Headache

Headache is the most common neurological disorder. It affects almost everybody during sometime in their life. Headaches are divided mainly in to two categories: Primary and secondary.

Primary headaches are common causes for headache. These are usually benign and longstanding. Common primary headaches are migraine and tension type headache. 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 between 3 hours and 3 days.

Secondary Headache: These may be caused by problems elsewhere in the head or neck. Some of these are not harmful, such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.

Serous causes of secondary headache include, brain tumors, stroke and brain hemorrhage. Patients having very severe headache, or sudden change in pattern of long duration headache, or having associated symptoms like: vision loss, frequent vomiting, seizures and drowsiness can have serious disease. These type of headache requires brain scan (CT or MRI Scan).

Epilepsy (Seizures or Fits)

Seizures or epilepsy is a common neurological disease. It affects about 1-2% of population. Epileptic seizures result from abnormal, excessive or hypersynchronous neuronal activity in the brain.[Most of the patients having seizures have no identifiable cause (idiopathic). Common identified causes for seizures or epilepsy are brain infection (TB or Neurocysticercosis), birth trauma, head injury, brain tumors and drugs. Epilepsy is easily treatable disease. For diagnosis it requires brain scan (CT Scan and MRI scan). Epilepsy is usually controlled, but not cured, with medication. However, few cases do not have seizure control even with the best available medications. Surgery may be considered in these difficult cases.

Stroke (Paralysis)

Stroke is third most common cause of death. A stroke, or cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a haemorrhage. As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field. A stroke is a medical emergency and can cause permanent neurological damage and death. Risk factors for stroke include old age, high blood pressure, previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, tobacco smoking, alcohol and atrial fibrillation.

An ischemic stroke is treated in a hospital with Thrombolysis (also known as a "clot buster"), and some hemorrhagic strokes benefit from neurosurgery. Acute stroke (infarct) if detected within 3 hours can be treated with Thrombolytic (clot bursting) therapy and it improves outcome of stroke significantly.

Treatment to recover any lost function is termed stroke rehabilitation, ideally in a stroke unit and involving health professions such as speech and language therapy, physical therapy and occupational therapy. Prevention of recurrence may involve the administration of antiplatelet drugs such as aspirin, clopidogrel and dipyridamole, control and reduction of high blood pressure, and the use of cholesterol lowering drugs. Selected patients may benefit from carotid endarterectomy and carotid bypass surgery. Diagnosis of stroke is done by clinical symptoms and by brain scan (CT and MRI scan).

Neuropathy

Neuropathy or weakness of nerves is a common disorder. It can involve may nerves (Polyneuropathy) or only one nerve (mononeuropathy). Common symptoms are tingling, numbness, needle pricking like sensation, burning sensation, loss of sensation, recurrent ulcers and weakness of limbs (difficulty in gripping footwear), loss of muscle bilk (wasting), cramps, sexual dysfunction (loss of libido and erectile dysfunction), urinary problems. Neuropathy can be caused by diabetes (most common), vitamin deficiency (vitamin B12), drugs (cancer related medicines and TB medicines) and alcohol. Patients having neuropathy requires routine blood tests and nerve conduction study (NCV/ ENMG). Most of the time treatment of neuropathy is symptomatic and to treat the underlying disease.

GBS (Guillaine Barre Syndrome) is acute ascending type of poly neuropathy that can involve respiratory muscles also. This is considered as medical emergency. It can be treated with Intravenous immunoglobulins or Plasmapheresis (blood exchange). Some patients with severe weakness may require ventilator support.

CIDP (Chronic Inflammatory Demyelinating Polyradiculoneuropathy) is a chronic (more than six month) disorder involving nerves. It causes significant limb weakness. Its treatment involves long term steroids and other immunosuppressive drugs.

Trigeminal neuralgia (TN) is a specific neuropathic disorder characterized by episodes of intense, current like pain in the face, originating from trigeminal nerve. Pain can be triggered by chewing, swallowing, washing face, brushing and by eating cold items. Clinical association between TN and hemifacial spasm is common and is called tic douloureux. It has been described as among the most painful conditions known to mankind. In a majority of cases, TN symptoms begin appearing more frequently over the age of 50, although there have been cases with patients being as young as three years of age. It is more common in females than males. The trigeminal nerve is a paired cranial nerve that has three major branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3). One, two, or all three branches of the nerve may be affected. It is usually unilateral (one sided) but, 10-12% of cases are bilateral.

Trigeminal neuralgia most commonly involves the middle branch (the maxillary nerve or V2) and lower branch (mandibular nerve or V3) of the trigeminal nerve, but the pain may be felt in the ear, eye, lips, nose, scalp, forehead, cheeks, teeth, or jaw and side of the face. TN is not easily controlled but can be managed with a variety of treatment options. Mostly it is treated with medicines (carbamazepine, phenytoin, pregabaline, amytryptiline). Few resistant cases can be treated by surgical procedure called Micro Vascular Decompression (MVD) of trigeminal nerve. MVD is very successful procedure and gives almost instant pain relief.

Carpal Tunnel Syndrome (CTS)

CTS is a median entrapment neuropathy, that causes paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve (Thumb, index and middle finger) due to its compression at the wrist in the carpal tunnel. Some of the predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools but not lighter work even if repetitive.

The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. The numbness often occurs at night, with the hypothesis that the wrists are held flexed during sleep. It can be relieved by wearing a wrist splint that prevents flexion. Long-standing CTS leads to permanent nerve damage with constant numbness, weakness of muscles.

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Conservative treatments include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.

Multiple sclerosis (MS)

also known as "disseminated sclerosis" or "encephalomyelitis disseminata", is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring.

Disease onset usually occurs in young adults, and it is more common in women. MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other effectively. In MS, the body's own immune system attacks and damages the myelin. When myelin is lost, the axons can no longer effectively conduct signals.

Almost any neurological symptom can appear with the disease, and the disease often progresses to physical and cognitive disability. Common symptoms include: loss of vision in one or both eyes, double vision, slurred speech, imbalance, weakness of one side of body or both lower limbs, reduced sensation below waist, urinary disturbance and sexual dysfunction.

There is no known cure for multiple sclerosis. Treatments attempt to return function after an attack, prevent new attacks, and prevent disability. The prognosis is difficult to predict; it depends on the type of the disease, individual's disease characteristics, initial symptoms and degree of disability the person experiences as time advances. Pulse steroid is treatment of choice for acute attack. For prevention of attacks interferons are used commonly. Life expectancy of people with MS is 5 to 10 years lower than that of the unaffected population.

Neck and Back Pain

Neck and Back Pain is pain felt in the back and neck that usually originates from the muscles, nerves, bones, joints or other structures in the spine. Back and neck pain may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may radiate into the arms and hands as well as the legs or feet, and may include symptoms other than pain. These symptoms may include tingling, weakness or numbness. Back pain is one of humanity's most frequent complaints. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, all of which are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.

There are several potential sources and causes of back pain. However, the diagnosis of specific tissues of the spine as the cause of pain presents problems. This is because symptoms arising from different spinal tissues can feel very similar and is difficult to differentiate without the use of invasive diagnostic intervention procedures, such as local anesthetic blocks.

One potential source of back pain is skeletal muscle of the back. Potential causes of pain in muscle tissue include muscle strains (pulled muscles), muscle spasm, and muscle imbalances.

Another potential source of lower back pain is the synovial joints of the spine. These have been identified as the primary source of the pain in approximately one third of people with chronic low back pain, and in most people with neck pain following whiplash.

There are several common other potential sources and causes of back pain: these include spinal disc herniation and degenerative disc disease or spondylolisthesis, osteoarthritis (degenerative joint disease) and lumbar spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease. The anterior ligaments of the intervertebral disc are extremely sensitive, and even the slightest injury can cause significant pain. Radicular pain (sciatica) is distinguished from 'non-specific' back pain, and may be diagnosed without invasive diagnostic tests like MRI Scan. Back pain can be managed with medicines, rest and in some cases with surgical decompression.

Brain Tumor

Brain Tumor is an intracranial solid neoplasm, a tumor (defined as an abnormal growth of cells) within the brain. Brain tumors include all tumors inside the cranium or in the central spinal canal. They are created by an abnormal and uncontrolled cell division, usually in the brain itself, but also in lymphatic tissue, in blood vessels, in the cranial nerves, in the brain envelopes (meninges), skull, pituitary gland, or pineal gland. Within the brain itself, the involved cells may be neurons or glial cells (which include astrocytes, oligodendrocytes, and ependymal cells). Brain tumors may also spread from cancers primarily located in other organs (metastatic tumors).

Any brain tumor is inherently serious and life-threatening because of its invasive and infiltrative character in the limited space of the intracranial cavity. Brain tumors or intracranial neoplasms can be cancerous (malignant) or non-cancerous (benign); however, the definitions of malignant or benign neoplasms differs from those commonly used in other types of cancerous or non-cancerous neoplasms in the body. Its threat level depends on the combination of factors like the type of tumor, its location, its size and its state of development. Because the brain is well protected by the skull, the early detection of a brain tumor occurs only when diagnostic tools are directed at the intracranial cavity. Usually detection occurs in advanced stages when the presence of the tumor has caused unexplained symptoms.