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Category Archives: Neurosciences

Ataxia

The word “ataxia” has its roots in the Greek word, “a taxis,” which means “lack of order or coordination.” As such, ataxia is a disease that affects a person’s nervous system. The disease mainly attacks the cerebellum – area of the brain responsible for coordinating movement. Being a progressive, neurological disease, ataxia affects a person’s ability to walk, talk, and use fine motor skills – muscle coordination or control. People suffering from this condition may find it challenging to use their hands, legs, fingers, arms, even tongue and eyes. The disease may affect people of all age groups.

Symptoms of ataxia

Many symptoms of ataxia mimic those caused by excessive alcohol consumption such as slurred speech, stumbling and falling, and lack of coordination. However, given below is an extensive list of symptoms for the disease –

  • Lack of muscle control or coordination
  • Stammering speech (dysarthria)
  • Gait abnormalities/Poor balance
  • Abnormalities in eye movements (nystagmus)
  • Tremors
  • Inability to use fine motor skills – writing, buttoning or ironing a shirt, etc.

What causes ataxia?

There can be more than one reason for developing ataxia. In general, ataxia can be –

  • Inherited
  • Acquired or
  • Be idiopathic in nature

Here are the causes explained in detail based on the type of ataxia a person develops.

  1. Inherited ataxia

As the name suggests, inherited ataxia is inherited – it occurs when there are mutations in specific genes that ultimately damage nerve tissue. There are two ways in which inherited ataxia can be passed down from one generation to the other – dominant inherited ataxia wherein the mutated gene may be passed down from either of the parents, and recessive inherited ataxia wherein the mutated gene is passed down from both parents.

Dominant inherited ataxia and recessive inherited ataxia can be further classified. Examples of dominant inherited ataxia include spinocerebellar ataxia, which is a highly progressive and degenerative condition and episodic ataxia which occurs in episodes and is not progressive. Recessive inherited ataxia’s examples include Friedrich’s ataxia which generally affects the heart and causes muscle weakening and ataxia telangiectasia wherein the patient has dilated blood vessels in the eye and face; this type of recessive inherited ataxia makes people more prone to infections and cancers.

  • Acquired ataxia

This type of ataxia generally occurs due to nerve damage from external factors such as an injury to the head. Causes of acquired ataxia may include –

  • Stroke
  • Cerebral palsy
  • Tumours – either of the brain or its neighbouring area
  • Infections – meningitis, chickenpox, HIV, etc.
  • Autoimmune diseases such as multiple sclerosis, paraneoplastic syndromes, etc.
  • Hypothyroidism – an exceptionally underactive thyroid gland
  • Vitamin deficiencies – Vitamin B-12, E, etc.
  • Heavy metal poisoning – mercury, aluminium, lead, etc.
  • Excessive alcohol consumption
  • Toxic reaction to certain medications such as AED, chemotherapy drugs, barbiturates, etc.
  • Idiopathic ataxia

There may be individuals in whom ataxia may arise spontaneously and for which the exact cause may be unknown. In such people, the ataxia is considered idiopathic in nature.

Diagnosis and treatment

For an ataxia diagnosis, the very first thing the doctor will ask is for the patient’s medical and family history to rule out inherited ataxia. They may also ask for the kinds of medications the patient takes and their alcohol consumption levels.

Once done, physical and neurological evaluations will be performed, wherein the doctor will monitor the patient’s –

  • Balance
  • Movement
  • Clarity of speech
  • Eyesight
  • Coordination and control
  • Memory
  • Concentration levels
  • Auditory abilities

The healthcare provider may also ask for additional tests as they deem fit, such as –

  • A CT or MRI scan to get a detailed image of the brain
  • Blood tests to check for vitamin deficiencies, hypothyroidism, and infections
  • Spinal tap or lumbar puncture wherein a sample of the Cerebrospinal Fluid (CSF) is collected for testing
  • Genetic testing wherein a blood sample is collected to check for gene mutations

Once the diagnosis and the type of ataxia have been confirmed, the healthcare provider will determine the next course of action – treatment. The treatment method will depend upon the type and severity of the condition.

Note – There is no permanent cure for several kinds of ataxia; however, treatment can significantly reduce symptoms and improve the patient’s quality of life.

The treatment options include –

  • Medications – to help ease the symptoms. Medications may include amitriptyline or gabapentin for nerve pain, muscle relaxants for cramping and stiffness, and antidepressants in case the patient suffers from depression.
  • Physical therapy or physiotherapy – to help with balance and muscle coordination issues.
  • Speech therapy – wherein the therapist teaches the patients techniques to make their speech clearer.
  • Occupational therapy – which focuses on improving the quality of the patient’s day-to-day life – hand-eye coordination such as using scissors, controlling a pencil while writing, etc.

The right time to see a doctor

If you or a dear one experiences the following, visit a doctor as soon as possible –

  • Lose balance or muscle coordination frequently
  • Face difficulty in walking upright
  • Stammer in speech
  • Face difficulty chewing or swallowing food

Spinal Cord Diseases

The spinal cord is a bundle of nerves that carries signals between the body and the brain. It is protected by the vertebrae, made up of 26 bone disks, that protect and support the spinal cord and nerves. There are several conditions and injuries that affect the spine, damaging the vertebrae, causing pain and limited mobility. Often, spinal cord diseases are devastating. Common symptoms include numbness, pain, muscle weakness, and a loss of sensation around the spinal cord, arms, and legs. If recognized and treated at an early stage, many spinal cord diseases can be reversible.

What causes spinal cord disorders?

Depending on the condition, the causes differ. Some common causes of spinal cord disorders include:

  • Accidents
  • Infection
  • Congenital disorders (present since birth)
  • Inflammation
  • Degenerative wear and tear with aging

Among the risk factors, major ones are obesity, sedentary lifestyle, smoking, improper exercise, poor posture, and other conditions like thyroid, osteoarthritis, rheumatoid arthritis, etc.

Let’s take a look at the causes and symptoms of some common spinal cord diseases.

Spinal tumour

A spinal tumour is a growth either within the bones of the spine, blood vessels, or the spinal canal. While a spinal cord or intradural tumour begins within the spinal cord, a vertebral tumour affects the bones of the spine.

Spinal cord tumours can be classified in three categories depending on where they occur:

  • Intramedullary tumours begin in the cells within the spinal cord
  • Extramedullary tumours grow in the spinal cord membrane or the nerve roots that extend from the cord

Spinal tumours cause pain, neurological problems, and sometimes paralysis. Sometimes they may be life-threatening and cause permanent disability. Symptoms typically include pain at the site of the tumour, difficulty walking, back pain that extends to other body parts, loss of sensation in the arms and legs, and muscle weakness. Common treatments include surgery, chemotherapy, and other medications.

The cause of spinal tumours isn’t clear; experts suggest genetic factors and environmental factors like exposure to chemicals. If you have persistent and progressively worsening back pain that gets worse at night, a history of cancer, changes in bowel function, etc., seek medical attention.

Spinal infections

A spinal infection occurs when bacteria, fungi, or viruses attack spinal tissues in the vertebrae, spinal discs, spinal canal, or the spinal cord. Some common spinal infection types are –

  • Discitis – When the pathogens infect the intervertebral discs, the condition is called
  • Osteomyelitis – When pathogens infect bones in the spine
  • Spinal epidural abscess – Nerve pain and the buildup of pus, commonly found in the lumbar region
  • Meningitis – Swelling of tissues around the brain and spine

The symptoms of a spinal infection often develop slowly, sometimes taking months. Common warning signs include stiffness in the neck, low back pain, loss of mobility, fever, loss of appetite, surgical wounds that discharge pus, etc. While many of these infections are treatable with antibiotics, a spine infection is a health emergency and should be given immediate medical attention.

Causes behind spinal infections can range from taking immunosuppressants to recent spine or pelvic surgery. Other infections such as pneumonia and tuberculosis can also spread to the spine from the lungs. Diseases that increase the risk of contracting a spinal infection include cancer, HIV, diabetes, and malnutrition.

Transverse myelitis

This neurological disorder is the inflammation of both sides of one section of the spinal cord, damaging the myelin, which is the insulating material covering nerve cell fibres. In this condition, messages from the spinal cord to the rest of the body are interrupted. The result can be muscle weakness, pain in the lower back, paralysis, sensations of numbness, weakness in the arms or legs, or bladder and bowel dysfunction.

Causes of transverse myelitis range from infections and immune system disorders to spinal cord strokes.

Spinal muscular atrophy

Spinal muscular atrophy typically affects children, rendering them unable to use their muscles. When atrophy occurs, nerve cells in the brain and spinal cord break down, and the brain stops communicating messages that control muscle movement. As a result, patients have trouble controlling head movement, sitting without help, and sometimes even walking.

Spinal muscular atrophy is a genetic condition, a result of faulty genes from both parents. If the child receives these genes from just one parent, he will not have the condition but will be a carrier of the disease.

The symptoms of spinal muscular atrophy depend on the type of the condition. Type 1 is the most severe form, where the child cannot support his head without help and will have problems swallowing. Because of the attendant severe breathing problems, survival rate is low. Type 2, known as chronic infantile spinal muscular atrophy, has moderate to severe symptoms. Type 3 is the mildest form of the condition while Type 4 afflicts adults with symptoms that continue throughout life.

While there’s no cure for the condition, symptoms can be treated with medication.

Treatment for spine disorders

Spine specialists will use one or a combination of treatments, depending on the condition and severity. If you are experiencing signs and symptoms of spinal cord disorders, call your doctor and schedule a check-up.

Lumbar Sympathectomy

In the human body, the sympathetic nervous system controls involuntary actions such as the heart rate, digestion, breathing. While sympathetic nerves, that branch out from the spinal cord to the lower back (lumbar) region do not send pain signals to the brain, they start doing so in the case of malfunction. This results in painful sensations in the leg or foot, which can be treated with a lumbar sympathectomy.

Understanding sympathectomy

A sympathectomy is a procedure where a sympathetic nerve is cut or blocked to treat chronic conditions like severe sweating, excessive facial blushing, poor blood flow to the legs, chest pain, etc. This treats the symptoms by preventing signals passing from the brain through the nerve. Depending on the part of the nerve that is treated, the procedure is called endoscopic thoracic sympathectomy or endoscopic lumbar sympathectomy.

What is a lumbar sympathectomy?

The lumbar sympathetic chain is a bunch of nerves situated in the lower back, which control blood supply to the legs. In a lumbar sympathectomy procedure, an injection (typically a local anaesthetic and steroid anti-inflammatory) is introduced to block the pain-inducing sympathetic nerves, thus increasing blood supply to the leg and reducing pain.

Why is it done?

Lumbar sympathectomy is performed in the following cases –

  • To reduce leg and foot pain caused by poor blood supply
  • To treat excessive sweating of the feet
  • To heal leg and foot ulcers
  • To relieve leg and back pain caused by spinal canal stenosis

When an individual’s legs or feet are affected by the over-activity of sympathetic nerves in the lumbar region, the skin in the legs can appear blotchy or pale. Sometimes, there is also a loss of hair in the area. Pain associated with the sympathetic nerves is constant, coming and going in phases. It is often a stabbing or a sharp pain that can also change with seasons.

Unfortunately, this pain doesn’t respond too well to conservative treatments such as rest or oral pain killers like Ibuprofen and Paracetamol. Thus, a lumbar sympathectomy is the only viable option to treat the condition.

Lumbar sympathectomy – How is it done?

In lumbar sympathectomy, an injection is given to the group of sympathetic nerves that control the feet, legs, or lower back. This injection blocks pain signals from the brain, thus resulting in pain relief.

The patient is given an IV in the hand and a mild sedative. Then, the patient is placed on the stomach and a needle is guided to the site using a live X-ray. A local anaesthetic solution with or without steroid is injected close to the nerve. The entire procedure takes around 30 minutes. Most patients feel pain relief within 15 minutes of completion.

How effective is the procedure?

Some patients report pain relief immediately after the procedure. However, the pain can return a few hours later when the effect of the anaesthetic wears off. Longer-term pain relief typically happens in a couple of days, once the steroid starts its work. Usually, patients will require a series of injections to continue the pain relief.

What happens before the procedure?

Before the procedure, patients are advised to stop all blood thinning products and medications, except aspirin. If the patient is an insulin-dependent diabetic, they can take their insulin following the procedure.

Prior to the procedure, the patient must not eat, drink, it smoke.

Can complications develop?

As can happen with any procedure, some side-effects may occur after a lumbar sympathectomy. Typically, these are minor and pose no danger. Sometimes, there is a slight chance of contracting infection in the area where the needle is placed.

The sympathectomy injection can result in a drop in the patient’s blood pressure. Sometimes, this can last for a couple of weeks. There is a minuscule risk of damage to nearby structures like bowel, kidneys, or blood vessels in the abdomen.

In men, a lumbar sympathectomy on both sides can sometimesresult in sexual problems. Discuss this with your doctor before the procedure.

What happens after the procedure?

After the procedure, the patient’s blood pressure is checked and they are made to rest for an hour before they can leave. It is advisable to have someone to drive you home.

It is also advised to take it slow for some days before you can resume your usual activities.

Is lumbar sympathectomy right for me?

A lumbar sympathectomy is the right treatment for you if you are experiencing lower back or leg pain that does not respond to other treatment. You can discuss other treatment options with your doctor before you go ahead with this, who will give you up-to-date information about the likelihood of its success.

Varicose Vein Surgery

Varicose veins refer to enlarged and twisted veins in the leg, a condition that is often genetic and is made worse by excessive standing. How does this happen?

Our legs contain a group of deep veins buried within their muscles and a group of superficial veins that run underneath the skin. When a weakness in the walls of the superficial veins causes enlargement, there is a build-up of pressure that bulges out as varicose veins. Typically, varicose veins appear in the thighs and calves. They may look blue and bulge, and cause plenty of discomfort.

What is the treatment for varicose veins?

Varicose veins need treatment only when they cause discomfort. Treatment is necessary to ease symptoms like pain and to treat complications that may arise such as swelling, leg ulcers, or skin discolouration. Before treatment, physicians may recommend some self-care measures at home such as –

  • Compression stockings for putting pressure on the veins
  • Avoiding standing for long periods
  • Regular exercise
  • Elevating the affected area when resting
  • Avoiding crossing legs so blood vessels aren’t pinched

There are also less invasive options for treating varicose veins such as include endovenous radio frequency ablation, sclerotherapy, endovenous laser treatment, and surface laser treatment. One should consult the doctor about all possible treatment options before deciding on varicose vein surgery. 

When is a surgery required?

Varicose vein surgery is a general term used for various methods of surgically treating varicose veins.

A varicose vein surgery is done in the following cases –

  • Symptoms aren’t relieved with self-care measures
  • Complications occur such as leg ulcers
  • Veins causing bleeding through the skin
  • Inflammation in the veins and overlying skin
  • The appearance of varicose veins is upsetting to the individual

Varicose veins can be surgically removed in such cases. Because the damaged valves in the veins cannot be cured, removing them altogether is the only option. The aim of varicose vein surgery is to take pressure off the veins in the leg by tying or removing them. This doesn’t affect the blood supply to the legs; the blood is re-directed by other, healthy veins after the surgery. The result is that existing varicose veins are prevented from enlarging and new ones are prevented from growing.

What does the surgery involve?

Varicose vein surgery is one of the most commonly performed types of surgery. A combination of general and local anaesthesia is administered, depending on the type of surgery performed.

The main procedures used to remove varicose veins are –

  • Vein ligation and stripping – In this procedure, the surgeon makes two cuts – one at the top of the leg below the groin and one behind the knee. The vein is first tied off where the top incision is made, a procedure called vein ligation. It is then entirely pulled out through the incision near the groin. For the most serious cases, this surgery is performed. The recovery time can range from 1 to 4 weeks.
  • Phlebectomy – In this procedure, which is less complicated than vein ligation and stripping, several tiny cuts are made along the affected vein. Using a small hook, varicose veins close to the surface of the skin are then pulled out of the cuts. This technique is generally used for smaller veins.
  • PIN stripping – In this technique, the vein is removed through one incision near the top of the leg. The doctor runs a device called a PIN (perforate invaginate) stripper through the cut and pulls the vein up.

The surgeon can perform one or more of these, depending on the location and types of veins that require treatment. Surgery can also be combined with other less invasive procedures.

A varicose vein surgery is very effective in relieving symptoms like pain, swelling, and itching or it eliminates them completely. After the surgery, new varicose veins develop in a few years.

What happens before the surgery?


Before varicose vein surgery, a number of tests are done on the patient. These are of two types – to assess if the person qualifies for varicose vein surgery and some pre-operative tests like blood tests and ECG.

Can complications happen?

As is the case with all surgeries, the risk of complications exists. Some general complications include bleeding, infection, pain, scarring of the skin, and blood clots in legs. More specific ones are numbness, nerve damage, developing a lump under the wound, swelling of legs, etc.

How long does recovery take?

Typically, patients can go home the same day or the day after. Once the wounds are healed, patients can carry out normal activities. It is often advised to exercise regularly to be able to return to one’s usual life as quickly as possible.

Surgery for Brain Tumor

For patients with a brain tumour, a surgery is one of the most common treatments. Depending on the size and position of a tumour, the operation is performed by highly specialised surgeons. When a tumour is in a place that is difficult to reach or if the risk of damaging the vital parts of the brain is high with a surgery, the tumour is called inoperable. In such an event, the doctor will recommend other treatments.

What is a surgery for brain tumour?

A surgery is the process of removing a tumour and its surrounding tissue. Especially for low-grade brain tumours and those that can be removed without causing damage, this is the only treatment required. Performed by a neurosurgeon, a brain tumour surgery can help in improving neurological symptoms, improve the patient’s prognosis, and provide tissue for diagnosis.

Different types of surgeries and techniques are practised. A patient’s individual circumstances and history will determine the kind of approach taken by doctors.

When is a surgery done?

A brain surgery is performed for the following reasons -:

  • To remove the entire tumour
  • To remove some part of the tumour, as much is safe, to slow its growth
  • In assistance with other treatments like chemotherapy
  • To take a sample of the tumour for accurate diagnosis of its type

Many non-cancerous tumours are treated only with surgery. However, the majority of cancerous ones will require treatment in addition to the surgery, such as chemotherapy, radiation therapy, etc.

While a brain surgery is a serious procedure, it is quite safe, and is only carried out by highly skilled doctors. Even if the entire tumour cannot be removed, the neurosurgeon will try to remove as much as possible to slow its growth and curtail symptoms.

Types of surgery

There are two primary types of brain tumour surgery – Craniotomy and Neuroendoscopy.

Craniotomy (Open Brain Surgery)

This is the most common type of brain tumour surgery, where the patient is given a general anaesthetic and is asleep. In this procedure, the neurosurgeon cuts out some area of bone from the skull, using the opening to operate on the brain. In preparation for the surgery, a portion of the scalp is typically shaved. When the outermost layer of the brain tissue is exposed, the tumour is located and removed. Then, the scalp is stitched back shut. Since a part of the cranium is removed, this surgery is called craniotomy.

Neuroendoscopy (Keyhole Brain Surgery)

In a neuroendoscopy, all or part of a tumour in the fluid-filled areas of the brain is removed. The procedure uses an endoscope, an instrument shaped like a long tube that has a camera attached to a monitor and an eyepiece. A small hole is made into the skull, through which the endoscope is inserted. With the eyepiece, the surgeon can see what lies at the tip of the endoscope. There are tiny forceps and scissors at the end, using which the surgeon removes the tumour.

Can complications develop?

Brain surgery, much like any other invasive procedure, comes with a few risks despite the advances medical science has made in safety and precision. Some complications that can arise after a surgery are –

  • Bleeding in the brain region
  • Allergic reactions
  • Blood clots
  • Swelling due to trauma or fluid build-up
  • Infection that can cause swelling
  • Impairment of bodily functions

Preparing for a brain surgery

Before an actual surgery is carried out, doctors perform a series of assessments to test the patient’s suitability and fitness for a brain surgery. Several tests are done – blood tests to check for hormonal imbalance, an electro echocardiogram to check heart function, X-rays, MRI scans, etc. Typically, these assessments happen over 1-3 weeks before the surgery. Only after this happens do doctors decide which procedure is most suitable for the patient.

Doctors will also discuss drug and food allergies to decide the diet and post-operative medication. During such consultations, the patient’s medical history and family history are taken into account.

Some patients are also prescribed steroids before the surgery to help reduce the swelling caused by the tumour.

Recovering from brain surgery

Recovery from a brain surgery can take a couple of months, sometimes even more. The team performing the surgery typically creates a recovery plan. Usually, after the procedure, a patient is kept in the hospital for a few days, during which doctors monitor overall patient health and risk of complications.

Some patients have drips and tubes in place when they wake up; these are for providing fluid and drugs to the body, or draining them out. Some patients have a headache on waking up from the operation, which is treatable with painkillers.

After a surgery, some lifestyle changes are in order – less stress, reducing alcohol intake, frequent check-ups to monitor symptoms, etc. Because brain surgery causes exhaustion in the patient, it is crucial for the body to get adequate rest.

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