;parietal, temporal and occipital lobes; along withcingulate gyrus, corpus callosum, and hippocam-pus. Through the integration of these areas andpathways, we have higher order functioning, rea-soning, impulse control, language, memory, emo-tions, and motor and sensory function. Subcorticalrefers to all the other structures and their functionsand pathways. This would be the structures of theposterior fossa, including the cerebellum and brainstem. It also includes the basal ganglia, thalamus,and hypothalamus.
What is extrapyramidal? It is easier to under-stand pyramidal. The pyramidal tract is the corti-cospinal tract. It starts in the motor strip of thebrain called the homunculus that crosses out (thebig word used in the medical books is decussate;notice that I avoid those big confusing words!) inthe medulla and descends the spinal cord. Injury tothis system is most commonly seen in cerebralvascular accidents. So extrapyramidal would be themotor systems outside of pyramidal system. It’sthat simple. However, these patients present withmuch more complicated pathology. One of themost common disorders that we see in our prac-tice involving the extrapyramidal system isParkinson disease.
Since I’ve brought up the topic of spinal cord,let’s talk about it a bit. The term long tracts isoften used when discussing the spinal cord. Whatare we really referring to? The tracks that ascendand descend the spinal cord through the brainstem. They travel the entire length of the cord intothe cortex. Major long tracts include the anteriorand lateral spinothalamic tracts, the posteriorcolumns, and the cortical spinal tract. Sensorytracts are ascending and afferent pathways. Themnemonic ASA (Afferent-Sensory-Ascending) canhelp you remember the sensory long tract move-ment through the central nervous system (CNS).
Motor tracts are efferent and descending. Themnemonic MED (Motor-Efferent-Descending) canhelp you remember the motor long tract move-ment through the CNS.
In addition, sometimes the name of the tracthelps you determine its function. For example thecorticospinal tract starts in the cortex and ends inthe spine. Therefore it is a motor tract because itis descending. Refer to Table 2 for the major spinaltracts that you should be familiar with to helpunderstand CNS anatomy and physiology.
Although this column is in no way exhaustive,these are some of the major areas of concernwhen trying to understand neurology jargon. Bysimplifying the language and writing what you seeinstead of trying to use big words that confuseeveryone, we can gain better clarity as to what thepatient is actually doing and more meaningfullyinterpret the exam.
1555-4155/06/$ see front matter© 2006 American College of Nurse Practitionersdoi:10.1016/j.nurpra.2006.09.002
Barbara Bishop, MS, ANP-C, CNRN, MSCN, works atVirginia Beach Neurology in Virginia Beach, VA. She canbe reached at [email protected].
Table 2. Major Spinal Tracts and Neurologic Functions
Tract Pathway Function
Corticospinal Motor Voluntary movement
Anterior spinothalamic Sensory Light touch and pressure
Lateral spinothalamic Sensory Pain and temperature
Posterior columns Sensory Vibration and proprioception (conscious)
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