Neurology

Neurološke usluge u Poliklinici Da Medika

Efikasno otkrivaje uzroka i adekvatno lečnje svih neuroloških oboljenja najsavremenijim medicinskim aparatima i metodama. Centar za neurologiju u Polilinici Da Medika vodi prof. Dr Ranko Raičević, načelnik Klinike za neurologiju na VMA i bivši načelnik Grupe neuropsihijatrijskih klinika VMA.

What is neurology and what does it focus on?

Neurology is a branch of medicine which is devoted to diagnosing and treating diseases and disorders in functioning of the nervous system. The nervous system is divided into the central nervous system (comprising the brain and the spinal cord) and the peripheral nervous system (comprising the network of the nerves across the whole body). The immense importance of the nervous system is reflected in the fact that it participates in all functions of the organism.

Everything we do depends on the messages (nerve impulses) which the nervous system sends and transmits between the brain, the spinal cord and other parts of the body. The brain controls all vital functions, including breathing and heart’s functioning. Nerve impulses travel from the brain, along the spinal cord, and they control all functions of the organism, such as the movement of arms and legs, reactions of our senses, such as the touch and temperature, but also the functions of our internal organs which we are not aware of and which we cannot manage voluntarily. They are managed by the part of the peripheral nervous system which is called the autonomic nervous system. It regulates the work of heart, blood pressure, breathing, digestion, urination, sexual functions. As a result of injuries to and the diseases of the nervous system, a person may have difficulty moving or become immobile.

Neurology is concerned with the problems with the coordination of movements, muscle weakness, problems with the functioning of senses (of sight, touch, smell), confusion, memory, dizziness, headaches etc.

The symptoms which indicate you should visit a neurologist

You should visit a neurologist in the following cases:

  • Incessant headaches or headaches which worsen. There are more than 150 types of headaches, but migraines are particularly severe and painful and they disable a person in his or her functions and are recurrent. If you feel ache only on one side of your head, are sensitive to light and sound, feel nausea and you vomit, are weak and feel numbness, you have to visit a neurologist.
  • Sudden loss of sight, blurred or double vision may be the symptoms of a concussion, a stroke, transitory ischemic attack (TIA – mini-stroke), headaches, multiple sclerosis, myasthenia gravis, Parkinson’s disease, a brain tumour. These symptoms are often accompanied by loss of balance and poor coordination of movement.
  • Loss of hearing may be the sign of auditory neuropathy. That means that the inner ear recognises the sound, but there is a neurological problem for the sound to be transmitted to the brain through nerve impulses. Alzheimer’s disease, Parkinson’s disease, autism, ataxia, epilepsy and a stroke are among additional neurological problems that cause loss of hearing.
  • Stiffness and tingling in the extremities may be the signs of conditions and diseases such as: a stroke, transitory ischemic attack (mini-stroke), multiple sclerosis, epilepsy, peripheral neuropathy, polyneuropathy, peripheral nerve injuries, Guillain-Barré syndrome etc.
  • Muscle weakness may arise as a result of neuromuscular diseases such as: amyotrophic lateral sclerosis (ALS), hereditary neuropathy (Charcot-Marie-Tooth and the like), chronic inflammatory neuropathy (CIDP), Guillain-Barré syndrome (GBS), muscular dystrophy, myasthenia gravis, peripheral neuropathy etc.
  • Problems with balance and coordination of movement may occur with neurological conditions and diseases such as: a stroke, multiple sclerosis, benign paroxysmal positional vertigo, vestibular neuritis, Friedreich’s ataxia, a brain tumour.
  • Fainting may occur for neurological reasons such as: a vestibular migraine, an epileptic seizure, benign paroxysmal positional vertigo, Parkinson’s disease, multiple sclerosis.
  • Incessant pain in the back and the neck may indicate neurological causes such as: multiple sclerosis, transverse myelitis (inflammation of myelin sheath of the nerves of the spinal cord), Alzheimer’s disease, epilepsy, brain tumours.
  • Tremor and involuntary movements are typical symptoms of Parkinson’s disease.  They may also occur with diseases such as: multiple sclerosis, dystonia, chorea, ballismus, tics, Tourette’s syndrome etc.
  • Difficulty speaking and swallowing may be a consequence of brain damage as a result of diseases such as Parkison’s disease, but also of a traumatic brain injury, muscular dystrophy, muscular dystonia, cerebral palsy.
  • Convulsions are sudden, severe and successive contractions and relaxing of muscles, which leads to uncontrolled shaking of the body. Epilepsy is a disease with which they typically occur. There are also febrile convulsions (better known as a fever fit in children), which arise as a result of infectious inflammation of the central nervous system.
  • Facial asymmetry or weakness of one side of the body are typical of a stroke. They also occur with diseases, such as Bell’s palsy, bacterial and viral infections (Lyme disease, syphilis, chickenpox, mumps, mononucleosis etc.), migraines, multiple sclerosis, brain tumours, diabetic neuropathy, transitory ischemic attack (TIA – mini-stroke), traumatic brain injury etc.  
  • Problems with urination and/or bowel movement which are linked to neurological symptoms may be a consequence of conditions and diseases such as: spinal cord injury, traumatic brain injury, brain and spinal cord tumours, a stroke, multiple sclerosis, Parkinson’s disease,  amyotrophic lateral sclerosis (ALS), dementia, spina bifida, cerebral palsy, Guillain-Barré syndrome, diabetic peripheral neuropathy.  
  • Sudden or severe vertigo occurs with conditions and neurological diseases such as: vestibular neuritis (sudden vertigo), benign paroxysmal positional vertigo, head injury, nerve damage in the inner ear pressure created by benign tumours (a meningioma, a vestibular shwannoma), multiple sclerosis etc.
  • Difficulty learning or understanding speech may arise as a result of conditions and neurological diseases such as: a stroke, traumatic brain injury, Gerstmann syndrome, brain tumours, dementia, amyotrophic lateral sclerosis (ALS), primary progressive aphasia etc.

Diagnostic and treatment methods available at Da Medika Polyclinic

An examination by a neurologist involves taking personal and family medical history, a clinical examination with the application of neurological tests, the review of laboratory test results and MRI or other scans and the previous medical documentation, establishing of a diagnosis and drafting a medical report with the prescribed treatment. If a patient did not possess results which are necessary for establishing diagnosis on the occasion of the first examination, he or she is referred to additional diagnostic.

  • Diagnostics and treatment of neuromuscular diseases. Depending on the disease being suspected, the following is applied in the diagnostics of neuromuscular diseases: laboratory blood tests, MRI or other scans, lumbar puncture (taking a sample of cerebrospinal fluid from the spine), electromyoneurography (EMNG), genetic tests, but also a series of neurological tests which comprise the following:
    1. examination of the cranial nerves, i.s. of sight, hearing and facial expressions
    2. assessment of muscle function, strength, stretch reflex and tone
    3. examination of standing and walking ability
    4. examination of coordination of movements.

 

Treatment involves prescribing  medications for pain, cramps and stiffness, immunosuppressants with autoimmune diseases (interferon beta and biological therapy and the like), immunoglobulins for the creation of antibodies.

  • Diagnostics and treatment of headaches starts with an interview with a patient who is to describe the pain, its intensity, the part of the head where and the frequency with which it occurs, what causes and intensifies it and what alleviates it. The patient is also to mention any other potentially present problems (blurred vision and vomiting, loss of consciousness, problems with balance etc.) so that other neurological diseases would be excluded or diagnosed.  If required,  a neurologist will refer the patient to additional diagnostics, such as ultrasonography of the neck and head, scanning or MRI. When a neurologist diagnoses the type of headache, he or she prescribes treatment in the form of painkillers and gives advice on the habits which may relieve the discomfort.
  • Diagnostics and treatment of neurodegenerative diseases and multiple sclerosis comprise a clinical examination which includes the following: the examination of the cranial nerves and the function of sight, hearing and facial expressions; the assessment of muscle function, strength, stretch reflex and tone; inspection of the ability to stand and walk as well as of coordination of movement. What is usually often required as well are laboratory blood tests, ultrasound examination of the neck and brain, an x-ray, MRI or other scans of the brain and/or other parts of the body, density bone test (DEXA), electromyoneurography (EMNG), and if multiple sclerosis is suspected, taking of a sample of cerebrospinal fluid from the spine and its analysis is also needed.  Depending on the diagnosis, a neurologist prescribes treatment in the form of drugs and/or immunosuppressants (with multiple screlosis).
  • Diagnostics and treatment of neuropathic pain starts with an interview with a patient, who is asked to describe the pain, when and where it occurs, how intense it is and what causes it. Detailed medical history is taken as it is important to find out whether the patient suffers from diabetes or any other neurological diseases, whether he or she is exposed to any toxic substances etc. Establishing of diagnosis usually requires certain blood and neurological tests as well:  the examination of the cranial nerves and the functions of sight, hearing and facial gestures; the assessment of muscle function, strength, stretch reflex and tone; the examination of the ability to stand and walk as well as of coordination of movement. Sometimes electromyoneurography (EMNG), CT scanning  or MRI of the spine, nerve or skin biopsy are also required.

First-line drugs which are used are anticonvulsants and antidepressants, while non-steroidal anti-inflammatory drugs may be added as well.

  • Diagnostics and treatment of polyneuropathy (peripheral neuropathy) starts with an interview with a patient as polyneuropathy is identified by the symptoms which affect several parts of the body and afflict the nerves which control the senses and movements. Alongside this, blood tests, neurological tests which check reflexes, muscle strength, sensitivity to temperature and other sensations, coordination of movement and body posture are also required. MRI or other scans, electromyoneurography (EMNG), nerve and skin biopsy may also be needed.

Treatment involves taking different types of drugs, depending on the type of neuropathy. With milder pain, painkillers (ibuprofen) can help, but they can be taken for a limited period of time. Antidepressants are also used, and with mononeuropathy, corticosteriod injections and antiepileptic drugs (gabapentin,  pregabalin) are used.   

  • Diagnostics and treatment of neurological complications of internal and surgical diseases.

High blood pressure which is not treated or regulated may often lead to a stroke, whereas diabetes which is not treated or regulated may lead to neuropathy and polyneuropathy. The consequences of surgical interventions may be a stroke, delirium, problems with understanding speech, concentration, spinal cord ischemia etc. The treatment depends on the cause and type of problems, and in most cases it requires the examination by another specialist as well and that the treatment for the primary diseases which has caused the neurological complication should be prescribed.  

  • Treatment of the consequences of neurotrauma (traumatic brain injury). Patients with this diagnosis, above all, need to rest. The treatment depends on the very consequences, which may be headaches, fainting, vertigo and problems with the memory. The treatment is symptomatic,e. drugs against pain, nausea, sedatives etc. are administered. Neurotrauma may also result in epilepsy, which electromyoneurography (EMNG) is conducted for, and in that case, antiepileptic medications are prescribed.
  • Ultrasound diagnostics of blood vessels in the neck and brain is a completely safe and painless diagnostic procedure, which does not require any preparation. Gel is applied to the skin on the front side of the neck, and a neurologist slides a probe (which transmits ultrasonic waves) along the neck in the area below which carotid arteries, which connect the heart with brain, are to be found, while looking at the image of the blood vessels in the neck and the flow of blood through them on the screen.

An ultrasound of the brain (transcranial ultrasound) is conducted in the same way as an ultrasound of blood vessels in the neck, with a  difference that an ultrasonic probe is placed on the area of both temples, eyes and the back of the head. A neurologist can see the image of the base of the brain on the screen of the ultrasound machine and monitor the blood flow in that area.

An ultrasound of carotid arteries and brain (transcranial ultrasound) is conducted with the symptoms such as: weakness and tingling in arms and legs, facial droop and numbness, sudden blurred vision and double vision, difficulty speaking, loss of consciousness, vertigo and problems with concentration. This procedure may reveal the narrowing, clogging and widening of blood vessels, which may be the cause of a stroke. An ultrasound of blood vessels in the neck and the brain may reveal neurological problems such as: a stroke, TIA (a mini-stroke), vasospasms, arteriovenous malformations (AVM), vertebral artery dissection (VAD), a migraine with aura, cerebrovascular disorders (moyamoya and cortical dysplasia), brain tumours. It is also important for diagnosing Parkinson’s disease, with patients which suffered  bleeding within the meninges (subarachnoid haemorrhage) as well as for monitoring the effects of thrombolytic therapy for a stroke.  

  • Electromyoneurography (EMNG) is a diagnostic procedure which is used for the examination of the function of muscles, neuromuscular junctions and peripheral nerves. On the evening prior to the examination, the patient is not to apply any creams or other cosmetics to the skin. The examination takes between 30 and 90 minutes and it starts with having the patient’s weight and height measured. During electromyoneurography, the patient is in the supine position, and his or her peripheral nerves in the certain part of the body  are stimulated by electric current, i.e. an electrical impulse, while the muscles are examined by placing a needle electrode into the muscle. The response of the nerve and the muscle to the stimulation is visually displayed on the screen of the cathode ray tubes of the device or on the computer screen.

Electromyoneurography is performed with nerve injuries and damage, when a patient is feeling pain and weakness in the muscles, is experiencing loss of sensation and the change in the intensity of the pain as a reaction to touch, is feeling tingling and numbness in the muscles and muscle fatigue, but also when a clinical examination has revealed that he or she  has a diminished or absent muscle reflex.

Electromyoneurography is used for diagnosing diseases such as: hereditary neuropathy, polyneuropathy, radiculopathy, various types of myopathy,  autoimmune diseases, motor neurone diseases, nervus facialis disorders, muscular dystrophy, polymyositis, myotonia, ALS, myasthenia gravis and myasthenic syndromes etc. This method can also be used to examine the functions of the anal and urethral sphincters (ring-shaped muscles which regulate the opening and closing of the anus and the urethra).

The diseases which can be detected and treated by neurologists

Some of the most common diseases which can be detected and treated by neurologists are the following:

  • Migraines and other types of headaches are among the most common problems for which patients address neurologists. There are over 150 types of headaches, and thus the parts of the head which ache and symptoms are different. There are headaches such as: sinus headaches (pain in the area of the sinuses, the forehead  and the cheekbones), cluster headaches (pain in or around the eyes), tension headaches (pain feeling like a tight band around the head) and migraine headaches. Migraines are characterised by an excruciating pain which recurs in the identical way, and they are accompanied by the following symptoms: throbbing pain (usually on one side of the head), blurred vision or loss of vision in the part of the vision field with light flashes, nausea and vomiting, hypersensitivity to sound and smells, ear buzzing, sweating, fatigue, a lack of concentration etc. The diagnosis is established on the basis of symptoms, but brain scanning or MRI may also be required. It is treated with painkillers, triptans and dihydroergotamin The patient is provided with the instructions on the habits which may relieve the discomfort.
  • Vertigo is a common problem which most usually occurs as a result of a short-term interruption of or reduced blood flow in the brain or in the neck. The most common causes are: fatigue, dehydration (insufficient water intake), low blood sugar levels (below 4mmol/l), atherosclerosis (narrowing or clogging of blood vessels in the neck), degenerative changes in the cervical spine, a middle ear disorder, vision or hearing disorders, anaemia, a concussion, a stroke, a brain tumour, epilepsy, Parkinson’s disease, multiple sclerosis, ataxia and similar neurological causes.

Apart from a neurological clinical examination,  diagnostics include the ultrasound examination of carotid arteries and the brain. If needed, scanning or MRI or EMNG might be requested. The treatment depends on the cause of vertigo.

  • A stroke (a brain infarction or a brain attack) represents the cessation of the functioning of one part of the brain as a result of discontinued blood flow due to the constriction or the obstruction of a blood vessel by a blood clot (an ischemic stroke) or due to the rupture of a blood vessel and bleeding (a haemorrhagic stroke). The symptoms are the following: confusion, paralysis and/or numbness in one part of the face and the body, difficulty speaking, difficulty coordinating movements, double vision or loss of vision, dizziness, loss of balance. A stroke is a condition which requires immediate medical attention within the first hour so that thrombolytic therapy would be administered and thus the consequence of the stroke prevented, and sometimes in order to save the patient’s life. For establishing the diagnosis, blood tests, a test of haemostasis (an INR blood test) and a brain scan are required apart from a clinical examination by a neurologist.
  • A transient ischemic attack (TIA or a mini-stroke) is most usually caused by a blood clot (a thrombus), the constriction of the blood vessels in the neck (carotid arteries) or reduced blood flow through them, high blood pressure. This condition is transient (it lasts between several minutes and 24 hours), and the symptoms are the following: transient tingling and weakness on one part of the face and the body, blurred and double vision, difficulty speaking or understanding other people, dizziness, loss of balance and coordination of movements. It is necessary that the patient should visit a neurologist as soon as possible as a TIA may be a forewarning of a stroke. For establishing the diagnosis, a clinical examination by a neurologist and scanning  are required.  It is treated with medications which affect blood thickness, drugs for blood pressure (beta blockers), statins etc.
  • Parkinson’s disease is one of the common neurodegenerative diseases in persons over 60 years of age, which occurs as a result of reduced secretion of dopamine. The symptoms include the following: shaking (tremor) of the hand or fingers only when the arm is resting on the lap or when it is lowered loosely at the side of the body, and, more rarely, shaking of a leg, stiffness of arm and leg muscles, slowness of movement in performing everyday activities (shaving, washing hair, buttoning), stiffness (and sometimes pain) in the shoulder. The following may also be present:  changes in speech (slow and quiet speech, stutter), loss of automatic movements  (blinking, smiling, swinging arms while walking), difficulty writing (small handwriting), expressionless face etc. The diagnosis is established on the basis of symptoms, a neurological clinical examination and brain scanning. It is treated with medications which affect  dopamine levels.
  • Multiple sclerosis (MS) is a common neurodegenerative autoimmune disease which affects young adults (between 20 and 40 years of age), mainly women. The patient’s immune system attacks and destroys its own tissue, primarily the myelin sheath surround the nerve cells in the brain and the spinal cord.  The consequence is that nerve impulses are transmitted from the brain to other parts of the body with difficulty or they are not transmitted at all. The symptoms are the following: numbness and weakness in the limbs on one side of the body,  tingling and the feeling similar to an electric shock when moving the neck, poor coordination of movements, stumbling walk, blurred vision, double vision, dizziness, weakness   In the acute stage, it is treated with high doses of corticosteroids administered intravenously, and in the chronic stage, it is treated with interferon beta or with biological drugs.
  • Epilepsy is a chronic neurological disease which affects both children and adults. It is caused by inadequate nerve impulses being conducted from the brain (‘an electrical storm), which results in a so-called epileptic seizure which last between 1 to 5 minutes, which occurs suddenly and unexpectedly and is transient, but which is recurring. The symptoms are the following: loss of consciousness, bending of the trunk forwards and backwards, alternating contractions of the tongue and jaw muscles (biting of the tongue is possible), raised eye lids, eyes rolling upwards and dilated pupils, ‘an epileptic cry’, heart rate faster than normal, pallor, blue skin, twitching and spasm of the muscles of the face and the body, foaming at the mouth. It is treated with anti-epileptic drugs. 
  • Peripheral neuropathy (polyneuropathy) most often occurs with patients suffering from diabetes as a consequence of that disease, but also as a result of traumatic injuries, autoimmune diseases (Sjögren’s syndrome, lupus, rheumatoid arthritis, Guillain-Barré syndrome, vasculitis) and infections. Polyneuropathy involves damage to several peripheral nerves, predominantly those in calves and feet, and sometimes those in the arms. If it afflicts one nerve only, it is called mononeuropathy. The symptoms are as follows: piercing pain, tingling and burning (mainly at night); numbness in lower legs, feet, hands; dry and thin skin and skin ulcers (sores); muscle weakness and sharp and stabbing pain. The diagnosis is reached by a neurological clinical examination, blood tests and with the help of  electromyoneurography (EMNG). Treatment involves regulating  blood sugar levels (with diabetics) and administration of painkillers, anti-epileptic drugs (gabapetin and pregabalin), antidepressants, alpha-lipoic acid and skin creams.
  • Dementia is a general term which comprises various disorders which are reflected in difficulty remembering and performing other brain functions related to thinking, which disable normal functioning in everyday life. Alzheimer’s disease and vascular dementia, dementia with Lewy bodies and frontotemporal dementia are the most common forms. The typical signs include the following: forgetting things (mainly the most recent events ans actions), confusion and fear, lack of concentration, frequent retelling of the same stories and asking the same questions repetitively, forgetting words and names, disorientation and getting lost in place and time, neglecting personal hygiene etc.  The diagnosis is established on the basis of laboratory tests, ultrasound examination of blood vessels in the neck and the brain, a brain scan, neuropsychological testing. It is treated with the medications which improve circulation in the brain,  cholinesterase inhibitors, NMDA glutamate receptor antagonists and neuroleptics. 
  • Encephalitis is the inflammation of the brain caused by a viral or bacterial infection, and sometimes by an autoimmune reaction (when the very organism attacks its own tissues). The symptoms may include the following: a headache, a fever, confusion, disorientation, body spasms, involuntary movements, vision problems, paralysis of the nerves in the head or of peripheral nerves, epileptic seizures, speech disorders and disorders of the functions of vision, hearing, touch etc. For establishing the diagnosis, a clinical examination by a neurologist and an infectologist, a lumbar puncture and the analysis of cerebrospinal fluid,  a brain scan and  an electroencephalogram (EEG) are required. It is treated with anti-epileptic drugs, medications for oedema (a brain swelling), anti-viral drugs (when it is caused by a herpes simplex or other viruses).
  • Meningitis is the inflammation of meninges, and it is most commonly caused by viral infections (coxsackievirus, echovirus, West Nile virus, herpes simplex virus, mumps virus). Other causes may be fungi and toxins, but also bacteria (meningococcus, pneumococcus, streptococcus pyogenes, staphylococcus aureus, escherichia coli, klebsiella pneumoniae etc.). The symptoms are the following: a fever, a headache, vomiting, sensitivity to light (photophobia), and if the brain is affected as well, the symptoms may include disorders of consciousness and involuntary movements, weakness in the legs, cramps etc. A clinical examination by a neurologist and an infectologist, blood tests, a CT scan of the brain and a lumbar puncture with the analysis of cerebrospinal fluid are crucial for establishing whether meningitis is caused by a virus or a bacterium and for prescribing treatment in accordance with it. The swelling of the brain and the meninges is treated with corticosteroids and mannitol, while sometimes painkillers and anti-epileptic drugs are prescribed.
  • Myasthenia gravis is one of neurological autoimmune diseases which is manifested in muscle weakness and fatigue.  It most commonly occurs in young women and older men. The symptoms are as follows: one or both droopy eyelids, weak legs, double vision, difficulty speaking,  swallowing, chewing and breathing etc. Fatigue is felt even when performing easy tasks, and it intensifies as the day goes by. For establishing the diagnosis, a clinical examination by a neurologist, blood tests, analysis of acetylcholine receptor antibodies, a chest scan and electromyoneurography (EMNG) are required. It is treated with immunosuppressants and corticosteroids.
  • Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disease of motor neurons in the brain and the spinal cord, which is also known as Lou Gehrig’s disease. Neurons which control speech, chewing, breathing and walking are affected. Early symptoms include tripping, dropping things,  abnormal fatigue of the arms and legs, slurred speech, muscle twitches, uncontrollable laughing or crying. Ultimately the ability to make voluntary movements is lost.  This diseases is not curable and the survival period is around 5 years.  
  • Radiculopathy occurs as a result of one or more pinched nerves in the spine. The symptoms include numbness, tingling, weakness and (stabbing or burning) pain in the muscles and the affected parts of the spine (the cervical, thoracic or lumbar spine). The diagnosis is established on the basis of a clinical examination, a x-ray scan, a CT scan or magnetic resonance imaging of the affected part of the spine and electromyoneurography (EMNG). It is treated with non-steroidal anti-inflammatory drugs (ibuprofen, diclofenac, aceclofenac, naproxen,  acemetacin), corticosteroid injections and a drug against neuropathic pain (gabapentin).
  • Guillain-Barré syndrome (GBS) is a rare autoimmune neurological disease which is manifested as muscle weakness and numbness, back pain, tingling and the loss of reflexes in the arms and feet, difficulty breathing and swallowing, hearth rhythm and blood pressure disorders. It can be caused by a virus or a bacterium. The diagnosis is established on the bases of the clinical picture and a clinical neurological examination, a lumbar puncture and the analysis of cerebrospinal fluid and electromyoneurography (EMNG). It is treated with intravenous immunoglobulin (IVIG) therapy and plasmapheresis (the filtering of plasma of the very patient).
  • Neuropathy of the trigeminal nerve (Neuralgia trigemini) is the inflammation of the trageminal nerve which extends from the brain stem to the ear and then it splits into three branches: one towards the eye, one towards the cheek and one towards the jaw. Pain occurs suddenly, on one side, in the region of the cheek and the jaw. The patients describe it as the greatest pain you may imagine (greater than labour pain or pain caused by a bladder stone), and it resembles an electric shock. The pain may be triggered by touching the teeth or gums by the tongue, washing the face, brushing the teeth, shaving, putting on make-up, and especially chewing food and swallowing drinks. Pain relievers usually do not help. Primary trigeminal neuralgia occurs as a result a blood vessels which compresses the nerve in the region of the brain stem. Secondary trigeminal neuralgia is the consequence of multiple sclerosis (MS), an aneurysm or a tooth disease. It is treated with the combination of anti-epileptic drugs (pregabalin and carbamazepine), antidepressants and botulinum toxin injections. If that therapy becomes ineffective over time, a gamma knife surgery is conducted.   

An examination by a neurologist

Does an examination by a neurologist require preparation?

A clinical examination by a neurologist does not require any special preparation.

What does an examination by a neurologist involve?

A neurologist talks to the patient, listens about the problems the patient complains of and the symptoms he or she has, when they occur and worsen, and then the neurologist takes the patient’s personal and medical history (complete anamnesis).

Upon that, the neurologist examines the patient’s head. He or she pays attention to the mobility of the head and the neck, the presence of a muscle spasm and the possible presence of deformities (wry neck). He or she checks for the presence of sensitivity to pain of certain points on the head (Valleix points). What is tested are the nerves which control the eyeballs, those which are responsible for the sensitivity of the face to touch, the function of the tongue, the function of the nerves which control the sense of taste, the sense of smell and swallowing, the sense of hearing and balance. The examination and pupillary light reflex testing using a small torch is necessary. The movements of eyes are checked, i.e. it is examined whether the following are present: eyeball twitches, drooping eyelids, eyelid twitching, constriction and dilation of pupils, double vision etc.

What follows is the examination of arms and legs, i.e. checks on their mobility, gross motor skills, the tone (presence of cramps or stiffness) as well as flabbiness (looseness).

When brain and/or spinal cord damage is suspected, testing of muscle stretch reflexes is done necessarily. What is checked is whether the reflexes are decreased, absent or whether they are pathological.

Following that, the coordination of movement, balance and the presence of tremor (trembling) of arms and legs are checked, which gives information about the functioning of the cerebellum. It is examined whether instability is present while walking.

The patient is also asked questions about the function and the emptying of urinary bladder and the movement of the bowel, as they are also controlled by the nervous system

What can be expected after the examination?

If the clinical examination was not sufficient for establishing a diagnosis, after the examination, the patient might be referred to have blood and urine tests, CT scanning, MRI, electromyography (EMNG) or an ultrasound examination of the blood vessels in the neck and brain done or he or she may be referred to another specialist.

If the neurological clinical examination was sufficient, a diagnosis is established, the neurologist drafts a medical report, prescribes treatment and gives advise on the habits (what is to be avoided and what is to be done) so that the disease triggers would be avoided and the discomfort relieved.

Experts who conduct neurological examinations in Da Medika Polyclinic

Da Medika polyclynic has a top-notch team of experts in the area of neurology. The doctors available to patients are Prof. Ranko Raičević, MD, PhD, a neurologist, the Head of the Clinic of Neurology of the Military Medical Academy, and a full professor of the Faculty of Medicine of the Military Medical Academy of the University of Defence in Belgrade, one of the leading experts in Serbia in diagnosing numerous neurological diseases and conditions using ultrasound and electromyoneurography  (EMNG) and in the application of the most efficient treatment protocols,  Dr. Viktor Pasovski, a neurologist, an expert with years of experience in the area of transcranial ultrasound of blood vessels in the head and the neck, stroke, headaches (migraines), epilepsy, central and peripheral nervous system diseases, dementia (vascular dementia and Alzheimer’s disease), Parkinson’s disease and other neurological pathological conditions, as well as Dr. Aleksandar Marković, a neurologist, an expert for electromyoneurography  (EMNG) with wide clinical experience gained at the Military Medical Academy. 

For prices of neurological examinations, please see our price list.

Our team of neurologists

Head of the Clinic of Neurology of the Military Medical Academy
Neurologist-Angiologist

Impressions of our patients

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