Neuro exam?

[monnie115]

How detailed should a neuro exam be on the first visit? The neuro I saw just hit my head with a tuning fork and tested my knee and elbow reflexes. I wasn't evaluated for gait or balance or anything like that. Is that considered a detailed enough exam? I was in the office to review MRI findings comsistemt with MS after being diagnosed with trigeminal neuralgia. I am not diagnosed at this time. Thanks.

[Guitar_grrrl]

I'm with Jen on this one, Monnie!  I've had TN twice in the last 5 years!  TN is more common than your neuro thinks it is!  Foolish neuro...  :-(

[jensequitur]

Well, now I'm even more dubious about this neuro.  One of my first symptoms was a tingling in my chin and cheek, which my PCP thought was trigeminal neuralgia.  I would say that TN is a very common symptom with MS sufferers.  There's lots of white matter in the head, which tends to get attacked by MS first.

[SarahL2491]

I had the tuning fork but he started it vibrating and held it to my head and to my ears......among my hands and feet.  My R side flunked in many places.
which he showed me by moving it from my right (when it failed) to my left where I still felt it......then I understood

I think that a first neuro exam should include the areas that you have c/o about, at least.  

[teenyturner]

Ah Monnie,  that explains the tapping of the head thing.  He wanted to know if you could get sound conduction through the bones of your skull.  Other than that, he really should have been a bit more thorough but for some reason or other they seem to wait and see if you turn up again and whether your symptoms have progressed before they start getting excited enough to examine you properly.

Regards

Chirley

[monnie115]

The MRI was discussed; he read the impression first which was "multiple lesions consistent with MS" but told me not to get excited because MS rarely presents with TN. At this point my only issues are TN and nuisance symptoms of tingles and zaps I never thought were important. I did have temporary hearing loss last summer which he thought was somewhat significant. I have a first degree relative with MS (mother) but at this point I am not diagnosed. The lesions were periventricular, subcortical, brainstem, and pons. I am seeking a second opinion.

[Sailorsong]

A doctor should never be hitting a patient on the head with those tuning forks.

Dennis

[Lulu54]

Have I Ever heard of someone being tapped on the head with the tuning fork?  I don't think so.  That is used to feel vibration in the bones, particularly in the extremities (feet, ankles, hands). I am going to look into this use!

What was the word on your MRI results?  Were those discussed at all?

[doublevision1]

here's a good resource on the neuro exam from Univ of Toronto.  Target audience is medical students but it's very clear and straightforward for the layperson as well.

http://www.utoronto.ca/neuronotes/NeuroExam/main.htm

[pauper]

I would try to find another neurologist stat!  I am a paralegal and see all kinds of med malpractice, but I try as hard as I can not to let that interfere with my judgment. There are good doctors out there, but sometimes very hard to find.  I think everyone deserves a thorough examination and a physician who listens and take his or her time.  You know your own body and know when to sense that something is not right (such as the limited exam your neuro did).  

It's hard to go to another doctor, as I know from experience.  I have a GP who keeps mentioning my "high blood pressure" when it is well below normal.  It would be ideal if you could talk to someone who has a great neuro, but other than that it's just trial and error, I guess.  But keep looking and hope you find one.

[jensequitur]

A complete neuro exam should take about fifteen minutes, and includes a heel walk, gait check, balance evaluation, checking of sensation on various limbs, and a check of your eyes to see how well they track.  It doesn't sound like you received a complete exam, but to be honest, I didn't get one either on my first neurologist.  He never stopped long enough for me to tell him yes, I could feel it, no I couldn't, or no, the sensation was different.