Adult neurologist: when to apply, a reminder before taking

Author: Druzhinkina V.Yu., neurologist.
June, 2021.

The nervous system is the command and regulatory center of every person's body. It consists of the brain, spinal cord, and nerves. In case of violations in any link, various symptoms arise that worsen the state of health, reduce efficiency, and reduce the quality of life. An adult neurologist is engaged in the identification of pathologies, treatment and observation of patients over 18 years of age.

Photo: human nervous system: brain, spinal cord, nerves.

Diseases treated by a neurologist

The area of ​​responsibility of the neurologist includes the identification and treatment of disorders in the work of the central and peripheral nervous system, arising at the physical level or in the form of mild disorders psychological spectrum. This is a huge list of pathologies. The most common diseases with which a neurologist is consulted:

• osteochondrosis any part of the spine;
• encephalopathy;
• myositis (muscle inflammation), neuralgia (nerve inflammation), including against the background of herpes;
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• stroke and its consequences;
• epilepsy;
• neuroses;
• dementia;
• panic attacks;
• nervous tic;
• multiple sclerosis;
• amyotrophic lateral sclerosis (ALS);
• illness Alzheimer's, Parkinson's;
• myasthenia gravis;
• meningitis;
• intracranial hypertension;
• restless legs syndrome;
• carpal tunnel syndrome;
• consequences of craniocerebral injuries, spinal injuries;
• headaches of various types, migraine.

To achieve a positive result, the doctor resorts to drugs, physiotherapy, exercise therapy, acupuncture, massage.

Differences from a neuropathologist and psychiatrist

Neurologist, neuropathologist and psychiatrist: the similarities between these terms are as follows - they all refer to specialists with a higher medical education. However, the list of diseases that doctors deal with, as well as approaches to treatment and patient management, differ significantly.

The psychiatrist works exclusively with mental problems, without touching on physiology. The main effect is medication. A psychiatrist is involved in therapy when mental disorders develop against the background of neurological pathology (for example, with Alzheimer's disease).

Neuropathologist - this is an outdated name for the specialty "neurologist", used in the 70s and 80s, is now not used.

Symptoms with which to consult a neurologist

Often, patients underestimate the severity of their condition or do not know at what signs it is time to seek medical help. In some cases, this worsens the prognosis, leading to the transition of the disease into a chronic form. Some symptoms at first glance seem insignificant, but in fact they are very serious - a list of complaints that serve as a reason for contacting a neurologist:

• dizziness;
• headaches;
• noise in ears;
• violation of memory, attention;
• insomnia;
• drowsiness;
• weakness in the arms, legs.

More serious manifestations of neurological disorders:

• disorder of urination;
• fecal incontinence or constipation;
• back pain, limbs, especially fingers, face;
• violation of any kind of sensitivity on the skin;
• impairment of vision, hearing, taste, smell, touch;
• double vision;
• loss of balance;
• loss of consciousness;
• tremor (trembling) of the hands, head, legs;
• swallowing disorders;
• convulsive seizures;
• paralysis of a part of the body.

The listed symptoms do not always indicate a neurological disease, but they definitely require examination by a neurologist.

Does a neurologist treat depression, panic attacks

Yes, a neurologist has the right to prescribe medications for these conditions if the patient comes to an appointment with appropriate complaints or the symptoms were identified during the conversation. With panic attacks, depressed mood or excessive excitability, suspicious, impressionable young people often come to the doctor. For them, the joint work of a neurologist and a psychotherapist will be useful.

Exceptions are people who have warning signs - thoughts of suicide, harm to others, obsessions or movements, or previously identified mental illness. In such cases, the neurologist is not a competent specialist, therefore, he refers to a psychiatrist or psychotherapist.

Can a neurologist prescribe antidepressants?

The doctor has the right to prescribe antidepressants on a prescription form if the patient's condition requires it.

Examination by a neurologist: what is checked and why

Examination by a neurologist involves assessing the activity of the central and peripheral nervous systems. It includes:

• Visual inspection. Are noted: strabismus; relaxed or, conversely, compressed muscles of the limbs; features of gait, voice, manner of communication; tremor; paralysis; drooping of the eyelid (ptosis); liveliness of facial expressions.
• Assessment of the clarity of consciousness. The patient is asked to answer what day of the week is today, day of the month, time of year, etc.
• Reflex test. A reflex is the body's response to a stimulus. When stimulating (pressing, tapping, scratching, light stroking movements) certain points, muscle contraction occurs. Normally, they are of average severity. The weakening of the reflex response indicates a violation of the passage of the nerve impulse through the fibers, which is more often the case with peripheral paralysis. Strengthening is observed with increased emotionality, excitability, as well as central paralysis, which is often associated with a lack of response in the brain. For the examination, a neurological hammer is used, with which light blows are applied to the exit points of the nerves, thereby provoking a response from the nervous system.
• Determination of sensitivity. All types are studied - painful (pinches, claps, injections), temperature (application of cold and warm objects), tactile (pick up an object and describe it with closed eyes), vibration (used fork). The ability to discriminate between tastes and odors can be tested if the patient's condition requires it.
• Evaluation of the cranial nerves. The ability to move the eyes up, down, to the sides and in a circle is impaired with paralysis of the oculomotor nerve, strokes, intoxication, neuroinfections, trauma and brain tumors. Also, the doctor asks to stick out the tongue to determine whether it deviates to the side or not; furrow your forehead, puff out your cheeks, raise your shoulders, swallow saliva, pronounce individual sounds or syllables. It determines the reaction of the pupils to light - how quickly and synchronously they constrict when a beam of light is directed into the eye.
• Coordination. With the help of tests, including Romberg's poses. To perform it, you need to stand upright, close your eyes and touch the tip of the nose first with the index finger of one hand, then with the other. So the doctor determines whether there is a violation of the function of maintaining balance.
• Determination of muscle strength. The neurologist asks to squeeze his hand with the right and left hand, to prevent the extension of the limbs in the joints. So he understands if there are disorders in the field of muscle work.
• Palpation (feeling) of the muscles for tension, weakness, atrophy, soreness. It is necessary for osteochondrosis, myositis, paralysis.
• Check for meningeal symptoms or signs of meningeal irritation. The test is performed as follows - the subject lies on his back, the doctor bends the leg at the hip and knee joints at a right angle, with pathology it is difficult to straighten it; this is Kernig's symptom. The symptoms of Brudzinsky are also checked - when the head is tilted forward or when the pubic area is pressed, the legs are bent, which is a pathological sign. The tests are relevant for meningitis, encephalitis, high intracranial pressure, and oncological diseases of the brain.

A high-quality examination takes from 15 minutes to an hour, which is determined by the complexity of the pathology, the severity of the condition, and clinical manifestations. In addition to the main points above, the doctor can conduct additional tests and samples if necessary.

Medical examination with the participation of a neurologist

It is carried out in cases of examination for weapons, driver's license, before employment, study.

It proceeds according to the same principles as in the case of a disease, but there is no in-depth study of reflexes, searches for pathological signs, if a person is healthy.

Examinations: what a neurologist can prescribe

To clarify the diagnosis and identify the degree of dysfunction of the nervous system, the doctor uses laboratory and instrumental examination methods. These include:

• X-ray of the spine concerned. It is used to establish osteochondrosis, cracks, fractures.
• X-ray of the cervical spine with functional tests (the radiologist asks to tilt the head back, sideways, so that the picture shows how much the vertebrae move when moving). Helps to identify increased joint mobility - hypermobility.
• X-ray of the skull. It is needed to exclude / confirm fractures and cracks of the cranium, including its base.
• CT scan or Spine MRI - allows you to examine problem areas in detail. CT is more relevant for trauma, as it better reflects hard structures (bones). MRI also shows soft tissues - nerves, ligaments, muscles, as well as edema, therefore it is suitable for detecting protrusions, hernias, nerve entrapments, aneurysms, neoplasms, stroke and spinal cord infections.
• CT scan of the brain - it is used to diagnose hemorrhagic stroke, as well as hemorrhages, damage to the bones of the skull against the background of injuries.
• MRI of the brain - the best option for determining ischemic stroke, tumors.
• Ultrasound of the vessels of the neck and brain is an older, but available method of examination, reflecting the narrowing, expansion of veins and arteries, as well as their patency.
• MR-angiography of the vessels of the neck and brain shows the same vessels as ultrasound, but in 3d format, which is more informative.
• Electroencephalography (EEG) - reflects the work of the brain at the time of examination, convulsive readiness. Important for the diagnosis of epilepsy. Indirectly, one can judge about hyperexcitability, emotional lability.
• Electroneuromyography (ENMG) - shows the response of muscles and nerves in response to stimulation. It is used to diagnose diseases of the peripheral nervous system, genetic diseases.
• Electromyography (EMG) - the same thing, only the response from the muscles is recorded when the muscle fibers are excited.

MRI can be performed with contrast - a dye is injected into the vein, which illuminates the vessels in the images or accumulates in pathological foci. It is important in the diagnosis of aneurysms and other vascular pathologies of the brain, tumors, multiple sclerosis.

Laboratory diagnostics is not widely used in neurology. An actual study of cerebrospinal fluid for sugar, protein, sterility, which can help to diagnose a tumor, infection, hemorrhage.

If myasthenia gravis is suspected, a blood test is taken for specific cells - antibodies to the acetylcholine receptor, which are recorded in this disease.

A general and biochemical blood test can also be prescribed to assess the severity of the inflammatory reaction, blood loss. Additional studies are prescribed by a doctor based on the clinical picture of an individual patient.

Memo before taking

What you can do before you take

Before visiting a doctor, it is not worth taking tests or giving instrumental studies - after the examination, the doctor may decide that he needs completely different examinations than those passed before the appointment.

In general, what can be preliminarily passed on the basis of complaints:

• headaches - MRI of the brain;
• pain in the spine - X-ray or MRI of the corresponding section;
• violation of sensitivity, numbness, tingling, creeping feeling - blood for sugar, ENMG / ENG;
• visual impairment - consultation with an ophthalmologist;
• pain in the face, jaw - examination by the dentist;
• violation of the sense of smell - a visit to the ENT doctor.

What the neurologist asks about at the appointment

To clarify the picture of the disease, the doctor will ask questions. What you need to remember before taking:

• when the first complaints appeared;
• whether there was a trend towards an increase or decrease in the severity of symptoms;
• whether relatives have similar problems;
• whether any preliminary examinations were carried out;
• individual intolerance to drugs, products;
• how they tried to be treated - which remedies helped and which did not.

There is no need to worry - the doctor himself will ask the patient about everything in order to obtain the necessary information. But excessive anxiety, on the contrary, will reduce the information content of the conversation.

Most often forgotten to mention at the reception:

• preconditions for the onset of the disease, i.e. what, in the patient's opinion, could provoke the development of symptoms;
• the presence of injuries, operations;
• the use of drugs prescribed by a doctor of another specialty is important to determine the compatibility of funds.

A neurologist is a doctor who treats a large number of pathologies associated with a malfunction of the brain, spinal cord or nerve fibers. To make the final diagnosis, the patient is sent for additional instrumental and laboratory examinations. The earlier a person seeks medical help, the higher their chances of recovery.