People often worry that any strange sensation, twitch or memory lapse must mean a serious neurological disease. In reality, neurologists see a huge range of symptoms and many of them are harmless, even if they feel unpleasant or inconvenient.
In this blog, consultant neurologist David Lynch explains which neurological symptoms usually need urgent attention and which ones are almost always benign and not of particular concern.
Although this blog outlines the types of symptoms that are unlikely to be a serious health concern, it does not assume that the symptoms aren’t impacting individuals and their day-to-day life.
It should not be used to replace a visit to your GP if you are feeling unsure about anything or feel concerned. Please book an appointment at your surgery if you would like further assessment and/or reassurance.
There are a wide range of symptoms that patients share with me, as a neurologist. Some of them are a genuine reason for concern, but there are many common symptoms that don’t usually ring any alarm bells.
Just because they aren’t alarming to me as a neurologist doesn’t mean that they don’t impact patients and their day-to-day lives, and any information shared in this blog is designed to reassure, not to replace the advice of a GP. Please speak to your GP if you have concerns about your health; that is what they are there for.
With that said, here are some of the common symptoms we see as neurologists, including the ones that need further investigations:
Visual symptoms
There are several visual symptoms that, while debilitating, aren’t a cause for alarm.
Migraines can cause a huge range of strange visual effects that are benign, including:
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Sparkles or flashing lights
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Coloured or black and white spots
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Visual snow (a grainy, snowy field of tiny dots)
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‘After images’ that appear in a trail when something moves, called palinopsia.
These are very typical of migraine and not a sign of brain disease.
However, it is fair to say that some visual problems are red flags and should be checked urgently. These include:
Sudden loss of vision in one eye, especially if painless
This may be caused by a detached retina, reduced blood supply, or acute optic nerve inflammation. Any of these problems need to be seen by a specialist eye doctor (ophthalmologist).
Reduced vision with eye pain
If pain gets worse when the eye moves and colours look faded or blurred; this may be optic neuritis - an inflammation of the optic nerve. This is usually treated quickly with steroids, so early assessment (ideally from a specialist eye A&E, but, if there isn’t one close, then a general A&E) is important.
Double vision in both eyes (disappears when one eye is closed) Acute double vision can point to problems such as a stroke. This needs to be assessed urgently, usually through A&E.
Memory and cognitive symptoms in younger people
Memory problems in people under about 50 to 60 are very rarely caused by dementia. Far more commonly they are linked to stress, poor sleep, anxiety, or low mood.
This can include things like:
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Forgetting what you went to the shop for
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Re-reading pages because nothing sinks in
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Forgetting names at social events
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Driving home and not recalling the journey (known as highway amnesia)
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Writing down every small lapse out of fear of dementia.
More worrying problems around memory loss
It is best to get checked out by a neurologist if any of the following symptoms arise, as they could signal the start of a cognitive problem:
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Family or friends are more concerned than the patient, especially if the patient doesn’t notice their own difficulties
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Work problems that are out-of-character, particularly repeated or serious mistakes
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Clear changes in behaviour, such as serious loss of interest (apathy), saying inappropriate things (disinhibition) or other personality changes
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Getting lost in familiar places
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Cognitive problems alongside other neurological signs such as tremor, seizures or abnormal reflexes.
Twitching, weakness and neuromuscular symptoms
Some twitches are completely normal:
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Eyelid twitching, even when it continues for weeks or months
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Thumb twitching that makes the joint move
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Calf twitching, which is extremely common and normally benign
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Tingling of the face and tongue during migraines
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Positional tingling, such as waking with a numb arm or tingling when leaning on the elbow, is usually from temporary nerve compression and not serious.
However, there are some neuromuscular symptoms that should be reviewed by a neurologist, which include:
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Twitching combined with muscle wasting or weakness, which develops over time
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Muscle twitching in the tongue
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Weakness with loss of function, such as foot drop or difficulty doing up buttons
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Pain followed by weakness, which can indicate nerve inflammation
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A clear ‘boundary’ on the body, where everything below a certain point feels altered
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Progressively increasing numbness or unsteadiness.
If you are experiencing any of these symptoms, then further investigation is worthwhile, as they could indicate a spinal problem or a movement disorder.
Fits, faints and blackouts
When faints look dramatic but are not epilepsy
Sometimes people faint and have a few muscle spasms or ‘jerks’. This is called convulsive syncope. If there was a clear trigger such as heat, dehydration, or standing too long, and there was the typical “faint feeling” first, this is far more likely to be fainting rather than epilepsy. These cases are usually best investigated by a heart specialist (cardiologist) rather than a neurologist.
Non-epileptic episodes
These are common and can look like seizures, but the person is often conscious during the event. They may:
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Hear or see everything but feel unable to respond
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Describe feeling disconnected or ‘watching themselves’
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Have episodes lasting many minutes or even longer without needing emergency care.
These are not epileptic seizures and are managed differently, often through psychological support. However, this diagnosis can only be made by a neurologist. If the attacks can be recorded on video to show the neurologist, that can be incredibly helpful.
When to see a neurologist following a fit or seizure
The signs of a likely epileptic seizure include:
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Going stiff then jerking
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Loss of awareness with prolonged confusion afterwards
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Repetitive movements such as lip smacking
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Biting the side of the tongue.
If these events occur, then it is essential to seek further assessment from a neurologist.
Tremors and shakes
Tremors or shakes may lead to concerns about Parkinson’s disease.
In a patient that may have Parkinson’s, the most obvious signs include:
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A tremor on one side of the body
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Tremor when the limb is at rest
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Slowness or stiffness
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A change in the way the person walks or reduced arm swing.
If these symptoms are occurring, then we would suggest a prompt appointment with a neurologist, as Parkinson’s disease usually responds well to treatment and early intervention can be valuable.
Tremor symptoms that are usually not worrying
Although they can still be troublesome, there are types of tremor that aren’t of particular concern to a neurologist including tremor made worse by stress, caffeine or medication such as SSRIs, lithium, valproate and some asthma inhalers.
It may still be worth speaking to your GP about any help that is available for these concerns.
However, there is a condition known as essential tremor, which is a neurological disorder characterised by involuntary shaking of the hands, head, trunk, voice, or legs. This movement disorder can sometimes be confused with Parkinson’s disease. There is value in having your tremor assessed by a specialist neurologist to assess the best way of treating it effectively.
In summary...
Many symptoms that people fear, such as eyelid twitching, thumb twitching, calf twitching and everyday forgetfulness, are simply part of normal human life.
However, we recognise that even benign symptoms can still be frustrating and deserve proper assessment by a GP or another healthcare professional. But knowing which symptoms are usually harmless can make the wait for an appointment much less stressful.
