Neurology Diagnosis
What are the most common symptoms of a neurological problem?
New onset headaches could be a sign that would make you suspicious that there may be a neurological problem. As would changes in your behaviour, out of the blue. Difficulties with your thinking and memory, depending on your age; that would be something that you would worry about. Numbness someplace. Incoordination. Difficulty with your gait; bumping into things and so forth. Visual disturbances. Loss of hearing in one ear. Difficulty with your bladder control. Pain of unknown ideology; unknown cause. Now, with all of these, the primary physician would probably do some tests to make sure it's not something systemic. If you have the flu or if you have a urinary tract infection, you're going to have trouble with your urine as well. If you don't have a urinary tract infection and you're having problems with urgency, frequency, or whatever, they might send you to a urologist first, but if the urologist says, "Well, this looks like a neurogenic bladder," then you'd see a neurologist at that point. Certainly things like difficulty with your handwriting, difficulty with fine coordination, difficulty with your speech; all of those things would warrant that he send you to a neurologist.
What kind of special training does a neurologist have?
After medical school, you need at least one year of medicine, which is a prerequisite, for a full year. And then there's three years of neurology residency. Most neurologists take a fellowship. So my fellowship was in research, but there are fellowships in electrophysiology, neuroradiology, in neuromuscular diseases, and cognitive problems, et cetera, et cetera. So overall most neurologists with the year of medicine, three years of neurology, and either at least one or two years of fellowship, have about six years of training.
How is a neurological evaluation performed?
It's a combination of getting the history, listening to what the patient has to say, putting those pieces together, knowing the nervous system so that you can figure out roughly what's happening, what's normal and what isn't, trying to sort it out from psychiatric overlay and all the things that are going on in the patient's life, etc., and figuring the patient's age, how long it's been going on, family history of things, and so forth. And then when you examine the patient, if you find specific abnormalities, being able to say, "Well that seems to be in this region of the brain, this seems to be peripheral nervous system versus central nervous system," etc. And then you run diagnostic tests to confirm your impression. So, I'll give you an example in MS: Our major tool for confirming diagnosis is the MRI. But initially, about 10% of MS patients have normal MRI's. So therefore, we want to look at spinal fluid in that patient. If they have an abnormal spinal fluid and they have a history that's consistent with MS, we'll make the diagnosis even though there's a normal MRI.
What are the most common neurological diseases?
Diseases for the most part are diseases like Parkinson's, Alzheimer's, stroke, MS, peripheral neuropathies, muscular dystrophy, myasthenia gravis. For the most part, the neurologists in general do not take care of brain tumors, although we diagnose them, generally speaking. There are a few neurologists who really have an interest in brain tumors, but most of us do not.