Neurology 101

A stroke is also known as a “brain attack;” stroke is when blood supply to the brain is temporarily suspended, resulting in tissue death and reduced brain function. Positive prognosis is much greater the quicker medical attention is sought after the onset of symptoms such as changes in vision, speech pr consciousness; weakness; vertigo or extreme dizziness. The most common cause of stroke is arteries clogged by fatty deposits that collect on artery walls and form plaque; thereby blocking blood flow. Blood clots can also cause strokes. Post stroke victims experience a wide range of physical symptoms ranging from mild numbness on one side of the body to severe loss of movement.

From migraines to cluster headaches and chronic daily headaches, headache disorders can be very disruptive to everyday life. Cluster headaches are characterized by severe, sudden headache most often during the dreaming part of sleep. Migraines occur most commonly in women and genetically tend to run in families. Symptoms are varied and can include visual changes, difficulty speaking, weakness or numbness. Migraines seem to originate from several sources, such as hereditary, environmental and/or food factors. For more information go to www.imitrex.com, www.migrainesupport.com, or contact the American Council for Headache Education at 1(800)255-2243.

Affecting millions of people in the U.S., epilepsy is the defining term when a seizure disorder has no identifiable cause such as head trauma or brain tumor and is recurring. Many varieties of seizure disorders exist – as well as many new treatment options. Symptoms of seizures and types of seizures are widely varied and include blank stares, brief loss of awareness or appearance of daydreaming with petit mal seizures to rigid, stiff muscle contraction, loss of consciousness and confusion with grand mal seizures. Partial seizures may present as muscle contractions of a specific body part, or abnormal sensations, sweating, automatism and change in personality or consciousness. Diagnostic tools include EEG, MRI, and CAT scan among others. For more information go to www.epilepsyfoundation.org.

A progressive neurological disorder affecting approximately 400,000 in the United States, with 200 new cases per month diagnosed. For more information contact the Multiple Sclerosis Association of America at 1(800)833-4672; the MS Foundation at 1(800)441-7055; or the National Multiple Sclerosis Society at 1(800)FIGHT; or go to www.betaseron.com.

There are many types of Neuropathy, you may notice numbness, tingling, abnormal sensations, or pain in your feet. Some people feel like they have socks on, even though they are barefoot. Over time, this feeling spreads to your legs and hands. You may find it harder and harder to walk. Your legs feel heavy. You have to drag yourself up the stairs. You find yourself losing your balance, not being exactly sure where your feet are; so, you stumble into things or fall. To keep your balance, you are likely to widen your way of walking, and your walking becomes less rhythmic or fluid. As for your hands, you think you have a good grip on something, like your keys, but they drop right out of your hands. In the worst cases, you can end up in a wheelchair. Some neuropathies can be fatal. Peripheral neuropathy is common. It is estimated that upwards of 20 million Americans suffer from this illness. It can occur at any age, but is more common among older adults. A 1999 survey found that 8-9% of Medicare recipients have peripheral neuropathy as their primary or secondary diagnosis. Diabetes is the most common cause of neuropathy in the Western World. Diabetic neuropathy may occur in both type I and type II diabetes. A large cross-sectional study of 6487 diabetic patients in the UK found the prevalence of diabetic neuropathy to be 28.5% (Young et al 1993). However, the prevalence of diabetic neuropathy varies greatly among various series, from a low of less than 5% to a high of 100% (Thomas and Tomlinson 1993). Differences in prevalence arise partially from differences in age, but primarily from differences in the definition of diabetic neuropathy, and whether this is based on symptoms only, signs and symptoms, nerve conduction abnormalities, or composite definitions.

Neurological disorders are common in women of childbearing age and are an important cause of morbidity and mortality in pregnancy. The natural history of these disorders may be influenced by pregnancy itself. Some may even present for the first time, and their investigation and management may be complicated by concerns for the safety of both mother and child. An overview of three of the commonest disorders is provided. The etiology, investigation and management of cerebrovascular disease and headaches are discussed. The course of epilepsy, potential complications and management is discussed. This information can provide a basis for counseling women with neurological conditions who are pregnant or planning a pregnancy.

Carpal tunnel syndrome is caused by pressure on the median nerve in the wrist. The median nerve supplies sensation to the thumb-side of the palm, and to the thumb, index finger, middle finger, and the thumb-side of the ring finger. The “pinching” of the nerve results in painful burning, numbness, tingling or other uncomfortable sensations in the affected hand. The nerve enters the hand between the wrist bones and the tough membrane that holds the bones together. The space in between is the carpal tunnel. The condition occurs most often in people 30 to 60 years old, and is 5 times more common in women. However, it is not just a condition of the “computer age” as symptoms were reported as early as the 1800’s! Without treatment, this condition can lead to permanent nerve damage in the affected area.

Alzheimer’s is a progressive illness leading to memory loss and thinking, reasoning and functioning difficulties. Often mistaken for “getting older” Alzheimer’s is not part of the normal aging process but instead a progressive form of dementia with an unknown cause. For more information: www.alz.org, www.alzheimers.org, or www.caregiveraction.org.

This is a progressive disorder characterized by tremors and shaking, rigidity and balance instability. Most commonly diagnosed after age 50, Parkinson’s can occur in younger adults. This disease is the result of deterioration of the nerve cells of the part of the brain that controls muscle movement; however, the reason deterioration begins in not clear. Additional symptoms include: gait changes, difficulty initiating any voluntary movement, inability to resume movement, changes in facial expression – including ability to show expression, voice and speech changes and loss of fine motor skills. For more information go to www.parkinson.org

From an inability to fall asleep or stay asleep, to unusual daytime sleepiness, snoring, gagging and stopping breathing during the night, sleep disorders affect the victim’s health and can also adversely affect family members sleeping patterns. Sleep disorders are a major health concern that is often ignored, diagnosis and treatment often increases the quality of life in addition to decreasing other health risks.

Characterized by sensations in the lower legs that make the person uncomfortable unless the legs are moved. The sensation generally occurs at night, but may also occur during the daytime. The urges to move the legs while in bed result in decreases quality of sleep with increased likelihood of falling asleep during the day, and confusion or slowed thought processes from lack of sleep. For more information go to www.rls.org.

Vertigo is the feeling that you or your environment is moving or spinning. It differs from dizziness in that vertigo describes an illusion of movement. When you feel as if you yourself are moving, it’s called subjective vertigo, and the perception that your surroundings are moving is called objective vertigo. Unlike nonspecific lightheadedness or dizziness, vertigo has relatively few causes. Vertigo can be caused by problems in the brain or the inner ear. Including Meniere’s disease, vestibular neuritis, benign paroxysmal positional vertigo, acoustic neuroma, decreased blood flow to the base of the brain, head trauma and neck injury, migraines, or complications from diabetes can cause arteriosclerosis.

Bell’s palsy is a condition that causes the facial muscles to weaken or become paralyzed. It’s caused by trauma to the 7th cranial nerve, and is not permanent. Bell’s palsy is not as uncommon as is generally believed. Worldwide statistics set the frequency at just over .02% of the population (with geographical variations). In human terms this is 1 of every 5000 people over the course of a lifetime and 40,000 Americans every year. Symptoms of Bell’s palsy progresses very quickly. Most people either wake up to find they have Bell’s palsy, or have symptoms such as a dry eye or tingling around their lips that progress to classic Bell’s palsy during that same day. Occasionally symptoms may take a few days to be recognizable as Bell’s palsy. The degree of paralysis should peak within several days of onset – never in longer than 2 weeks (3 weeks maximum for Ramsey Hunt Syndrome). A warning sign may be neck pain, or pain in or behind the ear prior to Palsy, but it is not usually recognized in first-time cases.