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Neurology: The Cranial Tale

Neurology  in india

What Does Neurology Treatment Mean?

The branch of medicine dealing with nervous system is termed as neurology. The nervous system is composed of the central (brain and spinal cord) and peripheral (cranial and spinal nerves) systems. The brain is the prime coordinator of all the activities and sends signals to several of the body parts via sensory nerves. The parts in turn send the motor impulses to the brain via the motor nerves. The central and the peripheral systems both work in synchronicity to bring about a harmonious functioning of the human skeleton.

Causes Of Neurology Diseases:

  • Genetic/inherited disorders: These mostly occur congenitally and result due to mutations in the genes in the fetus during gestation. These include diseases of the peripheral nerves primarily such as Charcot-Marie-Tooth disease, Refsum disease, porphyria and hereditary neuropathy.
  • Autoimmune disorders: In such cases, the body produces cells which aim at destroying the nervous system of the host. The etiology of such cases is often unknown and they almost always go unrecognized unless the symptoms are very severe. These majorly include diffuse cerebral sclerosis of Schilder and acute disseminated encephalomyelitis.
  • Trauma: Nervous system injuries include the spinal cord and brain injuries leading to hematoma, hemorrhages, brain cancer and stroke. Skull fractures, leakage of blood and CSF from head openings often occurs following involvement of head and brain in road traffic accidents/stabbing head/fights.
  • Acquired after birth/Old age: Conditions such as epilepsy, ataxia, cerebral palsy and scoliosis of spine can occur at any age ranging from early childhood to late adolescence. Bacterial infection of the spinal cord and the meninges (covering of brain) often leads to tuberculosis of spine and meningitis respectively. Old age often is accompanied with loss of memory functions and wearing out of the nerves such as Alzheimers disease, schizophrenia, Parkinson’s disease and multiple sclerosis respectively. The cause of all these are attributed either to genetic mutations, hypoxia (reduced oxygen supply to brain) or in some cases and unknown factor.

Signs & Symptoms Of Neurology Disorders:

  • Uncoordinated movements of limbs
  • Partial/complete paralysis
  • Nausea, vomiting, frequent headaches
  • Muscle weakness and fatigue
  • Partial/complete loss of sensation such as blurred vision,  partial hearing, slurred speech, stammering while talking, difficulty in adapting to temperature changes
  • Leakage of cerebrospinal fluid from ears and nose during trauma to the head
  • Difficulty in reading and writing and understanding things
  • Partial/complete loss of memory
  • Seizures, panic attacks, ataxia
  • Poor cognitive abilities
  • Unexplained pain.
  • Decreased alertness

Diagnostic Tests For Neurology Diseases:

  • Laboratory screening tests of blood, urine and cerebrospinal fluid can be used to help diagnose some neurological diseases and monitor levels of therapeutic drugs. 
  • Genetic testing or counseling can help parents who have a family history of a neurological disease determine if they are carrying one of the known genes that cause the disorder or find out if their child is affected.  Amniocentesis is usually done at 14-16 weeks of pregnancy which tests a sample of the amniotic fluid in the womb for genetic defects. Chorionic villus sampling CVS can also be one such method which is performed by removing and testing a very small sample of the placenta during early pregnancy.  Uterine ultrasound is routinely performed noninvasive test which can suggest the diagnosis of conditions such as chromosomal disorders.
  • A physical examination helps to assesses motor and sensory skills, the functioning of one or more cranial nerves, hearing and speech, vision, coordination and balance and the mental status. A tuning fork, flashlight, reflex hammer, ophthalmoscope, and needles are used to help diagnose brain tumors, meningitis and Parkinson’s disease.
  • Electroencephalography EEG smonitors brain activity and is  used to help diagnose certain seizure disorders, brain tumors, inflammation of the brain and/or spinal cord, certain psychiatric disorders, sleep disorders. It also monitors brain activity when a patient has been fully anesthetized or loses consciousness and confirms brain death.
  • Angiography can be done in order to study the position, course and pathology of the arteries and veins in the brain
  • Biopsy and FNAC are the procedures done in cases of brain tumors and cysts in which a part of the pathological mass is removed and sent to the laboratory for evaluation.
  • Radiological examinations brain scans with the help of computed tomography CT, PET scans, magnetic resonance imaging MRI which gives a sliced image of all the parts of brain in sections with the exact location, size, number of pathologies present.

Types Of Neurology Diseases:

For the ease of segregation, these are mentioned below in the alphabetical order

  • Alzheimer’s disease: It is an irreversible and progressive disorder of brain affecting the memory cells leading to dementia ie complete loss of memory. It is an absolute disease of the old age. Slowly and steadily the ability to carry out daily routine functions also gets impaired. The patient becomes forgetful and looses the orientation of time and space.
  • Ataxia: Ataxia is a symptom of neurologic disorder which clinically manifests in the form of uncoordinated movements between the limbs, vision and speech. Friedreich’s ataxia is an autosomal recessive, degenerative disease that involves the central and the peripheral nervous systems and the heart. Ataxia telangectasia A-T, a congenital neurodegenerative disorder, occurs during early to late childhood period which shows delayed walking/standing in infancy, jerky and unsteady movements and de pigmentation patches on skin. A group of congenital ataxias leading to impairment of limbs, vision and speech are termed as spinocerebellar ataxias SCA.
  • Autism: It is a learning disability occurring in 1 in 60 live births. An autistic child has excellent motor and sensory skills and the condition may go unnoticed for quite some time of life. The behavioral pattern and communication skills of autistic children are defective.
  • Brain tumor: A brain tumor occurs due to excessive and rapid multiplication of cells anywhere within the fore, mid or hind brain. As a result of an abnormal mass of growth, the blood and the nerves get compressed. This may lead to either less blood and oxygen supply to the brain tissues or a fault in the neurotransmission by nerves, hence the symptoms occur.
  • Cerebral palsy: a child with this disorder shows defective motor coordination in children. A hand/leg or both the limbs may show jerky movements or un synchronous activity. A child also may become stiff, head may jerk if left unsupported with hands.
  • Epilepsy: It is a brain disorder manifesting in the form of seizures of brief period occurring at repeated intervals. Seizures occur as a result of change in the electrical or chemical activity of brain which may occur due to trauma to the brain, reduced oxygen supply or cranial infections.
  • Meningitis: It is a condition of bacterial infection of the meninges ie the fibrous covering of the brain and spinal cord leading to its swelling. It leads to extremely high grade fever, loss of sensation, nausea, vomiting and disorientation in children.        
  • Multiple sclerosis: It is a sort of demyelinating disease of the brain and spinal cord in which the insulating covering of the nerve cells gets damaged. It may result in vision problems, tingling and numbness, pains and spasms, weakness or fatigue, balance problems or dizziness, bladder issues, sexual dysfunction and cognitive problems.
  • Parkinson’s disease: It is a chronic progressive neurological disease which includes tremors, muscular rigidity, and slow improper movements, mostly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.
  • Peripheral neuropathy: It is a disease of the peripheral nerves which occurs due to a damage or trauma of the peripheral nerves carrying information to and from the brain to the various parts of the human body. It majorly disrupts the neurotransmitter mechanism, may lead to a host of loss of sensations.
  • Schizophrenia: It is regarded as a partial loss of memory occurring in the middle to the old age group. It is a sort of an autoimmune disorder in which the cells taking up sodium and potassium from the blood to the brain are destroyed. Due to this imbalance in the ionic levels of sodium, the memory cells loss their ability to remember things partially. Thus such patients find it difficult to revive certain situations/things/memories.
  • Scoliosis: It is a spinal disease hitting the early adolescent children in which the spine becomes accentuated S shaped, making many movements limited. It may occur secondary to cerebral palsy and muscular dystropy, in certain cases the etiology is unknown.
  • Tuberculosis: It is a bacterial infection of the spinal cord manifesting in early to late adolescent period. Extremely high grade fever, pain along the course of spinal cord curvature, dizziness and drowsiness, limited movements and bed ridden stage are commonly encountered with this diseases.

Complications & Risk Factors Associated With Neurology Diseases:

  • Family history of brain diseases are more likely to be passed on to the young individuals.
  • Smoking/alcohol aggravate the neurological symptoms
  • Existing systemic conditions such high blood pressure and diabetes tend to complicate brain disorders
  • Epilepsy, cerebral palsy and ataxia may lead to paralysis of a part of body is the progression is rapid.
  • Treatment of cardiac disorders becomes difficult in cases with neurological disease signs.

Treatment Of Neurology Diseases:

  • Medications: Neuroleptics such as haloperidol and chlorpromazine are administered to treat organic disorders of the brain such as schizophrenia. There is no cure for Parkinsons disease but there are several medications that may help control symptoms. Physicians closely monitor the cases for drug side effects and adjust dosages or change medications depending on how patients respond. Simple analgesics such as ibuprofen, acetaminophen and opiates can be prescribed to treat the painful effects of many neurological ailments.
  • Speech/motivational therapies: For cases with autism, cerebral palsy and epilepsy, various kinds of therapies are available. The child is taught to respond to a number of stimuli, train to walk/climb/ perform daily activities on his/her won. At the same time, the parents are also counseled to keep patience with such children.
  • Radiation and chemotherapy: These are the modes of treatment in cases of benign tumors of the brain which do not require a surgical intervention.
  • Surgical approach: This is mostly the approach in cases of brain tumors, brain hemorrhages, abscess and other traumatic conditions. For the benign tumors of brain, total resection should be done without leaving any margins in the cranial tissues. However a small part of the healthy tissues also is removed to prevent any chance of recurrence.

In case of brain stroke or infarcts, the hypoxic tissues are removed and the blood supplying vessel is re coursed in order to supply proper blood nutrients and oxygen to the brain. Abscess are mostly drained and followed by a heavy antibiotic and analgesic course. Hemorrhages occurring as a result of extensive trauma to the brain cells are controlled with the help of coagulants and blood vessels sutured in order to stop bleeding.

The neurology surgical procedures often seem easy to read and understand, however are quite complicated in the course of diagnosis, tretamnet planning and on table handling of added complications.

Technique used in the Neurosurgery:-

There are two techniques that are used in the field of Neurosurgery. The following are the two processes:- 

  • Traditional surgery - This is the conventional method of surgery. It is also known as open surgery. In this technique the neurosurgeon creates an opening in the skull through which the surgeon can get an access to the structures of brain.  These days smaller craniotomies are used with the aid of much better visualizing microscopic tools. Still this remains to be the choice of method in cases of acute emergencies like trauma, fractures or massive lesions. 
  • Minimal invasive endoscopic surgery - With the modern amenities, the use of techniques that involves the use of minimal intervention and incisions are preferred. In this method smaller incisions are made and endoscopic tools are used to repair the structures. It includes the following techniques:
    1. Awake craniotomy- in this procedure the patient is kept awake throughout the surgery. This is achieved by monitoring the critical functioning of the patient with the help of brain mapping technology. 
    2. Endoscopic endonasal approach- It is an innovative technique in which the tumours which are located on the base of the skull are removed through the nose and the sinuses which acts as the natural pathways to access the tumours.
    3. Stereotactic Radiosurgery- In this technique gamma radiation is used that targets the lesions within the brain without requiring any surgical incisions. In recent years cyberknife M6 is also used for the same especially in patients with larger lesions. 

Benefit of the treatments:- 

  • The recovery is better.
  • Helps in correcting the fractures from trauma or injury
  • Improves the neurological deficit
  • Stop the recurrent episodes of epilepsy
  • It is also useful for diagnosis of the cause of the neurological disorders
  • Limit the damage from infection
  • Reduce hemorrhage or fluid pressure in the ventricles of the brain. 

Am I a good candidate for Neurosurgery?

If you are having problems related to central nervous system which is not responding to conventional method of treatment then your doctor may recommend Neurosurgery. In certain medical emergencies that involves severe injuries or trauma to the brain or the spinal cord, neurosurgery might be your best option. 

Success Rate Of In India:

Success rate for the medications provided for neurology diseases which only help in subsiding the symptoms almost by 50 percent is also the same. Medications do not intend at increasing the longevity of the patient, only suppressing the signs. Surgical approaches for tumors have a success rate og 34.89 percent with a high chance of both, fatality and recurrence.

Why Medcureindia?

medcureIndia makes quite an apt proclamation is calling itself as one of the prime platforms of medical tourism in the country. And very righteously we direct our clients to the best of neurological institutes making sure our people are at safe hands.

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