Most people who come in for a neurological evaluation have lived with a symptom for a while: a headache pattern that changed, a hand that keeps going numb, a spell nobody has explained. The evaluation is where we work out whether the nervous system is responsible, which part of it, and what to do next. A new-patient visit is a full 60 minutes with Dr. Achillefs Ntranos, MD, a board-certified neurologist, in person or by video anywhere in California.
What is a neurological evaluation?
It has two halves. The history, the story of your symptoms told in detail, provides most of the diagnosis. The examination confirms it and pins down the location, from the brain and spinal cord to the nerves and muscles. Only then do we decide whether a test would change the answer. Many evaluations end with a diagnosis, a plan, and no test.
An evaluation is not a scan. A normal MRI rules out a short list of things and says nothing about migraine, most neuropathies, epilepsy, or most dizziness. If you have had a normal scan and still have symptoms, the evaluation is the step that was skipped.
This page describes the evaluation of a new or unexplained symptom. If you already have a diagnosis and want it re-examined, that is a second opinion. If you want the same evaluation by video, our telehealth page explains what works on screen and what does not.
How a neurological evaluation finds direction
- History: describe how the symptoms started and changed.
- Examination: check the nervous system to locate the problem.
- Next step: order tests only when they would change the answer.
Reasons to have one
You do not need a diagnosis in mind, or a referral. The symptoms that most often bring people in:
- Headaches that are new or changing, and frequent migraine
- Dizziness, vertigo, or imbalance
- Numbness in the hands or feet, or burning pain with no clear cause
- Weakness, a foot that drags, or a change in walking
- Memory loss, word-finding trouble, or brain fog
- Tremor, seizures, blackouts, or unexplained spells
- Facial weakness or pain, including Bell's palsy and trigeminal neuralgia
- Double vision, vision loss in one eye, or restless legs and insomnia
- Symptoms attributed to stress or anxiety without a neurological examination
We also perform agency evaluations: the FAA neurological evaluation for medical certification, and the California DMV driver medical evaluation (form DS-326).
Some symptoms should not wait for an appointment
Sudden weakness or numbness on one side, trouble speaking, the worst headache of your life, a first seizure, or sudden loss of vision are emergencies. Call 911 or go to the nearest emergency department. We are glad to see you afterwards.
What happens during the evaluation
Before you come
Write down when the symptom started, how it has changed, what triggers it, and your questions. Bring your medications and supplements. Prior imaging can be uploaded through patient tools. Bring someone if the concern is memory.
The history, about half the visit
When it started, what it feels like, what makes it better or worse, plus your medical history, medications, family history, sleep, and work. The history narrows the possibilities more than any test does, which is why a new-patient visit is scheduled for a full hour.
The examination
A short general examination first, including blood pressure and the neck vessels when dizziness or stroke risk is in question, since some neurological symptoms have a non-neurological cause. Then the neurological examination, section by section.
Testing, only when it would change the answer
MRI or CT through your insurance, with prior authorization handled by us; blood tests for causes such as B12 deficiency or thyroid disease; EEG for possible seizures; EMG and nerve conduction studies, which we refer out for; a small fiber skin biopsy, neuropsychological testing, a home sleep study, or neurogenetic testing, arranged here; or a lumbar puncture elsewhere, under fluoroscopy.
After the visit
A diagnosis or working diagnosis in plain language, a written plan, prescriptions sent electronically, and a superbill. Results are reviewed at a 30-minute follow-up.
Prepare the story, records and questions
- Timeline: note onset, progression, triggers and what symptoms stop you doing.
- Records: bring medications, supplements and prior test reports or images.
- Questions: write down concerns and bring someone when memory is part of the problem.
What a neurologist tests, part by part
The examination is the part people know least about. It checks the nervous system in sections, and the pattern across them shows where the problem is.
| What is checked | What it tells us |
|---|---|
| Mental status | Attention, memory, language, and reasoning at the bedside |
| Cranial nerves | Vision, eye movements, facial strength, hearing, and speech, testing the brainstem |
| Motor function | Muscle strength, tone, and any involuntary movement |
| Sensation | Whether a nerve, a root, the cord, or the brain causes the numbness |
| Reflexes | Brisk, absent, or asymmetric reflexes localize in ways a scan cannot |
| Coordination and gait | Cerebellar function, and how the system works together when you walk |
Numb feet with absent ankle reflexes suggest a peripheral neuropathy. Numb feet with brisk reflexes and a stiff gait suggest the spinal cord. The examination tells them apart.
By video, Dr. Ntranos performs a structured version of this examination following the American Academy of Neurology's telehealth guidance. Reflexes, the eye-movement tests that separate inner-ear vertigo from a brain cause, and new weakness need an in-person visit.
Two caveats about testing. A normal test does not mean nothing is wrong; it means one explanation has been removed. And an abnormal test does not always explain your symptom, since incidental MRI findings are common, and part of our job is saying when one does not matter.
Exam, MRI, EEG or EMG: what each one can and cannot show
Each test answers a different question, and none of them replaces the history and the examination. This is what each one can tell you, and where it stops.
| Test | What it can show | What it cannot show |
|---|---|---|
| Neurological exam | Where the problem sits: brain, spinal cord, nerve root, nerve, or muscle | The cause on its own. It points to the test, if any, that would find it |
| MRI | The structure of the brain and spinal cord: MS lesions, tumors, inflammation, and pressure on the spinal cord or a nerve root | How the nervous system is working. A normal MRI does not rule out migraine, most neuropathies, epilepsy, or most dizziness |
| EEG | The brain's electrical activity, including patterns that point to epilepsy and its type | The brain's structure, which takes an MRI. A normal EEG between seizures also does not rule epilepsy out |
| EMG and nerve conduction studies | How the large nerves and the muscles work: carpal tunnel syndrome, a pinched nerve root, many neuropathies, and muscle disease | Damage to the small nerve fibers behind burning pain, which needs a skin biopsy, or problems in the brain and spinal cord |
Requesting a visit
If the problem turns out not to be neurological, we will say so and point you to the right specialist rather than keep you on the schedule. The full list of what we diagnose is in our conditions library.
Not knowing whether a symptom is serious is reason enough to have it checked. A first visit is 60 minutes and ends with a diagnosis or working diagnosis and a written plan. New patients are usually seen the same or next business day, in person at our Beverly Hills office or our Los Angeles office, or by video anywhere in California. It is the same doctor and the same hour at either office, so choose whichever is closer; the offices section on our home page has the addresses, maps, and hours. Follow-ups are usually every one to three months and last 30 minutes. Request a visit with no referral, and the office confirms your request within 1 business day. You can read what happens from request to follow-up before you decide, and how the visit is billed on our billing page.