Neurosurgery

Some symptoms need emergency care, not a directory search. The CDC lists these signs of stroke: sudden numbness or weakness in the face, arm, or leg, especially on one side of the body; sudden confusion, trouble speaking, or difficulty understanding speech; sudden trouble seeing; sudden trouble walking, dizziness, loss of balance, or lack of coordination; and a sudden severe headache with no known cause. The CDC says to call 9-1-1 right away for any of them, and not to drive to the hospital or let someone else drive you, so that treatment can start on the way. After a bump, blow, or jolt to the head, the CDC says the people checking on you should call 9-1-1 or take you to an emergency department right away for: a headache that gets worse and does not go away; weakness, numbness, decreased coordination, convulsions, or seizures; repeated vomiting; slurred speech or unusual behavior; one pupil larger than the other; not recognizing people or places, or getting confused, restless, or agitated; and losing consciousness, looking very drowsy, or not being able to be woken up.

The American Association of Neurological Surgeons lists six red flag symptoms of cauda equina syndrome: urinary retention, which it calls the most common symptom; urinary or fecal incontinence; saddle anesthesia, a sensory disturbance that can involve the anus, genitals, and buttock region; weakness or paralysis of usually more than one nerve root, which can affect the lower limbs; pain in the back or legs, also known as sciatica; and sexual dysfunction. For any of them, AANS says immediate medical attention is required to evaluate whether they represent cauda equina syndrome, and that those experiencing them should be evaluated by a neurosurgeon or orthopedic spine surgeon as soon as possible. Left untreated, it can result in permanent paralysis and incontinence. Our own guidance is to go to an emergency department for those symptoms rather than wait for an office appointment, because the AANS page calls for immediate evaluation without naming a destination. That instruction is ours rather than AANS's. MedlinePlus places several of the same symptoms one tier lower, under contacting your provider right away, and we are being deliberately more cautious on this one cluster. Your own clinician is the right person to confirm what to do.

A neurosurgeon operates on the brain, spine, and nerves, and the American Board of Neurological Surgery describes the specialty as covering non-operative management as well. A neurologist treats nervous-system conditions without operating. Many patients see both: a neurologist may manage a condition over time and refer to a neurosurgeon if and when an operation is being considered. Ask either office directly what they do and do not handle.

A neurosurgical consultation does not necessarily lead to surgery. For acute low back pain, MedlinePlus states that most people with back pain improve or recover within four to six weeks and often much sooner, that bed rest is not recommended, and that physical therapy may help. Ask the surgeon to walk you through the non-surgical options for your specific condition and what would have to be true for an operation to be the better choice.

For a non-emergency procedure, a second neurosurgical opinion is a reasonable step, and bringing your imaging and the notes from your first visit makes it a more useful one. Coverage for a second opinion depends on your plan, so call the number on your insurance card to check before you book.

It depends on your plan, so check the number on your insurance card or the surgeon's profile for accepted insurance. If a primary-care provider or neurologist is already involved in your care, ask their office to send the imaging and notes ahead of the appointment.