INVESTIGATION

 

I qualified in medicine in 1976.  At that time, I became a Neurology Houseman.  In that year, CT brain scanning became available at the London Hospital and it was revolutionary although the picture quality was hazy and rather poor. 

Before CT scanning emerged, I would always have had on my ward many patients who had undergone such horrendous investigation as direct puncture, carotid angiography, air encephalography or Myodil myelography.  These investigations now committed to             a history of medicine text book, used to leave people desperately unwell for days and the information achieved was very limited compared to what CT scanning then provided.

If we thought that CT scanning was a revolution, then there is no word that actually describes what MRI scanning has done for neurology.  The ability to look at soft tissues within the skull and in particular the back part of the brain and the spinal column is actually truly remarkable and I still get a thrill when I show patients the wonder of our modern technology.  We are actually able to see the nervous system more clearly than was available to ancient anatomists when they undertook fine dissections of autopsy material.

This has meant a great change for neurological practice.

In my early years at the National Hospital, much time was always spent on anatomical localisation and diagnosis with very little energy being left for treatment.  Hours of discussion would take place as to where a problem was arising in the nervous system and often patients had to be kept as in-patients for weeks or even months, allowing a natural history to develop and a more obvious diagnosis achieved.

Now with the advent of MRI scanning, no discussion really needs to take place.  All that needs to happen is the appropriate investigation carried out and then all attention can be given to the management of the condition. 

This is not saying that there needs to be extensive discussion about diagnosis but the anatomical localisation is confirmed or denied almost immediately. 

MRI scanning can look at the whole of the neuraxis, peripheral nerves and muscles and experimental so-called functional MRI is beginning to look at the brain from a functional as opposed to a purely anatomical way.  More information about this can be obtained from visiting appropriate MRI websites.