Neurology treatment

The nervous system is subdivided on the central and the peripheral parts. The central nervous system contains brain and spinal cord, and the peripheral contains peripheral nerves.

Brain is responsible for memory, speech, calculation, reading , writing, spatial orientation, practical skills, will, emotions and mood, controls organs of sensation, general sensation, movements, in particular for planning, programming and coordination of movements. Spinal cord also regulates activity of the human. It contains motor neurons and pathways via which signals descend from brain to muscles and also it contains ascending sensory.

Spinal cord and nerve roots, which form plexus and peripheral nerves, are situated in the vertebral channel. The condition of vertebral column is interconnected with how spinal cord and its roots function.

Brain and spinal cord also contain autonomous centers which regulate behavior, diameter of vessels, internal organs function and function of skin.

Signals from the central nervous system pass to muscles via motor nerves. Signals from skin and internal organs pass to the central nervous system via sensory pathways. Peripheral part of the autonomous nervous system supports regulation of vessels, skin and internal organs functions.

Disorders of the nervous system may be inherited and acquired.

Disorders of the nervous system are variegated. The following groups are distinguished:

• Cerebrovascular diseases ( acute, like stroke, brain hemorrhage, and chronic),
• Infectious diseases (for instance, encephalitis, meningitis, myelitis are the infectious processes in brain, its meninges and spinal cord),
• tumors
• injury
• degenerative disorders (for instance, Parkinson’s disease in which programming of voluntary movements becomes deranged, or Alzheimer’s disease in which cognitive functions vanish gradually, or amyotrophic lateral sclerosis in which motor neurons responsible for voluntary movements gradually die)
• epilepsy (disease in which bouts of loss of consciousness with or without seizures occur), which may be inherited or acquired
• autoimmune disorders in which nervous system is affected due to abnormal functioning of immune system which starts to damage nervous system (multiple sclerosis, acute disseminated encephalomyelitis, myasthenia, acute and chronic inflammatory demyelinating neuropathy, motor neuropathy with conduction block)
• metabolic disorders (i.e. diabetic polyneuropathy)
• Intoxications (i.e. peripheral neuropathy and encephalopathy due to alcohol abuse)
• Involvement of peripheral nerves, synapses and muscles, described in the section “Electromyography».
• The separate groups are Sleep disorders, Developmental abnormalities of the nervous system, Migraine and other headaches

In the majority of cases correct diagnosis is made after discussion with a patient about his life history and a history of his disease. Discussion (history collection) helps to distinguish one or more damaging factors, to suppose acquired or inherited mode of disease. The next stage envisages examination in neurology (ultrasound Doppler of vessels, nerves, electromyography – EMG, electroencephalography - EEG). Sometimes the cause of pathological process may be elucidated only by visualization ( X-ray, MRI, CT, angiography). When inherited character of the disease is suspected molecular genetic studies are performed. In some cases routine blood and urine analysis are required. Diagnosis of infectious diseases is made by serological tests.

Sometimes, and very often, neurologist sees that signs and symptoms are connected with not a single, but several pathological conditions, in this case the pathological process may be located in different parts of the nervous system, especially in elderly, but sometimes in other age groups. Those cases require consultations of external specialists (ophthalmologist, therapist, cardiologist, urologist, pulmonologist). When tumor is found , oncologist and/or neurosurgeon have to consult a patient. When peripheral nerves are compressed a patient require neurosurgeon too.

In some cases it is required to see the patient in the follow up manner in order to make diagnosis.

In some cases neurologist cannot find reason for the complaints, complaints may be unusual, not in consistence with innervation areas of clinical signs. If in such patient there are sleep disorder or mood disorder, the consultation of psychiatrist is required. When the patient applies to state health service, he usually have to wait for a long time, may encounter demotivation of a specialist, cannot obtain examination or external consultation in time, often such specialists don’t have enough time to overthink the patient’s case and can use templates in making conclusion.

There are no such problems in our clinic. Consulting a patient with a rare disease, neurologist may encounter with a disease, thas has never been described yet. Besides, such conditions ar brain tumor or critical extend of vessel narrowing may not manifest for a long time or may manifest by some non-specific signs what leads to a situation when neurologist take them for more widely known disease. It is necessary to have examination especially in elderly in order to find such diseases in a preventive manner. Let us adduce several cases from practice of Gleb Levitsky, MD PhD, the head of our clinic, who has experience in simple and in difficult cases of neurological disease.

An old lady complained of head tremor and memory impairment. Montreal cog score showed early stage of Alzheimer’s disease, confirmed by external consultant, and there was essential tremor. At the same time auscultation of neck vessels lead to think about cerebrovascular contribution. Ultrasound Doppler revealed critical narrowing of carotid arteries requiring surgery and brain MRI revealed features of mild cerebrovascular disease and Alzheimer’s disease. The lady underwent surgery – carotid endarterectomy – and avoided heavy stroke with severe disability or death. In this example diseases coincide and one should not prefer one of pathological processes to diagnose solely. ***

A middle aged lady had surgery for a spinal cord tumor. But half a year passed and she noted intercostal pains and sensory impairment on trunc and legs. In the ambulatory a doctor said she had stress after surgery and prescribed antidepressants. When she was questioned thoroughly she reported a seizure after the surgery. Repeated MRI of truncal segment of the vertebral column revealed tumor on another level, EEG revealed features of epilepsy, and brain MRI revealed brain tumor of the same nature (meningioma). Thus she underwent repeated surgery and avoided the risk of disability in wheelchair and the risk of seizure while crossing road.
***

A middle aged man complained of appearance of large abdomen, weakness in hands and legs. Earlier he was diagnosed “spinal amyotrophy”. However, blood tests have never been taken. In blood analysis features of oncological diseasesof blood (lympholeukosis) were revealed in which selective damage of spinal cord has been described . The patient was directed to oncologist.
***

The middle aged lady complained of weakness in hands and legs, retention of urine, pains in hands and legs. She was diagnosed utreatable amyotrophic lateral sclerosis. She deteriorated and became wheelchair bound. However, analysis of clinical picture and EMG, brain MRI (which the specialist who made final diagnosis thought to be unnecessary) revealed inflammatory origin of the disease - leukoencephalitis. Treatment and rehabilitation lead to recovery, and now the patients walks and drives a car.
***

Young man complained of weakness in shoulders and nasal tune of speech. The diagnosis of amyotrophic lateral sclerosis was made in the ambulatory. But we payed attention to increase of mammal glands in size, impotence, diabetes mellitus, low reflexes in legs, unusual EMG for ALS. Molecular genetic test revealed Kennedy bulbospinal amyotrophy- it is a benign disorders that does not threaten patient’s life. Symptomatic treatment was begun.
***

Young man complained of weakness of his mimic muscles on the one half of his face. In the ambulatory diagnosis of facial nerve neuropathy was made. But several days later weakness appeared in the other half of face. Thorough EMG with pharmacological tests revealed rare form of mimic myastenia. Anticholinesterase drugs were administered, and the patient recovered.
***

A middle aged man appointed to a doctor with bout of loss of consciousness. Witnesses told about some seizures. The doctor in ambulatory thought it was due to alcohol abuse and started treatment. However, ECG daily monitoring revealed severe impairment of heart conductance. The patient received cardiostimulator.
***

An old man complanied of tinkles on the half of his groin. In the ambulatory a doctor made diagnosis of spondylosis and administered physiotherapy. We in turn reveled pathology in the urine test typical for kidney damage, and computed tomography revealed large tumor of retroperitoneal space. The patient was directed to oncologist.
***

A middle aged lady complained of tremor in her right extremities. At first diagnosis of Parkinson’s disease was made. Several details compelled us to think that brain MRI is required. MRI revealed large focus in the half of cerebellum, but Xray specialists could not interpret it properly. In another center X ray specialist said that the focus is a pseudotumor of multiple sclerosis, because he also revealed other small foci not seen by previous consultants. Specific treatment was started, condition improved Этот пример говорит о том, что в диагностике следует воздерживаться от стереотипов This example is teaching us not to follow stereotypes and to prefer services by qualified specialists.

We can continue those examples.

We use life style recommendations, medications, physiotherapy, periarticular, perineural and paravertebral injections. We treat headaches, sweating, hypersalivation and spasticity by botulinotherapy. Some diseases require intravenous infusions and we have this service also. Treatment envisages control of efficacy. Thus, we use clinical scales and tests on repeated examinations.