1. Neurology and Neurosurgery: Is there a difference? Daniel Boedeker, M.D. Neurosurgery Specialists

2. Neurology or Neurosurgery There is a lot of confusion with whether a patient needs a Neurologist or a Neurosurgeon, and for good reason.There is a lot of confusion with whether a patient needs a Neurologist or a Neurosurgeon, and for good reason. Treatment of a lot of the same body parts, issues and symptoms.Treatment of a lot of the same body parts, issues and symptoms. When is a neurologist needed and when is a neurosurgeon the one to call?When is a neurologist needed and when is a neurosurgeon the one to call?

3. Neurology Medical doctor specializing in diagnosis and treatment or management of certain conditions of the brain and nervous systemMedical doctor specializing in diagnosis and treatment or management of certain conditions of the brain and nervous system May have specialized training in one area or anotherMay have specialized training in one area or another

4. Neurology In some instances, a neurologist may take on the role of primary care physician if a patient is in need of continuing and extensive treatment for a conditionIn some instances, a neurologist may take on the role of primary care physician if a patient is in need of continuing and extensive treatment for a condition Examples: Parkinson’s, Alzheimer’s, Seizure disorder, etc.Examples: Parkinson’s, Alzheimer’s, Seizure disorder, etc.

5. Neurology Common ailments that lead to a neurology consultationCommon ailments that lead to a neurology consultation -Stroke -Headaches -Pain -Seizures -Brain or spinal cord injuries

6. Neurology Often confused with neuroSURGERY and vice versaOften confused with neuroSURGERY and vice versa Often treat similar problems and body partsOften treat similar problems and body parts Many patients need a neurology “work up” prior to seeing a neurosurgeon depending on the diagnosisMany patients need a neurology “work up” prior to seeing a neurosurgeon depending on the diagnosis

7. Neurosurgery Neurosurgeons treat conditions of the brain and spinal cord as well:Neurosurgeons treat conditions of the brain and spinal cord as well: -Head injury -Fracture -Spinal cord injury -Tumor of the brain or spine -Aneurysm -Bleed

8. Neurosurgery Neurosurgeons DO NOT treatNeurosurgeons DO NOT treat -headaches with no neurosurgical cause -Vertigo -Stroke -Post- Concussive Syndrome -Seizures without a neurosurgical cause

9. Examples Male 33 years old hit in the head on the jobMale 33 years old hit in the head on the job Brief loss of consciousnessBrief loss of consciousness ER visit- Neurosurgeon is calledER visit- Neurosurgeon is called CT is performed to assess for bleed or fracture. CT shows a small fracture of the skull and small intracranial hemorrhage.CT is performed to assess for bleed or fracture. CT shows a small fracture of the skull and small intracranial hemorrhage.

10. Examples Patient is discharged to follow up with neurosurgeonPatient is discharged to follow up with neurosurgeon Follow up CT’s are performed the following visitsFollow up CT’s are performed the following visits After two months, the CT is normal, meaning no bleed and no fractureAfter two months, the CT is normal, meaning no bleed and no fracture Patient calls two weeks later complaining that he had a seizure but the CT done in the ER was negativePatient calls two weeks later complaining that he had a seizure but the CT done in the ER was negative

11. Examples Who does patient need to follow up with?Who does patient need to follow up with? NEUROLOGYNEUROLOGY -management of any symptoms after the accident that are not neurosurgical

12. Examples Patient in MVAPatient in MVA Complains of headachesComplains of headaches Diagnostic testing is negative for any fractures, bleeds or traumaDiagnostic testing is negative for any fractures, bleeds or trauma Patient needs NEUROLOGYPatient needs NEUROLOGY

13. Examples Patient hit in the head on the jobPatient hit in the head on the job Wife calls us to make an appointment because he is “acting strange.”Wife calls us to make an appointment because he is “acting strange.” Patient needs work up by Primary Care and/or Neurology to determine whether there is anything Neurosurgical causing symptoms.Patient needs work up by Primary Care and/or Neurology to determine whether there is anything Neurosurgical causing symptoms. Only then will we need to see this patient.Only then will we need to see this patient.

14. Examples Patient has a seizurePatient has a seizure -Diagnostic testing to be done to determine whether seizure was caused by something neurosurgical such as bleed or tumor -Seizures can be caused by a variety of factors unrelated to neurosurgery so it is important that patient has a full work up to determine the cause

15. Symptoms/Treatment Patient’s symptoms can many times be assessed by a number of qualified physicians. However, unless it is something that is NEUROSURGICAL, neurology is the best course to take.Patient’s symptoms can many times be assessed by a number of qualified physicians. However, unless it is something that is NEUROSURGICAL, neurology is the best course to take.

16. Symptoms/Treatment Vertigo (dizziness)Vertigo (dizziness) -This is many times thought to be neurosurgical but is actually a condition treated by neurology -Involves the inner ear, sensory pathways and the brain -No surgery or neurosurgical management involved -NEUROLOGY

17. Symptoms/Treatment HeadachesHeadaches -This is neurosurgical if headaches are accompanied by a fracture, bleed, tumor or other neurosurgical condition -Headaches can stem from several causes and are best managed by… -NEUROLOGY

18. Symptoms/Treatment Post- Concussive SyndromePost- Concussive Syndrome -We receive many requests to consult on this diagnosis -Involves headaches and many times behavioral changes -Treatment includes treating the symptoms -NEUROLOGY

19. Symptoms/Treatment Memory LossMemory Loss -This could be caused by a number of factors -Often after a head injury or concussion -Treatment by NEUROLOGY

20. Neurosurgery We use many tests to determine whether something is indeed neurosurgicalWe use many tests to determine whether something is indeed neurosurgical -MRI or CT to check for: fracture, bleed, tumor, aneurysm -All are neurosurgical issues that may or may not be able to be treated surgically

21. Neurosurgery Conditions that may need immediate treatment by neurosurgeryConditions that may need immediate treatment by neurosurgery -Brain bleed/hematoma -Tumor -Severe herniated disk or spinal fracture -Aneurysm

22. ANY QUESTIONS?