What is a neurologist?
A neurologist is a medical doctor who specializes in treating diseases of the nervous system. The nervous system is made of two parts: the central and peripheral nervous system. It includes the brain and spinal cord.
The nervous system has two major parts: the central nervous system (CNS) and the peripheral nervous system (PNS). The central system is the primary command center for the body, and is comprised of the brain and spinal cord. The peripheral nervous system consists of a network of nerves that connects the rest of the body to the CNS.
The two systems work together to collect information from inside the body and from the environment outside it. The systems process the collected information and then dispatch instructions to the rest of the body, facilitating an appropriate response.
In most cases, the brain is the final destination point for information gathered by the rest of the nervous system. Once data arrives, the brain sorts and files it before sending out any necessary commands.
The brain is divided into many different sections, including the cerebrum and brain stem. These parts handle pieces of the brain’s overall workload, including storing and retrieving memory and making body movements smooth.
Although the brain is the control center, its job would not be possible without the spinal cord, which is the major conduit for information traveling between brain and body.
Peripheral system nerves branch from either the brain stem or the spinal cord. Each nerve is connected to a particular area of the torso or limbs and is responsible for communication to and from those regions.
The PNS can also be subdivided into smaller components: the somatic and autonomic systems. The somatic involves parts of the body a person can command at will, and the autonomic helps run involuntary functions such as pumping blood.
Information conveyed through the nervous system moves along networks of cells called neurons. These neurons can only send information one way. Those transmitting to the brain are sensory neurons; those that transmit from the brain are known as motor neurons.
The nervous system can suffer from a number of afflictions, including cancer (e.g., brain tumors). Other problems include multiple sclerosis, in which damaged nerves prevent signals from traveling along them, and meningitis, which causes an inflammation of the membranes surrounding the brain and spinal cord.
Illnesses, disorders, and injuries that involve the nervous system often require a neurologist’s management and treatment.
Before they can practice, neurologists must:
- graduate from medical school
- complete an internship
- receive three years of training in a neurology residency program
What does a neurologist do?
Neurologists manage and treat neurological conditions, or problems with the nervous system. Symptoms that commonly require a neurologist include:
Uncoordinated movement is also known as lack of coordination, coordination impairment, or loss of coordination. The medical term for this problem is ataxia.
For most people, body movements are smooth, coordinated, and seamless. Motions such as walking, throwing a ball, and picking up a pencil don’t require a tremendous amount of thought or effort. But each movement actually involves a number of muscle groups. They’re largely controlled by the cerebellum, an important structure in the brain.
Ataxia occurs when there’s a disruption in communication between the brain and the rest of the body. This causes jerky and unsteady movements. Ataxia can have a profound effect on a person’s day to day activities.
What are the symptoms of uncoordinated movement?
For some, ataxia may be a slowly developing condition. For others it may occur suddenly and without warning. The most common symptom of ataxia is loss of balance and coordination. If the condition does progress, you may experience difficulty walking and moving your arms and legs. Eventually there can be a loss of fine motor skills, affecting activities such as writing or buttoning up your shirt.
Other common symptoms of ataxia can include:
- visual difficulties
- problems or changes with speech
- difficulty swallowing
These symptoms can be very concerning because they are often similar to a stroke. Seek emergency medical attention if these symptoms suddenly appear.
What causes ataxia?
There are a number of known causes for ataxia. They range from chronic conditions to sudden onset. However, most conditions will relate to damage or degeneration of the cerebellum.
Disease and injury-related causes
Coordinated movements involve the cerebellum, the peripheral nerves of the body, and the spinal cord. Diseases and injuries that damage or destroy any of these structures can lead to ataxia. These include:
- head trauma
- multiple sclerosis, a chronic disease that affects the brain and spinal cord
- transient ischemic attack (TIA), a temporary decrease of blood supply to your brain
- genetic ataxias
- cerebral palsy, a group of disorders caused by damage to a child’s brain in early development
- brain tumors
- paraneoplastic syndromes, abnormal immune responses to certain cancerous tumors
- neuropathy, disease or injury to a nerve
- spinal injuries
Examples of some inherited conditions related to ataxia are Friedreich’s ataxia and Wilson’s disease. Friedreich’s ataxia is a genetic disease that causes problems with energy production in the nervous system and the heart. Wilson’s disease is a rare inherited disorder in which excess copper damages the liver and nervous system.
Some substances have toxic effects that can lead to ataxia. These include:
- alcohol (most common)
- seizure medications
- chemotherapy drugs
- cocaine and heroin
- mercury, lead, and other heavy metals
- toluene and other types of solvents
Sometimes people have a condition known as sporadic ataxia. This causes an ataxia not related to a genetic disorder or a specific known cause.
What to expect during your doctor visit
You should schedule a doctor’s visit right away if you experience any of the following:
- a loss of balance
- trouble swallowing
- lack of coordination for more than a few minutes
- loss of coordination in one or both legs, arms, or hands
- slurred speech
- trouble walking
Seeing the doctor
Your doctor will ask you about your medical history and perform a basic physical examination. They’ll perform a detailed neurological exam that includes your muscular and nervous systems. They’ll check your ability to balance, walk, and point with your fingers and toes. Another common test is the Romberg test. It’s used to see if you can balance while closing your eyes and keeping your feet together.
Sometimes the cause of ataxia is clear, such as a brain injury, infection, or toxin. Other times your doctor will ask questions about your symptoms to narrow down the possible cause of your ataxia. These questions often include:
- When did your symptoms begin?
- Does anyone in your family have similar symptoms?
- What are you most common symptoms?
- How much do your symptoms impact your life?
- What medications do you take, including vitamins and supplements?
- What substances have you been exposed to?
- Do you use drugs or alcohol?
- Do you have other symptoms, such as visual loss, speech difficulties, or confusion?
Tests to determine the cause of ataxia
Your doctor may order the following tests:
- blood tests
- urine tests
- computed tomography (CT) scan
- magnetic resonance imaging (MRI) scan
- spinal tap
- genetic testing
Your doctor will consider the overall picture of your symptoms and test results in making a diagnosis. They may also refer you to a neurologist, a specialist in the nervous system.
Living with ataxia
There’s no cure for ataxia itself. If an underlying condition is the cause, your doctor will first treat that. For example, a head trauma may eventually heal and ataxia may subside. But in other cases, such as cerebral palsy, your doctor may not be able to treat ataxia. But there are ways to manage this condition. Some medications may lessen the symptoms associated with ataxia.
In some cases, your doctor may recommend adaptive devices or therapy. Items such as canes, modified utensils, and communications aids may help to improve your quality of life. Therapies designed to help with uncoordinated movement are other options, such as:
Physical therapy: Exercises can help strength your body and increase your mobility.
Occupational therapy: This therapy aims to improve your skills with daily living tasks such as feeding and other fine motor movement.
Speech therapy: This can help with communication as well as swallowing or eating.
Simple changes can also make it easier for a person with ataxia to get around the house. For example:
- keep living areas clean and free of clutter
- provide wide walkways
- install hand rails
- remove rugs and other items that might cause slipping and falling
Researchers at the Albany Medical Center have discovered some treatable forms of ataxia. AVED (Ataxia with Vitamin E Deficiency) is a type of ataxia that improves with Vitamin E supplementation. Gluten ataxia improves with a gluten free diet.
The University of London also reported that vitamin B-3, or nicotinamide, may help people with Friedreich’s ataxia. This treatment may increase frataxin levels, a protein which is low in people with this type of ataxia. But research continues as it’s unknown if this supplementation will work long-term to slow or stop the disease.
Where to find support
Symptoms of ataxia can affect a person’s independence. This can result in feelings of anxiety and depression. Talking to counselor can help. If one-on-one counseling doesn’t sound appealing, consider a support group for people with ataxia or other chronic neurological conditions. Support groups are often available online or in-person. Your doctor may have a recommendation for a support group in your area.
Muscle weakness happens when your full effort doesn’t produce a normal muscle contraction or movement.
It’s sometimes called:
- reduced muscle strength
- muscular weakness
- weak muscles
Whether you’re ill or you simply need rest, short-term muscle weakness happens to nearly everyone at some point. A tough workout, for instance, will exhaust your muscles until you’ve given them a chance to recover with rest.
If you develop persistent muscle weakness, or muscle weakness with no apparent cause or normal explanation, it may be a sign of an underlying health condition.
Voluntary muscle contractions are usually generated when your brain sends a signal through your spinal cord and nerves to a muscle.
If your brain, nervous system, muscles, or the connections between them are injured or affected by disease, your muscles may not contract normally. This can produce muscle weakness.
Potential causes of muscle weakness
Many health conditions can cause muscle weakness.
- neuromuscular disorders, such asmuscular dystrophies, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS)
- autoimmune diseases, such asGraves’ disease, myasthenia gravis, and Guillain-Barré syndrome
- thyroid conditions, such ashypothyroidism and hyperthyroidism
- electrolyte imbalances, such ashypokalemia (potassium deficiency), hypomagnesemia (magnesium deficiency), and hypercalcemia (elevated calcium in your blood)
Other conditions that may cause muscle weakness include:
- herniated disc
- chronic fatigue syndrome (CFS)
- hypotonia, a lack of muscle tone that’s usually present at birth
- peripheral neuropathy, a type of nerve damage
- neuralgia, or sharp burning or pain following the path of one or more nerves.
- polymyositis, or chronic muscle inflammation
- prolonged bed rest or immobilization
- alcoholism, which can causealcoholic myopathy
Muscle weakness can also be caused by complications from certain viruses and infections, including:
Botulism, a rare and serious illness caused by Clostridium botulinum bacteria, can also lead to muscle weakness.
Prolonged use of certain drugs may also result in muscle weakness.
These drugs include:
- statinsand other lipid-lowering agents
- antiarrhythmic drugs, such asamiodarone (Pacerone) or procainamide
- colchicine(Colcrys, Mitigare), which is used to treat gout
Diagnosing the underlying cause of muscle weakness
If you experience muscle weakness for which there’s no normal explanation, make an appointment with your healthcare provider.
You’ll be asked about your muscle weakness, including how long you’ve had it and which muscles have been affected. Your healthcare provider will also ask about other symptoms and your family medical history.
Your healthcare provider may also check your:
- muscle tone
If needed, they may order one or more tests, such as:
- CT scans or MRIto examine the inner structures of your body
- nerve tests to assess how well your nerves are working
- electromyography (EMG)to test the nerve activity in your muscles
- blood teststo check for signs of infection or other conditions
Treatment options for muscle weakness
Once they’ve determined the cause of your muscle weakness, your healthcare provider will recommend appropriate treatment. Your treatment plan will depend on the underlying cause of your muscle weakness, as well as the severity of your symptoms.
Here are some of the treatment options for conditions that cause muscle weakness:
Physical therapists can suggest exercises to improve your quality of life if you have conditions such as MS or ALS.
For example, a physical therapist might suggest progressive resistive exercise to help someone with MS strengthen muscles that have become weak from lack of use.
For someone with ALS, a physical therapist might recommend stretching and range of motion exercises to prevent muscle stiffness.
Occupational therapists can suggest exercises to strengthen your upper body. They can also recommend assistive devices and tools to help with day-to-day activities.
Occupational therapy can be especially helpful during the stroke rehabilitation process. Therapists can recommend exercises to address weakness in one side of your body and help with motor skills.
Over-the-counter (OTC) pain relievers, such as ibuprofen or acetaminophen, can help manage pain associated with conditions such as:
- peripheral neuropathy
Recognizing a potential emergency
In some cases, muscle weakness can be a sign of something very serious, such as a stroke.
If you experience any of the following symptoms, call 911 or your local emergency services immediately:
- sudden onset of muscle weakness
- sudden numbness or loss of feeling
- sudden difficulty moving your limbs, walking, standing, or sitting upright
- sudden difficulty smiling or forming facial expressions
- sudden confusion, difficulty speaking, or trouble understanding things
- chest muscle weakness resulting in difficulties breathing
- loss of consciousness
People rely on their sense of touch to quickly pull away from a hot object or to feel changes in terrain under their feet. These are referred to as sensations.
If you can’t feel as well, especially with your hands or feet, it’s known as impaired sensation. If you have impaired sensation, you may not feel anything at all. Or you may feel unusual sensations, such as:
Impaired sensation can lead to injury and balance problems.
It can be a temporary occurrence that takes place after an injury or a chronic condition that results from diabetes or another illness. Sudden impaired sensation can be a medical emergency.
What are the causes of impaired sensation?
If you’ve ever crossed your legs and had one of them go numb, you’ve experienced impaired sensation. While this feeling may go away within a few minutes, impaired sensation that’s caused by other conditions may not.
Impaired sensation can result from a variety of conditions, such as:
- brain tumor
- carpal tunnel syndrome
- Charcot-Marie-Tooth disease
- chronic kidney failure
- Guillain-Barré syndrome
- head injury
- herniated disc
- lead poisoning
- opioid dependence
- peripheral neuropathy
- phantom limb pain after an amputation
- spinal cord injury
- ulnar nerve palsy
When should I seek medical help for impaired sensation?
Sudden loss of sensation can be a medical emergency because it may be a sign of stroke.
Seek immediate medical attention if you or a loved one experiences the following symptoms:
- loss of balance
- sudden confusion
- sudden, severe headache with no known cause
- sudden weakness on one side of the body
- trouble seeing
If you have symptoms of impaired sensation that seem to be getting worse or you’re experiencing falls or loss of balance because of impaired sensation, let your healthcare provider know.
How is impaired sensation diagnosed?
To diagnose the extent and cause of impaired sensation, your healthcare provider may start by asking you several questions, such as:
- Where do you feel the change in sensation? Do you feel it deep under your skin or just across the top of your skin?
- When do the new sensations or loss of sensation occur most often? Do they last all day, or do they come and go?
- Does anything make your symptoms feel worse or better, such as rest, moving, or sleeping?
Next, they will often perform a physical examination. They may tap lightly on your skin to determine how much you can feel.
They may also recommend one or more of the following tests:
- imaging scans, such ascomputed tomography (CT) or magnetic resonance imaging (MRI), to check for injury or abnormalities in your head, spine, or other areas
- nerve conduction velocity studies, which measure how well electrical impulses pass through your nerves
- reflex tests
How is impaired sensation treated?
Your healthcare provider’s recommended treatment for impaired sensation will depend on the cause.
For example, diabetic neuropathy is a common cause of impaired sensation. If you have diabetic neuropathy, your healthcare provider may coach you on how to better manage your blood sugar by checking your blood sugar levels and treating high blood sugar with medication.
Your healthcare provider may also prescribe pain medication to help manage your symptoms resulting from abnormal sensations.
Confusion is a symptom that makes you feel as if you can’t think clearly. You might feel disoriented and have a hard time focusing or making decisions.
If you or someone you care about is confused for a long period of time, dementia might be the reason. Dementia is a progressive condition caused by brain function decline that results in the loss of your ability to perform everyday functions. It also affects judgment, memory, and behavior.
Learn what might be causing confusion and when to seek help.
What are the signs of confusion?
Noticing confusion when it first appears will help you or your loved one get prompt treatment.
Some signs of confusion include:
- slurring words or having long pauses during speech
- abnormal or incoherent speech
- lacking awareness of location or time
- forgetting what a task is while it’s being performed
- sudden changes in emotion, such as sudden agitation
If you’re the one experiencing signs of confusion, it might be a good idea to call a friend or loved one for help. If you’re confused, you might need help with things that you could do on your own before.
When to see a doctor
If you or someone you know starts showing signs of confusion, call a doctor. Confusion can have many causes, including injury, infection, substance use, and medications. It’s important to find out what the underlying cause of the confusion is so that it can be treated.
Your doctor will ask you or your loved one to indicate when the confusion started and when you last exhibited “normal” thinking and behavior. Being able to describe the characteristics and duration of the confusion will help your doctor diagnose its cause.
People experiencing confusion can sometimes act aggressively or unpredictably. A person experiencing confusion should be closely observed and protected from harming themselves or others.
If their confusion is extreme or reaching the point of delirium, the doctor may recommend admitting them to a hospital.
If confusion follows a head injury or trauma, it could be a possible concussion and you should call 911 or go to an emergency room right away. It’s especially important to call a doctor if you notice confusion alongside the following symptoms:
- rapid heart beat
- clammy skin
- irregular breathing
- weakness on one side of the body
- slurred speech
What are the underlying causes of confusion?
There are a number of factors that can cause confusion, from serious health problems to vitamin deficiencies. Alcohol intoxication is a common cause of confusion.
Other causes include:
A concussion is a brain injury that occurs as a result of head trauma. A concussion can change someone’s level of alertness as well as their judgment, coordination, and speech.
You might pass out if you have a concussion, but it’s also possible to have one and not know it. You may not start to feel confusion due to a concussion until a few days after the injury.
Your body loses fluids everyday through sweating, urination, and other bodily functions. If you don’t replace these fluids often enough, you could eventually become dehydrated.
This can affect the amount of electrolytes (minerals) your body contains, which can cause problems with your body’s ability to function.
Certain medications can cause confusion. Not taking medications as prescribed can also cause confusion, as can withdrawal from a medication that you recently stopped taking.
Confusion is the most common sign of medical complications related to cancer treatment. Chemotherapy, which uses chemicals to kill cancer cells, often affects healthy cells along with cancerous ones. Chemotherapy can cause damage to your nerves, which can affect your brain’s functions and cause confusion.
Opioid medications are another common cause of confusion due to medications, especially in older people. These are powerful drugs used to treat pain.
Other potential causes
Confusion can be caused by a number of different factors. Other potential causes include:
- low blood sugar
- not getting enough sleep
- lack of oxygen
- a rapid drop in body temperature
- depressionor other mood disorders
- illegal drug use
What can be done about confusion?
For short-term cases of mild confusion caused by nutritional imbalances, dehydration, or sleep deprivation, you might find relief in treatment at home.
If the cause of your confusion is low blood sugar, drinking a sweetened beverage or eating a small piece of candy may be all you need to relieve your symptoms. If your confusion is caused by dehydration, drinking water or electrolyte drinks can help relieve your symptoms.
However, confusion due to a head injury requires immediate medical attention. If your confusion is caused by a concussion, your doctor will decide when it’s best to release you from treatment.
They’ll give you advice on how to structure your lifestyle around treating your concussion, such as eating light foods and avoiding alcohol for some time. You may not need to stay in bed, but you should have someone check on you every few hours if you think you may fall asleep within the first 12 hours of having a concussion.
Outlook for confusion
Because there are many serious conditions that can cause confusion, medical attention is often required. Don’t hesitate to call a doctor if a loved one suddenly displays signs of confusion.
It can be frightening when someone experiences confusion. Until a doctor determines the cause of the confusion, the most important thing you can do is stay with the person and observe how they’re acting. Your description of their behavior will be an important tool in determining what’s causing their confusion so they can be treated.
Dizziness is the feeling of being lightheaded, woozy, or unbalanced. It affects the sensory organs, specifically the eyes and ears, so it can sometimes cause fainting. Dizziness isn’t a disease, but rather a symptom of various disorders.
Vertigo and disequilibrium may cause a feeling of dizziness, but those two terms describe different symptoms. Vertigo is characterized by a spinning sensation, like the room is moving.
It may also feel like motion sickness or as if you’re leaning to one side. Disequilibrium is a loss of balance or equilibrium. True dizziness is the feeling of lightheadedness or nearly fainting.
Dizziness is common and its underlying cause usually isn’t serious. Occasional dizziness is not something to worry about. However, you should call your doctor immediately if you’re experiencing repeated episodes of dizziness for no apparent reason or for a prolonged period.
Causes of dizziness
Common causes of dizziness include a migraine, medications, and alcohol. It can also be caused by a problem in the inner ear, where balance is regulated.
Dizziness is often a result of vertigo as well. The most common cause of vertigo and vertigo-related dizziness is benign positional vertigo (BPV). This causes short-term dizziness when someone changes positions quickly, such as sitting up in bed after lying down.
Dizziness and vertigo can also be triggered by Meniere’s disease. This causes fluid to build up in the ear with associated ear fullness, hearing loss, and tinnitus. Another possible cause for dizziness and vertigo is an acoustic neuroma. This is a noncancerous tumor that forms on the nerve that connects the inner ear to the brain.
Some other possible causes of dizziness include:
- sudden drop in blood pressure
- heart muscle disease
- decrease in blood volume
- anxiety disorders
- anemia(low iron)
- hypoglycemia(low blood sugar)
- ear infection
- heat stroke
- excessive exercise
- motion sickness
In rare cases, dizziness could be caused by multiple sclerosis, a stroke, a malignant tumor, or another brain disorder.
Symptoms of dizziness
People experiencing dizziness may feel various sensations, including:
- lightheadedness or feeling faint
- a false sense of spinning
- loss of balance
- feeling of floating or swimming
Sometimes, dizziness is accompanied by nausea, vomiting, or fainting. Seek emergency medical help if you have these symptoms for extended periods.
When to call a doctor about dizziness
You should call your doctor if you continue to have repeated bouts of dizziness. You should also notify your doctor immediately if you experience sudden dizziness along with:
- a head injury
- a headache
- a neck ache
- a high fever
- blurred vision
- hearing loss
- difficulty speaking
- numbness or tingling
- droopiness of the eye or mouth
- loss of consciousness
- chest pain
- ongoing vomiting
These symptoms could indicate a serious health problem, so it’s important to seek medical attention as soon as possible.
If you don’t already have a primary care doctor, the Healthline FindCare tool can help you find a physician in your area.
What to expect during your appointment
Your doctor can narrow down the cause of dizziness and any other symptoms by performing a physical examination. They’ll ask you questions about your dizziness, including:
- when it occurs
- in what situations
- the severity of symptoms
- other symptoms that occur with the dizziness
Your doctor may also check your eyes and ears, do a neurological physical exam, observe your posture, and perform tests to check balance. Depending on the suspected cause, an imaging test such as a CT scan or MRI might be recommended.
In some cases, no cause for dizziness is determined.
Treatments for dizziness
Treatment for dizziness focuses on the underlying cause. In most cases, home remedies and medical treatments can control the cause of dizziness. For example:
- Inner-ear issues may be managed withmedications and at-home exercises that can help control balance.
- BPV can be resolved with maneuvers that can help alleviate symptoms. Surgery is an option for patients whose BPV is not otherwise controlled.
- Meniere’s disease is treated with a healthful low-salt diet, occasional injections, or ear surgery.
- Migraines are treated withmedications and lifestyle changes, such as learning to identify and avoid migraine triggers.
- Medication and anxiety-reducing techniques can help with anxiety disorders.
- Drinking plenty of fluids can help when dizziness is caused by excessive exercise, heat, or dehydration.
What you can do about dizziness
Follow these tips if you have recurrent bouts of dizziness:
- Sit or lie down immediately when you feel dizzy and rest until the dizziness goes away. This can prevent the possibility of losing your balance, which may lead to falling and serious injury.
- Use acane or walker for stability, if necessary.
- Always use handrails when walking up or down the stairs.
- Do activities that improve balance, such asyoga and Tai Chi.
- Avoid moving or switching positions suddenly.
- Avoid driving a car or operating heavy machinery if you frequently experience dizziness without warning.
- Avoid caffeine, alcohol, and tobacco. Using these substances may trigger dizziness or make it worse.
- Drink at least eight glass of water a day, get seven hours or more of sleep, and avoid stressful situations.
- Eat a healthful diet that consists of vegetables, fruits, and lean proteins to help prevent dizziness.
- If you suspect your dizziness is being caused by a medication, talk to your doctor about lowering the dose or switching to another medication.
- Take an over-the-counter medication, such asmeclizine (Antivert) or an antihistamine, if you experience nausea along with dizziness. These medications may cause drowsiness, so don’t use them when you need to be active or productive.
- Rest in a cool place and drink water if your dizziness is being caused by overheating or dehydration.
Always talk to your doctor if you’re concerned about the frequency or severity of your dizziness.
People who are having problems with their senses, such as touch, vision, or smell, may also need to see a neurologist. Problems with senses are sometimes caused by nervous system disorders.
Neurologists also see patients with:
Seizures are changes in the brain’s electrical activity. These changes can cause dramatic, noticeable symptoms, or in other cases no symptoms at all.
The symptoms of a severe seizure include violent shaking and a loss of control. However, mild seizures can also be a sign of a significant medical problem, so recognizing them is important.
Because some seizures can lead to injury or be a sign of an underlying medical condition, it’s important to seek treatment if you experience them.
What are the types of seizures?
The International League Against Epilepsy (ILAE) introduced updated classifications
in 2017 that better describe the many different types of seizures. The two major types are now called focal onset seizures and generalized onset seizures.
Focal onset seizures
Focal onset seizures used to be referred to as partial onset seizures. They occur in one area of the brain.
If you know that you’re having a seizure, it’s called a focal aware seizure. If you’re unaware when the seizure occurs, it’s known as a focal impaired awareness seizure.
Generalized onset seizures
These seizures start in both sides of the brain simultaneously. Among the more common types of generalized onset seizures are tonic-clonic, absence, and atonic.
- Tonic-clonic:These are also known as grand mal seizures. “Tonic” refers to muscle stiffening. “Clonic” refers to the jerky arm and leg movements during the convulsions. You will likely lose consciousness during these seizures that can last for a few minutes.
- Absence:Also called petit-mal seizures, these last for only a few seconds. They can cause you to blink repeatedly or stare into space. Other people may mistakenly think you’re daydreaming.
- Atonic:During these seizures, also known as drop attacks, your muscles suddenly go limp. Your head may nod or your entire body could fall to the ground. Atonic seizures are brief, lasting about 15 seconds.
Unknown onset seizures
Sometimes no one sees the beginning of a seizure. For example, someone may wake up in the middle of the night and observe their partner having a seizure. These are called unknown onset seizures. They are unclassified because of insufficient information about how they started.
What are the symptoms of a seizure?
You can experience both focal and generalized seizures at the same time, or one can happen before the other. The symptoms can last anywhere from a few seconds to 15 minutes per episode.
Sometimes, symptoms occur before the seizure takes place. These can include:
- a sudden feeling of fear or anxiousness
- a feeling of being sick to your stomach
- a change in vision
- a jerky movement of the arms and legs that may cause you to drop things
- an out of body sensation
- a headache
Symptoms that indicate a seizure is in progress include:
- losing consciousness, followed by confusion
- having uncontrollable muscle spasms
- drooling or frothing at the mouth
- having a strange taste in your mouth
- clenching your teeth
- biting your tongue
- having sudden, rapid eye movements
- making unusual noises, such as grunting
- losing control of bladder or bowel function
- having sudden mood changes
What causes seizures?
Seizures can stem from a number of health conditions. Anything that affects the body also may disturb the brain and lead to a seizure. Some examples include:
- alcohol withdrawal
- a brain infection, such asmeningitis
- a brain injury during childbirth
- a brain defect present at birth
- drug abuse
- drug withdrawal
- an electrolyte imbalance
- electric shock
- extremely high blood pressure
- a fever
- head trauma
- kidney or liver failure
- low blood glucose levels
- abrain tumor
- vascular abnormality in the brain
Seizures can run in families. Tell your doctor if you or anyone in your family has a history of seizures. In some instances, especially with young children, the cause of the seizure may be unknown.
What are the effects of seizures?
If you don’t get treatment for seizures, their symptoms can become worse and progressively longer in duration. Extremely long seizures can lead to coma or death.
Seizures also can lead to injury, such as falls or trauma to the body. It’s important to wear a medical identification bracelet that tells emergency responders that you have epilepsy.
How are seizures diagnosed?
Doctors can have a difficult time diagnosing seizure types. Your doctor may recommend certain tests to diagnose a seizure accurately and to help ensure that the treatments they recommend will be effective.
Your doctor will consider your full medical history and the events leading up to the seizure. For example, conditions such as migraine headaches, sleep disorders, and extreme psychological stress can cause seizure-like symptoms.
Lab tests may help your doctor rule out other conditions that can cause seizure-like activity. The tests may include:
- blood testing to check for electrolyte imbalances
- aspinal tap to rule out infection
- a toxicology screening to test for drugs, poisons, or toxins
An electroencephalogram (EEG) can help your doctor diagnose a seizure. This test measures your brain waves. Viewing brain waves during a seizure can help your doctor diagnose the type of seizure.
How are seizures treated?
Treatments for seizures depend on the cause. By treating the cause of the seizures, you may be able to prevent future seizures from occurring. The treatment for seizures due to epilepsy include:
- surgeryto correct brain abnormalities
- nerve stimulation
- a special diet, known as aketogenic diet
With regular treatment, you can reduce or stop seizure symptoms.
How do you help someone who is having a seizure?
Clear the area around a person who’s having a seizure to prevent possible injury. If possible, place them on their side and provide cushioning for their head.
Stay with the person, and call 911 as soon as possible if any of these apply:
- The seizure lasts longer than three minutes.
- They don’t wake up after the seizure
- They experience repeat seizures.
- The seizure occurs in someone who is pregnant.
- The seizure occurs in someone who has never had a seizure.
It’s important to remain calm. While there’s no way to stop a seizure once it’s begun, you can provide help. Here’s what the American Academy of Neurology recommends:
- As soon as you start noticing the symptoms of a seizure, keep track of time. Most seizures last between one to two minutes. If the person has epilepsy and the seizure lasts longer than three minutes, call 911.
- If the person having the seizure is standing, you can prevent them from falling or injuring themselves by holding them in a hug or gently guiding them to the floor.
- Make sure they’re away from furniture or other objects that could fall on them or cause injury.
- If the person having the seizures is on the ground, try to position them on their side so that saliva or vomit leaks out of their mouth instead of down their windpipe.
- Don’t put anything into the person’s mouth.
- Don’t try to hold them down while they’re having a seizure.
After the seizure
Once a seizure is over, here’s what to do:
- Check the person for injuries.
- If you couldn’t turn the person onto their side during their seizure, do so when the seizure is over.
- Use your finger to clear their mouth of saliva or vomit if they’re having trouble breathing, and loosen any tight clothing around their neck and wrists.
- Stay with them until they’re fully awake and alert.
- Provide them with a safe, comfortable area to rest.
- Don’t offer them anything to eat or drink until they’re fully conscious and aware of their surroundings.
- Ask them where they are, who they are, and what day it is. It may take several minutes to become fully alert and be able to answer your questions.
Tips for living with epilepsy
It can be challenging to live with epilepsy. But if you have the right support, it’s possible to live a full and healthy life.
Educate friends and family
Teach your friends and family more about epilepsy and how to care for you while a seizure is occurring.
This includes taking steps to reduce the risk of injury like cushioning your head, loosening tight clothing, and turning you on your side if vomiting occurs.
Find ways to maintain your current lifestyle
Continue your usual activities if possible, and find ways to work around your epilepsy so you can maintain your lifestyle.
For instance, if you’re no longer allowed to drive because you have seizures, you may decide to move to an area that’s walkable or has good public transportation or use ride-share services so you can still get around.
- Find a good doctor who makes you feel comfortable.
- Try relaxation techniques such asyoga, meditation, tai chi, or deep breathing.
- Find an epilepsy support group. You can find a local one by looking online or asking your doctor for recommendations.
Tips for caring for someone who has epilepsy
If you live with someone with epilepsy, there are some things you can do to help that person:
- Learn about their condition.
- Make a list of their medications, doctors’ appointments, and other important medical information.
- Talk to the person about their condition and what role they would like you to play in helping.
If you need help, reach out to their doctor or an epilepsy support group. The Epilepsy Foundation is another helpful resource.
How can you prevent seizures?
In many instances, a seizure isn’t preventable. However, maintaining a healthy lifestyle can give you the best chance at reducing your risk. You can do the following:
- Getplenty of sleep.
- Eat ahealthy diet and stay well hydrated.
- Exercise regularly.
- Engage instress-reducing techniques.
- Avoid taking illegal drugs.
If you’re on medication for epilepsy or other medical conditions, take them as your doctor recommends.
A stroke occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues.
According to the Centers for Disease Control and Prevention (CDC), stroke is the fifth-leading
cause of death in the United States. Every year, more than 795,000
U.S. people have a stroke.
Without oxygen, brain cells and tissue become damaged and begin to die within minutes.
The loss of blood flow to the brain damages tissues within the brain. Symptoms of a stroke show up in the body parts controlled by the damaged areas of the brain.
The sooner a person having a stroke gets care, the better their outcome is likely to be. For this reason, it’s helpful to know the signs of a stroke so you can act quickly. Stroke symptoms can include:
- numbness or weakness in the arm, face, and leg, especially on one side of the body
- trouble speaking or understanding speech
- slurring speech
- vision problems, such as trouble seeing in one or both eyes with vision blackened or blurred, or double vision
- trouble walking
- loss of balance or coordination
- severe, sudden headache with an unknown cause
A stroke requires immediate medical attention. If you think you or someone else is having a stroke, have someone call 911 right away. Prompt treatment is key to preventing the following outcomes:
- brain damage
- long-term disability
It’s better to be safe than sorry when dealing with a stroke, so don’t be afraid to call 911 if you think you recognize the signs of a stroke. Act FAST and learn to recognize the signs of stroke.
Symptoms of a stroke in women
Stroke is the fourth leading cause of death in U.S. women. Women have a higher lifetime risk of having a stroke than men.
While some stroke signs are the same in women and men, some are more common in women.
Stroke signs that occur more often in women include:
- nausea or vomiting
- general weakness
- shortness of breath or trouble breathing
- fainting or losing consciousness
- confusion, disorientation, or lack of responsiveness
- sudden behavioral changes, especially increased agitation
Women are more likely than men to die from a stroke, so it’s important to be able to identify a stroke as soon as possible. Learn more about recognizing the signs of stroke in women.
Symptoms of a stroke in men
Stroke is the fifth leading cause of death in men. Men are more likely to have a stroke in their younger years than women, but they’re less likely to die from it, according to the national institutes health. .
Men and women can have some of the same signs and symptoms of stroke (see above). However, some stroke symptoms occur more often in men. These include:
- drooping on one side of the face or an uneven smile
- slurred speech, difficulty speaking, and trouble understanding other speech
- arm weakness or muscle weakness on one side of the body
While some symptoms may differ between men and women, it’s equally important for both to be able to spot a stroke early and get help.
Types of stroke
Strokes fall into three main categories: transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke. These categories are further broken down into other types of strokes, including:
- embolic stroke
- thrombotic stroke
- intracerebral stroke
- subarachnoid stroke
The type of stroke you have affects your treatment and recovery process.
During an ischemic stroke, the arteries supplying blood to the brain narrow or become blocked. These blockages are caused by blood clots or blood flow that’s severely reduced. They can also be caused by pieces of plaque due to atherosclerosis breaking off and blocking a blood vessel.
The two most common types of ischemic strokes are thrombotic and embolic. A thrombotic stroke happens when a blood clot forms in one of the arteries supplying blood to the brain. The clot passes through the bloodstream and becomes lodged, which blocks blood flow. An embolic stroke is when a blood clot or other debris forms in another part of the body and then travels to the brain.
According to the CDC, 87% of strokes are ischemic strokes. Find out why ischemic strokes occur.
An embolic stroke is one of two types of ischemic strokes. It occurs when a blood clot forms in another part of the body — often the heart or arteries in the upper chest and neck — and moves through the bloodstream to the brain. The clot gets stuck in the brain’s arteries, where it stops the flow of blood and causes a stroke.
An embolic stroke may be the result of a heart condition. Atrial fibrillation, a common type of irregular heartbeat, can cause blood clots to develop in the heart. These clots may dislodge and travel through the bloodstream and into the brain.
Transient ischemic attack (TIA)
A transient ischemic attack, often called a TIA or ministroke, occurs when blood flow to the brain is blocked temporarily. Symptoms, which are similar to those of a full stroke, are typically temporary and disappear after a few minutes or hours.
A TIA is usually caused by a blood clot. It serves as a warning of a future stroke, so don’t ignore a TIA. Seek the same treatment you would for a major stroke and call 911.
According to the CDC, more than one third of people who experience a TIA and don’t get treatment have a major stroke within a year. Up to 10-15 of people who experience a TIA have a major stroke within three months.
A hemorrhagic stroke happens when an artery in the brain breaks open or leaks blood. The blood from that artery creates excess pressure in the skull and swells the brain, damaging brain cells and tissues.
The two types of hemorrhagic strokes are intracerebral and subarachnoid. An intracerebral hemorrhagic stroke, the most common type of hemorrhagic stroke, happens when the tissues surrounding the brain fill with blood after an artery bursts. The subarachnoid hemorrhagic stroke is less common. It causes bleeding in the area between the brain and the tissues that cover it.
According to the American Heart Association, about 13 percent of strokes are hemorrhagic. Learn more about the causes of hemorrhagic stroke, as well as treatment and prevention.
What causes a stroke?
The cause of a stroke depends on the type of stroke. The three main types of stroke are transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke.
A TIA is caused by a temporary blockage in an artery that leads to the brain. The blockage, typically a blood clot, stops blood from flowing to certain parts of the brain. A TIA typically lasts for a few minutes up to a few hours, and then the blockage moves and blood flow is restored.
Like a TIA, an ischemic stroke is caused by a blockage in an artery that leads to the brain. This blockage may be a blood clot, or it may be caused by atherosclerosis. With this condition, plaque (a fatty substance) builds up on the walls of a blood vessel. A piece of the plaque can break off and lodge in an artery, blocking the flow of blood and causing an ischemic stroke.
A hemorrhagic stroke, on the other hand, is caused by a burst or leaking blood vessel. Blood seeps into or around the tissues of the brain, causing pressure and damaging brain cells.
There are two possible causes of a hemorrhagic stroke. An aneurysm (a weakened, bulging section of a blood vessel) can be caused by high blood pressure and can lead to a burst blood vessel. Less often, a condition called an arteriovenous malformation, which is an abnormal connection between your veins and arteries, can lead to bleeding in the brain. Keep reading about the causes of different types of strokes.
Risk factors for stroke
Certain risk factors make you more susceptible to stroke. According to the national heart, lung and blood institute, the more risk factors you have, the more likely you are to have a stroke. Risk factors for stroke include:
An unhealthy diet that increases your risk of stroke is one that’s high in:
- saturated fats
- trans fats
Inactivity, or lack of exercise, can also raise your risk for stroke.
Regular exercise has a number of health benefits. The CDC recommends that adults get at least 2.5 hour of aerobic exercise every week. This can mean simply a brisk walk a few times a week.
Your risk for stroke also increases if you drink too much alcohol. Alcohol consumption should be done in moderation. This means no more than one drink per day for women, and no more than two for men. More than that may raise blood pressure levels as well as triglyceride levels, which can cause atherosclerosis.
Using tobacco in any form also raises your risk for stroke, since it can damage your blood vessels and heart. This is further increased when smoking, because your blood pressure rises when you use nicotine.
There are certain personal risk factors for stroke that you can’t control. Stroke risk can be linked to your:
- Family history.Stroke risk is higher in some families because of genetic health issues, such as high blood pressure.
- According to the CDCTrusted Source
, while both women and men can have strokes, they’re more common in women than in men in all age groups.
- The older you are, the more likely you are to have a stroke.
- Race and ethnicity.Caucasians, Asian Americans, and Hispanics are less likely to have a stroke than African-Americans, Alaska Natives, and American Indians.
Certain medical conditions are linked to stroke risk. These include:
- a previous stroke or TIA
- high blood pressure
- high cholesterol
- heart disorders, such as coronary artery disease
- heart valve defects
- enlarged heart chambers and irregular heartbeats
- sickle cell disease
To find out about your specific risk factors for stroke, talk to your doctor.
Diagnosis of stroke
Your doctor will ask you or a family member about your symptoms and what you were doing when they arose. They’ll take your medical history to find out your stroke risk factors. They’ll also:
- ask what medications you take
- check your blood pressure
- listen to your heart
You’ll also have a physical exam, during which the doctor will evaluate you for:
- numbness in your arms, face, or legs
- signs of confusion
- vision issues
Your doctor will then do certain tests. A variety of tests are used to aid in diagnosis of a stroke. These tests can help doctors determine:
- if you had a stroke
- what may have caused it
- what part of the brain is impacted
- whether you have bleeding in the brain
These tests can also determine if your symptoms are being caused by something else.
Tests to diagnose strokes
You may go through various tests to further help your doctor determine if you’ve had a stroke, or to rule out another condition. These tests include:
Your doctor might draw blood for several blood tests. Blood tests can determine:
- your blood sugar levels
- if you have an infection
- your platelet levels
- how fast your blood clots
MRI and CT scan
The MRI will help see if any brain tissue or brain cells have been damaged. A CT scan will provide a detailed and clear picture of your brain that shows any bleeding or damage in the brain. It may also show other brain conditions that could be causing your symptoms.
Your doctor may order an electrocardiogram (EKG), too. This simple test records the electrical activity in the heart, measuring its rhythm and recording how fast it beats. It can determine if you have any heart conditions that may have led to stroke, such as a prior heart attack or atrial fibrillation.
Another test your doctor may order to determine if you’ve had a stroke is a cerebral angiogram. This offers a detailed look at the arteries in your neck and brain. The test can show blockages or clots that may have caused symptoms.
A carotid ultrasound, also called a carotid duplex scan, can show fatty deposits (plaque) in your carotid arteries, which supply the blood to your face, neck, and brain. It can also show whether your carotid arteries have been narrowed or blocked.
An echocardiogram can find sources of clots in your heart. These clots may have traveled to your brain and caused a stroke.
Proper medical evaluation and prompt treatment are vital to recovering from a stroke. According to the American Heart Association, “Time lost is brain lost.” Call 911 as soon as you realize you may be having a stroke, or if you suspect a loved one is having a stroke.
Treatment for stroke depends on the type of stroke:
Ischemic stroke and TIA
These stroke types are caused by a blood clot or other blockage in the brain. For that reason, they’re largely treated with similar techniques, which include:
Antiplatelet and anticoagulants
Thrombolytic drugs can break up blood clots in your brain’s arteries, which still stop the stroke and reduce damage to the brain.
One such drug, tissue plasminogen activator (tPA), or Alteplase IV r-tPA, is considered the gold standard in ischemic stroke treatment. It works by dissolving blood clots quickly, if delivered within the first 3 to 4.5 hours after symptoms of your stroke began. People who receive a tPA injection are more likely to recover from a stroke, and less likely to have any lasting disability as a result of the stroke.
During this procedure, the doctor inserts a catheter into a large blood vessel inside your head. They then use a device to pull the clot out of the vessel. This surgery is most successful if it’s performed 6 to 24 hours after the stroke begins.
If your doctor finds where artery walls have weakened, they may perform a procedure to inflate the narrowed artery and support the walls of the artery with a stent.
In the rare instances that other treatments don’t work, your doctor may perform surgery to remove a blood clot and plaques from your arteries. This may be done with a catheter, or if the clot is especially large, your doctor may open an artery to remove the blockage.
Strokes caused by bleeds or leaks in the brain require different treatment strategies. Treatments for hemorrhagic stroke include:
Unlike with an ischemic stroke, if you’re having a hemorrhagic stroke, the treatment goal is to make your blood clot. Therefore, you may be given medication to counteract any blood thinners you take.
You may also be prescribed drugs that can reduce blood pressure, lower the pressure in your brain, prevent seizures, and prevent blood vessel constriction.
During this procedure, your doctor guides a long tube to the area of hemorrhage or weakened blood vessel. They then install a coil-like device in the area where the artery wall is weak. This blocks blood flow to the area, reducing bleeding.
During imaging tests, your doctor may discover an aneurysm that hasn’t started bleeding yet or has stopped. To prevent additional bleeding, a surgeon may place a tiny clamp at the base of the aneurysm. This cuts off blood supply and prevents a possible broken blood vessel or new bleeding.
If your doctor sees that an aneurysm has burst, they may do surgery to clip the aneurysm and prevent additional bleeding. Likewise, a craniotomy may be needed to relieve the pressure on the brain after a large stroke.
In addition to emergency treatment, healthcare providers will advise you on ways to prevent future strokes.
Several medications are used to treat strokes. The type your doctor prescribes depends largely on the type of stroke you had. The goal of some medications is to prevent a second stroke, while others aim to prevent a stroke from happening in the first place.
The most common stroke medications include:
- Tissue plasminogen activator (tPA).This emergency medication can be provided during a stroke to break up a blood clot causing the stroke. It’s the only medication currently available that can do this, but it must be given within 3 to 4.5 hours after symptoms of a stroke begin. This drug is injected into a blood vessel so the medication can start to work as quickly as possible, which reduces the risk of complications from the stroke.
- These drugs reduce your blood’s ability to clot. The most common anticoagulant is warfarin (Jantoven, Coumadin). These drugs can also prevent existing blood clots from growing larger, which is why they may be prescribed to prevent a stroke, or after an ischemic stroke or TIA has occurred.
- Antiplatelet drugs.These medications prevent blood clots by making it more difficult for the blood’s platelets to stick together. The most common antiplatelet drugs include aspirin and clopidogrel (Plavix). They can be used to prevent ischemic strokes and are especially important in preventing secondary stroke. If you’ve never had a stroke before, you should only use aspirin as a preventive medication if you have a high risk of atherosclerotic cardiovascular disease (e.g., heart attack and stroke) and a low risk of bleeding.
- Statins, which help lower high blood cholesterol levels, are among the most commonly prescribedTrusted Source
medications in the United States. These drugs prevent the production of an enzyme that can turn cholesterol into plaque — the thick, sticky substance that can build up on the walls of arteries and cause strokes and heart attacks. Common statins include rosuvastatin (Crestor), simvastatin (Zocor), and atorvastatin (Lipitor).
- Blood pressure drugs.High blood pressure can cause pieces of plaque buildup in your arteries to break off. These pieces can block arteries, causing a stroke. As a result, controlling high blood pressure can help prevent a stroke.
Your doctor may prescribe one or more of these drugs to treat or prevent a stroke, depending on factors such as your health history and your risks. There are numerous medications used to treat and prevent strokes, check out the full list here.
Recovering from a stroke
Stroke is a leading cause of long-term disability in the United States. However, the National Stroke Association reports that 10 percent of stroke survivors make an almost-complete recovery, while another 25 percent recover with only minor impairments.
It’s important that recovery and rehabilitation from a stroke start as soon as possible. In fact, stroke recovery should begin in the hospital. There, a care team can stabilize your condition, assess the effects of the stroke, identify underlying factors, and begin therapy to help you regain some of your affected skills.
Stroke recovery focuses on four main areas:
A stroke can cause speech and language impairment. A speech and language therapist will work with you to relearn how to speak. Or, if you find verbal communication difficult after a stroke, they’ll help you find new ways of communication.
After a stroke, many survivors have changes to their thinking and reasoning skills. This can cause behavioral and mood changes. An occupational therapist can help you work to regain your former patterns of thinking and behavior and to control your emotional responses.
Relearning sensory skills
If the part of your brain that relays sensory signals is affected during the stroke, you may find that your senses are “dulled” or no longer working. That may mean that you don’t feel things well, such as temperature, pressure, or pain. A therapist can help you learn to adjust to this lack of sensation.
Muscle tone and strength may be weakened by a stroke, and you may find you’re unable to move your body as well as you could before. A physical therapist will work with you to regain your strength and balance, and find ways to adjust to any limitations.
Rehabilitation may take place in a rehabilitation clinic, a skilled nursing home, or your own home. Here’s what you can expect during an effective stroke recovery process.
How to prevent a stroke
You can take steps to help prevent stroke by living a healthy lifestyle. This includes the following measures:
- Quit smoking.If you smoke, quitting now will lower your risk for stroke.
- Consume alcohol in moderation.If you drink excessively, try to reduce your intake. Alcohol consumption can raise your blood pressure.
- Keep weight down.Keep your weight at a healthy level. Being obese or overweight increases your stroke risk. To help manage your weight:
- Eat a diet that’s full of fruits and vegetables.
- Eat foods low in cholesterol, trans fats, and saturated fats.
- Stay physically active. This will help you maintain a healthy weight and help reduce your blood pressure and cholesterol levels.
- Get checkups.Stay on top of your health. This means getting regular checkups and staying in communication with your doctor. Be sure to take the following steps to manage your health:
- Get your cholesterol and blood pressure checked.
- Talk to your doctor about modifying your lifestyle.
- Discuss your medication options with your doctor.
- Address any heart problems you may have.
- If you have diabetes, take steps to manage it.
Taking all these measures will help put you in better shape to prevent stroke. Read more about how you can prevent strokes.
If you suspect you’re experiencing symptoms of a stroke, it’s vital that you seek emergency medical treatment. Clot-busting medication can only be provided in the first hours after the signs of a stroke begin, and early treatment is one of the most effective ways to reduce your risk for long-term complications and disability.
Prevention is possible, whether you’re preventing a first stroke or trying to prevent a second. Medications can help reduce the risk of blood clots, which lead to strokes. Work with your doctor to find a prevention strategy that works for you, including medical intervention and lifestyle changes
Multiple sclerosis (MS) is a chronic illness involving your central nervous system (CNS). The immune system attacks myelin, which is the protective layer around nerve fibers.
This causes inflammation and scar tissue, or lesions. This can make it hard for your brain to send signals to the rest of your body.
What are the symptoms of MS?
People with MS experience a wide range of symptoms. Due to the nature of the disease, symptoms can vary widely from person to person.
They can also change in severity from year to year, month to month, and even day to day.
Around 80 percent of people with MS report having fatigue. Fatigue that occurs with MS can become debilitating, affecting your ability to work and perform everyday tasks.
Difficulty walking can occur with MS for a number of reasons:
- numbness in your legs or feet
- difficulty balancing
- muscle weakness
- muscle spasticity
- difficulty with vision
Difficulty walking can also lead to injuries due to falling.
Other fairly common symptoms of MS include:
- acute or chronic pain
- cognitive issues involving concentration, memory, and word-finding difficulty
The condition can also lead to speech disorders.
How is MS diagnosed?
Your doctor will need to perform a neurological exam, request a clinical history, and order a series of other tests to determine if you have MS.
Diagnostic testing may include the following:
- Magnetic resonance imaging (MRI) scan.Using a contrast dye with the MRI allows your doctor to detect active and inactive lesions throughout your brain and spinal cord.
- Optical coherence tomography (OCT).OCT is a test that takes a picture of the nerve layers in the back of your eye and can assess thinning of the optic nerve.
- Spinal tap (lumbar puncture).Your doctor may order a spinal tap to find abnormalities in your spinal fluid. This test can help rule out infectious diseases and can also be used to look for oligoclonal bands (OCBs), which can be used to make an early diagnosis of MS.
- Blood tests.Doctors order blood tests to help eliminate other conditions with similar symptoms.
- Visual evoked potentials (VEP) test.This test requires the stimulation of nerve pathways to analyze electrical activity in your brain. In the past, brain stem auditory and sensory-evoked potential tests were also used to diagnose MS.
An MS diagnosis requires evidence of demyelination occurring at different times in more than one area of your brain, spinal cord, or optic nerves.
Lyme disease vs. multiple sclerosis
Sometimes conditions can have similar symptoms. If you feel tired, dizzy, or have numbness or tingling in your arms or legs, you may have multiple sclerosis (MS) or Lyme disease.
While both conditions may present themselves similarly in terms of symptoms, they’re very different in nature. If you suspect you have either, it’s best to contact your doctor for testing and diagnosis.
Lupus is an autoimmune disease, which means the immune system reacts against healthy antigens. These are proteins that trigger the body’s immune response.
It’s as if the immune system can’t tell the difference between antigens that are supposed to be in your body and infections or other foreign “invaders” that the immune system is supposed to attack.
With lupus, your immune system attacks various parts of the body, such as:
- internal organs
MS and lupus have some distinct symptoms. People with MS may experience:
- difficulty walking
- vision loss
- slurred speech
Lupus, on the other hand, often causes skin rashes and fever.
MS and lupus do have several things in common, however. The arthritis that accompanies lupus can often be mistaken for joint and muscle stiffness and pain caused by MS. The two diseases can also leave you feeling very tired.
MS and lupus are also alike in that symptoms can come and go. People with lupus may refer to having a “flare,” which means the symptoms are prominent. These symptoms can include:
- joint pain
- weight loss
- muscle aches
Sometimes the symptoms are like those you’ve had in the past, while other flares can bring on new symptoms.
Many people with MS also have “relapsing-remitting” symptoms. This means that signs of the disease can develop over a period of weeks and then gradually disappear. The remission period can last a couple of months or a couple of years.
However, as the disease progresses, many symptoms tend to get worse without going into remission. The most obvious signs of worsening MS are walking problems.
Can you have both?
Doctors usually determine that you have MS by eliminating other conditions, such as lupus. Both MS and lupus can be difficult to diagnose. It’s also possible to have overlapping diseases like lupus and another autoimmune disease, such as rheumatoid arthritis.
These diseases also tend to “cluster” in families meaning that you may have one autoimmune disease while a sibling or parent has a different type.
While it’s unlikely to have both MS and lupus, it’s common for someone with MS to be incorrectly diagnosed with lupus because these diseases share common symptoms.
Aside from lupus, MS actually has several other “mimic” conditions, including Lyme disease. Part of the confusion is that there is no single diagnostic test for MS.
Sjögren’s syndrome is an autoimmune disorder that primarily affects salivary and lacrimal glands. These glands help the body create moisture in the eyes and mouth, in the form of saliva and tears.
In a person with Sjögren’s syndrome, the body fails to produce enough moisture.
This is a chronic, systemic disorder that affects 1 to 4 million people in the United States, according to the National Institute of Neurological Disorders and Stroke.
The condition is typically diagnosed as either primary or secondary. In primary Sjögren’s syndrome, there’s no other autoimmune disease present. Secondary Sjögren’s syndrome is diagnosed when an individual has another autoimmune disease.
Primary Sjögren’s syndrome tends to be more aggressive and can cause more dryness than the secondary type.
What are the symptoms of Sjögren’s syndrome?
Dry mouth is a common symptom, which can increase your risk of cavities. It can also make it more difficult to speak or swallow. Chewing gum or sucking on candies may help with this symptom.
Dryness of the eyes often occurs, too. This may feel like a burning sensation or like something is in your eye.
Sjögren’s syndrome can affect the whole body. Some individuals have vaginal dryness, dry skin, fatigue, rashes, or joint pain. Sjögren’s syndrome can cause inflammation of organs like the kidneys or lungs.
If you have constant inflammation, your doctor might prescribe medications to help prevent organ damage. These medications are called disease-modifying antirheumatic drugs. They help tamp down the immune system even more than immune-suppressing drugs.
What are the early signs of MS?
MS can develop all at once, or the symptoms can be so mild that you easily dismiss them. Three of the most common early symptoms of MS are:
- Numbness and tingling that affects the arms, legs, or one side of your face.These sensations are similar to the pins-and-needles feeling you get when your foot falls asleep. However, they occur for no apparent reason.
- Uneven balance and weak legs.You may find yourself tripping easily while walking or doing some other type of physical activity.
- Double vision, blurry vision in one eye, or partial vision loss.These can be an early indicator of MS. You may also have some eye pain.
It isn’t uncommon for these early symptoms to go away only to return later. You may go weeks, months, or even years between flare-ups.
These symptoms can have many different causes. Even if you have these symptoms, it doesn’t necessarily mean that you have MS.
RRMS is more common in women, whereas PPMS is equally common in women and men. Most experts believe that MS in men tends to be more aggressive and recovery from relapses is often incomplete.
What causes MS?
If you have MS, the protective layer of myelin around your nerve fibers becomes damaged.
It’s thought that the damage is the result of an immune system attack. Researchers think there could be an environmental trigger, such as a virus or toxin, that sets off the immune system attack.
As your immune system attacks myelin, it causes inflammation. This leads to scar tissue, or lesions. The inflammation and scar tissue disrupt signals between your brain and other parts of your body.
MS isn’t hereditary, but having a parent or sibling with MS raises your risk slightly. Scientists have identified some genes that seem to increase susceptibility to developing MS.
What are the types of MS?
Types of MS include:
Clinically isolated syndrome (CIS)
Although this episode is characteristic of MS, it’s not enough to prompt a diagnosis.
If there are more than one lesion or positive oligoclonal bands (OCB) in your spinal fluid at the time of a spinal tap, you’re more likely to receive a diagnosis of relapsing-remitting MS (RRMS).
If these lesions aren’t present, or your spinal fluid doesn’t show OCBs, you’re less likely to receive an MS diagnosis.
Relapsing-remitting MS (RRMS)
Relapsing-remitting MS (RRMS) involves clear relapses of disease activity followed by remissions. During remission periods, symptoms are mild or absent, and there’s no disease progression.
RRMS is the most common form of MS at onset and accounts for about 85 percent of all cases.
Primary progressive MS (PPMS)
If you have primary progressive MS (PPMS), neurological function becomes progressively worse from the onset of your symptoms.
However, short periods of stability can occur. The terms “active” and “not active” are used to describe disease activity with new or enhancing brain lesions.
Secondary progressive MS (SPMS)
Secondary progressive MS (SPMS) occurs when RRMS transitions into the progressive form. You may still have noticeable relapses in addition to disability or gradual worsening of function.
The bottom line
Your MS may change and evolve, for example, going from RRMS to SPMS.
You can only have one type of MS at a time, but knowing when you transition to a progressive form of MS may be difficult to pinpoint.
What is the life expectancy for people with MS?
Life expectancy for people with MS is about 7.5 years shorter than expected. The good news is, life expectancy in those with MS is increasing.
It’s almost impossible to predict how MS will progress in any one person.
About 10 to 15 percent of people with MS have only rare attacks and minimal disability 10 years after diagnosis. It’s generally presumed they’re not on treatment or injectables. This is sometimes called benign MS.
With the development of disease-modifying therapies (DMTs), studies show promising results that the progression of the disease can be slowed.
Progressive MS generally advances faster than RRMS. People with RRMS can be in remission for many years. A lack of disability after 5 years is usually a good indicator for the future.
Age and sex
The disease tends to be more severe and debilitating in men and older adults. The same prognosis is also seen in African Americans and those who have a high relapse rate.
The bottom line
Your quality of life with MS will depend on your symptoms and how well you respond to treatment. This rarely fatal, but unpredictable, disease can change course without warning.
Most people with MS don’t become severely disabled and continue to lead full lives.
How is MS treated?
No cure is currently available for MS, but multiple treatment options exist.
Disease-modifying therapies (DMTs)
Disease-modifying therapies (DMTs) are designed to slow disease progression and lower your relapse rate.
Self-injectable disease-modifying medications for RRMS include glatiramer acetate (Copaxone) and beta interferons, such as:
Oral medications for RRMS include:
- dimethyl fumarate (Tecfidera)
- fingolimod (Gilenya)
- teriflunomide (Aubagio)
- cladribine (Mavenclad)
- diroximel fumarate (Vumerity)
- siponimod (Mayzent)
Intravenous infusion treatments for RRMS include:
- alemtuzumab (Lemtrada)
- natalizumab (Tysabri)
- mitoxantrone (Novantrone)
- Ocrelizumab (Ocrevus)
In 2017, the Food and Drug Administration (FDA) approved the first DMT for people with PPMS. This infusion drug is called ocrelizumab (Ocrevus), and it can also be used to treat RRMS.
Another drug, ozanimod (Zeposia), has recently been approved for treating CIS, RRMS, and SPMS, but it isn’t yet marketed due to the COVID-19 pandemic.
Not all MS drugs will be available or appropriate for every person. Talk to your doctor about which drugs are most appropriate for you and the risks and benefits of each one.
Other treatments may also ease your symptoms and improve your quality of life.
Because MS is different for everyone, treatment depends on your specific symptoms. For most, a flexible approach is necessary.
What’s it like to live with MS?
Most people with MS find ways to manage their symptoms and function well.
Having MS means you’ll need to see a doctor experienced in treating MS.
If you take one of the DMTs, you’ll need to adhere to the recommended schedule. Your doctor may prescribe other medications to treat specific symptoms.
Diet and exercise
Regular exercise is important for physical and mental health, even if you have disabilities.
Your diet should mainly consist of:
- a variety offruits and vegetables
- lean sources ofprotein, such as fish and skinless poultry
- whole grainsand other sources of fiber
- low-fat dairy products
- adequate amounts ofwater and other fluids
The better your diet, the better your overall health. You’ll not only feel better in the short term, but you’ll also be laying the foundation for a healthier future.
You should limit or avoid:
- saturated fat
- trans fat
- red meats
- foods and beverages high in sugar
- foods high in sodium
- highly processed foods
If you have other medical conditions, ask your doctor if you should follow a special diet or take any dietary supplements.
Read food labels. Foods that are high in calories but low in nutrients won’t help you feel better or maintain a healthy weight.
Other complementary therapies
Studies regarding the effectiveness of complementary therapies are scarce, but that doesn’t mean they can’t help in some way.
The following therapies may help you feel less stressed and more relaxed:
What are the statistics on MS?
According to the National Multiple Sclerosis Society, there hasn’t been a scientifically sound national study on the prevalence of MS in the United States since 1975.
In a 2017 study, however, the Society estimated that around 1 million Americans have MS.
Other things you should know:
- MS isthe most widespreadTrusted Source
neurological condition disabling young adults worldwide.
- Most people diagnosed with RRMS arebetween ages 20 and 50 at the time of their diagnosis.
- Overall, MS is more common inwomen than men. According to the National Multiple Sclerosis Society, RRMS is two to three times more common in women than men. PPMS rates in women and men are roughly equal.
- Rates of MS tend to be lower in places that are closer to the equator. This may have to do withsunlight and vitamin D People who relocate to a new location before age 15 generally acquire the risk factors associated with the new location.
- Data from 1999 to 2008 showed that direct and indirect costs of MS were between$8,528 and $54,244 per year. Current DMTs for RRMS can cost up to $60,000 a year. Ocrelizumab (Ocrevus) costs $65,000 a year.
Canadians have the highest rate of MS in the world.
What are the complications of MS?
The lesions MS causes can appear anywhere in your CNS and affect any part of your body.
As you age, some disabilities MS causes may become more pronounced.
One of the most common symptoms of MS is fatigue, but it’s not uncommon for people with MS to also have:
- some degree of cognitive impairment
The bottom line
Mobility issues can lead to a lack of physical activity, which can cause other health problems. Fatigue and mobility issues may also have an effect on sexual function.
- neuromuscular disorders, such asmyasthenia gravis
Myasthenia gravis (MG) is a neuromuscular disorder that causes weakness in the skeletal muscles, which are the muscles your body uses for movement. It occurs when communication between nerve cells and muscles becomes impaired. This impairment prevents crucial muscle contractions from occurring, resulting in muscle weakness.
According to the Myasthenia Gravis Foundation of America, MG is the most common primary disorder of neuromuscular transmission. It’s a relatively rare condition that affects between 14 and 20 out of every 100,000 people in the United States.
What are the symptoms of myasthenia gravis?
The main symptom of MG is weakness in the voluntary skeletal muscles, which are muscles under your control. The failure of muscles to contract normally occurs because they can’t respond to nerve impulses. Without proper transmission of the impulse, the communication between nerve and muscle is blocked and weakness results.
Weakness associated with MG typically gets worse with more activity and improves with rest. Symptoms of MG can include:
- trouble talking
- problems walking up stairs or lifting objects
- facial paralysis
- difficulty breathingdue to muscle weakness
- difficulty swallowing or chewing
- hoarse voice
- drooping of eyelids
- double vision
Not everyone will have every symptom, and the degree of muscle weakness can change from day to day. The severity of the symptoms typically increases over time if left untreated.
What causes myasthenia gravis?
MG is a neuromuscular disorder that’s usually caused by an autoimmune problem. Autoimmune disorders occur when your immune system mistakenly attacks healthy tissue. In this condition, antibodies, which are proteins that normally attack foreign, harmful substances in the body, attack the neuromuscular junction. Damage to the neuromuscular membrane reduces the effect of the neurotransmitter substance acetylcholine, which is a crucial substance for communication between nerve cells and muscles. This results in muscle weakness.
The exact cause of this autoimmune reaction is unclear to scientists. According to the Muscular Dystrophy Association, one theory is that certain viral or bacterial proteins may prompt the body to attack acetylcholine.
According to the National Institutes of Health, MG typically occurs in people over the age of 40. Women are more likely to be diagnosed as younger adults, whereas men are more likely to be diagnosed at 60 or older.
How is myasthenia gravis diagnosed?
Your doctor will perform a complete physical exam, as well as take a detailed history of your symptoms. They’ll also do a neurological exam. This may consist of:
- checking your reflexes
- looking for muscle weakness
- checking for muscle tone
- making certain your eyes move properly
- testing sensation in different areas of your body
- testing motor functions, like touching your finger to your nose
Other tests that can help your doctor diagnose the condition include:
- repetitive nerve stimulation test
- blood testing for antibodies associated with MG
- edrophonium (Tensilon) test: a drug called Tensilon (or a placebo) is administered intravenously, and you’re asked to perform muscle movements under doctor observation
- imaging of the chest usingCT scans or MRI to rule out a tumor
Treatment options for myasthenia gravis
There is no cure for MG. The goal of treatment is to manage symptoms and control the activity of your immune system.
Corticosteroids and immunosuppressants can be used to suppress the immune system. These medications help minimize the abnormal immune response that occurs in MG.
Additionally, cholinesterase inhibitors, such as pyridostigmine (Mestinon), can be used to increase communication between nerves and muscles.
Thymus gland removal
Removal of the thymus gland, which is part of the immune system, may be appropriate for many patients with MG. Once the thymus is removed, patients typically show less muscle weakness.
According to the Myasthenia Gravis Foundation of America, between 10 and 15 percent of people with MG will have a tumor in their thymus. Tumors, even those that are benign, are always removed because they may become cancerous.
Plasmapheresis is also known as a plasma exchange. This process removes harmful antibodies from the blood, which may result in an improvement in muscle strength.
Plasmapheresis is a short-term treatment. The body continues to produce the harmful antibodies and weakness may recur. Plasma exchange is helpful before surgery or during times of extreme MG weakness.
Intravenous immune globulin
Intravenous immune globulin (IVIG) is blood product that comes from donors. It’s used to treat autoimmune MG. Although it’s not entirely known how IVIG works, it affects the creation and function of antibodies.
There are some things you can do at home to help alleviate symptoms of MG:
- Get plenty of rest to help minimize muscle weakness.
- If you’re bothered bydouble vision, talk to your doctor about whether you should wear an eye patch.
- Avoid stress and heat exposure, as both can worsen symptoms.
These treatments cannot cure MG. However, you’ll typically see improvements in your symptoms. Some individuals may go into remission, during which treatment is not necessary.
Tell your doctor about any medications or supplements you take. Some drugs can make MG symptoms worse. Before taking any new medication, check with your doctor to ensure it’s safe.
Complications of myasthenia gravis
One of the most dangerous potential complications of MG is myasthenic crisis. This consists of life-threatening muscle weakness that can include breathing problems. Talk with your doctor about your risks. If you start to have trouble breathing or swallowing, call 911 or go to your local emergency room immediately.
The long-term outlook for MG depends on a lot of factors. Some people will only have mild symptoms. Others may eventually become confined to a wheelchair. Talk to your doctor about what you can do to minimize the severity of your MG. Early and proper treatment can limit disease progression in many people.
Encephalitis is an inflammation of the brain tissue. The most common cause is viral infections. In rare cases it can be caused by bacteria or even fungi.
There are two main types of encephalitis: primary and secondary. Primary encephalitis occurs when a virus directly infects the brain and spinal cord. Secondary encephalitis occurs when an infection starts elsewhere in the body and then travels to your brain.
Encephalitis is a rare yet serious disease that can be life-threatening. You should call your doctor immediately if you have symptoms of encephalitis.
What are the symptoms of encephalitis?
The symptoms of encephalitis can range from mild to severe.
Mild symptoms include:
Severe symptoms include:
- fever of 103°F (39.4°C) or higher
- slower movements
- sensitivity to light
Infants and young children show different symptoms. Call a doctor immediately if your child is experiencing any of the following:
- bulging fontanel(soft spot in the scalp)
- constant crying
- body stiffness
- poor appetite
What causes encephalitis?
Many different viruses can cause encephalitis. It’s helpful to categorize the potential causes into three groups: common viruses, childhood viruses, and arboviruses.
The most common virus that causes encephalitis in developed countries is herpes simplex. The herpes virus typically travels through a nerve to the skin, where it causes a cold sore. In rare cases, however, the virus travels to the brain.
This form of encephalitis usually affects the temporal lobe, the part of the brain that controls memory and speech. It can also affect the frontal lobe, the part that controls emotions and behavior. Encephalitis caused by herpes is dangerous and can lead to severe brain damage and death.
Other common viruses that can cause encephalitis include:
Vaccines can prevent the childhood viruses that used to cause encephalitis. Therefore, these types of encephalitis are rare today. Some childhood viruses that can cause encephalitis include:
Arboviruses are viruses carried by insects. The type of arbovirus that’s transmitted depends on the insect. Below are different types of arboviruses:
- California encephalitis(also called La Crosse encephalitis) is transmitted through mosquito bites and mainly affects children. It causes few to no symptoms.
- Louis encephalitisoccurs in the rural Midwest and southern states. It’s generally a mild virus and causes few symptoms.
- West Nile virusis most often found in Africa and the Middle East. However, it can occur in the United States. It’s usually relatively mild, causing flu-like symptoms. However, it can be fatal among older adults and people with weak immune systems.
- Colorado encephalitis(also called Colorado tick fever) is transmitted by the female wood tick. It’s typically a mild disease, and most people will recover quickly.
- Eastern equine encephalitisis spread by mosquitoes. It affects both humans and horses. Although rare, it has a 33 percent mortality rateTrusted Source
- Kyasanur forest diseaseis transmitted through tick bites. People can also get it by drinking raw milk from goats, sheep, or cows. Hunters, campers, and farmers are most at risk for getting this disease.
What are the risk factors for encephalitis?
The groups most at risk of encephalitis are:
- older adults
- children under the age of 1
- people with weak immune systems
You may also have a higher risk of getting encephalitis if you live in an area where mosquitos or ticks are common. Mosquitos and ticks can carry viruses that cause encephalitis. You’re more likely to get encephalitis in the summer or fall when these insects are most active.
Although the MMR (measles, mumps, rubella) vaccine has a long history of being safe and effective, in rare cases it has caused encephalitis. Approximately 1 in 3 million children who receive the vaccine develop encephalitis. However, the statistics are much more striking for children who don’t receive the vaccine. Rates of encephalitis in the days before routine vaccination reached as high as 1 in 1,000. In other words, encephalitis was roughly 3,000 times more common before vaccination was available.
How is encephalitis diagnosed?
Your doctor will first ask you about your symptoms. They may perform the following tests if encephalitis is suspected.
Spinal tap or lumbar puncture
In this procedure, your doctor will insert a needle into your lower back to collect a sample of spinal fluid. They will test the sample for signs of infection.
Brain imaging with CT scan or MRI
CT scans and MRI detect changes in brain structure. They can rule out other possible explanations for symptoms, such as a tumor or stroke. Certain viruses have a tendency to affect certain areas of the brain. Seeing what parts of your brain are affected can help determine what type of virus you have.
An EEG uses electrodes (small metal discs with wires) attached to the scalp to record brain activity. An EEG does not detect the virus that causes encephalitis, but certain patterns on the EEG may alert your neurologist to an infectious source of your symptoms. Encephalitis can lead to seizures and coma in later stages. That’s why the EEG is important in determining the areas of the brain that are affected and the types of brain waves that occur in each area.
A blood test can reveal signs of a viral infection. Blood tests are rarely performed alone. They usually help diagnose encephalitis along with other tests.
In a brain biopsy, your doctor will remove small samples of brain tissue to test for infection. This procedure is rarely performed because there’s a high risk of complications. It’s usually only done if doctors can’t determine the cause the brain swelling or if treatment isn’t working.
How is encephalitis treated?
Anti-viral medications can help treat herpes encephalitis. However, they aren’t effective in treating other forms of encephalitis. Instead, treatment often focuses on relieving symptoms. These treatments may include:
- pain killers
- corticosteroids (to reduce brain inflammation)
- mechanical ventilation (to help with breathing)
- lukewarm sponge baths
- anticonvulsants (to prevent or stop seizures)
- sedatives (for restlessness, aggressiveness, and irritability)
- fluids (sometimes through an IV)
You may need to be hospitalized during treatment, especially with brain swelling and seizures.
What are the complications associated with encephalitis?
Most people who are diagnosed with severe encephalitis will experience complications. Complications resulting from encephalitis can include:
- loss of memory
- behavioral/personality changes
- physical weakness
- intellectual disability
- lack of muscle coordination
- vision problems
- hearing problems
- speaking issues
- difficulty breathing
Complications are more likely to develop in certain groups, such as:
- older adults
- people who have had coma-like symptoms
- people who didn’t get treatment right away
What is the long-term outlook for someone with encephalitis?
Your outlook will depend on the severity of the inflammation. In mild cases of encephalitis, the inflammation will likely resolve in a few days. For people who have severe cases it may require weeks or months for them to get better. It can sometimes cause permanent brain damage or even death.
People with encephalitis may also experience:
- loss of brain function
- problems with speech, behavior, memory, and balance
Depending on the type and severity of encephalitis, it may be necessary to receive additional therapy, including:
- physical therapy: to improve strength, coordination, balance, and flexibility
- occupational therapy: to help redevelop everyday skills
- speech therapy: to help relearn muscle control needed for talking
- psychotherapy: to help with coping strategies, mood disorders, or personality changes
Can encephalitis be prevented?
Encephalitis isn’t always preventable, but you can lower your risk by getting vaccinated for viruses that can cause encephalitis. Also make sure your children receive vaccinations for these viruses. In areas where mosquitos and ticks are common, use repellant, and wear long sleeves and pants. If you’re traveling to an area that’s known for viruses that cause encephalitis.
What is meningitis?
The most common causes of meningitis are viral and bacterial infections. Other causes may include:
What are the symptoms of meningitis?
The symptoms of viral and bacterial meningitis can be similar in the beginning. However, bacterial meningitis symptoms are usually more severe. The symptoms also vary depending on your age.
Viral meningitis symptoms
Viral meningitis in infants may cause:
- decreased appetite
In adults, viral meningitis may cause:
- stiff neck
- sensitivity to bright light
- nauseaand vomiting
- decreased appetite
Bacterial meningitis symptoms
Bacterial meningitis symptoms develop suddenly. They may include:
- altered mental status
- sensitivity to light
- stiff neck
- purple areas of skin that resemble bruises
Seek immediate medical attention if you experience these symptoms. Bacterial and viral meningitis can be deadly. There’s no way to know if you have bacterial or viral meningitis just by judging how you feel. Your doctor will need to perform tests to determine which type you have.
Fungal meningitis symptoms
Symptoms of fungal meningitis resemble the other types of this infection. These may include:
- sensitivity to light
- confusion or disorientation
Each type of meningitis has some distinguishing symptoms. Learn more about these so you can understand the differences between each type of meningitis.
One of the late signs that one bacterial cause of meningitis, Neisseria meningitidis, are in your bloodstream is a faint rash on your skin. The bacteria from a meningococcal meningitis infection reproduce in your blood and target cells around capillaries . Damage to these cells leads to capillary damage and mild blood leaks. This shows up as a faint pink, red, or purple rash. The spots may resemble tiny pinpricks and are easily mistaken as a bruise.
As the infection worsens and spreads, the rash will become more obvious. The spots will grow darker and larger.
People with dark skin may have a hard time seeing meningitis rash. Lighter areas of skin, such as the palms of hands and the inside of the mouth may show signs of a rash more easily.
Not every rash looks the same. See photos of meningitis rashes to understand how this symptom might occur.
Types of meningitis
Viral and bacterial infections are the most common causes of meningitis. There are several other forms of meningitis. Examples include cryptococcal, which is caused by a fungal infection, and carcinomatous, which is cancer-related. These types are less common.
- coxsackievirus A
- coxsackievirus B
Viruses in the Enterovirus category cause about 10 to 15 million infections per year, but only a small percentage of people who get infected will develop meningitis.
Other viruses can cause meningitis. These include:
- West Nile virus
- herpes viruses
- Coltivirus, which causesColorado tick fever
Viral meningitis typically goes away without treatment. However, some causes do need to be treated.
Bacterial meningitis is contagious and caused by infection from certain bacteria. It’s fatal if left untreated. Between 5 to 40% of children and 20 to 50% of adults with this condition die. This is true even with proper treatment.
The most common types of bacteria that cause bacterial meningitis are:
- Streptococcus pneumoniae, which is typically found in the respiratory tract, sinuses, and nasal cavity and can cause what’s called “pneumococcal meningitis”
- Neisseria meningitidis, which is spread through saliva and other respiratory fluids and causes what’s called “meningococcal meningitis”
- Haemophilus influenza, which can cause not only meningitis but infection of the blood, inflammation of the windpipe,cellulitis, and infectious arthritis
- Listeria monocytogenes, which are foodborne bacteria
- Staphylococcus aureus, which is typically found on the skin and in the respiratory tract, and causes “staphylococcal meningitis”
Fungal meningitis is a rare type of meningitis. It’s caused by a fungus that infects your body and then spreads from your bloodstream to your brain or spinal cord.
People with a weakened immune system are more likely to develop fungal meningitis. This includes people with cancer or HIV.
The most common funguses related to fungal meningitis include:
- Cryptococcus, which is inhaled from dirt or soil that is contaminated with bird droppings
- Blastomyces, another type of fungus found in soil, particularly in the Midwestern United States
- Histoplasma, which is found in environments that are heavily contaminated with bat and bird droppings, especially in the Midwestern States near the Ohio and Mississippi Rivers
- Coccidioides, which is found in soil in specific areas of the U.S. Southwest and South and Central America
This type of meningitis is less common than viral or bacterial meningitis, and it’s caused by parasites that are found in dirt, feces, and on some animals and food, like snails, raw fish, poultry, or produce.
One type of parasitic meningitis is rarer than others. It’s called eosinophilic meningitis (EM). Three main parasites are responsible for EM. These include:
- Angiostrongylus cantonensis
- Baylisascaris procyonis
- Gnathostoma spinigerum
Parasitic meningitis is not passed from person to person. Instead, these parasites infect an animal or hide out on food that a human then eats. If the parasite or parasite eggs are infectious when they’re ingested, an infection may occur.
One very rare type of parasitic meningitis, amebic meningitis, is a life-threatening type of infection. This type is caused when one of several types of ameba enters the body through the nose while you swim in contaminated lakes, rivers, or ponds. The parasite can destroy brain tissue and may eventually cause hallucinations, seizures, and other serious symptoms. The most commonly recognized species is Naegleria fowleri.
Non-infectious meningitis is not an infection. Instead, it is a type of meningitis that’s caused by other medical conditions or treatments. These include:
- a head injury
- brain surgery
- certain medications
What are the causes of meningitis?
Each type of meningitis has a slightly different cause, but each ultimately acts in the same way: A bacterium, fungus, virus, or parasite spreads through the bloodstream until it reaches the brain, or spinal cord. There, it sets up in the lining or fluids around these vital body parts and starts developing into a more advanced infection.
Non-infectious meningitis is the result of a physical injury or other condition; it doesn’t involve an infection.
Is there a vaccine for meningitis?
Yes, there is a vaccine for several types of bacterial meningitis. Meningococcal meningitis, caused by Neisseria meningitidis, is one version for which vaccines are available. While viral meningitis is more common, bacterial meningitis can be more dangerous if it’s not diagnosed and treated quickly.
For that reason, the two primary vaccines for meningitis are for bacterial causes. The first vaccine, the meningococcal conjugate vaccine, features a vaccine that targets four of the most common types of bacterial serotypes. It lasts longer and offers greater protection, especially if you maintain booster shots.
The second vaccine, MenB, targets one specific strain, and its protection window is much shorter. Only certain populations are recommended to get this vaccine.
Side effects of a meningitis vaccine include soreness, redness, and burning at the injection site. Some people may experience a low-grade fever for a day or two following the injection. Chills, headache, joint pain, and fatigue are also possible.
Who should be vaccinated against meningococcal meningitis?
These five groups are considered at risk and should get a meningitis vaccine:
- college freshmen who live in dorms and haven’t been vaccinated
- adolescents who are 11 to 12 years old
- people traveling to countries where meningococcal disease is common
- children ages 2 or older who don’t have a spleen or who have a compromised immune system
Teenagers should protect themselves by getting a meningitis vaccine. Find out when to get your child vaccinated.
How is meningitis treated?
Your treatment is determined by the cause of your meningitis.
Bacterial meningitis requires immediate hospitalization. Early diagnosis and treatment will prevent brain damage and death. Bacterial meningitis is treated with intravenous antibiotics. There’s no specific antibiotic for bacterial meningitis. It depends on the bacteria involved.
Fungal meningitis is treated with antifungal agents.
Parasitic meningitis may either involve treating just the symptoms or attempting to treat the infection directly. Depending on the cause, this type may get better without antibiotic treatment. If it worsens, however, your doctor may try to treat the infection itself.
Viral meningitis may resolve on its own, but some causes of viral meningitis will be treated with intravenous antiviral medications.
How contagious is meningitis?
Several types of meningitis are not contagious. Fungal, parasitic and non-infectious meningitis are not contagious.
Viral meningitis is contagious. It’s spread through direct contact with body fluids, including mucus, feces, and saliva. Droplets of infected fluid can be spread and shared with sneezing and coughing. You do not have to come into direct contact with an infected person to pick up this infection.
Bacterial meningitis, the most serious form of meningitis, can also be contagious, especially if it’s meningococcal meningitis. It’s spread through extended contact with an infected person. Schools, daycare centers, military barracks, hospitals, and college dormitories are prime locations for sharing this infection. Some types of meningitis are spread through person-to-person contact but not all.
Meningitis in infant
Babies who develop meningitis may show different signs and symptoms of an infection than adults. These symptoms can include:
- body or neck stiffness
- high-pitched crying
- inconsolable behaviors
- sleepy and difficulty waking
- irritable and grumpy
- doesn’t feel well and has a weak suck during breastfeeding
Viral meningitis is common in infants. It develops as a result of colds, cold sores, flu, and diarrhea. The viruses that cause these common conditions also cause viral meningitis.
Bacterial meningitis, which is common but life-threatening, most likely spreads from a serious infection in a nearby area of the body. For example, the bacteria from a severe ear infection or sinus infection can enter the bloodstream and find their way to the brain or spinal cord and cause a bigger infection.
Meningitis in children
Meningitis becomes more common in children as they grow older and reach high school and college ages. Symptoms of viral and bacterial meningitis in children are very similar to symptoms in adults. These include:
- sudden fever
- body and neck aches
- confusion or disorientation
- tiredness or fatigue
You may be curious if your child is at risk for developing this condition.
Meningitis in adults
The risk for several forms of meningitis decreases after young adulthood. That’s in large part due to changing circumstances. Schools and college dormitories are common sites where some forms of meningitis can be easily shared. Once a young adult ages out of these settings, the likelihood of an infection begins to fall.
However, after age 60, the risk starts to rise again. That’s because of underlying diseases or health conditions that weaken the immune systems in older individuals.
Adults with a compromised immune system are at a greater risk for developing meningitis. Likewise, adults in environments where individuals are in close contact with one another may be at greater risk for an infection. This includes teachers, healthcare providers, daycare staffers.
How is meningitis diagnosed?
Diagnosing meningitis starts with a health history and physical exam. Age, dorm residence, and day care center attendance can be important clues. During the physical exam, your doctor will look for:
- a fever
- an increased heart rate
- neck stiffness
- reduced consciousness
Your doctor will also order a lumbar puncture. This test is also called a spinal tap. It allows your doctor to look for increased pressure in the central nervous system. It can also find inflammation or bacteria in the spinal fluid. This test can also determine the best antibiotic for treatment.
Other tests may also be ordered to diagnose meningitis. Common tests include the following:
- Blood culturesidentify bacteria in the blood. Bacteria can travel from the blood to the brain. meningitidis and S. pneumonia, among others, can cause both sepsis and meningitis.
- Acomplete blood count with differential is a general index of health. It checks the number of red and white blood cells in your blood. White blood cells fight infection. The count is usually elevated in meningitis.
- Chest X-rayscan reveal the presence of pneumonia, tuberculosis, or fungal infections. Meningitis can occur after pneumonia.
- ACT scan of the head may show problems like a brain abscess or sinusitis. Bacteria can spread from the sinuses to the meninges.
Your doctor may also conduct a glass test. For this test, your doctor will roll a glass over the meningitis rash. If the rash doesn’t fade under the pressure, it’s likely meningitis rash. If it does fade, the unusual spots on the skin may be the result of another condition.
How is meningitis prevented?
Maintaining a healthy lifestyle, especially if you’re at increased risk, is important. This includes:
- getting adequate amounts of rest
- avoiding contact with sick people
If you’ve been in close contact with one or more people who have a bacterial meningococcal infection, your doctor can give you preventive antibiotics. This will decrease your chances of developing the disease.
Vaccinations can also protect against certain types of meningitis. Vaccines that can prevent meningitis include the following:
- Haemophilus influenzaetype B (Hib) vaccine
- pneumococcal conjugate vaccine
- meningococcal vaccine
Practicing good personal hygiene may also help you prevent meningitis. Some types of meningitis are spread through close contact with an infected person’s body fluid, such as saliva and nasal secretions. Avoid sharing drinks, utensils, and personal items that may carry saliva or other fluids. Take these steps to prevent getting meningitis.
What are the complications from meningitis?
These complications are typically associated with meningitis:
- hearing loss
- vision loss
- memory problems
- migraine headaches
- brain damage
- a subdural empyema, or a buildup of fluid between the brain and the skull
A meningitis infection may produce bacteria in the bloodstream. These bacteria multiply and some release toxins. That can cause blood vessel damage and leaking of blood into the skin and organs.
A serious form of this blood infection can be life-threatening. Gangrene may damage skin and tissue. In rare cases, amputation may be necessary. Several other serious complications may occur in people with meningitis. Read more about them and the long-term effects of an infection.
Meningitis and pneumonia
Pneumococcal meningitis is a rare but serious and life-threatening form of bacterial meningitis. Even with treatment, 20 percent of people with this type of infection die.
About 40 percent of people carry bacteria called Streptococcus pneumoniae in their throat and the back of the nose. These bacteria are responsible for common illnesses like pneumonia, sinus infections, and ear infections.
From time to time, however, those bacteria manage to cross the blood-brain barrier and cause inflammation and infection in the brain, spinal cord, or fluids immediately surrounding them.
Symptoms of this serious form of meningitis include:
- high fever
- chest pain
Fortunately, two vaccines are available to prevent pneumococcal meningitis.
What are the risk factors for meningitis?
The following are some of the risk factors for meningitis:
People with an immune deficiency are more vulnerable to infections. This includes the infections that cause meningitis. Certain disorders and treatments can weaken your immune system. These include:
Cryptococcal meningitis, which is caused by a fungus, is the most common form of meningitis in people with HIV.
Meningitis is easily spread when people live in close quarters. Being in small spaces increase the chance of exposure. Examples of these locations include:
- college dormitories
- boarding schools
- day care centers
Pregnant women have an increased risk of listeriosis, which is an infection caused by the Listeria bacteria. Infection can spread to the unborn child.
All ages are at risk for meningitis. However, certain age groups have a higher risk. Children under the age of 5 are at increased risk of viral meningitis. Infants are at higher risk of bacterial meningitis.
Working with animals
Farm workers and others who work with animals have an increased risk of infection with Listeria.
An abscess in the brain of an otherwise healthy person is usually caused by bacterial infection. Fungal brain abscesses tend to occur in people with weakened immune systems. The infection will cause your brain to swell from the collection of pus and dead cells that forms.
A brain abscess forms when fungi, viruses, or bacteria reach your brain through a wound in your head or an infection somewhere else in your body. According to the Children’s Hospital of Wisconsin, infections from other parts of the body account for between 20 and 50 percent of all brain abscess cases. Heart and lung infections are among the most common causes of brain abscesses. However, brain abscesses can also begin from an ear or sinus infection, or even an abscessed tooth.
See your doctor right away if you think you may have a brain abscess. You’ll need the appropriate treatment to prevent any brain damage from the swelling.
What are the risk factors?
Nearly anyone can get a brain abscess, but certain groups of people are at a higher risk than others. Some diseases, disorders, and conditions that raise your risk include:
- a compromised immune system due toHIV or AIDS
- cancer and other chronic illnesses
- congenital heart disease
- majorhead injury or skull fracture
- immunosuppressant drugs, such as those used inchemotherapy
- chronicsinus or middle ear infections
Certain birth defects allow infections to reach the brain more easily through the teeth and intestines. One example of this is tetralogy of Fallot, which is a heart defect.
What are the symptoms of a brain abscess?
Symptoms usually develop slowly over several weeks, but they can also come on suddenly. Symptoms you should watch for are:
- differences in mental processes, such as increased confusion, decreased responsiveness, and irritability
- decreased speech
- decreased sensation
- decreased movement due to loss of muscle function
- changes in vision
- changes in personality or behavior
- neck stiffness, especially when it occurs with fevers and chills
- sensitivity to light
In babies and young children, most of the symptoms are similar. However, your child may show other symptoms of a brain abscess. The soft spot on top of your baby’s head, called the fontanelle, may be swollen or bulging. Other symptoms in your child can include:
- projectile vomiting
- high-pitched crying
- spasticity in the limbs
How is a brain abscess diagnosed?
Many of these symptoms closely resemble other diseases or health problems. Talk to your doctor immediately if you develop any of the symptoms. You’ll likely need a neurological exam. This exam can reveal any increased pressure within the brain, which can occur from swelling. CT and MRI scans can also be used to diagnose a brain abscess.
In some cases, your doctor may need to perform a lumbar puncture, or spinal tap. This involves the removal of a small amount of cerebral spinal fluid to test for any problems other than an infection. A lumbar puncture will not be performed if any significant brain swelling is suspected, as it can temporarily worsen the pressure inside the head. This is to avoid the risk of brain hematoma, or a ruptured blood vessel in the brain.
What’s the treatment for a brain abscess?
A brain abscess is a serious medical situation. A stay in the hospital will be required. Pressure due to swelling in the brain can lead to permanent brain damage.
If your abscess is deep inside your brain or it’s 2.5 centimeters or less, it will probably be treated with antibiotics. Antibiotic medications will also be used to treat any underlying infections that may have been the cause of the brain abscess. Broad-spectrum antibiotics that kill a variety of different bacteria are the most commonly prescribed. You may need more than one type of antibiotic.
Surgery is often the next step if an abscess doesn’t get smaller with the use of antibiotics. It may also be the preferred treatment for abscesses greater than 2.5 centimeters wide. Surgically removing an abscess usually involves opening the skull and draining the abscess. The fluid that’s removed is normally sent to a lab to determine the cause of the infection. Knowing the cause of the infection will help your doctor find the most effective antibiotics. Surgery may also be necessary if antibiotics aren’t working, so that the organism causing the abscess can be determined to help guide the most effective treatment.
Surgery must be performed in the most severe cases when the abscess causes a dangerous buildup of pressure in the brain. Your doctor may recommend surgery as the best option in the following cases:
- Your brain abscess is at risk of rupturing inside of your skull.
- Your brain abscess contains gasses sometimes produced by bacteria.
Can a brain abscess be prevented?
A brain abscess is a serious medical condition. Prevention is important. You can lower your risk by monitoring any conditions that can cause a brain abscess. Call your doctor at the first sign of a brain abscess.
If you have any type of heart disorder, talk with your doctor before having any dental or urological procedures. Your doctor can prescribe antibiotics for you to take before these procedures. This will reduce your risk of an infection that could spread to your brain.
Amyotrophic lateral sclerosis (ALS) is a degenerative disease that affects the brain and spinal cord. ALS is a chronic disorder that causes a loss of control of voluntary muscles. The nerves controlling speech, swallowing, and limb movements are often affected. Unfortunately, a cure has not yet been found for it.
The famous baseball player Lou Gehrig was diagnosed with the disease in 1939. ALS is also known as Lou Gehrig’s disease.
What Are the Causes of ALS?
ALS can be classified as either sporadic or familial. Most cases are sporadic. That means no specific cause is known.
The Mayo Clinic estimates that genetics only cause ALS in about 5 to 10 percent of cases. Other causes of ALS aren’t well understood. Some factors that scientists think might contribute to ALS include:
- free radical damage
- an immune response that targets motor neurons
- imbalances in the chemical messenger glutamate
- a buildup of abnormal proteins inside nerve cells
The Mayo Clinic has also identified smoking, lead exposure, and military service as possible risk factors for this condition.
The onset of symptoms in ALS usually occurs between the ages of 50 and 60, although symptoms can occur earlier. ALS is slightly more common in men than in women.
How Often Does ALS Occur?
According to the ALS Association, every year about 6,400 people in the United States are diagnosed with ALS. They also estimate that around 20,000 Americans are currently living with the disorder. ALS affects people in all racial, social, and economic groups.
This condition is also becoming more common. This may be because the population is aging. It could also be due to increasing levels of an environmental risk factor that hasn’t been identified yet.
What Are the Symptoms of ALS?
Both sporadic and familial ALS are associated with a progressive loss of motor neurons. The symptoms of ALS depend on what areas of the nervous system are affected. These will vary from person-to-person.
The medulla is the lower half of the brainstem. It controls many of the body’s autonomic functions. These include breathing, blood pressure, and heart rate. Damage to the medulla can cause:
- slurred speech
- difficulty swallowing
- emotional lability, which is characterized by excessive emotional reactions such as laughing or crying
- a loss of tongue muscle contour, or tongue atrophy
- excess saliva
- difficulty breathing
The corticospinal tract is a part of the brain made up of nerve fibers. It sends signals from your brain to your spinal cord. ALS damages the corticospinal tract and causes spastic limb weakness.
The anterior horn is the front part of the spinal cord. Degeneration here can cause:
- limp muscles, or flaccid weakness
- muscle wasting
- breathing problems caused by weakness in the diaphragm and other respiratory muscles
Early signs of ALS may include problems performing everyday tasks. For example, you may have difficulty climbing stairs or getting up from a chair. You might also have difficulty speaking or swallowing, or weakness in your arms and hands. Early symptoms are usually found in specific parts of the body. They also tend to be asymmetrical, which means they only happen on one side.
As the disease progresses, the symptoms generally spread to both sides of the body. Bilateral muscle weakness becomes common. This can lead to weight loss from muscle wasting. The senses, the urinary tract, and bowel function usually remain intact.
Does ALS Affect Thinking?
Cognitive impairment is a common symptom of ALS. Behavioral changes can also occur without mental decline. Emotional lability can occur in all ALS sufferers, even those without dementia.
Inattention and slowed thinking are the most common cognitive symptoms of ALS. ALS-related dementia can also occur if there’s cell degeneration in the frontal lobe. ALS-related dementia is most likely to occur when there’s a family history of dementia.
How Is ALS Diagnosed?
ALS is usually diagnosed by a neurologist. There’s no specific test for ALS. The process of establishing a diagnosis can take anywhere from weeks to months.
Your doctor may start to suspect you have ALS if you have progressive neuromuscular decline. They’ll watch for increasing problems with symptoms such as:
- muscle weakness
These symptoms can also be caused by a number of conditions. Therefore, a diagnosis requires your doctor to rule out other health problems. This is done with a series of diagnostic tests including:
- an EMG to evaluate the electrical activity of your muscles
- nerve conduction studies to test your nerve function
- an MRI that shows which parts of your nervous system are affected
- blood tests to evaluate your general health and nutrition
Genetic tests may also be useful for people with a family history of ALS.
How Is ALS Treated?
As ALS progresses, it becomes more difficult to breathe and digest food. The skin and subcutaneous tissues are also affected. Many parts of the body deteriorate, and all of them must be treated appropriately.
Because of this, a team of doctors and specialists often work together to treat people with ALS. Specialists involved in the ALS team might include:
- a neurologist who is skilled in the management of ALS
- a physiatrist
- a nutritionist
- a gastroenterologist
- an occupational therapist
- a respiratory therapist
- a speech therapist
- a social worker
- a mental health professional
- a pastoral care provider
Family members should talk to people with ALS about their care. People with ALS may need support when making medical decisions.
Riluzole (Rilutek) is currently the only drug approved for the treatment of ALS. It can prolong life by several months, but it cannot eliminate the symptoms entirely. Other medications may be used to treat the symptoms of ALS. Some of these medications include:
- quinine bisulphate, baclofen, and diazepam for cramping and spasticity
- nonsteroidal anti-inflammatory drugs (NSAIDs), the anticonvulsant gabapentin, tricyclic antidepressants, and morphine for pain management
- Neurodex, which is a combination of vitamins B-1, B-6, and B-12, for emotional lability
Scientists are investigating the use of the following for a subtype of hereditary ALS:
- coenzyme Q10
- COX-2 inhibitors
However, they have not yet been proven effective.
Stem cell therapy also hasn’t been proven to be an effective treatment for ALS.
What Are the Complications of ALS?
The complications of ALS include:
- bed sores
What Is the Long-Term Outlook for People with ALS?
The typical life expectancy for a person with ALS is two to five years. Approximately 20 percent of patients live with ALS for over five years. Ten percent of patients live with the disease for over 10 years.
The most common cause of death from ALS is respiratory failure. There’s currently no cure for ALS. However, medication and supportive care can improve your quality of life. Proper care can help you live happily and comfortably for as long as possible.
People in the United States end up paying more for prescription drugs over time due to rising list prices, according to new research.
In a paper published this month in JAMA Network Open, a team of researchers led by Dr. Benjamin Rome, an instructor of medicine at Harvard Medical School and a researcher at Brigham and Women’s Hospital in Boston, reported that the list price of 79 brand-name drugs rose by more than 16 percent while average out-of-pocket costs went up by more than 3 percent from 2015 to 2017.
Rome told Healthline that the findings shine a light on drug policy in the United States.
“I think most people who work in insurance companies and health policy experts recognize this problem, which is that a growing number of patients are paying coinsurance and deductibles that are based on the list price of the drugs,” he said. “I don’t think our findings are terribly unexpected in that sense, but they do prove a key point that I think has big policy implications as Congress and states figure out how to get their pricing under control.”
Is there a solution?
Perhaps the biggest contributor to rising out-of-pocket costs is that drug manufacturers are unregulated — they can set any price they feel is appropriate for a given drug, even if it outpaces inflation.
Rome says drafting legislation that would add oversight — which was proposed last year — could help.
Another possible solution? Get rid of rebates, so there’s a single price paid by the insurance company and the consumer.
A third option could be for insurance companies to pass on rebates to consumers.
“This means that even if insurance companies keep getting the rebates, they should not be allowed to calculate patients’ out-of-pocket costs or charge patients a percentage of the list price,” Rome said
What is Alzheimer’s disease?
Alzheimer’s disease is a progressive form of dementia. Dementia is a broader term for conditions caused by brain injuries or diseases that negatively affect memory, thinking, and behavior. These changes interfere with daily living.
According to the Alzheimer’s Association, Alzheimer’s disease accounts for 60 to 80 percent of dementia cases. Most people with the disease get a diagnosis after age 65. If it’s diagnosed before then, it’s generally referred to as early onset Alzheimer’s disease.
There’s no cure for Alzheimer’s, but there are treatments that can slow the progression of the disease.
Although many people have heard of Alzheimer’s disease, some aren’t sure exactly what it is. Here are some facts about this condition:
- Alzheimer’s disease is a chronic ongoing condition.
- Its symptoms come on gradually and the effects on the brain are degenerative, meaning they cause slow decline.
- There’s no cure for Alzheimer’s but treatment can help slow the progression of the disease and may improve quality of life.
- Anyone can get Alzheimer’s disease but certain people are at higher risk for it. This includes people over age 65 and those with a family history of the condition.
- Alzheimer’s and dementia aren’t the same thing. Alzheimer’s disease is a type of dementia.
- There’s no single expected outcome for people with Alzheimer’ Some people live a long time with mild cognitive damage, while others experience a more rapid onset of symptoms and quicker disease progression.
Each person’s journey with Alzheimer’s disease is different.
Dementia vs. Alzheimer’s
The terms “dementia” and “Alzheimer’s” are sometimes used interchangeably. However, these two conditions aren’t the same. Alzheimer’s is a type of dementia.
Dementia is a broader term for conditions with symptoms relating to memory loss such as forgetfulness and confusion. Dementia includes more specific conditions, such as Alzheimer’s disease, Parkinson’s disease, traumatic brain injury, and others, which can cause these symptoms.
Causes, symptoms, and treatments can be different for these diseases.
Alzheimer’s disease causes and risk factors
Experts haven’t determined a single cause of Alzheimer’s disease but they have identified certain risk factors, including:
- Most people who develop Alzheimer’s disease are 65 years of age or older.
- Family history.If you have an immediate family member who has developed the condition, you’re more likely to get it.
- Certain genes have been linked to Alzheimer’s disease.
Having one or more of these risk factors doesn’t mean that you’ll develop Alzheimer’s disease. It simply raises your risk level.
To learn more about your personal risk of developing the condition, talk with your doctor.
Alzheimer’s and genetics
While there’s no one identifiable cause of Alzheimer’s, genetics may play a key role. One gene in particular is of interest to researchers. Apolipoprotein E (APOE) is a gene that’s been linked to the onset of Alzheimer’s symptoms in older adults.
Blood tests can determine if you have this gene, which increases your risk of developing Alzheimer’s. Keep in mind that even if someone has this gene, they may not get Alzheimer’s.
The opposite is also true: Someone may still get Alzheimer’s even if they don’t have the gene. There’s no way to tell for sure whether someone will develop Alzheimer’s.
Other genes could also increase risk of Alzheimer’s and early onset Alzheimer’s.
Symptoms of Alzheimer’s disease
Everyone has episodes of forgetfulness from time to time. But people with Alzheimer’s disease display certain ongoing behaviors and symptoms that worsen over time. These can include:
- memory loss affecting daily activities, such as an ability to keep appointments
- trouble with familiar tasks, such as using a microwave
- difficulties with problem-solving
- trouble with speech or writing
- becoming disoriented about times or places
- decreased judgment
- decreased personal hygiene
- mood and personality changes
- withdrawal from friends, family, and community
Symptoms change according to the stage of the disease.
Alzheimer’s is a progressive disease, which means the symptoms will gradually worsen over time. Alzheimer’s is broken down into seven stages:
- Stage 1.There are no symptoms at this stage but there might be an early diagnosis based on family history.
- Stage 2.The earliest symptoms appear, such as forgetfulness.
- Stage 3.Mild physical and mental impairments appear, such as reduced memory and concentration. These may only be noticeable by someone very close to the person.
- Stage 4.Alzheimer’s is often diagnosed at this stage, but it’s still considered mild. Memory loss and the inability to perform everyday tasks is evident.
- Stage 5.Moderate to severe symptoms require help from loved ones or caregivers.
- Stage 6.At this stage, a person with Alzheimer’s may need help with basic tasks, such as eating and putting on clothes.
- Stage 7.This is the most severe and final stage of Alzheimer’ There may be a loss of speech and facial expressions.
As a person progresses through these stages, they’ll need increasing support from a caregiver.
Early onset Alzheimer’s
Alzheimer’s typically affects people ages 65 years and older. However, it can occur in people as early as their 40s or 50s. This is called early onset, or younger onset, Alzheimer’s. This type of Alzheimer’s affects about 5 percent of all people with the condition.
Symptoms of early onset Alzheimer’s can include mild memory loss and trouble concentrating or finishing everyday tasks. It can be hard to find the right words, and you may lose track of time. Mild vision problems, such as trouble telling distances, can also occur.
Certain people are at greater risk of developing this condition.
Diagnosing Alzheimer’s disease
The only definitive way to diagnose someone with Alzheimer’s disease is to examine their brain tissue after death. But your doctor can use other examinations and tests to assess your mental abilities, diagnose dementia, and rule out other conditions.
They’ll likely start by taking a medical history. They may ask about your:
- family medical history
- other current or past health conditions
- current or past medications
- diet, alcohol intake, or other lifestyle habits
From there, your doctor will likely do several tests to help determine if you have Alzheimer’s disease.
There’s no definitive test for Alzheimer’s disease. However, your doctor will likely do several tests to determine your diagnosis. These can be mental, physical, neurological, and imaging tests.
Your doctor may start with a mental status test. This can help them assess your short-term memory, long-term memory, and orientation to place and time. For example, they may ask you:
- what day it is
- who the president is
- to remember and recall a short list of words
Next, they’ll likely conduct a physical exam. For example, they may check your blood pressure, assess your heart rate, and take your temperature. In some cases, they may collect urine or blood samples for testing in a laboratory.
Your doctor may also conduct a neurological exam to rule out other possible diagnoses, such as an acute medical issue, such as infection or stroke. During this exam, they will check your reflexes, muscle tone, and speech.
Your doctor may also order brain-imaging studies. These studies, which will create pictures of your brain, can include:
- Magnetic resonance imaging (MRI).MRIs can help pick up key markers, such as inflammation, bleeding, and structural issues.
- Computed tomography (CT) scan.CT scans take X-ray images which can help your doctor look for abnormal characteristics in your brain.
- Positron emission tomography (PET) scan.PET scan images can help your doctor detect plaque Plaque is a protein substance related to Alzheimer’s symptoms.
Other tests your doctor may do include blood tests to check for genes that may indicate you have a higher risk of Alzheimer’s disease.
There’s no known cure for Alzheimer’s disease. However, your doctor can recommend medications and other treatments to help ease your symptoms and delay the progression of the disease for as long as possible.
For early to moderate Alzheimer’s, your doctor may prescribe medications such as donepezil (Aricept) or rivastigmine (Exelon). These drugs can help maintain high levels of acetylcholine in your brain. This is a type of neurotransmitter that can help aid your memory.
To treat moderate to severe Alzheimer’s, your doctor may prescribe donepezil (Aricept) or memantine (Namenda). Memantine can help block the effects of excess glutamate. Glutamate is a brain chemical that’s released in higher amounts in Alzheimer’s disease and damages brain cells.
Your doctor may also recommend antidepressants, antianxiety medications, or antipsychotics to help treat symptoms related to Alzheimer’s. These symptoms include:
Other Alzheimer’s treatments
In addition to medication, lifestyle changes may help you manage your condition. For example, your doctor might develop strategies to help you or your loved one:
- focus on tasks
- limit confusion
- avoid confrontation
- get enough rest every day
- stay calm
Some people believe that vitamin E can help prevent decline in mental abilities, but studies indicate that more research is needed. Be sure to ask your doctor before taking vitamin E or any other supplements. It can interfere with some of the medications used to treat Alzheimer’s disease.
In addition to lifestyle changes, there are several alternative options you can ask your doctor about. Read more about alternative Alzheimer’s treatments.
Just as there’s no known cure for Alzheimer’s, there are no foolproof preventive measures. However, researchers are focusing on overall healthy lifestyle habits as ways of preventing cognitive decline.
The following measures may help:
- Quit smoking.
- Exercise regularly.
- Try cognitive training exercises.
- Eat a plant-based diet.
- Consume more antioxidants.
- Maintain an active social life.
Be sure to talk with your doctor before making any big changes in your lifestyle.
If you have a loved one with Alzheimer’s, you may consider becoming a caregiver. This is a full-time job that’s typically not easy but can be very rewarding.
Being a caregiver takes many skills. These include patience perhaps above all, as well as creativity, stamina, and the ability to see joy in the role of helping someone you care about live the most comfortable life they can.
As a caregiver, it’s important to take care of yourself as well as your loved one. With the responsibilities of the role can come an increased risk of stress, poor nutrition, and lack of exercise.
If you choose to assume the role of caregiver, you may need to enlist the help of professional caregivers as well as family members to help.
The statistics surrounding Alzheimer’s disease are daunting.
- According to the Centers for Disease Control and Prevention (CDC), Alzheimer’s is the sixth most common cause of death among U.S. adults. It ranks fifth among causes of death for people 65 years and older.
- Astudy found that 4.7 million Americans over the age of 65 years had Alzheimer’s disease in 2010. Those researchers projected that by 2050, there will be 13.8 million Americans with Alzheimer’
- The CDC estimates thatover 90 percentTrusted Source
of people with Alzheimer’s don’t see any symptoms until they’re over 60 years old.
- Alzheimer’s is an expensive disease. According to the CDC, about$259 billionTrusted Source
was spent on Alzheimer’s and dementia care costs in the United States in 2017.
Alzheimer’s is a complicated disease in which there are many unknowns. What is known is that the condition worsens over time, but treatment can help delay symptoms and improve your quality of life.
If you think you or a loved one may have Alzheimer’s, your first step is to talk with your doctor. They can help make a diagnosis, discuss what you can expect, and help connect you with services and support. If you’re interested, they can also give you information about taking part in clinical trials.
- spinal cord disorders, including inflammatory and autoimmune disorders
- headaches, such ascluster headaches, and migraine
What Are Cluster Headaches?
Cluster headaches are severely painful headaches that occur in clusters. You experience cycles of headache attacks, followed by headache-free periods.
The frequency of your headaches during these cycles may range from one headache every other day to several headaches per day. Pain from cluster headaches can be extremely severe.
Cluster headaches are most common between adolescence and middle age, but can occur at any age.
Older studies showed that cluster headaches were more commonly reported by men than women, such as a 1998 study published in Cephalagia, which shows that before 1960, men reported cluster headaches six times more often than women. Over time however, that gap has shrunk, and by the 1990s, cluster headaches were found in only twice as many men than women.
Types of Cluster Headaches
There are two types of cluster headaches: episodic and chronic.
Episodic cluster headaches occur regularly between one week and one year, followed by a headache-free period of one month or more.
Chronic cluster headaches occur regularly for longer than one year, followed by a headache-free period that lasts for less than one month.
A person who has episodic cluster headaches may develop chronic cluster headaches, and vice versa.
Distinguishing a Cluster Headache from Other Types of Headaches
Cluster headaches usually start suddenly. A small percentage of people experience aura-like visual disturbances, such as flashes of light, before headaches begin.
Most commonly, headaches begin a few hours after you fall asleep and are often painful enough to wake you, but they may also begin when you are awake.
Headache pain becomes severe 5-10 minutes after the headache starts. Each headache usually lasts for several hours, with the most intense pain lasting between 30 minutes and 2 hours.
Cluster headache pain occurs on one side of the head, but can switch sides in some people, and is generally located behind or around the eye. It is described as a constant and deep burning or piercing pain. People with this pain say it is like a hot poker being stuck into your eye. The pain may spread to the forehead, temples, teeth, nose, neck, or shoulders on the same side.
Other signs and symptoms may be evident on the painful side of the head, including:
- a droopy eyelid
- a constricted pupil
- excessive tearing from your eye
- eye redness
- sensitivity to light
- swelling under or around one or both of your eyes
- a runny nose or stuffy nose
- facial redness or flushing
- agitation or restlessness
What Causes Cluster Headaches?
The pain from cluster headaches is caused by the dilation, or widening, of the blood vessels that supply blood to your brain and face. This dilation applies pressure to the trigeminal nerve, which transmits sensations from the face to the brain. It is unknown why this dilation occurs.
Researchers believe that abnormalities in the hypothalamus, a small area of the brain that regulates body temperature, blood pressure, sleep, and the release of hormones, may be responsible for cluster headaches.
Cluster headaches may also be caused by a sudden release of the chemicals histamine, which fight allergens, or serotonin, which regulates mood.
How Are Cluster Headaches Diagnosed?
Your doctor will ask you questions about your symptoms and give you a physical and neurological exam. This may include an MRI or CT scan of your brain to rule out other causes of the headaches, such as a brain tumor.
Treatment for Cluster Headaches
Treatment involves relieving and preventing your headache symptoms using medication. In rare cases, when pain relief and preventive treatment do not work, your doctor may recommend surgery.
Pain medication relieves your headache pain once it has begun. Treatments include:
- Oxygen: Breathing 100-percent pure oxygen when the headache begins can help relieve symptoms.
- Triptan medications: A nasal spray medication called sumatriptan (Imitrex), or other tripitan medications constrict blood vessels, which can help ease your headache.
- DHE: An injected medication called dihydroergotamine (DHE), can often relieve cluster headache pain within five minutes of use. Note: DHE can’t be taken with sumatriptan.
- Capsaicin cream: Topical capsaicin cream can be applied to the painful area.
Preventive medications stop headaches before they start. These medications may not be 100-percent effective, but they can reduce the frequency of your headaches. These medications include:
- blood pressure medications, such aspropranolol (Inderal) or verapamil (Calan, Covera, Isoptin, Verelan), which relax your blood vessels
- steroid medications, such as prednisone, which reduce nerve inflammation
- a medication called ergotamine that keeps your blood vessels from dilating
- antidepressant medications
- anti-seizure medications, such as topiramate (Topamax) and valproic acid
- lithium carbonate
- muscle relaxants, such as baclofen
As a last resort, a surgical procedure can be used to disable the trigeminal nerve. The surgery can cause permanent pain relief for some patients, but serious side effects, such as permanent facial numbness, can result.
Tips to Prevent Cluster Headaches
You may be able to prevent cluster headaches by avoiding the following:
- high altitudes
- strenuous activities
- hot weather
- hot baths
- foods that contain large amounts of nitrates, such as:
- hot dogs
- preserved meats
Cluster headaches are not life-threatening, but there is no cure for them. With these tips and treatments, your headaches may become less frequent and less painful over time, or they may eventually disappear completely.
What is migraine?
Migraine is a neurological condition that can cause multiple symptoms. It’s frequently characterized by intense, debilitating headaches. Symptoms may include nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. Migraines often run in families and affect all ages.
The diagnosis of migraine headaches is determined based on clinical history, reported symptoms, and by ruling out other causes. The most common categories of migraine headache are those without aura (previously known as common migraines) and those with aura (previously known as classic migraines).
Migraines can begin in childhood or may not occur until early adulthood. Women are more likely than men to have migraines. Family history is one of the most common risk factors for having migraines.
Migraines are different from other headaches. Find out about different types of headaches and how to tell if your headaches might be migraines.
Migraine symptoms may begin one to two days before the headache itself. This is known as the prodrome stage. Symptoms during this stage can include:
- food cravings
- fatigue or low energy
- frequent yawning
- neck stiffness
In migraine with aura, the aura occurs after the prodrome stage. During an aura, you may have problems with your vision, sensation, movement, and speech. Examples of these problems include:
- difficulty speaking clearly
- feeling a prickling or tingling sensation in your face, arms, or legs
- seeing shapes, light flashes, or bright spots
- temporarily losing your vision
The next phase is known as the attack phase. This is the most acute or severe of the phases when the actual migraine pain occurs. In some people, this can overlap or occur during an aura. Attack phase symptoms can last anywhere from hours to days. Symptoms of a migraine can vary from person to person. Some symptoms may include:
- increased sensitivity to light and sound
- dizziness or feeling faint
- pain on one side of your head, either on the left side, right side, front, or back, or in your temples
- pulsing and throbbing head pain
After the attack phase, a person will often experience the postdrome phase. During this phase, there are usually changes in mood and feelings. These can range from feeling euphoric and extremely happy, to feeling very fatigued and apathetic. A mild, dull headache may persist.
The length and intensity of these phases can occur to different degrees in different people. Sometimes, a phase is skipped and it’s possible that a migraine attack occurs without causing a headache. Learn more about the migraine symptoms and stages.
People describe migraine pain as:
It can also feel like a severe dull, steady ache. The pain may start out as mild, but without treatment will become moderate to severe.
Migraine pain most commonly affects the forehead area. It’s usually on one side of the head, but it can occur on both sides, or shift.
Most migraines last about 4 hours. If they’re not treated or don’t respond to treatment, they can last for as long as 72 hours to a week. In migraines with aura, pain may overlap with an aura or may never occur at all.
More than half of the people who get migraines have nausea as a symptom. Most also vomit. These symptoms may start at the same time the headache does. Usually, though, they start about one hour after the headache pain starts.
Nausea and vomiting can be as troubling as the headache itself. If you only have nausea, you may be able to take your usual migraine medications. Vomiting, though, can prevent you from being able to take pills or keep them in your body long enough to be absorbed. If you have to delay taking migraine medication, your migraine is likely to become more severe.
Treating nausea and preventing vomiting
If you have nausea without vomiting, your doctor may suggest medication to ease nausea called anti-nausea or antiemetic drugs. In this case, the antiemetic can help prevent vomiting and improve the nausea.
Acupressure may also be helpful in treating migraine nausea. A 2012 study
showed that acupressure reduced the intensity of migraine-associated nausea starting as soon as 30 minutes, gaining improvement over 4 hours.
Treating nausea and vomiting together
Rather than treating the nausea and vomiting separately, doctors prefer to ease those symptoms by treating the migraine itself. If your migraines come with significant nausea and vomiting, you and your doctor may talk about starting preventive (prophylactic) medications. See how to cope with the nausea and vertigo that may accompany your migraine.
Doctors diagnose migraines by listening to your symptoms, taking a thorough medical and family history, and performing a physical exam to rule out other potential causes. Imaging scans, such as a CT scan or MRI, can rule out other causes, including:
Migraines can’t be cured, but your doctor can help you manage them so you get them less often and treat symptoms when they occur. Treatment can also help make the migraines you have less severe.
Your treatment plan depends on:
- your age
- how often you have migraines
- the type of migraine you have
- how severe they are, based on how long they last, how much pain you have, and how often they keep you from going to school or work
- whether they include nausea or vomiting, as well as other symptoms
- other health conditions you may have and other medications you may take
Your treatment plan may include a combination of these:
- self-caremigraine remedies
- lifestyle adjustments, includingstress management and avoiding migraine triggers
- OTC pain or migraine medications, such asNSAIDs or acetaminophen (Tylenol)
- prescriptionmigraine medications that you take every day to help prevent migraines and reduce how often you have headaches
- prescription migraine medications that you take as soon as a headache starts, to keep it from becoming severe and to ease symptoms
- prescription medications to help with nausea or vomiting
- hormone therapy if migraines seem to occurin relation to your menstrual cycle
- alternative care, which may includebiofeedback, meditation, acupressure, or acupuncture
You can try a few things at home that may also help remedy the pain from your migraines:
- Lie down in a quiet, dark room.
- Massage your scalp or temples.
- Place a cold cloth over your forehead or behind your neck.
Medications can be used to either prevent a migraine from happening or treat it once it occurs. You may be able to get relief with OTC medication. However, if OTC medications aren’t effective, your doctor may decide to prescribe other medications.
These options will be based on the severity of your migraines and any of your other health conditions. Medication options include both those for prevention and those for treatment during an attack.
Medication overuse headache
The frequent and recurring use of any kind of headache drugs can cause what’s known as medication overuse headache
(previously called a rebound headache). Persons with migraine are at higher risk of developing this complication.
When determining how to deal with your migraine headaches, talk to your doctor about the frequency of your medication intake and alternatives to medications. Learn more about medication overuse headaches.
There are a couple of surgical procedures that are used to treat migraine. However, they haven’t been approved by the U.S. Food and Drug Administration (FDA). The procedures include neurostimulation procedures and migraine trigger site decompression surgery (MTSDS).
The American Migraine Foundation encourages anyone considering migraine surgery to see a headache specialist. A headache specialist has completed an accredited headache medicine fellowship or is board certified in headache medicine.
During these procedures, a surgeon inserts electrodes under your skin. The electrodes deliver electrical stimulation to specific nerves. Several types of stimulators are currently being used. These include:
- occipital nerve stimulators
- deep brain stimulators
- vagal nerve stimulators
- sphenopalatine ganglion stimulators
Insurance coverage for stimulators is rare. Research is ongoing as to the ideal role of nerve stimulation in the treatment of headaches.
This surgical procedure involves releasing nerves around the head and face that may have a role as trigger sites for chronic migraines. Onabotulinumtoxin A (Botox) injections are typically used to identify the trigger point nerves involved during a migraine attack. Under sedation, the surgeon deactivates or decompresses the isolated nerves. Plastic surgeons usually perform these surgeries.
The American Headache Society doesn’t endorse treatment of migraine with MTSDS. They recommend that anyone considering this procedure have an evaluation by a headache specialist to learn the risks first.
These surgeries are considered experimental until further studies show they work consistently and safely. They may however have a role for people with chronic migraines that haven’t responded to other treatment. So, is plastic surgery the answer to your migraine woes?
What causes migraines?
Researchers haven’t identified a definitive cause for migraines. However, they have found some contributing factors that can trigger the condition. This includes changes in brain chemicals, such as a decrease in levels of the brain chemical serotonin.
Other factors that may trigger a migraine include:
- bright lights
- severe heat, or other extremes in weather
- changes inbarometric pressure
- hormone changesin women, such as estrogen and progesterone fluctuations during menstruation, pregnancy, or menopause
- excess stress
- loud sounds
- intense physical activity
- skipping meals
- changes in sleep patterns
- use of certain medications, such asoral contraceptives or nitroglycerin
- unusual smells
- certain foods
- alcohol use
If you experience a migraine, your doctor may ask you to keep a headache journal. Writing down what you were doing, what foods you ate, and what medications you were taking before your migraine began can help identify your triggers. Find out what else might be causing or triggering your migraines.
Foods that trigger migraines
Certain foods or food ingredients may be more likely to trigger migraines than others. These may include:
- alcohol or caffeinated drinks
- food additives, such as nitrates (a preservative in cured meats), aspartame (an artificial sugar), or monosodium glutamate (MSG)
- tyramine, which occurs naturally in some foods
Tyramine also increases when foods are fermented or aged. This includes foods like some aged cheeses, sauerkraut, and soy sauce. However, ongoing research is looking more closely at the role of tyramine in migraines. It may be a headache protector in some people rather than a trigger. Check out these other foods that trigger migraines.
There are many types of migraines. Two of the most common types are migraine without aura and migraine with aura. Some people have both types.
Many individuals with migraines have more than one type of migraine.
Migraine without aura
This type of migraine used to be called common migraine. Most people with migraine don’t experience an aura.
According to the International Headache Society, people who have migraine without aura have had at least five attacks that have these characteristics:
- Headache attack usually lasting 4 to 72 hours if it’s not treated or if treatment doesn’t work.
- Headache has at least two of these traits:
- it occurs only on one side of the head (unilateral)
- pain is pulsating or throbbing
- pain level is moderate or severe
- pain gets worse when you move, like when walking or climbing stairs
- Headache has at least one of these traits:
- it makes you sensitive to light (photophobia)
- it makes you sensitive to sound (phonophobia)
- you experience nausea with or without vomiting or diarrhea
- Headache isn’t caused by another health problem or diagnosis.
Migraine with aura
This type of migraine used to be called classic migraine, complicated migraine, and hemiplegic migraine. Migraine with aura occurs in 25 percent of people who have migraines.
According to the International Headache Society, you must have at least two attacks that have these characteristics:
- An aura that goes away, is completely reversible, and includes at least one of these symptoms:
- visual problems (the most common aura symptom)
- sensory problems of the body, face, or tongue, such as numbness, tingling, or dizziness
- speech or language problems
- problems moving or weakness, which may last up to 72 hours
- brainstem symptoms, which includes:
- eye problemsin only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur they’re called retinal migraines)
- An aura that has at least two of these traits:
- at least one symptom spread gradually over five or more minutes
- each symptom of the aura lasts between five minutes and one hour (if you have three symptoms, they may last up to three hours)
- at least one symptom of the aura is only on one side of the head, including vision, speech, or language problems
- aura occurs with the headache or one hour before the headache begins
- Headache isn’t caused from another health problem and transient ischemic attack has been excluded as a cause.
An aura usually occurs before the headache pain begins, but it can continue once the headache starts. Alternatively, an aura may start at the same time as the headache does. Learn more about these two types of migraine.
Chronic migraine used to be called combination or mixed headache because it can have features of migraine and tension headaches. It’s also sometimes called severe migraine and can be caused by medication overuse.
People who have chronic migraines have a severe tension or migraine headache more than 15 days a month for 3 or more months. More than eight of those headaches are migraines with or without aura. Check out more differences between migraine and chronic migraines.
Compared to people who have acute migraines, people with chronic migraines are more likely to have:
- severe headaches
- more disability at home and away from home
- another type of chronic pain, like arthritis
- other serious health problems (comorbidities), such as high blood pressure
- previous head or neck injuries
Acute migraine is a general term for migraines that aren’t diagnosed as chronic. Another name for this type is episodic migraine. People who have episodic migraines have headaches up to 14 days a month. Thus, people with episodic migraines have fewer headaches a month than people with chronic ones.
Vestibular migraine is also known as migraine-associated vertigo. About 40 percent of people who have migraines have some vestibular symptoms. These symptoms affect balance, cause dizziness, or both. People of any age, including children, may have vestibular migraines.
Neurologists typically treat people who have difficulty managing their migraines, including vestibular migraines. Medications for this type of migraine are similar to ones used for other types of migraine. Vestibular migraines are also sensitive to foods that trigger migraines. So you may be able to prevent or ease vertigo and the other symptoms by making changes to your diet.
Your doctor may also suggest you see a vestibular rehabilitation therapist. They can teach you exercises to help you stay balanced when your symptoms are at their worst. Because these migraines can be so debilitating, you and your doctor may talk about taking preventive medications. Keep reading about vestibular migraine.
Optical migraine is also known as eye migraine, ocular migraine, ophthalmic migraine, monocular migraine, and retinal migraine. This is a rarer type of migraine with aura, but unlike other visual auras, it affects only one eye.
The International Headache Society defines retinal migraines as attacks of fully reversible and temporary vision problems in only one eye. The symptoms may include:
- flashes of light, called scintillations
- a blind spot or partial loss of vision, called scotomata
- loss of vision in one eye
These vision problems usually occur within an hour of the headache. Sometimes optical migraines are painless. Most people who have an optical migraine have had another type of migraine before.
Exercise may bring on the attack. These headaches aren’t caused from an eye problem, such as glaucoma. Find out more about the causes of this type of migraine.
Complex migraine isn’t a type of headache. Instead, complex or complicated migraine is a general way to describe migraines, though it’s not a very clinically accurate way to describe them. Some people use “complex migraine” to mean migraines with auras that have symptoms that are similar to symptoms of a stroke. These symptoms include:
- trouble speaking
- loss of vision
Seeing a board-certified headache specialist will help ensure that you get a precise, accurate diagnosis of your headaches.
Menstrual-related migraines affect up to 60 percent of women who experience any type of migraine. They can occur with or without an aura. They can also occur before, during, or after menstruation and during ovulation.
Research has shown that menstrual migraines tend to be more intense, last longer, and have more significant nausea than migraines not associated with the menstrual cycle.
In addition to standard treatments for migraines, women with menstrual-related migraines may also benefit from medications that affect serotonin levels as well as hormonal treatments.
Acephalgic migraine or migraine without headache
Acephalgic migraine is also known as migraine without headache, aura without headache, silent migraine, and visual migraine without headache. Acephalgic migraines occur when a person has an aura, but doesn’t get a headache. This type of migraine isn’t uncommon in people who start having migraines after age 40.
Visual aura symptoms are most common. With this type of migraine, the aura may gradually occur with symptoms spreading over several minutes and move from one symptom to another. After visual symptoms, people may have numbness, speech problems, and then feel weak and unable to move a part of their body normally. Read on to get a better understanding of acephalgic or silent migraines.
Also known as menstrual migraines and exogenous estrogen withdrawal headaches, hormonal migraines are linked with the female hormones, commonly estrogen. They include migraines during:
- your period
- the first few days after you start or stop taking medications that have estrogen in them, such as birth control pills or hormone therapy
If you’re using hormone therapy and have an increase in headaches, your doctor may talk with you about:
- adjusting your dose
- changing the type of hormones
- stopping hormone therapy
Stress migraine isn’t a type of migraine recognized by the International Headache Society. However, stress can be a migraine trigger.
There are stress headaches. These are also called tension-type headaches or ordinary headaches. If you think stress may be triggering your migraines, consider yoga for relief.
Because the nervous system is complex, a neurologist may specialize in a specific area. They’ll do a fellowship in that area after residency training. Subspecialties have evolved to narrow a doctor’s focus.
There are many subspecialties. Some examples include:
- headache medicine
- neuromuscular medicine
- neurocritical care
- geriatric neurology
- autonomic disorders
- vascular (stroke care)
- child neurology
- intervention neuroradiology
Typical neurological procedures
During your first appointment with a neurologist, they’ll likely perform a physical exam and a neurological exam. A neurological exam will test muscle strength, reflexes, and coordination.
A physical examination is a routine test your primary care provider (PCP) performs to check your overall health. A PCP may be a doctor, a nurse practitioner, or a physician assistant. The exam is also known as a wellness check. You don’t have to be sick to request an exam.
The physical exam can be a good time to ask your PCP questions about your health or discuss any changes or problems that you have noticed.
There are different tests that can be performed during your physical examination. Depending on your age or medical or family history, your PCP may recommend additional testing.
The purpose of an annual physical exam
A physical examination helps your PCP to determine the general status of your health. The exam also gives you a chance to talk to them about any ongoing pain or symptoms that you’re experiencing or any other health concerns that you might have.
A physical examination is recommended at least once a year, especially in people over the age of 50. These exams are used to:
- check for possible diseases so they can be treated early
- identify any issues that may become medical concerns in the future
- update necessary immunizations
- ensure that you are maintaining ahealthy diet and exercise routine
- build a relationship with your PCP
Since different disorders can have similar symptoms, your neurologist may need more testing to make a diagnosis.
Neurologists may recommend a variety of procedures to help diagnose or treat a condition. These procedures may include:
Your neurologist may use a lumbar puncture to test your spinal fluid. They may recommend the procedure if they believe your symptoms are caused by a problem in your nervous system that can be detected in your spinal fluid.
The procedure involves inserting a needle into the spine after numbing it and taking a sample of spinal fluid.
A lumbar puncture is sometimes called a “spinal tap.” It’s a medical procedure that can involve collecting a sample of cerebrospinal fluid (CSF). CSF is the fluid that surrounds your spinal cord and brain. A laboratory can test it for signs of certain medical conditions and infections.
When is a lumbar puncture used?
Your doctor may order a lumbar puncture for a few different reasons. They may use it to check for signs of certain medical conditions, such as:
- demyelinating diseases, such as multiple sclerosis
- cancers that can affect your spinal cord and brain
- subarachnoid hemorrhage
In some cases, they may use a lumbar puncture to administer medication directly into your spinal canal. For example, they may use it to give you chemotherapy drugs.
What are the benefits of a lumbar puncture?
A lumbar puncture can help your doctor accurately diagnose or rule out certain medical conditions, including some life-threatening illnesses. The quicker they make a diagnosis, the sooner you can get appropriate treatment. Some conditions, such as bacterial meningitis, can be fatal if you don’t get treatment for them quickly enough.
A lumbar puncture can also help your doctor give you some types of medication.
What are the risks of a lumbar puncture?
A lumbar puncture is generally considered safe, but it can involve some risks. According to the Mayo Clinic, up to a quarter of people who get a lumbar puncture develop a headache afterward. Lying down for a few hours after the procedure may lower your risk of getting a headache.
Other potential risks include tenderness or pain in your lower back and bleeding near the puncture site. You may experience some pain and numbness that shoots down your legs. In rare cases, people experience brainstem herniation, which is the movement of brain tissue from its normal position in your skull. This is uncommon.
How should you prepare for a lumbar puncture?
Tell your doctor about all of the medications you’re taking and ask them if you should stop taking any of them before your lumbar puncture. For example, they may advise you to stop taking blood thinners, such as aspirin or warfarin.
Your doctor may also order a CT or MRI scan before your lumbar puncture. They can use it to check for signs of swelling around your brain or other problems.
What should you expect during a lumbar puncture?
Your doctor will conduct a lumbar puncture using a needle and syringe. They’ll collect a sample of your spinal fluid in a tube attached to the syringe. Then, they’ll send it to a laboratory for testing.
The procedure usually takes about 45 minutes. It usually includes the following steps:
- They’ll likely position you on your side.
- They’ll clean your back with an antiseptic solution to reduce your risk of infection and numb it with a local anesthetic.
- They’ll inject a hollow needle into your subarachnoid space to collect a sample of your CSF. You may feel some pressure at this point, but the procedure usually isn’t painful.
- After they remove the needle, they’ll clean and bandage the puncture site.
For a short period after the procedure, it’s likely they’ll monitor you for a headache, dizziness, or other side effects.
What do the results of a lumbar puncture mean?
They’ll send the CSF sample to a lab for testing. Professionals in the lab may:
- evaluate its appearance for cloudiness
- check it for the presence of protein and glucose
- measure the level of red and white blood cell levels it contains
- check it for the presence of bacteria or viruses
It may take anywhere from a few hours to several days for them to analyze your sample. Your doctor can help you understand what the results mean. They’ll also advise you on any follow-up steps you should take.
This procedure can help your neurologist diagnose myasthenia gravis. In this test, your doctor injects you with a medicine called Tensilon. Then they observe how it affects your muscle movements.
The Tensilon test uses the drug Tensilon (edrophonium) to help your doctor diagnose myasthenia gravis. Tensilon prevents the breakdown of the chemical acetylcholine, a neurotransmitter that nerve cells release to stimulate your muscles.
People with the chronic disease myasthenia gravis don’t have normal reactions to acetylcholine. Antibodies attack their acetylcholine receptors. This prevents muscles from being stimulated and makes muscles easy to tire.
A person tests positive for myasthenia gravis if their muscles get stronger after being injected with Tensilon.
Your doctor might order the Tensilon test if they suspect that you have myasthenia gravis. If you’ve already been diagnosed, they may also perform the test to monitor your dosage of Tensilon or another drug of a similar type, called an anticholinesterase. Anticholinesterase drugs work by preventing the breakdown of acetylcholine in people with myasthenia gravis.
Labored breathing and extremely weak muscles are symptoms that your myasthenia gravis has worsened or that you’ve overdosed on the medication. The Tensilon test helps your doctor determine the right treatment.
Before the test, your doctor might set dietary restrictions or tell you to discontinue your use of certain medications or supplements. Let your doctor know all of the medications you’re taking, including herbs. Some substances can interfere with your test results.
The test will start with an intravenous (IV) needle placed in your arm or the back of your hand. A small amount of Tensilon will then be injected. Your stomach might feel upset or your heart rate might increase from the drug. Depending on why the test is being administered, the rest of the procedure will continue in different ways.
For diagnosing myasthenia gravis
If your doctor suspects that you have myasthenia gravis, they’ll tell you to perform a repetitive movement to test your muscles. This movement may be:
- getting up and down from your chair
- crossing and uncrossing your legs
- holding your arms overhead until they get tired
- counting backward from 100 until your voice starts to weaken
Each time you get tired, they’ll give you another dose of Tensilon. You might get 3 or 4 doses of the drug. Your doctor will observe whether the dose revives your strength each time. If it does, you may be diagnosed with myasthenia gravis. Your doctor may also administer another anticholinesterase drug, called neostigmine (Prostigmin), to confirm the diagnosis.
For checking Tensilon overdose and disease progression
If your doctor is trying to determine whether you’ve overdosed on Tensilon or if your disease is getting worse, they’ll inject a small amount of Tensilon and see what happens. Depending on the results, you’ll be given an additional drug, either neostigmine or atropine (Atreza), to stabilize you.
Each of these procedures should take about 15 to 30 minutes.
Results of the Tensilon test
Your doctor should be able to tell you the test results right away. You’ll likely be put on long-term anticholinesterase drug therapy if you’re diagnosed with myasthenia gravis. Your doctor might want you to undergo additional testing to confirm the diagnosis.
For determining whether you overdosed on medication or your condition has worsened, this test provides and immediate answer. If an injection of Tensilon temporarily boosts your strength, the myasthenia gravis has gotten worse and you’ll need further treatment. If the Tensilon injection makes you even weaker, then you might have too much anticholinesterase medication in your system.
Anticholinesterase medication is taken when necessary. There’s no fixed dosage. This is because the symptoms of myasthenia gravis can vary each day due to factors such as stress and weather. The varying dosage makes an unintentional overdose more likely. Reducing your dosage should solve the problem if you have minimal side effects.
Contact your doctor immediately if you have:
- noticeable muscular weakness
- difficulty swallowing
- respiratory problems
Risks of testing
The Tensilon test has a number of common side effects. These usually last for less than a minute. Side effects include:
- upset stomach
- blurred vision
- increased saliva production
- dizzinessor fainting
- breathing difficulties
- twitchingor rapid, uncontrollable blinking
If you continue to feel unwell, the doctor may give you an injection of atropine. This drug reverses the effects of Tensilon.
In rare cases, the Tensilon test can have dangerous outcomes. These may include breathing failure or abnormal heart rhythms. That’s why the test is performed in places where emergency resuscitation equipment is available.
You might not be a good candidate for the test if you have:
- a slow heart rate
- an irregular heartbeat
- low blood pressure
- obstructions in theurinary tract or intestines
If you have sleep apnea, your doctor might not recommend the Tensilon test. This is a condition in which you temporarily stop breathing while sleeping.
Let your doctor know if you have any of these conditions. They’ll be able to determine the right treatment options for you.
An EMG measures electrical activity between your brain or spinal cord to a peripheral nerve. This nerve is found in your arms and legs, and is responsible for muscle control during times of movement and rest.
EMGs can help your neurologist diagnose spinal cord disease as well as general muscle or nerve dysfunction.
During this test, your neurologist-technician inserts small electrodes into your muscles to help measure activity during periods of movement and rest. Such activity is recorded by a machine attached to the electrodes with a series of wires, which may be somewhat uncomfortable.
Oftentimes, a neurologist will order a nerve conduction velocity (NCV) study in conjunction with an EMG. While an EMG measures muscle activity, an NCV assesses the ability of your nerves to send the necessary signals that control these muscles. If your neurologist recommends both tests, you’ll likely do the EMG first.
During an NCV test, electrodes are taped over the same muscles that you had EMG electrodes in previously. Two sets of electrodes are used here — one sends small pulses in an effort to stimulate your nerves, while the other set measures the results.
In all, the average EMG/NCV combination test may take about an hour or longer to complete. You’ll want to avoid any stimulants, such as caffeine and nicotine, several hours before your test, or else these substances may alter your results.
Your neurologist may also ask that you don’t take any blood-thinning medications or nonsteroidal anti-inflammatory drugs (NSAIDs) for 24 hours ahead of the EMG.
Electromyography (EMG) is a diagnostic procedure that evaluates the health condition of muscles and the nerve cells that control them. These nerve cells are known as motor neurons. They transmit electrical signals that cause muscles to contract and relax. An EMG translates these signals into graphs or numbers, helping doctors to make a diagnosis.
A doctor will usually order an EMG when someone is showing symptoms of a muscle or nerve disorder. These symptoms may include tingling, numbness, or unexplained weakness in the limbs. EMG results can help the doctor diagnose muscle disorders, nerve disorders, and disorders affecting the connection between nerves and muscles.
Some doctors may refer to electromyography as an electrodiagnostic exam.
Why is electromyography performed?
Your doctor may perform an EMG if you’re experiencing symptoms that may indicate a muscle or nerve disorder. Some symptoms that may call for an EMG include:
- muscle weakness
- muscle pain or cramping
- involuntary muscle twitching(or tics)
The results of an EMG can help your doctor determine the underlying cause of these symptoms. Possible causes could include:
- muscle disorders, such asmuscular dystrophy
- disorders that affect the ability of the motor neuron to send electrical signals to the muscle, such asmyasthenia gravis
- peripheral nerve disorders that affect the nerves outside the spinal cord, such ascarpal tunnel syndrome
- nerve disorders, such asamyotrophic lateral sclerosis (ALS)
How do I prepare for electromyography?
Make sure to notify your doctor about any over-the-counter or prescription medications you may be taking. It’s also important to tell your doctor if you have a bleeding disorder, or if you have a pacemaker or implantable defibrillator. You may not be able to have an EMG if you have any of these medical conditions or devices.
If you’re able to have an EMG, you should do the following beforehand:
- Avoid smoking for at least three hours before the procedure.
- Bathe or take a shower to remove any oils from the skin. Don’t apply any lotions or creams after washing.
- Wear comfortable clothing that doesn’t obstruct the area that your doctor will be evaluating. You may be asked to change into a hospital gown right before the procedure.
What happens during an electromyography?
You will be asked to lie down on an examination table or to sit in a reclined chair. Your doctor may ask you to move into different positions during the procedure.
There are two components to an EMG test: the nerve conduction study and needle EMG. The nerve conduction study is the first part of the procedure. It involves placing small sensors called surface electrodes on the skin to assess the ability of the motor neurons to send electrical signals. The second part of the EMG procedure, known as needle EMG, also uses sensors to evaluate electrical signals. The sensors are called needle electrodes, and they’re directly inserted into muscle tissue to evaluate muscle activity when at rest and when contracted.
The nerve conduction study is performed first. During this portion of the procedure, your doctor will apply several electrodes to the surface of your skin, usually in the area where you’re experiencing symptoms. These electrodes will evaluate how well your motor neurons communicate with your muscles. Once the test is complete, the electrodes are removed from the skin.
After the nerve conduction study, your doctor will perform the needle EMG. Your doctor will first clean the affected area with an antiseptic. Then, they will use a needle to insert electrodes into your muscle tissue. You may feel slight discomfort or pain while the needle is being inserted.
The needle electrodes will evaluate the electrical activity of your muscles when contracted and when at rest. These electrodes will be removed after the test is over.
During both parts of the EMG procedure, the electrodes will deliver tiny electrical signals to your nerves. A computer will translate these signals into graphs or numerical values that can be interpreted by your doctor. The entire procedure should take between 30 and 60 minutes.
What are the risks of electromyography?
An EMG is a very low-risk exam. However, you may feel sore in the area that was tested. The soreness may last for a few days and can be relieved with an over-the-counter pain reliever, such as ibuprofen.
In rare cases, you may experience tingling, bruising, and swelling at the needle insertion sites. Make sure to tell your doctor if the swelling or pain becomes worse.
What do my electromyography results mean?
Your doctor may review the results with you right after the procedure. However, if another healthcare provider ordered the EMG, then you may not know the results until you attend a follow-up appointment with your doctor.
If your EMG shows any electrical activity in a resting muscle, then you may have:
- a muscle disorder
- a disorder affecting the nerves that connect to the muscle
- inflammation caused by an injury
Depending on your results, your doctor will talk to you about any additional tests or treatments that might be needed.
With electrodes applied to your scalp, an EEG measures electrical activity in the brain. It’s used to help diagnose conditions of the brain, including inflammation, tumors, and injuries, as well as seizures and psychiatric disorders.
Unlike an EMG, an EEG doesn’t usually cause any discomfort. Before the test, a technician places electrodes around the scalp that look like small cups. As small charges in the brain are measured through the electrodes, the technician will create changes in the environment to measure brain signals, such as different lighting or noises.
Like an EMG, you’ll need to avoid stimulants the day prior to the test. You can also expect the EEG to take an hour. Sometimes the test is done while you’re sleeping.
An electroencephalogram (EEG) is a test used to evaluate the electrical activity in the brain. Brain cells communicate with each other through electrical impulses. An EEG can be used to help detect potential problems associated with this activity.
An EEG tracks and records brain wave patterns. Small flat metal discs called electrodes are attached to the scalp with wires. The electrodes analyze the electrical impulses in the brain and send signals to a computer that records the results.
The electrical impulses in an EEG recording look like wavy lines with peaks and valleys. These lines allow doctors to quickly assess whether there are abnormal patterns. Any irregularities may be a sign of seizures or other brain disorders.
Why is an EEG performed?
An EEG is used to detect problems in the electrical activity of the brain that may be associated with certain brain disorders. The measurements given by an EEG are used to confirm or rule out various conditions, including:
- seizure disorders (such asepilepsy)
- head injury
- encephalitis(inflammation of the brain)
- brain tumor
- encephalopathy(disease that causes brain dysfunction)
- memory problems
- sleep disorders
Are there risks associated with an EEG?
There are no risks associated with an EEG. The test is painless and safe.
Some EEGs do not include lights or other stimuli. If an EEG does not produce any abnormalities, stimuli such as strobe lights, or rapid breathing may be added to help induce any abnormalities.
When someone has epilepsy or another seizure disorder, the stimuli presented during the test (such as a flashing light) may cause a seizure. The technician performing the EEG is trained to safely manage any situation that might occur.
How do I prepare for an EEG?
Before the test, you should take the following steps:
Wash your hair the night before the EEG, and don’t put any products (like sprays or gels) in your hair on the day of the test.
Ask your doctor if you should stop taking any medications before the test. You should also make a list of your medications and give it to the technician performing the EEG.
Avoid eating or drinking anything containing caffeine for at least eight hours before the test.
Your doctor may ask you to sleep as little as possible the night before the test if you have to sleep during the EEG. You may also be given a sedative to help you relax and sleep before the test begins.
After the EEG is over, you can continue with your regular routine. However, if you were given a sedative, the medication will remain in your system for a little while. This means that you’ll have to bring someone with you so they can take you home after the test. You’ll need to rest and avoid driving until the medication wears off.
What can I expect during an EEG?
An EEG measures the electrical impulses in your brain by using several electrodes that are attached to your scalp. An electrode is a conductor through which an electric current enters or leaves. The electrodes transfer information from your brain to a machine that measures and records the data.
Specialized technicians administer EEGs at hospitals, doctor’s offices, and laboratories. The test usually takes 30 to 60 minutes to complete, and involves the following steps:
You’ll lie down on your back in a reclining chair or on a bed.
The technician will measure your head and mark where to place the electrodes. These spots are scrubbed with a special cream that helps the electrodes get a high-quality reading.
The technician will put a sticky gel adhesive on 16 to 25 electrodes, and attach them to spots on your scalp.
Once the test begins, the electrodes send electrical impulse data from your brain to the recording machine. This machine converts the electrical impulses into visual patterns that appear on a screen. A computer saves these patterns.
The technician may instruct you to do certain things while the test is in progress. They may ask you to lie still, close your eyes, breathe deeply, or look at stimuli (such as a flashing light or a picture).
After the test is complete, the technician will remove the electrodes from your scalp.
During the test, very little electricity passes between the electrodes and your skin, so you’ll feel very little to no discomfort.
In some instances, a person may undergo a 24-hour EEG. These EEGs use video to capture seizure activity. The EEG may show abnormalities even if the seizure does not occur during the test. However, it does not always show past abnormalities related to seizure.
What do the EEG test results mean?
A neurologist (someone who specializes in nervous system disorders) interprets the recordings from the EEG and then sends the results to your doctor. Your doctor may schedule an appointment to go over the test results with you.
Electrical activity in the brain appears in an EEG as a pattern of waves. Different levels of consciousness, like sleeping and waking, have a specific range of frequencies of waves per second that are considered normal. For example, the wave patterns move faster when you’re awake than when you’re asleep. The EEG will show if the frequency of waves or patterns are normal. Normal activity typically means you don’t have a brain disorder.
Abnormal EEG results may be due to:
- epilepsy or another seizure disorder
- abnormal bleeding orhemorrhage
- sleep disorder
- encephalitis (swelling of the brain)
- dead tissue due to a blockage of blood flow
- alcoholor drug abuse
- head injury
It’s very important to discuss your test results with your doctor. Before you review the results, it may be helpful to write down any questions you might want to ask. Be sure to speak up if there’s anything about your results that you don’t understand.
Neurologists may use other types of tests, as well. Although they may not perform the test, they may order it, review it, and interpret the results.
To make a diagnosis, a neurologist may use imaging tests such as:
A computerized tomography scan (CT or CAT scan) uses computers and rotating X-ray machines to create cross-sectional images of the body. These images provide more detailed information than normal X-ray images. They can show the soft tissues, blood vessels, and bones in various parts of the body. A CT scan may be used to visualize the:
During a CT scan, you lie in a tunnel-like machine while the inside of the machine rotates and takes a series of X-rays from different angles. These pictures are then sent to a computer, where they’re combined to create images of slices, or cross-sections, of the body. They may also be combined to produce a 3-D image of a particular area of the body.
Why Is a CT Scan Performed?
A CT scan has many uses, but it’s particularly well-suited for diagnosing diseases and evaluating injuries. The imaging technique can help your doctor:
- diagnose infections, muscle disorders, and bone fractures
- pinpoint the location of masses and tumors (including cancer)
- study the blood vessels and other internal structures
- assess the extent of internal injuries and internal bleeding
- guide procedures, such as surgeries and biopsies
- monitor the effectiveness of treatments for certain medical conditions, including cancer and heart disease
The test is minimally invasive and can be conducted quickly.
How Is a CT Scan Performed?
Your doctor may give you a special dye called a contrast materialto help internal structures show up more clearly on the X-ray images. The contrast material blocks X-rays and appears white on the images, allowing it to highlight the intestines, blood vessels, or other structures in the area being examined. Depending on the part of your body that’s being inspected, you may need to drink a liquid containing the contrast. Alternatively, the contrast may need to be injected into your arm or administered through your rectum via an enema. If your doctor plans on using a contrast material, they may ask you to fast for four to six hours before your CT scan.
When it comes time to have the CT scan, you’ll be asked to change into a hospital gown and to remove any metal objects. Metal can interfere with the CT scan results. These items include jewelry, glasses, and dentures. Your doctor will then ask you to lie face up on a table that slides into the CT scanner. They’ll leave the exam room and go into the control room where they can see you and hear you. You’ll be able to communicate with them via an intercom.
While the table slowly moves you into the scanner, the X-ray machine will rotate around you. Each rotation produces numerous images of thin slices of your body. You may hear clicking, buzzing, and whirring noises during the scan. The table will move a few millimeters at a time until the exam is finished. The entire procedure may take anywhere from 20 minutes to one hour.
Magnetic resonance imaging (MRI) of the head is a painless, noninvasive test that produces detailed images of your brain and brain stem. An MRI machine creates the images using a magnetic field and radio waves. This test is also known as a brain MRI or a cranial MRI. You will go to a hospital or radiology center to take a head MRI.
An MRI scan is different from a CT scan or an X-ray in that it doesn’t use radiation to produce images. An MRI scan combines images to create a 3-D picture of your internal structures, so it’s more effective than other scans at detecting abnormalities in small structures of the brain such as the pituitary gland and brain stem. Sometimes a contrast agent, or dye, can be given through an intravenous (IV) line to better visualize certain structures or abnormalities.
Why do I need a head MRI?
A head MRI is a useful tool for detecting a number of brain conditions, including:
- aneurysms, or bulging in the blood vessels of the brain
- multiple sclerosis
- spinal cord injuries
- hydrocephalus, a buildup of spinal fluid in the brain cavities
- hormonal disorders, such asacromegaly and Cushing’s syndrome
- hemorrhage, or bleeding
- problems with development or structure (such as aChiari malformation)
- blood vessel issues
- an issue due to a previous head injury
A head MRI can help determine whether you sustained any damage from a stroke or head injury. Your doctor may also order a head MRI to investigate symptoms such as:
- changes in thinking or behavior
- blurry vision
- chronic headaches
These symptoms may be due to a brain issue, which an MRI scan can help detect.
A functional MRI (fMRI) of the brain is useful for people who might have to undergo brain surgery. An fMRI can pinpoint areas of the brain responsible for speech and language, and body movement. It does this by measuring metabolic changes that take place in your brain when you perform certain tasks. During this test, you may need to carry out small tasks, such as answering basic questions or tapping your thumb with your fingertips.
Additionally, there is a type of MRI called magnetic resonance angiography (MRA), which better examines the blood vessels in the brain.
How do I prepare for a head MRI?
The medical staff will need to know if you have any metal in your body, including:
- inner ear implants
- artificial joints
- a defibrillator or pacemaker
- particular types of heart valves
- vascular stents
- brain aneurysm clips
They’ll also ask whether you’ve ever worked with sheet metal or been injured with metal shrapnel. All of these things can affect how safely you can undergo an MRI. In the case of implants and pacemakers, those items can stop working properly due to an MRI’s powerful magnetic field.
If you’re wearing anything that contains metal, including jewelry or sunglasses, you will need to remove those items. Metal interferes with the MRI machine’s ability to produce a clear image. Braces and dental fillings typically won’t pose a problem, but pocketknives, pens, pins, and certain dental appliances can interfere. The staff may ask you to wear a hospital gown or clothing that doesn’t contain metal fasteners. You can’t have electronic devices in the MRI room.
Tell the medical staff if you’re pregnant. An MRI’s magnetic field affects unborn children in a way that isn’t yet fully understood.
Additionally, it’s important to let the staff know if you have claustrophobia. If so, you might need to take sedatives during the exam or have an “open” MRI. Open MRI machines have wider tunnels, which tend to be more tolerable for claustrophobic patients.
What is the procedure for a head MRI?
During the exam, it’s important to stay still to obtain the clearest images. Children who have difficulty staying still may need sedation, administered either orally or through an IV line. Sedation can also be helpful for adults who are claustrophobic.
You will lie down on a table that slides into the MRI machine. The table slides through a large magnet shaped like a tube. You may have a plastic coil placed around your head. After the table slides into the machine, a technician will take several pictures of your brain, each of which will take a few minutes. There will be a microphone in the machine that allows you to communicate with staff.
The test normally takes 30 to 60 minutes. You may receive a contrast solution, usually gadolinium, through an IV to allow the MRI machine to see certain parts of your brain more easily, particularly your blood vessels. The MRI scanner will make loud banging noises during the procedure. You may be offered earplugs to block the MRI machine’s noises, or you may listen to music during the test.
There are no risks associated with an MRI itself. There is a very slight chance that you will have an allergic reaction to a contrast solution. Tell the medical staff if you have decreased kidney function. It may not be safe to use contrast solution if this is the case.
What happens after a head MRI?
After the test, you can get dressed and leave the testing facility. If you were sedated for the exam, staff may move you to a recovery area until you wake up — usually one to two hours after you received the sedative.
A radiologist will analyze your MRI images and provide your doctor with the results. Your results will be available quickly if your head MRI was an emergency procedure.
Next steps will depend on whether the results revealed anything unusual or discovered the cause of any abnormalities.
A brain positron emission tomography (PET) scan is an imaging test that allows doctors to see how your brain is functioning.
The scan captures images of the activity of the brain after radioactive “tracers” have been absorbed into the bloodstream. These tracers are “attached” to compounds like glucose (sugar). Glucose is the principal fuel of the brain.
Active areas of the brain will be utilizing glucose at a higher rate than inactive areas. When highlighted under a PET scanner, it allows doctors to see how the brain is working and helps them detect any abnormalities.
It’s typically an outpatient procedure. This means you’ll be able to go about your day after the test is complete.
Why is a brain PET scan performed?
The test accurately details the size, shape, and function of the brain.
Unlike other scans, a brain PET scan allows doctors a view of not only the structure of the brain, but how it’s functioning as well.
This allows doctors to:
- check for cancer
- determine ifcancer has spread to the brain
- diagnose dementias, includingAlzheimer’s disease
- differentiate betweenParkinson’s disease and other conditions
- prepare forepilepsy surgery
Your doctor may have you undergo a brain PET scan regularly if you’re undergoing treatment for brain disorders. This can help them monitor the success of your treatment.
How to prepare for a brain PET scan
Your doctor will provide you with complete instructions to help you prepare for your brain PET scan.
Alert your doctor to any medications you may be taking, whether they’re prescription, over the counter, or even nutritional supplements.
You may be instructed not to eat anything for up to eight hours before your procedure. You will be able to drink water.
Tell your doctor if you’re pregnant or believe you could be pregnant. The test might be unsafe for your fetus.
You should also tell your doctor about any medical conditions you may have. For example, people with diabetes will likely be given special instructions for the test. Fasting beforehand could negatively affect their blood sugar levels.
Immediately before the test, you may be asked to change into a hospital gown and remove all of your jewelry.
Of course, you want to plan your day around your appointment as well.
How a brain PET scan is performed
You’ll be brought into the procedure room and seated in a chair. A technician will insert an intravenous catheter (IV) into your arm. A special dye with radioactive tracers will be injected into your veins through this IV.
Your body needs time to absorb the tracers as blood flows through the brain, so you’ll wait before the scan begins. This typically takes about an hour.
Next, you’ll undergo the scan. This involves lying on a narrow table attached to the PET machine, which looks like a giant toilet paper roll. The table glides slowly and smoothly into the machine so the scan can be completed.
You will have to lie still during the scans. The technician will tell you when you need to remain motionless.
The scans record brain activity as it’s happening. These can be recorded as video or as still images. The tracers are concentrated in areas of increased blood flow.
When the desired images are stored in the computer, you’ll exit the machine. The test is then complete.
Following up after a brain PET scan
It’s a good idea to drink plenty of fluids after the test to help flush the tracers out of your system. Generally all tracers are out of your body after two days.
Other than that, you’re free to go about your life unless your doctor gives you other instructions.
Meanwhile, a specialist trained in reading PET scans will interpret the images and share the information with your doctor. Your doctor will then go over the results at a follow-up appointment.
Interpreting the results of a brain PET scan
The images of brain PET scans appear as multicolored images of the brain, ranging from dark blue to deep red. Areas of active brain activity come up in warmer colors, such as yellow and red.
Your doctor will look at these scans and check for abnormalities.
For example, a brain tumor will show up as darker spots on the PET scan. A person with Alzheimer’s and other forms of dementia will have larger-than-normal portions of their brain appear darker on the scan.
In both of these cases, the dark areas signify areas of the brain that are impaired.
Your doctor will go over your personal scan to explain what the results mean and what will be the next course of action.
The risks of a brain PET scan
While the scan does use radioactive tracers, the exposure is minimal. It’s too low to affect the normal processes of the body.
The risks of the test are minimal compared with how beneficial the results can be.
However, radiation is believed to be unsafe for fetuses, so women who are pregnant, think they may be pregnant, or are nursing should not undergo a brain PET scan or any other kind of PET scan.
Other risks include uncomfortable feelings, if you are claustrophobic or anxious about needles.
Other diagnostic procedures include sleep studies and angiography. Angiography determines blockages in the blood vessels going to the brain.
Polysomnography (PSG) is a study or test done while you’re fully asleep. A doctor will observe you as you sleep, record data about your sleep patterns, and may identify any sleep disorders.
During a PSG, the doctor will measure the following to help chart your sleep cycles:
A sleep study registers your body’s shifts between the stages of sleep, which are rapid eye movement (REM) sleep, and non-rapid eye movement (non-REM) sleep. Non-REM sleep is divided into “light sleep” and “deep sleep” phases.
During REM sleep, your brain activity is high, but only your eyes and breathing muscles are active. This is the stage in which you dream. Non-REM sleep involves slower brain activity.
A person without a sleep disorder will switch between non-REM and REM sleep, experiencing multiple sleep cycles per night.
Observing your sleep cycles, along with your body’s reactions to the changes in these cycles, can help identify disruptions in your sleep patterns.
Why do I need a polysomnography?
A doctor can use a polysomnography to diagnose sleep disorders.
It often evaluates for symptoms of sleep apnea, a disorder in which breathing constantly stops and restarts during sleep. The symptoms of sleep apnea include:
- sleepiness during the day despite having rested
- ongoing and loudsnoring
- periods of holding your breath during sleep, which are followed by gasps for air
- frequent episodes ofwaking up during the night
- restless sleep
Polysomnography can also help your doctor diagnose the following sleep disorders:
- narcolepsy, which involves extreme drowsiness and “sleep attacks” during the day
- sleep-relatedseizure disorders
- periodic limb movement disorder orrestless legs syndrome, which involves uncontrolled flexing and extension of the legs while asleep
- REM sleep behavior disorder, which involves acting out dreams while asleep
- chronicinsomnia, which involves having difficulty falling asleep or remaining asleep
warns that if sleep disorders go untreated, they can raise your risk of:
There’s also a link between sleep disorders and an increased risk of injuries related to falling and car accidents.
How do I prepare for a polysomnography?
To prepare for a PSG, you should avoid consuming alcohol and caffeine during the afternoon and evening of the test.
Alcohol and caffeine can affect sleep patterns and some sleep disorders. Having these chemicals in your body could impact your results. You should also avoid taking sedatives.
Remember to discuss any medications you’re taking with your doctor in case you need to stop taking them before the test.
What happens during a polysomnography?
A polysomnography typically takes place at a specialized sleep center or a major hospital. Your appointment will begin in the evening, about 2 hours before your usual bedtime.
You’ll sleep overnight at the sleep center, where you’ll stay in a private room. You can bring whatever is necessary for your bedtime routine, as well as your own pajamas.
A technician will administer the polysomnography by monitoring you as you sleep. The technician can see and hear inside your room. You’ll be able to hear and talk to the technician during the night.
During the polysomnography, the technician will measure your:
- brain waves
- eye movements
- skeletal muscle activity
- heart rate and rhythm
- blood pressure
- blood oxygen level
- breathing patterns, including absence or pauses
- body position
- limb movement
- snoring and other noises
To record this data, the technician will place small sensors called “electrodes” on your:
The sensors have adhesive patches so they’ll stay on your skin while you sleep.
Elastic belts around your chest and stomach will record your chest movements and breathing patterns. A small clip on your finger will monitor your blood’s oxygen level.
The sensors attach to thin, flexible wires that send your data to a computer. At some sleep centers, the technician will set up equipment to make a video recording.
This will allow you and your doctor to review the changes in your body position during the night.
It’s likely you won’t be as comfortable at the sleep center as you would be in your own bed, so you may not fall asleep or stay asleep as easily as you would at home.
However, this usually doesn’t alter the data. Accurate polysomnography results normally don’t require a full night’s sleep.
When you wake up in the morning, the technician will remove the sensors. You may leave the sleep center and participate in normal activities the same day.
What are the risks associated with it?
Polysomnography is painless and noninvasive, so it’s relatively free of risks.
You may experience slight skin irritation from the adhesive that attaches the electrodes to your skin.
What do the results mean?
It may take up to about 3 weeks to receive the results of your PSG. A technician will compile the data from the night of your sleep study to graph your sleep cycles.
A sleep center doctor will review this data, your medical history, and your sleep history to make a diagnosis.
If your polysomnography results are abnormal, it may indicate the following sleep-related illnesses:
- sleep apnea or other breathing disorders
- seizure disorders
- periodic limb movement disorder or other movement disorders
- narcolepsy or other sources of unusualdaytime fatigue
To identify sleep apnea, your doctor will review the results of the polysomnography to look for:
- the frequency of apnea episodes, which occur when breathing stops for 10 seconds or longer
- the frequency ofhypopnea episodes, which occur when breathing is partially blocked for 10 seconds or longer
With this data, your doctor can measure your results with the apnea-hypopnea index (AHI). An AHI score lower than 5 is normal.
This score, along with normal brain wave and muscle movement data, usually indicates that you don’t have sleep apnea.
An AHI score of 5 or higher is considered abnormal. Your doctor will chart abnormal results to show the degree of sleep apnea:
- An AHI score of 5 to 15 indicates mild sleep apnea.
- An AHI score of 15 to 30 indicates moderate sleep apnea.
- An AHI score greater than 30 indicatessevere sleep apnea.
What happens after a polysomnography?
If you receive a sleep apnea diagnosis, your doctor may recommend that you use a continuous positive airway pressure (CPAP) machine.
This machine will provide a constant air supply to your nose or mouth while you sleep. A follow-up polysomnography may determine the right CPAP setting for you.
If you receive a diagnosis of another sleep disorder, your doctor will discuss your treatment options with you.
Your neurologist may help you manage your symptoms and neurological disorder alone, or with your primary care physician and other specialists.