Neurology

Neurology is the discipline of medicine that studies the neural system and diagnoses and treats nervous system illnesses. Diseases of the nervous system include those that directly impact the central, peripheral, and autonomic nervous systems, and those that indirectly induce illness states. These can include vascular disorders (e.g., stroke) and muscular diseases (e.g., dystrophy), among others. In the neurology outpatient clinic, we examine patients who come for their first specialist examination due to neurological disorders, and patients who seek a second opinion on their treatment or a consultation regarding the necessity for surgical therapy.

WHICH SERVICES DOES THE CLINIC OFFER?

Patients are given a clinical examination, tests for nerve disorders or diseases, EMG (nerve conduction testing), autonomic nerve function testing, and a tilt table test. If necessary, the patient is referred for more investigation. Based on the patient’s medical history, clinical picture, and test results, we decide or recommend treatment options for patients with central nervous system (brain, cerebellum, and spinal cord) and peripheral nervous system disorders.

ELECTROMYOGRAPHY (EMG)

An EMG is a test that detects nerve cell defects outside the brain and spinal cord, as well as muscle disorders (myopathies).
AUTONOMIC NERVOUS SYSTEM FUNCTION TESTS

The test is designed to evaluate the function of the autonomic nervous system, which controls the heart and circulation. Each test evaluates whether cardiovascular nerve function is normal or compromised, and if so, to what extent.

The autonomic nervous system test is required for chronic disorders that can impair autonomic nervous system function, such as diabetes, Parkinson’s disease, multisystem atrophy (MSA), and amyloidosis.

Take your usual medications before the exam. Before the test, you will address any medical issues you may have and any medications you use regularly.
The exam consists of several short tests in which your blood pressure and heart rate are continuously monitored. A cuff will be placed on the fingers of your left hand to measure your blood pressure continuously, while electrodes will be placed on your chest to record your ECG.

We’ll run the following tests:

• Lying still in complete stillness (10 minutes)
• Valsalva test: blowing against resistance of 20 mm Hg (20 seconds, three repetitions).
• Deep breathing test (90 seconds, 2 repetitions)
• Orthostatic test: an individual stands up and stands still for 6 minutes (two repetitions)

The tests are simple, safe, and non-invasive. Dizziness or lightheadedness may occur on rare occasions during the test. Failure to finish the test may influence the diagnosis of an autonomic nervous system illness.

During the test, you will tell if you have any difficulties (nausea, weakness, fever, dizziness, etc.).

The test lasts one hour.

TILT TABLE TEST

The tilt table test aims to determine the reason of unexplained fainting. If you experience recurring bouts of fainting or dizziness, your doctor may recommend a tilt table test. Continuous blood pressure and heart rate monitoring will indicate the type of syncope (temporary loss of consciousness).

The autonomic nervous system regulates your heart rate and blood pressure. When you tilt your body, your heart rate and blood pressure may drop temporarily. This reduces blood flow to the brain, resulting in loss of consciousness.

The test is generally safe, and problems are uncommon.

Possible complications:

• Nausea and vomiting after fainting
• Nausea that may last for several hours
• Persistent low blood pressure after the test

Complications usually resolve quickly when you return to a horizontal position.

THE EXAMINATION PROCESS

Before the examination, we will discuss your medical history and current medications.

On the day of the test, take all your prescription medications, including any epilepsy medication. Do not eat or drink for at least 4 hours before the scan.
While lying on the table, you will be confined with special straps to keep you from falling. The healthcare expert will install a continuous blood pressure cuff on your left index finger and a conventional blood pressure cuff on your right upper arm. Four electrodes will be attached to your chest to monitor your heart function (ECG). Your blood pressure and heart rate will be continuously monitored and recorded throughout the exam. After lying down for five minutes, you’ll spend 45 minutes lying on a passively tilted examination table at a 60-degree angle. Try to remain calm as possible during the tilt and report any indications or symptoms, such as nausea, sweating, feeling helpless, being hot, or having an irregular heartbeat. If you have no symptoms, you will receive Nitrolingual (1 puff under the tongue) within 30 minutes. Nitrolingual is not often used in those under the age of 18, the elderly, or those suffering from heart disease. You will be placed in a horizontal posture 20 minutes after receiving the sublingual medicine Nitrolingual, or when you lose consciousness.

The test lasts about an hour.

INTERPRETING THE RESULTS:

The results are based on whether you faint during the test, and how your blood pressure and pulse rate change. A positive result means that your blood pressure decreased and you became dizzy or fainted during the test.

If your heart rate rises only slightly, your blood pressure does not fall much, and you have no indications or symptoms of fainting, the outcome is negative. In this instance, you will most likely need more testing to determine the cause of the fainting.

WHEN TO MAKE AN APPOINTMENT?

In most cases, you will be referred to us by your GP, however, it is also important to manage risk factors and treat people who already have problems with vascular disease and peripheral nervous system problems.