A neurologist is a doctor who specializes in conditions that affect your brain, spinal cord and nervous system. Your nervous system controls all you body's functions – from processing memories to the beating of your heart. Neurologists focus on understanding and treating neurological problems, including headaches, sleep disorders and Alzheimer’s disease.
In this guide we explore what neurologists do and how they handle neurological issues. You'll learn the distinction between neurologists and other health care providers who work with disorders of the brain, such as neuroscientists and psychiatrists.
What Does a Neurologist Do?
Neurologists are medical doctors with specialized training in evaluating, treating and managing signs and symptoms related to the nervous system.
You could be referred to a neurologist for a number of symptoms, including:
- Headaches.
- Problems with focus or concentration.
- Cognition or memory issues.
- Numbness and tingling.
- Nerve pain, often described as burning or electric shock.
- Muscle weakness, spasms or twitching.
- Vision problems.
- Seizures.
- Stroke.
- Taste or smell disturbances.
- Vertigo.
- Tremors.
- Imbalance when walking.
“In general, you're talking about something related to an issue that's involving the nervous system, meaning the brain, spinal cord, peripheral nerves or neuromuscular system,” says Dr. Vernon Williams, a board-certified sports neurologist, pain management specialist and founding director of the Center for Sports Neurology and Pain Medicine at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles.
Nowadays, “neurologists are much more actively involved in not only ameliorating symptoms but reversing disease,” he says.
Neurological Problems
Common neurological conditions that neurologists diagnose, treat and manage include:
- Alzheimer’s disease or other forms of dementia.
- Headaches or migraines.
- Concussions.
- Brain or spinal cord injury.
- Brain, nerve or spine tumor.
- Nerve pain.
- Meningitis.
- Stroke.
- Peripheral neuropathy.
- Epilepsy and seizures.
- Muscular dystrophies.
- Multiple sclerosis.
- Parkinson's disease.
- Amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
- Infections of the nervous system, such as meningitis and encephalitis.
Neurologist vs. neuroscientist
Neuroscientists are medical scientists who perform clinical research to better understand the body’s nervous system. They do not diagnose, treat or manage conditions directly with a patient population. Rather, they may perform clinical trials, study human activity and write academic research papers.
Neurologists, on the other hand, are medical doctors who work directly with patients to treat conditions affecting the nervous system.
Neurologist vs. neurosurgeon
“Most people think we’re surgeons,” says Dr. Elaine C. Jones, a neurologist and medical director of quality for Access TeleCare, a nationwide specialty telemedicine company. She is also a Fellow of the American Academy of Neurology.
Though there is a fair amount of overlap between neurologists and neurosurgeons, they’re not the same. The fields of neurosurgery and neurology are both made up of specialized doctors who diagnose and treat conditions of the brain, spine and nervous system.
Neurologists focus on treating and managing neurological disorders through medication, lifestyle modifications or other nonsurgical therapeutic interventions, whereas neurosurgeons undergo additional training in surgery to treat patients too. Neurosurgeons may treat conditions through nonsurgical or surgical interventions, such as brain surgery or spinal surgery to treat conditions like a brain tumor, aneurysm or herniated disc.
Neurologist vs. psychiatrist
“The difference between psychiatry and neurology is the most complex,” Jones says.
Both psychiatrists and neurologists work with conditions affecting the brain. Jones says that psychiatrists typically care for conditions that are less of a “structural issue” and more of a “chemical process” issue within the brain, such as anxiety or depression.
That means that neurologists work to address physiological dysfunctions in the brain, whereas psychiatrists address mental health disorders.
“But there is a lot of overlap, especially when you come to diagnoses like dementia,” Jones says. “We do collaborate a lot with our colleagues, both internal medicine and pediatrics, and certainly neurosurgery and psychiatry.”
What to Expect at Your First Neurologist Visit
When visiting a neurologist, there are generally two processes – an emergency or inpatient situation versus an outpatient setting.
Inpatient visit
Some neurological signs and symptoms may require more emergent care.
“In an emergency situation, a patient will come into the ER if they have anything that seems to be affecting the nervous system,” Jones says.
For example, that could mean the patient had a stroke or seizure, or they’re experiencing weakness, numbness, trouble walking or speaking, or visual changes.
Jones practiced for about 17 years as a solo practice neurologist in Rhode Island, but now she works in teleneurology for a nationwide company that covers the emergency room. When she’s on call, she could receive a call from an emergency department in any of the 26 states where she’s licensed to practice.
“We’ll assist with the local emergency room team on figuring out what needs to be done,” she says.
That may mean prescribing medication, making a diagnosis or referring the patient to another specialist within the hospital.
Outpatient visit
Outpatient visits are typically less pressing, and the patient is sometimes referred by their primary care physician.
Taking the patient’s comprehensive history includes a review of symptoms, discussing medical history and social history.
First, Williams says they’re asking questions about symptoms, such as:
- How did your symptoms start?
- When did they start?
- Are there any clear patterns or characteristics to the symptoms?
- How is it affecting your daily function or quality of life?
Next, Williams says your doctor will review your medical history, asking questions like:
- Do you have any other conditions or diagnoses that may predispose you to certain kinds of neurologic conditions?
- What medications are you taking?
He adds that neurologists will sometimes do a “review of systems,” where they ask questions about other body parts or systems unrelated to the brain or nervous system that may be causing symptoms.
Lastly, Williams says they’ll take a comprehensive social history, with questions that may include:
- Do you smoke?
- Do you drink alcohol?
- Have you used drugs?
- Do you exercise?
- How’s your sleep?
Your neurologist will focus the physical examination on the nervous system. This can include examining your:
- Vision, hearing and speech.
- Muscle strength, which includes assessing muscle tone or stiffness.
- Motor function, including balance and coordination.
- Mental health, which could entail memory and cognitive function assessments.
- Sensory function, such as temperature sensitivity and pain tolerance.
Depending on the outcome of the comprehensive history and physical examination, your doctor may order further neurological tests. If you’re lucky, your doctor may offer those in-house.
“In my particular practice, I try to do as much as possible in real time when the person is with me and as much as possible in the office so that we can really improve continuity of care,” Williams says.
Testing may include blood work and laboratory testing. It could also involve electrodiagnostic testing, which tests the nerves and how they’re sending signals throughout the body. It could also involve electrical testing of the brain. Looking at brainwave activity could involve imaging like MRIs, CAT scans, PET scans or functional imaging, Williams says.
Here are some common neurological tests:
- Electroencephalography, or EEG. This measures electrical activity of the brain and detects brain wave abnormalities.
- Electromyography, or EMG. This assesses muscle function and nerve cells that control them and is often used when someone is experiencing symptoms like tingling, numbness or weakness.
- MRI, or magnetic resonance imaging. This medical imaging technique can create detailed images of the brain and spinal cord. The test could detect abnormalities like tumors or structural issues.
- CT scan, or a computed tomography scan. CT scans use X-rays to create cross-sectional images of the brain, blood vessels and soft tissues.
- Biopsy. This procedure is done to remove a piece of tissue from a muscle, nerve or brain for further testing or analysis.
- Genetic testing. This may be used to identify genetic mutations association with neurological conditions like Huntington's disease.
Review of findings
Your doctor will review their patient’s symptoms, physical examination, test results and any other relevant information that was discussed during their appointment, Williams says.
Your neurologist will then map out a “curated, personalized, individualized approach to their care, to their treatment or intervention,” Williams says.
Treatments included in a personalized care plan will vary depending on your specific diagnosis, severity of symptoms and individual needs. However, common treatments that may be prescribed as part of a neurological care plan may include:
- Medications. Medications are frequently used to manage symptoms, such as anticonvulsants for epilepsy and seizures.
- Physical therapy, which can help improve strength, mobility and coordination for some neurological conditions.
- Occupational therapy, which can be beneficial for conditions that affect motor skills or activities of daily living.
- Speech therapy, which may be used for patients with speech, language or swallowing conditions.
- Surgical interventions. For example, you may be referred to a neurosurgeon to have a tumor removed or to repair damaged nerves.
- Lifestyle modifications, which could mean dietary modifications or exercise recommendations.
- Mental health therapy or group counseling, as some neurological conditions can have a significant psychological impact.
How Should I Prepare for My First Neurologist Appointment?
To ensure you get the most out of your first visit, preparing ahead of your neurologist appointment is key. Here are some steps to help you prepare for your first appointment:
Send a copy of your medical records.
Your doctor will want a full picture of your medical history. The best way to ensure your neurologist has the complete picture is to make sure all of your medical records have been sent to your doctor's office ahead of time. Not only will this give the full picture, but it can help avoid duplicate testing and speed up the process of getting a diagnosis.
This includes gathering any past test results, imaging scans like CT scans or MRIs, surgeries and major illnesses. Even something that seems insignificant to your visit may provide valuable information to your neurologist.
Make a list of symptoms.
You should write down any symptoms you're experiencing, even if they seem minor or unrelated. Your neurologist will want to know additional details like when your symptoms started, their frequency and duration and if you've noticed any triggers or patterns.
Bring a list of medications and supplements.
A list of any and all medications, vitamins and supplements you're taking will help ensure nothing is missed. Be sure to include dosage and frequency as well.
Your neurologist needs to know what you're taking for two reasons: They could be contributing to or causing your symptoms, or they could interact with some neurological medications.
Write down a list of questions.
Doctor's appointments go quickly, and writing down your questions in advance of the appointment can help ensure no questions are left unanswered. Your questions likely vary greatly depending on your individual symptoms or diagnosis, but examples may include:
- Are there any major red flags with my condition I should be aware of?
- What are potential side effects of my treatment and/or medication?
- What can I do to monitor my condition at home?
- How often should I follow up with you?
- What can I expect at my next appointment?
Bring a friend or family member.
A visit to the neurologist can be overwhelming – particularly if you're facing a neurological illness that is associated with cognitive issues. Having a loved one with you to take notes and be your advocate during the appointment can be helpful logistically to keep information organized. Receiving a diagnosis for a neurological disorder can also be a lot to process, so having a loved one available may provide emotional support.
Neurology Specialties
There are a range of subspecialty areas in the field of neurology, such as:
- Pediatric neurology.
- Geriatric neurology.
- Sports neurology.
- Nerve specialist.
- Sleep medicine.
- Specializing in particular disorders, like epilepsy, headaches/migraines or multiple sclerosis.
Williams is a practicing neurologist who subspecialized in sports neurology, “which is a relatively new subspecialty in neurology that’s involved in evaluating and treating injuries that can occur to the nervous system through participation in sports.”
He often sees concussions or head injuries, but he also sees spinal cord injuries or peripheral nerve injuries. “In addition to treating injuries, sports neurologists will often assist people with other neurologic conditions in improving their function,” Williams says. “For instance, we know people who have Alzheimer’s disease and Parkinson’s will benefit greatly from exercise and from physical activity that really improves their symptoms and prolongs deterioration.”