Neurological Disorders

A concussion is the mildest form of traumatic brain injury (TBI) and results in temporary loss of brain function. It is caused by events such as a fall, a blow to the head, a car accident, or forceful impact of the body that jar or shake the brain back and forth inside the skull.

• There are an estimated 3.8 million concussions each year in the U.S., but only 1 in 6 concussions is diagnosed.
• In many cases, there are no visible signs of head trauma.
• Symptoms of concussion include:
  • Headache
  • Confusion
  • Dizziness
  • Nausea or vomiting
  • Slurred speech
  • Fatigue
  • Double vision or blurred vision
  • Balance problems
  • Some people may experience a loss of smell or taste
  • Temporary loss of consciousness
  • Sleeping more or less than usual
• Recovery from a mild concussion may take only a few hours, but recovery from a severe concussion may take up to a few weeks.
• Your doctor or healthcare provider may do a general neurological exam to evaluate your vision, balance, coordination, and hearing. Your doctor may order imaging tests such as CT scan or an MRI to see if there is any bleeding or bruising.
• The best way to recover from a concussion is to physically and mentally rest. Physical activity should be minimized, especially if activity makes your symptoms worse. You may need to have shortened school or work days, or even stay home for a few days right after your injury.
• Your doctor or healthcare provider will monitor you for improvement and let you know when it is safe to increase physical activities or activities that involve thinking.
• You should not drive a car or operate machinery until your doctor or healthcare provider tells you it is safe to do so.

• A few of the causes of dementia include:
  • Alzheimer’s disease (the most common cause of dementia)
  • Dementia with Lewy Bodies
  • Frontotemporal dementia
  • Huntington’s disease
  • Normal pressure hydrocephalus
  • Vascular dementia
• Other conditions that can cause dementia or dementia-like symptoms including:
  • Reactions to medications
  • Metabolic problems
  • Endocrine abnormalities
  • Nutritional deficiencies
  • Infections
  • Depression
• Dementia may cause one or more of the following mental and physical impairments:
  • Poor reasoning and judgment
  • Memory problems or difficulty remembering conversations, names, or events
  • Difficulty communicating or speaking
  • Disorientation
  • Altered or poor visual perception
  • Inability to focus
  • Difficulty walking

• Treatment can help in cases where dementia is caused by a medical condition. Some medications can help slow the progression of certain types of dementia, such as that caused by Alzheimer’s, and combat various stages of symptoms.
• More information about dementia can be found at the Alzheimer’s Association.

Dystonia is a movement disorder in which faulty nerve signals from the brain cause repetitive, uncontrollable muscle contractions, sometimes in painful spasms.

• Often there is no cause for dystonia, but acquired dystonia can be related to damage in the basal ganglia in the brain caused by physical trauma, infection, or poisoning.
• It can occur as the result of a voluntary repetitive motion such as writing or swimming, or it can occur as a result of stress or fatigue.
• It may begin in either childhood, or in adulthood.
• Symptoms can range from mild to severe, and often progress through stages.
• Dystonia is classified by the affected body parts:
  • Generalized affects most of or all of the body
  • Focal affects just a specific body part
  • Multifocal affects more than one unrelated body part
  • Segmental involves adjacent body parts
  • Hemidystonia affects the arm and leg on the same side of the body
• Your doctor will identify the best course of treatment based on the type of dystonia and its severity.
• Treatments may include speech therapy, physical therapy, stress management, or certain medications that reduce the actions of the faulty nerve signals.
• The Dystonia Medical Research Foundation provides additional information.

Epilepsy is an overload of electrical signals in the brain that result in seizures.

• The seizure may be physical convulsions, minor physical movements, changes in thoughts, or a combination of these.
• Treatments for epilepsy vary and depend on the cause.
• Often the doctor or healthcare provider will prescribe medication that decreases the frequency of the seizures.
• If medicines do not work, your doctor or healthcare provider may suggest a certain type of nerve stimulation called vagus nerve stimulation (VNS) or other surgical intervention.
• For some people, your doctor or healthcare provider may prescribe a very strict, special diet called a ketogenic diet that is high-fat and low-carbohydrate to control seizures.
• Please visit the Epilepsy Foundation for more information and patient support.

Gait disturbance is involuntary abnormal walking (gait) or locomotion that results when the nervous system does not work properly.

• Causes of gait disturbance may include multiple sclerosis, Parkinson’s disease, stroke, neuropathy or musculoskeletal disorders.
• Gait disturbance can also be caused by a reaction to certain medications such as antiarrhythmics, diuretics, digoxin, narcotics, or anticonvulsants, or it may occur after a recent acute medical illness, hospitalization, or surgery.
• Types of gait disorders include dragging gait or functional leg weakness, sudden knee buckling, swaying gait, or taking small, slow steps where the person appears to be “walking on ice”.
• Gait disturbances are a common cause of falls in older adults, and fall risk assessment is an important part of the patient’s evaluation.
• Treatment for gait disorders is based on the underlying condition.

Headache is pain in the head or neck.

• There are several different types of headaches; the most common are migraine, tension, and cluster headaches.
• The pain can occur on one part or side of the head, or it can happen on both sides at the same time.
• Headaches can feel sharp, throbbing, or dull.
• The pain can appear gradually or suddenly, and it can be short and last from less than an hour, or it can last up to several days.
• Headaches can be caused by stress, high blood pressure, anxiety, or depression.
• Some headaches can reflect a more serious neurological problem, which will deserve additional tests.
• Headaches can be managed by avoiding triggers, exercise, relaxation techniques, medications, and Botulinum toxin injections.
• If you would like more information about headache, please visit the National Headache Foundation or the American Headache Society.

Multiple sclerosis is an autoimmune disease of the brain and spinal cord that attacks the protective sheath (myelin) that covers nerve fibers. When the myelin breaks down it causes communication problems between your brain and the rest of your body.

• If it is not treated, multiple sclerosis can cause nerve cells to deteriorate and become permanently damaged.
• Symptoms initially come as “episodes” and include blurred or double vision, dizziness, numbness, tingling, imbalance, weakness, and difficulty walking.
• There are many medications available that successfully slow or sometimes stop the disease from getting worse.
• In addition to medications, nutrition, exercise, stress management, and overall wellness are essential to successful treatment of patients with multiple sclerosis.
• Patients at Mount Auburn Hospital with multiple sclerosis receive expert care at our Multiple Sclerosis Care Center, which is affiliated with the National Multiple Sclerosis Society.

Muscle Disorders

Muscle is the tissue in the body that allows you to move and helps your body function. There are 3 types of muscle in the body, each with a different job.

• Skeletal muscle is attached to bones and provides movement
• Your heart is made of cardiac muscle
• Internal organs are made of smooth muscle

Muscle disorders may be a direct result of the muscle not working properly (myopathy), or it may be the result of the nerve that communicates or “talks” to the muscle not working (neuropathy).

Symptoms of different muscle disorders can vary. Depending on the disorder, only some muscles may be affected, such as those in the face or legs, or all the muscles may be affected. Patients with muscle disorders may require physical aids such as leg braces, crutches, or a wheelchair.

Some of the muscle disorders we treat are listed here.

This is a fatal genetic disorder that occurs when a person does not make a particular protein, called dystrophin, which is needed for muscles to work the way they should.

• It occurs primarily in boys between the ages of 3 and 5.
• The muscles get progressively weaker, usually starting in the hips, pelvis, thighs, and shoulders. Later, muscles in the arms and legs are affected, and by the early teens the heart and respiratory muscles may be affected.
• Patients with this disorder develop problems walking and breathing.
• There is no cure for Duchenne muscular dystrophy, and treatment is done to control symptoms and maximize the patient’s quality of life.
• Please go to Cure Duchenne for more information on this fatal disease.

HMSN is a genetic disease that affects the peripheral nerves causing weakness and numbness in the legs, feet, and arms.

• Sometimes the nerves don’t work because the protective cover (myelin) is damaged, and sometimes the nerve itself is damaged.
• Common symptoms of the disease include pain, numbness, poor balance, fatigue, and foot deformities such as high arches in the feet or “hammer” toes.
• A neurological evaluation by your doctor to evaluate muscle weakness and sensory responses is needed to diagnose this disease.
• Your doctor or healthcare provider may order a genetic blood test, an EMG, or nerve conduction study to confirm the diagnosis.
• Because it is hereditary, your doctor will ask you questions about your family’s health.
• There is no cure or definitive treatment for HMSN, but physical and occupational therapy, physical activity, and stretching may help maintain muscle strength and improve independent functioning.
• This disorder is also called Charcot-Marie-Tooth disease after the three doctors who first identified it.

LEMS is an autoimmune disease in which the body’s immune system attacks the connection between nerves and muscles. This disease produces harmful proteins that cause faulty communication between nerves and muscles so the nerves cannot “talk” to the muscles.

• Many people with LEMS are often diagnosed with a certain type of cancer called small cell lung cancer.
• LEMS often begins in middle age, but it can also begin in childhood.
• Some symptoms of LEMS include bladder and bowel changes, changes in blood pressure, dizziness when standing, dry mouth, fatigue, problems talking or swallowing, or trouble breathing.
• To help diagnose LEMS, your doctor or healthcare provider will perform a physical exam and ask you about your symptoms.
• Your doctor may order a special blood test, an EMG, or a nerve conduction study.
• Because people with this disease often have small cell lung cancer, your doctor may check you for this or other types of cancers
• Treatment for LEMS includes removing harmful proteins in blood (called plasmapheresis) or given large amounts of helpful proteins.
• People with LEMS who also have cancer receive treatment for the cancer; if you respond well to the cancer treatment then the LEMS often improves, too.
• Some medications can help make the immune system less active so it does not attack the nerves.

McArdle disease is a genetic condition that interferes with the body’s ability to metabolize food for energy production. People with this disease are not able to break down, or metabolize, a protein called glycogen.

• Because their muscles cannot properly metabolize food to create energy, people with this disease may feel tired or fatigued when they try to do strenuous activities such as jogging, swimming, biking, or for some, even walking.
• Some people may suffer muscle damage if they try to do exercises that require strength, such as weightlifting, doing squats, or activities that require lifting heavy objects.
• Symptoms of McArdle disease include muscle cramps, pain, weakness, or stiffness, fatigue, and poor stamina.
• The disease may start in childhood, but not be identified until adulthood.
• Some of the tests your doctor or healthcare provider may do to help diagnose this disease are an EMG, MRI, genetic tests, special blood tests, muscle biopsy, or urine test.
• Although there is no specific treatment, McArdle disease is not life-threatening.
• Lifestyle management to reduce symptoms includes doing a gentle warm up before exercising, not exercising for too long or too strenuously, and eating enough protein.

Also known as amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease, motor neuron disease is a rare, progressive nerve disease that affects cells in the brain and the spinal cord.

• This disease causes nerves that control chewing, walking, breathing, and talking to slowly stop working.
• Symptoms of ALS include muscle twitches or muscle cramps in the arms, legs, shoulder, or tongue, tight and stiff muscles, muscle weakness in the arms, legs, neck or diaphragm, and slurred speech and difficulty chewing or swallowing.
• Exact causes of ALS are not known, but certain things such as prolonged strenuous physical activity, physical trauma, viruses, and behavioral and occupations and in few cases genetic factors have been found to be associated with patients who have this disease.
• There is no cure for ALS so treatments focus on controlling symptoms and preventing unnecessary complications.
• Medications can help manage muscle cramps and stiffness; physical therapy is used to help maintain range of motion, and speech therapy teaches patients communication strategies and how to use assistive devices.
• Please visit the ALS Association web site for more information.

MG is a chronic autoimmune disease that causes weakness and rapid fatigue in the muscles responsible for movement and breathing.

• The body’s immune system creates antibodies that attack the connection between nerves and muscles (neuromuscular junction) which results in problems in the normal communication between nerves and muscles.
• Researchers think the thymus gland, a part of your immune system, may tell your body to create the antibodies.
• Affected muscles can include those in your neck, arms, legs, eyes, face, or throat, although arms are usually more often than legs.
• Symptoms may include weakness in the arms, hands, fingers, legs, and neck, blurred or double vision, difficulty breathing, or difficulty chewing or swallowing.
• Your doctor or healthcare provider may do a physical and neurological exam and order several tests to confirm the diagnosis, including a pulmonary function test (PFT) to see how well you are able to breathe, special blood tests, an EMG, or imaging tests such as computed tomography (CT) or magnetic resonance imaging (MRI).
• There is no known cure for MG, and treatment helps to reduce and improve muscle weakness.
• More information can be found at the Myasthenia Gravis Foundation of America.

Polymyositis is a type of myopathy (muscle disease) that causes inflammation of the muscles or blood vessels that are in the muscles. The weakness may be sudden, but it usually develops gradually and progress slowly. If the lungs are involved, it can be difficult to breathe.

• The exact cause is unknown.
• Symptoms can be different for each person, but include weakness in the hands and fingers, pain or weakness in the joints, difficulty swallowing, fatigue, and chronic dry cough.
• Your doctor will ask for a complete medical history and will perform a thorough physical examination.
• Diagnostic tests that your doctor or healthcare provider may order include blood tests, and EMG, MRI, or a muscle biopsy.
• There is no cure for polymyositis, but treatments such as medications and therapy can improve muscle strength and function.

Parkinson’s disease is a neurodegenerative disorder of the central nervous system that affects your body’s ability to control movement.

• Parkinson’s disease occurs when nerve cells in the brain don't produce enough of a brain chemical called dopamine.
• The symptoms are progressive, which means they come on slowly and get worse over time. The symptoms include muscle rigidity, tremors, changes in speech, and changes in how you walk.
• There is no cure, but treatment can help relieve symptoms.
• The Parkinson’s Disease Foundation has more information about this condition.

Peripheral neuropathy is pain and damage to the nerves that connect your brain and spinal cord to the rest, or “peripheral” part, of your body.

• Most often your toes and fingertips are affected, but peripheral neuropathy can also occur in your face, mouth, legs, arms, and internal organs.
• There are many different causes including diabetes, infections, certain medications, arthritis, alcoholism, trauma from injury, or autoimmune disorders.
• Symptoms of peripheral neuropathy often start slowly and get worse over time, and may include numbness, tingling, sensitivity to touch, muscle weakness, or sharp, throbbing that feels like freezing or burning pain.
• Treatment for this condition is based on the cause. Your doctor or healthcare provider may prescribe over-the-counter or prescription pain medications, splints or casts may be used to provide support for weak muscles, or complimentary treatments such as acupuncture, massage, or yoga may be used to relieve the discomfort.

Sleep disorders are conditions that interfere with a person’s ability to sleep well. It is normal to occasionally have difficulty sleeping, but it is not normal to regularly or frequently not be able to sleep well.

• About 40 million people in the U.S. have chronic, long-term sleep disorders, and about half of adults over 65 have some type of sleep disorder.
• Your internal body clock (circadian rhythm) controls when you feel tired or sleepy. Sleep and wakefulness are also affected by external factors such as light or darkness, and emotions. Sleep disorders may also be caused by an underlying health problem.
• The three classifications of sleep disorders are lack of sleep (such as insomnias), disturbed sleep (such as restless leg syndrome or sleep apnea), or excessive sleep (such as narcolepsy).
• Sleep apnea is a common but serious disorder with significant health consequences. People with sleep apnea stop breathing while they sleep. Breathing may stop for a few seconds to a few minutes each time, and these episodes may happen up to hundreds of times in one night.
• Many shift workers who need to be awake during late hours such as law enforcement, fire fighters, healthcare workers, or transportation workers experience a condition called shift work disorder. These people often have either excessive sleepiness or insomnia.
• Disorders that cause a lack of sleep may be caused by stress, caffeine or alcohol, an underlying disease, chronic pain, allergies, or respiratory problems.
• Symptoms of a sleep disorder include being sleepy during the daytime, difficulty falling asleep, needing to take frequent naps, difficulty concentrating, feeling irritable, and reacting slowly.
• Keeping a sleep diary for a week or two can help identify issues that may be contributing to sleep problems. A sleep diary should track:
  
  • What time you go to bed
  • What time you wake up
  • Quality of sleep
  • What you did if you woke up in the night (stay in bed, get up, use the bathroom, etc.)
  • What and when you ate foods that affect sleep such as caffeine or alcohol
  • Any medications you are taking, when you take them, and what dose
  • What your feelings are when you go to be (are you happy, sad, anxious, etc.)
• To diagnose a sleep disorder, your doctor or healthcare provider will usually perform a physical exam. Your doctor may also order a sleep study test that measures nighttime brain activity and body movement.
• Treating sleep disorders is often done by treating the underlying cause or health problem, or removing the external factors that interfere with sleep.
• For more information on sleep disorders and how they are treated, please go to Mount Auburn Hospital’s Sleep Disorders Clinic.

A stroke occurs when blood flow to a part of the brain is stopped because a blood vessel in the brain is blocked (ischemic stroke) or it bursts and causes bleeding in the brain (hemorrhagic stroke).

• It is sometimes called a “brain attack”.
• Stroke is a medical emergency that can result in serious disability or death and requires immediate attention.
• Without treatment cells in the brain will not get enough oxygen and will quickly begin to die.
• The symptoms of a stroke happen suddenly and include:
  • Severe headache
  • Weakness, especially on one side of the body
  • Difficulty speaking or understanding others
  • A problem with balance, dizziness, or difficultly walking
  • Changes in vision in one or both eyes
  • Difficulty swallowing
• Treatment for ischemic stroke where a blood vessel is blocked is extremely urgent and time sensitive; the eligible patient may receive medications called “clot busters” as soon as possible to reduce the chance of damage to the brain. Other interventions such as mechanical disruption of the clot can be helpful in some patients.
• For more information, the National Stroke Association provides education, resources about prevention of stroke and advocacy for patients.

Tremors are involuntary muscle contractions that cause shaking movements in one or more parts of the body.

• Tremors may occur in the arms, head, voice, trunk, or legs, but they most often affect the hands.
• They can occur at any age but are most common among middle-aged and older adults.
• Tremors may be a symptom of a neurological disorder, or they me be a side effect of certain medications such as amphetamines, corticosteroids, and drugs used for certain psychiatric disorders.
• Causes of tremor include neurological disorders such as multiple sclerosis, stroke, or traumatic brain injury; alcohol abuse or withdrawal, mercury poisoning, overactive thyroid, or liver or kidney failure.
• Symptoms include rhythmic shaking in the affected body part, a shaky voice, or problems holding or controlling items with the hands, such as a pencil or a spoon.
• Duration of tremors may be intermittent (occurring at separate times, with breaks) or constant, and they may occur sporadically (on their own) or happen as a result of another disorder.
• Treatments for tremor are based on the underlying condition and include:
  • Medications such as beta-blockers, anti-seizure medications, tranquilizers, Botulinum toxin, or medications used to treat Parkinson’s disease
  • Deep brain stimulation
  • Lifestyle changes such as reducing or eliminating tremor-inducing substances or medications
  • Physical therapy
• Although tremor is not life threatening, this condition can be embarrassing and disabling and make tasks of daily living very difficult.
• For more information about this disorder, please visit the International Essential Tremor Foundation.