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Conditions a neurosurgeon treats

Conditions a neurosurgeon treats

Ten neurosurgical conditions explained from the symptom, with the red flags stated explicitly.

Conditions

Start from the symptom, not from the name of the operation

Ten neurosurgical conditions explained from what you actually feel, with the red flags stated explicitly.

Brain tumour

Not every brain tumour is cancer, and not all are operated the same way. The first task is to know which type it is, where it sits and what it is doing to the brain.

A new or different headache, worse in the morning or on waking
A first seizure in an adult who has never had one
Weakness, clumsiness or sensory loss on one side of the body
Visual changes: double vision or loss of visual field
Changes in behaviour, memory or language noticed by the family
Nausea and vomiting without a digestive cause, with progressive drowsiness

Herniated disc and sciatica

Pain running down the leg, with tingling or weakness, almost always comes from a compressed nerve root in the low back. Most cases improve without surgery.

Pain running from the buttock down the leg, sometimes to the foot
Tingling or numbness in a specific territory of the leg
Pain that worsens on coughing, sneezing or straining
Weakness lifting the foot or standing on tiptoe
Pain that eases lying down and worsens after prolonged sitting
EMERGENCY: loss of bladder or bowel control with numbness between the legs

Brain aneurysm

A bulge in the wall of a brain artery. Most give no symptoms until they bleed, and when they bleed, time is everything.

EMERGENCY: sudden headache, the worst of your life
Neck stiffness, vomiting and light intolerance after that headache
Loss of consciousness or a seizure of abrupt onset
Recent onset of double vision or a drooping eyelid
Pain behind one eye with a dilated pupil
Family history of aneurysm or subarachnoid haemorrhage

Hydrocephalus

Accumulation of cerebrospinal fluid inside the brain. It presents very differently in a newborn and in an older adult, and in both it is treatable.

In infants: accelerating head circumference and a tense fontanelle
In infants: irritability, vomiting and fixed downward gaze
In children and adults: headache, vomiting, blurred vision and drowsiness
In older adults: short-stepped gait with feet seemingly stuck to the floor
In older adults: urinary incontinence and failing memory
With an existing shunt: return of headache, vomiting or drowsiness

Traumatic brain injury

Not every blow to the head needs a CT, but some do and cannot wait. These are the signs that separate one from the other.

Loss of consciousness, however brief
Repeated vomiting after the injury
A headache that increases rather than settles
Confusion, drowsiness or difficulty waking
Blood or clear fluid from the nose or ear
Seizure, one-sided weakness or unequal pupils

Lumbar spinal stenosis

If you walk a hundred metres and must stop because of heaviness in the legs, and sitting or leaning forward relieves it, that combination has a name.

Heaviness, burning or cramping in the legs after walking a certain distance
Relief on sitting or leaning forward
Tolerating a shopping trolley better than walking upright
Pain and tingling in both legs, not just one
A sense of instability or of legs that do not respond
Progressive difficulty walking distances that used to be easy

Trigeminal neuralgia

Bursts of electric pain across half the face, triggered by speaking, chewing or brushing the cheek. Many patients undergo dental treatments they never needed.

Electric or lancinating pain on one side of the face, lasting seconds
Attacks triggered by speaking, chewing, brushing teeth or cold air
Pain-free periods between attacks
Pain that respects the midline and affects only one side
Previous dental treatment without relief
Avoiding eating, speaking or washing for fear of triggering the pain

Subdural haematoma

Blood between the dura and the brain. In older adults it can appear weeks after a minor knock and be mistaken for dementia.

Progressive confusion or drowsiness in an older adult
Recent clumsiness walking, falls or unsteadiness
Persistent headache weeks after a knock
Weakness on one side of the body, sometimes intermittent
Changes in personality or language noticed by the family
A history of head injury, however minor

Neck pain and cervical disc disease

Pain running down the arm, tingling in the fingers, or clumsy hands. The last of those three is the one not to let slide.

Pain running from the neck down the arm to the hand
Tingling or numbness in specific fingers
Weakness in the arm or hand
Manual clumsiness: dropping things, difficulty buttoning
Unsteady gait or a sense of imbalance
An electric sensation down the back on bending the neck

Epilepsy and seizures

Epilepsy is treated with medication and led by neurology. The neurosurgeon enters in two scenarios: when a lesion is causing the seizures, and when drugs fail to control them.

A first seizure in adulthood
Seizures persisting despite two or more properly chosen medications
Focal seizures: odd movements, sensations or smells without losing consciousness
Seizures accompanied by neurological deficit or progressive headache
Increasing frequency or a change in seizure type in someone already diagnosed
EMERGENCY: a seizure lasting over five minutes, or repeated seizures without regaining consciousness

Warning signs

What each condition actually feels like

Six signs per condition, written the way a patient describes them rather than the way a textbook does — with the red flags marked in capitals.

Brain tumour

A new or different headache, worse in the morning or on waking
A first seizure in an adult who has never had one
Weakness, clumsiness or sensory loss on one side of the body
Visual changes: double vision or loss of visual field
Changes in behaviour, memory or language noticed by the family
Nausea and vomiting without a digestive cause, with progressive drowsiness

Herniated disc and sciatica

Pain running from the buttock down the leg, sometimes to the foot
Tingling or numbness in a specific territory of the leg
Pain that worsens on coughing, sneezing or straining
Weakness lifting the foot or standing on tiptoe
Pain that eases lying down and worsens after prolonged sitting
EMERGENCY: loss of bladder or bowel control with numbness between the legs

Brain aneurysm

EMERGENCY: sudden headache, the worst of your life
Neck stiffness, vomiting and light intolerance after that headache
Loss of consciousness or a seizure of abrupt onset
Recent onset of double vision or a drooping eyelid
Pain behind one eye with a dilated pupil
Family history of aneurysm or subarachnoid haemorrhage

Hydrocephalus

In infants: accelerating head circumference and a tense fontanelle
In infants: irritability, vomiting and fixed downward gaze
In children and adults: headache, vomiting, blurred vision and drowsiness
In older adults: short-stepped gait with feet seemingly stuck to the floor
In older adults: urinary incontinence and failing memory
With an existing shunt: return of headache, vomiting or drowsiness

Traumatic brain injury

Loss of consciousness, however brief
Repeated vomiting after the injury
A headache that increases rather than settles
Confusion, drowsiness or difficulty waking
Blood or clear fluid from the nose or ear
Seizure, one-sided weakness or unequal pupils

Lumbar spinal stenosis

Heaviness, burning or cramping in the legs after walking a certain distance
Relief on sitting or leaning forward
Tolerating a shopping trolley better than walking upright
Pain and tingling in both legs, not just one
A sense of instability or of legs that do not respond
Progressive difficulty walking distances that used to be easy

Trigeminal neuralgia

Electric or lancinating pain on one side of the face, lasting seconds
Attacks triggered by speaking, chewing, brushing teeth or cold air
Pain-free periods between attacks
Pain that respects the midline and affects only one side
Previous dental treatment without relief
Avoiding eating, speaking or washing for fear of triggering the pain

Subdural haematoma

Progressive confusion or drowsiness in an older adult
Recent clumsiness walking, falls or unsteadiness
Persistent headache weeks after a knock
Weakness on one side of the body, sometimes intermittent
Changes in personality or language noticed by the family
A history of head injury, however minor

Neck pain and cervical disc disease

Pain running from the neck down the arm to the hand
Tingling or numbness in specific fingers
Weakness in the arm or hand
Manual clumsiness: dropping things, difficulty buttoning
Unsteady gait or a sense of imbalance
An electric sensation down the back on bending the neck

Epilepsy and seizures

A first seizure in adulthood
Seizures persisting despite two or more properly chosen medications
Focal seizures: odd movements, sensations or smells without losing consciousness
Seizures accompanied by neurological deficit or progressive headache
Increasing frequency or a change in seizure type in someone already diagnosed
EMERGENCY: a seizure lasting over five minutes, or repeated seizures without regaining consciousness

Other conditions treated

Meningioma
Pituitary adenoma
Vestibular schwannoma
Arachnoid cyst
Chiari malformation
Syringomyelia
Hemifacial spasm
Facial palsy
Brain abscess
Arteriovenous malformation
Cerebral infarction with mass effect
Spondylolisthesis
Degenerative scoliosis
Osteoporotic vertebral fracture
Carpal tunnel syndrome
Tethered cord syndrome
Craniosynostosis
Myelomeningocele

Neurosurgical consultation

Bring your imaging and settle the question

One consultation with your MRI or CT in hand is worth more than ten internet searches. Book by phone or through the form and you will be told what is there, what it means and what your options are.

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