Which patients should consult a neurologist (brain and nerve diseases) specialist and which patients should consult a brain and nerve surgeon (neurosurgery)?
Patients with complaints about the brain and nervous system (head pain, dizziness, speech impairment, paralysis, numbness in hands and feet, gait disturbance, forgetfulness, facial paralysis, visual impairment, muscle wasting, neck pain and lower back pain) often confuse neurology with brain neurosurgery. First of all, some neurosurgeons in this regard. He may think differently than neurologists. Roughly speaking, neurology; Detailed evaluation of complaints related to the brain, nerves and muscles is important in their diagnosis and treatment. If drug therapy is required in the treatment of these diseases, the neurologist must treat and follow up the patient. In surgical cases requiring brain and nerve trauma and surgery, the neurosurgeon must treat and follow up the patient. Brain surgeons can also perform drug therapy, but they have less experience in monitoring some medications than neurologists. For example, brain surgery can ignore some rare side effects of epilepsy and depression medications. And it is possible for them to prescribe and report some medications only where there are no neurologists. The reason I brought up this topic is that patients confuse neurology and brain surgery, are misled, and waste their time. Patients may apply to neurosurgery instead of neurology and neurology instead of neurosurgery. I will mention some topics under headings.
Headache; If the headache occurs after a trauma or a fall, it would be appropriate for the patient to first consult a neurosurgeon. If headache attacks cause unilateral or bilateral severe throbbing pain in the eye, one should consult the neurology department. Because the two most common causes of headache are migraine and tension headache. Neurological follow-up and treatment is definitely required. Those with persistent (chronic) headaches can apply to both departments. If there is a mass underlying the chronic headache, neurosurgical treatment comes to the fore. If there is migraine or stress-related tension headache underlying the chronic headache, the patient should be treated by a neurologist. In addition, a rare cluster headache occurs with unilateral pain and redness above the eye. Conditions such as these are special conditions and their treatment is very challenging and requires follow-up by a neurologist. In cases of sudden, severe electric shock-like pain, which we call neuralgia, neurology follow-up and drug treatment are required first. If drug treatment is inadequate and drugs are not used due to side effects, the patient must first apply to the neurosurgery or algology department to intervene in the nerve.
Dizziness; If dizziness occurs after a trauma or fall, the patient must first apply It would be appropriate to consult neurosurgery. If dizziness occurs in attacks, one should consult neurology or ear, nose and throat department. If dizziness usually occurs in attacks, it may be due to diseases related to the balance organ in the inner ear or abnormalities related to the cerebellum. It requires brain MRI and neck vascular ultrasound and neurological follow-up. Those who have persistent and long-term dizziness should consult the neurology department. If there is a mass underlying chronic dizziness, neurosurgical treatment and follow-up come to the fore.
Epilepsy: Epilepsy is a condition that primarily requires follow-up and treatment by the neurology department. Approximately 70% of patients benefit from drug therapy. Epilepsy medications can cause serious side effects and unexpected situations. Therefore, epilepsy drug treatment is the field of neurology. Structural abnormalities are detected in the brain in some (10%) of epilepsy patients. If it is proven by the neurologist that an area of the brain is having an epileptic seizure via EEG, neurosurgical opinion and treatment is required to surgically remove that area.
Forgetfulness: Forgetfulness should first be followed by the neurologist. It is a necessary complaint. Because 95% of forgetfulness is due to progressive neurological diseases (such as Alzheimer's), neurological follow-up and treatment is required for these issues. However, patients are sent to neurosurgery in cases of fluid accumulation in the brain, brain hemorrhage, and post-traumatic forgetfulness, which are rare compared to conditions such as Alzheimer's disease.
Paralysis: Usually unilateral paralysis, sensory loss, and speech impairment. If it is due to cerebral vascular occlusion or cerebral hemorrhage, the patient is evaluated in the emergency room. If it is due to cerebral vascular occlusion, the neurologist will follow up. If it is due to a major brain hemorrhage, neurosurgery follows. If paralysis occurs after a trauma or accident, neurosurgery should be evaluated directly.
Facial paralysis; It is usually a neurological condition, usually due to inflammation of the facial nerve behind the ear. Since brain surgery is not required, neurological monitoring and treatment is required for drug therapy. Sometimes it may be due to middle ear infection, in which case an ear, nose and throat specialist should follow up.
Parkinson's disease: Parkinson's disease is a progressive disease characterized by gait disturbance, tremors and slowness of movements. Medication is given. If side effects of drug treatment occur as the disease progresses, the patient is sent to neurosurgery for a brain pacemaker or surgery on a part of the brain.
Numbness in the hands: The cause of numbness in the hands (cervical disc herniation, nerve compression, neuropathy). It needs to be revealed, the pain and numbness radiating from the neck to the arm may be due to a cervical hernia. For this, a neck MRI is taken and an EMG is performed. If the cervical disc herniation puts serious pressure on the nerve, the patient should be examined by a neurosurgeon. If the cervical disc herniation is mild, medication and physical therapy are required. Numbness in the hands may be due to nerve compression in the wrist, and this is detected by EMG. If nerve compression is severe, surgery is performed by a neurosurgeon or orthopedic surgeon. Numbness in the hands and feet may be due to the nerve vessels being affected, which is called polyneuropathy. For this, EMG should be done by a neurologist and blood tests should be done to investigate the cause.
Numbness in the feet: If the numbness in the feet is bilateral and there is no loss of strength, it should first be evaluated by the neurologist. Numbness in the feet; If it is accompanied by numbness in the hands, it may be due to the effects of nerve vessels called polyneuropathy. For this, an EMG must be performed by a neurologist and blood tests must be performed to investigate the cause. If there is pain and numbness radiating from the waist down and weakness in the standing leg, neurosurgery should be evaluated first. There may be a serious herniated disc and may require surgery.
Muscle wasting: Widespread muscle wasting in the body is primarily caused by neurological diseases. It should be evaluated by a rhologist. Because muscle wasting is usually due to progressive special neurological conditions that we call muscle diseases and motor neuron disease, in some cases drug treatment is required. However, there is no surgical treatment.
Brain tumors; First of all, it is a condition that requires follow-up and treatment of brain surgery. If the patient has seizures due to a brain tumor, the neurologist should be involved in the follow-up of the patient.
Traumas or accidents; It is a condition that primarily requires follow-up and treatment by neurosurgery. If the patient has post-traumatic seizures or forgetfulness, the neurologist should be involved in the follow-up of the patient.
Multiple sclerosis; It is a neurological disease with attacks that include vision loss, imbalance, numbness, paralysis and gait disturbance. Brain surgery is not a disease that can be treated, neurology follow-up and treatment is required.
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