NEUROLOGY

NEUROLOGY

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Highly skilled Pediatric and Adult Neurologists at our hospital for management of all neurological disorders

Our affiliated neurologists are some of the best known in the world

Highly skilled team of Neurologists, having gained huge experience in India and abroad at pioneer institutions, capable of managing some of the most complex neurological disorders with clinical outcomes at par with global standards.

NABH and JCI accredited world class hospitals having state of the art facilities.

Brain Suite

Brain Suite is an advanced operating theatre with capability of intra-operative Magnetic Resonance imaging and Magnetic Resonance guided surgery. Surgeon can perform a high resolution MRI during the surgery to assess the degree of tumor removal as well as to avoid normal brain tissues. The safety of the surgeries performed is helped by special techniques to visualize tumor during the surgery (tumor luminescence).

3 Tesla MRI

Magnetic resonance imaging or MRI is an imaging test which uses the magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. MRI, in many cases gives different information about structures in the body than cannot be seen with an X-ray, ultrasound, or computed tomography (CT) scan.

EEG or Electroencephalogram

An electroencephalogram or an EEG is a test that detects and records the electrical activity in a patient’s brain using special sensors (electrodes) attached to the scalp. Brain cells communicate via electrical impulses and are active all the time, even when you’re asleep. This activity shows up as wavy lines on an EEG recording. Certain conditions, such as seizures, can be seen by the changes in the normal pattern of the brain’s electrical activity.

Sleep Study Labs

Sleep studies are tests conducted in a specific room or sleep lab equipped with devices that record the body activity during sleep. The common equipment used is a video EEG. They are helpful in identification of sleep disorders. Polysomnography, a type of sleep study, is the gold standard to rule out obstructive sleep apnea.

Neurology

Neurology

Neurology deals with problems, diagnosis, treatment and managing disorders that arise in the nervous system. The nervous system includes the central, autonomic, peripheral and the somatic nervous system. Neurology refers to a non-surgical specialty while its surgical specialty is known as neurosurgery. The nervous system is a complex, sophisticated system that regulates and coordinates body activities. Neurology takes care of various disorders through medical management or surgery. A doctor who specializes in neurology is called a neurologist. A neurologist treats disorders that affect the brain, spinal cord, and nerves, such as :-

 

*Cerebrovascular disease, such as stroke

 

*Demyelinating diseases of the central nervous system, such as multiple sclerosis

 

*Headache disorders

 

*Infections of the brain and peripheral nervous system

 

*Movement disorders, such as Parkinson’s disease

 

*Neurodegenerative disorders, such as Alzheimer’s disease, Parkinson’s disease, and Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)

 

*Seizure disorders, such as epilepsy

 

*Spinal cord disorders

 

*Speech and language disorders

 

On this page we mentioned disorders which require medical management. Neurologists do not perform surgery. If one of their patients requires surgery, they refer them to a neurosurgeon. Our affiliated centres are some of the known best for neurosciences centre around the world. Our expert team of neurologists work diligently for delivering the best neurology/neurosurgery services in India. Over the years we have assisted people from all the parts of the world, to come and get the best services at affordable rates.

COMPREHENSIVE RANGE OF ADVANCED SERVICES OFFERED BY HEALTH & HOLIDAYS

Our staff is sensitive to the needs of the patients and stand with you every step of the way.  They are capable to deliver assistance 24*7 in case of emergencies.

  • Pre-arrival, no-obligation free quote for your medical condition along with consultations and selection of best doctor/hospital

Pre – Treatment

A patient looking for medical management of neurological disorders sees a neurologist. Once he/she arrives in India, they undergo a series of tests depending on the disorder. These tests may include MRI, CT Scan, EEG, Video-EEG, Blood Tests, Dopplers among others. The series of tests may take about 3-4 days to finish. Once all the reports are collated, the neurologist devises a treatment plan as per his/her best judgement. Most treatments can be given on a out patients basis through oral medications but some might require an admission.

Post – Treatment

Most Neurological disorders can be managed on an outpatient’s basis through oral medications although some might require an admission for administering IV drugs and other treatment modalities. Incase of a admission, the drugs to be taken once discharged are mentioned in the discharge summary provided. The patient might need regular monitoring for dose adjustments for a few days to provide a long lasting relief. The same might be required for a longer duration and can be done through video conferencing/emails once you are back in your home country. In most cases the patient is fit-to-fly back immediately after treatment has been prescribed.

Carpal Tunnel treatment

What is Carpal Tunnel treatment?
Carpal tunnel treatment refers to the treatment of carpal tunnel syndrome, which is a disease caused by pressure on the median nerve of the wrist. Patients suffering from carpel tunnel syndrome experience numbness, tingling sensations, weakness or pain in the hand, fingers, and forearm. This may occur due to pregnancy, diabetes, obesity, hypothyroidism and arthritis. It also occurs as a result of wrist injuries, such as fractures. Carpal tunnel syndrome is also caused by improper usage of the hands and wrists for a long period. This is caused by pressure on the median nerve that leads to swelling of the tissues surrounding the carpal tunnel. Carpal tunnel treatments may include surgical as well as non-surgical treatments.

What are the different types of carpel tunnel treatments?
The different types of carpel tunnel treatments are as follows:

  • Medication:
    Carpal tunnel syndrome may be treated with various medications to heal the pain and subside the swelling of the affected area. Pain killers and non-steroidal anti-inflammatory medicines may be given to the patient for early symptoms caused by strain. Medication may need to be taken orally or injected into the wrist. Vitamin B supplements are also provided to patients suffering from carpal tunnel syndrome.
  • Exercise:
    Exercises such as stretching and strengthening are also used as a carpal tunnel treatment. A physical therapist or an occupational therapist may supervise these exercises.
  • Other therapies: Acupuncture and chiropractic treatment may also benefit patients who are suffering from the symptoms of carpal tunnel syndrome. Yoga is also known to be effective in treating this disease.
  • Surgery
    Surgery is recommended if the patient has been suffering from the symptoms since 6 months without any effect of the non-surgical treatments. The tissue around the wrist is cut open to reduce the pressure on the median nerve. Surgery may be required on both hands. There are two types of surgery:

    • Open Release Surgery
      In an open release surgery, an incision of about 2 inches is made in the patient’s wrist. The carpel ligament is then cut to expand the carpal tunnel. Pressure on the nerve of the carpal tunnel is then relieved. The incision is closed and bandaged with a dressing.
    • Endoscopic Surgery
      In an endoscopic surgery, two incisions of about half an inch each is made in the wrist and palm. An endoscopic tube with a camera attached to it is inserted through one of the incisions either in the wrist or in the palm, which makes the surgeon to see the surgery on a monitor. The carpal ligament is then cut using endoscopic surgical tools to expand the carpal tunnel. Pressure on the nerve of the carpal tunnel is then relieved. The incision is then closed and bandaged with a dressing. An endoscopic surgery decreases scarring and helps in quicker recovery time.

How to prepare for carpal tunnel surgery?

  • The patient is required to stop eating anything solid or liquid for a minimum of 8 hours before the surgery.
  • The doctor may impose diet restrictions. Beforerecommending any surgery, the doctor will perform certain diagnosis on the patient to examine the nerve function of the patient’s hand.
  • A neurologist, an orthopedic surgeon or a rheumatologist may examine the nerve conduction and find out if arthritis is causing the carpal tunnel syndrome.

Duration of procedure/surgery :Carpal tunnel surgery takes 30 minutes to 1 hour

Days admitted :None. Carpal tunnel treatment is usually done as an outpatient procedure.

Anesthesia :Carpal tunnel surgery is done under local anesthesia. Other forms of treatment do not require anesthesia.

Recovery :– After the surgery, the patient is taken to the recovery room until the anesthesia wears off. – Patients may experience nausea and shivering, for which medication and blankets may be provided. – Pain medication may also be given to relieve pain after the surgery. – If patients have undergone surgery in both hands, they may be unable to perform any activities up to 2 weeks. – Normally, patients can resume daily activities 3 to 4 weeks after the surgery. They may be able to perform heavy activities 6 weeks after the surgery. – Most of the patients recover fully following surgery without any furthur recurrence of the disease. – Some patients may need to undergo physical therapy to recover wrist strength.

Risks :The risks involved in a carpal tunnel surgery are as follows: – Reaction to anesthesia – Infection – Incomplete ligament release – Stiffness – Damage to the nerves – 10% of patients may experience wrist weakness

After care :– Patients should not drive for a minimum of 24 hours after the surgery. – For the first few days, patients are advised to keep their hand elevated above the level of the heart. This is done to reduce swelling. – Wrist support has to be worn exactly as per the doctor’s advise. Medication and wound care should be followed carefully exactly the way it is prescribed by your health care provider- Heavy activities should be avoided for a month or two. – A complete recovery may take 3 to 12 months depending on the type and intensity of the surgery.

 

Vagus Nerve Stimulation

What is Vagus Nerve Stimulation?
Vagus nerve stimulation is a method of epilepsy treatment. It requires a surgical procedure in which a device like a pacemaker is implanted in the body, which generates electric pulses to stimulate the vagus nerve. Vagus nerve stimulation is performed to reduce the severity, length, and number of seizures in a patient. In some cases, the frequency of the seizures is also reduced. However, it does not creates imporovements in some patients and it cannot completely cure epilepsy.

Vagus nerve stimulation is used along with antiepileptic mediation. The effect of this vagus nerve stimulation  experienced only after a long period of time.

How Does a Vagus Nerve Stimulator Work?
The vagus nerve stimulator is a computer programmed device. It is implanted under the patient’s skin below the left collar bone. This is connected to the vagus nerve in the left part of the neck. The stimulator is switched on after four weeks of implant. The stimulator is programmed & controlloed by the doctor with the help of a portable hand-held computer. The doctor sets the stimulator to give the required amount of stimulation, which varies for different patients. The stimulated is usually started at a lowest level and then gradually increased to the required level for an individual patient. The common setting of the stimulator is 30 seconds of stimulation per 5 minutes. The stimulator is battery operated and has a validity of maximum 10 years. When the battery life comes to end , it is recommended to replace the stimulator.

The vagus nerve stimulator can be used to provide extra stimulation before or during a seizure. This is performed by positioning a special magnet over the stimulator which can can stop the seizure from arising, or decrease a seizure that is already occurring.The patient can carry the magnet all the time in the belt .
How is a Vagus Nerve Stimulation Surgery Performed?
An incision is made on the left side of the patient’s chest, below the collar bone. The stimulator device is implanted on incision area under the skin. The implanted stimulator is a round device usually measuring about 1.5 inches (4cm) in diameter, and 10 to 13 mm in thickness. New models of this device may be smaller. A horizontal incision is then made in the lower neck and the wire from the stimulator is coiled around the vagus nerve that lies in the left side of the neck. Stimulation is only provided on the left side vagus nerves, because the right vagus nerves help to control heartbeat. A minimal swelling may appear on the skin after the stimulator has been implanted.

What are the Necessary Preparations for the Surgery?

  • Many tests may be performed on the patient to find out the focal point of the seizures. These tests include
    • Neuroimaging
    • Psychological tests that determine the patient’s cognitive potentials and weaknesses
  • The patient will be explained in detail about vagus nerve stimulation.

Duration of procedure/surgery :Approximately 2 hours

Days admitted :Vagus nerve stimulation is done either as an inpatient or an outpatient procedure. As an inpatient, the patient will stay overnight in the hospital.

Anesthesia :General anesthesia

Recovery :– Pain medication may be provided by the doctor if required. – Vagus nerve stimulation is successful in reducing 50% of the seizures. – The stimulator’s settings are adjustable and follow-up visits are scheduled to adjust it to the accurate settings as per the patients physical condition -the doctor guides the patient on how to use the magnet to increase stimulation temporarily. – When the battery of the vagus nerve stimulator diminishes after many years, the implant has to be replaced in an outpatient procedure.

Risks :The risks include during the surgery are as follows: – Injury to the surrounding blood vessels, e.g. carotid artery and jugular vein – Infection – Bleeding – Allergy to anesthesia The side effects caused by vagus nerve stimulation are mild and temporary.These may be: – Hoarseness – Coughing – feeling of discomfort in the throat – Swallowing difficulty – Tingling sensation in the neck – Headache – Ear pain The settings of the stimulator can be adjusted by the doctor if the side effects persist and discomfort is getting worse.

After care :– Patients who have vagus nerve stimulation implants should avoid powerful magnets that may affect the settings of the stimulator. – If it is required to get done  Magnetic Resonance Imaging (MRI) of the patient, he/she must inform about their vagus nerve stimulation implant and If the doctor gives permission for the MRI to be performed on patients with stimulator implants, the stimulator needs to be switched off prior to the scan. – Patients should avoid areas which have warning sign posts for pacemakers. – The doctor’s instructions on safety precautions should be followed carefully.

 

Pediatric Neurology

What is Pediatric Neurology?

This is a sub-specialty of medicine that mainly focuses on the diagnosis, treatment, and management of diseases and disorders of the nervous system in infants, children and adolescents. This includes the brain, spine, and spinal cord.
Who is a Pediatric Neurologist?

This is a medical doctor who has special training in treating disorders involving the nervous system in infants, children, and adolescents.
Training

Neurologists should have completed 4 years of medical school, at least 1 year of residency in pediatrics and at least 3 years of residency in adult and pediatric neurology in order to become paediatric neurologist.
Why see a Pediatric Neurologist?

Pediatric neurologists have the special training that allows them to deal with pediatric patients and provide them with the best care possible. They have better knowledge and understanding of pediatric nervous system disorders and dealing with children’s behaviour.

They collaborate with other doctors and professionals to ensure that the overall care is comprehensive. These include dieticians, primary care physician, speech therapists and other pediatric specialists.
Conditions treated

  • Seizure disorders such as febrile convulsions, seizures in newborns and epilepsy
  • Weakness including cerebral palsy, muscular dystrophy, and nerve-muscle disorders
  • Behavioral disorders such as attention-deficit or hyperactivity disorder (ADHD), autism and sleep problems
  • Developmental disorders such as developmental delay, delayed speech, motor milestones, and coordination issues
  • Medical aspects of brain tumors and head injuries
  • Brain injuries including concussions
  • Headaches, including migraines
  • Hydrocephalus
  • Cerebral palsy
  • Neurogenetic disorders
  • Stroke
  • Neurofibromatosis

Tests and procedures performed include:

  • Electroencephalogram (EEG):This is a noninvasive and pain-free test which measures brain signals using special sensors attached to the head. This test determines the cause of seizures as well as pinpoints various neurological conditions.
  • Electromyography (EMG):This test assesses the health f the nerves controlling the muscles and the muscles. A needle is inserted into the muscle and electrical activity is observed when nerves are stimulated. The electrical activity is displayed on an oscilloscope. This test assists the doctor to differentiate primary muscle conditions from muscle weakness due to neurological disorders.
  • Nerve conduction velocity test:This test is usually performed in conjunction with an EMG to evaluate the speed of conduction of impulses through a nerve. Electrodes are placed on the skin to stimulate the nerves with mild electrical impulses. This test is used to diagnose and evaluate nerve destruction and damage.
  • Evoked potential tests:These tests gauge the transmission of electrical signals within the spinal cord and brain. It is used to diagnose conditions such as multiple sclerosis. Lumbar puncture: This test measures the intercranial pressure. The test can also be sued to remove cerebrospinal fluid for further laboratory testing. A small needle is inserted into the lumbar vertebrae and pressure measurements are taken during that moment or cerebrospinal fluid is removed. The test is used to determine if a headache and vision problems are due to increased pressure.
  • Sleep tests:Sleep studies record your child’s physical state at various stages of wakefulness and sleep. A sleep test is also referred to as a polysomnogram. It provides information that is useful in diagnosing sleep problems.
  • Radiology tests:These are tests that produce images of the inside of the body. They are also called imaging tests. They use various energy forms which are passed through the body to produce the clear

 

 

Headache and Facial Pain

Headache and Facial Pain

A headache is a continuous pain in the head. Facial pain is pain felt in the facial area which includes the eyes and mouth.
What causes facial pain?

  • Sinus infections (sinusitis):This is an inflammation of the tissue lining the sinuses
  • Deviated septum:This happens when the nasal septum (a thin structure separating the two sides of the nose) is not in the middle of the nose
  • Temporomandibular Joint (TMJ) disorders:These are problems affecting the muscles and joints which connect the skull to the jaw on both sides of the head.
  • Hypoparathyroidism:This is a rare condition which occurs when the parathyroid glands in the neck produce insufficient parathyroid hormone (PTH)
  • Salivary gland infections (sialadenitis):These occur when a viral or bacterial infection affects the salivary gland or duct.
  • Trigeminal neuralgia (TN):This is a condition which leads to intense pain in part or all of the face.
  • Temporal arteritis:This occurs when the temporal arteries become damaged or inflamed.
  • Mumps:This is a disease caused by a virus and is transmitted trough nasal secretions, saliva, and personal close contact. It is contagious.
  • Glaucoma:This is an eye condition which damages the optic nerve.
  • Acoustic neuroma:This is a benign tumor which grows on the nerve that connects your ear and your brain.
  • Fibromyalgia:This is a chronic disorder which results in widespread unexplained pain in the tender points in joints and muscles.
  • Multiple sclerosis (MS):This a chronic autoimmune disease which affects the central nervous system
  • Polymyalgia rheumatic:This is an inflammatory disorder which causes muscle stiffness and pain.

Primary Headache Syndromes

  • Migraine:This is a throbbing, unilateral pain
  • Cluster headache:This occurs as minutes to hours of severe unilateral temporal headache, which occurs in grouped attacks over several weeks to months.
  • Tension headache:This causes mild to moderate pain. The pain is usually bilateral and nonpulsatile.

Secondary Facial Pain and Headache

  • Secondary facial pain and headache are usually attributed to the following causes.
  • Vascular headache
  • Head trauma and neck trauma
  • Disorders of cranial and facial structures such as orbital pain, otalgia, cervical spine disorder
  • Substance abuse or withdrawal such as caffeine withdrawal
  • Oral cavity and craniomandibular pain
  • Nonvascular intracranial disorders such as hydrocephalus, tumor
  • Infection such as meningitis
  • Homeostasis disorders such as hypoxia, hypertension
  • Central and Idiopathic Facial Pain and Headache
  • Two main idiopathic disorders that cause a headache and facial pains are midfacial segment pain (a tension-type headache of the midrace) and atypical facial pain (a constant deep unilateral pain)

Diagnosis

  • History: The doctor will ask you questions to try and diagnose the cause of a headache or facial pain. The doctor will ask about the onset, location, duration and relieving factors of the pain. Your family’s medical history with conditions such as sinusitis, rhinitis, and hyposmiashould be informed and explained in front of the doctor during consultation. A full list of medications in use should be given to the doctor.
  • Physical examination: The doctor will perform a comprehensive physical examination of the head and neck. This includes testing of trigger points, jaw clicks, palpation for points of tenderness and testing of the cranial nerves.
  • Imaging tests
  • Noncontrast CT of the sinuses
  • MRA
  • MRI

Treatment

Treatment is usually determined by the possible causes of a headache or facial pain. your doctor will consult with other specialists such as the otolaryngologist, neurologist, dentists and oral surgeons in most cases, if you have got the treatment from them.

 

Sleep Disorder

What is a Sleep Disorder?

This is a medical condition causing disorder of sleep patterns. It is also referred to as somnipathy. Severe sleep disorders can interfere with the normal mental, physical, emotional and social functioning of a person.

Common sleep disorders include:

  • Insomnia disorder (primary insomnia):This is a chronic difficulty in falling asleep and/or maintaining sleep
  • Catathrenia:This is nocturnal groaning during prolonged exhalation.
  • Delayed sleep phase disorder (DSPD): This is the inability to wake up or fall asleep at socially acceptable times.
  • Restless legs syndrome (RLS):This is an irresistible urge to move legs.
  • Idiopathic hypersomnia: This is a primary, neurologic cause of long-sleeping
  • Bruxism:This is a condition where a person involuntarily grinds or clenches the teeth while sleeping.
  • Kleine–Levin syndrome:This is a rare disorder characterized by cognitive or mood changes or persistent episodic hypersomnia
  • Narcolepsy:This is a condition where you fall asleep spontaneously but unwillingly at inappropriate times.
  • Hypopnea syndrome:This is the abnormally slow respiratory rate or shallow breathing while sleeping.
  • Sleepwalking:This is the engaging in activities normally associated with wakefulness that may include walking, without the conscious knowledge of doing so
  • Night terror:This is a sleep terror disorder whereby you abruptly awaken from sleep with behavior consistent with terror.
  • Nocturia:This is a frequent need to get up and urinate at night.
  • Sleep paralysis:This is characterized by temporary paralysis of the body shortly before or after sleep.
  • Parasomnias:This is the disruptive sleep-related events which involve inappropriate actions during sleep such as night terrors, sleepwalking, and catathrenia.
  • Periodic limb movement disorder (PLMD): This is the sudden involuntary movement of arms and/or legs during sleep such as kicking the legs.
  • Sleep apnea:This is the obstruction of the airway during sleep, which causes lack of sufficient deep sleep and is often accompanied by snoring.
  • Rapid eye movement sleep behavior disorder (RBD):This is the acting out of violent or dramatic dreams while in REM sleep, sometimes injuring bed partner or self
  • Shift work sleep disorder (SWSD):This is a situational circadian rhythm sleep disorder
  • Somniphobia:This is a fear or dread of falling asleep.

Types of sleep disorders

  • Dyssomnias:These include a wide category of sleep disorders characterized by either insomnia or hypersomnia.
  • Parasomnias:This is a category of sleep disorders which involve abnormal as well as unnatural movements, emotions, behaviors, perceptions and dreams with regard to sleep.
  • Circadian rhythm sleep disorders:This includes delayed sleep phase disorder, non-24-hour sleep–wake disorder and advanced sleep phase disorder.
  • Sleeping sickness:This is a parasitic disease transmitted by the tsetse fly.
  • Medical or psychiatric conditions that may produce sleep disorders such as mood disorders, alcoholism, and psychosis.

Signs and symptoms of sleep disorders

  • Difficulty staying awake while sitting still, reading or watching television
  • Feeling irritable or sleepy during the day
  • Difficulty concentrating
  • Having trouble controlling emotions
  • Falling asleep or feeling fatigued when driving
  • Reacting slowly
  • Requiring caffeinated beverages to keep awake
  • Feeling like taking a nap almost everyday
  • What is the treatment for sleep disorders?
  • Behavioral and psychotherapeutic treatment
  • Rehabilitation and management
  • Medication
  • Other somatic treatment

 

Neuroncology

What is Neuroncology?

This is a medical subspecialty of neurology that studies the brain and spinal cord neoplasms (Abnormal growth of tissue). These neoplasms are typically dangerous and life threatening. Cancer spreads to the nervous system brain metastasis, compression or direct invasion. Compression from continuous tissues or direct invasion is associated with the proximity of the nervous system to other neuro- structures such as the lumbosacral plexus, brachial plexus, cranium, base of the skull, vertebral neuroforamina, and pelvic bones.
Risk factors include:

  • Histology
  • Tumor location
  • Blood-brain barrier disruption

Symptoms of Neuroncological conditions include:

  • Visual impairment
  • Tissue destruction
  • Local brain infiltration
  • Increased intracranial pressure
  • Cerebral edema

Types of neuroncology tumors

  • Primary tumors
  • Malignant astrocytomas
  • Other astrocytomas
  • Glioma
  • Pituitary region tumors
  • Brain stem gliomas
  • Germ cell and pineal region tumors
  • Meningiomas and other meningeal tumors
  • Medulloblastoma and other primitive neuroectodermal tumors
  • Oligodendrogliomas: these include anaplastic oligodendroglioma, low-grade oligodendroglioma, and oligoastrocytoma.
  • Tumors of the optic nerve and chiasm
  • Primary spinal cord tumors
  • Primary central nervous system lymphoma
  • Glioblastoma multiforme
  • Ependymoma
  • Pontine glioma
  • Brain stem tumors
  • Neuroepithelial tumors
  • Nerve sheath tumors such as schwannoma, neurofibroma

Metastatic Tumors of the Central Nervous System

  • Intracranial Metastasi: Three types of intracranial metastasisare present named brain metastasis, leptomeningeal metastasis, and dural metastasis.
  • Brain metastasis:It can be single or multiple and it involves any part of the brain
  • Leptomeningeal metastasis:It is commonly a result of lung, breast or melanoma primary tumors
  • Dural metastasis: It is due to direct invasion or hematogenous spread from a contagious bone
  • Skull Metastasis: There are two types of skull metastases depending on the general site namely skull base and calvarium. Metastases to the calvarium are usually asymptomatic. Due to the close proximity to vascular structures and cranial nerves, metastases to the skull are symptomatic.
  • Spinal Metastasis: The spine is usually affected by the metastatic disease which involves the epidural space. This occurs as an invasion of paravertebral masses through a neuroforaminal or direct invasion from a vertebral body. Management or treatment of spinal cord metastases is determined by the overall status of the patient’s cancer and if the metastasis is causing epidural spinal cord compression.

Diagnostic procedures

  • Diagnostic Imaging of the Brain and Spinal Cord:Common imaging studies used in neuroncology include magnetic resonance imaging (MRI) as well as computed tomography (CT). Other imaging techniques used are positron emission tomography (PET), myelography and diagnostic angiography.
  • Lumbar Puncture (LP) and Cerebrospinal Fluid Analysis (CSF): These tests are used for the evaluation of some metastatic conditions, primary tumors and neurologic complications due to cancer.
  • Pathologic Diagnosis:This uses biopsies which are surgically obtained to make a histologic diagnosis.

Commonly used treatments in neuroncology

  • Radiotherapy:This treatment uses ionizing radiation to control or kill malignant cancer cells.
  • Chemotherapy:This is a type of cancer treatment that uses drugs to kill cancer cells.
  • Corticosteroids
  • Neurosurgical Interventions

Neurologic complications of cancer

  • Neuroncological conditions can cause the following complications.
  • Complications of cancer therapy such as neuropathies related to chemotherapy
  • Seizures related to cancer
  • Paraneoplastic Syndromes such as myasthenia gravis, limbic encephalitis
  • Opportunistic Infections
  • Stroke in Cancer Patients

 

Neuropsychology

What is Neuropsychology?

This is a medical sub-specialty which main focuse is on the structure and function of the brains and their relation to psychological behaviors and processes.

It aims at understanding how cognition and behavior are influenced by brain function. It also focuses on the diagnosis, treatment, and management of cognitive and behavioral effects happening due to neurological disorders.
Who is a neuropsychologist?

This is a medical doctor who specializes in providing assessments and treatment recommendations for people with neurological disorders.
Why see a neuropsychologist?

Neuropsychologists provide treatments that employ behavioral, cognitive, educational or psychosocial methods. They have better knowledge & skills in assessing, diagnosing as well as treating an array of neurological disorders.They have the expertise to understand the behavioral, cognitive and emotional effects of a wide range of conditions.
A neuropsychologist helps people who are experiencing difficulties with:

  • Learning
  • Memory
  • Attention
  • Reading
  • Language
  • Decision making
  • Problem solving
  • Behavioral and thinking abilities
  • Growth and development
  • Metabolism
  • Degenerative
  • Toxic poisoning
  • Demyelinating
  • Drugs
  • Alcohol
  • Epilepsy
  • Vascular
  • Cortical dysplasia
  • Immunological
  • Psychiatric
  • Inflammation
  • Endocrine
  • Nutrition
  • Trauma
  • Infection

Diagnostic methods and tools

  • Standardized neuropsychological tests :聽These tests have been designed such that the performance of the task can be linked to specific neurocognitive processes. The test is standardized which means that they have been administered to a specific group of individuals before being used in individual clinical cases.
  • Brain scans :聽Brain scans are used to investigate the structure and function of the brain with high-resolution pictures or by observing the relative activations of various brain areas. Brain scans are thetechnologies which yield data related to function or structure such as:
  • Positron emission tomography (PET)
  • Functional magnetic resonance imaging (fMRI)
  • Magnetic resonance imaging (MRI)
  • Computed axial tomography (CAT or CT)

Electrophysiology

Electrophysiology is referred to electrophysiological measures which are designed to measure the activation of the brain by measuring the magnetic or electrical field produced by the nervous system. This may include magnetoencephalography (MEG) or electroencephalography (EEG)
Experimental tasks

This uses specially designed experimental tasks often controlled by computers to measure the accuracy and reaction time on particular tasks. The tasks are thought to be corresponding to specific neurocognitive processes.
Software products

This uses gaming technology which researchers have mapped to scan neural activity in the brain through brain scans.
Neuropsychology subspecialties

  • Experimental neuropsychological:聽This approach uses experimental psychology methods to investigate the relationship between cognitive function plus the nervous system.
  • Clinical neuropsychology:聽This approach uses neuropsychological knowledge to assess, manage and rehabilitate people who have suffered injury or illness (especially to the brain) which has resulted in neurocognitive problems.
  • Cognitive Neuropsychology:聽This approach aims at understanding the mind and brain by studying people who have suffered neurological illness or brain injury.
  • Connectionism:聽This approach uses artificial neural networks to model particular cognitive processes using simplified but plausible models of how neurons operate.
  • Functional neuroimaging:聽This approach uses specific neuroimaging technique to take readings from the brain. It is performed when a person is doing a particular task. It mainly focusesat understanding how the activation of particular brain areas is related to the task.

Treatments

 

ALS

What is ALS?

Amyotrophic lateral sclerosis or ALS is a condition where certain nerve cells in the spinal cord and brain gradually start dying. These nerve cells are referred to as motor neurons, and they control the muscles, which let you move your body parts. ALS is also known as Lou Gehrig’s disease.

Getting Medical as well as lifestyle advises from your physician, joining a support group, or getting counseling, can help you manage your emotions. Your family members might as well need counseling and support as your disease worsens.
What causes ALS?

Doctors do not know what brings about ALS. In 1 case out of ten roughly, it runs in families. This implies 9 times out of ten, an individual with ALS does not have a family member with the condition.
What are the symptoms?

The first sign of Amyotrophic lateral sclerosis is usually weakness in the tongue, one hand, one leg, or the face. The weakness gradually spreads to both legs and arms. This weakness arises and increases as the motor neurons gradually die thus stop transmitting signals to the muscles. So the muscles do not have anything informing them to move. As time passes, without signals from the motor neurons telling the muscles to move, the muscles become small and weak.

As time passes, ALS as well leads to:

  • Muscle twitching.
  • Problems with breathing, eating, speaking, walking, and swallowing.
  • Trouble using your fingers, and hands to perform tasks.
  • Problems with thinking, memory, and changes in personality. However, these are not aren’t common.

How is ALS diagnosed?

It may be difficult for your doctor to tell if you have the condition. Most of the times it doesn’t get clear that you have the ASL until symptoms worsen or until your physician has conducted more testing. To check if you have the disease, your doctor will perform a physical examination and will ask you regarding your past health and symptoms. You will as well have tests, which show how your nerves and muscles are working.

Simply because you have twitching, fatigue, muscle weakness, and stiffness does not imply that you have ALS. Those symptoms may also be due to other conditions. So consult your doctor if you have those symptoms. The physician will refer you to a neurologist to confirm.
How is ASL treated?

There’s no cure for the disease; however, treatment may help you stay strong and independent for as long as possible. For instance:

  • Occupational and physical therapy may help you stay strong thereby making the most of the abilities you still have.
  • Speech therapy may help you with talking, coughing, and swallowing after weakness in the chest, face, and throat starts.
  • Supportive equipment and devices are going to be helpful for you tocommunicate, stay mobile, and perform everyday tasks such as dressing, bathing, and eating. Some examples are shower seats, wheelchairs, handrails, canes, raised toilet seats, walkers, and ramps. You may as well get braces to support your neck, feet, or ankles.
  • Medicines: you will find medicines that can assist with most of the symptoms you may have, like pain, extra saliva and drooling, muscle issues (twitching, stiffness, cramps), and mood swings and depression.
  • A feeding tube may help you get adequate nutrition to stay strong as long as you can.
  • Breathing devices may help you breathe without difficulty as your chest muscles get weak.

A medicine known as riluzole (Rilutek) might extend survival by roughly two months. However, it does not improve the quality of life or symptoms in ways that those with ASL, their doctors, their caregivers have been able to notice. Several people may experience the positive effect of riluzole very well; however, it may cause adverse reactions, which include coughing, vomiting, dizziness, nausea, and weakness.
Palliative care

Palliative care is a type of care for those who have a severe disease. It is different from care to cure your disease. Its objective is to improve your quality of life-not only in your body but even in your spirit and mind.

 

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