What’s the Difference Between a Neurologist and a Neurosurgeon?

As you learned in the article The Nervous System and How it Works, neurology is the study of the nervous system. Today’s article will discuss the differences between a neurologist and a neurosurgeon and how each profession works with people who experience problems with their nervous system.

Neurologists

Neurologists are medical doctors who learn what the nervous system does and how the nerves work in conjunction with the brain and the rest of your body. They recognize when someone has a healthy nervous system, and when someone doesn’t. When people come to them with a problem, they work hard to figure out what might be wrong and how it can be corrected without surgical intervention.

Some neurologic conditions, like your arm falling asleep, are temporary and don’t require a neurologist’s care. But other illnesses, disorders, or injuries involving the nervous system may need a neurologist’s intervention. If individuals experience problems with their sense of touch, smell or even sight, a neurologist can determine if the conditions are temporary, permanent, or treatable. Although not all sensory and muscle problems are caused by nervous system disorders, some may be. That’s why a neurologist’s opinion can be vital.

People may elect to see a neurologist if any of the following symptoms occur regularly:

• changes in sensation/feeling
• chronic dizziness
• confusion
• coordination problems
• muscle weakness

What conditions do neurologists treat?

People see neurologists for a variety of reasons. You may be familiar with some of them, but not know a neurologist treats them. These include:

Headaches – Some headaches are caused by tension, stress, or even lack of sleep. Most are temporary and can be relieved with over-the-counter medications. But some people experience chronic headaches. Chronic means that the pain is severe and recurring. Migraines, one of the most well-known forms of chronic headaches, and can prevent people from going about their normal routines. They can make suffers sick to their stomachs and highly sensitive to light and sound. Some people can’t even leave their homes. These types of headaches have to be diagnosed and treated by neurologists. The American Migraine Foundation provides information to people with migraines or those interested in learning more.

Multiple Sclerosis – Multiple Sclerosis, also referred to as MS, is an autoimmune disorder. Autoimmune diseases are when the body attacks its own immune system. In the case of MS, the disease wears away the protective coating of the nerves. If you compare the nerves to speaker wires, MS will occur when the plastic layer protecting those wires is stripped away. When exposed, the wires are more likely to sustain damage. If they become damaged, the quality of sound coming from the speakers diminishes.

MS works the same way with one key difference. It spreads and eventually weakens all bodily functions because it attacks the brain and spinal cells. In the early stages of the disease, a person will feel numbness and tingling. As the nerves degenerate, a person suffers, among other things, exhaustion and balance issues. MS is considered a progressive disorder. When a disease is progressive, it means symptoms gradually worsen with little hope of improvement. In the case of MS, the person eventually loses control of mobility. In its later stages, seizures may occur. Since there is no known cure, a neurologist sees individuals with MS indefinitely. The National MS Society can tell you more about this disease.

Neuromuscular Disease – Neuromuscular diseases, or disorders, impact your voluntary muscles. These are muscles you control, such as your hands, legs, and arms. If the nerves that send messages to these muscles are damaged, or even die, communication between them and your brain is less capable. When that happens, your muscles weaken and eventually could waste away. A person can experience twitching and joint and movement problems. Although MS is an autoimmune disorder, it’s also considered a neuromuscular disease since it affects voluntary muscles. The American Association of Neuromuscular & Electrodiagnostic Medicine can update you with the latest research and education on neuromuscular disorders.

Seizure Disorders – When the electrical wiring in your brain is disrupted, a person may experience twitching, shaking or some other kind of involuntary movement. These involuntary movements are known as seizures. A car accident where you hit your head on the windshield could cause a single occurrence of a seizure. Since this is situational in nature, it’s unlikely to recur. So it’s not considered a seizure disorder. Although you may see a neurologist just to be sure everything is okay, the seizure would only be diagnosed as a disorder if you have two or more of them. A type of seizure disorder you may be familiar with is epilepsy.  The Epilepsy Foundation can tell you more.

Stroke – A stroke can occur when the blood flow to the brain is interrupted in some way. The interference deprives the brain of oxygen, which, in turn, damages that area of the brain. The amount of damage is determined by how long the body has been without oxygen. The body part(s) controlled by that section of the brain will subsequently be impaired in some way. Sometimes a person will lose muscle control. Other times one side of the face may droop. An inability to talk can also occur. Neurologists work with stroke patients and provide treatment plans for their recovery. Some people end up being fine. Others may not be as fortunate and experience permanent damage. If you’d like to learn more about strokes, the National Stroke Foundation do so.

Although these are not all the disorders and diseases that neurologists come into contact with, they are some of the most common. The more you study neurology, the more you’ll realize the many kinds of ailments neurologists treat.

Due to the complexity of the nervous system, neurologists may choose to specialize in certain areas, learning everything they can about that one aspect of the nervous system.

In addition to the ones listed above, these include:

• autonomic disorders (involuntary functions of the nervous system)
• child/pediatric neurology (nervous system disorders suffered by children)
• epilepsy (disturbances in the senses, seizures and other abnormal electrical activity within the brain)
• geriatric neurology (nervous system disorders in older populations)
• headache neurology (headache pain caused by vascular disorders or inflammations)
• neurocritical/neurointensive care (life-threatening diseases of the nervous system)
• neuromuscular medicine (soft tissues and muscles)
• neuro-oncology (cancer of the nervous system)
• stroke care (vascular care)

It’s easy to see that the field of neurology is extensive. If you decide to become a neurologist and choose to specialize, you will have many options.

Neurosurgeons

As well-trained as they are, neurologists are not neurosurgeons. Some neurologic problems require surgery to correct. A neurosurgeon trains in the surgical aspects of neurology. However, to be an excellent neurosurgeon, he or she will be knowledgeable about neurology in general.

Neurosurgeons are considered specialists in the field of neurology. But as the name suggests, they focus on surgical procedures. Neurosurgeons are called in for emergencies requiring treatment of brain, spine and skull trauma. They may also remove tumors and blood clots. Some perform radiation treatments, traditional open surgery or perhaps microsurgery. Frequently they face severe conditions in which someone’s life may depend upon their skills and expertise.

What surgeries does a neurosurgeon perform?

Like neurologists, neurosurgeons deal with a variety of conditions. You may be familiar with a few, but not know neurosurgeons treat them. These include:

Aneurysm repair – An aneurysm is a weak area in a blood vessel that causes it to bulge or balloon out. Weaknesses may be so severe the blood vessel bursts. If it does, it may cause bleeding, or hemorrhaging, into the brain. This bleeding could result in the blood collecting or clotting which is known as a hematoma. Neurosurgeons will attempt to repair an aneurysm in one of two ways.

• Clipping – Clipping is done by opening your scalp, skull and other coverings of the brain. Then a metal clip will be placed at the base of the neck of an aneurysm, so it doesn’t rupture.
• Endovascular repair – When an endovascular repair is done, thin metal wires are inserted into an aneurysm. They coil into a little mesh ball resembling a tea strainer. Blood clots form around it which prevent the rupture of an aneurysm. Occasionally a stent, which is a mesh tube, is also inserted to keep the coil in place.

Much research and education on brain aneurysms is conducted by the Brain Aneurysm Foundation.

Craniotomy – A craniotomy is when a neurosurgeon cuts an opening in the skull to expose the part of the brain beneath it. At the conclusion of the surgery, tiny plates and screws replace the opening. Neurosurgeons perform craniotomies to diagnose, remove or treat brain tumors; repair aneurysms and skull fractures; remove blood or blood clots from leaking blood vessels; drain brain abscesses, and relieve pressure on the brain caused by traumatic injuries.

Disk removal – A disk removal is one of the more common types of back surgeries. The official name for this kind of operation is diskectomy or discectomy. When performing a disk removal, the neurosurgeon removes an intervertebral disk. Intervertebral disks are the flexible parts of the spine between each vertebra. Intervertebral disks protect the brain and spinal cord from any impact produced by the body’s movements in the same way shock absorbers protect passengers of a car from bumps and potholes in the road. This type of surgery is only suggested if a person has been in back pain for six or more weeks. It is done under general anesthesia and can take a person up to eight weeks to resume all normal activities.

Lumbar puncture – Sometimes a neurological disorder can be determined by sampling some spinal fluid. If this is the case, a neurosurgeon may perform a lumbar puncture. The surgeon numbs the spine and then inserts a needle into it drawing out some fluid. It’s similar to a blood test when a phlebotomist inserts a needle into your arm and removes blood for examination in a lab. A lumbar puncture works the same way. Sometimes after a lumbar puncture, a person may develop a headache or experience some back pain, both of which are temporary. A lumbar puncture can help diagnose neurologic disorders such as acute bacterial, fungal and viral infections, including meningitis, encephalitis, and syphilis. It can also identify certain cancers involving the brain or spinal cord.

Other types of surgeries can help the following conditions:

• brain tumors (primarily abnormal growth of cells in the brain)
• functional neurological disorders (when the brain appears normal but functions incorrectly)
• neurovascular diseases (strokes and aneurysms)
• pediatric and developmental disorders (covers a wide range of physical and mental neurologic disorders in children, some of which emerge at birth)
• pituitary tumors and other neuroendocrine disorders (any disease that affects how the nervous system interacts with the endocrine system which is series of glands that regulate metabolism, sleep, mood and other things)
• trauma, emergency, intensive care and general neurosurgery (brain injuries, strokes, and life-threatening situations in the nervous system)

Want to learn more?

If you’re interested in neurology and what it takes to become a neurologist or neurosurgeon, The Apprentice Doctor offers a For Future Doctors Course and Kit. You can start learning today! In addition to fact and theory, the course also provides opportunities to practice some of the skills neurologists, and neurosurgeons perform. In essence, you become an apprentice neurologist.

If you missed any article in our neurology series and would like to go back and catch up, click on the following links:

Path to Becoming a Neurologist or Neurosurgeon.

A Day in the Life of a Neurologist and Neurosurgeon.

Interview conducted with a practicing neurosurgeon.