Over the years, I have observed many difficulties patients face during the consultation with us. The patient and the family are already stressed, and usually no I idea what their neuro doctor is expecting from them, this usually results in the much-prolonged consultation and/or dissatisfied patients.
What is different about neuro diseases?
Unlike other systems in the body, the nervous system disease manifestations are quite different. Each component of the nervous system carries out specific functions so the involvement of different components gives rise to a different set of symptoms which are unique to that area of involvement.
But how is this fact relevant to patients?
One may think so that the above-mentioned fact doesn't carry much importance for patients. Up to certain extent that's true.
But this fact is of utmost important for the neurosurgeon or neurologist. We localise the problem only based on your symptoms. We advise the scans just to confirm our clinical localisation and to get the anatomical details in the surgical cases.
So the point to be stressed is, your way presentation of your symptoms is important for us.
Well, so how to go about it? I will discuss it in simplest possible way.
1. Make a list of your symptoms.
Start with the earliest symptom you had.
Usually, for cranial cases, the earliest symptom is either a headache or seizure and for spinal cases the low back pain.
Add on the symptom from earliest to latest.
2. Describe each symptom.
Each symptom should be described in three aspects: pattern of onset, duration of it and changes over a period of time.
3. Negative history.
It's also important to tell us what you don't have.
Usually, we look for 5 set of symptoms in cranial cases:
A. Higher mental dysfunction like change in personality, aggressive behaviour, lack of motivation, loss of executive function, memory disturbance, etc
B. Cranial nerve involvement like problem with smell, vision, sensation on face, weakness of face, hearing difficulty, speech/swallowing difficulty etc
C. Motor symptoms: exact description of weakness, if you have any.
D. Sensory symptoms: anatomical distribution of the loss of sensation or abnormal sensations should be given
E. Cerebellar symptoms: imbalance if any. Incoordination in any form.
F. Automatic symptoms, bowel / bladder symptoms
We expect you to give us relevant summary of symptoms in above sets, please don't miss to mention if you have them. If you don't have any of them, mention briefly about their absence.
For spinal and peripheral nerve cases mainly we expect description about three set of symptoms:
A. Motor symptoms: exact distribution of the weakness, associated stiffness of the muscles if any
B. Sensory symptoms: exact distribution of the positive sensory symptoms (tingling/pin and needle like sensations/shock like sensations) or negative sensory symptoms (numbness/reduced sense of hot and cold)
C. Bowel and bladder symptoms are very important to mention in the spinal diseases.
Please note, that I am not trying to confuse you by narrating so many details, these are not the must have details. But if you have an idea of what is expected, you can present your symptom profile very elegantly, your doctor can put the diagnosis quickly.
I hope this article helps.
Dr Hardik rajyaguru