Neurology

This past month I had the pleasure of interviewing a very prominent neurosurgeon in Houston, Texas. Dr. Subrata Ghosh is primarily a brain surgeon, although after many years of practice knows quite a bit about neurology in general.

His philosophy is: I am a physician first and then a Neurosurgeon. I treat patients as people, not as a laboratory number or radiological study. I manage my patients with an individualized approach, as if it is my own body. I also believe in three principles when it comes to treating patients: Availability, Amicability and Affability. I am absolutely committed to provide the highest level of no-compromise care possible for my patients, utilizing the most modern and advanced technologies available.

Because neurosurgery is a demanding field requiring an enormous amount of time and devotion, we are appreciative that Dr. Ghosh was able to spend a few minutes with us answering some questions related to neurosurgery and the profession in general. Here’s the interview:

Thank you for agreeing to talk with us today. First of all, what got you interested in neurosurgery?

Well, when I was in medical school I always knew I wanted to be a surgeon. I completed general surgery post-graduate training and practiced as one for several years. But neuroscience was (and still is) the least understood sub-specialty in medicine. My curiosity towards Neuroscience is what drove me into neurosurgery. I liked neuroscience & I liked surgical principles, so the combination naturally led to Neurosurgery.

Thank you. If you were to describe to a high school student what you do during the day, how would you describe it?

Well, as I said before, I’m a physician first and then a neurosurgeon. The best example I’ll give you is what I’ve told my daughter since she was four years old. I still say this to young high school and college students that I mentor quite regularly.

I remember telling my daughter when she was four years old: I want you to wake up every morning and tell yourself, “I have to do two things today. Number one: I have to learn something new today. Number two:  I have to help one person today.” I remember her being just 4 years old at that time she would ask me, “How do I help them?” And then I said to her, “Well, you could help by sharing your lunch with your friend in school who may have forgotten to bring a lunch. You could give a dollar to a person who doesn’t have money to buy food. Or you could help a blind man across the road. Or you could help like I do by treating patients. Just help one person a day.”

And because children are always fundamentally curious to learn, she asked “Why.” It’s the question every child asks, doesn’t matter what it is. I said, “Well, if you do these two things on a daily basis, you’ll go to heaven.”

Then came the hardest question: “What is heaven?” I remember telling her that I do not know what exactly is Heaven or how beautiful heaven looks, but I’m told it’s the most beautiful place. But I can guarantee you a few things. No human being alive will ever be able to describe to you exactly what heaven looks like or how beautiful it is. That’s number one. And number two, if you do these two things on a daily basis you will go to heaven way before all those people who claim they are religious, whether they go to churches, mosques or synagogues or temples. And that’s where the conversation ended.

So, going back to your question, I simply try to help at least one person a day and that is what drives me as a physician and that is how I would like to define my profession.

That is a great story. Thanks so much for sharing it. I know our readers appreciate it. The next question is: What surgeries do you do more often than others?

I usually do more brain surgeries than spine surgeries. A general neurosurgeon usually performs about 70-75% spine, and 25-30% brain surgeries. My practice is a little more sub-specialized in that I do 60% brain and 40% spine surgeries.

Is there any one particular kind of brain surgery you do?

I’ve done more neurovascular (brain aneurysms and AVMs) and complex brain surgeries over the last 15 years in Houston than most other neurosurgeons. Because of that reputation, my practice is weighted more towards brain than spine problems.

Thank you. Now, about medical school. Of course we all have our preconceived notions of what that would be like, especially if we’ve not gone to medical school and don’t know for sure. What was the hardest part of med school and how did you deal with it?

The hardest surprise for me was just this huge, explosive amount of knowledge that you initially have to muster in a short time through memorizing. Medicine is an Applied Science in its truest sense. It gets easier to comprehend and understand this knowledge once you are able to apply it in clinical practice. Then it makes more sense and is easier to remember. But the amount of explosive knowledge that you have to cram initially just to go through the medical school and pass several examinations was probably the hardest part.

I don’t ever think that the number of years or the amount of time it takes one to pursue a career is an important criterion for choice of a career. You have to be passionate enough to pass through any period of time for anything you want to do. People may think that the number of years that you have to go through for medical school is a long time. But in an average span of 80-plus years of life, that one year or two extra years of school is not important.

Learning never stops, whether one is in school or not. We all need to learn something new every day. One also has to realize that all of us will spend the greater part of our lives in our work environment, whether a lawyer, a politician, an artist or a physician. Therefore, one needs to follow his/her passion to choose a career so that he/she can wake up every morning at 5, go to work and return home at 6 or 7 in the evening and NOT tell him/herself, “I hate my job!” My advice to the younger generation is: “Never, never compromise your passion and take short cuts to try and save one or two years of school because you will be miserable for the greater part of your life.” I didn’t fully appreciate this when I was young and now I do. It is very important for kids to be aware of this.

That is great advice. But given that you’ve just said that, was there ever a point where you wanted to quit?

That word “quit” was never in my dictionary; not now, not in my past. I never wanted to quit medical school or anything I ever did. If I start something I will have to see it through to the end and then move on from there. I’ve never thought about quitting anything. That has always been my mind set. I also tell kids: “If you want to be ‘successful’ in life, whatever that definition of success may be to you, you have to be both lucky and good. You have no control over the luck part, so simply forget about getting lucky, follow your passion, study and work as hard as you can, be honest to yourself and everything else will follow you in life.

That makes sense. Did you have a favorite part of medical school?

Friends and associations. This is more advice I have for kids, including my own daughter. Education starts at home with parents, not in school. I reflect on how I grew up myself as a child and I believe that by fifth, sixth or seventh grade a child has already developed certain levels of expectations of his/her own in terms of studies and growing up as a person with regards to life’s values. After that it is too late for parents to help guide them for the most part. After the age of 10 years or so, I believe the friends and associations that the child will have from the age of 10 to 25 years will dictate where they would go in life.

I strongly believe that I am here today in my life due to the wonderful friends and associations that I have had in my younger age through my middle and high school and college years. It is extremely important to choose your friends correctly; friends who would influence you positively in life.

I have had friends in college who were extremely talented in school, yet we had this wonderful, healthy and competitive relationship whereby we would share our notes and knowledge to help each other go through endless number of tests. Yet we had fun in between with sports and music at the same time. I have been playing drums and singing throughout my college and professional life over the last 40 years, off and on. I still perform almost every year for charity here in Houston. I was also a semi-professional athlete in Cricket and Ping Pong. I feel very lucky that I have had the opportunity to associate with such a bunch of wonderful and talented friends when I grew up and that’s why I am who I am today.

Thank you. And our final question. What advice would you offer a high school student considering this as a career?

I have mentored many high school seniors and undergraduate students over the last 35 plus years. I’ve always told them that medicine is a profession, indeed, but if you’re not humane enough, you should not be in this profession. My biggest criticism of medical school curriculum is that we were never taught in medical school about how important it is to be a people person.

Just think about it. On a daily basis when I treat patients, whether in surgery or seeing them in my office for the first time, I come across a person and family members who are all stressed, concerned, in denial or angry, upset, depressed or frustrated. So to be a physician, one has to have enough conscience, empathy, and patience to listen for the humanity in him/her before one can gain enough trust to heal them. A patient trusts and surrenders to a physician with his or her own life. No other profession creates this unique kind of bond as it does between patient and a physician. That is why I have always felt that if you are not a people person and not humane enough to handle it, please don’t get into this profession.

Another important tip: Medicine may not be the right choice for you if you think you are the smartest person in the world and want to make a “lot” of money. But if you are, you shouldn’t be in this profession. You need to be humble enough to consider yourself like every other average human being and be willing to be a team player. Most often, it’s not just one physician treating a patient; there are multiple specialties involved including so many other allied health professionals. So my advice for choosing medicine as a profession would be: “Please consider this profession only If you think you are an average or above average person, compassionate, a team player and hardworking. And if you are, you will always lead a very decent life, professionally, financially and emotionally and live with honor and dignity in any society regardless of wherever in the world you live in.

Dr. Ghosh, I cannot thank you enough for your time today.

Dr. Subrata Ghosh is a neurosurgeon in Houston, Texas. He is the Medical Director of Neurosciences at HCA Gulf Coast Division. He is also the Chief of Neuroscience at Clear Lake Regional Medical Center and serves as a Clinical Faculty of the Dept. of Neurosurgery of Baylor College of Medicine. Dr. Ghosh received his medical degrees from Calcutta National Medical College, India, completed his training and practiced as a General Surgeon for several years before he came to USA as a Ph.D. Student. He completed Post-doctoral fellowship from College of Physicians and Surgeons of Columbia University, NY and completed Neurosurgery training from Indiana University. Dr. Ghosh has been in independent neurosurgical practice for over 16 years.

Get started on the path of neurology today

This concludes our series on neurology. If, based on the information, you’ve decided you’d like to enter the field of neurology, you can start learning today regardless of your age.

The Apprentice Doctor offers a For Future Doctors Course and Kit. In addition to fact and theory, the course also provides opportunities for you to practice some of the skills neurologists, and neurosurgeons perform. You become an apprentice in the field.

If you missed any article in our neurology series and would like to go back and catch up, click on the following links:

The Nervous System and How it Works

What’s the Difference Between A Neurologist & Neurosurgeon?

Path to Becoming a Neurologist or Neurosurgeon.

A Day in the life of a Neurologist and Neurosurgeon.

If you would like to read another interview with a neurosurgeon, we recommend the visiting: https://www.npr.org/2016/10/07/496948795/a-neurosurgeon-reflects-on-the-awe-and-mystery-of-the-brain

It’s important to understand that while becoming a neurologist or a neurosurgeon is a fulfilling career choice, it’s not easy to get there. Having a high level of interest is necessary. You must also enjoy interacting with people and listening carefully to what they have to say. In some ways diagnosing a neurological disorder is detective work. Anything a patient tells you may be substantial.

Other essential skills involve outstanding communication and leadership. You will have to be good at problem-solving and have great amounts of patience, dexterity and physical stamina. As for any medical doctor, compassion and empathy are necessary since you will be interacting with people who are ill and very worried about their health and longevity.

Because the field of neurology is so detailed, the amount of education you need is extensive. Here are the basic steps you’ll take:

Step 1: Obtain an Undergraduate Degree

Post-secondary education is a must. Research colleges and find the ones you are most interested in attending. Look for universities with excellent reputations and outstanding pre-medical curriculum. There is no doubt you will choose a major in one of the sciences like chemistry or biology. Focusing on advanced biological sciences is a good option. Pre-requisite medical courses should include microbiology, biochemistry and human anatomy.

The objective of your undergraduate degree is to prepare you for medical school, which is the next step. Besides attending a well-respected university with an excellent science curriculum, maintaining a grade point average of 3.5 or higher is critical if you want to optimize your potential acceptance into a U.S. medical school.

By incorporating one, or all of the following activities in your undergraduate career, you may improve your chances of getting into medical school:

Job shadowing – Most colleges and universities can help you find opportunities so you can follow, or shadow a neurologist, or neurosurgeon throughout a workday. Doing so gives you a good perspective on what to anticipate in these careers. It also provides some practical experience you can include on your medical school applications.

Volunteer – Doing well in school and having a high-grade point average may not be quite enough to get into medical school. So being active in your community on a volunteer basis could give you an edge.

Learn a foreign language – Including 3-4 years of a foreign language while in college is helpful. Neurosurgeons and neurologists work with many patients who do not speak English. Learning a second language, especially Spanish, will help you stand out against other medical school candidates.

Step 2: Take the MCAT and Apply to Medical Schools

All medical schools require potential students to take an admissions exam known as the MCAT® (Medical College Admission Test). You’ll take this standardized exam during your junior year of college. The results of this test give medical schools a good idea of the skills you acquired in your undergraduate pre-med program. You will have to obtain a minimum score on this if you want an admissions interview at any medical school. Since admission into these schools is highly competitive, taking a specialized study course to get the best score you can is something to plan on. The AAMC has more information on the MCAT. You can also refer to the American Medical Association or the American Association of Colleges of Osteopathic Medicine (AACOM) .

Step 3: Attend Medical School and Obtain a Medical Degree

Once you’re in medical school, you’ll take four years of medical curriculum. This curriculum is general and consists of medical classes intended to give you an overview of the content. Experiential opportunities exist where you practice what you are learning in the classroom.

In the second half of a traditional four-year program, aspiring neurosurgeons and neurologists can register for courses that include medical diagnostics, disease management and, in the case of neurosurgery, surgical practices. When you get to the point of practical rotations, choose those experiences that allow you to examine and treat patients within what is called a teaching hospital. Interacting with patients under the supervision of qualified neurologists or neurosurgeons exposes you to situations you may encounter in your practice.

For those wanting to be neurosurgeons, you want to be sure you’re doing the same thing; only you’ll be under the supervision of an actual brain surgeon.

Step 4: Complete an Internship or Neurosurgical Residency Program

In addition to passing a medical licensure exam (explained in Step 5), you’ll complete an internship. The internship allows you to apply everything you learned in medical school but under the supervision of a seasoned, qualified medical doctor. This hands-on experience will make you a better physician, and further prepare you for your specialization of neurology.

With your interest in neurology, part of your medical training will include a one-year hospital internship. During this phase, you’ll manage patients and develop some of the skills that will be vital to your future career. Part of your internship will include staying updated with the latest information in the field.

While you’re engaged in your internship, you will search for a residency program unique to the neurological specialty you selected. Tracks include headache medicine, neuromuscular medicine, strokes, etc. If your desire is to become a neurosurgeon, you’ll involve yourself in a neurosurgical internship.

Upon completion of your internship, you’ll enter your residency program. For the non-surgical neurologist, your residency will be about three years in length. You’ll make hospital rounds with a supervising neurologist and have opportunities to monitor patients and perhaps examine them yourself.

For a neurosurgeon, the residency is six to eight years. You will work with licensed neurosurgeons learning the skills and techniques required in a daily surgical practice. At some point in your residency, you’ll scrub in and assist with surgeries.

Residency programs are long and intense. But they can also be enjoyable because you are practicing in the field of your choice. In addition to working with patients, you’ll also attend lectures and have opportunities to discuss scenarios involving actual case studies.

Step 5: Get Board Certified and State Licensed

Your journey is not yet over. There are licensure and certification tests you must take, and pass. They have both oral and written components. These exams assess your ability to apply the knowledge, principles, and concepts you have learned in school to actual practice. By the conclusion of them, you will have independent verification that you can practice safe and effective patient care. These tests are rigorous, and as with the MCAT, it is strongly recommended that you take the time to participate in a review course before attempting any of the exams.

To become licensed as a medical doctor, you must become fully state licensed and board certified. The first step in this process is applying to take the test through the United States Medical Licensing Examination organization. This begins a three-step process sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). Additional information can also be found through the American Medical Association (AMA).

The American Board of Psychiatry and Neurology, Inc. (ABPN) is a member of the American Board of Medical Specialties (ABMS).

The American Board of Neurological Surgery is also a member of the ABMS and facilitates the certification exam for neurosurgeons. Their website lists the training requirements and the components of the exam as well as exam deadlines and testing dates.

For details on becoming a certified as a neurologist or a neurosurgeon, visit the ABMS.

You may wonder why there are so many exams. You are interacting and working with human beings. In some cases, their lives may depend upon your skills and abilities. So the medical profession polices itself. By doing so, it does its very best to ensure doctors and surgeons are well qualified to extend patient care.

Step 6: Continuing Education

In spite of all the education required for becoming a neurologist or neurosurgeon, continuing education is necessary to renew your state license and board certification. Both of these have to be periodically updated for you to keep practicing.

Continuing education can be completed through fellowships for both neurologists and neurosurgeons. You can choose to focus on oncology or pediatrics or other subspecialties within the field of neurology, surgical or non-surgical. Specialization requires several more years of education. The length varies depending upon your subspecialty. For example, a vascular neurology fellowship may take only a year, but a child neurology fellowship could be three years.

In the alternative, you can attend classes and seminars offered by various medical associations and schools. There are local, state, and national medical organizations all over the country. Some are general while others are very specific. Some even accept student members. A web search can turn up ones in your geographic area.

No matter what option you choose, the objective of continuing education is to ensure you remain current on new procedures, techniques, and breakthroughs in the field of neurology.

Some things you can do right now

Although you may still be in high school, or younger, there are some things you can do right now to learn more about neurology and becoming a neurologist or neurosurgeon.

One is attending a summer internship program designed for high school students. There are a few specific to neurology. Others focus on alternative medical specialties. A number of them exist for further explorations into science which is helpful for students interested in science or medicine but aren’t sure what field to pursue.

Two summer high school programs specific to neurology

The first is the Summer Student Program offered by the University of Wisconsin Medicine Department of Neurological Surgery. It gives students an opportunity to explore basic and clinical neurosciences.

The second one is facilitated by the National Institute of Neurological Disorders and Stroke in Bethesda, Maryland. Their Summer Program in the Neurological Sciences focuses on research in neurological science.

If you are still not old enough to attend one of these, or the one you’re interested in is too expensive, or too far away, you have a much more convenient, less costly option.

Become an online neurologist/neurosurgeon apprentice!

Before college educations were available, on-ground or online, people apprenticed to masters to learn various trades like plumbing, or bricklaying. You may have heard the phrase “apprenticed to a master plumber” (or electrician or construction worker). It took years to become a master, and there were levels between an apprentice and master, such as journeyman. Apprenticeships were often unpaid.

Some trades still offer apprenticeships. Professional occupations in medicine do not. However, the Internet allows you an option to be an apprentice in neurology. Regardless of your age, you can start learning with the help of The Apprentice Doctor.

They offer an online neurology program you can start today. The Apprentice Doctor offers an inexpensive For Future Doctors Course and Kit for aspiring medical professionals. In addition to fact and theory, the course also provides opportunities to practice some of the skills neurologists, and neurosurgeons perform. In essence, you become an apprentice neurologist.

If you missed any article in our neurology series and would like to go back and catch up, click on the following links:

The Nervous System and How it Works.

What’s the Difference Between A Neurologist & Neurosurgeon?

A Day in the life of a Neurologist and Neurosurgeon.

Interview conducted with a practicing neurosurgeon.

As you learned in the article The Nervous System and How it Works, neurology is the study of the nervous system. Today’s article will discuss the differences between a neurologist and a neurosurgeon and how each profession works with people who experience problems with their nervous system.

Neurologists

Neurologists are medical doctors who learn what the nervous system does and how the nerves work in conjunction with the brain and the rest of your body. They recognize when someone has a healthy nervous system, and when someone doesn’t. When people come to them with a problem, they work hard to figure out what might be wrong and how it can be corrected without surgical intervention.

Some neurologic conditions, like your arm falling asleep, are temporary and don’t require a neurologist’s care. But other illnesses, disorders, or injuries involving the nervous system may need a neurologist’s intervention. If individuals experience problems with their sense of touch, smell or even sight, a neurologist can determine if the conditions are temporary, permanent, or treatable. Although not all sensory and muscle problems are caused by nervous system disorders, some may be. That’s why a neurologist’s opinion can be vital.

People may elect to see a neurologist if any of the following symptoms occur regularly:

• changes in sensation/feeling
• chronic dizziness
• confusion
• coordination problems
• muscle weakness

What conditions do neurologists treat?

People see neurologists for a variety of reasons. You may be familiar with some of them, but not know a neurologist treats them. These include:

Headaches – Some headaches are caused by tension, stress, or even lack of sleep. Most are temporary and can be relieved with over-the-counter medications. But some people experience chronic headaches. Chronic means that the pain is severe and recurring. Migraines, one of the most well-known forms of chronic headaches, and can prevent people from going about their normal routines. They can make suffers sick to their stomachs and highly sensitive to light and sound. Some people can’t even leave their homes. These types of headaches have to be diagnosed and treated by neurologists. The American Migraine Foundation provides information to people with migraines or those interested in learning more.

Multiple Sclerosis – Multiple Sclerosis, also referred to as MS, is an autoimmune disorder. Autoimmune diseases are when the body attacks its own immune system. In the case of MS, the disease wears away the protective coating of the nerves. If you compare the nerves to speaker wires, MS will occur when the plastic layer protecting those wires is stripped away. When exposed, the wires are more likely to sustain damage. If they become damaged, the quality of sound coming from the speakers diminishes.

MS works the same way with one key difference. It spreads and eventually weakens all bodily functions because it attacks the brain and spinal cells. In the early stages of the disease, a person will feel numbness and tingling. As the nerves degenerate, a person suffers, among other things, exhaustion and balance issues. MS is considered a progressive disorder. When a disease is progressive, it means symptoms gradually worsen with little hope of improvement. In the case of MS, the person eventually loses control of mobility. In its later stages, seizures may occur. Since there is no known cure, a neurologist sees individuals with MS indefinitely. The National MS Society can tell you more about this disease.

Neuromuscular Disease – Neuromuscular diseases, or disorders, impact your voluntary muscles. These are muscles you control, such as your hands, legs, and arms. If the nerves that send messages to these muscles are damaged, or even die, communication between them and your brain is less capable. When that happens, your muscles weaken and eventually could waste away. A person can experience twitching and joint and movement problems. Although MS is an autoimmune disorder, it’s also considered a neuromuscular disease since it affects voluntary muscles. The American Association of Neuromuscular & Electrodiagnostic Medicine can update you with the latest research and education on neuromuscular disorders.

Seizure Disorders – When the electrical wiring in your brain is disrupted, a person may experience twitching, shaking or some other kind of involuntary movement. These involuntary movements are known as seizures. A car accident where you hit your head on the windshield could cause a single occurrence of a seizure. Since this is situational in nature, it’s unlikely to recur. So it’s not considered a seizure disorder. Although you may see a neurologist just to be sure everything is okay, the seizure would only be diagnosed as a disorder if you have two or more of them. A type of seizure disorder you may be familiar with is epilepsy.  The Epilepsy Foundation can tell you more.

Stroke – A stroke can occur when the blood flow to the brain is interrupted in some way. The interference deprives the brain of oxygen, which, in turn, damages that area of the brain. The amount of damage is determined by how long the body has been without oxygen. The body part(s) controlled by that section of the brain will subsequently be impaired in some way. Sometimes a person will lose muscle control. Other times one side of the face may droop. An inability to talk can also occur. Neurologists work with stroke patients and provide treatment plans for their recovery. Some people end up being fine. Others may not be as fortunate and experience permanent damage. If you’d like to learn more about strokes, the National Stroke Foundation do so.

Although these are not all the disorders and diseases that neurologists come into contact with, they are some of the most common. The more you study neurology, the more you’ll realize the many kinds of ailments neurologists treat.

Due to the complexity of the nervous system, neurologists may choose to specialize in certain areas, learning everything they can about that one aspect of the nervous system.

In addition to the ones listed above, these include:

• autonomic disorders (involuntary functions of the nervous system)
• child/pediatric neurology (nervous system disorders suffered by children)
• epilepsy (disturbances in the senses, seizures and other abnormal electrical activity within the brain)
• geriatric neurology (nervous system disorders in older populations)
• headache neurology (headache pain caused by vascular disorders or inflammations)
• neurocritical/neurointensive care (life-threatening diseases of the nervous system)
• neuromuscular medicine (soft tissues and muscles)
• neuro-oncology (cancer of the nervous system)
• stroke care (vascular care)

It’s easy to see that the field of neurology is extensive. If you decide to become a neurologist and choose to specialize, you will have many options.

Neurosurgeons

As well-trained as they are, neurologists are not neurosurgeons. Some neurologic problems require surgery to correct. A neurosurgeon trains in the surgical aspects of neurology. However, to be an excellent neurosurgeon, he or she will be knowledgeable about neurology in general.

Neurosurgeons are considered specialists in the field of neurology. But as the name suggests, they focus on surgical procedures. Neurosurgeons are called in for emergencies requiring treatment of brain, spine and skull trauma. They may also remove tumors and blood clots. Some perform radiation treatments, traditional open surgery or perhaps microsurgery. Frequently they face severe conditions in which someone’s life may depend upon their skills and expertise.

What surgeries does a neurosurgeon perform?

Like neurologists, neurosurgeons deal with a variety of conditions. You may be familiar with a few, but not know neurosurgeons treat them. These include:

Aneurysm repair – An aneurysm is a weak area in a blood vessel that causes it to bulge or balloon out. Weaknesses may be so severe the blood vessel bursts. If it does, it may cause bleeding, or hemorrhaging, into the brain. This bleeding could result in the blood collecting or clotting which is known as a hematoma. Neurosurgeons will attempt to repair an aneurysm in one of two ways.

• Clipping – Clipping is done by opening your scalp, skull and other coverings of the brain. Then a metal clip will be placed at the base of the neck of an aneurysm, so it doesn’t rupture.
• Endovascular repair – When an endovascular repair is done, thin metal wires are inserted into an aneurysm. They coil into a little mesh ball resembling a tea strainer. Blood clots form around it which prevent the rupture of an aneurysm. Occasionally a stent, which is a mesh tube, is also inserted to keep the coil in place.

Much research and education on brain aneurysms is conducted by the Brain Aneurysm Foundation.

Craniotomy – A craniotomy is when a neurosurgeon cuts an opening in the skull to expose the part of the brain beneath it. At the conclusion of the surgery, tiny plates and screws replace the opening. Neurosurgeons perform craniotomies to diagnose, remove or treat brain tumors; repair aneurysms and skull fractures; remove blood or blood clots from leaking blood vessels; drain brain abscesses, and relieve pressure on the brain caused by traumatic injuries.

Disk removal – A disk removal is one of the more common types of back surgeries. The official name for this kind of operation is diskectomy or discectomy. When performing a disk removal, the neurosurgeon removes an intervertebral disk. Intervertebral disks are the flexible parts of the spine between each vertebra. Intervertebral disks protect the brain and spinal cord from any impact produced by the body’s movements in the same way shock absorbers protect passengers of a car from bumps and potholes in the road. This type of surgery is only suggested if a person has been in back pain for six or more weeks. It is done under general anesthesia and can take a person up to eight weeks to resume all normal activities.

Lumbar puncture – Sometimes a neurological disorder can be determined by sampling some spinal fluid. If this is the case, a neurosurgeon may perform a lumbar puncture. The surgeon numbs the spine and then inserts a needle into it drawing out some fluid. It’s similar to a blood test when a phlebotomist inserts a needle into your arm and removes blood for examination in a lab. A lumbar puncture works the same way. Sometimes after a lumbar puncture, a person may develop a headache or experience some back pain, both of which are temporary. A lumbar puncture can help diagnose neurologic disorders such as acute bacterial, fungal and viral infections, including meningitis, encephalitis, and syphilis. It can also identify certain cancers involving the brain or spinal cord.

Other types of surgeries can help the following conditions:

• brain tumors (primarily abnormal growth of cells in the brain)
• functional neurological disorders (when the brain appears normal but functions incorrectly)
• neurovascular diseases (strokes and aneurysms)
• pediatric and developmental disorders (covers a wide range of physical and mental neurologic disorders in children, some of which emerge at birth)
• pituitary tumors and other neuroendocrine disorders (any disease that affects how the nervous system interacts with the endocrine system which is series of glands that regulate metabolism, sleep, mood and other things)
• trauma, emergency, intensive care and general neurosurgery (brain injuries, strokes, and life-threatening situations in the nervous system)

Want to learn more?

If you’re interested in neurology and what it takes to become a neurologist or neurosurgeon, The Apprentice Doctor offers a For Future Doctors Course and Kit. You can start learning today! In addition to fact and theory, the course also provides opportunities to practice some of the skills neurologists, and neurosurgeons perform. In essence, you become an apprentice neurologist.

If you missed any article in our neurology series and would like to go back and catch up, click on the following links:

Path to Becoming a Neurologist or Neurosurgeon.

A Day in the Life of a Neurologist and Neurosurgeon.

Interview conducted with a practicing neurosurgeon.

At the very center of the nervous system is your brain. What you see and hear first registers there. Imagine you are with your friends at school and they start acting silly. You see them and hear them, then decide you want to video them on your smart phone. All those thoughts have transpired in your brain, but the process doesn’t stop there. Once you’ve decided to video them, your brain tells you to pull out your smartphone, focus it on your friends, hit the record button and follow them around for a while. Although you may not realize it, your brain has masterminded each action.

Your brain produces tiny electrical signals throughout your body so it functions properly. It sends these signals through pathways known as neurons. The system of neurons creates your personal electric wiring.

The way your nervous system works can be compared to how your computer works. When you press the power on your computer, a signal goes out. The signal is a catalyst that generates a number of actions and responses. An electric current travels over the wires maintaining a connection to electricity. Your computer makes some sounds to let you know it’s working. Light comes onto the screen, images appear, programs are loaded and your Internet connects. In other words, based on the catalyst of the “on” button, your entire computer powers up.

Your nervous system works similarly. When you want certain muscles to move, your brain transmits messages over your neurons. This pathway maintains a continuous electrical connection between your brain and your muscles. The connection enables your muscles to move the way you wish.   Your muscles “power up.” That’s the essence of your nervous system.

Major parts of the nervous system

The nervous system is intricate with many elements working together. Your brain and spinal cord make up the first major part called the Central Nervous System (CNS). The nerves going to and from the CNS make up the second primary part; the Peripheral Nervous System (PNS).

Bone protects the CNS from injury. It safeguards your skull or cranium the same way shells protect the soft bodies of snails and turtles. Vertebrae are the bones protecting your spinal cord. Unlike the skull which is a single piece of bone and can’t bend, your vertebrae are flexible. The flexibility is why you can twist at the waist or curl up in a ball.

No type of boney armor surrounds your PNS. For example, have you ever had your arm fall asleep? When it does, you may not be able to move it or even to feel it for a minute or two. That happens because it’s been in one position too long and you have temporarily pinched a nerve. The pinch occurs due to lack of protection. That nerve is part of the PNS.

You can also separate the nervous system by what it does. Pretend you saw a hornet buzzing around you and it wouldn’t go away. You’re positive it’s going to sting you, so you want to put some distance between you and it. You run in the opposite direction. Maybe you’re brave and swat at it instead. It flies away from you. Either action keeps you safe which is a function of the sympathetic nervous system. When it recognizes danger, it “powers up.” It makes your heart beat faster and pumps more blood to your muscles so you can put up a fight or run like crazy. In psychology, this is called “fight or flight.” Fight or flight actions happen when you feel threatened in any way.

Let’s say no danger from bees, hornets or anything else is around you. But you are hungry and thirsty. You know you need to eat and stay hydrated. These are basic human survival needs. That’s when your parasympathetic nervous system kicks in. When you eat and drink, it “powers up” by ensuring your body digests everything correctly. It’s one way you remain healthy.

Other functions like your breathing, blood flow, or heart beat happen automatically. These are spontaneous, and you never have to think about them. However, if anything in your nervous system changes, you’ll recognize something isn’t quite right. When you do, you’ll seek out a neurologist who specializes in how the nervous system works and how to help if anything’s amiss.

Other significant parts that make up the nervous system

When you watch a television show, you focus a lot on the main characters. But without a supporting cast, they would fall flat. The entire ensemble of actors is vital to the success of the whole show. The nervous system works the same way. The brain and spinal cord are the main characters, but they need support from the rest of the cast in the nervous system. The ones listed below are the ones you’re most likely to run across in a basic anatomy or biology class.

Neurons – Neurons are nerve cells that respond to stimuli. A stimulus can either excite or irritate the nerve. Either one of these creates an impulse, which is a tiny electrical current that sends a message to the brain to act.

There are four ways neurons are stimulated.

• Sound – When neurons in your inner ear hear something, you respond to it. When you hear certain sounds on your smartphone, your response is generally to look at it. Only seconds pass between the sound and your action. In that short amount of time neurons have received all that information from your ear and then sent it to your brain, and then to your muscles and eyes.
• Heat – When neurons in your skin feel heat, you react to it in some way. If you plug in your smartphone for charging and get an electrical shock, you’ll feel some kind of heat. Your first action will be to let go of the phone. Your neurons have orchestrated all the impulses leading to that action.
• Light – The neurons in your eyes are sensitive to light and dark. You will react accordingly. Imagine you are learning a new app on your smartphone. You watch a tutorial and then repeat the actions you’ve seen demonstrated. That very repetition is made possible through the light stimuli the neurons receive through your eyes.
• Pressure or Length – Your muscles also contain neurons. When they sense a change in length or even pressure, your muscles respond. When you pull out your smartphone, muscular neurons provide sensory impulses to your brain. In turn, your muscles know how much pressure is needed to hold the phone so that you don’t drop it on the floor.

Neural networks, or connections, allow all these impulses to travel within your body. They operate much like the fiber optics connect you to the Internet. They send and receive electrical impulses quickly and reliably.

Dendrites and Axons – Dendrites and axons are extensions of the neuron or nerve cells. Dendrites bring information to the cell body. Axons take information away from the cell body. Text messaging is an example of how this works. There’s an electrical component (dendrite) in your smartphone that allows you to receive messages from your friends. A different electrical component (axon) enables you to send replies back to them.

Soma – The soma is the cell body of the neuron. It works almost like an assembly line in a factory. It packages up everything a neuron needs to send impulses to the brain for use.

Cerebrospinal fluid (CSF) – Cerebrospinal fluid covers the brain and the spinal cord. The fluid cushions the brain within the skull. It also provides general protection for the CNS. Lastly, it circulates nutrients and removes waste products from the brain.

Blood-brain barrier (BBB) – This wall or gate serves as a type of security guard for the brain. It’s semi-permeable which means some things can get through while others cannot. The BBB prevents foreign substances in the blood from entering the brain. It also protects the brain from the hormones and neurotransmitters operating in other areas of the body. Plus, it maintains a stable environment for the brain.

Formation of the central nervous system

When the CNS develops, it looks like a tube inside an embryo. The major regions of the brain begin to form at the head of this tube. Parts of the brain that develop here, as well as their primary functions, are:

Cerebellum – The cerebellum allows us to move parts of our body voluntarily. We are able to walk, write and stay balanced.

Cerebrum – Our brain is divided into a left and right hemisphere. The two spheres are located inside the cerebrum which is the largest part of the brain. Like a supervisor in a workplace, the cerebrum provides oversight for many of our activities of daily living. We can think critically and analytically due to our cerebrum. Talking, understanding language, and controlling our emotions are other actions controlled by this part of the brain.

• Left Brain & Right Brain – You have probably heard the phrases “left brained” and “right brained.” These terms refer to how we process information. People who primarily think on the left side of the brain (left hemisphere) seem more logical to us. People who mostly think on the right side of their brain (right hemisphere) seem more creative. Language and other logical processes may be conducted more on the left while visual and intuitive processes are carried out on the right. These are only patterns or tendencies, so it’s important to understand that both sides of the brain are involved in all processes in some way.

Diencephalon – The diencephalon is composed of two parts:

• Thalamus – The thalamus sorts all electrical impulses. It identifies the information coming to us through our senses and then directs it to appropriate areas of the brain for processing.
• Hypothalamus – The hypothalamus motivates us to eat and drink. It also maintains our normal body temperature of 98.6 degrees. Its other important function is controlling our pituitary gland. This gland manages all the other glands in the endocrine system.

Medulla oblongata – The medulla oblongata is part of the spinal cord. It controls the heart and lungs. Among other things it also helps regulate breathing, digestion, swallowing and even sneezing.

Midbrain – The midbrain assists with motor movements, especially those involving our eyes. It helps us process auditory and visual information.

Pons – The pons is a connector within the brain. A part of the brain stem, it links the thalamus and the medulla.

Neurologists and neurosurgeons become well acquainted with all areas of the brain – large and small. So it’s easy to understand why so many years of schooling are required before neurologists can practice.

What health-related functions does the nervous system regulate?

As you have seen, the nervous system relates to nearly every aspect of our health and well-being. It’s involved in something as simple as closing your eyes to managing more complex processes such as critical thinking.

Other functions regulated by the nervous system include:

• Aging
• Body temperature
• Brain growth/development
• Breathing/heartbeat
• Healing/rehabilitation
• Hunger/thirst/digestion
• Learning/memory
• Movement/balance/coordination
• Puberty/reproduction/fertility
• Sensations – touch and hearing and the mental processes of interpretation
• Sleep
• Stress/bodily responses to stress
• Thought and emotions

The nervous system impacts almost every part of our body at every stage of the life span. Specializing in how it all works together is important so we can maintain optimal health. Neurologists study the nervous system to understand when it is functioning properly or when changes impair it.

Want to learn more about the nervous system?

If you’re interested in the nervous system and what it takes to become a neurologist or neurosurgeon, The Apprentice Doctor offers a For Future Doctors Course and Kit you can start today. In addition to fact and theory, the course also provides opportunities to practice some of the skills neurologists, and neurosurgeons perform. In essence, you become an apprentice neurologist.

If you missed any article in our neurology series and would like to go back and catch up, click on the following links:

What’s the Difference Between A Neurologist & Neurosurgeon?

Path to Becoming a Neurologist or Neurosurgeon.

A Day in the life of a Neurologist and Neurosurgeon.

Interview conducted with a practicing neurosurgeon.