Brief notes on common neurological symptoms
with links to useful websites
The best prescription is knowledge
– Dr. C. Everett Koop
Tension headaches are the most common. They are from no apparent disease and are triggered by emotional stress. Women are more commonly affected. Persisting tension headaches must be investigated to rule out eye strain, dental problems, sinusitis, jaw-occlusion problems or cervical arthritis which are normally not symptomatic but present as headache precipitated by stress and should not be dismissed as psychological. Your local doctor can help.
Vascular headache is produced by a variety of blood vessel problems. Extraordinary swings in blood pressure may cause transient headache. Acute severe headache with or without disturbance in consciousness is usually due to bleeding in the brain precipitated by acute profound rise in blood pressure; or aneurysms (abnormal ballooning of blood vessel); or arteriovenous malformations (abnormal bunch of blood vessels) and requires immediate hospitalization. Inflammation of scalp blood vessels cause headache with tender spots, usually on the sides and require further investigations.
Migraine usually occurs on the one side of the head. The classic type starts with a premonitory sign such as blind spots, localized weakness or numbness which clears as the headache disappears. Nausea or vomiting may be associated. Women are more susceptible. The problem may run in families. Various medications are available for effective control. Only your doctor can select the one that suits you.
Headache is the late symptom of brain tumor. Typically the patient wakes up with headache which gets worse day by day and is associated with nausea, vomiting, visual problems and/or progressive weakness of limbs. It requires urgent investigations.
Facial pain may be sharp, short-lived and confined to one side of the face and is usually due to involvement of the nerve supplying that part of the face. They are often mistaken for tooth-ache. It is easily controlled with medication. If medication fails surgery may help.
More diffuse and chronic pain, usually called atypical facial pain, must be evaluated for more malignant causes such as throat cancer or tooth abscess..
Nagging aches with no apparent precipitating cause, are usually diagnosed as ‘spondylosis’ which means aging spine. A sudden change in lifestyle may be a cause. Active sports people who give up sports abruptly and those who suddenly become health conscious and take up vigorous ‘gym-works’ are more prone. Weight reduction and graded exercises will help. Maintenance of erect posture, using a firm mattress, going down on knees to pick-up things from the floor and using western toilets instead of Indian toilets will help. If performing regular daily excercises it is essential to stretch to avoid these injuries. Adding a yoga session to your routine can be a great way to add stretching to your week.
In addition to yoga has many health benefits of yoga, as proven by science.
Persisting pain must be investigated to rule out serious problems such as cancer or infection. Investigation should also be undertaken, if the backache is associated with leg or arm pain or belt like pain around the trunk which may suggest nerve involvement. Some tumors in the spinal cord also present this way and may be associated with progressive weakness and/or numbness of limbs. Women must obtain a gynecologist’s assessment as well.
Many diseases cause transient or permanent visual loss. Transient loss (amaurosis fugax) occurs most often as a result of blood flow problem to the eye and may precede a stroke. Inflammation of the eye nerve (optic neuritis) is associated with eye pain and causes transient loss of vision, which if unattended may proceed to permanent loss. Diabetes and glaucoma (increased intra eye pressure) are other common causes of disturbed vision.
Eyes look at objects, but the brain sees them. Many disorders of the brain cause blindness. Either the whole of the visual field, or more typically part of it, is lost depending on the area of the brain involved. The brain also controls the eye ball movement which is essential for identical images in both eyes or else double vision is the result.
Obviously every visual disturbance, even if it is a transient one, should be evaluated.
Dizziness is a complaint of postural instability. Vertigo is the perception of illusory environmental rotation. Standing may be difficult with dizziness, but virtually impossible with vertigo. Either of them may result from brain or ear disease with hearing loss and/or tinnitus.
Labrynthitis (inflammatory ear disease) is presumed to be caused by viruses. It is self limiting, but can recur. Disturbance in blood flow to the brain, some brain tumors and tumors of the ear nerve are some of the serious problems that present with vertigo or dizziness and must be ruled out.
One needs an intact brain to perceive what the ears hear. Inability to recognize specific types of noise and auditory hallucinations result from involvement of specific areas in the brain and requires neurological assessment.
Tinnitus is the perception of ringing or whistling noises independent of external stimuli and usually associated with diminished hearing in one ear which may disappear when the hearing loss is total. A wide variety of medications including aspirin may induce tinnitus as a side effect. Unusual cause is a tumor in the hearing nerve.
Any patient with a personality disorder must be evaluated, even at old age. The disorder may be acute or chronic and the settings for the same involve trauma, fever, intoxication or a genetic predisposition. Excessive brain fluid accumulation in the brain (hydrocephalus) may be the cause in some. On occasions a brain tumor or blood collection inside the head may be diagnosed during evaluation of a personality disorder and requires urgent surgical attention.
Personality changes may be transient or permanent after severe head injury. Memory impairment especially for recent events is common in severe head injury. Various brain fevers may produce severe thought disorders. Hormonal disturbances such as severe hypothyroidism produce impaired memory, inattention and depression.
Degenerative diseases of the brain (Alzheimer’s the most common) slowly produce progressive dementia
Many sexual problems are either psychological, urological or neurological. Neurological dysfunction may arise from damage to the regional nerve, the spinal cord or the brain by trauma, infections, tumors or stroke. Diabetes and alcoholism may disturb neurological control.
Hormonal problems resulting in sterility and unsatisfactory sex may be due to a brain tumor. Impotence is the most common presenting problem. Antihypertensives and antiepileptics rarely cause impotence. In some brain problems, patients exhibit hyper sexuality and inappropriate sexual activities.
Urinary bladder control is affected in many neurological problems and associated with sexual dysfunction. As the bladder fills beyond it’s capacity, the patient develops over flow incontinence as happens in lumbosacral spinal cord or in peripheral nerve involvement. Higher spinal cord involvement results in a shrunken bladder, premature contraction of the bladder and incontinence.
Brain decides when to pass urine. When specific areas in the brain are involved incontinence results. Incontinence at sleep may be an early sign of seizure
‘Stroke’ is a sudden loss of neurological function.
Stroke is due to disturbance in blood flow to the brain. Atherosclerosis (thickening of the blood vessel wall), long standing hypertension, some heart diseases, high cholesterol, smoking and diabetes are some of the well known predisposing factors. Intracranial bleeding due to various causes can result in stroke. Inflammation of blood vessels in the brain may lead to blockage and stroke.
Stroke may be lethal if massive brain swelling or clot is associated. Some people recover completely, but most are left with residual deficit. If the patient reaches a specialized center within 6 hours of the event, newer medicines that promise complete recovery are available. In any case, especially in people under 60 years of age, every stroke must be investigated and not assumed to be due to diabetes and hypertension. Effective measures must be taken to prevent a recurrence
Seizures are episodes of disorganized electrical activity in the brain resulting in loss of consciousness and involuntary jerking of limbs with frothing in the mouth, tongue biting and urinary incontinence. The so-called ‘minor ones’ may have just abnormal behavior or sensations with no convulsions or unconsciousness.
The tendency to have recurrent seizures is called epilepsy.
During an attack the patient should be put on his side so that the froth does not go into his lungs. Some hard object in the mouth will prevent tongue biting. Convulsing limbs should not be restrained. Repeated or persistent attacks need hospitalization. Any disturbance in the brain, be it injury, tumor, stroke, infection or even a post operative scar may produce seizure.
In these days of CT & MRI scans, everyone with seizure should be investigated. Effective medications are available. In selected cases where medication does not provide adequate control, surgery may help.
Weakness may be generalized or localized to a part of the limb, whole limb or more than one limb. The muscles, regional nerve, spinal cord or brain may be involved.
In Myasthenia gravis, the patient complains of generalized weakness and/or blurred vision due to weakness of the eye muscles. The conditions can be effectively treated, unlike hereditary involvement of the muscles (various myopathies) which show up later in life and has no satisfactory treatment.
A regional nerve may be involved locally or at the exit from the spinal cord, as happens in prolapsed discs. The part of the limb supplied by the nerve is usually affected with numbness and/or pain. When the whole limb or more is involved, usually the spinal cord or the brain is at fault.
Causes may be toxins and diabetes. Surgically amenable causes may be local entrapment of nerves, prolapsed discs, and tumors of nerves and/or the spinal cord and brain disorders. Infections may require surgery.
Trauma to the muscle, nerve, spinal cord or the brain is another obvious cause and healing may be facilitated with immediate medical attention. A thorough assessment by a neurologist will help.