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Neurology

Neurological disorders are the consequence of nervous system abnormalities that could be structural, biochemical or electrical and are related to the brain, spinal cord and other nerves. Although the brain and spinal cord are surrounded by tough membranes, enclosed in the bones of the skull, they are susceptible to various injuries if compromised. Nerves tend to lie deep under the skin but can still become exposed to damage. Neurology is the medical specialty that uses neuropsychological assessment to precisely identify and track problems in mental functioning, usually after some sort of brain injury or neurological impairment. Neurosurgery, deals with surgical treatments of neurological and spine conditions.

Some of the advanced procedures are discussed below:

Deep Brain Stimulation

Movement-related symptoms of Parkinson's disease and other neurological conditions are caused by faulty electrical signals in the areas of the brain that control movement. The deep brain stimulation (DBS) therapy is a new "high-tech" treatment for a number of neurologic disorders. DBS in select brain regions can provide remarkable therapeutic benefits for otherwise treatment-resistant movement disorders such as PD, tremor and dystonia.

The surgery involves a thin electrode being implanted within a specific area of the brain and connected to a battery- operated neurostimulator (similar to a pacemaker). The neurostimulator is surgically placed in the chest wall usually one to two weeks after electrode placement.Once in place, the device is programmed to deliver a mild electrical pulse to the area of the brain that controls the abnormal movements associated with their disorder. By adjusting the stimulation, patients can experience relieved or decreased symptoms of tremor, rigidity, slowness of movement, stiffness, and balance.

The surgery is most beneficial for two types of Parkinson's disease (PD) patients: (1) patients with uncontrollable tremor for which medications have not been effective and (2) patients with symptoms that are well treated with medications but who experience severe motor fluctuations, including wearing off and dyskinesias, despite attempts to control such fluctuations with changes in medications.

Unlike previous surgeries for PD, DBS does not damage healthy brain tissue by destroying nerve cells. Instead, the procedure blocks electrical signals from targeted areas in the brain. Thus, if newer, more promising treatments develop in the future, the DBS procedure can be reversed. Also, stimulation from the neurostimulator is easily adjustable-without further surgery-if the patient's condition changes.

Although most patients still need to take medication after undergoing DBS, many PD symptoms improve after DBS and many times daily dose of anti-parkinson's medications is reduced. The amount of reduction varies from patient to patient but can be noticeably reduced in most patients. The reduction in dose of medication leads to a significant improvement in side effects like dyskinesias. In some cases, the stimulation itself can suppress dyskinesias without a reduction in medication.

DBS is also used to treat Essential Tremor. In many cases, the tremor is mild enough to be effectively treated with medication. However, in severe cases medications may not be effective and tremor can become profoundly disabling. DBS reduces essential tremor and improves patients' ability to perform daily activities.

DBS can be performed for both generalized and focal dystonia. Dystonia can be very disabling due to impairment of motor skills as well as significant pain. There are multiple medications along with botulinum toxin that can be effective to treat dystonia. When medications or other non-surgical therapies are not successful deep brain stimulation can be a very effective treatment.

Cerebral angiography

This is a procedure that makes a detailed picture (angiogram) of the blood vessels in the brain. It is used to study blood vessels in the brain that are obstructed, blocked, narrowed, enlarged or malformed, and diagnose the underlying cause.Cerebral angiography is only one method used to diagnose a variety of cerebrovascular diseases, disorders and conditions.

During the test, a contrast dye is passed into the blood vessels through a long, thin tube called a catheter. The dye helps the blood vessels show up better on x-rays. Then a series of x-rays of the brain is taken. A device called a fluoroscope immediately projects the x-ray images onto a special screen for viewing.

Carotid Endarterectomy

This is the treatment of choice for most patients with critical Carotid stenosis. Endarterectomy is the procedure used to remove plaque and clots from the internal carotid arteries (located in the neck) and re-establish uninterrupted blood flow to the brain.

Endarterectomy may help prevent a stroke from occurring in persons with symptoms with a carotid artery narrowing. Selected patients without symptoms may also be candidates for carotid endarterectomy.

Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to the brain sufficiently, it can cause an ischemic stroke, which can cause permanent brain damage, or death, if a large enough area of the brain is affected. If a clot or plaque blocks only a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke. A TIA is often a warning sign that a stroke may occur in the near future, and it should be a signal to seek treatment soon, before a stroke occurs.

Carotid endarterectomy is one of the most commonly performed vascular operations to remove plaque in the carotid arteries and help prevent a stroke. It is not only safe and but also provides long-lasting solution.

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