Parkinson’s Disease

Understanding Parkinson’s disease

Parkinson’s disease is a type of degenerative movement disorder which affects the nervous system. Symptoms start small with slight tremors and progressively become worse over time, leading to serious condition like dementia. In most cases, symptoms start to appear in people who are over the age of 60 years, but the disease can affect young adults as well. Recognising the early signs of Parkinson’s disease is vital in treating the condition. Some of these early signs include:

• Tremor in the hands
• Change in posture and shuffling gait
• Reduced sense of balance and coordination
• Tremor in the voice
• Fixed facial expressions
• Difficulty chewing and swallowing
• Decreased or loss of sense of smell
• Constipation and issues with urination
• Sleep problems and restless legs
• Mood changes

The early signs of Parkinson’s disease are often mistaken for the normal signs of aging. This is a large reason why people do not seek help at the right time. Early detection can help the patient manage and control symptoms better and lead an easier life.

What are the causes of Parkinson’s disease?

Medical experts are unsure about the causes of this condition, but the death of nerve cells in the brain is known to be a leading factor. Men are more likely to develop Parkinson’s disease compared to women. Genetic and environmental factors are also considered responsible in the onset of Parkinson’s disease. Exposure to toxic substances like pesticides and herbicides can make one more susceptible to developing this condition. As the causes of Parkinson’s disease are a mystery, it is also difficult to determine ways to prevent or delay the onset of this condition. Consuming a healthy diet rich in flavonoids and antioxidants has been known to help alleviate some symptoms. Regular exercise and aerobics is also a good way to help with symptoms.

Treatment of Parkinson’s disease

This condition cannot be cured, but its onset can be delayed and symptoms can be managed. Early detection is important as it helps patient manage their symptoms better with lifestyle changes and regular exercise. Physical therapy may also be prescribed to help improve balance and coordination. People suffering from Parkinson’s disease have low dopamine levels in their brain. Doctors can prescribe medications to elevate dopamine levels, which are also known to help with walking, balance and movement. If medication is not helpful, the patient may be given deep brain simulation where electrical impulses are sent to the brain to reduce symptoms.

Spot A Stroke F.A.S.T.

What is a Stroke?

A stroke is a neurological emergency that occurs when the blood and oxygen supply to the brain is reduced or interrupted. Due to a lack of oxygen, brain cells begin to die which results in brain damage leading to neurological deficits Quick treatment is vital when someone is having a stroke. It is important to recognise the signs and symptoms of a stroke so the individual can receive medical attention at the earliest. Here are some common symptoms:

• Trouble speaking such as slurred speech, garbled speech or no speech or difficulty understanding others’ speech.
• Sudden numbness or paralysis in the face, arm or leg. This may involve one arm or leg along with face drooping or both arms and legs.
• Vision problems, or field cuts involving one section of the visual field
• Headache accompanied by nausea, vomiting
• Dizziness or vertigo
• Trouble walking or loss of coordination.

To easily remember the symptoms of a stroke, experts recommend using the acronym “FAST.” Face: Is one side of their face drooping when they smile? Arms: Can they raise both arms and keep them raised? Is one arm drifting downwards? Speech: Is the person’s speech strange or slurred? Time: It is time to call for ambulance if you notice any of the above symptoms. What are the causes of a Stroke? The two main causes of stroke are a blocked artery or a ruptured blood vessel in the brain. These are known as ischemic stroke and haemorrhagic stroke respectively. In some cases, there may only be a temporary disruption of blood and oxygen flow to the brain. This is known as a transient ischemic attack (TIA) and its symptoms last few minutes usually. There are some risk factors that make one more prone to developing a stroke. These include:

• Smoking
• High blood pressure
• Cardiovascular disease
• Obstructive sleep apnea
• Diabetes
• Family history of stroke
• Leading a sedentary or physically inactive lifestyle
• Heavy consumption of alcohol or drugs like methamphetamine and cocaine
• Being obese or overweight
• Heart rhythm abnormality called atrial fibrillation

How is a Stroke treated?

If a person has had a stroke, they need to be immediately taken to a stroke ready hospital. This is a hospital which has MRI/CT facility, a Neurologist, Neurosurgeon, Radiologist availability round the clock. A CT Head/ MRI brain is done to distinguish between clot and bleed in the brain. If the patient presents within IV window period of 4.5 hours, once BP is brought to acceptable limits, IV clotbuster is administered if CT rules out a bleed (in case of clot) Subsequently if CT Angio or MR Angio shows a blockage of large artery (MCA/ICA/Basilar artery), mechanical clot extraction can be done via a stent retriever introduced through a groin puncture. This can be performed within 6 hours of onset of symptoms. Rarely, in few carefully selected patients, this procedure can be done upto 24 hours. In case of bleed in the brain, the blood pressure needs to be aggressively controlled. If there is increased pressure in the brain, surgical evacuation of hematoma or decompression (where skull bone flap is opened, allowing for brain to expand outwards, which can be a life saving measure.

Treat Spinal Fractures

What are spinal fractures?

Everyone is familiar with bone fractures. They are breaks in your bone that are caused by sports injuries, accidents or falls. Fractures are painful and need immediate medical treatment. Spinal fractures are small to large breaks in the bony spinal column that cause pain, difficulty in movement and even paralysis. Spinal fractures are different from fractures in your arms or legs because they can cause bone fragments to travel into the spinal cord or nerves, resulting in possible permanent damage such as partial or total paralysis. Spinal fractures can range from small and relatively harmless to debilitating spinal cord damage. Spinal fractures can affect any part of your spine. They can be categorized into three types: Fractures - The breaking of a bone after it has been subjected to a high amount of pressure. The most common type is the vertebral body compression fracture Dislocations - The stretching or tearing of the ligaments or discs connecting the vertebrae, which causes the bones to become misaligned Fracture-dislocations - Caused when the bone is broken and its connecting ligaments are damaged or torn

What are the causes of spinal fractures?

The most common causes of spinal fractures are falls, car accidents, acts of violence and sports. People who suffer from spine tumours and bone conditions such as osteoporosis are at high risks of developing spinal fractures.

What does the treatment involve?

The treatment of a spinal fracture can begin after it has been diagnosed using X-rays, CT scans or MRI scans in spinal fractures. Treatment typically involves stabilization using brace and pain management. Unstable spinal fractures often require surgical stabilization which may involve the use of screws and rods to stabilize the spine. Consult our Neuro specialists for more details on spinal fractures and its treatment.

Treat Spinal Tumours

What is a spinal tumour?

A tumour is an abnormal mass of tissue that is created by the uncontrolled growth and multiplication of cells. They are two types of tumours - cancerous or malignant and non-cancerous or benign. A spinal tumour is a type of tumour that is found in the spinal cord or spine. While some spinal tumours originate within or around the spine, others can spread into the spine from another site. The cause of spinal tumours is largely unknown. So far, it has been deduced that cancer-causing agents and genetics are responsible.

Types of spinal tumours

Spinal tumours are categorized into two types. 1. Based on the region of the spine that is affected. The basic areas include cervical, thoracic, lumbar and sacrum. 2. Based on the tumour’s location within the spine. This is further categorized as:

• Intramedullary - These are tumours found within the spinal cord
• Extradural - These are located outside the thin sheath covering the spinal cord known as the dura
• Intradural-extramedullary - These tumours are found between the dura and the spinal cord

The spinal column which is comprised of bones is often a target of bone metastasis, which is a common ramification of cancerous spinal tumours.

Symptoms and treatment

The most common symptoms associated with spinal tumours are:

• Muscle weakness or loss of sensation
• Pain, numbness or tingling sensation
• Spinal deformity such as scoliosis
• Loss of bladder or bowel function
• Stiff back or neck
• Paralysis

The treatment of spinal tumours involves multidisciplinary intervention, involving spine specialists, surgeons and medical oncologists. Depending on the severity of the condition, spinal tumours can be treated through surgical or non-surgical means. Radiation therapy and chemotherapy are part of non-surgical options.

Disc Prolapse

What is a Disc Prolapse?

Your spine is supported by small round pillow-like discs that sit between each vertebra which act as shock absorbers. A disc prolapse or herniated disc occurs when a fragment of the disc’s nucleus is pushed into the spinal canal through a rupture or tear in the outer layer. This herniation pushes against the spinal nerve in the spinal canal and can lead to severe pain. Herniated discs are often a sign of early degeneration and can affect any part of the spine.

What are the symptoms of a Disc Prolapse?

Symptoms of a herniated disc can vary greatly and depend on the size and position of the herniation. If the prolapsed disc is not pressing against a nerve, there may be some dull pain or no pain at all. If a spinal nerve is affected by the herniation, it can cause radiating pain in the limb, weakness or numbness in the area of the body supplied by that nerve. It can cause urinary symptom like incontinence.

What are the causes?

Excessive strain or physical injuries are the most common causes of disc prolapses. Disc material can naturally degenerate over time, causing the connecting ligaments to weaken. As this progresses, even a twisting movement or minor strain can cause the disc to herniate. This makes certain individuals more susceptible to disc problems than others, especially those who have a family history of herniated discs.

How is a Disc Prolapse treated?

The initial treatment for a disc prolapse is normally nonsurgical and conservative. The patient will be recommended to refrain from painful activity for a few weeks to allow the inflammation to reduce. Analgisics prescribed to alleviate the pain. Physical therapy may be necessary in some cases. Surgery is the better option when conservative treatment is unsuccessful. Surgery is often recommended in the following cases:

• Development of progressive neurological deficits such as numbness or weakness
• If the pain limits regular activity or quality of life
• Difficulty walking or standing
• Loss of normal bladder and bowel functions
• Physical therapy and medication are ineffective

The doctor will determine the appropriate procedure depending on the patient’s condition. Lumbar spine surgery is performed to relieve sciatica and leg pain caused by disc herniation. Cervical spine surgery is performed to relieve symptoms of a cervical prolapsed disc.

Treat Brain Tumours

What is a Brain Tumour?

A brain tumour is an abnormal collection of tissue made up of cells that show uncontrollable growth and multiplication. These tumours are also known as intracranial tumours as they are found inside the skull. Brain tumours fall under two main categories - primary and metastatic. Environmental factors and genetics are believed to be the primary causes of brain tumours. Primary brain tumours are those which originate within the brain and are made of the same tissue as the brain or its immediate surroundings. These tumours can be benign or malignant. Metastatic brain tumours are the kind that originate in other parts of the body such as the lungs or stomach and migrate into the brain. The migration happens typically through the bloodstream. Almost all metastatic tumours are considered malignant and cancerous.

What are the symptoms of Brain Tumours?

The location of the brain tumour can cause symptoms to vary, but the most common symptoms are:

• Severe headaches
• Convulsions or seizures
• Weakness or paralysis, especially on one side or part of the body
• Dizziness or loss of balance
• Personality changes
• Difficulty in speaking, articulating or thinking
• Changes in hearing
• Vision changes
• Disorientation or confusion
• Swallowing difficulties, nausea or vomiting

How are brain Tumours Treated?

Whether the tumour is benign or malignant, it is usually treated with surgery, chemotherapy and radiation therapy, either through individual treatments or various combinations. Before surgery, scans are performed to indicate the location of the tumour. A biopsy is then taken to confirm the type of brain tumour. To remove the tumour, a craniotomy is performed where part of the skull is removed so the surgeon can access the affected area. Doctors will determine the best course of action on a case-by-case basis.

AVM – Aneurysm

What is an AVM?

An AVM or arteriovenous malformation is a condition where the brain’s veins and arteries develop an abnormal connection causing the vessels to become tangled. An AVM goes unnoticed until the person starts showing symptoms like seizures, severe headaches and weakness (paralysis) of limb. If left unchecked, it can haemorrhage, which is often deadly.

What is an Aneurysm?

An aneurysm is a bulge in an artery in your brain caused by weakened arterial walls. It is a common condition, but it can be successfully treated if diagnosed in time. Most brain aneurysms are discovered when the artery bursts, which causes bleeding in the brain and its surrounding space called the subarachnoid. The primary goal in treating a ruptured aneurysm is to stop the bleeding and protect the patient from potential brain damage.

How are AVMs and Aneurysms treated?

Some AVMs and aneurysms are small and show a low risk of rupturing, so they do not require treatment. Surgery (Open Microscopic Assisted Endovascular) is required to treat those that possess a higher risk. In case of an aneurysm, the neurosurgeon will first perform a craniotomy where a section of your skull is removed. They will then place a clip across the weakened part of the artery which prevents blood flow into the aneurysm. Another technique is called coil embolization and this is not as invasive as the craniotomy. The neurosurgeon will insert a catheter into the artery through your leg and navigate it toward the aneurysm. Through his/her catheter tiny platinum coils are inserted into the aneurysm, preventing blood flow and a potential rupture. AVMs are also treated with similar techniques, but the doctor will determine the best way to tackle yourcondition based on its symptoms and severity.

Tubectomy

What is Tubectomy?

Tubal sterilisation or tubectomy is a surgical procedure which involves blocking the female fallopian tubes so that the eggs do not reach the uterus for fertilisation. The fallopian tubes are connecting structures inside a woman’s abdomen which start at the ovaries and end at the uterus. During this procedure, these tubes are cut and then clipped or tied, preventing the eggs from traveling from the ovaries to the uterus. Tubectomy is a permanent form of sterilisation. It is one of the most effective solutions in birth control with a success rate of over 99 percent. This procedure is suitable for women who do not want to become pregnant and are looking for a permanent form of birth control.

How is Tubectomy performed?

The patient is given general anaesthesia before the surgery to make them comfortable. A few small incisions are made in the abdomen. A small tube with a camera called a laparoscope is inserted into the abdominal cavity through these incisions. The laparoscope collects visuals and transmits them to a computer screen for the surgeon. Using these images, the surgeon then inserts specialised surgical tools through the other incisions and guides them toward the fallopian tubes. They are used to make cuts in the tubes or seal them using clips. There are different techniques used in tubectomy. Bipolar coagulation: The parts of the fallopian tubes are seared using electric current Monopolar coagulation: The tubes are seared shut using electric current and a radiating current is also passed to further damage them Tubal ring: The tubes are tied using silastic bands Tubal clip: The tubes are blocked using clips Fimbriectomy: A section of the tubes are disconnected from the ovaries, creating a gap and prevent the eggs from traveling to the uterus

What are the benefits of tubectomy?

There are several benefits to tubectomy, which is why more women are choosing to undergo this procedure every year.

• Unlike other forms of birth control, tubectomy is over 99 percent effective in preventing pregnancy
• Tubectomy does not cause hormonal imbalances or contraindications which are commonly seen with the use of oral contraceptives
• This procedure makes it more convenient and safer for people to have sex without having to rely on contraceptives
• Removing or blocking the fallopian tubes is shown to decrease the chances of contracting pelvic inflammatory disease
• This procedure also reduces the risk of fallopian tube cancer

Polypectomy

What is Polypectomy?

Polypectomy is a surgical procedure used to remove small finger-like growths called polyps that develop on the cervix or uterine lining. In most cases, these growths are non-cancerous, but they can cause issues such as heavy menstrual bleeding, abdominal pain or bleeding after menopause. There are two common types of gynaecological polypectomy:

• Uterine polypectomy where polyps are removed from the endometrial tissue that lines the uterus
• Cervical polypectomy where polyps are removed from the cervix

What are the causes of uterine polyps?

Hormonal factors are known to play role in the development of uterine polyps. These growths are sensitive to oestrogen, which means that they grow in response to the oestrogen circulating in the individual’s body. Perimenopausal or postmenopausal women are sometimes at risk of developing cervical or uterine polyps. Being obese or having high blood pressure are known risk factors as well. Women who are undergoing drug therapy for breast cancer are also more susceptible to developing uterine polyps.

How is Polypectomy performed?

Cervical polypectomy is a minimally-invasive procedure that is usually performed in the outpatient clinic. The procedure is not painful, so anaesthesia is not necessary. A speculum is inserted into the vagina to expose and dilate the cervix. Polyps that have stalks can be removed by grasping and twisting the polyp using forceps until it separates from the cervical wall. For polyps without a stalk, a local anaesthesia is injected into the site and heated wire loop is used to burn the polyps off the cervical wall. For uterine polypectomy, an ultrasound is first performed to confirm the presence of polyps inside the uterus. A speculum is inserted to expand the cervix. A thin tube with a camera known as a hysteroscope is inserted into the vagina to allow the doctor to examine the uterus and its walls. A suction catheter is used to collect specimens which are sent to the lap to determine if the polyps are cancerous or not. The hysteroscope also has certain tools that allow the doctor to cut and remove the polyps inside the uterus. If the polyps turn out to be cancerous, the doctor will determine the most suitable evaluation treatment.