“TIME IS BRAIN”- opening a blocked artery within 4 ½ ( four and a half) hours, reverses the paralysis and prevents life time disability.

If you are experiencing these symptoms- you could be having a stroke. You should see a doctor immediately.

• sudden paralysis of a leg, arm or one side of the face
• Sudden trouble speaking or understanding speech
• Sudden vision problems, such as blurred or double vision
• Sudden loss of coordination or problems with balance
• A severe, sudden headache without apparent cause
• Sudden numbness, weakness or dizziness

These symptoms can occur

if an Artery supplying blood to the brain gets blocked- this is an Ischemic Stroke Or due to an artery rupturing within the brain- this is called Brain Haemorrhage

Transient Ischemic Attack ( TIA):

• If the above mentioned symptoms are transient ( brief, short) and it is reversible within a few minutes, then it is referred to as a TIA ( transient ischemic attack)
• The blocked artery opened up on its own, hence the reversal of symptoms.
• TIA is an emergency, as the artery may get blocked again.

• EVALUATION BY THE NEUROLOGIST
• DIAGNOSIS OF STROKE CONFIRMED
• IMAGING

IMAGING

• 1) CT SCAN- *shows brain haemorrhage- proceed with investigations and treatment for the same.
  * CT scan shows no haemorrhage then a MRI of the head has to be taken.
• MRI HEAD- shows infarct due to blocked artery- proceed with investigations and treatment of Ischemic stroke / infarct.

Other investigations include-

• CT/MRI Angiogram- to locate the blocked artery
• Blood tests /ECG/ECHO/EEG ( if needed)

STROKE REHABILITATION- is an important part of recovery after stroke.

Stroke rehabilitation includes a dynamic process of assessment, goal setting and treatment focusing on improving sensory motor deficits, functional mobility and independence in their ADL ( Activity for Daily Living )and preventing other complications. STROKE REHABILITATION- is an important part of recovery after stroke.

Our team of experts include

• Neurologists and Neurosurgeons - Your primary care doctor — as well as neurologists and specialists in physical medicine and rehabilitation — can guide your care and help prevent complications. These physicians can also help you to gain and maintain healthy lifestyle behaviors to avoid another stroke.
• Physiatrist - aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities.
• Physiotherapist- These therapists help you relearn movements such as walking and keeping your balance.
• Occupational Therapists- OTs primary focus on the difficulty and quality of performance / of meaningful occupation (work , play , leisure) also includes ADL’s .Our department is equipped with separate ADL Room that enables the therapist / and the client to work collaboratively towards making the client independent in ADL performance through meaningful occupations and activities .

Those include :

• Hand Function Retraining
• ADL ( activity for daily living) Retraining (Brushing / Grooming / Bathing / Dressing
• Speech and language pathologists - These specialists help improve your language skills and ability to swallow. Speech and language pathologists can also work with you to develop tools to address memory, thinking and communication problems.
• Psychiatrists and Psychologists- These specialists assess your thinking skills and help address your mental and emotional health concerns.
• Dieticians
• Rehab Nurses

The main goal of stroke rehabilitation is to help you relearn skills you lost when a stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve your quality of life.

All our specialists work as a team and help in the patient's recovering process.

TIPS FOR THE CAREGIVERS: stroke rehabilitation takes time.

Stroke Rehabilitation starts when the patient is still in hospital. Sometimes it starts as early as the next day, where our rehab team guide you to work towards making you active.

Stroke rehabilitation is a long process. One has to be very patient and dedicated and enduring while undergoing rehab. The near and dear ones of the patient can be of great help during this course. It is your patience and perseverance, love and caring attitude that will help the patient recover sooner. Encourage your loved one to be active and independent.

Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.

Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.

Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age.

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms such as fear, anxiety or deja vu

There are many types of seizures. Most seizures end in a few minutes.

These are general steps to help someone who is having any type seizure:

• Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms.
• Comfort the person and speak calmly.
• Check to see if the person is wearing a medical bracelet or other emergency information.
• Keep yourself and other people calm.
• Offer to call a taxi or another person to make sure the person gets home safely.

Here are things you can do to help someone who is having this type of seizure:

• Ease the person to the floor.
• Turn the person gently onto one side. This will help the person breathe.
• Clear the area around the person of anything hard or sharp. This can prevent injury.
• Put something soft and flat, like a folded jacket, under his or her head.
• Remove eyeglasses.
• Loosen ties or anything around the neck that may make it hard to breathe.

Knowing what NOT to do is important for keeping a person safe during or after a seizure.

Never do any of the following things

• Do not hold the person down or try to stop his or her movements.
• Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
• Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure.
• Do not offer the person water or food until he or she is fully alert.

Seek immediate medical help if any of the following occurs:

• The seizure lasts more than five minutes.
• Breathing or consciousness doesn't return after the seizure stops.
• A second seizure follows immediately.
• You have a high fever.
• You're experiencing heat exhaustion.
• You're pregnant.
• You have diabetes.
• You've injured yourself during the seizure.

If you experience a seizure for the first time, seek medical advice.

Parkinson’s disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinson’s disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.

Scientists have discovered gene mutations that are associated with Parkinson’s disease. There is some belief that some cases of early-onset Parkinson’s disease – disease starting before age 50 – may be inherited. Scientists identified a gene mutation in people with Parkinson’s disease whose brains contain Lewy bodies, which are clumps of the protein alpha-synuclein. Scientists are trying to understand the function of this protein and its relationship to genetic mutations that are sometimes seen in Parkinson’s disease and in people with a type of dementia called Lewy body dementia. Several other gene mutations have been found to play a role in Parkinson’s disease. Mutations in these genes cause abnormal cell functioning, which affects the nerve cells’ ability to release dopamine and causes nerve cell death. Researchers are still trying to discover what causes these genes to mutate in order to understand how gene mutations influence the development of Parkinson’s disease. Scientists think that about 10% to 15% of person’s with Parkinson’s disease may have a genetic mutation that predisposes them to development of the disease. There are also environmental factors involved that are not fully understood.

Symptoms of Parkinson’s disease and the rate of decline vary widely from person to person. The most common symptoms include:

• Tremor: Shaking begins in your hands and arms. It can also occur in your jaw or foot. In the early stages of the disease, usually only one side of your body or one limb is affected. As the disease progresses, tremor may become more wide spread. It worsens with stress. Tremor often disappears during sleep and when your arm or leg is being moved.
• Slowness of movement (bradykinesia): This is the slowing down of movement and is caused by your brain’s slowness in transmitting the necessary instructions to the appropriate parts of the body. This symptom is unpredictable and can be quickly disabling. One moment you may be moving easily, the next you may need help moving at all and finishing tasks such as getting dressed, bathing or getting out of a chair. You may even drag your feet as you walk.
• Rigid muscles/stiff limbs: Rigidity is the inability of your muscles to relax normally. This rigidity is caused by uncontrolled tensing of your muscles and results in you not being able to move about freely. You may experience aches or pains in the affected muscles and your range of motion may be limited.
• Unsteady walk and balance and coordination problems: You may develop a forward lean that makes you more likely to fall when bumped. You may take short shuffling steps, have difficulty starting to walk and difficulty stopping and not swing your arms naturally as you walk. You may feel like your feet are stuck to the floor when trying to take a step.
• Muscle twisting, spasms or cramps (dystonia). You may experience a painful cramp in your foot or curled and clenched toes. Dystonia can occur in other body parts.
• Stooped posture. You have a “hunched over” posture. Other symptoms include:
• Decreased facial expressions: You may not smile or blink as often as the disease worsens; your face lacks expression.
• Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking.
The pitch of your voice may become unchanged (monotone).
• Handwriting changes: Your handwriting may become smaller and more difficult to read.
• Depression and anxiety.
• Chewing and swallowing problems, drooling.
• Urinary problems.
• Mental “thinking” difficulties/memory problems.
• Hallucinations/delusions.
• Constipation.
• Skin problems, such as dandruff.
• Loss of smell.
• Sleep disturbances including disrupted sleep, acting out your dreams, and restless leg syndrome.
• Pain, lack of interest (apathy), fatigue, change in weight, vision changes.
• Low blood pressure.

Each person with Parkinson’s disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinson’s disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms; others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset. In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

• Early stage Early symptoms of Parkinson’s disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing. Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement (no arm swing when walking) slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
• Mid stage Symptoms start getting worse. Tremor, muscle stiffness and movement problems may now affect both sides of the body. Balance problems and falls are becoming more common. You may still be fully independent but daily tasks of everyday living, such as bathing and dressing, are becoming more difficult to do and take longer to complete.
• Mid-late stage Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
• Advanced stage You now require a wheelchair to get around or are bedridden. You may experience hallucinations or delusions. You now require full-time nursing care.

Vertigo is a sensation of feeling off balance. If you have these dizzy spells, you might feel like you are spinning or that the world around you is spinning.

Vertigo is often caused by an inner ear problem. Some of the most common causes include:

BPPV these initials stand for Benign Paroxysmal Positional Vertigo.

BPPV occurs when tiny calcium particles (canaliths) are dislodged from their normal location and collect in the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. It helps you keep your balance.

BPPV can occur for no known reason and may be associated with age.

Meniere's disease. This is an inner ear disorder thought to be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss.

Vestibular neuritis or labyrinthitis. This is an inner ear problem usually related to infection (usually viral). The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance

Less often vertigo may be associated with:

• Head or neck injury
• Brain problems such as stroke or tumor
• Certain medications that cause ear damage
• Migraine headaches

Vertigo is often triggered by a change in the position of your head.

People with vertigo typically describe it as feeling like they are:

• Spinning
• Tilting
• Swaying
• Unbalanced
• Pulled to one direction

Other symptoms that may accompany vertigo include:

• Feeling nauseated
• Vomiting
• Abnormal or jerking eye movements (nystagmus)
• Headache
• Sweating
• Ringing in the ears or hearing loss

Symptoms can last a few minutes to a few hours or more and may come and go.

A headache can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety, or depression. It can lead to other problems. People with chronic migraine headaches, for example, may find it hard to attend work or school regularly.

Headache is a very common symptom and can affect people of all ages. Severe or recurring headaches, especially those accompanied by other symptoms, may be a sign of a more serious disorder and should be treated by a doctor.

Headaches can be ,

• Cluster headaches
• Migraine
• Tension headache

There are two types of headaches — primary, in which the headache is the disorder itself, and secondary, in which the headache is caused by another condition, such as a brain tumor; haemorrhaging or bleeding in the brain; meningitis, an infection causing inflammation of the membranes covering the brain and spinal cord; or giant cell arteritis, a disorder involving inflammation and damage to blood vessels.

Migraine is the most common type of primary headache for which people seek a doctor's care. Tension-type headache is typically less severe. Other primary headache disorders, such as cluster headache, are rarer and often very severe.

“ Headaches which cannot be ignored” and need immediate attention

• sudden, severe headache associated with vomiting/double vision/weakness of a limb in a person without previous history of headache- could be a brain haemorrhage
• fever and severe headache- could be brain fever

Migraine is the most common type of headache. These painful, recurring headaches can last hours to days, often accompanied by nausea, vomiting, and sensitivity to light and sound. Symptoms of migraine-

• nausea
• vomiting
• throbbing head pain ( one or both sides)
• severe pain for 2 to 72 hours
• increasing pain during physical activity
• hypersensitivity to light and noise

Triggering factors-

• bright lights / strong smells ( eg. perfumes)
• empty stomach ( hunger)
• particular food ( specific to individual)

Cluster headaches are recurring attacks of excruciating pain on one side of the head, often behind an eye. The pain may extend to the forehead, nose, cheek, upper jaw or back of the head on the same side. The attacks often happen multiple times per day, with each attack lasting less than three hours, even without treatment. Most often, the attacks occur every day for several weeks or months and then subside for a period, though for some people the attacks can continue for months or even years.

Men have cluster headaches three to four times more often than women. Generally, this condition does not run in families.

There are two kinds of cluster headache: episodic and chronic. Those suffering from episodic cluster headaches have relatively long, pain-free remissions between headaches. Chronic cluster headache sufferers do not have long remissions. If during the past year or longer, you have had only one month or less of relief between headache attacks, you may have chronic cluster headache. About 10 percent of people with cluster headaches are considered chronic sufferers.

• Some of the symptoms include,
• Red or teary eyes
• Runny or stuffy nose
• Facial swelling

Investigations for cluster headache

• CT/MRI Head to rule out Brain haemorrhage, brain tumors etc.