Symptoms Neurologists Say Never to Ignore

It can be difficult to understand all the conditions neurologists treat: cerebrovascular disorders like stroke and carotid artery disease, seizure disorders, neurodegenerative diseases like Alzheimer’s disease and frontotemporal dementia, headaches and facial pain, movement disorders like Parkinson’s disease, muscle diseases, sleep-related conditions like narcolepsy, and much more.

“If there’s a nerve somewhere, a neurologist might step in,” says Dr. Andrew Dorsch, division chief of general neurology at Rush University System for Health and a specialist in neurological rehabilitation. “And there are nerves all over the body. There are a lot of things that can go wrong with the nervous system, and it can take a lot of detective work to figure it out.”

Often, he adds, people ignore neurological symptoms for a long time, attributing them to age-related pain or assuming they will resolve on their own. This is a mistake.

We asked four neurologists what symptoms you should never ignore and what they might be reporting.

Double vision in one eye

A common symptom that people often overlook is double vision in one eye. There are a number of potential causes, including multiple sclerosis, stroke or aneurysm, myasthenia gravis, brain tumor or brain infection, says Dr. Luis Cruz-Saavedra, a neurologist at Memorial Hermann Health System.

When should it be taken seriously? “Immediately,” he said. “If you develop sudden double vision, that’s a reason to go to the emergency room.” Doctors there will check vital signs and look for warning signs of a stroke, perform eye and neurological exams, and may order imaging such as a head CT or brain MRI.

Weakness in a hand or leg

Have you ever noticed that you are dragging one leg behind you, or perhaps limping? Do you have difficulty having your morning coffee or writing with your dominant hand? If the answer is yes, make an appointment with the doctor.

“I have been impressed in my clinics by how many people are unaware of weakness in a hand or leg,” says Cruz-Saavedra. (That is: impressed in a bad way.) “People come in months after their symptoms start, but weakness is a weakness you can’t ignore. A lot of people think, ‘Oh, it’s just a pinched nerve,’ but it could actually be a stroke, a brain tumor, a disorder like multiple sclerosis, or any sort of brain inflammation.”

When neurologists see patients with this type of weakness, they typically test strength, reflexes, coordination, and gait, which can help rule out potential causes and point them in the right diagnostic direction.

Temporary insensitivity

Sometimes people with neurological problems go blank for a few seconds, then return to their normal state with no memory of what just happened. This experience is usually associated with temporal lobe seizures, which occur in parts of the brain important for short-term memory and emotion processing, Cruz-Saavedra explains.

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“Sometimes family members describe it because the patient doesn’t really notice it,” he adds. “They’ll say, ‘I was talking to him, and he just looked away, and then after 10 to 15 seconds he was back to normal.’ Or the patient might say, “Hey, sometimes I lose track of time. It’s almost like I’ve lost a small part of my day.

Speech problems

Strokes are a leading cause of death in the United States, but people often don’t recognize the symptoms and delay seeking care as quickly as they should. “I hear all the time someone has stroke symptoms and their reaction is, ‘Well, I’m going to take a nap and see if they go away,'” says Dr. Enrique Leira, director of the division of cerebrovascular diseases at the University of Iowa in Iowa City.

Stroke symptoms tend to come on suddenly and involve a lack of function resulting from brain injury. One way that manifests itself: difficulty speaking. People may begin to slur their speech, speak slowly, have difficulty finding words, or even be unable to understand what others are saying, Leira says. In this situation, seek emergency care, he advises.

Sudden headache during physical exertion

Neurologists must evaluate headaches: there are dozens of potential causes, and many are harmless. But some quickly justify attention. A headache can raise suspicion of a stroke if it “is unusually strong and sudden and doesn’t build up over minutes or hours,” says Leira. “And if it happens when you’re doing physical exertion, it’s concerning enough that it should be checked immediately.”

Numb feet and fingers

When Dorsch’s patients present with numbness, it usually affects their feet or fingers. “This usually tells us that the nerves are not sending information back to the brain as they should,” he says. “The nerve is asleep. It’s knocked out, or unfortunately in some cases it’s dead. No information is getting to the body or the brain.” This differentiates numbness from tingling, a tingling sensation that indicates a nerve is irritated.

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When someone suffers from numbness, the first step is usually to perform a complete assessment to determine which nerves are malfunctioning, what is causing the problem, and how best to treat it. Although some patients end up with diabetes, there are many possibilities: Others could have a genetic disease or their immune system could attack their nerves, Dorsch says.

A feeling of déjà vu

Everyone experiences déjà vu from time to time – the strange feeling that something has already happened. “But if you regularly have deja vu episodes, you probably want to come in and get checked out,” says Dorsch. Indeed, this could be a warning sign of a temporal lobe seizure. Dorsch recently treated a patient who “had recurring episodes every week, or every two weeks, which is not how often people usually experience déjà vu,” he says.

Difficulty getting up from a chair regularly

As people age, they tend to develop problems with their daily movements, such as stiffness or slowness. However, some complaints are different. If you regularly have trouble getting out of your chair, it’s a good idea to make an appointment with a doctor.

“Of course there could be joint problems, but we really want to take a look and make sure you don’t have a problem with your muscles, your nerves, or your spinal cord,” Dorsch says, such as Parkinson’s disease or amyotrophic lateral sclerosis (ALS). “It’s something I would like a family member to go get checked out.”

Voice changes

Neurologists pay attention to several types of vocal changes. One is hypophonic speech, meaning the voice is unusually soft or breathy; this may indicate Parkinson’s disease, says Dr. Alexandru Olaru, a neurologist at the University of Maryland St. Joseph Medical Center. Another problem is slurred speech, which could indicate a stroke.

Another concerning change, Olaru says, is wet dysarthria: when your voice sounds gurgly, likely from excess saliva or phlegm. “People lose the muscle mass in the back of the throat and the ability to handle saliva,” he says. This means it collects in the back of the throat, “so when you speak, it’s almost like you have water in your mouth.” Some of the most common causes include Parkinson’s disease, ALS, and multiple sclerosis.

Persistent muscle contractions

Everyone’s muscles tense from time to time, usually in different places. Sometimes you can actually see the muscles “rippling under the skin,” says Olaru. “Or, if you put your hand on the muscle, you can feel it.”

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If you regularly experience these fasciculations (the medical term for muscle twitching) in the same place, it’s worth talking to your doctor. You may have benign fascicular syndrome, which is harmless, or a more serious condition like spinal stenosis, ALS, or chronic inflammatory demyelinating polyneuropathy (an autoimmune disease that targets the protective layer around your peripheral nerves). Neurologists usually recommend an electromyography (EMG), which is an electrical test of the nerves and muscles that can help identify what is happening.