When to See a Neurologist

6 symptoms that should be evaluated by a neurological specialist

Brain Health & Conditions August 23, 2021
Neurologist examining brain scans

— I’ve been getting painful headaches a lot lately, but they don’t feel like regular tension headaches.

— Are these pins-and-needles sensations in my feet normal?

— I’m so forgetful these days that it’s tough to work. I don’t know if it’s stress-related brain fog or something else.

— Do I need to see a neurologist?

Figuring out whether you need to see a specialist can feel like a tough call sometimes — but many symptoms warrant it. We talked with Rush neurologist Tresa Zacharias, MD, about when it makes sense to see a neurologist.

Neurologists specialize in treating and diagnosing disorders that affect the brain, spinal cord, and peripheral nervous system, including headaches, sleep disorders, multiple sclerosis, epilepsy, neuropathic pain, dementia, Parkinson’s disease and stroke. While some neurologists specialize in one area, such as movement disorders or neuromuscular disease, others, like Zacharias, practice as general neurologists.

“If you need surgery or specialized care, your general neurologist can refer you to the specific specialist, but many conditions can effectively be managed by a general neurologist,” Zacharias says. General neurologists offer a full range of medical therapies and nonsurgical procedures, from injections to lumbar punctures.

She recommends being evaluated by a neurologist for these symptoms:

1. Chronic headaches or migraines

We all experience headaches — of varying durations and severity — due to everything from staring at a computer screen too long to loud noise to lack of sleep to a sinus infection. While painful, most headaches are temporary. Usually, conservative treatments like over-the-counter pain medications will provide relief.

See a neurologist in these instances:

  • Your headaches become severe or disabling.
  • You’re taking medication for headaches daily.
  • You routinely wake up with a headache.
  • Your headaches are accompanied by other neurological symptoms, such as vision changes, dizziness, nausea or even seizures (if you start vomiting or lose consciousness, go to the emergency room right away).
  • Your headaches are severe and are accompanied by a sensitivity to light, strong smells or loud sounds, which could indicate migraines.

Your neurologist can help determine what’s causing your headaches — and any other symptoms — and help you get relief.

In addition to prescribing medications or treatments like Botox, Zacharias emphasizes lifestyle modifications. “I always share tips with my patients,” she says. “For instance, I tell them to stay hydrated, don’t skip meals, avoid excessive caffeine and alcohol, engage in physical activity, and try relaxation therapy. All of those things can be helpful with headaches.”

So can sleep. “Headaches can be exacerbated by too little or too much sleep, or changes in your sleep routine,” Zacharias says. “That is actually true for many neurological conditions, so it’s important to practice good sleep hygiene if you’re having any sort of neurological issue.”

And if you’re having migraines, your neurologist can help you identify and avoid your triggers — including stress and certain foods — to prevent them.

2. Out-of-the-ordinary memory problems

Occasional forgetfulness, such as misplacing your keys or forgetting that your glasses are on top of your head, can be frustrating but probably isn’t a cause for concern.

“But if memory issues start interfering with work or your ability to function at home or take care of things at home, that’s a reason to see a neurologist,” Zacharias says. “We can determine the underlying cause, including ordering more specialized testing, if necessary.”

See a neurologist if you experience any of the following:

  • Difficulty speaking
  • Changes in personality
  • Confusion or disorientation
  • Frequent memory lapses
  • Repeating information or asking the same question multiple times

It’s important to note that not all memory problems are related to dementia or Alzheimer’s disease. Many things can cause memory issues, including certain medications, thyroid problems, poor sleep or fatigue, menopause, benign or cancerous tumors, stress or anxiety and alcohol use. Your neurologist will look at all potential factors that could be contributing to your memory loss.

If your symptoms are due to cognitive decline or dementia, your neurologist can work with you to try to prevent further memory loss with medications and lifestyle changes.

“The data shows that physical activity is critical, and we know that the Mediterranean and MIND diets both help to boost brain health. Social activity and mentally stimulating activities are also recommended,” Zacharias says.

3. Vertigo or balance issues

There are many reasons you might feel dizzy, lightheaded or off-kilter, for example, if you haven’t eaten all day, you’re overheated or you haven’t slept. Usually, these feelings go away once you take steps to address them. But certain types of dizziness can be a concern.

See a neurologist if you experience any of the following:

  • A feeling that either you or the world around you is spinning (vertigo)
  • Loss of balance or unsteadiness (disequilibrium)
  • Faintness or lightheadedness with no obvious cause
  • Feeling like you are falling or are going to fall
  • A floating sensation or dizziness
  • Sensitivity to motion
  • Vertigo or disequilibrium accompanied by other symptoms, including hearing or vision loss, ringing in your ears, ear pain or nausea

These symptoms can affect your quality of life, including your ability to work, and they should be evaluated by a neurologist even if they eventually go away on their own.

While dizziness or balance problems are often related to inner ear (vestibular) issues and are not life-threatening, a diagnosis will enable you to get treatment for the underlying condition. This can both prevent vertigo or disequilibrium from coming back and keep the condition itself from worsening.

If the cause is something more serious, like cardiovascular disease, acoustic neuroma (a rare noncancerous tumor), a head injury or a neurological condition like Parkinson’s disease, your neurologist can coordinate with other specialists to make sure you get the care you need.

4. Unusual spells or seizures

When you think of a seizure, you probably imagine a person lying on the ground convulsing. Seizures aren’t always that obvious, but any seizure is concerning.

See a neurologist if you or a loved one experience any of the following but have not been diagnosed with a seizure disorder like epilepsy:

  • Violent shaking
  • Uncontrollable stiffening of the body, especially the arms and legs
  • Staring spells (the person isn’t connecting or responding, or seems to be daydreaming)
  • Confusion or disorientation after a seizure (the person doesn’t appear to be “coming out” of the seizure)
  • Loss of bowel or bladder control
  • Falling for no apparent reason
  • Loss of consciousness

“While many types of epilepsy are present during infancy and childhood, you can experience the onset of epilepsy as an adult,” Zacharias says. “A seizure can also be a symptom of another potentially serious condition.”

Testing can determine whether the cause of a seizure is epilepsy or something else, such as meningitis, low blood glucose levels, very high blood pressure, kidney or liver failure, stroke or a vascular abnormality in the brain.

“It’s important to get a diagnosis so you can receive the appropriate treatment,” Zacharias says. Some people may have one seizure and never experience another, but untreated seizures can also worsen over time, becoming more frequent and longer in duration. Even seemingly minor seizures aren’t harmless; they can cause lasting brain damage or lead to injuries if you fall or are driving when one occurs. They can also affect your quality of life.

5. Numbness or weakness

You may experience numbness or tingling in your arms, hands, legs or feet for many reasons, like that “pins and needles” feeling you get when you sit too long, or when your circulation gets cut off from wearing something tight.

Similarly, there may be times when your muscles feel weak, such as after a grueling workout or when you have a virus like the flu.

Occasional, short-term numbness and weakness are typically harmless. If they linger or if they come on suddenly for no apparent reason, the issue may be something more worrisome — from thyroid disease to a neuromuscular disorder to a herniated disc to the West Nile virus.

See a neurologist if you experience the following, especially if you have a family history of neurological issues:

  • Numbness or weakness that comes on suddenly or happens on one side of the body (if you think you are having a stroke, however, go to the emergency room or call 911 immediately)
  • Persistent (over weeks or months) or worsening numbness
  • Chronic muscle weakness or a rapid decline in muscle strength
  • A weak handgrip that’s affecting your ability to eat, write or perform other daily activities
  • Foot drop, or difficulty lifting the front of your foot, which may cause it to drag
  • Lingering numbness and/or weakness after a stroke or injury
  • Numbness and/or weakness accompanied by other neurological symptoms, such as nerve pain or burning

6. Sleep problems

If your snoring is keeping your family up at night (a sign you might have obstructive sleep apnea), a neurologist probably can’t help you — though a sleep specialist may be able to help. But some sleep problems are neurological, like idiopathic hypersomnia and narcolepsy; commonly associated with neurological conditions; or side effects of medications used to treat neurological conditions.

See a neurologist if you experience any of the following:

  • Prolonged periods of excessive tiredness during the day after getting a full night’s sleep
  • Frequently falling asleep in relaxing surroundings
  • Frequent difficulty falling or staying asleep, especially if you are also having nightmares
  • Sleep problems following the diagnosis of a neurological condition, such as Alzheimer’s disease, epilepsy, a movement disorder or a neuromuscular disorder

One sleep issue, in particular, should always be evaluated by a neurologist: REM sleep behavior disorder.

“That’s when you act out your dreams,” Zacharias says. “These tend to be more violent dreams — so you’re kicking, fighting or even screaming in your sleep. Your bed partner may get hurt when you lash out, or you may fall out of bed. You’ll likely recall the dream but not your physical response to it.”

If you notice this behavior in a family member or friend, encourage them to see a neurologist. Not only do common causes include traumatic brain injury and post-traumatic stress disorder, but REM sleep behavior disorder is one of the strongest early indicators of developing Parkinson’s disease, dementia with Lewy bodies or multiple system atrophy.

“Typically, the dream enactment precedes a Parkinson’s diagnosis by 15 to 20 years,” Zacharias explains. A neurologist can help confirm or rule out the potential causes so you can get the proper care.

“As neurologists, we may not always find the ultimate cause of your symptoms, but often we’re able to eliminate the more serious conditions,” Zacharias says. “And if we do detect something concerning, it can then be treated appropriately — we either treat it ourselves or send you to the right specialist. When I show people their MRI and other test results, they feel a lot of relief when it turns out there’s nothing to be concerned about.”

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