When an elderly patient described a bout of sudden, temporary blindness he’d experienced recently, alarm bells went off “He’d been watching TV, and all of a sudden he couldn’t see out of one eye for 15 seconds. Otherwise he felt fine; he was almost matter-of-fact about it. I was concerned he’d had a ministroke – a transient ischemic attack,” notes Carcaterra, a family practice doctor with Mt. Sinai Doctors Five Towns in Hewlett, New York.
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Carcaterra immediately referred her patient to a neurologist. “It turned out that he did have a ministroke and had some blockage in his carotid artery. He needed surgery to avoid a stroke,” Carcaterra says.
Such life-threatening conditions – and plenty of other illnesses – are common reasons to be referred to a neurologist, who can diagnose and treat conditions related to the brain, spinal cord and nerves throughout the body.
Reasons for Being Referred to a Neurologist
You’ll typically be referred to a neurologist by a primary care provider who’s already considered your symptoms and medical history, done a thorough exam, looked for underlying conditions, ordered laboratory tests or imaging and still feels treatment or diagnosis needs further investigation.
Common reasons why you might be referred to a neurologist include:
- Ministrokes.
- Headaches.
- Epileptic seizures.
- Neuropathy.
- Back problems.
- Memory problems.
- Dizziness.
- Sleep issues.
SEE: Questions Doctors Wish Their Patients Would Ask. ]
Ministrokes. A transient ischemic attack is a temporary blockage of blood flow to the brain and is often a warning for a major stroke. You may experience minor symptoms like Carcaterra’s elderly patient, or you may experience more severe signs. “Visual changes, slurred speech, confusion, imbalance, walking difficulty – even if they only last a few seconds, all of those are something where I’d wonder if this person is having multiple TIAs,” Carcaterra says.
Headaches. “If someone has a headache that’s occasional and they can manage it – they rest, lie down, maybe take an over-the-counter painkiller and it goes away – it’s probably fine. But if they keep coming in with migraines, cluster headaches or tension headaches, I’ll send them to the headache specialist,” Carcaterra says. Note: Sudden, severe headache pain accompanied by other symptoms (confusion, weakness, facial drooping or slurred speech) could indicate a major stroke and should prompt a call to 911.
Epileptic seizures. There are many types of seizures. They may cause someone to fall, lose awareness, pass out or simply stare into space. “There was one particular lady who was referred to me by a primary care doctor who thought she was mentally troubled. The history was that she would get up each morning, have breakfast and repetitively butter her toast over and over again, for several minutes at a time. The lady was having seizures,” says Dr. Bernard Gran, a neurologist with the Miami Neuroscience Institute.
Back problems. Spine compression – from bone overgrowth or a collapsed spinal disc, for example – can irritate nerves and cause neuropathy, or it may cause pain that radiates down the leg. “If someone has back problems and neuropathic symptoms that are really impacting his life, I’ll send the person to a neurologist,” Carcaterra says.
Memory problems. If you are experiencing memory difficulty, your primary care provider can conduct a mini-screening to determine if you should be referred to a neurologist. “I have a lot of elderly patients in my practice, and many are concerned because they can’t remember certain words. That may not trigger a referral. But if a person is really concerned about it – or someone in his 70s isn’t recognizing a grandchild he sees three times a week – that will trigger my referral,” Carcaterra explains.
Dizziness. Dizziness describes a feeling of unsteadiness, imbalance, nausea or lightheadedness. You might be referred to a neurologist if dizziness is unexplained, recurrent or accompanied by other symptoms. “If it’s severe or if they get headaches or vomit or they’re incapacitated with it, I’m sending the person to the neurologist,” Carcaterra says.
Sleep issues. A relatively small but growing number of neurologists also practice sleep medicine, says Dr. Brijesh Malkani, a clinical assistant professor of neurology with Mount Sinai Doctors. He’s based in Westchester, New York.
Many of these doctors have completed specialist training and are able to manage an array of sleep-related disorders, including:
- Insomnia.
- Restless leg syndrome.
- Sleep apnea.
- Narcolepsy.
Sleep apnea, in particular, can cause significant negative effects on someone’s cardiovascular health, Malkani says.
Adequately treating the condition can, in turn, help manage these conditions:
