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Neurology

A network of dendrites from neurons in the hippocampus. System Nervous system Significant diseases Radiculopathy, neuropathy, visual snow, stroke, dementia, seizures and epilepsy, Alzheimer's disease, Attention deficit/hyperactivity disorder Significant tests Computed axial tomography, MRI scan, lumbar puncture Specialist

Carotid Artery Disease

Carotid Artery Disease is a condition in which the carotid arteries become narrowed or blocked. When the arteries become narrowed, blood can’t reach the brain. This is one of the causes of stroke and the condition is called carotid stenosis.

Risk factors for blockage of the arteries include:

  1.  Alcohol abuse
  2.  Cocaine use
  3.  Diabetes
  4.  Family history of stroke
  5.  High blood pressure
  6.  High cholesterol
  7.  Increasing age
  8.  Smoking

Test to diagnose carotid artery disease:
Carotid Ultrasound (Standard or Doppler):
This noninvasive, painless screening test uses high-frequency sound waves to view the carotid arteries. It looks for plaques and blood clots and determines whether the arteries are narrowed or blocked. A Doppler ultrasound shows the movement of blood through the blood vessels. Ultrasound imaging does not use X-rays.

Magnetic Resonance Angiography (MRA):
This imaging technique uses a powerful magnet to gather accurate information about the brain and arteries. Then a computer uses this information to generate high-resolution images. An MRA can often detect even small strokes in the brain.

Computerized Tomography Angiography (CTA):
More detailed than an X-ray, a CT uses X-rays and computer technology to produce cross-sectional images of the carotid arteries. Images of the brain can be collected as well. With this imaging test, the scan may reveal areas of damage on the brain. The CT scan uses a low level of radiation.

Cerebral Angiography (Carotid Angiogram):
This procedure is considered the gold standard for imaging the carotid arteries. It is an invasive procedure that lets a doctor see blood flow through the carotid arteries in real time. Cerebral angiography allows the doctor to see narrowing or blockages on a live X-ray screen as contrast dye is injected in the carotid arteries. This procedure provides the best information. It does carry a small risk of serious complications.

Treatments:
Angioplasty & Stenting:
Carotid artery stenting is an effective alternative to carotid artery endarterectomy as demonstrated in randomized controlled clinical trials (SAPPHIRE and CREST Trials). In carotid artery stenting, an embolic protection device is placed across the carotid artery stenosis. The embolic protection device reduces embolization of debris during the carotid artery stent deployment. The carotid artery stent is placed via the embolization device which serves as a tracking mechanism for the carotid artery stent placement. Once the stent is deployed, the embolization device is removed leaving the deployed stent to improve carotid flow, stabilize and trap plaque.

Carotid artery Endarterectomy:
Carotid artery endarterectomy is the surgical procedure in which a vascular surgeon surgically opens the carotid artery and removes the plaque from the artery to reduce the risk of future strokes.

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a condition in which there is pressure on the median nerve — the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.

Causes:

  1.  Alcohol abuse
  2.  Bone fractures and arthritis of the wrist
  3.  Cyst or tumor that grows in the wrist
  4.  Infections
  5.  Obesity
  6.  If your body keeps extra fluids during pregnancy or menopause
  7.  Rheumatoid arthritis

Symptoms:

  1.  Clumsiness of the hand when gripping objects
  2.  Numbness or tingling in the thumb and next two or three fingers of one or both hands
  3.  Numbness or tingling of the palm of the hand
  4.  Pain extending to the elbow
  5.  Pain in the wrist or hand in one or both hands
  6.  Problems with fine finger movements (coordination) in one or both hands
  7.  Wasting away of the muscle under the thumb (in advanced or long-term cases)
  8.  Weak grip or difficulty carrying bags (a common complaint)
  9.  Weakness in one or both hands

Treatments:
Carpal tunnel release is a surgical procedure that cuts into the ligament that is pressing on the nerve. Surgery is depends on how long the nerve compression has been occurring and its severity.

Epilepsy

What is Epilepsy?
Epilepsy is a physical condition that occurs when there is a sudden, brief change in how the brain works. When brain cells are not working properly, a person’s consciousness, movement, or actions may be altered for a short time. These physical changes are called epileptic seizures. Epilepsy is therefore sometimes called a seizure disorder. Epilepsy affects people in all nations and of all races.

CAUSES
Physical causes:

  1.  Trauma
  2.  Space occupying lesion
  3.  Stroke
  4.  Very raised blood pressure
  5.  Tuberous sclerosis

Metabolic causes:

  1.  Hypoglycemia (low sugar level)
  2.  Hyperglycemia (high sugar level)
  3.  Hypoxia low oxygen level)
  4.  Uremia
  5.  Hyponatraemia (low sodium level)
  6.  Hypernatraemia (high sodium level)
  7.  Hypocalcaemia
  8.  Liver diseases
  9.  Alcohol withdrawal
  10.  Drugs-phenothiazines,cocaine,benzodiazepines

Metabolic causes:

  1.  Encephalitis
  2.  Syphilis
  3.  Cysticercosis
  4.  HIV

Symptoms:

  1.  Eyes are generally open.
  2.  The person may not appear to be breathing. The person is often breathing deeply after an episode.
  3.  The return to consciousness is gradual and should occur within a few moments.
  4.  Loss of urine is common.
  5.  Often people will be confused briefly after a generalized seizure.

Risk Factor:

  1.  Your age
  2.  Your sex
  3.  Family history
  4.  Head injuries
  5.  Stroke and other vascular diseases
  6.  Brain infections
  7.  Prolonged seizures in childhood

Complication:

  1.  Falling
  2.  Drowning
  3.  Car accidents
  4.  Pregnancy complications
  5.  Emotional health issues

TREATMENTS:
Surgery:
Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn’t interfere with vital functions like speech, language or hearing. In these types of surgeries, your doctor removes the area of the brain that’s causing the seizures. If your seizures originate in a part of your brain that can’t be removed, your doctor may recommend a different sort of surgery in which surgeons make a series of cuts in your brain. These cuts are designed to prevent seizures from spreading to other parts of the brain. Other surgical approaches are reserved for specific types of epilepsy and are most often performed in young children. One approach is to remove a large part of one side of the brain (a hemispherectomy); another is to cut the nerve fibers connecting the two sides of the brain (a corpus colostomy).

Vagus nerve stimulation:
This therapy involves a device called a vagus nerve stimulator that’s implanted underneath the skin of your chest like a heart pacemaker. Wires from the stimulator are wrapped around the vagus nerve in your neck. The battery-powered device delivers short bursts of electrical energy to the brain through the vagus nerve. It’s not clear how this inhibits seizures, but the device can reduce seizures by 20 to 40 percent and completely control seizures in about 5 percent of people.

Head Injuries include:

  1.  Scalp wounds
  2.  Skull fractures
  3.  Bleeding

Types of Head Injury:
Close
A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.

Open
An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.

Complications:
Altered consciousness:
Moderate to severe traumatic brain injury can result in prolonged or permanent changes in a person’s state of consciousness, awareness or responsiveness, which leads to further problems like Coma, Vegetative state, minimally conscious, state Locked-in syndrome etc.

Fluid buildup:
Cerebrospinal fluid may build up in the spaces in the brain (cerebral ventricles) of some people who have had traumatic brain injuries, causing swelling and increased pressure in the brain.

Infections:
Skull fractures or penetrating wounds can tear the layers of protective tissues (meninges) that surround the brain. This can enable bacteria to enter the brain and cause infections. An infection of the meninges (meningitis) could spread to the rest of the nervous system if not treated.

Blood vessel & Nerve damage:
Several small or large blood vessels in the brain may be damaged in a traumatic brain injury. Injuries to the base of the skull can damage nerves that emerge directly from the brain. This damage could lead to a stroke, blood clots or other problems.

Cognitive problems:
Most people who have had a significant brain injury will experience changes in their thinking (cognitive) skills. Traumatic brain injury can result in problems with many skills like communication problems, Emotional changes, Behavioral changes, Sensory problem etc.

Degenerative brain diseases:
A traumatic brain injury may increase the risk of diseases that result in the gradual degeneration of brain cells and gradual loss of brain functions.

Surgeries:
Shunt Placement:

Shunt placement is one of the most common treatments for excess fluid. This is an artificial drainage system which consists of a long flexible tube whose one end is placed in one of the ventricles and the other is tunneled into that part of the body which can absorb the CSF well. It also has a valve which helps the fluid to flow in the right direction and at the right rate. This process may need additional surgeries. Though this process is considered effective, it is not 100% safe. There are few complications which one may face during or after the surgery. Infection, mechanical failure, lengthening or replacements of catheter are some of the complications. Apart from these, shunt problems may also be faced by some patients. Over draining or under draining of the CSF, both may cause fatal consequences. Hence if the person observes any problems after the surgery it is very important to get a proper check-up to know whether the device is working properly.

Ventriculostomy:
The next common surgery is known as ventriculostomy. This is used when there is an obstruction in the ventricles of the brain. The surgeon makes a hole in the lower part of the ventricle from where the fluid drains out and reaches the base of the brain where it can be absorbed easily

Hydrocephalus

What is Hydrocephalus?
Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain. The fluid is often under increased pressure and can compress and damage the brain. This is an abnormal increase in the amount of cerebrospinal fluid within the cranial cavity that is accompanied by expansion of the cerebral ventricles, enlargement of the skull and especially the forehead, and atrophy of the brain.

Causes:

  1.  Congenital brain defects
  2.  Hemorrhage, either into the ventricles or the subarachnoid space
  3.  Infection of the central nervous system (syphilis, herpes, meningitis, encephalitis, or mumps)
  4.  Tumor

Symptoms:

  1.  Headache
  2.  Nausea and vomiting, especially in the morning
  3.  Lethargy
  4.  Disturbances in walking (gait)
  5.  Double vision
  6.  Subtle difficulties in learning and memory
  7.  Delay in children achieving developmental milestones

Treatment:
Cerebral shunts:
It is commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid (CSF). If left unchecked, the cerebral spinal fluid can build up leading to an increase in intracranial pressure (ICP) which can lead to intracranial hematoma, cerebral edema, crushed brain tissue or herniation. The cerebral shunt can be used to alleviate or prevent these problems in patients who suffer from hydrocephalus or other related diseases. Shunts can come in a variety of forms but all of them consist of a pump or drain connected to a long catheter, the end of which is usually placed in the peritoneal cavity. The main differences between shunts are usually in the materials used to construct them, the types of pumps used, and whether the pump is programmable or not.

Parkinson’s Disease

Parkinson’s disease is a progressive nervous system disorder that affects how the person moves, including how they speak and write. Symptoms develop gradually, and may start off with ever-so-slight tremors in one hand. People with Parkinson’s disease also experience stiffness and find they cannot carry out movements as rapidly as before.

Risk factor:
Age – the older you get the greater the risk. Although Parkinson’s disease can affect young people, however this is exceptional.

Genetics – a person who has a close relative (brother, sister, mother, father) with Parkinson’s disease has a slightly higher risk of developing it himself/herself, compared to others. Even so, according to The Mayo Clinic, USA, the risk is still less than 5%.

Gender – males are slightly more likely to develop Parkinson’s disease compared to females.

Toxin Exposure – individuals who have been exposed to some chemicals, such as carbon monoxide, herbicides or pesticides have a slightly higher risk of developing Parkinson’s disease, compared to other people.

Some Medications – such as antipsychotics used to treat severe paranoia and schizophrenia can cause Parkinsonism (symptoms that resemble Parkinson’s disease).

Causes:
Parkinson’s disease is caused by the degeneration or destruction of dopamine-producing nerve cells (dopaminergic cells), which in turn makes it harder for the brain to control and coordinate muscle movement.
Symptoms:

  1.  A tendency to stoop, to lean forward
  2.  Cramping
  3.  Drooling
  4.  Fatigue
  5.  Loss of facial expression
  6.  Slowness of movement
  7.  Slowed motion
  8.  Shaking
  9.  Sexual dysfunction
  10.  Speech problems
  11.  Swallowing difficulties
  12.  The arms may not swing when walking
  13.  Sleep problems
  14.  Depression
  15.  Loss of energy
  16.  Muscle stiffness
  17.  Parenthesis
  18.  Reduced sensation of pain
  19.  Reduced sense of smell
  20.  Urinary incontinence
  21.  Urinary retention

Treatment:
Deep Brain Stimulation:
A surgical procedure used to treat several disabling neurological symptoms, such as tremor, rigidity, stiffness, slowed movement and walking difficulties.

Thalamotomy :
The thalamus is destroyed (lesioned) or removed by cutting (ablated). The thalamus is a tiny part of the brain. The procedure may help reduce tremor. Thalamotomy is rarely performed these days.

Subthalamotomy: Rarely performed these days. The subthalamus, a very small area of the brain, is destroyed.

Pallidotomy:
Since the introduction of deep brain stimulation, this procedure is rarely done. The gobus pallidus, a part of the brain, may be overactive in patients with Parkinson’s disease, causing a different part of the brain which controls movement to become less active. The surgeon destroys a small part of the globus pallidus by creating a scar, resulting in less activity in that area of the brain, which in turn may help relieve movement symptoms, such as rigidity and tremor.

Speech Therapy:
According to the National Health Service (NHS), UK, approximately half of all Parkinson’s patients experience communication problems, such as slurred speech and poor body language. A speech and language therapist can help with the use of language and speech. Patients with swallowing difficulties may also be helped by a speech therapist.

Stroke

What is Stroke?
A stroke is a condition in which the brain cells suddenly die because of a lack of oxygen. This can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralyzed.

Types
Ischemic stroke :
Accounts for about three-quarters of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.

Hemorrhagic stroke
Occurs when a blood vessel on the brain’s surface ruptures and fills the space between the brain and skull with blood or when a defective artery in the brain bursts and fills the surrounding tissue with blood.

Risk Factors:

  1.  High blood pressure
  2.  High cholesterol
  3.  Smoking
  4.  Diabetes
  5.  Increasing age

Symptoms:

  1.  Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
  2.  Sudden confusion, trouble speaking or understanding speech
  3.  Sudden trouble seeing in one or both eyes
  4.  Sudden trouble walking, dizziness, loss of balance or coordination
  5.  Sudden severe headache with no known cause

Three commands, known as the Cincinnati Prehospital Stroke Scale (CPSS), may help to determine if the potential for stroke exists. Ask the patient to do the following:

  1.  Smile
  2.  Raise both arms
  3.  Speak a simple sentence

Treatments:
Carotid endarterectomy:
In a carotid endarterectomy, a surgeon removes fatty deposits (plaques) from your carotid arteries that run along each side of your neck to your brain. In this procedure, your surgeon makes an incision along the front of your neck, opens your carotid artery, and removes fatty deposits (plaques) that block the carotid artery. Your surgeon then repairs the artery with stitches or a patch made with a vein or artificial material (graft). The procedure may reduce your risk of ischemic stroke.

Angioplasty and Stents:
In an angioplasty, a surgeon inserts a catheter with a mesh tube (stent) and balloon on the tip into an artery in your groin and guides it to the blocked carotid artery in your neck. Your surgeon inflates the balloon in the narrowed artery and inserts a mesh tube (stent) into the opening to keep your artery from becoming narrowed after the procedure.

Surgical Clip:
A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This can keep the aneurysm from bursting, or it can prevent re-bleeding of an aneurysm that has recently hemorrhaged.

Coiling (Endovascular Embolization):
In this procedure, a surgeon inserts a catheter into an artery in your groin and guides it to your brain using X-ray imaging. Your surgeon then guides tiny detachable coils into the aneurysm (aneurysm coiling). The coils fill the aneurysm, which blocks blood flow into the aneurysm and causes the blood to clot.

Surgical AVM (Arteriovenous Malformations) Removal:
Surgeons may remove a smaller AVM (Arteriovenous Malformations) if it’s located in an accessible area of your brain, to eliminate the risk of rupture and lower the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM (Arteriovenous Malformations) if it’s too large or if it’s located deep within your brain.

Rehabilitation:
Most stroke survivors receive treatment in a rehabilitation program. The doctor will recommend the most rigorous therapy program you can handle based on your age, overall health and your degree of disability from your stroke. The doctor will take into consideration your lifestyle, interests and priorities, and availability of family members or other caregivers. Rehabilitation program may begin before you leave the hospital. It may continue in a rehabilitation unit of the same hospital, another rehabilitation unit or skilled nursing facility, an outpatient unit, or your home.

Tumors

What is Tumor?
A tumor is an abnormal growth of body tissue. Tumors can be cancerous (malignant) or noncancerous (benign).

Causes
In general, tumors occur when cells divide excessively in the body. Typically, cell division is strictly controlled. New cells are created to replace older ones or to perform new functions. Cells that are damaged or no longer needed die to make room for healthy replacements. If the balance of cell division and death is disturbed, a tumor may form.

Types:

  1.  Malignant, cancerous
  2.  Benign, noncancerous
  3.  Brain Tumor, Adult
  4.  Bronchial Tumors, Childhood
  5.  Carcinoid Tumor, Childhood
  6.  Embryonal Tumors
  7.  Germ Cell Tumor
  8.  Islet Cell Tumors
  9.  Ovarian Low Malignant Potential Tumor
  10.  Pineal Parenchymal Tumors
  11.  Pituitary Tumor
  12.  Sarcoma
  13.  Supratentorial Primitive Neuroectodermal Tumors
  14.  Trophoblastic Tumor
  15.  Wilms Tumor

Symptoms:

  1.  Symptoms depend on the type and location of the tumor.
  2.  Chills
  3.  Fatigue
  4.  Fever
  5.  Loss of appetite
  6.  Malaise
  7.  Night sweats
  8.  Weight loss
  9.  Yellowing of skin or eyes
  10.  Vomiting
  11.  Urine discoloration
  12.  Stool discoloration

Treatment:
Chemotherapy:
 Chemotherapy involves the treatment of cancer with drugs that can destroy cancerous (malignant) cells. Healthy cells grow and die in a controlled fashion. Cancer causes cells in the body to continuously divide and form more cells at an abnormal and rapid pace. Anticancer drugs destroy cancer cells by retarding their growth and proliferation. As a side-effect, healthy cells may also be damaged. Healthy cells normally revive after chemotherapy is suspended or stopped.

Radiation Therapy:
Radiation therapy (also called radiotherapy, x-ray therapy, or irradiation) is a treatment approach that uses radiation to destroy cancer cells. Although radiation damages both cancer cells and normal cells, most normal cells can recover from the effects of radiation and function properly. The goal of radiation therapy is to damage as many cancer cells as possible, while limiting harm to nearby healthy tissue. Unfortunately, rapidly dividing healthy cells can also be killed by this process. Skin and hair are some of the tissues affected by radiation treatment, resulting in skin lesions, burning, hair loss, etc.

Surgery:
The doctor needs to decide if surgery should be done at all. Because cancers spread (metastasize) to normal tissues, sometimes at the other end of the body, the ability of surgery to cure must be addressed at the outset. As long as the cancer is localized, the initial presumption is that cure should be attempted by removing it as soon as possible. Once surgical removal has been decided, an oncologic surgeon will remove the tumor whole, taking with it a large section of the surrounding normal tissue. The healthy tissue is removed to minimize the risk of possible seeding.