A. One thing I've realized over the last few years---We (neurologists) do all these "things" during our examination of a patient, and we almost never explain what we are doing. So I thought I would post some explanation of what we are doing when we look in your eyes or "tickle" your feet. Eye examination:"Watch my finger" is a test to look at how the eye muscles move the eye, and lets me evaluate how the nerves that move these muscles work (the cranial nerves 3, 4, and 6).
We also look for abnormal eye movements that can be seen in some diseases. We look at how the pupil works (another reflex) which is controlled by the brainstem. We also look into the eye--the retina at the back of the eye is living nerve tissue, and we can actually look at it and observe its health. FaceWe ask you to smile to watch how the facial muscles (controlled by the facial nerve, cranial nerve 7) work, and make sure both sides move the same way.
Sometimes we ask patients to "close your eye" to look at the same nerve function. "Stick out your tongue and say ahh" lets us look at cranial nerve 12 (tongue muscles) and the muscles in the back of the throat. (Your family MD is often just looking for a sore throat) MusclesNeurologists do a lot of tests for muscle strength in the arms and legs. We are looking for any signs of weakness in the muscles.
The pattern of which muscles are weak helps us tell how well the brain, spinal cord and nerves are working. For example---if the weakness is one arm and leg on the same side, we worry mostly about a brain problem like stroke. These is the part of the examination where we ask the patient to squeeze our hands, make a muscle, stand on there toes, etc. Balance:We often ask patients to do some crazy sounding things while standing or walking, like "stand on one foot with your eyes closed" or "walk on your heels, now on your toes".
These are all tests of balance and coordination, and help us understand how part of the brain is working. Some diseases of the brain mainly affect balance and coordination (and some things like alcohol do as well, which is why the police "borrowed" that part of the neurologic examination to use on the roadside) Reflexes:About half of my patients giggle when I tap their knee and make their leg twitch.
This is a normal muscle reflex, and tells me a lot about the health of the nerves in the leg and the back. We can get the same reflex by tapping on the back of the ankle (achilles tendon) or the inside of the elbow (biceps tendon) or the back of the elbow (triceps tendon). The "tickling" of the foot is actually supposed to be scrapping something along the bottom of the foot. In normal people, not much happens (or the toes curl down).
In people with a brain problem, the first toe (Big toe) points up when we scrape on the sole of the foot. This is called Babinski's sign. Babies have a Babinski's sign because their spinal cord and brain are still maturing. Hope this is helpful. This answer should not be considered medical advice...This answer should not be considered medical advice and should not take the place of a doctor’s visit.
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What is a neurologist? A neurologist is a medical doctor who specializes in treating diseases of the nervous system. The nervous system is made of two parts: the central and peripheral nervous system. It includes the brain and spinal cord. Illnesses, disorders, and injuries that involve the nervous system often require a neurologist’s management and treatment. Before they can practice, neurologists must: graduate from medical school complete an internship receive three years of training in a Neurology residency program What does a neurologist do? Neurologists manage and treat neurological conditions, or problems with the nervous system.
Symptoms that commonly require a neurologist include: People who are having problems with their senses, such as touch, vision, or smell, may also need to see a neurologist. Problems with senses are sometimes caused by nervous system disorders. Neurologists also see patients with: Neurologist subspecialties Because the nervous system is complex, a neurologist may specialize in a specific area.
They will do a fellowship in that area after residency training. Subspecialties have evolved to narrow a doctor’s focus. There are many subspecialties. Some examples of subspecialties include: headache medicine neuromuscular medicine neurocritical care neuro-oncology geriatric neurology autonomic disorders vascular (stroke care) child neurology intervention neuroradiology epilepsy Typical neurological procedures During your first appointment with a neurologist, they will likely perform a physical exam and a neurological exam.
A neurological exam will test muscle strength, reflexes, and coordination. Since different disorders can have similar symptoms, your neurologist may need more testing to make a diagnosis. Neurologists may recommend a variety of procedures to help diagnose or treat a condition. These procedures may include: Lumbar puncture Your neurologist may use a lumbar puncture to test your spinal fluid. They may recommend the procedure if they believe your symptoms are caused by a problem in your nervous system that can be detected in your spinal fluid.
The procedure involves inserting a needle into the spine after numbing it and taking a sample of spinal fluid. Tensilon test This procedure can help your neurologist diagnose myasthenia gravis. In this test, your doctor injects you with a medicine called Tensilon. Then they observe how it affects your muscle movements. Electroencephalogram (EEG) With electrodes applied to your scalp, an EEG measures electrical activity in the brain.
Neurologists may use other types of tests, as well. Although they may not perform the test, they may order it, review it, and interpret the results. To make a diagnosis, a neurologist may use imaging tests such as: Other diagnostic procedures include sleep studies and angiography. Angiography determines blockages in the blood vessels going to the brain. Your neurologist may help you manage your symptoms and neurological disorder alone, or with your primary care physician and other specialists.