BRAIN AND SPINES
The centre provides cutting-edge care in Neurology, Neurosurgery and Interventional Neuroradiology. The range of care provided includes management of
Alzheimer’s disease (also known as Alzheimer or AD) is a progressive degenerative brain disease, and the most common type of dementia. People affected by AD have progressive and frequent memory loss. With time they may become withdrawn and develop trouble in thinking, planning, working, interacting socially or looking after themselves.
Normal Aging & Memory
The human brain contains over two billion neurons, and other than sensory analysis and execution of motor acts, it performs the unique and exceedingly complex & intricate function of accumulating knowledge that adds to the experience of an individual. This constitutes the intellect (cognitive ability) of a person and is person specific, develops with age, and is refined with education and exposure. In normal aging, the loss of intellectual faculties is not significant and people can live independent and productive lives.
Almost everyone experiences memory problems occasionally. However, memory loss is considered significant if the memory impairment is frequent and severe enough to interfere with work or daily routine.
Dementias are a group of neurological disorders that lead to decline in the cognitive abilities/intellect & interfere with a person’s ability to work and interact socially. There are various types of dementias that have different biological mechanisms, affect different regions of the brain, present in different ways and require different treatment. Some of these dementias are even reversible. Therefore, evaluation by a neurologist is important to identify the particular type of dementia as the treatment and prognosis of each dementia varies.
What are the types of dementia?
Tumors arising from in and around the brain – its substance, supporting tissue or its covering within the skull are all called brain tumors in general. They are fortunately not the commonest tumors in adults, but are the commonest solid tumors in children.
What is a Brain tumour?
A brain tumor is an abnormal mass of tissue in which some cells grow and multiply uncontrollably due to loss of mechanisms that control normal cells growth. The growth of a tumor takes up space within the skull and interferes with normal brain activity. A tumor can cause damage by increasing pressure in the brain, by shifting the brain or pushing against the skull, and by invading and damaging nerves and healthy brain tissue. The location of a brain tumor influences the type of symptoms that occur. This is because different functions are controlled by different parts of the brain. Brain tumors rarely metastasis (spread) to other parts of the body outside of the Central Nervous System (CNS) The CNS includes the brain and spinal cord.
Some tumor types are more common in children than in adults. When childhood brain tumors occur in adults, they often occur in a different part of the brain than in children. Although most primary tumors attack member of both sexes with equal frequency, some, such as meningiomas, occur more frequently in women, whereas others, such as medulloblastomas, more commonly affect boys and young men.
The treatment outcomes in brain tumor patients are as individual as the patients themselves. Your doctors will help you understand the possible repercussions of your specific tumor.
What is the difference between a primary brain tumour and a metastatic (secondary) brain tumour?
Primary brain tumors originate in the brain itself. Primary brain tumors do not spread from the brain to other parts of the body except in rare cases. Pathologists classify primary brain tumors into two groups:
Gliomas are composed of glial cells, which include astrocytes, oligodendrocytes, ependymal cells, Schwann cells, microglia and satellite cells. Nonglial tumors develop on or in structures within the brain, such as nerves, blood vessels and glands.
Metastatic or secondary brain tumors begin as cancer in another part of the body. Some of the cancer cells may be carried to the brain by the blood or may spread from adjacent tissue. The site where the cancerous cells originated is referred to as the primary cancer. Metastatic brain tumors are often referred to as brain metastases or lesions. Metastatic brain tumors are the most common brain tumors. Because people are surviving primary cancers for longer periods of time, there has been an increase in metastatic lesions.
Is a Brain tumour cancer?
Some brain tumors are cancerous and some are not. Malignant tumors are considered cancer. Two of the most common forms of brain cancer are metastatic brain tumors (brain metastases) and Glioblastoma Multiforme (GBM).
Benign tumors are not considered cancer. Some benign tumors have malignant forms, such as malignant meningiomas. Also, some benign brain tumors later develop into cancer. The reason for this is unknown.
What is the difference between a benign Brain tumour and a malignant (cancerous) Brain tumour?
Benign brain tumors are slow-growing tumors that can be removed or destroyed if in an accessible location. Malignant tumors (brain cancer) are rapidly growing tumors that invade or infiltrate and destroy normal brain tissue. No one is certain why, but some benign brain tumors may change over time to become malignant.
Tumors are graded to indicate
Epilepsy is the most common chronic neurological disorder that affects 1 in every 200 people in the community. It is estimated that in India, there are over five million people with epilepsy and one million with medically refractory epilepsy. There are nearly five hundred thousand people with focal epilepsies, and in a majority of them, surgery cures or controls epilepsy.
In urban India, the family practitioner, pediatrician, physician and neurologists are involved in epilepsy care. However, a large section of patients with active epilepsy especially in rural India go undiagnosed and untreated. This treatment gap in underdeveloped countries ranges from 70 to 94% with an estimated three million patients living in rural areas of India. The reasons are several: failure to identify persons with epilepsy; failure to deliver treatment to identified persons with epilepsy; knowledge, attitude and cultural practices of the people; and the cost of antiepileptic drugs.
What is Epilepsy?
Epilepsy is the tendency to have repeated spontaneous seizures (fits/convulsions). Seizures are episodes of disturbed brain electrical activity that cause changes in attention or behavior.
What are the different types of fits?
The normal brain continuously has electrical currents in a controlled manner. Fits or seizures occur because of brief excessive currents in the brain. The symptoms of a seizure vary depending on the part of the brain that has abnormal current. Accordingly there are different types of fits or seizures.
- Grand Mal Seizure
The classical ‘grand mal’ seizure is a result of the current invading the entire brain. In this type of seizure the person falls to the ground and becomes stiff and then shakes all over. There may be frothing at the mouth, the person may lose urine control and also bite his tongue. These are commonly called ‘convulsions’.
- Partial Seizures
These are seizures due to abnormal current in only some portion of the brain, the symptoms may vary with the location of the current.
- Simple Partial Seizure
The person is fully aware and has an unusual sensation or jerking of his limbs, and recollects this event later.
- Complex Partial Seizure
The person is not fully in his/her senses and has some irrelevant automatic behavior. The person cannot recollect this event later. This is called a complex partial seizure.
Minimally invasive spine surgery (MISS) also called as less invasive spine surgery. In these procedures, doctors use specialized instruments to access the spine through small incisions. Smaller incisions avoid significant damage to the muscles surrounding the spine. In most cases, this results in less pain after surgery and a faster recovery. MISS is a patient tailored approach. At AIMS Hospital we do not perform MISS as a fancy option, but we are more concerned about better results and outcome. Our aim is to avoid morbidity, complications, failed back surgeries, etc.
Physiotherapy is a branch of medical science being practiced at global level. The common diseases and disorders being treated under neurological physiotherapy are as follows:
Now a days Neurophysiotherapy becomes very essential both as conservative measures and for surgical intervention. The neurological physiotherapy is involved in determining how these conditions affect the patients movement and function and function and also in implementing strategy to regain maximum function, depending upon the type of disorder.
Physiotherapy doctor assess a patient to determine the issues causing concern for the patient. Goals are formulated based upon these issues and treatment plan is decided and administerered to the patient.
We started from the ICU and continue not only till the patient is independent but to make him to return the community.
Physiotherapist helps the patient with neurological problems to live easier and more mobile lives.
Our aims to restore a person with their optimal function otential with in the limits of his/her abilities and needs.
PARALYSIS, SENSORY LOSS SPASTICITY, BALANCE IMPAIRMENTS, PAIN ETC.
We are flourishing and advancing towards newer techniques, The beauty of various physiotherapy approaches in Neurological disorders is its ability to bring about the necessary adaptation required in central nervous system and to contribute towards the achievement as brain has the ability to mould itself at any age depending upon the various stimulus given a demand put in due to ability that is called “NEURO SPASTICITY”.
The process can be facilitated to greater extent by using following interventions:
Paediatric Neurological Disorders
There are a myriad of Pediatric Neurological Conditions, with varying degree of severity and scope of treatment, that range from common and relatively benign febrile seizures to uncommon yet complex neuro-metabolic disorders. Affected children may have multiple disabilities and complex medical needs. They are best looked after by a multidisciplinary team that provides comprehensive medical care.
Even in urban India there are very few comprehensive Pediatric Neurology centers. In rural areas the scarcity is predictably worse. This leads to huge treatment gaps. Parents and families struggle to get a diagnosis let alone appropriate treatment. Children with disabilities can prove to be a huge burden, financially and socially, to the affected families.
The commonest cause of seizures in childhood is febrile seizures – an incidence of 2-5% is seen between six months to two years. This is a relatively benign condition with a low risk of developing epilepsy in the long term. However, 1% of children will experience an afebrile seizure by 14 years of age.
Pediatric epilepsy syndromes are well-defined with indeed a few unique syndromes restricted to infancy and childhood. Management includes investigations, such as EEG, MRI, blood tests and medications. There are newer treatment modalities available for treatment of difficult to control epilepsies. These include epilepsy surgery for the surgically remediable epilepsies, ketogenic diet and vagal nerve stimulation.
It affects 1.5-3.0 children per 1000 live births. Prematurity is the single most important factor in developed countries. However, we still continue to see babies affected because of several factors related to poor antenatal care and maternal health issues. Developmental delay with abnormalities of tone, posture and/or movement is the most common presenting complaint in children with cerebral palsy.
Apart from motor difficulties, they also have associated morbidities, such as problems with feeding and swallowing/speech and language, visual impairment, epilepsy and learning difficulties. These children are best looked after by a pediatric rehabilitation team. Medically refractory spasticity and dystonia requires special treatments, such as intrathecal baclofen pump and botulinum injections. The goal of treatment is functional independence.
Headache ranks amongst the top five health problems in childhood. The prevalence rates range from 14% at age 7 to 75% by age 15. The commonest cause of headaches is migraine. Incidence of definite childhood migraine is about 1% at 15 years of age! It can be a very worrying situation for the family to have a child with recurrent headaches. Appropriate medications and lifestyle changes are the key treatments.
Acute Neurological Conditions
Several acute neurological conditions and emergencies are frequently encountered by those involved in pediatric medicine. These include meningitis, encephalitis, acute flaccid paralysis, status epileptics, childhood stroke, Bell’s palsy, acute demyelinating disorders, etc. They often require immediate expert neurological consult and intensive care treatment.
Autism/Attention Deficit Hyperactivity Disorder
The incidence of neuro-behavioural conditions, such as Autistic Spectrum Disorder, Attention Deficit Hyperactive Disorder, Asperger’s disorder and Childhood Disintegrative Disorder is steadily increasing, especially, in the urban areas. Early diagnosis is the key to the management, which is mainly therapy based.
Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.
Parkinson’s involves the malfunction and death of vital nerve cells in the brain, called neurons. Parkinson’s primarily affects neurons in an area of the brain called the substantia nigra. Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.
The specific group of symptoms that an individual experiences varies from person to person. Primary motor signs of Parkinson’s disease include the following.
- tremor of the hands, arms, legs, jaw and face
- bradykinesia or slowness of movement
- rigidity or stiffness of the limbs and trunk
- postural instability or impaired balance and coordination
Scientists are also exploring the idea that loss of cells in other areas of the brain and body contribute to Parkinson’s. For example, researchers have discovered that the hallmark sign of Parkinson’s disease — clumps of a protein alpha-synuclein, which are also called Lewy Bodies — are found not only in the mid-brain but also in the brain stem and the olfactory bulb.
These areas of the brain correlate to non-motor functions such as sense of smell and sleep regulation. The presence of Lewy bodies in these areas could explain the non-motor symptoms experienced by some people with PD before any motor sign of the disease appears. The intestines also have dopamine cells that degenerate in Parkinson’s, and this may be important in the gastrointestinal symptoms that are part of the disease.
The use of pedicle screws for spinal stabilization has become increasingly popular worldwide. Pedicle screw systems engage all three columns of the spine and can resist motion in all planes. Several studies suggest that pedicle screw fixation is a safe and effective treatment for many spinal disorders. We do percutaneous pedicle screw fixation for patients with thoraco-lumbar fracture with unstash spine injuries and degenerative spine disorders.
There are three common types of spinal tumors that can cause back pain: vertebral column tumors, intradural-extramedullary tumors, and intramedullary tumors.
Vertebral Column Tumors
Primary tumors: These tumors occur in the vertebral column, and grow either from the bone or disc elements of the spine. They typically occur in younger adults. Osteogenic sarcoma (osteosarcoma) is the most common malignant bone tumor. Most primary spinal tumors are quite rare and usually grow slowly.
Metastatic tumors: Most often, spinal tumors metastasize (spread) from cancer in another area of the body (See Image). These tumors usually produce pain that does not get better with rest, may be worse at night, and is often accompanied by other signs of serious illness (such as weight loss, fever/chills/shakes, nausea or vomiting).
- In women, spinal tumors most frequently spread from cancer that originates in the breast or lung.
- In men, spinal tumors most frequently spread from cancer that originates in the prostate or lung.
Intradural-Extramedullary (inside the dura) tumors grow within the spinal canal (under the membrane that covers the spinal cord) but outside of the nerves. Usually these tumors are benign and slow growing. However, they can cause symptoms of pain and weakness.
Most of these spinal tumors are:
- Meningiomas that occur in the membranes surrounding the spinal cord and are usually benign but may be malignant. These tumors are more common in middle age and elderly women.
- Nerve sheath tumors (schwannomas and neurofibromas) that arise from the nerve roots that come off the spinal cord. Again, this type of tumor is usually benign and slow growing, and it may be years before any neurological problems occur.
Intramedullary tumors grow from inside the spinal cord or inside the individual nerves and often arise from the cells that provide physical support and insulation for the nervous system (glial cells). These tumors occur most often in the cervical spine (neck). They tend to be benign, but surgery to remove the tumor may be difficult.
The two most common types of intramedullary tumors are astrocytomas and ependymomas.
What is a stroke?
Stroke is a block in a blood vessel or a rupture of a blood vessel inside the brain, which is sometimes called as ‘brain attack’. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting oxygen and the nutrients they need to function.
What are the types of stroke?
There are mainly two types of stroke:
- Ischemic Stroke – blockage of blood vessel
- Haemorrhagic Stroke – rupture of the blood vessel
What happens in an acute ischaemic stroke?
In an acute ischemic stroke, the blood flow to a part of the brain is interrupted because of sudden blockage of a blood vessel. The blockage is usually due to a blood clot and starves the brain of needed oxygen and nutrients. The centre of the starved area may die quickly, however the surrounding area may die slowly over hours, thus allowing hope of recovery.
Vertebroplasty & Kyphoplasty are similar medical spinal procedures in which bone cement is injected through a small hole in the skin (percutaneously) into a fractured vertebra with the goal of relieving back pain caused by vertebral compression fractures. It is effective in treatment of asteoporosis fractures, painful hemangiomas. These are the best possible options for the patients. These procedures are done under local anesthesia also.
What is Wilson Disease?
Wilson disease is a genetic disorder resulting in excessive accumulation of copper in the body. Normally, the liver excretes almost all of the ingested copper except for the minute quantities required for maintaining healthy nerves, bones, and skin. People with Wilson disease are unable to excrete copper, therefore, over a period of time copper slowly accumulates in their bodies resulting in damage to various organs.
Who needs to be tested for Wilson Disease?
Any child or young adult with the following problems needs to be evaluated for Wilson Disease:
All brothers and sisters of a person with Wilson Disease need to be tested, even if they are normal.