When an elderly patient described a bout of sudden, temporary blindness he’d experienced recently, alarm bells went off for Dr. Joann Carcaterra. “He’d been watching TV, and all of a sudden he couldn’t see out of one eye for 15 seconds. Otherwise he felt fine; he was almost matter-of-fact about it. I was concerned he’d had a ministroke — a transient ischemic attack,” notes Carcaterra, a family practice doctor with Mt. Sinai Doctors Five Towns in Hewlett, New York.
Carcaterra immediately referred her patient to a neurologist. “It turned out that he did have a ministroke and had some blockage in his carotid artery. He needed surgery to avoid a stroke,” Carcaterra says.
Such life-threatening conditions — and plenty of other illnesses — are common reasons to be referred to a neurologist, who can diagnose and treat conditions related to the brain, spinal cord and nerves throughout the body.
Reasons for Being Referred to a Neurologist
You’ll typically be referred to a neurologist by a primary care provider who’s already considered your symptoms and medical history, done a thorough exam, looked for underlying conditions, ordered laboratory tests or imaging and still feels treatment or diagnosis needs further investigation.
Common reasons why you might be referred to a neurologist include:
— Epileptic seizures.
— Sleep issues.
Ministrokes. A transient ischemic attack is a temporary blockage of blood flow to the brain and is often a warning for a major stroke. You may experience minor symptoms like Carcaterra’s elderly patient, or you may experience more severe signs. “Visual changes, slurred speech, confusion, imbalance, walking difficulty — even if they only last a few seconds, all of those are something where I’d wonder if this person is having multiple TIAs,” Carcaterra says.
Headaches. “If someone has a headache that’s occasional and they can manage it — they rest, lie down, maybe take an over-the-counter painkiller and it goes away — it’s probably fine. But if they keep coming in with migraines, cluster headaches or tension headaches, I’ll send them to the headache specialist,” Carcaterra says. Note: Sudden, severe headache pain accompanied by other symptoms (confusion, weakness, facial drooping or slurred speech) could indicate a major stroke and should prompt a call to 911.
Epileptic seizures. There are many types of seizures. They may cause someone to fall, lose awareness, pass out or simply stare into space. “There was one particular lady who was referred to me by a primary care doctor who thought she was mentally troubled. The history was that she would get up each morning, have breakfast and repetitively butter her toast over and over again, for several minutes at a time. The lady was having seizures,” says Dr. Bernard Gran, a neurologist with the Miami Neuroscience Institute.
Back problems. Spine compression — from bone overgrowth or a collapsed spinal disc, for example — can irritate nerves and cause neuropathy, or it may cause pain that radiates down the leg. “If someone has back problems and neuropathic symptoms that are really impacting his life, I’ll send the person to a neurologist,” Carcaterra says.
Memory problems. If you are experiencing memory difficulty, your primary care provider can conduct a mini-screening to determine if you should be referred to a neurologist. “I have a lot of elderly patients in my practice, and many are concerned because they can’t remember certain words. That may not trigger a referral. But if a person is really concerned about it — or someone in his 70s isn’t recognizing a grandchild he sees three times a week — that will trigger my referral,” Carcaterra explains.
Dizziness. Dizziness describes a feeling of unsteadiness, imbalance, nausea or lightheadedness. You might be referred to a neurologist if dizziness is unexplained, recurrent or accompanied by other symptoms. “If it’s severe or if they get headaches or vomit or they’re incapacitated with it, I’m sending the person to the neurologist,” Carcaterra says.
Sleep issues. A relatively small but growing number of neurologists also practice sleep medicine, says Dr. Brijesh Malkani, a clinical assistant professor of neurology with Mount Sinai Doctors. He’s based in Westchester, New York.
Many of these doctors have completed specialist training and are able to manage an array of sleep-related disorders, including:
— Restless leg syndrome.
— Sleep apnea.
Sleep apnea, in particular, can cause significant negative effects on someone’s cardiovascular health, Malkani says.
Adequately treating the condition can, in turn, help manage these conditions:
— High blood pressure.
What Does a Neurologist Do?
When you’re referred to a neurologist, the doctor will review your medical records before your appointment. Records can include tests your primary care provider has already ordered such as X-rays, CT scans or MRIs.
During your appointment, the neurologist will ask about your medical history and symptoms and conduct an examination. After that: “I come up with what’s called a differential diagnosis — based on these complaints, the patient’s history and physical examination,” Gran explains. “What are the possibilities? The job is to whittle down the differential diagnosis as to what is the actual problem in this particular patient, and this usually requires some testing,” Gran explains.
Imaging tests, like CT scans and MRIs, can be ordered by either a primary care physician or a neurologist, Malkani says. The same goes for blood work.
A neurologist may order additional tests, including:
— Tests to measure electrical activity in your nerves or brain.
— A cognitive exam.
— A spinal tap.
— A brain biopsy (in rare cases).
Once tests are completed, you’ll need another trip to see the neurologist. “I’ll discuss what I think you have, what probably caused it and where we need to go in terms of treatment,” Gran says.
Sometimes the neurologist may feel your symptoms aren’t related to a nerve or brain condition. In that case: “The patient comes back and you have to reevaluate and see where else we go with your symptoms,” Carcaterra says.
A Team Approach
If you are diagnosed with a neurological condition, you’ll be working with both your primary care provider and your neurologist to manage your condition. And it’s important that the two health experts communicate about their findings and recommendations to you. “It helps me to know exactly what the neurologist has diagnosed and how they’re treating the patient. And the neurologist may suggest that I follow up and check a patient’s blood work or order an X-ray,” Carcaterra says.
Communication usually happens by:
— Phone (if it’s urgent).
— Electronic medical records.
“Every time I see the patient, I generate a dictated note — whether it be the first one, which is a consult note, or a subsequent note for follow-up visits. Those notes go directly to the PCP, and all the information is safeguarded and encrypted,” Gran says.
In some cases, you may be referred to a neurologist who works in the same medical practice as your primary care provider. This helps streamline communication and access to your medical records among your health care providers.
What Should You Look for in a Doctor?
Because the neurologist’s take on your symptoms will help guide your primary care provider, it’s important to select the right doctor. Your primary care provider will likely have worked with many different health specialists before and have someone in mind when you are referred to a neurologist.
And remember that you also have a say about which expert you see.
Carcaterra and Gran say you’ll want someone who is:
— Board-certified in neurology.
— Experienced in treating people with your symptoms and potential condition.
— Willing to spend enough time with you at your appointment.
“People come to a neurologist and they are scared,” Gran says. “You have to be able to allay their fears and give them options so the patient no longer has to worry and can sleep easily.”
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Update 05/06/21: This article was previously published and has been updated with new information.