Headache is one of the most common types of recurrent pain as well as one of the most frequent symptoms in neurology. Although almost everyone gets occasional headaches, there are well-defined headache disorders that vary in prevalence and duration. Frequent, severe of unremitting headache may constitute a debilitating disorder severely limiting a person's daily functioning and activities. Headache is usually categorised into two broad categories: primary headache and secondary headache disorders. In primary disorders the headache is not due to another condition.In secondary disorders, headaches are caused by another condition, such as head injury, sinusitis, temporo-mandicular dysfunction or, rarely, brain tumours. In the case of secondary headaches, addressing the underlying disorder can often lead to resolution of the headaches.
The evaluation, diagnosis, and treatment of headache can be quite challenging. All patients that present with a chief complaint of headaches should have a thorough neurological examination, which should include funduscopy (examination of the back of the eyes) to assess for signs of increased intracranial pressure. Not all patients with headache require brain imaging studies, and cases should be considered on an individual basis.
Dizziness is one of the most common symptoms that prompt patients to seek advice from a neurologist. The evaluation and treatment of dizziness can be challenging, both because this complaint may be caused by several different conditions and because the term ‘dizzyness’ may encompass several different problems including vertigo, lightheadedness or poor balance.
In the majority of cases, dizziness occurs as a result of a benign disorder involving the labryrinth, the balance organ in each inner ear that is responsible for the sensations of balance and motion. However, dizziness may also be caused by other disorders, including abnormalities within the parts of the brain that deal with coordination or the integration of vision with motion to keep objects in view when the head is moved, problems with the regulatory function of the heart and blood vessels, or as a side effect of certain medications.
A diagnosis can often be made through a careful clinical history and thorough neurological examination, although sometimes it needs to be confirmed via additional tests. Treatment often requires simple head positioning manoeuvres but sometimes requires medication to suppress vertigo and nausea, or when indicated, to stabilise blood pressure.
Weakness is a common complaint that may result from a number of neurological and non-neurological conditions. It has a significant impact on people’s wellbeing, frequently affecting their ability to walk, use their hands effectively, work or perform common daily activities.
People who experience weakness may actually be suffering from different problems, including fatigue or loss of strength in their muscles. Fatigue has a variety of causes, including metabolic disorders like diabetes; endocrine anomalies like an underactive thyroid, sleep disorders, side effects of medication, infections and mood disorders like depression. Occasionally, the cause of fatigue may be easily identified from a carefully taken medical history but many times it proves elusive and requires a more extensive evaluation.
Loss of muscle strength may result from abnormal function of the any part of the motor pathway including the brain, spinal cord, nerves or the muscles themselves. In this case, the first step in determining the potential cause is to localise accurately the part of the pathway that is not working properly, using information obtained from the neurological history and examination. Important details such as the chronological order of events, presence or absence of other symptoms, and the pattern of weakness help to identify the underlying disorder. Tests may be required to screen for suspected causes, including blood investigations, tests on the electrical conduction properties of nerves, or scans of the brain and/or spinal cord.
Tremor is an involuntary, rhythmic movement of part of the body. Although tremor can involve any part of the body, the hands are most commonly affected. Many causes of tremor are benign, but this problem may nonetheless have a significant impact on people’s ability to perform certain activities of daily living, in their occupation, and enjoy social and recreational activities.
There are many different forms of tremor that may be identified on the basis of the body part affected, what makes the tremor better or worse, its speed and amplitude. Careful clinical observation is the most important aspect of physical examination and this, together with observation of the performance of some manoeuvers and functions, is often enough to reach a diagnosis, without the need for investigations.
Not all tremor has a neurological cause. Tremor may be caused by several other medical issues including an overactive thyroid, high levels of anxiety, too much regular alcohol or caffeine, and certain medications. One of the most common types of tremor – essential tremor – is genetic and familial. Understandably, the appearance of a tremor often leads to concern about the possible emergence of Parkinson’s disease (PD). However, PD usually leads to other symptoms that may be detected such as difficulty in movement, stiffness and changes in posture and appearance. PD is not curable but effective treatment options are available, so an early diagnosis by a neurologist is helpful.
Seizures / Epilepsy
Seizures are a common event in adults that require a systematic approach in order to determine their cause and the likelihood of their recurrence. The first generalised convulsive seizure is frequently a dramatic event for patients and their family. Among patients with suspected first seizures, many actually have other conditions such as simple faints, heart disorders or low blood pressure due to medication or other neurological conditions. Others have provoked seizures, due to sleep deprivation, alcohol, head injuries or infections. However, a proportion of individuals have multiple seizures and are diagnosed with epilepsy, which occurs in just under 1% of the population. In these cases, antiepileptic medications are the mainstay of management, but it may be challenging to know when to start treatment and which medication to choose. Patients may struggle with side effects from their medication, or with achieving complete control of clinical seizures. Howwever, the management of epilepsy does not simply involve counting seizures and prescribing medication. Epilepsy may affect employment, family planning, driving, cognitive function and mood, so the effective oversight of a neurologist coupled with a holistic approach to the patient with seizures is essential to optimise quality of life.
Many people in their life may perceive appreciable in their cognition that causes them concern, especially if this results in an impaired ability to perform daily functions in their personal, social or working life. Sometimes, this is an isolated problem with memory, but in other occasions patients may note changes in their language skills, multi-tasking and problem solving abilities, personality, judgement or behaviour towards others. The main worry is, understandably, the possibility of this reflecting the early stages of dementia, a common health problem affecting 3-11% of people older than 65 years of age that leads to impaired ability to drive, manage financial affairs, undertake personal care and retain independence. Diagnosing cognitive impairment involves careful measurement of different aspects of mental functioning (psychometric testing), brain imaging and the exclusion of other conditions that may cause temporary intellectual impairment