Department of Neurology

Diagnostic tests and therapeutic treatments of all neurological symptoms and disorders are conducted at the Department of Neurology. A detailed patient history is first taken, which places special emphasis on the initial appearance and progress of the symptoms, and is followed by a personal and family history to determine hereditary disorders. The most detailed component of the diagnostic approach is the neurological examination which includes:

• Evaluation of the psycho-intellectual state (psycho mobility and general behaviour, level of consciousness, orientation, attention and focus, memory, judgement, intelligence) and pathological symptoms (delusions, hallucinations, emotional disorders
• Examination of cranial nerves
• Examination of motor system and cerebellar functions during which muscle strength, reflexes, the coordination of muscles in posture, movement and gait are examined.
• Sensory examination (superficial, in depth and combined).
• Examination for apraxia, agnosia, aphasia and anarithmia. The ability to move and perform motor functions, the ability to recognise objects in the surrounding area, the recognition of parts of the body and the ability to speak and comprehend language (both written and spoken) are evaluated. 
• Neurological symptoms examined and treated include:
  1. Primary (benign) headaches (migraines, tension headaches, cluster headaches) and neuralgia (trigeminal neuralgia, postherpetic neuralgia etc.). Differential diagnosis and emergency treatment of secondary headaches (subarachnoid haemorrhage, subdural hematoma, temporal arthritis etc.).
  2. Painful syndromes such as neck pain and back pain (spondyloarthropathy, injuries, spinal cord tumours), pain in the extremities (pressure on the brachial plexus, carpel tunnel syndrome, peripheral neuropathy etc.).
  3. Dizziness and vertigo (benign positional vertigo, labyrinthitis, vestibular neuritis, Mėniėre's disease, cerebellopontine angle etc.).
  4. Fainting episodes (parasympathetic disorder, orthostatic hypotension, cardiac arrhythmia, epileptic seizures, transient stroke etc.).
  5. Tremors (Parkinson’s disease, benign (senile) tremor, cerebellar tremor), choreoathetoid movements, myoclonus and restless leg syndrome.
  6. Gait disorders (Parkinson’s gait, sickle cell gait disorder, spastic-ataxic, apractic etc.).
  7. Speech disorders (dysarthria, dysphonia, logoclonia, palilalia etc.).

Finally, neurological disorders are investigated, treated and regularly monitored. Alzheimer’s and other primary dementia syndromes (vascular dementia, frontotemporal dementia, dementia with Lewy bodies etc.) are clinically documented in great detail, based both on patient history and clinical examination and descriptions provided by the primary caregiver. In addition, a full lab workup (blood, biochemical, and thyroid) and imaging tests (CT or cerebral MRI scan) are performed. Key roles are also played by neuropsychological tests (memory, visuospatial capacity, every day task tests) in order for the diagnosis to be based on rigorous and internationally accepted criteria for dementia. The patient is given medication and is monitored regularly in order to regulate the medication and treat various symptoms which may present on occasion (depression, delirium etc.). Finally, caregivers are also afforded special attention and given instructions for the care of the patient and psychological support in the extremely difficult task of caring for dementia patients.

• Vascular cerebral accident (stroke): the patient is both clinically examined and undergoes imaging tests (CT and/or cerebral MRI scan), the rehabilitation programme is determined and treatment is administered to prevent a potential secondary accident. Potential accompanying pathological symptoms such as depression and dementia are also treated at the same time.
• Demyelinating disease (multiple sclerosis): when the disease is suspected, the examination involves both imaging tests (cerebral, cervical, thoracic and spinal MRI scans) and a full lab workup (blood, immunological, thrombophylic). In addition, the cerebrospinal fluid is also tested with a lumbar puncture to test for virological and oligoclonal IgG bands. The patient is given immunomodulatory medication and is monitored so as to ensure potential symptoms are treated (otho cyst disorders, fatigue, depression etc.) and is regularly informed about new developments regarding the treatment of the disease on an international level.
• Parkinson’s disease and other extrapyramidal syndromes [multiple system atrophy (MSA), progressive supranuclear palsy (PSP), Corticobasal Ganglionic Degeneration (CBD)]: the patient is monitored regularly, medication is regulated as required and various symptoms which may appear throughout the progress of the disease are treated.
• Epilepsy: patient undergoes imaging tests (cerebral MRI scan) and an EEG (Electroencephalogram). The patient is regularly monitored so as to evaluate the effectiveness of the medication and is given instructions regarding preventative measures in daily life.

In conclusion, thanks to the collaboration between all departments and state-of-the-art equipment in the Clinic, a full examination can be conducted and all neurological symptoms and diseases may be treated.

Georgios Dim. Nasis
Neurologist