Neurology

• 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.