Neurologists are medical professionals who specialize in conditions that affect the nervous system. Reasons for seeing a neurologist range from headaches and sleep problems to movement disorders.
A general practice doctor might make a referral to a neurologist if they believe that an individual shows signs of a neurological problem.
Neurological issues encompass a broad range of conditions, including Alzheimer’s disease, diabetic neuropathy, headaches, and nerve damage.
This article discusses the role of a neurologist, including the types of conditions they treat, the procedures they perform, and when a person might visit this specialist.
A neurologist is a medical doctor who specializes in evaluating, diagnosing, and treating diseases that affect the nervous system.
The nervous system has
- the central nervous system (CNS), which refers to the brain and spinal cord
- the peripheral nervous system (PNS), which includes all of the nerves outside of the CNS
What do neurologists specialize in?
Due to the complex nature of the nervous system, many neurologists focus on treating certain populations of people or people with specific neurological diseases.
After completing 4 years of medical school to become a physician, neurologists must complete a 4-year residency that consists of 1 year of general internal medicine or pediatrics training, followed by 3 years of neurology training. Some neurologists complete further subspecialty training, which is usually 1–3 years.
Examples of subspecialties within the field of neurology include:
- pediatric or child neurology
- neurodevelopmental disabilities
- neuromuscular medicine
- hospice and palliative care neurology
- pain medicine
- headache medicine
- sleep medicine
- vascular neurology
- autonomic disorders
- brain injury medicine
- neurocritical care
- movement disorders
- headaches and migraine
- brain tumors
- brain aneurysms
- peripheral neuropathy
- sleep disorders
- neurodegenerative diseases, such as Parkinson’s disease and Alzheimer’s disease
- neuromuscular disorders, such as muscular dystrophy, myasthenia gravis, and amyotrophic lateral sclerosis (ALS)
- multiple sclerosis (MS), an inflammatory neurological disease
- infections of the nervous system, such as encephalitis, meningitis, and HIV
Sometimes neurologists evaluate people in the hospital who have had surgery or a medical problem if they have a new problem, such as a seizure or decreased alertness.
These neurological evaluations may help determine outlook or the likelihood of improving from a severe illness.
What can a neurologist diagnose?
Neurologists can diagnose
- chronic migraine
- multiple sclerosis
- Parkinson’s disease
- dementia and Alzheimer’s disease
Neurologists perform a range of different tests and procedures to diagnose and treat neurological conditions.
Some of these procedures include:
A neurologist can use a lumbar puncture to collect a sample of spinal fluid. They may use this procedure to help
- inflammation of the spinal cord
- autoimmune diseases, such as MS
- bleeding in the brain
Neurologists can also use a lumbar puncture to treat conditions that affect the spinal cord. They can inject anesthetics, antibiotics, or cancer treatments using a lumbar puncture needle.
A neurologist can use electromyography (EMG) to assess how well a person’s muscles respond to electrical stimulation from motor neurons, which are nerves that control muscle movement.
Usually, a neurologist will also perform a nerve conduction study (NCV) to measure nerve activity by assessing someone’s response to superficial electric stimulation.
During an EMG, a specially trained technician inserts small needles called electrodes into the muscle. These electrodes record the different electrical activity that occurs in muscle tissue during periods of movement and rest.
The EMG machine produces an electromyogram, which is a record of this activity.
Neurologists can use the results of an EMG to diagnose neuromuscular diseases, such as myasthenia gravis and ALS.
Neurologists use electroencephalograms (EEG) to measure and record electrical activity in the brain.
Neurons in the brain communicate with other neurons through electrical impulses, which an EEG can detect. An EEG can also track brain wave patterns.
During an EEG, a technician will place electrodes on the person’s head. These electrodes connect to a computer that converts electrical signals into patterns that the technician can view on a screen or print on a piece of paper.
Neurologists can use EEG results to identify abnormal electrical activity in the brain and diagnose certain conditions, such as:
- brain tumors
- sleeping problems
- coma, or unresponsiveness
Myasthenia gravis is a rare neuromuscular disease that weakens the muscles in the arms and legs. A neurologist can use a Tensilon test to diagnose myasthenia gravis.
Tensilon is the brand name of a drug called edrophonium, which prevents the breakdown of acetylcholine, a neurotransmitter that stimulates muscle movement.
Myasthenia gravis causes the immune system to attack acetylcholine receptors in the muscles, which causes muscle fatigue and decreased muscle movement.
During a Tensilon test, a neurologist will inject a small amount of Tensilon into the bloodstream. Then, they will ask the person to perform different movements to determine if muscle strength improves.
The neurologist will continue administering doses of Tensilon each time the person feels tired. If the person notices that their strength returns after each Tensilon injection, this indicates that they are likely to have myasthenia gravis.
A neurologist can use the
- laboratory tests, such as blood and urine analyses
- imaging tests, such as ultrasounds and MRI, CT, and PET scans
- genetic testing
A neurological examination will involve tests to check muscle strength, memory, eye health and vision, and coordination. The tests are not usually painful but may cause some mild discomfort.
People will not need to prepare anything for their first neurological visit. The appointment
- asking about any symptoms and current or previous medical conditions or medications
- checking for any visible signs of a condition by assessing a person’s posture, walk, ease of movement, and balance
- performing a physical examination to measure pulse and blood pressure and listen to the lungs and heart
- asking about bowel movements and passing of urine, as these can indicate how well the autonomic nervous system is functioning
After this initial examination, a neurologist may then perform several assessments, such as:
- Cranial nerve tests: These test brain nerve function, which can affect the senses. People may need to identify certain scents and identify letters or numbers in an eye test.
- Coordination and motor skills tests: A neurologist may ask people to spin around, move their limbs in a specific way, tap fingers, or write. People may also have a reflex test, such as a tap on their knee to check the response.
- Sensation tests: A neurologist may check how well people respond to stimuli, such as soft fabric or touching containers holding warm or cold water.
- Cognitive ability tests: A neurologist may ask people about their job, the date, and the time of year to check people’s memory. Language and math tests can also test for concentration. Some tests of cognitive skill, such as the mini-mental state examination (MMSE) or the Montreal Cognitive Assessment (MoCA), are not standard, but a neurologist may perform them if a person is showing signs of cognitive impairment during the neurological evaluation.
A doctor might refer someone to a neurologist if they have symptoms that indicate a neurological condition,
- frequent or severe headaches
- muscle weakness
- loss of coordination
- partial or complete paralysis
- sensory changes that affect the sense of touch, vision, smell, or taste
Both neurologists and neurosurgeons treat people who have conditions that affect the nervous system. However, neurosurgeons perform surgery, whereas neurologists do not.
Neurosurgeons complete medical school and then neurosurgery residency, which includes 1 year of general surgery internship, followed by 6–8 years of neurosurgery residency.
All neurosurgeons are qualified to operate on the brain and the spine, and some neurosurgeons further specialize in highly technical procedures.
Generally, a person’s general practice doctor will refer them to a neurologist or a neurosurgeon. Sometimes a neurologist may refer to a neurosurgeon if surgery would be beneficial, and sometimes a neurosurgeon will refer to a neurologist if the individual requires neurological management.
Neurologists diagnose and treat medical conditions that affect the nervous system.
A general practice doctor may refer a person to a neurologist if they show signs of a neurological disorder, such as:
- persistent or severe headaches
- muscle weakness
- loss of coordination
- partial or complete paralysis
Neurologists can perform various procedures to help diagnose and treat neurological conditions. However, if a person requires surgery, their neurologist or doctor will refer them to a neurosurgeon.