Is it Time to See a Neurologist?

Forgetting the name of an acquaintance or misplacing your keys aren’t necessarily reasons to get a neurological evaluation. Some degree of brain fog is common and typical in this world of constant stimulation and information overload.

So, when is forgetfulness an indicator of cognitive dysfunction? Could you recognize the warning signs if a loved one were experiencing a neurological emergency? When is it appropriate to see a neurologist?

What does a neurologist do?

A neurologist is a medical doctor who diagnoses, treats and manages disorders of the body’s “command center,” the nervous system. This includes the brain, spinal cord, and nerves, which control everything you think, feel and do.

Neurologists can diagnose and treat the following neurological disorders:

• Alzheimer’s disease, dementia
• Amyotrophic Lateral Sclerosis (ALS)
• Arteriovenous malformations
• Brain and spinal cord injury
• Cerebral aneurysms
• Cerebral Palsy
• Concussion
• Encephalitis
• Epilepsy
• Facial pain syndromes
• Headache/migraine
• Hydrocephalus
• Meningitis
• Multiple Sclerosis
• Myasthenia Gravis
• Myopathies
• Pain in the neck, back and spine
• Parkinson’s Disease
• Peripheral Neuropathy
• Sleep disorders
• Stroke
• Tremor
• Tumors of the brain, spine and nerves
• Vascular malformations

Signs of neurological dysfunction

“Most of the time, a patient is brought in by their caregiver (a family member or a spouse) because they have noticed something is not right — typically a serious behavior or event that can’t be ‘swept under the rug,’” says Dolores Perdomo, Ph.D., a faculty member at the University of Miami Miller School of Medicine’s Department of Psychiatry and Behavioral Sciences and UM Memory Disorder Center who specializes in treating aging adults experiencing neurological problems and their caregivers.

“Reasons to bring a loved one to a specialist for evaluation include getting lost while driving to familiar places, leaving the stove on, forgetting things that are simple or repeating themselves.” 

Schedule a consultation with a neurologist if you have a family history of neurological disorder and want to learn more about your risk and the warning signs or if you or a loved one experience any of the following:

Bodily changes

• Back pain that spreads to the feet, toes, or other parts of the body
• Burning or electrical shock-like pain in any body part
• Facial asymmetries (eyelid drooping, can’t fully smile)
• Muscle rigidity, cramps, spasms, twitching
• Muscle wasting or weakness (affecting one or more limbs while interfering with coordination and balance)
• Numbness or tingling (pins-and-needles sensation) in the arms or legs or on one side of the body 
• Persistent fatigue
• Routinely waking up with a headache
• Severe, chronic pain
• Sudden loss of bowel or bladder control
• Tremors and seizures
• Weakened handgrip that’s affecting the ability to eat and write

Movement/sensory changes

• Change in coordination or balance
• Deafness
• Difficulty in shrugging your shoulders or turning your neck
• Difficulty lifting the front of the foot or feet-dragging
• Difficulty swallowing
• Difficulty with tongue movements
• Dizziness that causes balance issues, feeling like you’re going to fall
• Falling for no apparent reason
• Ringing in the ears (tinnitus)
• Taste or smell disturbances
• Uncontrollable stiffening of the body, especially the arms and legs
• Uncontrolled movements or involuntary tremors
• Unexplained hoarseness in voice
• Vertigo (head feels like it’s spinning), floating feeling, motion sensitivity
• Vision changes (double vision, trouble focusing, blurry vision, or tunnel vision)

Cognitive changes

• Changes in behavior or personality
• Impaired mental ability (confusion, disorientation)
• Language difficulties (slurred speech, difficulty with expression or comprehension)
• Loss of consciousness
• Memory disturbances (frequent memory lapses)
• Staring spells

When are memory issues more than just brain fog or forgetfulness?

Gaps in long-term memory, short-term memory, “brain farts,” and forgetfulness are not necessarily signs of cognitive problems. But, if you or a loved one are experiencing a noticeable decline or sudden change in short-term or long-term memory, mental sharpness, or awareness, speak with a primary care physician about these changes. They can make a referral to a neurological specialist if needed.

A neurologist should evaluate the following cognitive and behavioral changes, as they can indicate neurological issues.

• Asking the same questions over and over again
• Becoming more confused about time, people and places
• Behaving unsafely (like leaving things unattended in the kitchen, leaving a car parked running, or forgetting to lock doors)
• Difficulty expressing oneself or finding the right words, using incorrect words, or describing an item or a person instead of naming them (e.g., saying, “It’s the thing you write with” instead of “pen”)
• Getting lost in places you or your loved one used to know well
• Having trouble understanding instructions or following directions
• Memory is interfering with work or the ability to function at home. 
• Neglecting personal hygiene
• Not keeping up with regular routines, not paying bills on time, missing appointments
• Unexplained changes in mood, getting easily frustrated or defensive, isolating from others

What to expect during a neurological exam

When someone sees a neurologist, it’s best to take a partner, friend, family member or caretaker. Individuals with neurological problems may not be aware of the changes they’re experiencing. So, it’s helpful to have a knowledgeable and trusted advocate in the room to assist in answering the doctor’s questions and taking note of their recommendations.

During a brain health check, the doctor does a thorough exam. This includes checking the patient’s coordination, reasoning, memory, problem-solving, and other reflexes. 

“Early detection of a neurological problem is key,” Dr. Perdomo says. “By the time a patient gets to a neurologist, severe damage has already occurred and may be difficult to repair.

“In the case of irreversible dementias (like Alzheimer’s disease, stroke, Parkinson’s disease, and Lewy body), the treatment plan is to slow down the progression, not so much repair,” she says. “Slowing down the progression can extend the quality of life for the patient. In the case of dementias, the medications that are usually used (Aricept, Memantine, etc.) are most effective in the early stages of the disease.”

When is a neurological condition an emergency?

The following signs of a possible neurological emergency require immediate medical attention. Do not wait to schedule an appointment with a neurologist.

• convulsions
• sudden chronic headaches
• fainting
• slurred speech, facial drooping, mental confusion and a limp/weak arm (signs of stroke)

Expert neurology care in South Florida

Neurologists with the University of Miami Health System offer expert urgent care at two intensive care units in South Florida at UHealth Tower and Jackson Memorial Hospital.

UHealth’s Neurology Department has clinical research focused on conditions including Parkinson’s Disease, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Tourette Syndrome, Huntington’s Disease, Lewy Body Dementia, Charcot Marie Tooth Disorder, and Wilson’s Disease.

To schedule an appointment, call 305-243-3100 or request an appointment online.

Written by Dana Kantrowitz for UHealth.

Tags: affect the brain, brain health, Dr. Dolores Perdomo, memory issues, Neurological symptoms, Neurology care in Miami, Signs of neurological disorders