Most common diagnoses at neurology clinic?

[unsung]

What are the most frequent diagnoses seen at a typical neurology clinic, in a typical day?

Top 10, let's say.

I am about to embark on this rotation & would like to be better prepared for the bread & butter.

Also, how much knowledge am I expected to have re: EMGs & what not?

Thanks.

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[typhoonegator]

There are a lot of neuro diagnoses out there, and you probably don't see many of the top 10 on one particular day. It also depends pretty heavily on your population and clinic composition. And whether you see medicare/medicaid patients.

Headache, length-dependent peripheral neuropathy, nerve entrapment syndromes, foot drop, carpal tunnel, secondary prevention of stroke, seizure (first-timers and epilepsy), back pain/sciatica, trigeminal neuralgia, dizziness are all pretty common. If you see VA patients then PTSD, post-concussion syndromes are frequent.

 

[Mattchiavelli]

I think for students knowing that an EMG or EEG exists and when you would use one and who actually performs/interprets that test is already a step in the right direction. I would also add MS and Parkinson's to the list of outpatient type diagnoses. Focus more on learning a full neurologic exam and when to use or omit certain parts of it, also what medications are used for the things mentioned and what they do if they're overdosed/underdosed as clinic has a lot of managing meds long term.

 

[kutastha]

Just offt the top of ny head, my top ten referrals are for:

1. Migraine
2. Dizziness
3. Radiculopathy/Peripheral neuropathy
4. Memory loss
5. Parkinson's
6. Essential tremor
7. Syncope
8. Seizure
9. "Clearance for driving"
10. Fatigue

But my top ten diagnoses are:

1. Medication-overuse headache
2. Presyncope
3. Tension headache
4. Sleep apnea
5. Peripheral neuropathy
6. Parkinson's
7. Essential tremor
8. Hearing loss (in the patients referred for memory loss)
9. Epilepsy
10. Conversion disorder/Hyperventilation syndrome (tie)

I've also received consults on fatigue, urinary retention in a female with bladder prolapse, hypersensitive genitalia, alcohol withdrawal seizure, and a handful of unidentified bright objects on MRI.

 

[ushush]

Just offt the top of ny head, my top ten referrals are for:

1. Migraine
2. Dizziness
3. Radiculopathy/Peripheral neuropathy
4. Memory loss
5. Parkinson's
6. Essential tremor
7. Syncope
8. Seizure
9. "Clearance for driving"
10. Fatigue

But my top ten diagnoses are:

1. Medication-overuse headache
2. Presyncope
3. Tension headache
4. Sleep apnea
5. Peripheral neuropathy
6. Parkinson's
7. Essential tremor
8. Hearing loss (in the patients referred for memory loss)
9. Epilepsy
10. Conversion disorder/Hyperventilation syndrome (tie)

I've also received consults on fatigue, urinary retention in a female with bladder prolapse, hypersensitive genitalia, alcohol withdrawal seizure, and a handful of unidentified bright objects on MRI.

cool. is this private practice or academics?

 

[neurologist]

70% of my general neuro referrals are for some type of pain complaint. Headache is by far the biggest part of these, with back/neck pain being the next largest component.

 

[danielmd06]

70% of my general neuro referrals are for some type of pain complaint. Headache is by far the biggest part of these, with back/neck pain being the next largest component.

Good heavens please tell us where you are so we can all scrupulously avoid working there!

My own experience as a neuro resident was outpatient clinic held a generous mixture of headache, stroke, epilepsy, first-time seizure, MS, Parkinson's, and peripheral neuropathy patients. The other stuff paled in comparison to these seven, though I admittedly remembr the pain and psych most of the remainders.

The full-time general neuro guy in my private practice group tells me he sees huge amounts of peripheral neuro, stroke, headache, and epilepsy compared to other stuff. He sends me about one sleep patient per two weeks.

 

[neurologist]

Good heavens please tell us where you are so we can all scrupulously avoid working there!

That's been the pattern everywhere I've been since (and including) residency.

In an academic center, there is some referral/selection bias as certain dx will get sent to sub-specialists (i.e., epilepsy to the epileptologist, Parkinsons to the movement d/o person, etc). Unless there is a headache/pain subspecialist (which there has never been anyplace I've worked), all the pain stuff gets put into wherever there is an open slot.
Right now I'm doing about 50% subspecialty, but practically all my general neuro slots are for headache and other pain stuff. Maybe once or twice a week I'll get a neuropathy or dementia or hospital stroke f/u.

Addendum:
So, I looked at my schedule for the last month:
Of my non-sleep patients,
52% headache
17% seizure
11% "dizziness"
20% everything else

 

[kutastha]

cool. is this private practice or academics?

Private- but it's no different than when I was doing residency. Neuro is a "black box" to other physicians. If they don't know what it is (excellent example being "dizziness") or don't want to go near it (pain), they'll often refer to a neurologist.

Many of my visits are for "migraine", but the patients more often than not have medication overuse headache and/or sleep apnea.

 

[PETRAN]

In the outpatient neurology i practice now (which is academic) there are lots of parkinson(-isms)/movement disorders and dementias/alzheimer/cognitive problems (but i guess that they are "specialized" into that sort of thing). Today there was a very interesting case of a 40-year old male who had "autoimmune limbic encephalitis" in the past (manifested with delirium and seizures that led to chronic epilepsy) and left with huge problems in learning/recalling information and parkinsonism/reduced motor-volition-like symptoms (also some emotional lability). You could see the damaged hippocampus and surrounding middle temporal lobes in the MRIs. This is a very interesting kind of neuro-population in relation to pain/headache/dizziness (over and over again) IMO. I guess that it depends on where you work.

 

[95439]

Just a PGY 2, but in my limited experience it seems the economics of the patient population dictates what you'll see. If you want more diversity, work with the 'indigent' population. At my continuity clinic I've got two familial amyloid angiopathies, a Wilson's disease, Lambert Eaton + Dermatomyositis, and a lot of other interesting cases.
The headache/pain patients seem to be the upper class patients - coddled and nothing better to do with their time then take too many medications and develop side effects from them. Lots of hand holding and explaining what "conversion disorder" means...

 

[Mattchiavelli]

When all of you say "pain" patient is it like "?? abdominal pain"? because I was very much looking forward to not dealing with that in the future after my intern year.

 

[maddog2020]

In an academic neuromuscular practice,
I get about a third of each: pain (peripheral neuropathy), weakness, gait disorder
Diagnoses include peripheral neuropathy, myopathy, ALS, myasthenia gravis
Many times, I get to diagnose treatable or benign disorder because patients with benign fasciculations don't have ALS and patients with fatigue don't have MG. There is a fair bit of radiculopathy and carpal tunnel syndrome too.
Fortunately, there is a headache neurologist in my practice so I don't get those.
Occasionally, parkinsonism, dementia, epilepsy comes to the neuromuscular clinic but that keeps life interesting.
If you have a good referral stream and establish yourself as a good subspecialist, you can select what you see.

 

[HarveyCushing]

I am just a medical student so others on here have more experience with this question that I do, but from my experience on my neuro rotation in no particular order:

-Headache
-Alz/dementia/memory loss
-PD
-MS
-Peripheral neuropathy
-Seizures
-Dizziness/syncope
-Post stroke/CVA f/u

The above was just my experience. Completely depends on the clinic/attending you work with.