Initial consultations will take up to 40 minutes and will involve a full assessment of symptoms, neurological examination, arrangement of investigations, discussion of diagnosis and treatment options. Where appropriate, follow-up appointments will be arranged in order to discuss test results, response to treatment and future management.
Depending on clinical circumstances, Dr Chan will on occasion refer on to consultant colleagues for specialist management, such as neurosurgical intervention or inclusion in drug trials of novel therapies. As part of best diagnosis and management, Dr Chan benefits from multidisciplinary inputs from MRI experts, specialist nurses and therapists as well as close links with local GPs for long term care.
The basis of neurological diagnosis rests on detailed taking of the "history" of the onset and evolution of symptoms followed by a neurological examination. This traditional approach is designed to help the neurologist arrive at the correct anatomical ("where in the nervous system is the problem?") and pathological ("what is the nature of this problem?") diagnosis and in turn guide treatment and management decisions. This clinical diagnostic process is supplemented, when appropriate, by investigations including state of the art imaging, such as MRI, and electrical studies of nerve and muscle function.
The following represents some (but by no means all) typical neurological symptoms and their potential underlying causes.
Headache and facial pain.
Causes of headache include migraine, tension in the neck muscles, cluster headache, benign intracranial hypertension, medication overuse and sometimes structural abnormalities such as brain tumours or cysts. Facial pain can be caused by trigeminal neuralgia, sinusitis and temporomandibular joint dysfunction.
Numbness and/or tingling in hands and feet.
This could represent peripheral neuropathy (damage to the nerve endings) secondary to old age, medications, diabetes, vitamin and nutritional deficiency, sometimes alcohol overuse. Other causes could include damage to the spinal cord and diseases of peripheral nerves including inflammatory and metabolic disorders. Numbness and tingling can also be a feature of multiple sclerosis.
There are numerous causes of balance impairment including vertigo - a sense of abnormal movement such as rotation or swaying - secondary to migraine or an inner ear problem, damage to the brain's coordination system (aka cerebellar ataxia) or joint position sensing, blood vessel blockage in the brain (aka cerebrovascular disease), spinal cord problems and neurodegenerative disorders such as Parkinson's disease.
Slowing of movement may be due to cerebrovascular disease, Parkinson's disease or other neurodegenerative disorders such as progressive supranuclear palsy and multiple system atrophy. Involuntary movements includes tremor (causes include benign essential tremor, Parkinson's disease, thyroid disease and medication side effects), tics, myoclonic jerks and dystonia.
Arm or leg weakness.
Limb weakness can result from disorders of the central nervous system such as strokes and damage to the spinal cord and conditions affecting the peripheral nervous system such as trapping of the nerve roots, damage to the nerves (eg carpal tunnel syndrome, ulnar nerve entrapment), diseases of the motor nerves, the nerve-muscle junction (such as myasthenia gravis) or the muscles themselves (myopathies).
Nerve-related (or neuropathic) pain is often characterised by a burning discomfort. Such pains do not respond to over-the-counter medications such as aspirin or ibuprofen and require the use of specialist treatments. Neuropathic pain can be related to peripheral nerve disorders, but may also represent trapping of nerve roots or sometimes damage to the spinal cord.
Fits and faints.
Loss or impairment of consciousness can represent epilepsy and may sometimes (but not always) be associated with other symptoms such as limb shaking, tongue biting and prolonged disorientation on coming round. Partial seizures may be characterised by other symptoms such as a sense of disconnection, memory disturbance, an abnormal taste in the mouth or a sense of impending doom. Loss of consciousness can also be caused by cardiological disorders such as low blood pressure or abnormalities of the heart rhythm.
Abnormalities of vision (double vision, loss of vision, abnormal visual images) can arise from disorders of the eye and optic nerve, including eye muscle disorders and MS, and from diseases affecting the visual systems in the brain such as migraine and stroke.
Sleep disturbances may occur as a result of respiratory conditions such as sleep apnoea or uncomfortable sensations or movement of the legs (restless legs syndrome). A condition known as REM sleep behaviour disorder is characterised by physical enactment of vivid dreams and nightmares, such as shouting out or violent movements of the arms or legs (striking or kicking out). This symptom can sometimes be associated with the early stages of Parkinson's disease.