Neurologists: what do they diagnose and treat?

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What conditions does a neurologist treat?

Neurology is the branch of medicine that deals with diseases of the central and peripheral nervous system. The central nervous system includes the brain and spinal cord, while the peripheral includes nerves, muscles and neuromuscular junctions.

Author: Dr Andreas P. Moustris
Category: Articles and developments

Common diseases and symptoms that a neurologist diagnoses and treats are the following:

  • Memory loss, Alzheimer’s disease and related dementias
  • Parkinson’s disease and movement disorders (tremor, tics, dystonia, myoclonus, chorea, dyskinesias)
  • Stroke
  • Headache
  • Epilepsy and episodes of loss of consciousness
  • Multiple sclerosis and demyelinating diseases
  • Dizziness, vertigo and imbalance
  • Sleep disorders
  • Numbness
  • Muscle weakness
  • Problems with vision or ocular motility  (i.e. double vision, optic neuritis)
  • Peripheral neuropathies
  • Myasthenia gravis and myopathies
  • Spinal cord diseases

Specializing in Neurology in Greece requires 5 years of training (after graduation from medical school). During this period, residents undertake 9 months of training in Internal Medicine, 6 months in Psychiatry and 45 months in Neurology. After completing the residency, some neurologists choose to further specialise in particular fields of Neurology, such as epileptology, movement disorders, cerebrovascular disease, neurophysiology, etc.

 

What is the neurological examination?

Despite advances in technology, diagnosing a neurological disorder remains a primarily clinical task. Taking a good medical history and performing the neurological examination, leads to a firm diagnosis in the majority of cases. The neurological examination consists of a series of painless tests that help the physician assess various functions of the nervous system. Neurologists usually use light pens, reflex hammers, tuning forks and ophthalmoscopes. The extent of the examination varies depending on the nature of the symptoms and underlying diseases.

In a routine neurological exam following are assessed:

  • Higher cognitive functions
  • Gait, posture and balance
  • Cranial nerves:
    • Ocular motility and fundus
    • Pupillary reflexes
    • Visual fields
    • Facial muscles and sensation
    • Tongue and pharynx
    • Neck and shoulders strength
  • Muscle tone and power
  • Coordination
  • Muscle stretch and plantar reflexes
  • Sensation

 

Does a neurologist perform surgery?

No.

Surgical treatment of neurological conditions is delivered by Neurosurgeons. Neurologists may refer patients for neurosurgical evaluation or recommend neurosurgical treatment. In many cases, close collaboration between the two specialties is necessary.

 

Is a neurologist also a psychiatrist?

Up to a few decades ago, Neurology and Psychiatry where unified. A 3-year residency led to the acquisition of the title “Neurologist-Psychiatrist” and the right to practice both specialties. However, developments in both fields combined with the need for more specialization, made their separation necessary. In Greece, Neurology and Psychiatry have been distinct specialties for over 30 years.

 

Neurology and Psychiatry: common ground and differences

Essentially both specialties deal with disorders that stem from the same organ of the human body, namely the brain. Distinguishing between what constitutes the subject of each specialty, can be done according to the following:

  • Phenomenology of symptoms:
    Psychiatry focuses on disorders of mood, behavior and thought (i.e. anxiety, depression, delusional thinking, panic attacks, auditory hallucinations). The most common neurological symptoms have already been mentioned in the first section of this article.
  • “Organicity” of symptoms:
    The term “organicity” implies that symptoms are a direct result of identifiable lesions in the nervous system (for example, evident in a brain MRI). As a general rule, Psychiatry is focused primarily on disorders that do not have a clear organic substrate, while Neurology deals with everything that is related to identifiable lesions.

It should be stressed that the above criteria are not absolute.  Furthermore, the exact meaning of the term “organicity” is constantly revised, as diagnostic procedures become more sensitive and new evidence regarding the etiopathogenesis of mental disorders come to light.

In everyday clinical practice, collaboration between neurologists and psychiatrists is common, owing to the fact that many psychiatric disorders present with neurological symptoms and vice versa. In addition, the occurrence of mixed symptomatology (neuro-psychiatric) is not rare. The following examples illustrate the close relationship between Neurology and Psychiatry:

  • Functional disorders:
    Functional disorders can present with a variety of symptoms and therefore require evaluation by physicians of different medical specialties. They are particularly common in neurology outpatient clinics, accounting for approximately 15% of all visits. An alternative term is “psychogenic disorders”, reflecting the fact that they are related primarily to psychological, rather than organic factors. Common functional symptoms include numbness, paroxysmal spasms that resemble epilepsy, involuntary movements, dizziness and blindness. In such cases, neurologists rule out organic causes by ordering various tests, explain the diagnosis to patients and subsequently refer them to psychiatrists for further evaluation and treatment.
  • Limbic encephalitis:
    Limbic encephalitis is an uncommon, serious condition. Patients usually present with psychiatric symptoms, cognitive impairment and seizures, developing over weeks or months. In some cases, psychological symptoms predate all others; therefore, the initial medical evaluation is done by a psychiatrist. However, limbic encephalitis is an immune-mediated neurological syndrome. Psychiatrists suspect the nature of the disease and refer to neurologists for further management.
  • Tourette syndrome:
    Gilles de la Tourette syndrome is a chronic disorder with onset during childhood or adolescence. Its basic characteristic is the presence of multiple tics, motor and vocal. Tics are essentially a neurological movement disorder: they have a neurobiological basis and a strong genetic component. However, a significant proportion of people with Tourette syndrome also have psychiatric disorders (obsessive compulsive disorder, attention-deficit and hyperactivity disorder).

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