Medical history and neurological examination provide the basis for a proper diagnosis. In order to provide you with the best possible care, a comprehensive analysis of your current complaints alongside your past medical history and your life situation may be necessary. After neurological examination, I can determine which further examinations are indicated. Many of these can be offered directly in my private practice, for others I would like to refer you to specialist colleagues.
The following additional examinations are often used in neurological diseases:
Sonography / Duplex sonography of brain-supplying vessels
For the assessment of the brain-supplying arteries both in the neck area ("extracranial") and in the cranium ("intracranial"), color-coded duplex sonography is used. With its means blood flow and the vessel wall texture can be judged. Disturbances of blood flow (stenoses, vessel occlusions) and pathological changes of the vessel wall (plaques, broadening of the intima media thickness) are recorded and assessed to their extent.
Further, sonography is used in addition to neurography if an entrapment syndrome of peripheral nerve, e.g. carpal tunnel syndrome is suspected. Among others, thickenings of the cross section of a peripheral nerve can support the diagnosis of an entrapment syndrome.
Electroencephalography (EEG) is an essential part of epilepsy diagnostics. For this noninvasive exam, many scalp electrodes are placed to predefined areas of the head. EEG records electric activity of the brain by using voltage fluctuations resulting from ion currents in neurons. In addition to epilepsy diagnostics, Electroencephalography is of diagnostic importance also in disorders of consciousness and other neurological diseases (i.e. neurodegenerative diseases), but its results have to be interpreted in the context of all available medical information.
Evoked potentials (EPs)
The assessment of evoked potentials (EPs) is used to investigate different structures of the central and peripheral nervous system dedicated to specific sensory pathways. In order to examine the visual pathway, especially the optic nerve and optic tract, visually evoked potentials (VEPs) are derived, auditory evoked potentials (AEPs) are used for the examination of the auditory pathway. Sensory evoked potentials (SEPs) examine the function within structures dedicated to the transmission of sensory inputs, usually from the skin. For assessment of central motor pathways motor evoked potentials (MEPs) are recorded by transcranial magnetic stimulation of the motor cortex. The underlying principle in generating EPs is a repeated stimulation with precisely defined stimuli of the pathway examined and an averaging of the responses of the nerve structures involved in information processing.
Neurography ("Nerve conduction study") and Electromyography (EMG)
In neurography, a peripheral nerve is stimulated with slight electrical impulses by means of a surface electrode attached to the skin, and the nerve response is determined with regard to the nerve conduction velocity (NLG) and amplitude. Both sensory and motor nerves can be examined by neurography. It is mainly used for suspected polyneuropathy or entrapment syndromes such as carpal tunnel syndrome.
Electromyography (EMG) records electrical activity produced by a skeletal muscle. For this purpose, a thin, sterile needle electrode is placed at different points of the muscle under investigation. The examination is performed both at rest and under slight and strong muscle contraction. Electromyography is an important examination in musculoskeletal disorders (myopathies) as well as in several peripheral nerve disorders, for example in disc herniation or polyneuropathy.
To determine disturbances of memory and cognition, structured testing is required in addition to a thorough assessment of your medical history. Standardized test panels are used to examine changes in concentration, attention or memory performance. In specific circumstances, a broader neuropsychological assessment performed by specially qualified neuropsychologists is warranted.
Lumbar puncture / Spinal tap
In the case of a lumbar puncture, a fine needle is used to obtain some milliliters of cerebrospinal fluid (CSF) from the spinal canal. The CSF is then examined extensively. Examination of CSF is particularly important in the suspicion of acute or chronic inflammation of the nervous system. It also plays a part in the diagnosis of dementia.
Radiological examinations (MRI, CT)
Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) are performed for imaging of the head or spine. These examinations are carried out by radiological practices in the region in close collaboration with me.
There are close links between disturbances of sleep and neurological symptoms or diseases. For example, obstructive sleep apnea is an established risk factor for ischemic stroke. However, memory impairments and fatigue may be a result of non-effective sleep. With the help of a handy device (WatchPAT) to be worn for one night many important physiological parameters as oxygen saturation, sleep cycles and snoring can easily be assessed.