Neurology
(Neurological Disease)Introduction Any disease that interferes
with the normal functioning of the nervous system is considered a neurological
disease. A number of very varied clinical presentations such as headaches, strokes,
Parkinson's disease, seizure disorders, carpal tunnel syndrome, multiple sclerosis
and others all belong into this group of diseases. Choose a topic from the table
above and click on the link for more details. I would like to outline some
of the common principles of these diseases and what the patient and their loved
ones should know when one of these diseases is encountered. Before any treatment
can be done, the treating physician will need to diagnose the condition. If the
condition is misdiagnosed the consequences could be disastrous. Let me
give you an example: A 40 year-old patient had numbness in the right thumb, index
finger and middle (=long) finger. This got worse with heavy lifting and grabbing
of heavy objects. The patient saw his family doctor and was told that this likely
would be due to carpal tunnel syndrome (CTS) and that a small surgery at the wrist
would bring this back to normal. The doctor sent the patient to a neurosurgeon
(or plastic surgeon) to have this done. The surgeon examined the patient carefully
and noticed that there were a few symptoms and findings of CTS that were missing.
Also, he found out by more detailed questioning that there were a few symptoms
that did not fit the diagnosis of CTS. For instance, there was pain in
the right side of the neck as well as right shoulder pain whenever he felt numbness
in his right hand. The surgeon felt that two studies should be done: EMG studies
(electromyography studies) by a neurologist and X-rays of the neck in an X-ray
clinic. When the surgeon saw the patient again, he could explain to him that the
provisional diagnosis of CTS was wrong and that the tests showed the following:
there was no blockage of the electrical signal traveling along the median nerve
through the wrist and for this reason the patient did not have CTS or need wrist
surgery. However, the X-rays of the neck (cervical spine) showed a severe degenerative
process in the lower end of the neck with narrowing of the space between the 5th
and 6th vertebral bodies of the cervical spine. We count from the top down
where C1 would be the first vertebral body and C5/6 was the area in this patient
where the narrowing and pinching of the right C6 nerve root had occurred. The
surgeon had asked about a previous sports injury and motor vehicle accident. When
the patient was 16 years old he had a serious fall from a bicycle and banged his
head. There was no fracture at the time, but it took him 2 months to regain most
of his neck mobility. Unfortunately, 3 years later he was a passenger in a car
driven by a drunk friend and they hit a telephone pole. Fortunately nothing was
fractured, but he had sustained a moderately severe whiplash type neck injury,
which took 6 months to heal. He was able to return to contact sports, where
he had sustained several smaller neck injuries. However, he was symptom free for
many years until he awoke with a stiff neck that lasted a day or so at age 41.
Gradually he also developed different symptoms such as intermittent shoulder pains,
arm pains and numbness in his right hand. The surgeon explained to him that the
old injuries had led to some scarring that eventually caused a degenerative arthritic
condition at the right C5/6 level of his cervical spine. He also explained carefully
that this type of problem would not improve, but that it would often be bearable
for a number of years until neck surgery would be necessary. The standard procedure
for this would be a discectomy and fusion surgery done at the same time (at the
C5/6 level in the case of this patient). A surgical release procedure of
this patient's wrist would have done nothing for his numbness symptoms that originated
from the neck. In this case the patient was able to live with his condition for
another 4 years. At that time the condition worsened and an MRI scan showed a
disc
herniation that pushed directly on the right C6 nerve root. The patient
required a discectomy
with a fusion surgery, an example of which is shown with this link.
All of the symptoms disappeared, but he elected to no longer do contact sports
for fear of re-injuring his neck. This is an example demonstrating the
importance of a correct diagnosis. In neurological conditions this is even more
important than in any other specialty of medicine. It will become clear in all
of the conditions that are described under the links in the
above table that the symptoms have to be identified, the physician
needs to come to a diagnosis, based on history, examination of the patient and
tests, and only then can treatment for the condition be successful. With neurological
conditions often a neurologist, the specialist in this field, needs to be consulted.
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