Neurological consultations

Multiple sclerosis (MS) is the most common disease of the central nervous system in young adults in our latitudes. It is a chronic inflammatory disease in which the immune system is directed against its own nerve cells and their sheathing. In most cases, it is characterised by acute flare-ups of the disease, which often regress spontaneously. If left untreated, the majority of patients experience further flare-ups, which are often followed by slow progression of the disease. Only in less than 15% of patients, the disease begins primarily progressively.

Typical symptoms include sensitivity disorders on the extremities, acute blurred vision in one eye due to inflammation of the optic nerve and motor disturbances such as gait disorders. Bladder disorder or concentration difficulties can also occur. It is very common for patients to experience a slight fatigue («chronic fatigue») and a worsening of symptoms in hot weather conditions.

The diagnosis is based on the detection of inflammatory centres in several places of the central nervous system (brain and spinal cord), which have occurred at different times. Already during the first episode of the disease, a therapy is advisable. Therefore, it is vital to have the diagnosis as early as possible and to start treatment quickly. By now there are a number of drugs that modulate the immune system and can prevent further flare-ups.

A stroke or cerebrovascular accident (CVA) occurs due to an acute circulatory disruption of the brain and neck arteries. Causes are usually vascular calcification or blood clots from the heart. Due to typical vascular risk factors such as elevated blood pressure, abnormal blood lipids, high blood sugar, smoking or lack of exercise, strokes usually only occur at an older age and are the most common cause of permanent neurological disability. However, young people can also become victim of strokes, e.g. due to heart defects, injury to the brain supplying arteries or rare genetic diseases.

The principal symptom is the sudden onset of a usually half-sided paralysis as well as sensory, visual and cognitive disturbances, dizziness and facial paralysis. A stroke, similar to a heart attack, is a medical emergency (even if there is usually no pain involved or symptoms recede by itself) and requires the immediate alerting of the emergency services. To rule out a cerebral haemorrhage, a computer tomography is always required. Specialised treatment centres (stroke units or stroke centres) try to restore cerebral circulation as quickly as possible (within a few hours, every minute counts!) or to limit the extent of the damage to the brain. Thereafter, intense rehabilitation treatment must be undergone in a specialised neuro-rehabilitation clinic. Treatments include physiotherapy, occupational therapy, speech therapy, neuropsychological training, measures for reintegration and prevention for recurrence of strokes. Medical conditions after stroke include chronic paralysis and disability, pain and epileptic seizures.

Prevention of stroke is primarily possible through control of the above risk factors from an early stage and should preferably begin at adolescence. Migraine patients have a slightly increased risk of stroke, but frequent auras practically never lead to permanent damage. However, when a migraine aura occurs for the first time, the distinction from a stroke is sometimes difficult to draw.

Act immediately!
If a stroke or a TIA (transient ischemic attack) is suspected, immediate medical attention is absolutely necessary. Emergency services can be reached under tel. 144 or +41 44 387 39 99 (Hirslanden Klinik Zürich stroke emergency).

Muscle and nerve diseases, so-called neuromuscular diseases, can affect people at any age. Neuromuscular diseases are often chronic and can lead to physical restrictions such as fatigue, paralysis, muscle atrophy or changes of sensitivity in those affected. In addition to the muscles themselves, neuromuscular diseases can also affect the nerves, which are supplying the muscle or the signal transmission from the nerve to the muscle. Some neuromuscular diseases are congenital or inherited, others occur due to inflammation, metabolic disorders or neurodegenerative diseases. A total of over 800 different neuromuscular diseases are known to this day. The diagnosis must be carefully in order to be able to properly treat the cause of the disease.

An epileptic seizure leads to excessive electrical discharge of large groups of nerve cells in the brain. Depending on the affected brain region, the symptoms can consist of motor symptoms such as muscle spasms or twitches, sensitivity disorders such as tingling or disorders of higher brain functions such as speaking. Stand-alone symptoms such as salivation or wetting, but also cardiac arrhythmias are not uncommon. If larger areas of the brain are affected, a clouding of consciousness or a sudden complete loss of consciousness occurs and can therefore lead to falls or accidents, among other things.

In principle, every brain can suffer an epileptic seizure due to triggering factors such as alcohol (withdrawal), medication or high fever, or also due to damage of all kinds (including traumatic brain injury, stroke, brain inflammation, hypoglycaemia). If seizures occur on a consistently high level of frequency, one speaks of an epilepsy, which can often have genetic causes. With appropriate diagnostics, about 2/3 of patients manage to stop having seizures thanks to the appropriate medication. For some patients, brain surgery can stop the seizures permanently. However, this procedure is highly complex and requires sophisticated diagnostics and surgical expertise, which only a specialised centre can offer.

Sleeping disorders are among the most common health issues in industrialised countries. Around one in four adults suffers from sleeping disorders. One speaks of a sleeping disorder when sleep is too short or too long, frequently interrupted or not recuperative. A sleeping disorder can also be present when severe daytime tiredness or sleepiness occur.

Everyone sleeps badly at times and this is not yet a cause for concern. However, a medical assessment should be carried out if the condition becomes chronic, i.e. if the person concerned sleeps poorly for at least three nights a week over a period of at least one month.

According to ICSD-3 (International Classification of Sleep Disorders) sleeping disorders are divided into 6 groups:

  • Insomnia: This refers to sleep disturbances and major sleeping disorders. If the affected person needs more than 30 minutes to fall asleep, one speaks of a sleeping disorder. In the case of sleep-maintenance insomnia, the affected person often wakes up and can only fall asleep with difficulty. This form of sleeping disorder also includes waking up early, when the affected person wakes up too early in the morning and cannot fall asleep again.
  • Hypersomnia: This refers to a strong daytime sleepiness. Despite getting enough sleep, the affected person suffers from extreme daytime tiredness and has an increased need for sleep.
  • Parasomnia: Parasomnia refers to behavioural abnormalities during sleep such as sleepwalking, teeth grinding or nightmares.
  • Circadian Rhythm Sleep Disorder (CRSD): With this type of sleeping disorder, the sleep rhythm shifts, with delayed or early sleep phases. This can be the result of poor sleep hygiene, untreated depression, time difference (jet lag) or shift work.
  • Sleep-related breathing disorders: Sleep can be disturbed by sleep-related breathing disorders such as short respiratory failures and snoring. This is the case, for example, with sleep apnoea syndrome.
  • Sleep-related movement disorders: Movement disorders such as restless legs syndrome (restless legs) can negatively affect falling asleep. Periodic limb movement disorder (periodic movements of limbs during sleep) can also interfere with falling asleep.

Good quality of sleep with sufficient sleep duration is vital for well-being and performance levels. If a person suffers from a sleeping disorder for a long time, it will affect his physical and mental performance. As a result, cardiovascular diseases, diabetes, muscle tension, increased irritability, mood swings, increased anxiety and impaired ability to concentrate may occur. If you suffer from sleeping problems, it is therefore important to act quickly before the situation gets worse.

Dementia is the loss of already acquired intellectual abilities. Memory is often the first to be affected, but so-called executive functions such as planning, judgment and problem solving can also be leading symptoms. Pains of those affected or their relatives can therefore be very differing. The spectrum can range from the preliminary stage of mild cognitive impairment with deficits that are barely noticeable in daily life to complete helplessness and a need for care. The most common causes of dementia are degenerative processes such as Alzheimer’s disease or vascular calcification of the cerebral arteries. They worsen with age and are therefore an increasing medical and social problem in an aging society.

A large number of metabolic diseases or inflammations can lead to an, at times, well-treatable dementia, but the differentiation from depression («pseudo-dementia») is not always easy. Therefore, a careful diagnosis, usually involving brain imaging, blood and neuropsychological tests, is necessary to make precise diagnosis.

Neurovascular diseases describe the impairment of nerve tissue due to damage or abnormalities of the blood vessels. The most important of these diseases is a stroke, which was induced by a narrowing or an occlusion of a brain supplying vessels (inside or outside the brain). Depending on the supply area of the affected vessel, the duration of the interrupted blood supply and the presence of any bypass circuits, stroke symptoms can vary greatly or even be absent.

Main symptoms are sudden (half-sided) weakness, sensitivity disorders or visual loss as well as disorders of the higher brain functions (e.g. language). If a stroke is suspected, every minute counts and emergency services (Tel 144 or +41 44 387 39 99 for Hirslanden Klinik Zürich stroke emergency) must be called immediately.

The patient can then be taken to an emergency care facility (so-called stroke unit or stroke centre), where vessels, that may have been closed, can be reopened by using highly specialised procedures. Also, it may be possible to keep the level of damage to the brain tissue as low as possible through optimising blood pressure, body temperature, blood composition etc. An outpatient examination is usually not helpful and only results in unnecessary loss of time, since imaging of the brain (CT or MRI) is required in most of the cases.

Cerebral haemorrhages due to the rupture of a blood vessel, a vascular malformation or vascular sagging are also categorised as neurovascular diseases. The main symptom of cerebral bleeding in the area of the meninges (so-called subarachnoid bleeding, SAB) is the sudden thunderclap headache (lasting seconds to minutes), often with subsequent neck stiffness and accompanying paralysis. Again, this is a life-threatening emergency with the need of immediate calling of emergency services.

However, migraine can also be counted among the neurovascular diseases in the broader sense, since migraine attacks can very well lead to changes in blood circulation and (practically always reversible) neurological symptoms such as visual loss, sensitivity disorders or paralysis. In the so-called familial hemiplegic migraine, stroke-like symptoms develop due to a genetic defect, which are usually followed by a specific form of headache. In this case, characteristics are the family history and the uniformity of the attacks. At first occurrence of this clinical pathology, it is necessary to proceed the same way as when a stroke is suspected (Emergency services Tel 144 or +41 44 387 39 99 for Hirslanden Klinik Zürich stroke emergency).

Parkinson’s disease stems from a degeneration of dopamine-producing cells in the midbrain and is a disease of older age, but can rarely also occur at the age of adolescence. Symptoms include a progressively reduced mobility of limbs and trunk (hypokinesis), a characteristically increased muscle tension (rigor) and a coarse tremor at rest (tremor), whereby typically one half of the body is initially significantly more affected.

Already in the early phase of the disease, non-motor symptoms such as sleeping disorders with nightmares and progressive loss of the sense of smell occur. At a late stage, mental disorders such as increased impulsivity, autonomic disorders such as bladder dysfunction or dementia can manifest. Parkinson’s disease can often be treated quite well over the years with medication or neurostimulation. However, other diseases can initially have a similar clinical appearance, but must be distinguished carefully.

Dizziness is one of the most common symptoms with which general practitioners and neurologists are being consulted. In general, dizziness occurs when the brain receives information from sensory impressions that do not match. Most typically, conflicting information stems from sensory organs of the inner ear and the eyes. A typical example of such a mechanism is seasickness or strongly moving images at the movie theatre. A blood circulation or/and metabolism disorder as well as a disturbance of electrical processes in the area responsible for information processing in the brain stem can also be the cause for dizziness (e.g. drop in blood sugar levels, strong fluctuations in blood pressure, stroke or after alcohol, drugs or medication intake). Mental processes, especially fears, are often also triggers for dizziness.

Through a careful assessment of the medical history (vertigo, triggering situations, duration, accompanying symptoms) and neurological examination with special attention to eye movement and balance, the cause of dizziness can often be found out. Depending on the cause, the therapy can be very differing and consists of positioning exercises, physiotherapy, medication or psychotherapy.