ABOUT THIS RESOURCE
'Where is the lesion? What is the lesion?'
Neurology is often viewed as difficult by students and doctors alike. Despite this, neurological disorders are very common - globally, they are the leading cause of disability and the second biggest cause of death.
People consistently rate neurology the most challenging part of the medical curriculum. Reasons include the volume of material needed to cover, and the gulf between the basic science - particularly anatomy - and the clinical method: taking a history and performing an examination, then making a diagnosis.
This gulf should not exist. The clinical depends on the science. Doctors should not learn the science without any clinical context - they are not anatomists - while attempting a neurological assessment without anatomy is impossible.
This resource aims to marry the two. It takes the form of illustrative cases, all derived from patients encountered in my practice. It is dedicated to them, in the hope that their examples help people learn neurology - and that it will ultimately help people with neurological conditions.
It concentrates on focal lesions which produce clinical features that can be localised to a specific point - for example an area of cortex or a peripheral nerve. As a result, it is limited to processes that produce focal lesions. This is deliberate - these ‘pure’, solitary lesions are the best way to learn clinical neuroanatomy and localisation skills.
There is much more to neurology than localising lesions - but it's a good place to start, and a crucial skill for anybody seeing patients with neurological problems.
About the author
I am a neurologist based in Scotland. I am passionate about clinical diagnosis and the art of neurology, as well as neuroanatomy - all three attracted me to the specialty many years ago and continue to fascinate me in my day job.
I am also an active educator, working with medical students and doctors in training. My clinical interests include cognition, movement disorders and neuro-infections, and my research background is in prion diseases.
I believe there is no better way to learn neurology than through interactive cases - and the more interactive the better. I'd love to sit and talk through these cases with learners in person, but I hope this helps as the 'next best thing'. I wrote it deliberately phrased to walk you through each case - the idea is to take a journey through the relevant anatomy and bring it to life.
I made this resource both to help other learners and to improve my own knowledge of clinical neuroanatomy. It's been a rewarding experience so far and I have learned a great deal from it. I plan to continue compiling these cases for years to come, building a large lesion study bank - and am excited for what's ahead!
The cases
These cases are all from people I managed in my job as a neurologist. Everybody consented to being included in a free, educational resource - or their next-of-kin did on their behalf.
All agreed that any use of their story as a means to promote education and awareness, and ultimately help other patients in future, was a worthwhile exercise. I've done my best to honour them with this resource.
As you work through the cases, please do think of the people they concern and who suffered the effects of these lesions - I hope you can spare a moment of gratitude to them all for this gift. I'm eternally thankful.
Illustrations
I made all the pictures and videos digitally, drawing them myself.
The majority are not meant to be anatomically life-like or drawn to scale - they are schematics, which show the key areas and tracts and how things connect, and the functional consequences of lesions.
I drew original shapes, but made extensive studies of anatomical resources and real brain scans to help me learn the key structures with all their features. For bony structures I took photos of a model skeleton and drew those.
Scans used are from my own practice. I tended to cover facial outlines in sagittal views to reduce idenfitiability - not that anybody would likely ever find an anonymous individual from a single slice of a brain scan.
The aim is always to show things of functional usage to clinicians, but in images, I usually labelled other nearby structures to help orientate the viewer to the 'neighbourhood' surrounding the area being shown.
Use of AI statement
Words and illustrations are all my own. The only use of AI in producing this resource was to help me with coding - I'm not a web designer and had no experience of HTML and CSS before this. ChatGPT helped me make something that looks exactly like I intended - but it had no hand in the content itself and was only a guide to making a web page and troubleshooting glitches. Forgive me if you find any that I've missed - and do let me know!