A neurologist is a doctor with specialized training in diagnosing and treating diseases of the brain, spinal cord, peripheral nerves and muscles. Most of the time, a primary care doctor refers people to a neurologist if they have symptoms concerning for a neurological disease.
Diseases managed by neurologists include:
• Neurological trauma
• Tumors of the nervous system
• Infections of the nervous system
• Multiple sclerosis and other autoimmune diseases
• Peripheral nerve disease
• Neuromuscular diseases
• Movement disorders
• Sleep disorders
A primary care doctor may not be certain that a patient has a neurological problem. However, certain symptoms may make the doctor suspect that a neurologist would be useful. What symptoms might require a neurologist's advice?
Almost everyone suffers from headaches at some point, usually due to tension or perhaps a mild illness like a cold. On the other hand, some people suffer from more severe headaches like frequent migraines. In rare cases, the headache may be caused by something serious, like bleeding into the brain or increased pressure in the skull. Patients with severe or life threatening headaches may need to be managed by a neurologist.
To learn more about headaches, read here: Classifying headaches
Many people have pain in their lower back or neck. While this kind of pain can often be managed by a primary care physician, sometimes a neurologist will become involved, especially if this pain is associated with other neurological problems like weakness, numbness, or problems with bladder or bowel control.
To learn more about chronic neck or back pain, start here: Back and Neck Pain: Symptoms-Conditions.
People mean many different things when they say they're dizzy, and different kinds of dizziness require different kinds of doctors. Neurologists commonly see patients with vertigo and disequilibrium. Vertigo involves a sense of the world spinning, as if you were on a merry-go-round. Disequilibrium means a lack of coordination or balance. These feelings have various causes, some more serious than others.
To tell if your dizziness could be serious or require the attention of a neurologist, follow the link to this article: Causes of Vertigo.
Numbness or Tingling
Like dizziness, numbness and tingling can be caused by many medical problems. A primary care doctor can manage many of these problems, but some require the attention of a neurologist. Numbness and tingling is most concerning when it comes on quickly, only affects one side of the body, or is associated with weakness. These may be signs of something as serious as a stroke, requiring urgent evaluation.
On the other hand, benign things such as anxiety or not having recently eaten may cause finger numbness and tingling that comes for short periods of time. If the numbness persists or gets worse, it may be due to peripheral nerve disease, and a neurologist may be called for. If you have any doubts, contact your physician to see what further evaluation is needed.
Some people confuse weakness with fatigue. An example of true weakness is being unable to lift something no matter how hard you try, although you may have been able to do so earlier. Fatigue means that with full effort, you can get the strength you need to lift something, but it may feel more difficult and tiresome to do so. Weakness usually only affects some muscle groups, whereas fatigue affects all of them.
The difference between weakness and fatigue is important because while fatigue can be caused by benign problems like sleep loss or a mild illness, weakness can signify something more important, such as stroke or neuromuscular disease. Like numbness, weakness is especially concerning if it comes on suddenly or just affects one side of the body. This may be a sign of a stroke or other serious problem, and requires immediate attention.
If you want to know more about stroke, read How to Recognize Stroke Symptoms.
Problems with Movement
Problems with movement include clumsiness, tremor, rigidity, unintentional movements, or difficulty walking. Some patients have an apraxia, that is they are unable to perform certain movements, such as brushing their teeth, despite having the coordination and strength required. Almost all of us have barely noticeable tremor, which may be worsened if you have too much coffee or if you're anxious. If tremor interferes with daily life, a neurologist may be needed. Tremor does not automatically mean that you have Parkinson's disease-many other things can cause tremor, including smoking and some medications. Still, it may still be a good idea to have your tremor evaluated.
For more information about symptoms of movement disorders, read here: Early Signs and Symptoms of Parkinson's Disease.
Gradual vision loss associated with aging is best managed by an eye doctor. Sudden vision loss, on the other hand, can be caused either by a problem with the eye or a problem with the nervous system, and requires immediate medical attention. A new case of seeing double should also be evaluated as soon as possible.
If you have new vision problems, try closing one eye. Information from one eye travels in the optic nerve to meet information from the other eye in the optic chiasm near the front of the brain. If the visual abnormality goes away with one eye closed, the problem is likely in the eye. If the abnormality is in both eyes, the trouble may be in the nervous system.
To learn more about eye problems usually seen by an eye doctor rather than a neurologist, read Common Eye Problems.
When most people imagine a seizure, they picture something very dramatic: someone shaking their entire body, foaming at the mouth, and losing consciousness. While some seizures do look like this, they can appear in subtler ways as well.
It may seem surprising that not all seizures require seeing a neurologist. If a person has never had a seizure before and has another medical problem known to cause seizures, such as low blood sugar or alcohol withdrawal, their seizures can be treated by addressing the underlying problem. Also, when a person passes out their body may twitch for a few seconds. This is not the same thing as an epileptic seizure, and also does not require a neurologist.
On the other hand, if someone has a seizure without any obvious cause, a neurologist may be needed. If someone has more than one unprovoked seizure, this is sufficient for a diagnosis of epilepsy, in which case a patient may be need to be followed by a neurologist for a prolonged time.
To learn more about how seizures can appear, read Symptoms of Epilepsy.
Difficulty thinking can mean a number of different things, including difficulty finding words or speaking, problems with memory, change in personality, or confusion, in which case a neurologist can be helpful. Difficulty thinking may also imply problems with depression, mania, or even psychotic features like hallucinations, in which case a psychiatrist may be more appropriate. In children, some learning disabilities require evaluation by a neurologist. Sometimes it is difficult even for experts to determine which specialist is best for a patient, and in some cases, such as certain dementias, both psychiatry and neurology may become involved.
For more information about diseases that cause cognitive problems, read Symptoms of Alzheimer's Disease and Top 8 Tips to Recognize Early Signs of Learning Disabilities.
Sleep disorders are very common, and many different types of physicians see patients with these disorders. Depending on what is happening, you may best be served by a pulmonologist, psychiatrist, or neurologist. For more information on sleep disorders, read the following: Common Sleep Disorders.
If you have one of the problems above, you may be tempted to go straight to a neurologist rather than a primary care doctor. Sometimes it can be difficult even for medical professionals to determine whether a neurologist or different doctor is best for you. Having a primary care physician helps ensure that someone is responsible for coordinating your medical care. This can prevent information from being lost and tests from being unnecessarily repeated. Coordinated medical care also reduces the likelihood of drug interactions or overdoses.
However, if you already have a diagnosed neurological condition, are unhappy with the care your primary doctor is providing, or simply would like another opinion, then seeing a neurologist is reasonable.
For more information about selecting a neurologist, try the following article-while focused on MS, the tips included apply to other neurological issues as well. Find a Multiple Sclerosis Doctor.
Hirtz et al. How common are the "common" neurologic disorders? Neurology. 2007 Jan 30;68(5):326-37.
Neurologic Emergencies: A Symptom Oriented Approach. 2nd edition. By Greg L. Henry, Andy Jagoda, Neal E. Little and Thomas R. Pellegrino. 2003. Pp. 346. New York: McGraw‐Hill.