Becoming 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.
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:
- coordination problems
- muscle weakness
- a change in sensation
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:
- seizure disorders, such as epilepsy
- multiple sclerosis
- neuromuscular disorders, such as myasthenia gravis
- infections of the nervous system, including encephalitis, meningitis, or brain abscesses
- neurodegenerative disorders, such as Lou Gehrig’s disease and Alzheimer’s disease
- spinal cord disorders, including inflammatory and autoimmune disorders
- headaches, such as cluster headaches, and migraine
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.
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.
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.
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.
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.
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:
- computed tomography, or CT scan
- magnetic resonance imaging, or MRI scan
- positron emission tomography, or PET scan
Other diagnostic procedures include sleep studies and angiography. Angiography determines blockages in the blood vessels going to the brain.
Your neurologist may help you manage your symptoms and neurological disorder alone, or with your primary care physician and other specialists.
- AAN position: Definition of neurology subspecialty. (2012). aan.com/policy-and-guidelines/policy/position-statements/definition-of-neurology-subspecialty/
- Electromyography (EMG). (n.d.). urmc.rochester.edu/highland/departments-centers/neurology/tests-treatments/emg.aspx
- Neurological diagnostic tests and procedures fact sheet. (2018). ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Neurological-Diagnostic-Tests-and-Procedures-Fact
- What is a neurologist? (n.d.). urmc.rochester.edu/highland/departments-centers/neurology/what-is-a-neurologist.aspx