How to keep your distance from a neurologist

An apple a day will never be enough to avoid neurological diseases. For one, the nervous system is extensive, vulnerable from the top of the head to the tips of the toes. For another, the cells that constitute the nervous system are susceptible to an astonishing variety of insults. This explains the diversity and number of neurological diseases, and why medical students and doctors find neurology daunting.

 

There are many neurological diseases that we can do absolutely nothing to guard against. This is the case with genetic neurological diseases, unless we find a way of choosing our parents wisely! Proven ways of improving our defences include exercising regularly, eating healthily, and stopping smoking; these however have their limitations against many neurological disorders.

But don’t despair, there are measures we can take to shield ourselves against some avoidable neurological conditions. Many of these arise because of activities we engage in, often mindless of their consequences. The list is fairly long, but here are my  ‘12 Don’ts of Neurology’ to help avoid a meeting with a neurologist.

1. Don't get angry

Anger is an unpredictable negative emotion which hardly ever serves any useful purpose. If you need a very good reason to keep your cool, know that anger is a recognised trigger of stroke. On balance therefore, it’s not worth blowing a fuse.

2. Don’t stay too long at the hair-dressers sink

Excessive neck extension, as occurs at the hairdresser’s or the chiropractor, could stretch and tear the inner lining of a neck artery. This painful tear is called a dissection and it allows a blood clot to form. What happens next is the serious part; the clot may dislodge and travel up the blood vessel where it blocks blood flow to the brain. The result, understandably, is called the beauty parlor stroke syndrome.

3. Don’t cross your legs

 

We all do it: sit back and hang one leg over the other knee. Habitual crossed-leg sitting however puts your peroneal nerve at risk of compression where it crosses round the knee to innervate the leg and foot muscles. The result is foot drop. Sitting in the yoga lotus position causes a similar damage, as does prolonged squatting (strawberry pickers foot drop).

4. Don’t stay too long on the toilet seat

The sciatic nerve is the largest peripheral nerve in the body, and it traverses the buttock on its way to innervate most of the lower limb muscles. It is vulnerable to prolonged sitting on hard surfaces, and it’s a no-brainer that this is called toilet-seat neuropathy. You could of course have your toilet seat nicely padded! You may also protect your sciatic nerve by not putting thick wallets and coins in your back pocket.

5. Don’t build your muscles to excess

It is trendy to have a nice six-pack or firm pecs, but this may come at a price. As the muscles get stronger and bulkier, they may compress the nerves which pass through them. Most vulnerable are the thoracodorsal, the suprascapular, and the pectoral nerves. A shrunken pectoral muscle on one side is sure evidence that you have overdone it.

6. Don’t over-do the athletic thing

Athletic sports that involve excessive upper limb movements may stretch and compress the nerves. Particularly vulnerable is the axillary nerve which supplies the muscles you need to lift your arm away from your body. The culprit sports include volleyball, javelin, rock climbing, and rugby.

7. Don’t overload that backpack

It’s so convenient to sling a backpack over the shoulder, but it is not benign if you overload it. This is because the heavy weight of a backpack may damage the brachial plexus, the large network of nerves that innervate the upper limb. The resulting limp upper arm is called…you guessed it, rucksack paralysis.

8. Don’t ever be handcuffed

 

The wrist is the gateway to three important nerves, all vulnerable to compression. External pressure on the wrist particularly picks on the superficial branch of the radial nerve. The resulting handcuff palsy causes pain and tingling over the back of the hand. A similar effect may result from tight wristwatches and bracelets. A good reason to go bare below the elbows.

9. Don’t hold to tightly to your bicycle handlebars

 

To avoid the so-called cyclists palsy, you must not only choose your machine carefully, but take care when riding. This is to protect your ulnar nerve which traverses the wrist just where the cycle handlebars would compress it. This causes paralysis of many of the small muscles of the hand, sparing only the thumb.

10. Don’t tighten your belt excessively

The victim nerve this time is a branch of the femoral nerve, the second largest nerve of the lower limb. This nerve migrates from the abdomen into the thigh by squeezing just under the belt line. It is vulnerable to compression here, and the result is meralgia paraesthetica. This is a fairly common condition, easily recognised by a combination of pain, tingling, and numbness over a well-demarcated patch on the outer thigh. Wearing skinny jeans is another recognised cause, as are prolonged sitting and weight gain.

11. Don’t use ill-fitting ski boots

 

Choosing the wrong ski boots may not just mess up your skiing holiday, it could result in compression of the peroneal nerve around the ankle . This causes tingling over the foot …but this may persist long after you have (angrily?) discarded the offending boots.

12. Don’t fail a hanging attempt

 

The nerves vulnerable to the hangman’s noose are the greater auricular nerves. These nerves transmit sensation from the ears; not a major problem if the hanging is successful; if the attempt fails however, be prepared for numb ears in resurrection.

 

To explore this topic in further detail, I recommend the following books:

Localization in Clinical Neurology 

Peripheral Neurology: Case Studies