|
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 there was narrowing
and a right C6 nerve root impinchment 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.
|
