Neurology FAQs


 

How is a neurologist different than a brain surgeon? Do I need to have both?

A neurologist is a physician who has received special training in the diagnosis and medical treatment of nervous system diseases. Neurologists do not do brain surgery.

Neurosurgeons are physicians who have been specially trained to do surgery on nerves, the brain and the spinal cord.

Persons who believe they may have a neurologic condition are usually referred to a neurologist first to diagnose their condition. If it is a condition for which neurosurgery is appropriate, the patient would then be referred to a neurosurgeon. However, there are many different types of neurologic conditions, and not all of them require surgery to treat. Should you require surgery after seeing a neurologist, the Department of Neurosurgery is dedicated to advancing the field of neurosurgery.

 

 

How can you tell the difference between a simple headache and a headache caused by a brain tumor or a stroke?

Headaches are among the most common medical complaints. Some people have them often, while others hardly ever have them. Both chronic and recurring headaches may be painful and distressing but rarely reflect a serious medical condition. However, a change in the pattern or nature of headaches - for instance, from rare to frequent or from mild to severe - could signal a serious problem and calls for prompt medical attention.

Headaches can have a variety of causes, including muscle tension, eyestrain or problems with the nose, throat, teeth and ears. Usually a doctor can determine the cause of a headache from the patient's medical history and a physical examination. A variety of tests can be used to detect illness that may be causing the headache, including:

  • Blood tests that can identify an underlying illness
  • A spinal tap, in which a small amount of fluid is taken from the spine and checked for infection or bleeding
  • Scanning techniques, such as computed tomography (CT) or magnetic resonance imaging (MRI), which are used when a brain tumor, stroke or other problem is suspected

Only rarely are chronic headaches caused by brain tumors, brain injuries or lack of oxygen to the brain.

 

Are all brain tumors caused by cancer?

No, a brain tumor can either be benign (noncancerous) or cancerous. A tumor is a mass or growth of abnormal cells.

Brain tumors are usually classified as either primary or secondary. Primary brain tumors are ones that start in the brain and can be either benign or malignant. More than 20,000 Americans a year are diagnosed with these fairly rare tumors. Secondary brain tumors, which are malignant, result from cancer that started elsewhere in the body and spread to the brain. These tumors are more common, affecting approximately 100,000 Americans a year.

Benign tumors are usually slow growing, easier to remove and less likely to recur compared to malignant ones. However, in a few cases, even a benign tumor can cause serious problems or be life threatening, depending where in the brain it is. Malignant brain tumors can grow rapidly and crowd or destroy nearby brain tissue.
 

 

What are the warning signs of stroke?

Not everyone gets all of the following warning signs of stroke, you may only get one of the symptoms. And, sometimes these signs can go away and return. Treatment is most effective if given immediately when the symptoms begin. If you have any of these symptoms, call 911 right away!

  • Sudden numbness or weakness of face, arm, or leg, especially on one side of the body.
    Sudden confusion or trouble speaking or understanding speech;
  • Sudden trouble walking, dizziness, or loss of balance or coordination;
  • Sudden severe headache with no known cause;
  • Blurred or double vision, drowsiness, and nausea or vomiting.

What is a "mini-stroke" or transient ischemic attack (TIA)?

A "mini-stroke" refers to a transient ischemic attack (TIA). In a TIA, there is a short-term reduction in blood flow to the brain. This causes temporary stroke symptoms like the symptoms mentioned above (often just for a few minutes). TIAs don't cause brain damage, but they are important warning signs and powerful risk indicators that a person is at risk of having a stroke. If you have a TIA, you should seek medical care right away to prevent a going on to have a stroke.

How is a stroke prevented?

The more stroke risk factors you have, the greater the chance that you will have a stroke. There are certain risk factors that cannot be controlled, such as aging, family health history, race and gender.

Here are some of the best ways to prevent stroke:

  • Eat a healthy diet low in saturated fat and rich in fruits, vegetables, and whole grains. Don't overeat, and keep your weight under control.
  • Get regular exercise (30 minutes a day, most days of the week, or more).
  • Find ways to manage stress in your life.
  • If you have high blood pressure, take your blood pressure medicine as prescribed by your health care provider.
  • If your cholesterol level is too high, talk to your health care provider about ways to lower it.
  • If you smoke, stop smoking. If it is hard to quit on your own, there are products like nicotine patches, support groups, and programs to help you stop smoking.
  • If you have heart disease or diabetes, take good care of yourself. See your health care provider and take your medicine as prescribed.
  • Get help if you have a TIA ("mini-stroke"). Talk to your health care provider to see if you need medicine or surgery.
  • Aspirin therapy may be useful, but check with your health care provider before starting to take aspirin on a daily basis.

What is Parkinson's disease?

Diagnosed in approximately 60,000 Americans every year (source: National Parkinson's Foundation), Parkinson's disease is a degenerative disorder of the central nervous system. Parkinson's disease affects nerve cells (neurons) in the part of the brain that controls muscle movement, leading to symptoms, such as trembling, rigidity, difficulty walking and problems with balance and coordination. In about 15 percent of cases, Parkinson's disease begins before age 50. For most people, the first symptoms develop after age 50, and the likelihood of developing Parkinson's disease continues to increase with age.

Parkinson's disease is progressive, meaning the symptoms become worse over time. Although the disease may eventually be disabling, signs and symptoms usually develop gradually, and most people have many years of productive living after a diagnosis.

 

What causes Parkinson's disease?

Since Parkinson's disease was first described nearly 200 years ago, researchers have been intensely studying the causes of this complex disorder. Parkinson's disease develops when certain nerve cells in a part of the brain called the substantia nigra are damaged or destroyed. Normally, these cells release dopamine - a chemical that transmits signals between the substantia nigra and another part of the brain, the corpus striatum. These signals cause your muscles to make smooth, controlled movements. Everyone loses some dopamine-producing neurons as they age, but people with Parkinson's disease lose at least 60 percent of neurons in the substantia nigra.

Currently, scientists believe Parkinson's disease may result from a combination of genetic and environmental factors, including:

  • Genetic factors. Research has revealed that people who have a parent, a sibling or a child who has or had Parkinson's disease are three times more likely to develop the disease themselves. If you have two such relatives with Parkinson's disease, your risk can increase as much as 10 times.
  • Exposure to herbicides and pesticides can raise your risk of developing Parkinson's disease three times, but so far, no one has been able to connect a specific herbicide or pesticide to the disease.
  • Medications. Drugs, such as haloperidol (Haldol) and chlorpromazine (Thorazine), which are prescribed for certain psychiatric disorders, and drugs used to treat nausea, such as metoclopramide (Reglan) and prochlorperazine (Compazine) can increase your risk of developing Parkinson's disease. The epilepsy drug valproate (Depacon) also may cause some of the features of parkinsonism. In fact, this drug is notorious for producing tremors, although these tremors are a little different from those seen in Parkinson's disease.
  • Toxins. Exposure to manganese dust, the chemical MPTP - a byproduct of heroin production - among other toxins, can lead to parkinsonism. Scientists first became aware of MPTP-induced parkinsonism in the 1980s when heroin addicts using a street drug contaminated with MPTP developed all the symptoms of Parkinson's disease. Still, toxin-related cases are extremely rare.

 

Currently, what are the most effective treatments available for Parkinson's disease?

Recognizing the signs and symptoms of Parkinson's disease and seeking early diagnosis are essential to beginning appropriate treatment and managing symptoms for as long as possible. Unlike other serious neurologic diseases, such as Lou Gehrig's and Huntington's disease, Parkinson's disease is treatable. For a long time, the drug L-dopa was used to treat Parkinson's. Today newer drugs, including dopamine agonist medications, are also used - either alone or in combination with L-dopa.

Experiments with surgically transplanted stem cells, fetal nerve cells or genetically engineered cells to replace lost or damaged neurons are also being done. Deep brain stimulation (DBS) is another form of surgical therapy for Parkinson's disease that has had encouraging results. It involves implanting a brain stimulator, similar to a heart pacemaker, in an area of the brain called the thalamus. It has been used for the past decade to treat parkinsonian tremor, and researchers believe that implanting this device in a part of the brain called the subthalamic nucleus may help treat other aspects of the disease as well.

 

How do you diagnosis Amyotrophic lateral sclerosis (ALS)?

ALS is a very difficult disease to diagnose because the symptoms are similar to those of other disorders. There is no one test or procedure that can definitively confirm the diagnosis of ALS. It is through a clinical examination performed by a neurologist and series of diagnostic tests (often ruling out other diseases that mimic ALS) that help confirm a diagnosis. A comprehensive diagnostic evaluation includes most, if not all, of the following procedures:

  • Electrodiagnostic tests including electomyography (EMG) and nerve conduction velocity (NCV);
  • Blood and urine studies including high resolution serum protein electrophoresis, thyroid and parathyroid hormone levels and 24 hour urine collection for heavy metals;
  • Spinal tap;
  • X-rays, including magnetic resonance imaging (MRI);
  • Muscle and/or nerve biopsy.

These tests are done at the discretion of the physician, usually based on the results of other diagnostic tests and the physical examination.

 

What is the main difference between the care provided by a neurologist and an ALS interdisciplinary team?

Typically, when a patient receives care in a neurologist's office there is a physician and nurse or medical assistant involved in your care. They perform an assessment, review symptoms and establish a plan of treatment. Part of this treatment plan may involve consulting additional therapists. These separate therapists report their findings the physician.

With the ALS Program interdisciplinary team the neurologist, nurse, and team members are all located in one clinic and all services can be provided in one visit. Additionally, the ALS team has the opportunity to openly discuss each patient's plan of care from their various points of view during team meetings. Therefore the neurologist works in direct consultation with a team knowledgeable in the ALS disease process. This approach provides the opportunity for a collaborative plan of care to be established for each patient.
 

For an appointment, a second opinion or more information, please call 1-800-CEDARS-1 (1-800-233-2771) or email us at neurologicaldisorders@cshs.org.