Neurological Diseases


Stroke clinic is a multi-disciplinary clinic which would consist of a neurologist,physiotherapist,occupational therapist,neuropsychologist and a speech therapist.

What are the activities in the Stroke clinic?

Initially the neurologist will take details of your stroke and clinically examine you.A diagnosis of stroke,the type and severity of stroke and the cause of storke will be ascertained. If necessary,blood tests and scans will be requested for.

If it is a follow up visit,after examination,patient will be directed to the physiotherapist.The physiotherapist will evaluate the patient and teach necessary physiotherapy.There are a variety of equipment for strike patients including muscle stimulation,suspension therapy ,passiveassisted ROM, muscle strengthening. Mat exercises,parallel bars,posture mirror,staircase training,quadriceps table and weight training.

The occupations therapist will suggest modifications in the home and work environment to suit the needs of a stroke patient

Depression is a very common problem that hinders recovery and rehabilitation in stroke patients. Our neuropsychologist will look into psychological aspects of stroke,neuropsychological assessments, behavioural and emotional problems. Based on the patient's cognitive impairment, social, behavioural, emotional, difficulties, neuropsychologist will teach cognitive re-training techniques, cognitive skills, brain gym, cognitive behaviour therapy, behaviour modification techniques and relaxation therapy.

Speech therapist will assess speech and swallow of the patient. Various modes of speech therapy like melodic intonation therapy will be given to the patient

To summarize,the stroke clinic will look into various aspects of stroke like diagnosis, treatment, speech and swallow, memory and mental status. Physiotherapist and occupational therapist will work together to improve the motor weakness and adaptability to the environment.

The ultimate aim of the stroke clinic is to re-integrate the stroke patient into the community,as fast as possible

A headache is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. During a given year, 90% of people suffer from headaches. Primary headaches account for more than 90% of all headache complaints, and of these, episodic tension-type headache is the most common.It is estimated that women are three times more prone than men to suffer from migraines. Migraines appear to be experienced by 30 – 40%of the population.

The brain itself is not sensitive to pain, because it lacks pain receptors. However, several areas of the head and neck do have pain sensors and can thus sense pain. These include the extracranial arteries, large veins, cranial and spinal nerves, head and neck muscles and the meninges. Headache often results from traction to or irritation of the meninges and blood vessels. The pain receptors may also be stimulated by factors other than head trauma or tumors and cause headaches. Some of these include stress, dilated blood vessels and muscular tension.

Primary Headaches

The most common types of headache are the "primary headache disorders", such as tension-type headache and migraine. They have typical features; migraine, for example, tends to be pulsating in character, affecting one side of the head, associated with nausea, disabling in severity, and usually lasts for hours to days. Rarer primary headache disorders are trigeminal neuralgia (a shooting face pain), cluster headache

Secondary Headaches

Headaches may be caused by other problems elsewhere in the head or neck. For example cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches. A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes; some of these may be life-threatening or cause long-term damage. A number of "red flag" symptoms therefore means that a headache warrants further investigations, usually by a specialist. The red flag symptoms are a new or different headache in someone over 50 years old, headache that develops within minutes (thunderclap headache), inability to move a limb or abnormalities on neurological examination, mental confusion, being woken by headache, headache that worsens with changing posture, headache worsened by exertion, visual loss or visual abnormalities, neck stiffness, fever, and headaches in people with HIV, cancer or risk factors for thrombosis. Headaches are most likely to be primary (non serious and self-limiting), some specific secondary headache syndromes may demand specific treatment or may be warning signals of more serious disorders. Differentiating between primary and secondary headaches can be difficult.

As it is often difficult for patients to recall the precise details regarding each headache, it is often useful for the sufferer to fill-out a "headache diary" detailing the characteristics of the headache. When the headache does not clearly fit into one of the recognized primary headache syndromes or when atypical symptoms or signs are present then further investigations are justified and neuroimaging [CT/MRI] is generally recommended. One type of treatment, however, is usually not sufficient for chronic sufferers and they may have to find a variety of different ways of managing, living with, and seeking treatment of chronic daily headache pains.

There are however two types of treatment for chronic headaches, i.e. acute abortive treatment and preventive treatment. Whereas the first is aimed to relieve the symptoms immediately, the latter is focused on controlling the headaches that are chronic.. The primary goal of preventive treatment is to reduce the frequency, severity, and duration of headaches. This type of treatment involves taking medication on a daily basis for at least 3 months and in some cases, for over 6 months.

Headache Clinic

Headache clinic is a speciality centre where the patients with headache are evaluated in detail with different structured questionnaires by specialists in headache and councillers. They are also given presentations about various headache disorders.

Epilepsy is a chronic disorder that causes unprovoked, recurrent seizures. A seizure is a sudden rush of electrical activity in the brain.

There are two main types of seizures. Generalized seizures affect the whole brain. Focal, or partial seizures, affect just one part of the brain.

A mild seizure may be difficult to recognize. It can last a few seconds during which you lack awareness.

Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening.

There are several reasons you might have a seizure. These include:

• high fever

• head trauma

• very low blood sugar

• alcohol withdrawal

What are the symptoms of epilepsy?

Seizures are the main symptom of epilepsy. Symptoms differ from person to person and according to the type of seizure.

Focal (partial) seizures

A simple partial seizure doesn't involve loss of consciousness. Symptoms include:

• alterations to sense of taste, smell, sight, hearing, or touch

• dizziness

• tingling and twitching of limbs

Complex partial seizures

involve loss of awareness or consciousness. Other symptoms include:

• staring blankly

• unresponsiveness

• performing repetitive movements

Generalized seizures

Generalized seizures involve the whole brain. There are six types:

• Absence seizures

• Tonic seizures

• Atonic seizures

• Clonic seizures

• Myoclonic seizures

• Tonic-clonic seizures

Parkinsonism is any condition that causes a combination of the movement abnormalities seen in Parkinson's disease - such as tremor, slow movement, impaired speech or muscle stiffness - especially resulting from the loss of dopamine - containing nerve cells (neurons).

Possible causes

Not everyone who has parkinsonism has Parkinson's disease. There are many other causes of parkinsonism (secondary parkinsonism) including:

Medications, such as those used to treat psychosis, major psychiatric disorders and nausea

Repeated head trauma, such as injuries sustained in boxing

Certain neurodegenerative disorders, such as multiple system atrophy and progressive supranuclear palsy

Exposure to toxins, such as carbon monoxide, cyanide and organic solvents

Certain brain lesions, such as tumors, or fluid buildup

Metabolic and other disorders, such as chronic liver failure and hypoparathyroidism

Lewy body dementia

The role of medications

For drug - induced parkinsonism, discontinuing the medications that cause the condition can reverse it.

For other forms of parkinsonism, taking Parkinson's disease medications - typically a combination of carbidopa and levodopa (Sinemet, Parcopa) - can help.

However, these drugs aren't likely to be as effective for some forms of parkinsonism as they are for Parkinson's disease. Levodopa - which occurs naturally in the body and is always taken as a combination drug - replenishes brain dopamine, and brain dopamine loss is fundamental to Parkinson's disease. However, in other parkinsonian disorders, additional chemical messengers besides dopamine may be affected.

Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles and other parts of the body. The pain is usually described as a burning sensation and affected areas are often sensitive to the touch. Symptoms of neuropathic pain may also include excruciating pain, pins and needles, difficulty correctly sensing temperatures and numbness. Some people may find it hard to wear thick clothes as even slight pressure can aggravate the pain.

What causes neuropathic pain?

Common causes of neuropathic pain include nerve pressure or nerve damage after surgery or trauma, viral infections, cancer, vascular malformations, alcoholism, neurological conditions such as multiple sclerosis and metabolic conditions such as diabetes. It may also be a side effect of certain medications. Occasionally no identifiable cause is found which can be distressing for the individual experiencing the pain.

Chronic neuropathic pain is common and may be related to an underlying health condition such as cancer or diabetic neuropathy, or it could be related to treatments such as chemotherapy.

How do you treat neuropathic pain?

The primary goals of treatment for neuropathic pain are to manage the pain as much as possible and to minimise the negative side effects of the treatment. Individuals with chronic neuropathic pain may be referred to a pain clinic for assessment, management and advice on living with chronic pain.

Every person is different and your doctor will take into consideration your needs so as to suggest the most suitable treatment for you. There are various treatments available for neuropathic pain and often it is a 'trial and error' process to find the best option for an individual.

Regular painkillers such as non-steroidal anti-inflammatory drugs or NSAIDs (for example ibuprofen, aspirin and paracetamol) are usually not effective for neuropathic pain.

Multiple sclerosis, or MS, is a long-lasting disease that can affect your brain, spinal cord, and the optic nerves in your eyes. It can cause problems with vision, balance, muscle control, and other basic body functions.

The effects are often different for everyone who has the disease. Some people have mild symptoms and don't need treatment. Others will have trouble getting around and doing daily tasks.

MS happens when your immune system attacks a fatty material called myelin, which wraps around your nerve fibers to protect them. Without this outer shell, your nerves become damaged. Scar tissue may form.

The damage means your brain can't send signals through your body correctly. Your nerves also don't work as they should to help you move and feel. As a result, you may have symptoms like:

• Trouble walking

• Feeling tired

• Muscle weakness or spasms

• Blurred or double vision

• Numbness and tingling

• Sexual problems

• Poor bladder or bowel control

• Pain

• Depression

• Problems focusing or remembering

What Causes MS?

Doctors don't know for sure what causes MS, but there are many things that seem to make the disease more likely. People with certain genes may have higher chances of getting it. Smoking also may raise the risk.

Some people may get MS after they've had a viral infection -- like the Epstein-Barr virus or the human herpesvirus 6 -- that makes their immune system stop working normally. The infection may trigger the disease or cause relapses. Scientists are studying the link between viruses and MS, but they don't have a clear answer yet.

Some studies suggest that vitamin D, which you can get from sunlight, may strengthen your immune system and protect you from MS. Some people with higher chances of getting the disease who move to sunnier regions seem to lower their risk.

A brain tumor is a mass or growth of abnormal cells in your brain or close to your brain.

Many different types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in your brain (primary brain tumors), or cancer can begin in other parts of your body and spread to your brain (secondary, or metastatic, brain tumors).

How quickly a brain tumor grows can vary greatly. The growth rate as well as location of a brain tumor determines how it will affect the function of your nervous system.

Brain tumor treatment options depend on the type of brain tumor you have, as well as its size and location.

Symptoms and causes

Symptoms

The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor's size, location and rate of growth.

General signs and symptoms caused by brain tumors may include:

• New onset or change in pattern of headaches

• Headaches that gradually become more frequent and more severe

• Unexplained nausea or vomiting

• Vision problems, such as blurred vision, double vision or loss of peripheral vision

• Gradual loss of sensation or movement in an arm or a leg

• Difficulty with balance

• Speech difficulties

• Confusion in everyday matters

• Personality or behavior changes

• Seizures, especially in someone who doesn't have a history of seizures

• Hearing problems

Causes

Brain tumors that begin in the brain

Primary brain tumors originate in the brain itself or in tissues close to it, such as in the brain-covering membranes (meninges), cranial nerves, pituitary gland or pineal gland.

Primary brain tumors begin when normal cells acquire errors (mutations) in their DNA. These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die. The result is a mass of abnormal cells, which forms a tumor.

Primary brain tumors are much less common than are secondary brain tumors, in which cancer begins elsewhere and spreads to the brain.

Cancer that begins elsewhere and spreads to the brain

Secondary (metastatic) brain tumors are tumors that result from cancer that starts elsewhere in your body and then spreads (metastasizes) to your brain.

Secondary brain tumors most often occur in people who have a history of cancer. But in rare cases, a metastatic brain tumor may be the first sign of cancer that began elsewhere in your body.

Secondary brain tumors are far more common than are primary brain tumors.

Any cancer can spread to the brain, but the most common types include:

• Breast cancer

• Colon cancer

• Kidney cancer

• Lung cancer

• Melanoma

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