Types of Stroke and Treatment in India

What is stroke?

Stroke refers to a brain disease caused by either blockage of blood supply or rupture of a blood vessel to a particular part of the brain. This results in reduction of blood and oxygen supply to the affected part of brain resulting in loss of function

A stroke can be categorized into two types –

Hemorrhagic Strokes: This type of stroke occurs when a blood vessel bleeds and burst within the brain. This accumulated blood compresses the nearby tissues of the brain. This could be due to –

• A blood vessel on the brain surface starts bleeding in between the area of the skull and the brain.
• A blood vessel bleeding or bursting inside the brain

Hemorrhagic strokes has two main types –

• Subarachnoid hemorrhage: In this, there is bleeding in between the area of the brain and the thin tissues covering the brain.
• Intracerebral hemorrhage: This is considered as the most common type of hemorrhagic strokes. This occurs when an artery bursts inside the brain and resulting in the flooding of the nearby blood tissues.

Ischemic Stroke: This occurs when something is causing blockage in an artery which is carrying blood to the brain. The potential causes are –

• When there is a blockage in the small blood vessels within the brain
• When a blood clot develops in the main artery to the brain
• When an air bubble, a blood clot or fat globule develops in a blood vessel which is carried to the brain.

Causes

Some of the causes that can lead to a stroke are as follows:

1.       Ageing

2.      High blood pressure

3.      Diabetes

4.      Cardiovascular diseases

5.      High cholesterol

6.      Obesity

7.      Vitamin B12 deficiency

8.     Excessive alcohol and drug abuse

Symptoms:
Symptoms of a stroke occur suddenly. Symptoms vary depending on the location of the stroke. Each area of the brain is supplied by specific arteries. If an artery supplying the area of the brain that controls the left arm movements is blocked, that arm becomes weak or paralyzed.

The five most common signs and symptoms of stroke are:

1. Sudden numbness or weakness of the face, arm, or leg - like weakness of half of the body called as hemiplegia.
2. Sudden confusion or trouble speaking or understanding others called aphasia in medical terms.
3. Sudden trouble seeing in one or both eyes called as mono or binocular vision disturbance. This could be due a stroke anywhere in the visual pathway.
4. Sudden dizziness, trouble walking, or loss of balance or coordination, this is commonly due to posterior circulation strokes.
5. Sudden severe headache with no known cause is due to hemorrhage or sometimes infarction.

Diagnosis:

The diagnosis Is based on the symptoms and a good history given by the patient or an observer. Usually any neurologic symptom occurring suddenly in a neurovascular territory is attributed to a stroke. CT scan done immediately after a stroke is almost always normal in ischemic strokes. MRI with diffusion images is sensitive to diagnose acute infarction.

Treatment of a Stroke

The treatment for both hemorrhagic and ischemic stroke is different.

The purpose of treating ischemic stroke is to restore the flow of the blood in the brain. Medications are given in the first four and a half hours of the stroke for destroying the clots in the blood vessels. An injection of tissue plasminogen (TPA) can also be given to a patient for improving the probability of a full recovery.

The main purpose of treating a hemorrhagic stroke is to stop bleeding and decrease the pressure on the brain. Instead of blood thinners, clotting drugs can be given. After the area has been healed and the bleeding is controlled, the damaged and leaky blood vessels are then repaired.

The first stroke device approved by FDA is Merci retriever. The aim of this device is to restore the flow of the blood in the neurovasculature by removing thrombus in those patients who have ischemic stroke.

The penumbra system (endovascular thromboaspiration) is the last FDA approved device that has been primarily developed for removing a clot in the case of acute ischemic stroke. In order to eliminate or reduce the clot burden, this system uses dual approaches to clot extraction by using debulking and aspiration of the thrombus. Clot retrieval is then used where a ring device holds the thrombus by capturing it in clasps with a cylinder. This is then withdrawn at the time of flow arrest. This new aspiration device (the penumbra system) has an excellent safety profile and a high rate of ‘target vessel’ recanalization.

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Advanced Epilepsy Treatment Options Available at World Best Hospital in India

How is Epilepsy treated?

The main line of treatment is with antiepileptic drugs, which are effective in controlling seizures in 70%-80% of patients with epilepsy. There are several antiepileptic medications. Since certain medications are much better for some seizures, the choice of the medication should be made by a physician who is familiar with these medications. If possible, the child should be evaluated in a center specializing in epilepsy. If this is not feasible, usually pediatric neurologists have training in epileptic disorders and are a good source for a referral.

When antiepileptic drugs fail to control the seizures, the patients may improve with surgical procedures.

Who is a candidate for epilepsy surgery?

Surgery is indicated in a small group of children.

It usually takes the failure of two or three antiepileptic medications before a child would be considered as a potential candidate for surgery. In general, this happens at least after two or three years of continuous treatment with medications. The failure might be due:

1.   to a resistance to the antiepileptic medications that are available,

2.   to the presence of intolerable side effects to the antiepileptic medication,

3.   or to a combination of both.

Since surgical procedures might be very effective in some children, once it is clear that the child's epileptic disorder is not responding to treatment with antiepileptic medications, surgery should be considered. Young age is not a contraindication for surgery, and there is no benefit in waiting for the child to be older.

In fact, there is considerable evidence that the younger a child is at the time of surgery, the better his/her potential will be for good function after the surgery. There is a certain degree of plasticity in the brain that helps with the recovery of functions that can be damaged at the time of surgery. This plasticity is higher in younger than in older children.

Advanced Epilepsy Treatment Options Available at World Best Hospital in India

Best Neurosurgery Hospital in India | Neurosurgeon India : Stroke Patient from Nigeria

Till the time a person develops a second seizure, treatment for epilepsy will not begin. This is due to the reason that a person may have one seizure and never develops a second seizure. Medicines are successful in treating epilepsy. These medicines do not cure epilepsy, they prevent recurring of the seizures. These medicines changes the chemical or electrical transmissions in the brain in a particle way that decreases the chance of a seizure.

Vagus Nerve Stimulation (VNS) :

VNS therapy is recommended when medicines are unable to control epilepsy. During the surgical procedure, an electrical device is implanted underneath the skin. The lead of this device is wrapped around one of the nerves on the neck’s left side. This nerve is called as vagus nerve. This device continuously passes an electric dose to the nerve in order to stimulate it. This process reduces the severity and frequency of the seizures. If a person is feeling a warning seizure symptom then extra stimulation is given for preventing recurrence of the seizure.

Ketogenic Diet :  This is also considered as one of the treatment for epilepsy. Ketogenic diet is recommended for children as it involves eating a diet which is low in proteins and carbohydrates and high in fats. The chemical balance of the brain can be altered that also reduces the chance of having seizures. Ketogenic diet is not meant for adults as the diet can result in any other serious medical condition like heart disease, high blood pressure or strokes.

Advanced Surgical Procedures for Management of Epilepsy

Depending on the particular clinical situation, one of the following surgical procedures is chosen by the Medical team at our affiliate hospital. These operations either aim to resect the disease area of the brain, to disconnect it from other areas so as to relieve the seizures, or to lessen their impact.

• Anteromedial Temporal Lobectomy
• Selective Amygdalohippocampectomy
• Electrocorticography guided Resections
• Multiple Subpial transections
• Quadrantic Resections
• Multilobar Resections
• Functional Hemispherotomy
• Vagal Nerve stimulation
• Radiosurgery (selected cases)
  
  
  
  
  
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What Are the Symptoms of a Brain Tumor in Adults? : BRAIN TUMOR TREATMENT IN INDIA

Symptoms of brain tumors vary according to the type of tumor and the location. Because different areas of the brain control different functions of the body, where the tumor lies affects the way symptoms are manifested.

Some tumors have no symptoms until they are quite large and then cause a serious, rapid decline in health. Other tumors may have symptoms that develop slowly.

A common initial symptom of a brain tumor is headaches. Often, they don't respond to the usual headache remedies. Keep in mind that most headaches are unrelated to brain tumors.

Other symptoms include:

·         Seizures

·         Changes in speech or hearing

·         Changes in vision

·         Balance problems

·         Problems with walking

·         Numbness or tingling in the arms or legs

·         Problems with memory

·         Personality changes

·         Inability to concentrate

·         Weakness in one part of the body

It's important to keep in mind that these symptoms can be caused by a number of different conditions. Don't assume you have a brain tumor just because you experience some of them. Check with your doctor.

How Are Brain Tumors Diagnosed?

To diagnose a brain tumor, the doctor starts by asking questions about your symptoms and taking a personal and family health history. Then he or she performs a physical exam, including a neurological exam. If there's reason to suspect a brain tumor, the doctor may request one or more of the following tests:

·      Imaging studies such as a CT(CAT) scan or MRI to see detailed images of the brain

·     Angiogram or MRA, which involve the use of dye and X-rays of blood vessels in the brain to look for signs of a tumor or abnormal blood vessels

The doctor may also ask for a biopsy to determine whether or not the tumor is cancer. A tissue sample is removed from the brain either during surgery to remove the tumor or with a needle inserted through a small hole drilled into the skull before treatment is started. The sample is then sent to a lab for testing.

HOW TO TREAT BRAIN TUMORS

• Tumors near the surface of the brain may be surgically removed. In many cases, however, it is only possible to remove a portion of a tumor, since taking it all out would cause unacceptable amounts of brain damage. Still, removing even part of it may afford a period of improvement by relieving pressure within the cranium.
• Tumors deep within the brain may be treated with microsurgery, laser surgery, or radiation therapy.
• For malignant primary tumors, surgery may be followed with radiation or chemotherapy. Surgery may also be preceded by radiation.
• Your doctor may prescribe corticosteroids to reduce swelling of brain tissue, anticonvulsant drugs to control seizures, and pain relievers.

Treatment for brain tumors is based on many factors, such as:

• Your age, overall health, and medical history
• The type, location, and size of the tumor
• How likely the tumor is to spread or recur
• Your tolerance for specific medications, procedures, or therapies

Treatment for these symptoms may include:

• Antiseizure/Antiepileptic Drugs (AEDs)
• Steroids
• Surgery

Often, low-grade tumors (grade I and II), which are not aggressive, are treated with watchful monitoring or surgery alone. Though all tumors are monitored with repeat scans, grade II tumors are watched more closely after surgery and over time to make sure there is no recurrence.

Higher grade tumors (grade III and IV), which are malignant and can grow quickly, are more difficult to remove and require additional treatments beyond surgery, such as radiation, chemotherapy, or a clinical trial if one is available. Microscopic tumor cells can remain after surgery and will eventually grow back. All treatments, therefore, are intended to prolong and improve life for as long as possible.

Additional treatment options for high-grade tumors include:

• Radiation therapy: X-rays and other forms of radiation can destroy tumor cells or delay tumor growth.
• Chemotherapy: The use of drugs to kill rapidly dividing cells. It can be taken orally or intravenously.
• Targeted therapy: The focus on a specific element of a cell, such as molecules or pathways required for cell growth, in order to use them as a target
  
  
  

Services offered at our Network Hospitals for the treatment of various types of Brain and Neurological Disorders

The neurologists and the neurosurgeons at our network hospitals in India take a multidisciplinary approach to care, using the latest research and technology. The modern surgical facilities at these hospitals include state-of-the-art dedicated operating rooms equipped for most advanced and latest intraoperative computerized tomography (CT) and magnetic resonance imaging (MRI) machines. The operating rooms are designed for both open and endovascular neurosurgery.

A lot of focus is given on new innovations that extend and improve medical care and patients' quality of life.

The expert team of neurologist, neurosurgeons and paramedical offers compassionate, world-class diagnosis and treatment for patients with all types of neurological problems like brain tumours, vascular diseases, movement disorders, epilepsy, chronic pain and traumatic brain injuries.

Our Network Hospitals in India use the most innovative technologies and latest research to deliver the best outcomes for our patients.

Services offered at ourNetwork Hospitals for the treatment of various types of Brain and NeurologicalDisorders

·         Highly advanced surgeries for the patients with Vascular Malformations, Cerebral Aneurysms, Complex Craniofacial Malignancies andAcoustic Tumours

·         Diagnosis and Treatment of Cancerous Brain Tumours with complete range of treatment options that include surgery, radiosurgery , radiation therapy, chemotherapy and other cancer treatments

·         Deep Brain Stimulation ( DBS) for patients with Parkinson's Disease and tremors from other neurological conditions

·         Paediatric neurologists and neurosurgeons who specialize in the surgical management of a wide range of paediatric diseases including brain tumours, epilepsy, spinal bifida and hydrocephalus

·         Minimally Invasive Brian Surgeriesusing the most sophisticated 3-D image-guided technology

Why should you choose ourNetwork Hospitals in India for Brain Surgery?

There are many reasons why so many patients from all over the world come to our network hospitals in India for various types of treatments related to Brain and other Neurological disorders. Following are the most common reasons.

Highly Skilled andExperienced Neurosurgeons and Neurologists

Our Network Hospitals in India have dedicated Neurology and Neurosurgery Department. The neurosurgeons operate with the most advanced technology systems. They use an image-guided management system for an improved perspective on the progress of complex brain surgeries. It can also help reduce the need for patients to undergo additional surgeries. The neurosurgeons have the expertise in Computer-assisted brain surgery, stereotactic radiosurgery, Awake Brain Surgery, Deep Brain Stimulation (DBS) and other complex surgical procedures related to brain and nervous system. They have been trained and have worked in some of the leading Brain Surgery Centres across the world. They work with a multi-disciplinary team of doctors that consists of neurologists, neuro-oncologists), neuroradiologists, orthopaedicsurgeons, ENT specialists, endocrinologists, general medicine and rehabilitation, pain medicine, and other areas to provide the most appropriate treatment for your condition.

Intraoperative Magnetic Resonance Imaging (iMRI)

The neurosurgeons at our network hospitals in India use a high-resolution intraoperative magnetic resonance imaging (iMRI) while performing brain surgeries. This helps them to see the brain tumours while performing surgery thereby greatly reducing the risk of damaging other parts of the brain. Moreover this also helps to confirm the successful removal of the entire tumour. The Intraoperative magnetic resonance imaging (iMRI) is used during the surgery to remove brain tumors and pituitary tumors with greater accuracy and safety. It is also used to place deep brain stimulator systems .

Computer-assisted Brain Surgery

In Computer-assisted Brain Surgery, various imaging technologies, such as Magnetic Resonance Imaging (MRI), Computerized Tomography (CT) and Positron Emission Tomography (PET) are used to create a 3-D model of the brain. The computer system precisely guides the neurosurgeon to the area/s of your brain requiring treatment. This helps the neurosurgeons to plan the safest way to treat your condition with greater degree of accuracy. The computer-assisted surgery helps a lot in performing Awake Brain Surgery. Computer-assisted techniques is also be usedin treating brain tumours and other lesions with precisely focused beams of radiation using stereotactic radiosurgery.

Stereotactic radiosurgery (SRS)

Stereotactic Radiosurgery (SRS) uses precisely focused radiation beams to treat brain tumours and other abnormal growths in the brain. The advantage of modern Stereotactic Radiosurgery is, it delivers high doses of radiation to the tumour with minimal exposure to surrounding healthy tissue. A multidisciplinary team of experts plan the treatment and carefully monitor doses to avoid the risk of radiation overexposure.Unlike traditional radiation therapy, in this treatment, no incision is made. This minimizes the chances of infection or excessive bleeding. A plan has to be developed before undergoing this surgery. A multi-disciplinary team of doctors plan an appropriate treatment for you depending on thetype of tumour, location and size.

Awake Brain Surgery

In an Awake Brain Surgery you're awake during the surgery. Awake Brain Surgery is done by expert brain surgeons to treat some brain conditions such asbrain tumors or epileptic seizures. Awake Brain Surgery allows yourbrain surgeon to work directly with you in order to locate critical functional tissue of the brain. This process is called mapping. Once the brain has been exposed, you will be awakened and the brain is stimulated to determine the function of each area of tissue. You may be awake during surgery to respond to your surgeon. Your responses will help the surgeon to ensure that he is treating the precise area of your brain that needs surgery. Awake Brain Surgery is mainly done if your tumor is near the parts of your brain that control movement or speech. Awake Brain Surgery helps in lowering the risk of damage to functional areas of your brain. In Awake brain surgery the important areas of the brain can be avoided and preserved during surgery.

Minimally Invasive Brain Surgery

Minimally invasive brain surgeries are commonly done at our network hospitals in India. The hospitals have expert surgeons who specialise in minimally invasive brain surgery techniques. In a minimally invasive brain surgery , the brain surgeons insert two small tubes and use what are called endoscopes. One tube carries a fibre optic camera and light source, the other carries miniaturized surgical instruments. The surgeons operate by watching a TV monitor.

In the traditional way of doing a brain tumour surgery, a more invasive approach was used to remove tumors close to the brainstem. The surgery took much longer time and was performed through an incision behind and below the ear. This took hours of bone drilling to reach the tumor. Since it was an open surgery, the risks were more. Nowadays, with the development of technology and expertise, some of the brain surgeries can be done through nose. The technique is called the endoscopic expanded endonasal brain tumour surgery. 

This technique allows neurosurgeons to pass a camera and specialized surgical instruments to the back of the nasal passage and directly to various regions of the skull base, without scarring and with a shorter recovery. Even though this technique was first described decades ago for pituitary tumor surgery, but recent advancements have helped to use the endonasal approach to safely remove tumors in a variety of other critical skull-base locations. There are very few surgeons in the world who have the expertise to use this technique in brain tumour surgery. At our network hospitals in India, you will find some expert neurosurgeons who have successfully performed many brain tumour surgeries using this technique. Some of the benefits of Endoscopic TransnasalBrain Tumour Surgery are No Brain Retraction, Faster Recovery Time, No Facial Scars, Fewer Complications and shorter Hospital Stays.

Advanced DiagnosticFacilities

Our network hospitals in India provide sophisticated diagnostic services for diagnosing or detecting a wide range of brain and other neurological disorders and conditions. Some of the advanced diagnostic facilities available at our network hospitals in India are as follows.

·         

  Electroencephalograms (EEG): Electroencephalograms or EEG is a non-invasive diagnostic procedure that is done to study the electrical activity of the brain. Electroencephalograms or EEG helps to diagnose seizure disorders, stroke, headaches, dizziness and fainting episodes.

·        

     Evoked Potentials: Evoked potentials studies help to measure the electrical signals along nerve pathways.Evoked potentials studies are used to diagnose visual losses, hearing losses, and nerve damage or degeneration within the spinal cord or nerve roots.

·         

    Nerve Conduction Studies: Nerve conduction velocity test measures how quickly electrical impulses move along a nerve and it is often done with electromyogram to exclude or detect muscle and nerve disorders.

·         

        Electromyography: Electromyography is used diagnose neuromuscular disorders such as Motor Neuron Disease, neuropathy, nerve damage and muscle damage.

·         

      Brain Suite System: To treat complex neurosurgical casesefficiently and safely, our network hospitals in India are equipped with an advanced Brain Suite System. The Brain Suite System allows high-resolution MRI images to be taken while performing the surgery. This helps the brain or neurosurgeons to remove complex tumours without harming the critical brain tissues.

·         

    Flat Panel DSA with 3D technology: This diagnostic technology provides high-resolution 3D images. You will have a much decreasedexposure toradiation.

·         

     Other Diagnostic Facilities: Isocentric C Arm,Neurophysiology Laboratory, Cerebral Angiography, Computed Tomography Scan (CT Scan), Intracranial pressure monitoring, Lumbar puncture, Magnetic Resonance Imaging (MRI), Myleogram, NeuroHisto Pathology, Pathology, Transcranial Doppler, Support Services, 1.5 T MRI ,64-slice CT facilities, functional MRI, MRI spectroscopy, diffusion/perfusion MRI etc.

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The brain tumors found most often in children - Childhood Brain Tumor Facts

Childhood Brain Tumor Facts

Brain and spine tumors are the second most common cancers in children after leukemia. 

Brain Has Crucial Roles

The brain controls many important facets of everyday life, including emotions, thought, speech, vision, hearing and movement. The brain sends messages throughout the body via the spinal cord and cranial nerves in the head. The network of the brain and spinal cord is called the central nervous system (CNS). Tumors can develop in the spinal cord and cranial nerves.

The hard, bony skull protects the brain, and the bones (vertebrae) of the spine protect the spinal cord. A liquid called cerebrospinal fluid (CSF) surrounds both the brain and the spinal cord.

The brain has four main parts:

Cerebrum: The outer and largest part of the brain. It has two halves called hemispheres and is responsible for:

• Emotions
• Reasoning
• Language
• Movement of muscles
• Senses of seeing, hearing, smelling, touch
• Perception of pain

Basal ganglia: Found deeper inside the brain, these play a part in muscle movement.

Cerebellum: At the back of the brain, this section helps control and coordinate movement, such as walking and swallowing.

Brain stem: Located at the base of the brain, the brain stem has nerve fibers that carry messages between the cerebrum and the rest of the body. A small but important area, the brain stem plays a part in breathing and heartbeat.

Childhood Brain Tumor Types

Because the brain and spinal cord are made up of many kinds of tissues and cells, many types of tumors – both benign and malignant– can develop in these areas. These tumors may require different treatment and have different outlooks.

Even when brain tumors are benign, they can cause serious problems. Although non-cancerous brain tumors usually grow slower than cancerous brain tumors, they may damage and press against normal brain tissue or the spine as they grow.

Childhood brain and spinal cord tumors differ from adult tumors. The location where they develop, the type of cell in which they develop, and their treatment and outlook often are different.

Brain tumors are classified by the types of cells they contain. This determines how they grow and what kind of treatment they require.

The brain tumors found most often in children are the following.

Medulloblastoma

Astrocytoma: These form in the cerebrum in cells called astrocytes. They usually grow slowly, but higher-grade tumors spread more quickly. Since they mix with normal brain tissue, they can be difficult to remove surgically. They may spread along pathways of CSF but seldom spread outside the brain or spinal cord. Glioblastoma is the highest grade astrocytoma and the fastest growing.

Diffuse intrinsic pontine glioma: This dangerous tumor often has a poor prognosis. It grows in a vital area of the brain called the pons, which is in the brain stem.

Ependymomas develop in the brain lining, usually in the posterior fossa or along the spinal cord in glial cells. About five percent of childhood brain tumors are ependymomas. They begin in cells that line the ventricles or central canal of the spine. Ependymomas do not usually spread outside the brain or spinal cord, but they may block CSF, causing hydrocephalus.

Primitive neuroectodermal tumors (PNET): These aggressive tumors can develop anywhere in the brain, but they are usually in the frontal, temporal or parietal lobes.

Pineoblastomas: A type of PNET that develops in pineal gland and can be difficult to treat.

Craniopharyngiomas: These slow-growing tumors start above the pituitary gland but below the brain. They may press on the pituitary gland and hypothalamus, causing hormone problems. Since they start near the optic nerves, they can cause vision problems and be difficult to remove without damaging vision.  

Mixed glial and neuronal tumors: Certain tumors that develop in children and young adults (and rarely in older adults) have both glial and neuronal cell components. They tend to have a fairly good prognosis.

• Pleomorphic xanthoastrocytoma (PXA) and dysembryoplastic neuroepithelial tumors (DNETs) look as if they could grow quickly when viewed under the microscope, but these tumors tend to be fairly benign, and most are cured by surgery alone.
• Ganglioglioma is a type of tumor that has both mature neurons and glial cells. Most can be cured by surgery alone or surgery combined with radiation therapy.

Choroid plexus tumors: These rare tumors start in the choroid plexus within the ventricles of the brain. Most are benign and can be removed by surgery.

Other tumors that start in or near the brain

Meningiomas: These tumors begin in the meninges, the tissue around the outer part of the brain and spine. They may press on the brain or spinal cord. Meningiomas are almost always benign and are usually cured by surgery. If they are near vital structures in the brain, they may need additional treatment.

Chordomas start in the bone at the base of the skull or at the lower end of the spine. They can injure the nervous system by pressing on it. They usually do not spread to other areas.

Germ cell tumors: Developing from germ cells, which normally form eggs in women and sperm in men, these are rare tumors. They form in the fetus when germ cells move to abnormal locations, including the brain. Germ cell tumors of the nervous system are usually found in children, most commonly in the pineal gland or above the pituitary gland.

Brain metastases: Cancers that metastasize (spread) to the brain from other areas of the body are called metastases. These are treated differently than primary brain cancers.