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Old 08-15-2012, 02:05 AM   #1
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Neurological examination questions

Hello,
I'm planning to get an appointment with a neurologist, but I have HA and I'm expecting the worse. I would like to ask some questions:

My first question is what it is like...what are the typical tests performed?

Second, if somehow (I highly doubt it) the tests are normal, does it mean that I can be sure I don't have neuro diseases like MS or ALS?

On the other hand if I fail one or more tests does it mean for sure there's a neuro disease like MS or ALS?

Any answer is appreciated.

Thanx

 
Old 08-15-2012, 03:29 AM   #2
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Re: Neurological examination questions

Hi. Youre question is alittle confusing, but let me see if I address it correctly.

A neuro exam is a place where the doctor will take your history and physical- a TON of questions basically trying to give him or her the reason why you are there, what your symptoms are, how long they have been happening and what needs to be done to start giving you a diagnosis.

Very few tests are ever done in a neurological office, unless your office has the capacity to do blood draws, that COULD happen. The tests which will be done are painless such as watching you walk, giving you some reflex tests (like bumping your knee with the rubber hammer to make it jump) the babinsky test- which is the sharp side of the hammer underneathe your foot to see if your toes curl. They may do some simple coordination tests (touch your nose, touch my finger, touch your nose, touch my finger) all the while the finger is moving around. He may ask to see you walk if you are demonstrating gait problems. He may have you stand with your eyes closed and touch your nose- to see if you tilt from side to side. You may have to walk heel to toe (like a drunk driving test) to see how your balance is.

Primarily, the most important test a neurologist orders is an MRI. So, there is a good chance you will walk out of there with an order for one....usually of the head and spine (the central nervous system). Also, many neuros look at things like spinal fluid, on occasion a lumbar puncture (spinal tap) are needed....any number of tests could be ordered depending on what they are looking for - or in the case of MS- to rule out.

There is a test for ALS and there is a test for Lupus- there is NO TEST for MS, so in order to diagnose it, you have to rule out everything else.....many patients have to wait a year to get that diagnosis....others, like me, get it in 72 hours based on a MRI and symptoms.

Im not sure how much this helped you....but until you figure out what the doctor thinks you may have, you wont know how lengthy it will take to get answers. I wish you a speedy answer without any bad news...but whatever you find out, know you are not alone- and we are here to help!

Nikki
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Old 08-15-2012, 07:23 AM   #3
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Re: Neurological examination questions

ALS is one test that is given early in the diagnostic process because ALS is serious and it has a specific test. Other serious diseases which have specific tests are also done early. These tests are good because it eliminates possibilities early and if something is found early, then therapies or meds can be started early without subjecting the patient to further needless testing.

If your neurologist is following the Revised McDonald Criteria, you should be fine. A negative (normal) LP might be a possible outcome for you, BUT a negative LP does not eliminate MS as a possibility because up to 15% of MSers who have had LP's have had negative results. As to a normal MRI, early on if there are few lesions or if the image is poor, the result could also be negative. The entire diagnostic process may take some time, but you should get the answers you need. In the meanwhile, I would encourage you not to start doubting or blaming or worrying. Relax and let the doctors do their job, but follow along and be proactive as you are a member of the team!! Keep us updated. I certainly hope you do not have MS!
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Old 08-15-2012, 07:39 AM   #4
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Re: Neurological examination questions

Thank you both for the replies. I was mostly referring to a physical examination. I'm afraid that if I fail one or more tests, he'll send me for a MRI and I'll assume the worst.

On the other hand if the physical examination is normal, can I relax and not worry about neurological diseases...or more tests (like MRI) are needed to exclude them?

P.S Sorry if I'm bothering you with so many questions.

 
Old 08-15-2012, 07:54 AM   #5
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Re: Neurological examination questions

The initial physical exam will allow the neurologist to observe your gait, your eyes, your reflexes, strength, coordination. These were all part of my first exam and my neuro continues to perform all of these every 6 months. The neurologist rates you on a scale.

I also had a Babinski reflex test my first exam. This is where they scrape your foot bottom and observe your toes.

Based on your initial exam and your presenting symptoms, the neurologist will likely order an MRI as part of the process to either clear you or to warrant further testing.

The neurological physical exams are not looking for diseases that a GP might be looking for. You are seeing the neurologist because you have a neurogenic cause or possibility. The entire process of diagnosing MS is a process of elimination. At any time during the process an answer might be found. If so, then there would be no need for further testing.

You should not assume the worst at any time. Remaining optimistic and self-advocating through the process is important. I think it is great that you ask many questions. The questions you ask may inspire others who read the thread or it may be the very question a reader is to afraid to ask themselves. When we ask questions, we all learn!
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Old 08-15-2012, 08:06 AM   #6
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Re: Neurological examination questions

First of all thank you so much for being so supportive and answering my questions. It's highly appreciated.

Just some more info...here where I live I think it works a bit different to the US or UK. Usually the GP doesn't do many tests...you can directly ask for a referral and they'll give you one. Two weeks ago I asked to get a referral to get a heart holter monitor, blood pressure holter monitor and abdominal echo and I got them. If I would go to the state owned clinic I would have to wait in the list, but since I have a private insurance also I got the tests done the next day in a private hospital. It's the same for the neuro appointment, I'll get one from the GP, but she hasn't done any tests and there is a chance (myself I doubt it) that the issues are not at all neurological.

 
Old 08-15-2012, 08:13 AM   #7
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Re: Neurological examination questions

I really would not worry. If your symptoms are not neurogenic, at least you have eliminated that batch. You certainly have a different set up in Albania, but I think you have asked for all of the right things so far.

The neurologist should be able to help you and they can also tell you which specialist you might need to see based on their testing. Given the circumstances of your location, you have done well so far. It is quite understandable why you should have so many questions.

IF another disease or disorder is eventually determined, let us know either way. There are many other boards on this site which you can visit when you know more. Set aside your doubts and worries- I think you are doing the best you can.
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Old 08-15-2012, 08:19 AM   #8
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Re: Neurological examination questions

Thanx for your quick reply. I'll keep you updated whatever the outcome.

Since I'm planning to go in holidays in the weekend for about 2 weeks, I'll probably postpone the neuro examination until after the holidays. I'm hoping some rest will help me.

All the best

 
Old 08-16-2012, 07:42 AM   #9
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Re: Neurological examination questions

Hi, my GP sent me to rheumatolist who done a few test for pinched nerves etc I could push against hnd with feet etc then he touch my muscle around shoukers calf really tight and sore but only when they touched it. Anyway he sent me for nerve conduction test. The shocks were painfull. I didn't feel little electdic shocks. Infact they were intense, no needles just the round sticky things. He only asked with side was the worse. Then done test and told me nothing. Said I have to see the specialist that sent me there but I don't see him till inve mri which he ordered but only of lumbar spine and legs. Tingling just doesn't stop. Eased off with but still there. My physio says neural damage my GP wants to rule out ms

 
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