STAR Hospitals is the best Neurology Hospital in Hyderabad with a team of top Neurologist in Hyderabad. It has 8 bedded Neuro Intensive care unit (NICU), supported by well trained and experienced staff providing 24 hours Neuro Critical Care Services.
24 hrs Emergency Neurology Services (Neuro Intensive Care Unit) supported by Neurosurgery and Critical Care. Emergency management comprising mechanical ventilators.Stroke management with thrombolytic therapy.Ventilator management for acute neurological cases which includes GB syndrome, status epilepticus.Out patient services offered includes: The Neurologic Outpatient Unit operates six days per week and treats a large volume of ambulatory patients along with investigations. which consists of·
Patients are admitted for diagnosis and treatment of a wide variety of neurologic diseases. Those diagnosed with chronic illnesses are followed by attendings and housestaff in the Neurologic Outpatient Unit.
Stroke Unit is the place where our patients recovering from stroke receive care from specially trained staff. It provides a high standard of care for stroke patients The nurses here understand the unique medical requirements of patients recovering from various types of stroke. Our physical, occupational and speech therapists work solely with patients who are overcoming strokes and other neurological problems.
Epilepsy is a chronic neurological disease characterised by recurrent spontaneous seizures. A seizure is a sudden onset of symptoms and clinical manifestations caused by sudden abnormal bursts of electrical brain activity that disrupt brain functions. Epileptic seizures may arise from different brain regions and can cause abnormal motor activity, sensory changes, mood changes and unconsciousness.
A person may experience one or many seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:
– In newborns and infants:
> Congenital problems
> Birth trauma
> Metabolic or chemical imbalances in the body
– In children, adolescents, and adults:
> Alcohol or drugs
> Head trauma
> Congenital conditions
> Genetic factors
> Progressive brain disease
> Alzheimer’s disease
Other possible causes of seizures may include the following:
– Brain tumor
– Neurological problems
– Drug withdrawal
The person may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs of seizures
– Jerking movements of the body
– Stiffening of the body
– Periods of rapid eye blinking and staring
– Loss of consciousness
– Falling suddenly for no apparent reason
– Breathing problems or breathing stops
– Loss of bowel or bladder control
– Not responding to noise or words for brief periods
– Appearing confused or in a haze
– Sleepiness and irritability upon waking in the morning
– Lips may become bluish and breathing may not be normal
The evaluation of patients with epilepsy is aimed at determining the type of seizures (epileptic versus non-epileptic) and their cause, since various seizure types respond best to specific treatments. The diagnosis is based on:
– Detailed medical history
The patient’s medical history, including any family history of seizures, associated medical conditions, and current medicines. A detailed and accurate history of a patient’s episodes is the most helpful tool for making the diagnosis of epilepsy. The doctor will want to know:
How did the episode begin and what happened?
Was there a lack of sleep or unusual stress preceding the episode?
Was there any recent illness?
Had the person taken any medications or drugs, including over-the-counter drugs, alcohol, or illegal drugs?
What was the person doing immediately before the attack: lying, sitting, standing, getting up from a lying position, exercising?
Was consciousness lost or impaired?
Were there jerking movements, automatic chewing or hand movements, eye deviation or blinking, head turning to one side, loss of bladder control, or a tongue bite?
Afterward, did the person go to sleep? Or appear confused?
How long did the episode last?
– Others who have often seen you before, during, and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness.
General Medical Examination
Because seizures may be caused by medical disorders, a general medical examination is an important part of the first consultation. The examination and certain laboratory studies can tell the doctor whether the liver, kidneys, and other organ systems are functioning properly.
Both the neurologist and the primary doctor should know if a person has both seizures and a medical disorder such as thyroid or kidney disease. The primary doctor may have insights into the cause of the seizures. Also, if an antiepileptic drug is recommended, the doctors need to discuss the possibility that it will interact with medication taken for the medical disorder.
– Identifying whether there is an area of abnormal brain function is the essence of the neurological examination. A complete neurological exam of muscle strength, reflexes, eyesight, hearing, and ability to detect various sensations is used so that your doctors can better understand the cause of your seizures. A detailed examination is performed to evaluate patterns of weakness or sensory loss, and to detect subtle signs or asymmetries not apparent to an untrained observer. Additional testing often includes:
An electroencephalogram (EEG), which measures electrical activity in the brain,
Imaging studies of the brain, such as magnetic resonance imaging (MRI)
Blood tests to measure red and white blood cell counts, blood sugar, blood electrolyte levels, and to evaluate liver and kidney function (Blood tests help rule out other illnesses.)
Other tests are used as needed, including magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single photon emission computed tomography (SPECT).
If epilepsy is suspected, there are many neurological tests available to help with the diagnosis. Electroencephalography, or EEG, is the most specific test for diagnosing epilepsy because it records the electrical activity of the brain. It is the only test that directly detects electrical activity in the brain (seizures are defined by abnormal electrical activity in the brain). During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are also attached to a monitor to record the brain’s electrical activity. The EEG is useful to confirm a diagnosis of epilepsy and to determine the type of epilepsy.
The routine EEG is the most common test for epilepsy, but a routine EEG records only about 20 minutes of brain waves. Because this is such a short amount of time, prolonged EEG monitoring might be necessary. Prolonged EEG-video monitoring is an even better diagnostic method. During this type of monitoring, an EEG monitors the brain’s activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special hospital facility for several days. Prolonged EEG-video monitoring is sometimes required to definitively diagnose epilepsy.
Antiepileptic drugs (AEDs) can prevent seizure activity by altering neurotransmitter activity in nerve cells, but cannot correct the underlying condition. Approximately 70% of patients successfully control seizures with medication. Nearly 50% of those require two drugs to be seizure free. Because medications interact, the drug regimen must be carefully designed to maximize the effectiveness and to avoid serious complications and side effects. The type of treatment prescribed will depend on several factors, including the type of epilepsy (focal/partial versus generalized), the frequency and severity of the seizures, the person’s age, overall health, and medical history.
The goals of treatment are no seizures and no side effects. If possible, treatment should consist of one drug (called monotherapy). Seizure management is complicated when patients are given more than one drug. The patient may experience drug interactions, increased side effects, and other adverse reactions.
Compliance is essential. To control seizures, a constant level of medication must be maintained in the body. Antiepileptic drugs should not be discontinued abruptly because of the risk for triggering life-threatening status epilepticus.
When seizures cannot be controlled by medications or control can be achieved only at the cost of severe and unacceptable adverse effects, surgery is an alternative. Epilepsy surgery has an excellent chance of completely controlling seizures and its absolute risk is less than that of uncontrolled epilepsy. Modern brain imaging and non-invasive neurophysiologic analysis of normal and abnormal brain function have allowed an understanding of a person’s epilepsy never before possible. Neurosurgery has evolved and benefited from advanced technology and a growing understanding of complex brain function, making surgery of the brain safer than ever before. By considering and comparing the risks of recurrent seizures and the usual progression of epilepsy over the patient’s lifetime to the risks of epilepsy surgery, epilepsy surgery, which can completely control seizures, is in the long run less risky than uncontrolled seizures.
Vagal nerve stimulation (VNS) is another surgical option for the treatment of epilepsy. It involves implantation of an electrode that stimulates the vagus nerve, a nerve that travels through the neck and is connected to various areas of the brain. With this new treatment, approximately 40 percent to 60 percent of patients are helped, in that seizures might become less frequent or less severe. VNS is typically reserved for those epilepsy patients who are not candidates for respective surgery.
People with epilepsy whose seizures are not fully controlled by antiepileptic drugs or who experience troublesome adverse effects may consider looking into the emerging field of complementary and alternative therapies (CAM). Options in the alternative health care arena include treatments such as herbal medicine, relaxation and biofeedback, acupuncture and even chiropractic therapy.
Strokes, or brain attacks, are a major cause of death and permanent disability. They occur when blood flow to a region of the brain is obstructed and may result in death of brain tissue.
There are two main types of stroke: ischemic and hemorrhagic. Ischemic stroke is caused by blockage in an artery that supplies blood to the brain, resulting in a deficiency in blood flow (ischemia). Hemorrhagic stroke is caused by the bleeding of ruptured blood vessels (hemorrhage) in the brain.
During ischemic stroke, diminished blood flow initiates a series of events (called ischemic cascade) that may result in additional, delayed damage to brain cells. Early medical intervention can halt this process and reduce the risk for irreversible complications.
Stroke occurs when blood flow to a region of the brain is obstructed, causing brain tissue death.
Ischemic Stroke: This is the most common type of stroke. Usually this type of stroke results from clogged arteries, a condition called atherosclerosis. Fatty deposits collect on the wall of the arteries, forming a sticky substance called plaque. Over time, the plaque builds up. Often, the plaque causes the blood to flow abnormally, which can cause the blood to clot.
Another important cause of cerebral embolisms is a type of arrhythmia called atrial fibrillation. Other causes of ischemic stroke include endocarditis, an abnormal heart valve, and having a mechanical heart valve. A clot can form on a heart valve, break off, and travel to the brain. For this reason, those with mechanical or abnormal heart valves often must take blood thinners.
Hemorrhagic Stroke: A second major cause of stroke is bleeding in the brain hemorrhagic stroke. This can occur when small blood vessels in the brain become weak and burst. Some people have defects in the blood vessels of the brain that make this more likely. The flow of blood after the blood vessel ruptures damages brain cells.
High blood pressure is the number one reason that you might have a stroke. The risk of stroke is also increased by age, family history of stroke, smoking, diabetes, high cholesterol, and heart disease.
Certain medications increase the chances of clot formation, and therefore your chances for a stroke. Birth control pills can cause blood clots, especially in woman who smoke and who are older than 35.
Men have more strokes than women. But, women have a risk of stroke during pregnancy and the weeks immediately after pregnancy.
Cocaine use, alcohol abuse, head injury, and bleeding disorders increase the risk of bleeding into the brain.
Strokes, or brain attacks, are medical emergencies that require immediate medical attention. Remember that someone having a stroke may not experience all of the warning signs and that warning signs can come and go. Anyone having these symptoms should seek prompt medical attention. The sooner treatment begins, the more effective it is. Warning signs of a stroke include the following:
– Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
– Sudden confusion, difficulty speaking or understanding
– Sudden difficulty seeing in one or both eyes
– Sudden difficulty walking, dizziness, loss of balance or coordination
– Sudden severe headache with no known cause
If stroke is suspected, prompt, accurate diagnosis and treatment is necessary to minimize brain tissue damage. Diagnosis includes a medical history and a physical examination including neurological examination to evaluate the level of consciousness, sensation, and function (visual, motor, language) and determine the cause, location, and extent of the stroke.
Physical examination includes assessing the airway, breathing, and circulation (ABCs) and the vital signs (i.e., pulse, respiration, temperature). The head (including ears, eyes, nose, and throat) and extremities are also examined to help determine the cause of the stroke and rule out other conditions that produce similar symptoms (e.g., Bell’s palsy).
Blood tests (e.g., complete blood count) and imaging procedures (e.g., CT scan, ultrasound, MRI) help the physician determine the type of stroke and rule out other conditions, such as infection and brain tumor.
Carotid ultrasound. In this procedure, a wand-like device (transducer) sends high-frequency sound waves into your neck. The sound waves pass through tissue and then return, creating on-screen images that show any narrowing or clotting in your carotid arteries.
Arteriography. This procedure gives a view of arteries in your brain not normally seen in X-rays. Your doctor inserts a thin, flexible tube (catheter) through a small incision, usually in your groin. The catheter is manipulated through your major arteries and into your carotid or vertebral artery. Then your doctor injects a dye through the catheter to provide X-ray images of your arteries.
Computerized tomography (CT). In computerized tomographic angiography (CTA), a dye is injected into your vein and X-ray beams create a 3-D image of the blood vessels in your neck and brain. Doctors use CTA to look for aneurysms or arteriovenous malformations and to evaluate arteries for narrowing. CT scanning, which is done without dye, can provide images of your brain and show hemorrhages, but without as much detailed information about the blood vessels.
Magnetic resonance imaging (MRI scan) with magnetic resonance angiography (MRA) uses a magnetic field to produce detailed images of brain tissue and arteries in the neck and brain, allowing physicians to detect small-vessel infarct (i.e., stroke in small blood vessels deep in brain tissue).
ECG (electrocardiogram) may be performed to detect reduced blood flow to the heart (myocardiac ischemia) or irregular heartbeat (cardiac arrhythmia).
Echocardiogram may be used if the cause may be an embolus (blood clot) from the heart.
Angiogram involves injecting a contrast agent (dye) into the bloodstream and taking a series of x-rays of blood vessels. This test is used to identify the source and location of arterial blockage and to detect aneurysms and blood vessel defects.
Single photon emission computed tomography (SPECT) and positron emission tomography (PET) involve injecting a radioactive substance into the bloodstream and monitoring it as it travels through blood vessels in the brain. These tests allow physicians to detect damaged regions of the brain resulting from reduced blood flow.
Treatments (OPTION 1) (either this can be used or option 2 description of treatment be used)
A stroke is a medical emergency. Physicians have begun to call it a “brain attack” to stress that getting treatment immediately can save lives and reduce disability. Treatment varies, depending on the severity and cause of the stroke. For virtually all strokes, hospitalization is required, possibly including intensive care and life support.
The goal is to get the person to the emergency room immediately, determine if he or she is having a bleeding stroke or a stroke from a blood clot, and start therapy — all within 3 hours of when the stroke began.
Thrombolytic medicine, such as tPA, breaks up blood clots and can restore blood flow to the damaged area. People who receive this medicine are more likely to have less long-term impairment. However, there are strict criteria for who can receive thrombolytics. The most important is that the person be examined and treated by a specialized stroke team within 3 hours of when the symptoms start. If the stroke is caused by bleeding rather than clotting, this treatment can make the damage worse — so care is needed to diagnose the cause before giving treatment.
In other circumstances, blood thinners such as heparin and Coumadin are used to treat strokes. Aspirin may also be used.
Other medications may be needed to control associated symptoms. Painkillers may be needed to control severe headache. Medicine may be needed to control high blood pressure.
Nutrients and fluids may be necessary, especially if the person has swallowing difficulties. The nutrients and fluids may be given through an intravenous tube (IV) or a feeding tube in the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.
For hemorrhagic stroke, surgery is often required to remove pooled blood from the brain and to repair damaged blood vessels.
Treatment (OPTION II)
Because their mechanisms are different, the treatments for the types of stroke are different:
– Removing obstruction and restoring blood flow to the brain treats Ischemic stroke.
– In Hemorrhagic stroke, doctors introduce an obstruction to prevent rupture and bleeding of aneurysms and arteriovenous malformations.
– Clot busters, e.g., tPA
The most promising treatment for ischemic stroke is the FDA-approved clot-busting drug tPA (tissue plasminogen activator), which must be administered within a three-hour window from the onset of symptoms to work best. Administering tPA or other clot-dissolving agents is complex and is done through an intravenous (IV) line in the arm by hospital personnel. If given promptly, tPA can significantly reduce the effects of stroke and reduce permanent disability. Generally, only 3 to 5 percent of those who suffer a stroke reach the hospital in time to be considered for this treatment.
Antiplatelet agents such as aspirin and anticoagulants such as warfarin interfere with the blood’s ability to clot and can play an important role in preventing stroke.
– Carotid Endarterectomy
Carotid endarterectomy is a procedure in which blood vessel blockage is surgically removed from the carotid artery.
Doctors sometimes use balloon angioplasty and implantable steel screens called stents to treat cardiovascular disease and reduce fatty buildup clogging a vessel.
Hemorrhagic Stroke (SUBARACHNOID HEMORRHAGE OR AVM)
– Surgical Intervention
For hemorrhagic stroke (specifically for a subarachnoid hemorrhage), surgical treatment is often recoommended to either place a metal clip at the base, called the neck, of the aneurysm or to remove the abnormal vessels comprising an arteriovenous malformation (AVM).
– Endovascular Procedures, e.g., “coils”
Endovascular procedures are less invasive and involve the use of a catheter introduced through a major artery in the leg or arm, guided to the aneurysm or AVM where it deposits a mechanical agent, such as a coil, to prevent rupture.