Mail: praxis@neurologie-wuermtal.de | Tel. +49-89-18930915 | Schedule an appointment: Mo. – Fr. 08 am – 6 pm
Symptoms & Neurological Disorders
What is Neurology?
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Neurology is the branch of medicine that deals with the diagnosis and non-surgical treatment and management of disorders of the brain, spinal cord, peripheral nerves and muscles.
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What do I do as a neurologist?
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The main part in finding the correct diagnosis is the patient-oriented conversation with you and the comprehensive physical examination according to your complaints. As a neurologist, I perform neurological examinations of the nerves of the head and neck. I test muscle strength, movement, balance, ambulation, and reflexes as well as sensation, memory, speech, language, and other cognitive abilities.
Some of the more common disorders that I as a neurologist diagnose and treat include:
Headache, migraine
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Headaches are a common phenomenon and often harmless. Almost 70% of all Germans experience a phase of headache or facial pain at least once in their lives, which significantly impairs their everyday life. The causes are manifold. Either it is an independent illness or a symptom of other disorders affecting the nervous system. A detailed anamnesis and careful neurological examination enables a more precise classification and therapy recommendation. Additional examinations such as EEG, duplex sonography of the vessels or imaging (CT/MRI) may be useful.
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Vertigo and dizziness
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Dizziness is one of the most common symptoms in medicine. Dizziness occurs when the information from vision (visual system), balance from the vestibular system, and position sense (proprioceptive system) do not match. If there is conflicting or insufficient information from these systems, this leads to unsteadiness and/or vertigo. There are several types of vertigo, some of which are easily treatable (e.g., benign paroxysmal positional vertigo). Other types of vertigo may be symptoms of a serious neurological disease (vasoconstriction/stenosis, circulatory disorders/stroke, brain tumors, inflammation) or even a medication side effect, which is why a specific diagnosis must be initiated. Anxiety can further aggravate the vertigo experience or become a problem itself. A new and especially sudden onset of dizziness should be taken seriously and promptly clarified neurologically.
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Concentration and memory disorders
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Declining concentration and memory are normal as one gets older, but they can also be signs of neurological diseases and dementia processes. But memory disorders do not mean dementia and dementia does not mean Alzheimer's disease. The task for me as a neurologist is to distinguish 'age-related forgetfulness' from 'pathological forgetfulness' through detailed anamnesis, careful examination, EEG and targeted neuropsychological testing.
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Neck and back pain and other various forms of pain
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The vast majority of patients have nonspecific neck or lower back pain, meaning there is no specific underlying condition. However disc herniation may cause damage to a spinal nerve root. Patients present with pain radiating down the arm or leg, sensory loss, weakness, and/or reflex changes consistent with the nerve root involved. Further testing such as EMG and imaging may be required to decide who may be a candidate for invasive therapies.
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Movement disorders, tremors, falls, unsteady gait
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Tremor is the most common neurological movement disorder and can affect not only the hands but also the legs, head or voice. Tremor does not automatically mean Parkinson's disease, it can be caused by many other disorders and can also be psychologically, or stress, amplified or even conditioned. Tremor can also be familial, the result of a metabolic disorder or the influence of medication. A neurological clarification is necessary to exclude a confusion with Parkinsonian tremor, to initiate the correct therapy and to avoid unnecessary treatments.
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Muscle cramps / muscle pain
Muscle complaints occur in very many neurological diseases. The causes can lie in the brain, spinal cord and peripheral nervous system. In actual muscle diseases, however, the cause lies directly in the muscle. In myasthenia, an inflammatory damage of the transmission sites between nerve and muscle leads to a load-dependent muscle weakness. Electromyography (EMG) can provide further differential diagnostic assistance here.
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Sleep disorders
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The individual need for sleep varies greatly. If sleep is insufficient or interrupted, this can result in typical symptoms such as daytime fatigue, reduced performance, impaired concentration and even depressive moods. Various underlying causes can be differentiated and treated by neurological examinations.
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Loss of consciousness, fall, syncope, "black-out", epileptic seizure
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A wide variety of causes can lead to a loss of consciousness. A detailed medical history is usually the key to further differential diagnosis. In order to exclude or prove a passive circulatory disturbance of the brain or epilepsy, EEG, duplex sonography and, if necessary, imaging of the head are useful.
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Pain in arms, legs, face or trunk
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Pain can be caused by irritation of nerves, soft tissue structures or the musculoskeletal system. In particular, pain caused by irritation or damage to nerves (neuropathic pain) responds poorly to conventional analgesics. The precise delimitation of the cause of pain and the initiation of a specific therapy is the task of the neurologist.
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Visual disturbances, double vision
Visual disturbances and double images often have a neurological cause and further examinations such as VEP and duplex sonography help to narrow them down.
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Speech, reading and writing disorders
Many neurological diseases can lead to altered speech, difficulties in speech production and difficulties in speech comprehension. Reading and writing disorders can also be an expression of a brain disease and belong in the hands of the neurologist for further classification.
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Weakness, up to paralysis symptoms
Weakness of the musculature or paralysis are symptoms that should be taken seriously and promptly clarified further neurologically.
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Typical Neurological Symptoms
Migraine, Tension Headache, Cluster Headache
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The "classic" headache that almost everyone experiences from time to time is the dull, pressing so-called tension headache, which can occur in different places or diffusely throughout the head. Typical characteristics of migraine, on the other hand, are mostly unilateral, pulsating-pounding headache attacks. They are often accompanied by loss of appetite, nausea, sensitivity to light and noise. In some cases, headaches may even be preceded by skin sensations, paralysis, speech or visual disturbances as aura symptoms. There are episodic and chronic forms, additionally a familial predisposition can be assumed. Various medications are available for treatment, and specific migraine medications have also been available for several years. In the case of frequent migraine attacks, prophylactic therapy can also be initiated.
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Herniated disc
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Pain that radiates into the leg or arm can indicate a herniated disc. The discomfort caused by a herniated disc depends on where it occurs, how large it is, and whether nerves or nerve roots are involved. Herniated discs in the lumbar spine often radiate into the back of the leg (ischialgia, lumbago), in the cervical spine over the shoulder into the arm sometimes to the hand. The task of neurology is to help decide whether there is dysfunction or damage to the nerve root pressed by the intervertebral disc and whether conservative measures are still possible or whether surgery is necessary. This is done by neurological examination supplemented by neurography (NLG), electromyography (EMG) and, if necessary, sonography of the muscles and nerves.
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Carpal tunnel syndrome
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Pinching of the metacarpal nerve in the wrist tunnel with mostly nocturnal accentuated pain and falling asleep of the fingers or the hand, sometimes with radiating pain into the arm. The diagnosis of carpal tunnel syndrome can be made by determining the nerve conduction velocity (neurography/NLG) and sonography of the median nerve.
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Polyneuropathy
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The term polyneuropathy means that many (Greek poly = many) nerves of the peripheral nervous system are diseased at the same time. This can cause numbness, tingling or unsteadiness of gait. The diagnosis of polyneuropathy is made by neurological examination and measurement of the nerve conduction velocity of the affected nerves (NLG and EMG). If necessary, additional blood tests, rarely nerve fluid tests (CSF puncture) or nerve sampling (nerve biopsy) are required.
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Stroke
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A stroke is a sudden disease of the brain, usually caused by a lack of blood flow through a blocked vessel or, much more rarely, by a cerebral hemorrhage. Hemiplegia, speech disorders, dizziness, double vision, gait unsteadiness, visual disturbances can be symptoms of a stroke. Every stroke is an emergency that must be treated professionally as quickly as possible and taken to a hospital, preferably with a special stroke unit.
Reducing the basic risk factors, especially high blood pressure, elevated cholesterol and blood sugar levels, lack of exercise, smoking and excessive alcohol consumption, significantly reduces the likelihood of stroke. Stroke prophylaxis includes strict adjustment of these cardiovascular risk factors as well as duplex sonography of the vessels supplying the brain.
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Dementia
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Dementia is the pathological decline in memory and thinking ability that goes beyond the 'normal aging process' and is so pronounced that it impairs professional and/or private everyday activities. In addition to Alzheimer's dementia, in which the brain tissue in certain areas is destroyed in a characteristic way, there are also various other forms of dementia, e.g. dementia due to circulatory disorders in the brain. Characteristic of Alzheimer's disease, the most common form of dementia, is the slowly progressing memory impairment, which restricts affected persons in their everyday life. Examination methods used include EEG recording, cerebral magnetic resonance imaging, Doppler or color duplex sonographic examination of the vessels supplying the brain, and test psychological methods. It is crucial for the prognosis to detect and treat the disease at an early stage. Brain training (link cognitive training) (by solving memory tasks, etc.) is also useful to maintain or regain independence as long as possible.
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Parkinson
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höheren Lebensalter. Es handelt sich um eine Bewegungsstörung, die typischerweise durch Bewegungsverlangsamung, ein kleinschrittiges unsicheres Gangbild, Muskelsteifigkeit und Zittern gekennzeichnet ist. Bei der Parkinson-Krankheit liegt vor allem ein Mangel an dem Nervenbotenstoff Dopamin in bestimmten Arealen des Gehirns vor. Therapeutisch lassen sich die Symptome durch Gabe von Dopamin-ähnlichen Medikamenten und physiotherapeutischen, ergotherapeutischen und logopädischen Maßnahmen meist sehr gut behandeln. Die Diagnose basiert vorrangig auf der klinisch neurologischen Untersuchung, oft in Verbindung mit neuropsychologischer Testung. Bildgebende Verfahren wie die Computertomografie (CT) und die Magnet-Resonanz-Tomografie (MRT) dienen vor allem dem Ausschluss anderer Ursachen. Bei Diagnoseunsicherheit können spezielle bildgebende Verfahren wie die Positronen-Emissons-Tomografie (PET) oder der DAT-Scan spezifisch eine Verminderung der Dopamin ausschüttenden Zellen im Gehirn sichtbar machen.
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Syncope & Epilepsy
Epileptic seizures are basically caused by uncontrolled electrical discharges of nerve cells in the brain. These discharges can lead to perceptual disturbances, behavioral abnormalities, impaired consciousness, and even unconsciousness. The causes of epilepsy vary widely. Not every fainting (syncope), even if accompanied by twitching of the arms and legs, is an epileptic seizure. Circulatory fainting can also look very similar. In addition to a history of the seizure and physical examination, an electroencephalogram (EEG), magnetic resonance imaging (MRI) and, if necessary, duplex sonography of the vessels supplying the brain are usually necessary to make a diagnosis.
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Multiple Sclerosis
Multiple sclerosis is a chronic immunologically mediated inflammatory disease of the brain and/or spinal cord (central nervous system, CNS) with manifold symptoms and mainly affects young adults. It is one of the most common neurological disorders. Multiple sclerosis can cause very different neurological symptoms depending on the site of inflammation in the central nervous system. Possible signs include sensory disturbances, dizziness, coordination difficulties or paralysis. To confirm the diagnosis of multiple sclerosis, electrophysiological examinations, especially evoked potentials, MRI of the brain and spinal cord, nerve fluid examinations (Liqour diagnostics) and laboratory tests are used to exclude other possible diseases. The treatment options for multiple sclerosis have improved significantly in recent years. Various immunomodulatory substances are available for treatment.
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Restless Legs Syndrome
Characteristic complaints are tingling sensations in the legs, which occur mainly at rest and at night and are reduced by walking around, moving the legs, massages or alternating showers. The incidence is high and is estimated between 5-10% of the population. The cause is not yet precisely understood; it is probably a disorder in the transmitter metabolism of the brain. In particular, the nerve messenger dopamine seems to play a role here, since patients almost invariably respond well to drugs that improve the effect of this messenger. Diagnosis requires a neurological examination, measurement of nerve conduction velocities (NLG) on the legs and blood laboratory tests.
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