Neurological consultation is an examination procedure carried out to check the condition and detect disorders in the body's nervous system, as well as to diagnose neurological diseases that may be suffered by the patient. The results of the consultation will be used as a guide for doctors to determine and plan the appropriate type of treatment.
Nervous disease is a disorder that occurs in the body's nervous system, including the brain and bone marrow (central nervous system), as well as the nerves that connect the central nervous system to the body's organs (peripheral nervous system). Disruption of the nervous system can cause disruption of all or part of body functions, such as difficulty moving, breathing, speaking, memory problems, and impaired function of internal organs, such as the heart and lungs.
There are three types of nerves in the human body, including:
- motor nerves, a type of nerve that sends signals (impulses) from the brain and spinal cord to all muscles in the body. This nervous system allows a person to perform various activities, such as walking, catching a ball, or moving his fingers to pick up something.
- sensory nerves, a type of nerve that sends back signals (impulses) from the skin and muscles back to the spine and brain. This nervous system affects the function of the senses in the human body, such as sight, hearing, touch, taste, smell, and balance.
- autonomic nerves, a type of nerve that controls involuntary or semi-conscious bodily functions, such as heart rate, blood pressure, bowel movements, and regulation of body temperature.
The medical science that studies the human nervous system is neurology. Meanwhile, doctors who specifically treat neurological diseases are called neurologists (Sp.S) or neurologists. The main purpose of a neurology consultation is to diagnose, treat, and prevent various types of neurological diseases experienced by patients.
Indications for Neurological Consultation
Patients suspected of having neurological disease generally show different symptoms depending on the type of nerve that is affected, either autonomic nerves, motor nerves, or sensory nerves. Some of the symptoms that can occur, including:
- Headache.
- Back pain that radiates to the arms or legs.
- Tremors.
- seizures.
- Muscle strength is weakened or lost.
- Loss of balance and body coordination.
- Decreased or lost memory ability.
- Loss or decreased ability of the senses, such as seeing or hearing.
- Impaired speech (aphasia), difficulty speaking or slurred speech.
- dysphagia.
- Paralysis (paralysis)
Types of Nerve Disease
The following are some disorders that may occur in the nervous system, including:
- Infection, such as meningitis, encephalitis, and polio.
- Disorders of blood vessels (vascular), such as stroke, TIA (transient ischemic attack), and subarachnoid hemorrhage.
- structural disorders, like CTS (carpal tunnel syndrome), Bell's palsy, Guillain-Barre syndrome, and peripheral neuropathy.
- functional disorders, such as epilepsy and trigeminal neuralgia.
- Degenerative disease, such as Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS) or motor neuron disease, and Alzheimer's disease.
Before Neurology Consultation
Patients generally do not need to make special preparations before undergoing a neurological disease consultation. However, there are several things that patients need to take with them when meeting with a neurologist. These include:
- Overall medical history.Patients should bring all the results of previous examinations, such as the results of laboratory tests, X-rays, CT scans, MRIs, EEGs, or EMGs that have been carried out.
- The type of drug, supplement, or herbal product you are currently taking. Patients should bring a list of drugs or physical forms of drugs that are being consumed, so that doctors can find out which treatment therapy is being carried out.
- Reference letter. Patients should bring a referral letter from a general practitioner or other specialist. A referral letter can be a guide or an initial description of the patient's condition and further treatment that may be carried out.
In addition, patients can also make a list of questions that they want to ask a neurologist when undergoing a consultation. Sort the questions starting with the most important question you want to ask.
Neurological Consultation Procedure
The patient will undergo several examinations as part of the neurological disease consultation process. The type of examination that will be carried out depends on the condition and symptoms experienced by the patient. These types of inspections include:
- Medical history tracing.As a first step in the examination, the doctor will ask the patient several questions, including:
- Complaints about health problems that are being experienced by the patient.
- Medical history of the patient and the patient's family, including a history of allergies, types of diseases that have been suffered, or hereditary diseases that may be owned by the patient's family.
- The patient's history of surgery or medical therapy.
- Types of drugs being consumed.
- Lifestyle, including smoking habits, alcohol consumption, use of illegal drugs, type of work, and hobbies.
- Physical examination (physical examination). To begin the physical examination, the doctor will measure the patient's height and weigh the patient. Then, the doctor will perform a follow-up physical examination including:
- vital sign checks,including measurement of blood pressure, heart rate, body temperature, and respiratory rate.
- General examination of the patient's condition namely examination of various parts of the body to detect abnormalities or disorders that may be experienced by the patient. This examination includes examination of the head and neck, heart, lungs, stomach, and skin.
- Nerve examination. Nervous examination consists of several types of examinations, including:
- Nerve function tests. Examination of nerve function generally includes gait, speech, and mental status.
- gait analysis (gait analysis), namely a method of examining the pattern and gait of humans. When a person is unable to walk normally, the condition may be caused by injury, genetics, disease, or impaired function of the legs or feet.
- Speech analysis (speech analysis), namely a method of checking the ability of individuals when communicating with other individuals.
- Mental status evaluation (mental status evaluation), namely an examination of the patient's psychological condition, especially memory, orientation, and intelligence.
- Cranial nerve examination. Examination of nerve function which includes the olfactory (olfactory) nerves, the optic nerves (vision), the oculomotor nerves (eye movements), the facial nerves (facial expressions), and the vestibulocochlear nerves (hearing and balance).
- Sensory nervous system examination. Examines neural responses to touch, pain, temperature (hot and cold), and vibration, and identifies the shape and size of an object.
- Motor nervous system examination. Examination of motion, muscle shape and size, muscle strength, and muscle mass.
- Examination of reflexes, cerebellum, and meningeal. Reflex checks are usually done by tapping on several parts of the body, such as the elbows, knees, or ankles. Meningeal examination can be performed with Brudzinski examination (neck stiffness test) and Kernig examination (examine the flexibility of the thigh at the hip joint to form a 90o angle). Meanwhile, examination of the cerebellum is done by looking for signs of dysarthia (slurred or slow speech), dysmetria (inability to start or stop fine motor movements), or gait abnormalities, for example in ataxia sufferers.
- autonomic nervous system examination namely examination of signs of autonomic nerve dysfunction, such as sweating, paleness, changes in skin and nails, and changes in blood pressure.
- Nerve function tests. Examination of nerve function generally includes gait, speech, and mental status.
- Supporting investigation. The doctor may perform additional examinations to confirm the diagnosis of neurological disease that the patient may be experiencing. Several types of investigations that may be carried out include:
- Laboratory examination. An examination of a sample of blood, urine, or other fluids for analysis in the laboratory. Several types of laboratory tests, including:
- Blood test.This test can detect infections of the brain and bone marrow, bleeding, damage to blood vessels, toxins that affect the nervous system, and measure drug levels in epilepsy patients.
- Urine test (urinalysis). This test is done to detect abnormal substances in the urine that cause nerve disorders.
- Biopsy. This test is done by taking tissue in the muscles, nerves, or brain for later analysis in a laboratory.
- radiology. This type of examination uses light waves, high-frequency sound, or a magnetic field. Types of radiological examination include:
- X-ray's photo. Examination uses X-rays to see the condition of the body, such as the skull.
- CT scan.Examination using a computer and a rotating X-ray machine. In neurological examination, CT scans can detect the location of brain damage in patients with head injuries, blood clots or bleeding in stroke patients, or brain tumors. This check takes 10-15 minutes.
- MRI. Examination using magnetic fields and computer technology to detect tumors of the brain and spinal cord, multiple sclerosis, stroke, and spinal stenosis. An MRI takes 15-60 minutes.
- Positron emission tomography (PET). Tests to detect tumors and tissue damage, measure cell and tissue metabolism, blood vessel disorders, and evaluate patients with neurological disorders, such as Alzheimer's disease. PET uses a radioactive liquid that is injected into the patient and a scanning machine equipped with gamma rays.
- myelography. The examination uses a special dye (contrast) injected into the spinal canal and X-rays. This examination can detect injuries, wounds, and tumors in the spinal cord. This examination takes 45-60 minutes.
- Neurosonography. An examination that uses high-frequency sound waves to produce detailed images of the brain and spinal cord. Neurosonography results are used to analyze blood flow to the brain and diagnose stroke, brain tumors, and hydrocephalus.
- nerve conduction test, is an examination of the speed and function of electrical signals that travel through the nerves of the body. There are several types of nerve conduction tests, including:
- Electroencephalography (EEG). Examination using electrodes placed on the scalp to detect electrical activity in the brain. EEG is used to help diagnose seizures, brain tumors, brain damage from head injuries, and inflammation of the brain and spinal cord. This examination takes 1-3 hours depending on the patient's condition.
- Electromyography (EMG). Examination of the function of the peripheral nerves in the patient's arms and legs, using a very thin needle inserted into the muscle. An EMG can detect the location and severity of a pinched nerve. This examination takes 15-45 minutes.
- Electronystagmography (ENG), This is a test used to diagnose balance and eye movement disorders. This test is performed using small electrodes that are placed around the eye or special glasses if the test involves infrared light instead of electrodes.
- Polysomnogram. Measurement of body and brain activity while the patient is asleep. This test is performed using electrodes placed on the scalp, eyelids, or chin. The electrodes will record brain waves, eye movements, blood pressure, heart rate, and muscle activity. The test results are used to identify sleep disorders, as well as movement disorders and breathing disorders during sleep.
- Cerebral angiography. Examination to detect narrowed or blocked arteries or blood vessels in the brain, head, and neck, and detects the location and size of brain aneurysms. This examination uses a catheter that is inserted through a needle into the artery, as well as contrast fluid. Cerebral angiography takes 1-2 hours.
- Lumbar puncture (spinal tap). Examination performed by inserting a needle into the spinal cord to take samples of fluid from the brain and spinal cord (cerebrospinal). This fluid will be analyzed in a laboratory and the results are used to detect bleeding and infection in the brain and spinal cord, as well as measure the pressure inside the head. This check takes about 45 minutes.
- Laboratory examination. An examination of a sample of blood, urine, or other fluids for analysis in the laboratory. Several types of laboratory tests, including:
After Neurological Consultation
After the patient has consulted and gone through the examination stage, the neurologist will assess and analyze the results of the physical examination and supporting examinations that have been carried out.
Through the results of these examinations, the neurologist can determine several things, including:
- Diagnosis.After performing a physical examination and confirming the diagnosis with investigations, a neurologist can determine a possible diagnosis based on the patient's symptoms.
- Therapy or treatment plan. After the patient is diagnosed with a neurological disorder, the doctor will make a treatment plan and determine the type of treatment therapy that suits the patient's condition. This therapy plan aims to control symptoms and treat neurological disorders experienced by the patient. The therapy plan includes:
- Treatment plan, either outpatient or inpatient.
- Drugs to be used.
- Physiotherapy.
- Operations such as craniotomy, foraminotomy, laminectomy, or nerve transplantation.
