Why would you need to see a neurologist?
An evaluation by a neurologist may be recommended by your primary care physician for a wide range of conditions. These conditions include headaches and migraines, dizziness or passing out (called syncope), memory loss, personality change, vision changes, strokes or mini-stroke symptoms, and tremors. Neurologists also monitor chronic, or ongoing, medical conditions such as multiple sclerosis, neuropathy, and brain tumors. They also help manage diseases such as Alzheimer’s or Parkinson’s, and can help diagnose and manage infections in the brain or spinal cord, including meningitis.
What does a neurologist do on your first visit?
On your first visit with a neurologist, you should expect the physician to take a careful medical history, review your current medications, and ask about your recent neurological symptoms that may have prompted this visit, such as headaches, seizures, dizziness, or memory problems. If you have had prior neurological testing, you should bring these results for the physician to review.
The neurologist will then do an extensive physical exam focusing on the nervous system, including your nerves and muscles.
He or she may order blood work or imaging tests such as MRI or CT scans of the head or spine to help diagnose your condition. Other common tests can include an EMG (electromyogram), which tests for the interaction of a nerve and its related muscle, and an EEG (electroencephalograph), which is a test that monitors brain function and helps diagnose seizures. In cases of suspected infection, a spinal tap (also called lumbar puncture) may be performed.
What does a full neurological exam consist of?
A full neurological exam consists of evaluation of the many aspects of the nervous system. This includes a mental status evaluation, in which the physician will assess if the patient is oriented to person, place, and time, as well as ensuring that the patient is speaking and interacting in a normal manner. Coordination and balance are also evaluated. Sensory testing, including the ability to distinguish between hot and cold is also performed. Reflexes are tested with a reflex hammer.
Additionally, the 12 cranial nerves are also tested. These include:
- Cranial nerve I- olfactory nerve, responsible for sense of smell
- Cranial nerve II- optic nerve, involved in vision
- Cranial nerve III – oculomotor nerve, involved in pupil size and some eye movement
- Cranial nerve IV – trochlear nerve, involved in eye movement
- Cranial nerve V- trigeminal nerve, muscle of chewing and allowing for face sensation
- Cranial nerve VI- abducens nerve, involved in some eye movement
- Cranial nerve VII- facial nerve – involved in movement of face, taste, and smiling
- Cranial nerve VIII- acoustic nerve, involved in hearing
- Cranial nerve IX- glossopharyngeal nerve – involved in taste, swallowing, and gag reflex
- Cranial nerve X – vagus nerve, involved in swallowing, gag reflex, taste, and some speech
- Cranial nerve XI- accessory nerve – involved in shoulder and neck movement
- Cranial nerve XII – hypoglossal nerve – involved in movement of the tongue
What can a neurologist diagnose?
A neurologist can diagnose a wide range of disorders related to the nervous system, including the brain, spinal cord, nerves and muscles. These include strokes and mini-strokes (also called TIAs or transient ischemic attacks), traumatic brain injury, tumors, inflammation of the brain or spinal cord, infections of the nervous system such as meningitis and Bell’s palsy, vascular abnormalities such as aneurysms, brain damage, epilepsy, neurodegenerative diseases, and multiple sclerosis. Other conditions that neurologists can diagnose include peripheral neuropathy, degenerative disc disease, and attention deficit hyperactivity disorder.
What can you expect when meeting with a neurologist?
Upon meeting with a neurologist, you can expect that your medical history, current medications, and neurologic symptoms will be discussed and reviewed. You will have a physical exam that will focus on the nervous system, including brain, spinal cord, nerves, and the muscles associated with them. You may have further testing ordered, including blood and urine tests. CT or MRI of the brain may also be ordered, depending on your condition. At subsequent visits to your neurologist, you can expect to receive tests results and guidance about your condition. Medication may be prescribed. If you have a chronic condition, such as multiple sclerosis or peripheral neuropathy, your level of functioning should be reassessed at each visit.
Why would a neurologist order an MRI of the brain?
A neurologist may order an MRI of the brain to assess for various brain problems or conditions. An MRI, or magnetic resonance imaging test of the brain, is a painless test that uses computer generated radio waves and a strong magnetic field to create images of the brain that can help diagnose various medical problems. The patient lays on a table inside a tube and a magnetic field is created around the patient which enables images of the nervous system to be created for review. Some patients may experience claustrophobia during this test, which can take up to one hour. If you know you are claustrophobic, you should discuss this with your neurologist prior to having your MRI.
The brain MRI helps assess and diagnose conditions such as stroke, brain injury, tumors, inflammation, infections such as meningitis, degenerative brain diseases, and conditions such as multiple sclerosis.
