One of the many core abilities of any physician is the ability to accurately locate nerve lesions based upon the combination of neurological signs and symptoms at presentation.
Doctors must have a good understanding of the various spinal tracts and also where they decussate in order to track down the specific location.
This is often one of the more complicated areas of pre-clinical medicine for students to understand although there is now a free app available which explains the various spinal tracts and helps clinicians accurately locate the site of a lesion.
Neuro Localizer has been developed by staff at the University of Michigan Department of Neurology and is one of a range of neurology apps available.
Neuro Localizer opens with an image of a gingerbread man which is somewhat unnerving and masks the true detail and power in this app. Users can tap on a part of the man to bring up a list of signs/symptoms as can be seen in the screenshot below. Entering more specific detail about the deficit on the submenus helps identify the exact pathway.
Adding more signs and symptoms adds more nerve pathways.
Once you have selected an exact issue, the app displays an animation showing the spinal tract/nerves affected clearly highlighting where the nerve decussates.
It is possible to add up to 5 signs to observe how the relevant pathways all interact. The real strength of the app is that it attempts to localize the legion based upon the signs entered. When you enter the first sign, there are clearly lots of places where a nerve lesion could be. As you add more signs in, the lesion is likely to be in areas which all the pathways run through. This is very helpful for refreshing your memory on the various nerve tracts and pathways but it also serves a useful purpose ensuring that you scan the right part of someone looking for a lesion.
As you can see from the screenshots the app has used the presenting signs and narrowed down the potential locations of a nerve lesion eventually localizing to the Left Pons. One improvement would be some extra information related to which tracts are actually affected. This would help understand why a lesion in that particular area may cause the presenting symptoms.
The user interface is simple and straightforward to use. The limitation of five signs means you need to be quite selective and go for general signs if there are lots of areas affected. However, this is also helpful if you are trying to identify a specific nerve root lesion as the detail is high — e.g. reduced flexion in fingers or thumb on one hand. The purpose of the suggestions tab is not entirely clear although it can be amusing at times.
- Clear animations and use of colour highlighting the path of each sign
- Ability to quickly localise a lesion
- Clear simple effective user interface
Dislikes (Future updates)
- The fact that the main character is a gingerbread man does not do the app justice
- Extra information related to each pathway tract to help understand why each lesion causes certain signs and symptoms
- No neurological information related to pelvic autonomic functions e.g. cauda-equina etc
Healthcare providers that would benefit from the app
- Practicing Physicians, Residents, trainees and medical students
- Expert patients who are interested in understanding the physiology and anatomy behind a potential nerve lesion may find this helpful and informative without being overpowering.
Neuro Localizer is a great app for physicians and trainees to remind themselves of the various nerve pathways and how they cause neurological signs and symptoms. Medical students will also find the combination of simple user interface, clear colourful animations helpful when trying to understand the various types of nerve lesion and the basic principal of localization
Rating: (1 to 5 stars) 4
1. User Interface 4 – How easy is the app to navigate? No problems at all. Simple app with a simple user interface
2. Multimedia usage 4- Great usage of animations to clearly highlight each pathway and the potential site of a lesion
3. Price – 5 Free
4. Real world applicability – 3 Neurological deficits are important to localise to plan appropriate treatment and management
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.