Neurology

Overview

Neurology is the branch of medicine that deals with the study and treatment of nervous system disorders. The nervous system itself is composed of the central nervous nervous system and the peripheral nervous system. The central nervous system is the brain and the spinal cord, while the peripheral nervous system is composed of all the other nerves and sensory receptors in the sense organs (such as the eyes, ears, skin etc.).

A doctor who specialises in neurology is called a neurologist, and surgeons who perform surgeries related to neurology are called neurosurgeons.

Why NH?

Cerebral stroke or 'Brain Attack' is the leading cause of disability and probably the third leading cause of death in India. At Narayana Health, we use a new technique known as a temporary endovascular bypass. There are interventional neurological procedures, which are used for the treatment of acute stroke or epilepsy and are practised abroad very routinely. We hope to increase awareness of stroke and its prevention so that the focus is on prevention rather than cure.

The network of hospitals under Narayana Health offers comprehensive packages for epileptic care services, cerebral stroke programmes including rehabilitation and evaluation of complex neuromuscular disorders for which a recommended course of neurological disorders treatment is followed.

Our neurologists are experienced in treating patients with neurological disorders and diseases including:

Autism, learning disabilities

Epilepsy, dizziness and fainting

Chronic tension or stress-related headache, migraine

Persistent backache and spine problems

Short-term memory loss and dementia

Parkinson's disease, cerebral stroke

Cancers and tumours

Meningitis or brain fever

Sleep apnoea, semi-somnia, insomnia (sleep disorders)

Nerve-related issues (stress and nervous tensions) and trauma cases

Types of Neurology Diseases

Neurological disorders and diseases are caused by problems in either the central or peripheral nervous systems, or both. They can affect one, or many parts, of the nervous system such as the brain, spinal cord, nerves, nerve roots, neuromuscular junctions, the autonomic nervous system, and so on.

The causes of neurological disorders are varied. They can be caused by faulty genes, injuries, malnutrition, infection, or a response to an infection. Narayana Health is the best neurology hospital in India to treat all types of neurological disorders. There are more than 600 types of neurological diseases and disorders, but they can be broadly classified as follows-

Problems at the developmental stages of the nervous system such as spina bifida.

Genetic diseases such as muscular dystrophy and Huntington’s disease.

Degenerative or demyelinating diseases that cause the cells of the nervous system to die, or get damaged, over time such as Parkinson's disease and Alzheimer's disease.

Problems with the blood supply to the brain causing cerebrovascular disease such as a stroke.

Memory loss and dementia

Spinal cord disorders

Speech and learning disorders

Headache disorders such as migraines

Seizures

Pinched nerves

Tremors or uncontrolled movements

Cancers

Infections

Sleep disorders

Diagnosis

During the first meeting with a neurologist, they will probably perform an exam to check the patient’s speech, vision, cognitive abilities, coordination, strength, sensation and reflexes. Subsequently, diagnostic tests will be prescribed if required to better study and confirm the neurological problem if any.

At Narayana Health, the best neuro hospital in India, the most commonly prescribed tests for neurological disorders are

Imaging

Modern imaging techniques use different methods to obtain and study images of tissues within the body, in order to diagnose various problems. The most commonly used imaging techniques to diagnose neurological problems are Computed Tomography (CT or CAT), Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET) and Single-Photon Emission (SPECT) scans. These scans help the neurologist to clearly observe and diagnose strokes, injuries, tumours, malformation or haemorrhage of blood vessels or abnormalities during the development of the brain.

Computed Tomography (CT): CT scans are extensively used to obtain two-dimensional images of the internal structures of the body. It involves the injection of a contrast dye into the bloodstream of the patient to help visualise the images better. A CT scan of the brain can be used to easily detect any structural abnormalities, strokes, haemorrhages, bone or blood vessel malformations or damage, amongst other disorders. Spinal CT scans can be used to diagnose problems such as a spinal fracture, herniated disc, or narrowing of the spinal canal. CT scans should be avoided by pregnant women as they involve radiation and may be harmful to the fetus. These scans are preferable for those patients who are unable to undergo an MRI scan.

Magnetic Resonance Imaging (MRI): This type of imaging uses a very powerful magnetic field and radio waves to obtain images of the body. In addition to showing images, it can also be used to measure the flow of blood as well as mineral deposits. A contrast dye may be injected to improve imaging. MRI scans are usually used to diagnose multiple sclerosis, brain damage, inflammation, infection, structural abnormalities, damage and degeneration. Since an MRI’s magnetic field works on the water molecules in the tissues, it can be used to clearly study the water content and properties of different tissues. It’s important that there be absolutely no metal on the patient as the metal will be attracted by the magnetic field. People with implanted devices or infusion devices must be especially cautious to avoid MRIs. MRIs are much safer than CT scans because there is no radiation used.

Functional MRI (fMRI): Blood has its own magnetic properties. fMRI uses these unique properties of blood to obtain images of the blood flow to different areas of the brain. This gives neurologists a tool by which they can study and pinpoint the areas of the brain that are activated for different functions and also study how long they stay active. This helps to localise the regions used for different functions before surgery, degenerative disorders and head injuries.

Positron Emission Tomography (PET): PET scans are used to produce images that are more detailed than a CT or MRI scan. PET scans produce two and three-dimensional images using radioactive isotopes that are called tracers injected into the bloodstream. These scans are used to study tumours, blood flow, tissue metabolism, diseased tissue, as well as brain changes. Different compounds can be used to study multiple functions of the brain simultaneously.

Single Photon Emission Computed Tomography (SPECT): This is a nuclear imaging test that also uses radioactive isotopes similar to those used in PET scans. It is used as a followup to other scans to diagnose neurological problems such as infections, tumours, degenerative diseases, spine disease, stress fractures and the areas of the brain that are involved in seizures. A Dopamine Transporter Imaging With Single-photon Emission Computed Tomography (DAT-SPECT) scan is another type of SPECT scan that is particularly used to diagnose Parkinson disease.

Blood And Urine Tests

Blood and urine tests are used by neurologists to detect the presence of toxins, as well as, infections and protein disorders.

Electroencephalogram (EEG)

EEG is a test that is used to study and record the electrical patterns generated in the brain. This is achieved by placing electrodes on the scalp to detect electrical patterns. EEG is useful in diagnosing epilepsy, seizures, injuries, headaches, dizziness, tumours and sleeping disorders; this test is also used to confirm brain death.

Electromyogram (EMG)

EMG is a test that is used to evaluate communication levels between a specific nerve and the muscle that it controls. This is achieved by the placement of electrodes on the skin’s surface or through a needle.

Electronystagmography (ENG)

This is a set of tests that are designed to diagnose neurological problems that cause dizziness, balance issues, and involuntary eye movements. Small electrodes or infrared photography is used during these tests.

Polysomnogram

This is a test that is used to monitor the activity of the body and the brain when the patient is asleep. It involves placing electrodes to the patient's eyes, scalp, and chin to record brain waves. The person's heart rate, breathing, eye movements, and other body movements are also recorded to diagnose sleep disorders.

Evoked Potentials

Evoked potentials are the tests that are used to study and determine the reaction and response of the brain to specific stimuli. The equipment is similar to that used in an EEG.

Spinal Tap or Lumbar Puncture

When a neurologist needs to study the cerebrospinal fluid for infection, blood or any other abnormalities, a spinal tap or lumbar puncture is performed. This involves extracting a small amount of the spinal fluid to be examined in the laboratory.

Nerve or Muscle Biopsy

A biopsy of nerve or muscle tissue is performed in patients with neuromuscular disorders. Muscle samples are usually removed surgically or through a thin hollow needle. Nerve samples are removed through an incision. Sometimes skin biopsies are required to test for metabolic disorders or for the measurement of the small nerve fibres present in the sample. Certain infections or tumours in the brain are tested through a biopsy where the sample is retrieved through a surgical procedure.

Ultrasound Imaging / Ultrasonography

This test uses high-frequency sound waves to get images of the body. It is usually used to assess a fetus or a newborn for any neurological problems, such as hydrocephalus. Ultrasounds are also useful in studying the blood flow in specific areas of the body. The carotid Doppler ultrasound studies the blood flow in the blood vessels within the neck, while the transcranial Doppler ultrasound studies the blood flow in blood vessels within the skull. These studies are particularly useful in patients who are being assessed for risk of stroke.

Treatment & Preventions

Most neurological problems are not preventable. However, the ones that are avertible can be prevented by maintaining a healthy lifestyle; this means you should have a balanced diet. Keeping your fat intake to the minimum ensures that the blood vessels don’t get clogged. Avoiding bad habits such as drinking and smoking, along with leading an active lifestyle supports overall good health. Regular medical checkups are important to catch any problems early. When there are underlying health conditions such as high blood pressure and diabetes, they should be managed under medical supervision. When a person has been diagnosed with a neurological disorder, it should be treated under medical supervision, and in conditions such as epilepsy, measures should be taken to prevent further episodes.

Here are some of the significant neurology specialities at Narayana Hospital that offer excellent patient treatment services:

Interventional Neurology

Interventional neurology is a speciality which uses minimally invasive and image-based technologies procedures for the diagnosis and treatment of diseases of blood vessels of the brain and spinal cord (neurovascular diseases). These kinds of neurological diseases include paralytic strokes, brain aneurysms and arteio-venous malformations (AVM’s) of blood supplying the brain and spinal cords using coiling, stenting and embolization. Stroke “Brain attack” is the rapidly developing loss of brain functions due to the disturbance in the blood supply to the brain. Stroke is one of the leading causes of disability and death in India. India will face an enormous socio-economic burden to meet the costs of rehabilitation of "Stroke victims" because the population is now surviving through the peak years of the occurrence of stroke. Stroke is a treatable and preventable disease.

An interventional neurologist is specially trained to perform minimally invasive procedures for the treatment of conditions like aneurysms, strokes, spinal compression fractures and other complex diseases of the brain, neck and spine. Depending on your medical condition, they may order one or more of the following procedures.

Angiogram and venogram

Angiogram and venogram are a type of X-rays, which are used to identify any blockages in the blood vessel and other problems associated with it. The procedure involves advancing a tiny tube in the vein or artery and injecting a dye through it. This enables the doctor to monitor blood flow.

Angioplasty and Stenting

These procedures are followed to open narrowed or blocked blood vessels that lead to the spine or brain. A `thin tube is used in the procedure. It holds a guidewire with a tiny deflated balloon in it. The guidewire is advanced through the blood vessel until it reaches the blockage. The balloon is then inflated to remove the blockage and open the blood vessel. Sometimes, a small, metal mesh tube called a stent is used to open the blood vessel permanently.

Catheter Embolization

Through catheter embolization procedure, the blood supply to an unhealthy tissue in the brain or spine (such as a tumour) can be rerouted or completely stopped. It can be carried out by placing a glue-like fluid or coil in the blood vessel.

Neuro Rehabilitation

Recognizing the need to rehabilitate patients with neurological/spinal injuries or disorders into mainstream life, Narayana Health has a specially designated department to take care of those who need counselling, care and routine check-up. The objective of this department is to improve a patient's quality of life in case of a traumatic case history or simply provide handholding and offer support services until the individual can manage his life smoothly. The path to recovery is then a quick and smooth process.

Some of the conditions that can benefit from a neurological rehab centre are as follows.

Trauma by injury to the brain or spinal cord

Vascular disorders like haemorrhagic strokes, ischemic strokes, subdural haematoma and transient ischemic attacks

Structural or neuromuscular disorders, such as cervical spondylosis, bell palsy, brain or spinal cord tumours, carpal tunnel syndrome, myasthenia gravis, peripheral neuropathy and Guillain-Barré syndrome.

Infections, such as meningitis, polio, encephalitis and brain abscesses

Degenerative disorders like multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, Huntington chorea, etc.

Neurology FAQ's