Neurology is a medical specialty focused on the brain, spinal cord and the body’s network of nerves. Together these comprise the “nervous system,” which essentially controls everything that happens in the body and everything the body does — from digestion and breathing to moving, thinking and learning.
The brain is the hub of the nervous system: Like a “mission control center” it interprets and responds to the messages the peripheral nerves send it from inside and outside the body. The spinal cord is often a kind of first stop and relay station for these signals, sending them up to the brain from there, but also able to respond to some on its own (we call these “reflexes”). Let’s say you put your hand over a flame; peripheral nerves in the finger send the message “HOT!” over larger nerves in the arm and eventually to even larger nerves in the neck where the signal enters the spinal cord. The spinal cord forwards the “HOT!” message up to the brain at the same time it sends a message to the arm muscles to pull the hand away. By the time the brain knows there was something “HOT!” going on, the hand is already out of the fire, and it all happens in a fraction of a second.
Hundreds of diseases and disorders may affect the nervous system and cause a wide range of symptoms, from weakness, numbness or pain to problems moving, speaking, breathing, swallowing, seeing, hearing or remembering. The specific problems that may develop and the symptoms and severity vary depending on what part or parts of the system are affected and the underlying cause.
Causes of neurologic problems include genetic defects (e.g., involving nerve or muscle function), brain or spinal cord injuries or tumors, infections (e.g., meningitis, encephalitis), diseases or disorders of blood vessels (e.g., stroke, brain hemorrhage, migraine), loss of the lining around nerves (multiple sclerosis), and diseases that damage or destroy the brain’s nerve cells (e.g., Alzheimer’s disease, Parkinson’s disease). The root causes of some of these issues remain unclear, although with stroke we do know that some of the responsible factors are the same ones that increase the risk for heart attacks (i.e., family history, obesity, elevated cholesterol, high blood pressure, diabetes and smoking).
Many neurologic disorders and their associated symptoms have the potential to cause significant impairment, and many are challenging to treat. As with all health problems, but particularly for potentially-treatable conditions, an accurate diagnosis is the critical first step in the care of patients with signs or symptoms of a neurologic disorder. Although primary care physicians are trained to recognize possible neurologic problems and can treat or manage some disorders of the nervous system, a neurology specialist is typically consulted at some point in the care process.
Physicians who specialize in the diagnosis and nonsurgical management of disorders of the nervous system are called neurologists. Physicians in other disciplines will often consult a neurologist as the principal specialist involved in evaluating a patient with a suspected neurologic disorder. Neurologists are experienced in carrying out and interpreting results of specialized neurologic tests, such as brain or spinal cord imaging, studies of the electrical activity of the brain (electroencephalography) or peripheral muscles and nerves (electromyography, nerve conduction studies), evaluations to identify problems during sleep (e.g., sleep-related movement or breathing disorders), and spinal fluid tests (spinal tap).
Once a diagnosis is reached, the neurologist’s role in patient care varies depending on the severity and complexity of the diagnosis. For example, a neurologist may initially treat a patient who has suffered a head injury or stroke or who has newly diagnosed migraine and then may serve as a consultant on that patient’s ongoing treatment and management. A neurologist may be the principal care provider for patients with uncommon or difficult-to-treat conditions or with disorders that require frequent care (e.g., epilepsy, multiple sclerosis, Parkinson’s disease).
Neurologists do not perform surgery but may recommend surgical treatment. In this case, a patient would be referred to a neurosurgeon — a physician who specializes in surgical treatment of disorders of the brain, spinal cord, and other nervous system components.