Day: February 20, 2025

What causes arm pain?
Arm pain has a number of causes, including:

Muscle injury – also known as a strain, generally caused by overexertion

Ligament injury – also known as a sprain

Bone fracture – caused by impact or a fall. Injuries from overuse – some sports or occupations involve using the same muscles and tendons over and over again, leading to the tendons becoming inflamed.

Nerve compression – sometimes the nerves in your arm can become impressed, perhaps due to injury or the normal ageing process. This can lead to pain and tingling down your arm.

Cardiovascular issues – shooting arm pain associated with tightness in the chest is often a sign of a heart attack. More generally pain that comes on after any physical exertion can occur as a result of coronary heart disease

When should I see a doctor?
You should seek emergency medical treatment if:

• you have arm pain that has come on suddenly and is accompanied by a feeling of tightness or heaviness in your chest
• you think you might have fractured your arm
• you experience severe pain and swelling

How is arm pain diagnosed?
Diagnosis depends on the nature of your symptoms.

• If you go to the hospital with severe arm pain and tightness in your chest, you will have a number of urgent tests to check if you are having a heart attack.
• If you think you might have fractured your arm, your doctor is likely to refer you for an X-ray to see the bones inside your arm.

Otherwise, if you go to the doctor with pain that doesn’t seem to go away, you will need a thorough physical examination. This will look at where the pain is, when it occurs, and what movements are restricted due to the pain. You may then be referred for detailed scans, such as a CT scan or MRI scan, to look at the muscles, tendons and ligaments in your arm.

How is arm pain treated?
Most arm pain injuries can be treated at home, by making sure you:

• Take a break from using your arm
• Placing an ice pack on the area that is sore three times a day for 15-20 minutes
• Reducing swelling by using a compression bandage and keeping the arm elevated
• You may need specific treatment depending on the cause:

For tendon injuries or repetitive strain injuries it may be recommended that you follow a program of physiotherapy to restore the arm and prevent strain in the future. You’ll be given advice on how to properly warm up before using your arm for strenuous activity such as lifting, swinging (in golf or tennis for example) or holding it up to play an instrument.
For nerve compression, you may benefit from surgery to decompress the nerve
· If a tendon has been ruptured or you suffer a complex fracture, it may be necessary to have orthopaedic surgery to make sure the arm heals properly

Parkinson Disease (DBS)

Parkinson disease is second common neurological disorder in older age group. Patient usually started to have tremors of one hand and eventually , whole body started having tremors .Patient also have slow  walking, difficulty in writing, depression and memory impairment . Parkinson disease occurs due to decreased levels of brain hormone ,Dopamine . MRI Brain is done to look for any disease. Treatment is always started with medications. Patient usually remain stable after taking regular medications for five to seven years .  Thereafter, positive effect of drugs goes off. Most of patients worsen neurologically with time and after sometime, not able to manage day to day activity.  Overall expected life of a patient after diagnosis is approximately 15 years .

MY EXPERTISE

I am trained in functional neurosurgery. I am doing a surgery to put one micro-electrode in one of deep brain nucleus and give continuous current by a battery ,placed inside body of patient .this surgery is known as Deep Brain Stimulation (DBS).  This procedure , decrease symptoms of patient up to 80% and most of patients started doing well after surgery . This surgery is safe in expert hands only.

These are cerebrovascular disorders of brain where medial wall of arteries become weak leading to ballooning. As one side of arterial wall become weak, there are very high chances of rupture causing large hemorrhages in brain. This is a life-threatening condition and we have to manage at emergency basis. This arterial malformation is common in adult age group.

Symptoms: Sudden severe headaches are usual presentations. Patient may have weakness of one side body or sudden unconsciousness can be first presentation.

Investigations: CT Head, CT / MR cerebral angiography are done.

Treatment: depending upon size and location of aneurysm, endovascular coiling or surgical clipping can done.

MY EXPERTIES

I am trained in managing these challenging patients. After initial treatment and investigations, best treatment plan is made for patient. Surgical clipping of aneurysm is technically difficult and demanding technique.  I am well trained from renowned doctors in world for surgical clipping of aneurysm. My other Neuro-Interventionist is well trained in Endovascular coiling of aneurysm with experience of more than ten years.

I am trained in Endoscopic Disc excision. Here, small cut is made on skin and patient can be discharged after one day. I have done all kind of complex spine surgeries including spine tumors, cervical spine surgery, occipito-cervical fixations with good results.

Stroke is a common disorder of older age group but can occur in young age also. Stroke is of two types, Ischemic type and hemorrhage type. In ischemic stroke, some blood vessels supplying the brain are blocked by thrombus, causing failed blood supply to some brain tissue and its dies within few minutes. In hemorrhagic stroke, some vessels are ruptured and blood gets collect in brain tissue, Ischemic stroke is more common than hemorrhagic stroke and also carries better prognosis.
Contributory factor: hypertension, Diabetes, hyperlipidemia, smoking, sedentary life style etc.

Symptoms: Patient develops sudden deviation of mouth, difficulty in speech, weakness of arm or leg etc.

Investigation: CT Head or MRI brain

Treatment: In ischemic stroke, if patient reaches hospital within 4.5 hours, thrombolytic injection can begiven with good results.

Mechanical thrombectomy via angiography is other good option with good results.

If patient comes late, then further treatment with medication is done. In case of large infarcts or hemorrhages, surgery is also done to save life of the patient. We have well equipped Neuro -ICU with trained staff for care of such patient. We have trained Neuro-Physiotherapy department who help the patient to come up from the disease.

What is spinal surgery?

Spinal surgery consists of performing surgery to correct possible structural abnormalities.

Back injuries, and more specifically those of the spine, have become a problem that is affecting more and more people around the world. The passing of the years, accidents, overexertion and bad posture in everyday life are the causes of the problem.

Spine surgery allows surgeons to decompress, move and fix vertebral structures, and replace them if necessary. Back surgery is an option to consider when conservative treatments have not worked and the pain remains persistent and prevents the development of a normal life. There are several types of back surgery:

Discectomy: This involves removing the herniated part of the disc to access the swollen nerve and relieve its irritation.
Laminectomy: The bone covering the vertebrae is removed and enlarged to relieve pressure from a stenosis.

Fusion: Spinal fusion consists mainly of joining two or more bones of the spine together. This can relieve pain by giving stability to a fracture or simply to eliminate the pain that begins with the movement of the vertebrae, which can degenerate or injure some of the vertebral discs.

Disc implant: As an alternative to fusion, there is the implant of a disc, although it cannot be used by everyone.

Why is spinal surgery performed?

Spinal surgery is performed to correct spinal pathologies that cause pain. Back surgery is used to relieve the pain and/or numbness associated with this pain, which often radiates to other areas of the back, arms and legs. 

Normally, back and spinal pain is caused by the compression of a nerve within it. Nerves can be compressed for several reasons. An example would be disc problems, such as a herniated disk, which can end up pressing too hard on a vertebra against the nerve. Occasionally, osteoarthritis causes excess bone in the spine.

There are different options for intervening on the spine. They are as follows:

Fusion
Fusion or vertebral arthrodesis is usually used in the following cases:

There is instability, which can be caused by various causes, such as scoliosis or spondylolisthesis. In these cases, there is an excess of mobility in the spine. Arthrosis pain from hypertrophic arthrosis joints.

Deformities-when there is a deformity, such as from scoliosis

Spinal stenosis
Anterior cervical fusion: used to treat degenerative disc disease. Bone grafts are used to fuse the treated segment.

Posterior cervical fusion: Posterior lumbar fusion, Surgical techniques.

Percutaneous techniques: These are injections or techniques such as radiofrequency denervation to relieve lumbar and cervical pain.

Electro dermal therapy
Vertebroplasty: This consists mainly of increasing the intraosseous space of a vertebra by injecting bone cement to add vertebral stability.

Decompression techniques

Microdisectomy: used to remove herniated fragments from the intervertebral disc. One of the most commonly used procedures in spinal surgery is microdiscectomy with lumbar microdecompression.

Microdecompression: used to treat canal stenosis

Preparing for spine surgery

The patient is usually admitted to the clinic where the operation will be performed one day before undergoing it. The anaesthesia tests, as well as the physical and preoperative exams, will already be done at the time of the patient’s admission.

They should not eat or drink anything for at least 12 hours before surgery begins. Apart from the basic aspects, spinal surgery does not require any special preparation, although you should be prepared to face the weeks of recovery, when you may need the help of a family member or companion to get used to activities little by little.

Care after spinal surgery

Normally, the patient will be admitted under observation for several days, and once he or she returns home he or she will have to face recovery.

It is important to keep the wound clean and follow the instructions or recommendations provided by the specialist. If the patient has undergone a discectomy, it is common for the patients.

What is epilepsy Surgery?

Epilepsy is a common neurological disease in which patient have single or multiple episodes of seizures. Epilepsy can present in all age group of patients staring from new born to old ages. We must have seen patients or heard about this disease.

Our brain tissue works by sending electrical signals to other cells. If this electrical activity become erroneous due to any reason, patient develops over activity of cells leading to seizure episode. Epilepsy disorder can present from simple flickering of eye movement to full episode of seizure including frothing from mouth.

MYTH: There are many myths associated with epilepsy disorder like this is not curable  , three year medication is full course of epilepsy , we  should smell shoe or  put water in mouth during episode of seizure and this disorder is contagious problem etc.

Investigation:  like ECG of heart, we record electrical activity of brain by EEG(Electro-Encephalogram). This investigation helps us more if done during episode of seizure. Video recording of seizure episode at home is very helpful or Video EEG can be done after admission in hospital. Liver failure, low blood sugar levels, excessive alcohol drinking and other metabolic disorders can also be contributory to seizure episodes.

Causes: Most common cause of epilepsy disorder is Idiopathic. Other common causes are head injury, stroke, brain tumors, venous malformations in brain etc.

Contributory factors for seizure:  video games, over use of mobile phone, bright lights and high sound, movie in cinema, sleep deprivation and certain drugs.

Treatment:  Patient is advised to take regular medications without any pause. Usually, patient seizures are controlled with single drug but many patients require two or even three drugs to control seizures. Ketogenic diet has a protective role in epilepsy disorder left Vagus nerve stimulation is also used to control epilepsy disorder.

Caution: We should follow doctor advice very carefully and must take medication without halt as prescribed by doctor. 

MY EXPERTIES

Epilepsy surgery: It is seen usually seen that 30% of patients with epilepsy disorder still have multiple episode of seizures even after taking three antiepileptic drugs.

We evaluate these patients thoroughly with special Brain scans, Video EEG. if we found some defect in brain which is culprit for causing epilepsy disorder, we excise it safely with surgery . Epilepsy surgery is a specialized neurosurgery operation done by only few centers in India. Result of surgery is very rewarding 90% of patients become seizure free with or without medications. This surgery is really a boon for patients whose seizures are not controlled even by three medications.

What are brain tumours?   

Brain tumors are common in all age groups.  Brain tumor peaks can be seen in pediatric age group (5 to 10 years), adult age (20 to 40 years) and then geriatric age group (> 60 years) but it can be seen in all ages. Brain tumors are of two types, benign and malignant. Benign tumors are not infiltrative but expand in size with time and produce neurological deficit due to compression on brain. Malignant variety is dangerous as it infiltrates to adjoining brain tissue rapidly and causes damage.  Treatment of brain tumors depend upon age of patient, location and size of tumors. In expert surgical hands, brain tumors can be excised fully and patient’s life can be saved successfully.

Symptoms: Most common symptoms of brain tumors are early morning headaches, blurring of vision, nausea, vomiting, seizures, weakness of one side of body, vertigo and recent personality or behavior changes. 

Investigations:  CT Head can be done. MRI Brain is a better investigation. Higher investigations are used less frequently like PET Scan, SPECT scan etc

Stereotactic Biopsy: When brain tumors are deep seated and difficult to excise, then small part of brain tumor is taken out for biopsy so that further plan for tumor can be made. This procedure is done by wearing specialized head frame and under local anesthesia. This procedure is done by making less than 1 cm whole in brain. This procedure is safe in expert hands with > 95% success rates.

Treatment: Most important treatment for brain tumor is surgical excision of tumor.  Some tumors are also managed with medications, depending upon type and location of tumor.   Brain tumor tissue after surgery is send for Biopsy for grading and prognostication. Depending upon grade of tumor, oral chemotherapy and radiation is advised.

Prognosis:  Survival after surgery depends upon extent of surgical removal of tumor, site of tumor, pathological grading of tumor, age and other comorbidities.  Early and maximum safe excision of tumor carries best outcomes for patient life.

MY EXPERTISE: I have trained myself from various national/international hospitals to learn use of intra-operative ultrasonography for total/maximum excision of brain tumors. I am using routinely awake craniotomy, cortical stimulators, CUSA and many other instruments for better outcomes of patients.

Incidence of road traffic accident is highest in India.  Non-compliance of traffic rules, use of mobile phone and alcohol consumption while driving are major contributory factors for trauma. Every person should never hesitate to help the patient laying on road.  We should try to stop bleeding with hand after putting clean cloth and try to shift patient to nearby hospital. We should call 108 number for help. Immediate care of patient by a specialist doctor, preferably Neurosurgeon, makes a significant difference in outcomes of patient.

Investigation : CT Head and X- rays of other parts, USG abdomen

Treatment : Once patient reaches emergency room, initial quick clinical assessment is done and meanwhile ,resuscitation of patient is done by nursing staff. Active bleeding, splints for bony skeletal fractures and dressings are done simultaneously. After stabilization, CT head is done. Depending upon condition of patient and CT head findings, further plan for patient either with medications and surgery is made .

My Expertise

I am well trained in managing all kind of head injuries and spine injuries. I have vast experience of treating more than 10000 trauma patients over a period of last twelve years in various hospitals in India. I am expert in doing all kind of Neuro-surgeries done for these head injuriy and spine injury patients. I have well equipped Neuro-ICU and specially trained staff in managing these critical patients. Our hospital results are comparable to any known corporate hospital.

A brain haemorrhage is a rupture of a blood vessel (usually an artery) that causes bleeding in and around the brain.

Brain haemorrhages differ according to their location and the severity of the damage:

Spontaneous cerebral haemorrhage: associated with arterial hypertension, coagulation problems, tumours or formation of new blood vessels following ischemia, vasculitis, drugs or central nervous system infections, among others. It may be an intraparenchymal or intracerebral haemorrhage, which usually affects older people. This type of brain haemorrhage accounts for 10-15% of all strokes.

Intraventricular haemorrhage: when the ventricles of the brain that contain the cerebrospinal fluid are affected. It affects premature infants, especially those who have had respiratory distress syndrome, a collapsed lung or high blood pressure. In 70% of cases, this haemorrhage is secondary; that is, it originates from an intraparenchymal haemorrhage.

Subarachnoid haemorrhage: affects young people between the ages of 20 and 40. This is a serious pathology that is usually caused by the rupture of an aneurysm, head trauma, use of anticoagulants, bleeding disorder, etc. It is common in older people who have had falls or head injuries and in young people who have had a car accident.

Subdural haematoma: this is the most common traumatic bleeding. People with this condition often go into a coma during their hospitalisation.

Epidural haematoma: this may be the result of brain trauma. In most cases, it is caused by a skull fracture in children and adolescents.

Prognosis of a brain haemorrhage

A brain haemorrhage is a serious pathology which may result in death. Brain haemorrhage has a mortality rate of 40%. The main complications occur when the haematoma expands, because of perihematomal oedema, convulsions, hyperglycaemia, arterial hypertension, fever and infection, among others. In general, the severity of each case will depend on the amount of bleeding.

Symptoms of a brain haemorrhage

The main symptoms of a brain haemorrhage according to type are:

Spontaneous cerebral haemorrhage: manifests with a headache, vomiting and decreased consciousness, among others.

Intraventricular haemorrhage: sleep apnoea and bradycardia, high-pitched cry, seizures, anaemia, swelling or bulging of the soft spots between the bones of the baby’s head.
Subarachnoid haemorrhage: vision problems, muscle aches, sudden and severe headache, loss of consciousness, and nausea and vomiting, among others.
Subdural haematoma: headache, difficulty with balance or walking, slurred speech, lack of energy, seizures, nausea and vomiting, vision problems, etc.

Epidural haematoma: the main symptoms are dizziness, confusion, nausea or vomiting, drowsiness, head trauma and weakness, among others.

Medical tests for a brain haemorrhage

The first step in detecting a brain haemorrhage is to determine what type of haemorrhage it is, and this can be learned through CT and MRI scans.

Blood tests, an electrocardiogram, carotid ultrasound, and brain angiography may also be performed to help determine the type, cause, and location, and to rule out other conditions.

What causes a brain haemorrhage?
A brain haemorrhage may occur for non-obvious reason or may be caused by a brain injury.

Risk factors for brain haemorrhage include high blood pressure, the menopause, diabetes, smoking, and alcohol and caffeine consumption.

Spontaneous cerebral haemorrhage: as already mentioned, this is usually related to high blood pressure. Some controllable risk factors are alcohol and tobacco; another factor is diabetes mellitus.

Intraventricular haemorrhage: the causes of this type of haemorrhage are not clear, although it may be due to the fact that the blood vessels in the baby’s brain are very fragile and immature. People with respiratory problems are more susceptible. Bleeding almost always occurs during the first 4 days of life.