Things About The Neurosurgical Consultation You Need To Know

Consultation of neurological disease is an examination procedure undertaken to check the condition and detect nervous system disorders, as well as to diagnose neurological diseases the patient may suffer . The results of the consultation will be used as a guide for physicians to determine and plan the appropriate type of treatment.

Nerve disease is a disorder that occurs in the nervous system of the body, including the brain and bone marrow (the central nervous system), and the nerves that connect the central nervous system with the organs of the body (the peripheral nervous system). The disturbance of the nervous system can lead to disruption of all or some of the body's functions, such as difficulty moving, breathing, speaking, memory disturbances, and impaired internal organs, such as heart and lung.

Things About The Neurosurgical Consultation You Need To Know

There are three types of nerves in the human body, including:

  • Motor nerves, is the type of nerve that sends signals (impulses) from the brain and spinal cord to all the muscles in the body. This nervous system allows a person to perform various activities, such as walking, catching a ball, or moving a finger to grab something.
  • Sensory nerve, is 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 sensory functions of the human body, such as vision, hearing, touch, taste, smell, and balance.
  • Autonomic nerves, are the type of nerves that control the function of body movements that are not or semi-conscious, such as heart rate, blood pressure, bowel movements, and regulation of body temperature.

Medical science that studies the human nervous system is neurology. Meanwhile, doctors who specifically deal with neurological disease called neurologist (Sp.S) or neurologist. The primary goal of neurological consultation is to diagnose, treat, and prevent various types of neurological diseases that patients experience.

Indication of Neural Disease Consultation

Patients with suspected neurological disease generally show different symptoms depending on the type of nervous disorder, either the autonomic nerves, the motor nerves, or the sensory nerves. Some of the symptoms that can occur, including:

  • Headaches.
  • Back pain that spreads to the arms or legs.
  • Tremor.
  • Seizures.
  • Muscle strength is weakened or lost.
  • Loss of balance and body coordination.
  • The ability to remember is down or lost.
  • Lost or decreased sense capabilities, such as seeing or hearing.
  • Difficult to speak or talk lisp.
  • Dysphagia.
  • Paralysis (paralyzed)

Types of Nerve Diseases

Here are some of the disturbances that may occur in the nervous system, including:

  • Infection, such as meningitis, encephalitis, and polio.
  • vascular disorders, such as stroke, TIA (transient ischaemic attack ), and subarachnoid hemorrhage.
  • Structural disturbances, such as CTS ( carpal tunnel syndrome ), Bell's palsy, Guillain-Barre syndrome, and peripheral neuropathy.
  • Functional dysfunction, like epilepsy and trigeminal neuralgia.
  • degenerative diseases, such as Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), and Alzheimer's disease.

Prior to Nerve Disease Consultation

Patients generally do not need to make special preparations before undergoing a consultation of neurological diseases. However, there are some things that the patient needs to bring when meeting with a specialist neurologist. These include:

  • Health history overall. Patients should carry all previous examination results, such as laboratory test results, X-rays, CT scans, MRI, EEG, or EMG ever.
  • Type of drug, supplement, or herbal product that is being consumed. Patients should bring a list of drugs or physical form of the medication that is being consumed, so that the doctor can find out the ongoing treatment therapies.
  • Reference letter. Patients should bring referral letters from a general practitioner or other specialist doctor. Referral letters may serve as an initial guide or description of the patient's condition and possible further handling.

In addition, patients can also make a list of questions to be asked directly to the neurologist during consultation. Sort questions from the most important questions you want to ask.

Nerve Disease Consultation Procedure

The patient will undergo multiple checks as part of the neurological consultation process. The type of examination to be performed depends on the condition and symptoms experienced by the patient. Types of checks include:

  • Medical history search. As the first step of the examination, the doctor will ask some things to the patient, among others:
    • Complaints about the patient's health problems
    • Medical history of patients and family of patients, including history of allergies, type of illness ever suffered, or a hereditary disease that the patient's family may have.
    • History of surgery or treatment therapy ever experienced patients.
    • The type of medication that is being consumed.
    • Lifestyle, including smoking habits, alcohol consumption, drug use, occupation, and hobbies.
  • Physical examination ( physical examination ). To initiate a physical exam, your doctor will measure your height and weigh the patient's weight. Then, the doctor will perform a follow-up physical examination including:
    • Examination of vital signs, includes measurement of blood pressure, heart rate, body temperature, and respiratory rate.
    • General patient examination, is the examination of various parts of the body to detect any abnormalities or disorders that the patient may experience. This examination includes examination of the head and neck, heart, lungs, stomach, and skin.
    • Nerve check. Nerve checks consist of several types of examinations, including:
      • Examination of nerve function. The examination of nerve function generally includes walking style, speech, and mental status.
        • Gait analysis ( gait analysis ), is a method of checking human pattern and gait. When a person is unable to walk normally, it is likely that the condition is caused by injury, genetic factors, disease, or disruption of limb or foot function.
        • Speech analysis ( speech analysis ), is a method of checking individual capabilities when communicating with other individuals.
        • Evaluation of mental status ( mental status evaluation ), is the examination of the patient's psychic condition, especially memory, orientation, and intelligence.
      • Cranial nerve checks. Examination of nerve function which includes olfactory (olfactory) nerves, optic nerve (sight), oculomotor nerve (eye movement), facial nerve (facial expression), and vestibulocochlear nerve (hearing and balance)
      • Examination of the sensory nervous system. Examination of nerve responses to touch, pain, temperature (heat and cold), and vibration, and identify the shape and size of an object.
      • Examination of the motor neuron system. Examination of motion, shape and size of muscle, muscle strength, and muscle mass.
      • Reflex examination, cerebellum, and meningeal . Reflex examination is usually done with a tap method on some body parts, such as elbows, knees, or ankles. Meningeal examination can be done by examination of Brudzinski (neck stiffness test) and Kernig examination (examination of thigh flexibility in pelvic joints to form 90 o ) angle. Meanwhile, a small cerebral examination is performed by looking at signs of dysarthia (slow or slurred speech), dismetria (inability to start or stop fine motor movement), or gait abnormalities, eg in patients with ataxia.
      • Examination of the autonomic nervous system, is checking for signs of autonomic nerve dysfunction, such as sweating, pallor, changes in skin and nails, and changes in blood pressure.
  • Investigation. The doctor may perform investigations to confirm the diagnosis of the neurological disease that the patient may experience. Several types of investigations are possible, among others:
    • Laboratory checks. An examination of blood, urine, or other fluids for analysis in the laboratory. Some types of laboratory examinations, among others:
      • Blood test. This test can detect infections in 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 performed to detect an abnormal substance in the urine that causes nerve disorders.
      • Biopsy. This test is done by taking tissue on the muscles, nerves, or brain to be analyzed in the laboratory.
    • Radiology. Types of checks by using light waves, high-frequency sounds, or magnetic fields. Types of radiological examinations include:
      • X-rays. X-ray examination to see body conditions, such as skull bones.
      • CT scan. Inspection by using a computer and a rotating X-ray machine. In neural examination, CT scan can detect the location of brain damage in patients with head injury, 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 brain tumors and spinal cord, multiple sclerosis, stroke, and spinal stenosis. MRI takes 15-60 minutes.
      • Positron emission tomography (PET). Examination for tumor detection and tissue damage, measuring cell and tissue metabolism, vascular disorders, and evaluating patients with neurological disorders, such as Alzheimer's disease. PET uses the patient's injected radioactive fluid and a gamma-ray-scanner machine.
      • Myelography. The examination uses a special dye (contrast) injected into the spinal canal and X-rays. This examination can detect injuries, injuries, and tumors of the spinal cord. This check takes 45-60 minutes.
      • Neurosonography. Examination using high frequency sound waves to produce detailed images of the brain and spinal cord. Neurosonographic results are used to analyze blood flow in the brain and diagnose stroke, brain tumor, and hydrocephalus.
    • Neural conduction test, is an examination of the speed and function of electrical signals moving through the body's nerves. Some types of nerve conduction tests, among others:
      • Electroencephalography (EEG). Examination by using electrodes mounted on the scalp to detect electrical activity in the brain. EEG serves to help diagnose seizures, brain tumors, brain damage from head injury, and inflammation of the brain and spinal cord. This check takes 1-3 hours depending on the patient's condition.
      • Electromyography (EMG). Examination of peripheral nerve function in the patient's arm and leg, using a very thin needle inserted into the muscle. EMG can detect the location and severity of the pinched nerve. This check takes 15-45 minutes.
      • Electronistagmography (ENG), is a test used to diagnose impaired balance and eye movements. This test is performed by using a small electrode attached around the eyes or special glasses if the test involves infrared light instead of the electrode.
      • Polysomnogram. Measurement of body and brain activity during sleep. This test is performed by using electrodes mounted on the scalp, eyelids, or chin. The electrodes will record brain waves, eye movements, blood pressure, heart rate, and muscle activity. The test results were used to identify sleep disturbances, as well as impaired motion and respiratory disturbances during sleep.
    • Cerebral angiography . Examination to detect constriction or blockage of arteries or blood vessels in the brain, head, and neck, and to detect the location and size of brain aneurysms. This examination uses a catheter inserted through a needle into the artery, as well as a contrast fluid. Cerebral angiography takes 1-2 hours.
    • Lumbar puncture ( spinal tap ). An examination done by inserting a needle into the spinal cord to collect a sample of cerebrospinal fluid and cerebrospinal fluid. This fluid will be analyzed in the laboratory and the results are used to detect bleeding and infection in the brain and spinal cord, and measure the pressure inside the head. This check takes about 45 minutes.

After Neurosurgical Consultation

After the patient has consulted and through the examination phase, the neurologist will assess and analyze the results of the physical examination and investigation performed.

Through the results of the examination, then a specialist neurologist can determine several things, among others:

  • Diagnosis. After performing a physical examination and confirming the diagnosis by investigation, a neurologist may determine the possible diagnosis of symptoms experienced by the patient.
  • Planned therapy or treatment. After the patient has been diagnosed with a nervous breakdown, the doctor will make a treatment plan and determine the type of treatment therapy appropriate to the patient's condition. This therapy plan aims to control the symptoms and treat neurological disorders experienced by patients. Treatment plans include:
    • Treatment plan, either outpatient or inpatient.
    • Drugs to use.
    • Physiotherapy.
    • Surgery such as craniotomy, foraminotomy , or laminectomy.

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