Alzheimer’s disease is the most common form of dementia. The exact cause of Alzheimer’s disease is unknown. Most people who develop Alzheimer’s disease are 60 or older.
The earliest symptoms of Alzheimer’s disease involve memory loss and difficulty learning new information. Problems with getting lost, language, and emotional control are also common.
There is no specific test for Alzheimer’s disease. The diagnosis is made primarily by history and examination. Many tests, including brain imaging and laboratory studies, are done to rule out other possible causes.
Although currently there is no cure for Alzheimer’s disease, there are treatments available which can slow the progression of the disease.
AMYOTROPHIC LATERAL SCLEROSIS (ALS)
ALS, also known as Lou Gehrig’s disease, is a progressive degenerative disorder of the nervous system. ALS affects the motor neurons, which are nerve cells in the brain and spinal cord. These cells send messages to muscles throughout the body. In ALS, the motor neurons die.
Symptoms of ALS include weakness, problems with speaking, problems with swallowing, muscle twitches or cramps, muscle atrophy, and stiff muscles.
There is no single test to diagnose ALS. The diagnosis is based on history, neurologic examination, and EMG/NCS. ALS is a difficult disease to diagnose. About 5,000 people in the United States are diagnosed with ALS each year. There are two types of ALS: sporadic and familial. The cause for sporadic ALS is unknown.
Currently, there is no cure for ALS. For most people, there is progression of ALS resulting in death three to five years after diagnosis.
Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back ranging from an accident, sports injury, work around the house, lifting, twisting, etc.
Symptoms may range from muscle ache, shooting pain, limited flexibility, limited range of motion, and difficulty standing.
The diagnosis is made primarily by history and examination. Imaging of the spine may be needed in certain clinical situations.
Most cases of back pain will improve with conservative measures such as anti-inflammatory medications, muscle relaxants, and physical therapy. More invasive measures may be needed if conservative treatment is ineffective.
Bell’s palsy is the temporary paralysis of the face caused by inflammation or damage to the facial (7th cranial) nerve. Typically the paralysis affects one side of the face but, in rare cases, both sides can be affected. It is felt that the most common cause is a viral infection. In our geographic area, Lyme disease is a relatively common cause as well.
The symptoms can vary from person to person ranging from mild weakness to total paralysis of the face. Other symptoms can include twitching, drooling, dry eye, impaired taste, and excessive tearing in the eye. The prognosis for recovery is generally very good. Most individuals begin to improve within 2 weeks of onset and recover completely within 3-6 months. In a few cases, the symptoms never fully resolve. In rare cases, the symptoms may recur, either on the same or opposite side.
The diagnosis is made by history and examination.
Steroids and anti-viral medication can be used to shorten the course of the disease. In cases due to Lyme disease, the appropriate antibiotic should be prescribed.
CARPEL TUNNEL SYNDROME
Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist. The risk of developing CTS is higher in those who perform repetitive tasks with their hands. CTS is also associated with pregnancy, diabetes, thyroid disease, and rheumatoid arthritis.
The symptoms of CTS usually begin with numbness and pain in the hand or wrist. Initially, the symptoms are typically intermittent and at night. The pain can radiate up the arm. As the symptoms worsen, they can become more consistent and also occur during the day. The symptoms can progress to include decreased grip strength.
CTS is diagnosed by history, examination, and EMG/NCS.
Initial treatment usually involves resting the affected hand, a wrist splint, and anti-inflammatories. If conservative measures are not effective, surgical decompression may be considered.
Dementia is not a specific disease. Dementia refers to a collection of symptoms that can be caused by a number of disorders that affect the brain. People with dementia have impaired intellectual functioning that interferes with normal activities. Some of the diseases that can cause the symptoms of dementia are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia, Huntington’s disease, and Creutzfeldt-Jakob disease. Alzheimer’s disease is the most common form of dementia.
Memory loss is a common symptom of dementia but memory loss alone does not lead to a diagnosis of dementia. A person must have 2 or more brain functions that are impaired to diagnose dementia. Other symptoms of dementia can include personality changes, language dysfunction, loss of emotional control, loss of executive function, impaired mood.
There is no specific test for dementia. The diagnosis is made primarily by history and examination. Many tests, including brain imaging and laboratory studies, are done to rule out other possible causes.
Currently there is no cure for dementia. There are medications available for Alzheimer’s disease and some other progressive dementias which can slow the progression of the disease.
Epilepsy is a neurologic condition where a person has recurrent unprovoked seizures. A single seizure does not mean that a person has epilepsy. Seizures are episodes of altered function because of abnormal electrical discharges in the brain.
The most visible sign of epilepsy is a seizure. Most seizures are brief lasting seconds to minutes. There are many types of seizures. Some of the symptoms and behaviors that can occur during a seizure include: convulsions, staring, repetitive movements or behaviors, and decreased awareness of what is going on.
There are many different causes of epilepsy and in many cases no cause is found. Epilepsy is diagnosed by neurologic examination, imaging of the brain usually an MRI, and an EEG.
Multiple medications are available for the treatment of epilepsy.
Essential tremor is a repetitive, involuntary, rhythmic trembling of one or more parts of the body. Essential tremor is the most common form of abnormal tremor. Essential tremor affects about 10 million Americans. Essential tremor is commonly hereditary and in those cases may be referred to as familial tremor.
Hand tremor is most common but the head, arms, voice, tongue, legs, and trunk may also be involved. There may also be mild gait disturbance. The tremor is typically intention or postural tremor. Intention tremor occurs at the end of a voluntary movement. Postural tremor occurs when a body part is held in one position.
The diagnosis of tremor is made primarily by history and examination. Many tests, including brain imaging and laboratory studies, are done to rule out other possible causes.
There is no cure for essential tremor but there are treatments available to help manage the tremor.
There are four types of headaches: vascular, muscle contraction (tension), traction, and inflammatory. The most common type of vascular headache is migraine. Muscle contraction headaches involve the tightening or tensing of the facial and neck muscles. Traction and inflammatory headaches are typically symptoms of other disorders.
The specific symptoms of headache are variable depending on the type of headache.
The diagnosis is made by history and neurologic examination. In some cases, imaging of the brain may be needed.
There are various options for the acute treatment of headache depending on the type of headache. In patients with frequent headaches, there are treatments available for the prevention of headaches.
A migraine is a recurring moderate to severe headache. The exact cause of migraine is unknown. It appears to be an inherited biochemical disorder in the brain.
The pain is typically throbbing and unilateral. There can also be sensitivity to light, sound, and/or odors. Nausea and/or vomiting may accompany a migraine.
There is no medical test for the diagnosis of migraine. The diagnosis is made by history and neurologic examination. In some cases, imaging of the brain may be needed.
There are many options for the acute treatment of migraine. In patients with frequent migraines, there are several medications available for the prevention of migraines.
Multiple sclerosis (MS) is a neurologic disorder that affects the central nervous system (CNS), which includes the brain and spinal cord. In MS, the body’s immune system attacks the nerves in the CNS. The cause of MS is unknown. The most common type of MS is relapsing-remitting MS which means the symptoms come and go. The symptoms can last from days to weeks.
The symptoms of MS can include visual changes, dizziness, weakness, numbness, loss of balance, and incoordination.
MS is diagnosed by history, neurologic examination, MRIs of the brain and spinal cord, and sometimes a spinal tap.
Currently, there is no cure for MS. There are several medications available which can slow the progression of MS and also reduce the number of attacks.
Myasthenia gravis (MG) is a neuromuscular disorder that causes muscle weakness. The muscles commonly affected are those controlling the eyelids, eye movement, breathing, swallowing, the face, and the shoulders. MG is an autoimmune disorder in which the body produces antibodies that destroy the acetylcholine receptor. The acetylcholine receptor allows signals to be transmitted from nerves to muscles. The destruction of the acetylcholine receptor leads to muscle weakness.
The symptoms of MG vary from person to person but can include, drooping of the eyelids, problems with eye movements, double vision, difficulty with speech, difficulty swallowing, difficulty breathing, weakness of the face, weakness of the arms, and fatigue. MG usually does not reduce life expectancy and most people with MG are able to manage their symptoms.
MG is diagnosed by history, neurologic examination, blood tests for acetylcholine antibodies, and EMG/NCS.
Currently, there is no cure for MG but treatment is available that can effectively manage the symptoms.
A myopathy is a neuromuscular disorder in which the primary symptom is muscle weakness. Myopathies can be inherited or acquired. Inherited myopathies include the muscular dystrophies. Acquired myopathies include dermatomyositis and polymyositis.
The symptoms of myopathy can include muscle weakness, muscle cramps, stiffness, and spasm.
Myopathy diagnosed by history and neurologic examination. Additional testing may include EMG/NCS, laboratory studies, muscle biopsy, and genetic testing.
The treatment depends on the specific type of myopathy.
Narcolepsy is a chronic neurological disorder caused by the bran’s inability to regulate sleep-wake cycles normally. People with narcolepsy experience irresistible bouts of sleep.
The symptoms of narcolepsy include excessive daytime sleepiness (EDS), sleep attacks, cataplexy, vivid hallucinations during sleep onset or awakening, and sleep paralysis. Cataplexy is the sudden loss of voluntary muscle tone. Cataplexy can occur spontaneously but is more often triggered by sudden strong emotions such as fear, anger, stress, excitement, or humor. Sleep paralysis is the temporary inability to move or speak while falling asleep or waking.
Narcolepsy diagnosed by history, neurologic examination, and sleep studies including an overnight polysomnogram and MSLT.
Currently, there is no cure for narcolepsy but medications are available to treat EDS, sleep attacks, and cataplexy.
Parkinson’s disease (PD) is a movement disorder which results from the loss of a neurotransmitter in the brain called dopamine. Each year about 50,000 people are diagnosed with PD. About 4-6 million people have the disease worldwide.
The symptoms of PD include tremor, rigidity, stiffness, poor balance, poor coordination, shuffling gait, and slowness of movements. Typically there is gradual progression of symptoms with PD.
There is no medical test that can diagnose PD. PD is diagnosed by history and neurologic examination. Additional testing may be done to rule out other causes for the symptoms.
Currently there is no treatment that can cure or slow the progression of PD. There are several medications available which can help control the symptoms from PD. There are also surgical options available for the treatment of PD.
Peripheral neuropathy results from damage to the peripheral nerves. There are many forms and causes of peripheral neuropathy. The most common cause of peripheral neuropathy is diabetes. Other common causes include poor nutrition, alcohol abuse, certain drugs or toxins, autoimmune processes, inflammatory disorders, and genes. Sometimes a specific cause cannot be identified.
The early symptoms can include tingling, numbness, burning, stabbing pain, shock-like pain, muscle cramping, or sensitivity to touch. Over time the nerve damage can worsen. Later symptoms can include weakness, muscle atrophy, and loss of balance.
The diagnosis of peripheral neuropathy is made by history, neurologic examination, and EMG/NCS.
Depending on the cause of peripheral neuropathy, there may be treatment available for neuropathy itself. Many times treatment focuses on symptomatic management.
RESTLESS LEGS SYNDROME
Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move them.
The symptoms of RLS include throbbing, pulling, creeping, or other unpleasant sensations in the legs as well as an uncontrollable urge to move them. The symptoms occur primarily at night and typically with sitting or lying down.
RLS is diagnosed by history and neurologic examination. Additional testing including labs, sleep study, and EMG/NCS may be done to rule out other causes for the symptoms.
Currently there is no cure for RLS. There are several medications available which can help control the symptoms from RLS.
Sleep apnea is a common sleep disorder characterized by brief disturbances in breathing during sleep. The most common type of sleep apnea is obstructive sleep apnea (OSA) which is caused by the relaxation soft tissue in the back of the throat blocking the passage of air. Central sleep apnea is caused by irregularities in the brain’s normal signals to breathe.
The symptoms of sleep apnea can include excessive daytime sleepiness, restless sleep, snoring,, morning headaches, difficulty concentrating, forgetfulness, irritability, changes in mood, etc. Sleep apnea is more likely to occur in men and in people who are overweight or obese.
The diagnosis of sleep apnea is made by history, examination, and a sleep study.
Depending on each case, treatment may include changes in lifestyle, continuous positive airway pressure (CPAP), surgery, or medications. Patients with untreated sleep apnea can be at risk for stroke, TIA, and heart disease.
Many sleep disorders are brain disorders that cause interruptions in sleep patterns. Sleep disorders prevent people from getting enough sleep. The brain regulates sleep and is the only organ known to require or benefit from sleep. Untreated sleep disorders not only affect the quality of life but can also cause serious safety problems and medical issues. Most sleep disorders fall into one of these categories: Circadian rhythm disturbances, hypersomnia, insomnia, narcolepsy, sleep apnea, restless legs syndrome, REM sleep behavior disorder, and parasomnias.
Symptoms of sleep disorders can include fatigue, inability to fall asleep at night, inability to stay asleep at night, excessive daytime sleepiness, loud snoring, sleep attacks, sleepwalking, and sleep terrors.
The diagnosis of sleep disorders requires a careful history, examination, and often a sleep study.
Treatment varies and is based on the specific sleep disorder involved.
A stroke is caused by the sudden loss of blood flow to the brain or bleeding in the brain. Strokes can be either hemorrhagic or ischemic. Risk factors for stroke include high blood pressure, diabetes, high cholesterol, heart disease, smoking, and family history.
The symptoms of stroke can vary depending on which part of the brain is affected. The symptoms of stroke can include weakness, numbness, confusion, trouble speaking, changes in vision, loss of balance, dizziness, loss of coordination, or severe headache. The sudden onset of any of these symptoms should be evaluated on an emergent basis.
Stroke is diagnosed by history, examination, and brain imaging. People that have had a stroke are at a higher risk of having another stroke.
For patients with ischemic stroke who meet certain criteria, a clot-busting drug (tPA) can improve outcomes when given up to four-and-a-half hours after symptoms began. Other treatments are directed at reducing the risks of complications, optimizing recovery, and preventing future strokes. For hemorrhagic stroke, treatment could include: drugs that lower blood pressure, surgery to remove blood from the brain or decrease pressure on the brain, surgery to fix damaged blood vessels, insertion of a coil to block off bleeding blood vessels, and drugs that prevent or reverse brain swelling.
Syncope is a medical term used to describe a temporary loss of consciousness due to the sudden decline of blood flow to the brain. Syncope is commonly referred to as fainting or passing out. There are several types of syncope including vasovagal syncope, carotid sinus syncope, and situational syncope. Syncope can be a symptom of heart disease or an abnormal heart rhythm. Syncope is typically not primarily a sign of a neurological disorder but may indicate a risk for certain neurological disorders.
Prior to passing out there usually can be dizziness, lightheadedness, and nausea. The skin may be cold and clammy. After fainting a person is usually unconscious for a minute or two but will revive and return to normal.
The diagnosis of syncope is based on history and examination. Further cardiac and/or neurological evaluation may be needed depending on the specifics of each case.
Treatment varies based on the specific causes of syncope.
National Institute of Neurological Disorders and Stroke – ninds.nih.gov
A transient ischemic attack (TIA) is caused by the sudden loss of blood flow to the brain. By definition, the symptoms of TIA resolve within 24 hours. In fact, most TIAs last less than an hour. The risk factors for a TIA include high blood pressure, diabetes, high cholesterol, heart disease, smoking, and family history.
The symptoms of a TIA can vary depending on which part of the brain is affected. The symptoms of a TIA can include weakness, numbness, confusion, trouble speaking, changes in vision, loss of balance, dizziness, loss of coordination, or severe headache. The sudden onset of any of these symptoms should be evaluated on an emergent basis.
TIA is diagnosed by history and examination. Brain imaging is done to rule out a hemorrhage or stroke. Imaging of the cervical and/or intracranial blood vessels may be done to evaluate for possible stenosis. A TIA can be a warning sign for a future stroke. About one-third of those who have a TIA will have a stroke sometime in the future.
Depending on the etiology of the TIA, antiplatelet agents, such as aspirin, or blood thinners may be prescribed. If significant carotid stenosis is found, surgery or stenting may be needed.
Tremor is a repetitive, involuntary, rhythmic trembling of one or more parts of the body.
Tremor is characterized as rest tremor, intention tremor, or postural tremor. Rest tremor occurs when the affected body part is at rest. Intention tremor occurs at the end of a voluntary movement. Postural tremor occurs when a body part is held in one position.
The diagnosis of tremor is made primarily by history and examination. Many tests, including brain imaging and laboratory studies, are done to rule out other possible causes. There are many causes of tremor. Tremor can be one of the many symptoms of a brain disease, such as Parkinson’s disease. Rest tremor is a common symptom of Parkinson’s disease. When tremor is the only symptom, the most common cause is essential tremor. Intention and postural tremor are common symptoms of essential tremor. Essential tremor affects about 10 million Americans. Essential tremor is commonly hereditary and in those cases may be referred to as familial tremor. Other causes of tremor can include thyroid abnormalities, hormonal abnormalities, medications, and caffeine.
Depending on the cause of tremor, there are treatments available to manage the tremor.
Trigeminal neuralgia (TN) is a neurologic disorder which affects the trigeminal (5th cranial) nerve resulting in neuropathic pain. TN may be the result of a blood vessel pressing on the trigeminal nerve as it exits the brainstem. TN can also occur in patients with multiple sclerosis. Rarely, TN can result from a tumor or AVM compressing the trigeminal nerve. TN can also result from injury to the trigeminal nerve from facial trauma, stroke, oral surgery, or sinus surgery.
TN results in severe, sudden, burning or shock-like pain of the face. It is typically unilateral. The pain is usually brief lasting seconds to minutes but can occur repeatedly. The pain can be triggered by contact of the cheek, brushing teeth, eating, drinking, talking, or exposure to the wind.
TN is diagnosed by history and examination. An MRI of the brain is usually done to rule out tumor or multiple sclerosis as possible causes.
There are various medications which can relieve the pain from TN. There are surgical and other invasive options available if conservative measures are ineffective.
Member, American Society of Neuroimaging
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