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What to expect during a first visit to a neurologist
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What to expect during a first visit to a neurologist

I am 50 yr F, 128 lbs. 5'3".  About 7-8 wks ago (Sept 25) I experienced a sudden onset headache and simultaneous vomiting.  After sev days of headache/vomit went to GP, he said I had a virus and I was hospitalized for dehydration. 10 days later, woke 5 AM with head/nausea. Vomiting..went my GP.  I got shot for vomit/head 7 days later, woke with headache/vomiting. Went to GP got a shot.(stadol and phenergan)  It helped slightly. Headache remained stable but the nausea worsened. Went to ER, got shot for the headache/vomiting. Had a CT scan which was "normal". 10 days, woke with a headache/nausea. Vommiting by 10 AM. Every 10-15 min. I went to GP was put into hosp for IV rehydration and testing.  I had  "scope" to look at my esophogus and stomach.It was normal.  10 days later, woke w/headache & nausea. Went to GP for pain/nausea shot. Each visit to GP, he checked ears and did blood work both/ normal. These headaches are NOT like migraines.  They are about half as painful as migraine.  The head/nausea arrive simultaneously. I have head/nausea to a lesser degree MANY times.  Headache/nausea arrive simultaneously. My left ear feels "full", makes it hard to hear.  Without headache, my head feels funny, like floating at the top of my head.  My balance is a bit off.   GP has referred me to a neurologist in Little Rock, AR. 1. WHAT should I expect from this initial appointment?  2. WHAT  are the possible problems I might face besides tumor or perhaps an inner ear problem? 3. WHAT do I need to be prepared to take with me to the neurologist in addition to the symptoms I listed above?
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1.Although I can't tell you exactly what will happen as I don't know who you're seeing and have no way of predicting what will happen, I can tell you what happens during a new visit here and most places. Usually we start out by taking your full clinical history, meaning the exact nature of your symptoms and ask pointed questions to determine the degree of severity as well as to gather other pertinent information.  Then a formal neurological examination to see if there's any objective signs of neurological deficit. After the exam, we give the patient our impression of what's going on and outline a plan of management, including orders for further diagnostic testing. It is very possible that you may need an MRI of the brain. Depending on the urgency of the situation, we may admit the patient to the hospital or perform emergent testing if something requires immediate medical attention such as an impending stroke or spinal cord compression.
2.Hard to say without the formal exam and full clinical history.  Tumor is a consideration as you say, stroke, infection such as meningitis or abscess are all possibilities. Or even atypical migraine.
3.Bring lab reports from outside hospital as well as copy of CT scan of your brain, not just the report. Good luck.
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Question -  My neurologist has scheduled an MRI among several other tests.  He said I have polyneuropothy.  I noticed during his exam how little senstation I had in my feet and my hands.  Does this neuropothy have any connection to the headaches/nausea I have been experiencing? (I forgot to ask the doctor) When he tested my balance (walk heel to toe) I could not go 2 steps without falling.
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Dear Vicky,

I know that you had a CT of your brain, but was this evaluated for a Chiari malformation?  A Chiari malformation is an anomaly at the base of the skull in the area where your brainstem sits, and where the spinal cord leaves the skull.  Chiaris can sometimes cause intermittent hydrocephalus (basically, "water on the brain," meaning increased cerebrofluid pressure within the brain).  The symptoms of increased cerebrospinal fluid pressure are similar to what you describe - nausea and headache arriving together, often depending on the position of your body.  

Although I haven't looked this up specifically, I'd imagine that a Chiari might not be that easy to see on a CT.  The CT is not as good at evaluating the base of the brain as is MRI, and it doesn't allow the side views that really make this disorder pop out at the rardiologist reviewing the study.  Chiari can be difficult to diagnose at it is, and often is missed if people are not specifically looking for it.

Again, an MRI would seem to make sense for many other reasons, because there are certain things within the tissues of the brain that also are poorly visualized on CT.  As I said before, one of the main areas a CT has difficulty with is the base of the brain, because the bones of the skull interfere with the picture.    

Often doctors will check you for raised intracranial pressure by looking at the backs of your eyes for signs of swelling around the nerve to the eye.  This test is good at picking up severe, constant raised pressure, but is actually not that sensitive in picking up raised pressure that comes and goes, or lower levels of increased pressure.  It helps in diagnosis when the test is positive, but if it's not, that still doesn't mean the patient's headaches are not due to raised CSF pressure.  One has to take the story as a whole and do the necessary follow-up tests.  

If you do get an MRI, would you mind writing back in to let us know what the result was?  Totally up to you, but I'd be interested to hear.

Thanks, and good luck,
Annika

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