Neurological Services We Provide
Neurological Consultation:
In most cases the patient is referred by the primary
care physician for evaluation of a specific neurologic symptom or
suspected condition. The neurologist begins by
taking a focused subjective history from the patient and his/her family
including a detailed description of the complaint, followed
by recordation of past medical and family history, and review
of symptoms. This is followed by a focused objective
medical evaluation and a thorough general examination of
the neurological system, including mental status, cranial
nerves, reflexes, motor, sensation, and coordination. The neurologist
will then make an assessment of the clinical presentation
and physical findings. (S)he will develop a plan of action
including possible laboratory and imaging studies, or
consultations to finalize the diagnosis, and will initiate
treatment for improvement of symptomatology. Finally
the neurologist will prepare a written report to the
referring physician, and staff will make arrangements
for studies and a followup. Initial consultations can
take anywhere between thirty and forty minutes,
depending on the complexity and severity of the presentation.
Electroencephalography (EEG)
This study measures the brain's natural electrical activity
or brain waves. Surface electrodes are applied to the scalp
and spontaneous electrical activity is measured and
amplified. This is recorded while the patient is awake,
asleep, and in response to hyperventilation, and photic
stimulation. Important in diagnosis of seizures or epilepsy,
head trauma, metabolic, degenerative, infective, and sleep
disorders.
Electromyography (EMG)
Measures natural muscle electrical activity. A small, sterile,
disposable needle electrode is inserted through the skin into
the muscle to measure electrical activity associated with
muscle activity. It is recorded while the patient is at rest,
with mild, and maximal contraction. This test is important
in diagnosis of muscle (dystrophic, inflammatory) diseases,
ALS, denervating neuropathies, and spinal disorders. By
studying specific groups of muscles, patterns of nerve and root
damage may be precisely defined.
Nerve Conduction Study (NCS)
Measures electrical response of muscle and nerve tissues to
electrical stimulation. Small, brief shocks are delivered
through surface electrodes to underlying nerves. The
electrical impulse is transmitted down the nerve and the
resulting response in muscle and nerve measured. Time of
response is compared to the distances travelled and velocities
of nerve conduction determined. This test is important
in diagnosis of neuropathies; repetitive nerve stimulation studies in myasthenia
gravis.
Evoked Potentials (VER, BAER, SSEP)
Measures cortical electrical response of the brain to visual,
auditory, or other sensory stimulation. Visual evoked
responses result from visual stimulation (flashing black and
white video checkerboard); brainstem auditory evoked responses
from auditory stimulation (clicking sound in headphones), and
somatosensory evoked potentials from sensory nerve stimulation
(small shock delivered through the skin). Resulting electrical
potentials are measured by EEG-like scalp electrodes applied
over particular areas of the brain. Important in diagnosis
of multiple sclerosis or demyelinating disorders that result
in slowing of propagation of the signal in the central
nervous system (brain, spinal cord, brainstem or optic nerve).
Lumbar Puncture (LP)
Also called Spinal Tap. Under sterile conditions and local
anesthesia with lidocaine, a medium gauge spinal needle
is inserted into the lower back between the posterior spinal
processes through the arachnoid membrane surrounding the
spinal cord and roots. The pressure is measured, and
approximately 2-3 teaspoons (12 cc's) of cerebrospinal fluid (CSF)
is removed. This test is important in assessing the chemistry
of the brain and spinal cord, and for diagnosing acute MS,
normal pressure hydrocephalus, meningitis, and subarachnoid hemorrhage.
Neurological Followup
Return visits are arranged for a review of symptoms, any
interval laboratory and imaging studies, reassessment of
physical and neurologic findings, and response to treatment,
and reinforcement of any recommended lifestyle changes. Much of the
visit is spent talking with the patient and family and in counseling.
Followup visits can last between fifteen and twenty minutes,
and again result in a report to the referring physician.
Interval between followup visits generally run between 6 weeks
and one year. When diagnosis has been finalized and symptoms have
either been relieved or improved and stabilized the patient is
turned back over to the primary care physician.
