MS or a Stroke

Today I saw and examined many patients with neurologic complaints. Just to name a few of the complaints: short term memory loss, numbness and weakness of distal lower extremities (feet), burning sensation in left upper extremity, numb toes, right sided paralysis, new onset seizures, head aches, etc. This was all in clinic. Some of the patients were new patients with first time complaints and some were follow up patients with chronic pathology.

What does a neurologist do? The main goal of a neurologist is to localize the affected part of the nervous system which will lead to treatment. First you need to find out the history of the patient. What other diseases and problems exist? What familial medical issues exist? How did your parents die or what diseases do they have? Do you smoke? Do you drink? Do you use illicit drugs? Are you sexually active with men, women or both? Do you use protection? You basically want to gather any and all pertinent information that could play any role in the neurologic complaints. Then you will ask lots of questions about the complaint. When did the pain start? What does the pain feel like, is it sharp, stabbing dull? What makes the pain worse? What makes the pain go away? How long have you had the pain, etc? Next you will do a focused neurological exam to help pinpoint the problem. You look for weaknesses, decreased sensations, decreased reflexes, etc. Hopefully by the time you finish your history and physical you have a good idea of what pathology / disease you are dealing with. Then you order laboratory and diagnostic tests to help solidify your diagnosis or rule out certain pathologies.

The most common diagnostic tests in neurology are MRI of the brain and spinal cord, CT of the head and spinal cord, EEG (measure nerve impulses), EMG (measures nerve impulses in the muscles). 

Hopefully by the time you have finished all the laboratory and diagnostic tests you will have a firm diagnosis for the patient. Then depending on the disease or syndrome you will recommend treatment which could be short term or long term pharmacologic intervention. Surgery will be an option for some of the diseases. In general neurologic diseases are not mild in nature and will require some life changing interventions. On the mild side you have carpal tunnel syndrome and on the severe side you have hemorrhagic strokes leading to brain death or severe impairment. Sadly for many of the diseases there is no curative treatments and the existing treatments do not offer much help.