Say you have nasty neck pain that just won’t go away, or you notice changes in your coordination that go beyond occasional clumsiness. When you know it’s time to see a doctor, should you see a neurologist or a neurosurgeon? What’s the difference?
We asked two experts at RUSH — a neurologist and neurosurgeon — to explain how their specialties differ and offer some helpful guidance for patients seeking help for neurological concerns.
What do neurologists and neurosurgeons have in common, and how are they different?
“Both neurologists and neurosurgeons are specialists who deal with diseases of the nervous system, which includes the brain, the spine and the peripheral nerves,” says Stephan Munich, MD, a neurosurgeon and director of skull base neurosurgery at RUSH.
However, the two types of specialists treat these conditions differently. Neurologists manage neurological diseases with the latest medications and other nonsurgical treatments, while neurosurgeons treat these conditions with surgery, Munich says.
Where is the best place to start: with a neurologist or with a neurosurgeon?
“Your primary care provider can help guide you in the direction you need to go,” advises Malathi Rao, DO, a neurologist at RUSH.
Oftentimes, a general neurologist like Rao is the first specialist you might see if you or a loved one has a neurological problem like migraine headaches, dementia or neuropathy. These specialists are especially skilled at neurological detective work. “We start by conducting a thorough exam to determine if your symptoms might be caused by a neurological problem,” Rao says. “We might check your speech, memory, strength, reflexes and coordination. From there, the next step might involve imaging or other tests.”
Based on the findings from your exam and tests, a neurologist can create a personalized care plan. If you are dealing with a chronic neurological condition such as multiple sclerosis or Parkinson’s disease, a neurologist can coordinate your treatment over the long term, she adds.
However, there are exceptions to the “neurologist first” rule, particularly if you have an emergent neurological condition that requires surgery. For example, you might go to the emergency room for a very severe headache, and you have a brain scan there that reveals a brain hemorrhage (bleeding in the brain). In this case, the first expert you see might be a neurosurgeon, who can perform emergency surgery to drain blood from the brain and relieve pressure, Rao explains.
How do neurologists and neurosurgeons collaborate on patient care?
Many times, neurologists and neurosurgeons will combine their expertise and work together to treat patients, Munich says. For example, at RUSH’s Comprehensive Stroke Center, a patient who had a recent stroke might see a neurosurgeon and a stroke neurologist during the same appointment, gaining the benefit of both perspectives on their care.
“Having the collaboration between neurologists and neurosurgeons is critical to optimize the care for the patient and achieve the best results,” Munich says. “There may be times when medication is the more effective way to treat a disease, but in other cases, it may be surgical. In some cases, we might want to improve the patient’s medical condition to optimize the outcomes of surgery. Or we might perform surgery if medical therapy doesn’t give the results we had hoped for.”
How can patients get the most from their appointment with a neurologist or a neurosurgeon?
Rao recommends bringing any health records and recent imaging (such as brain or spine scans) you may have to your appointment, especially if you are getting a second opinion. This can help you avoid any unnecessary tests.
You may also want to bring a friend if you have mobility or balance issues. If you are making an appointment for a loved one with confusion or memory problems, it’s helpful to be there during the doctor visit, Rao says.
What are the benefits of seeing a neurologist or neurosurgeon affiliated with an academic medical center?
“One of the benefits of coming to a tertiary care center is that you may have access to subspecialists who are not available at some community hospitals,” Rao says.
At RUSH locations across Chicago and the western suburbs, patients can see general neurologists as well as neurologists who subspecialize in caring for patients with stroke, epilepsy, multiple sclerosis, Parkinson’s disease, neuromuscular diseases and other conditions. “So, while a patient might start by seeing a general neurologist, we might also recommend even more specialized care with resources that are specific to each subspecialty. For example, I might refer a patient with MS-like symptoms to see a neurologist specializing in MS at the RUSH Multiple Sclerosis Center, which has staff and resources dedicated specifically for these patients,” Rao says.
Munich also believes that patients with neurological issues benefit from receiving care where there is a comprehensive range of subspecialists. One example is a patient who requires complex skull base or pituitary surgery. At RUSH, the skull base and pituitary surgery team includes doctors from more than 10 specialties, including neurosurgeons, plastic surgeons, head and neck surgeons and rhinologists, also known as ear, nose and throat physicians.
“It’s really critical to have all of these subspecialists working together on the same team to provide comprehensive care,” Munich says.