Department of Neurology

Adhering to its “PATIENTS FIRST” approach, BIMS Hospital has established the most advanced neurology department with experienced super specialists and a supporting team building a firm base of satisfied patients with neurological problems. Bhavnagar Institute of Medical Sciences (BIMS Hospital) has one of the well-established stroke units in Bhavnagar District where several cases of neurology-related disorders and issues have undergone successful treatment within minutes of their presentations, which has changed the outcome significantly.

The team at the Neurology Department of BIMS Hospital comprises of highly-trained, skilled, and well-experienced team of Neurologists, Neurosurgeons, interventional radiologists, Neurophysiotherpists, and rehabilitation teams who make sure that the patients receive the best quality treatments for curing their neurological problems. A range of neurological treatments are available at our neurology hospital.

WHAT IS NEUROLOGY?

Neurology is the branch of medicine concerned with the study and treatment of disorders of the nervous system. The nervous system is a complex, sophisticated system that regulates and coordinates body activities. It has two major Divisions:

  • Central Nervous System: The Brain and Spinal Cord
  • Peripheral nervous system: All other neural elements, such as eyes, ears, skin, and other “Sensory Receptors”.

A doctor who specializes in the Medical Treatment of neurological problems is called a neurologist. The neurologist treats disorders that affect the brain, Spinal Cord and nerves.

WHEN A NEUROLOGIST SHOULD BE CONSULTED?

  • Headaches and other pain syndromes (migraine)
  • Epilepsy (convulsion/seizure)
  • Stroke (paralysis)
  • Giddiness (dizziness, vertigo)
  • Movement disorders (such as Parkinson’s disease, essential tremor, and dystonia)
  • Dementia (Alzheimer’s and others)
  • Infections of the brain (Meningitis, Encephalitis)
  • Cerebral palsy and spasticity
  • Multiple sclerosis
  • Spine disorders (backache, slip-disc, radiculopathy, spondylosis)
  • Nerve and muscle diseases (including amyotrophic lateral sclerosis, peripheral neuropathy, myasthenia gravis, muscular dystrophy, myopathies)
  • Sleep disorders
  • Mental/behavioral health disorders

WHAT IS NEUROLOGICAL EXAMINATION?

A neurological examination assesses motor and sensory skills, hearing and speech, vision, coordination, and balance. It may also test mental Status, Mood, and behavior. The Examination uses tools such as a tuning fork, flashlight, reflex hammer, and a tool for examining the eye. The results of the neurological examination and the patient’s history are used to determine a list of possibilities, known as the differential diagnosis, that help determine which additional diagnostic tests and procedures are needed.

COMMON SCREENING TESTS FOR NEUROLOGY PATIENT:

1. Laboratory screening tests of blood, urine, or other body fluids may help doctors diagnose disease, understand disease severity, and monitor levels of therapeutic drugs. Certain tests, ordered by the physician as part of a regular check-up, provide general information, while others are used to identify specific health concerns.

 Brain scans include several types of imaging techniques used to diagnose tumours, blood vessel malformations, stroke, injuries, abnormal brain development, and hemorrhage in the brain. Types of brain scans include computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and single proton emission (SPECT) scans.

2. Computed tomography (CT scan)uses X-rays to produce two-dimensional images of organs, bones, and tissues. A CT scan can aid in proper diagnosis by showing the area of the brain that is affected. CT scans can be used to quickly detect hemorrhage in the brain and to determine if someone who has had a stroke can safely receive intravenous treatment to dissolve clots. CT scans also may be used to detect bone and vascular irregularities, brain tumours and cysts, brain damage from head injury, hydrocephalus, brain damage causing epilepsy, and encephalitis, among other disorders. A contrast dye may be injected into the bloodstream to highlight the different tissues in the brain. A CT of the spine can be used to show herniated discs, spine fractures, or spinal stenosis.

CT scanning takes about 20 minutes and is usually done at an outpatient imaging center or in a hospital. The person lies on a special table that slides into a narrow, doughnut-shaped chamber. A sound system built into the chamber allows the person to communicate with the physician or technician. X-rays (ionizing radiation) are passed through the body at various angles and are detected by a computerized scanner. The data is processed and displayed as cross-sectional images, or “slices,” of the internal structure of the body or organ. Occasionally a light sedative may be given if the person is unable to lie still and pillows may be used to support and stabilize the head and body.
If a contrast dye is injected into a vein, the individual being scanned may feel a warm or cool sensation as the dye circulates through the bloodstream or may experience a slight metallic taste. CT scans are particularly useful in people who are unable to undergo MRI. Because CT uses X-rays, pregnant women should avoid the test because of potential harm to the fetus.

3. Magnetic resonance imaging (MRI) uses computer-generated radio waves and a powerful magnetic field to produce detailed images of body tissues. Using different sequences of magnetic pulses, MRI can show anatomical images of the brain or spinal cord, measure blood flow, or reveal deposits of minerals such as iron. MRI is used to diagnose stroke, traumatic brain injury, brain and spinal cord tumors, inflammation, infection, vascular irregularities, brain damage associated with epilepsy, abnormally developed brain regions, and some neurodegenerative disorders. MRI is also used to diagnose and monitor disorders such as multiple sclerosis. A contrast dye may be injected into the vein to enhance the visibility of certain areas or tissues.

An MRI scanner consists of a tube surrounded by a very large cylindrical magnet. These scanners create a magnetic field around the body that’s strong enough to temporarily realign water molecules in the tissues. Radio waves are then passed through the body to detect the shifting of molecules back to a random alignment. A computer then reconstructs a three-dimensional picture or a two-dimensional “slice” of the tissue being scanned. MRI can distinguish between bone, soft tissues, and fluid-filled spaces because of differences in water content and tissue properties. The individual lies on a special table that slides into the tube and will be asked to remove jewellery, eyeglasses, removable dental work, and clothing with metal and other items that might interfere with the magnetic imaging. The person may hear grating or knocking noises when the magnetic field direction is flipped. Earphones or earplugs can help block out the sounds. For brain MRI scans, a detector is placed over the head.

Due to the incredibly strong magnetic field generated by an MRI, people with implanted medical devices such as a pacemaker or infusion device generally should not have MRIs. In certain circumstances, facilities may have equipment to temporarily stop and reset the implanted device’s programming in order to allow MRI.

Unlike CT scanning, MRI does not use ionizing radiation to produce images. The test is painless and risk-free, although persons who are obese or claustrophobic may find it somewhat uncomfortable. Depending on the part(s) of the body to be scanned, MRI can take up to an hour to complete. Some centers use open MRI machines that do not completely surround the person being tested and are less confining. However, open MRI does not currently provide the same picture quality as standard MRI and some tests may not be available using this equipment.

Because people must remain still during the MRI, children may need to be sedated in order to be scanned. If intravenous contrast is required, people may first need a blood test to check kidney function because the contrast agent, called gadolinium, can increase the risk of a rare disease in people with advanced kidney disease.

A fetal MRI may be ordered when prenatal ultrasound reveals a possible problem with a fetus, A Fetal MRI is considered safe for the baby because it does not require radiation or contrast dye.

Functional MRI (fMRI) uses the blood’s magnetic properties to produce real-time images of blood flow to particular areas of the brain. FMRI can pinpoint areas of the brain that become active and show how long they stay active. This imaging process may be used to localize brain regions for language, motor function, or sensation prior to surgery for epilepsy. Researchers use fMRI to study head injury and degenerative disorders such as Alzheimer’s disease.

ADDITIONAL TESTS USED TO DIAGNOSE NEUROLOGICAL DISORDERS:

The following list of procedures—in alphabetical order—describes some of the other tests used to help diagnose a neurological condition.

  • ELECTROMYOGRAPHY, OR EMG, is used to diagnose nerve and muscle disorders, spinal nerve root compression, and motor neuron disorders such as amyotrophic lateral sclerosis. EMG records the electrical activity in the muscles. Muscles develop abnormal electrical signals when there is nerve or muscle damage. During an EMG, very fine needles or wires are inserted into a muscle to assess changes in electrical signals at rest and during movement. The needles are attached through wires to an EMG machine. Testing may take place in a doctor’s office or clinic and lasts an hour or longer, depending on the number of muscles and nerves to be tested. Because of a slight risk of bruising or bleeding, people will be asked if they are on aspirin or blood thinners. Most people find this test to be somewhat uncomfortable.
  • NERVE CONDUCTION STUDY (NCS): An EMG is usually done in conjunction with a nerve conduction study. An NCS measures the nerve’s ability to send a signal, as well as the speed (nerve conduction velocity) and size of the nerve signal. A set of recording electrodes is taped to the skin over the muscles or skin. Wires connect the electrodes to an EMG machine. A small electrical pulse (similar to the sensation of static electricity) is given on the skin a short distance away to stimulate the nerve to the muscle or skin. The electrical signal is viewed on the EMG machine. The physician then reviews the response to verify any nerve damage or muscle disease. There is minimal discomfort and no risk associated with this test.
  • ELECTROENCEPHALOGRAPHY, OR EEG, monitors the brain’s electrical activity through the skull. EEG is used to help diagnose seizure disorders and metabolic, infectious, or inflammatory disorders that affect the brain’s activity. EEGs are also used to evaluate sleep disorders, monitor brain activity when a person has been fully anesthetized or loses consciousness, and may be used to confirm brain death.

This painless, risk-free test can be performed in a doctor’s office or at a hospital or testing facility. A person being tested usually reclines in a chair or on a bed during the test. A series of cup-like electrodes are attached to the scalp with a special conducting paste. The electrodes are attached to wires (also called leads) that carry the electrical signals of the brain to a machine. During an EEG recording session, a variety of external stimuli, including bright or flashing lights, noise, or certain drugs may be given.

Individuals may be asked to open and close their eyes, or to change their breathing patterns. Changes in brain wave patterns are transmitted to an EEG machine or computer. An EEG test usually takes about an hour. Testing for certain disorders requires performing an EEG during sleep, which takes at least 3 hours.

  • In people undergoing evaluation for epilepsy surgery, electrodes may be inserted through a surgical opening in the skull to reduce signal interference. This is called an intracranial EEG. People typically remain in a hospital epilepsy monitoring unit while implanted electrodes are in place. During this time, the brain is monitored for seizures in order to determine where the seizures originate. People may also be asked to perform certain types of tasks (e.g., reading, speaking, or certain limited motor activities) so that the EEG can be used to identify brain regions that are important for normal function.
  • SOMATOSENSORY EVOKED POTENTIALS (SSEPS)measure responses from electrical stimuli to the nerves. In addition to electrodes on the scalp, electrodes are pasted to the arms, leg, and back to measure the signal as it travels from the peripheral nerves to the brain. Tiny electrical shocks are delivered by electrodes pasted to the skin over a nerve in an arm or leg. SSEPs may be used to help diagnose multiple sclerosis, spinal cord compression or injury, and certain metabolic or degenerative diseases. SSEP tests usually take longer than an hour.
  • CEREBROSPINAL FLUID ANALYSIS involves the removal of a small amount of the fluid that surrounds the brain and spinal cord. The procedure is commonly called a lumbar puncture or spinal tap. The fluid is tested to detect evidence of brain haemorrhage, infection, multiple sclerosis, metabolic diseases, or other neurological conditions Pressure inside the skull can be measured to detect conditions such as a false brain tumour. The lumbar puncture may be done as an inpatient or as an outpatient procedure. During the lumbar puncture, the person will either lie on one side, with knees close to the chest, or lean forward while sitting on a table, bed, or massage chair. The person’s back will be cleaned and injected with a local anesthetic. The injection may cause a slight stinging sensation. Once the anesthetic has taken effect, a special needle is inserted between the vertebrae into the spinal sac, and a small amount of fluid (usually about three teaspoons) is withdrawn for testing. Most people will only feel a sensation of pressure as the needle is inserted. Generally, people are asked to lie flat for an hour or two to reduce the after-effects of headache. There is a small risk of nerve root injury or infection from a lumbar puncture. The procedure takes about 45 minutes.
  • CAROTID DOPPLER ULTRASOUND is used to measure flow in arteries and blood vessels in the neck. Transcranial Doppler ultrasound is used to view blood flow in certain arteries and blood vessels inside the skull. Carotid dopplers and transcranial dopplers are used to assess the risk of stroke. Duplex ultrasound refers to ultrasound studies that are combined with anatomical ultrasound.
  • Angiography is a test that involves injecting dye into the arteries or veins to detect blockage or narrowing. A cerebral angiogram can show narrowing or obstruction of an artery or blood vessel in the brain, head, or neck. It can determine the location and size of an aneurysm or vascular malformation. Angiograms are used in certain strokes where there is a possibility of unblocking the artery using a clot retriever. Angiograms can also show the blood supply of a tumor prior to surgery or embolectomy (surgical removal of a blood clot or other material that is blocking a blood vessel).

Angiograms are usually performed in a hospital outpatient or inpatient setting and may take up to 3 hours, followed by a 6- to 8-hour resting period. The person, wearing a hospital or imaging gown, lies on a table that is wheeled into the imaging area. A physician anesthetizes a small area of the leg near the groin and then inserts a catheter into a major artery located there. The catheter is threaded through the body and into an artery in the neck. Dye is injected and travels through the bloodstream into the head and neck. A series of X-rays is taken. The person may feel a warm to hot sensation or slight discomfort as the dye is released. In many situations, cerebral angiograms have been replaced by specialized MRI scans, called MR angiograms (MRA), or CT angiograms. A spinal angiogram is used to detect blockage of arteries or blood vessels malformations in the vessels to the spinal cord.

  • Evoked potentials, also called evoked response, measure the electrical signals to the brain generated by hearing, touch, or sight. Evoked potentials are used to test sight and hearing (especially in infants and young children) and can help diagnose such neurological conditions as multiple sclerosis, spinal cord injury, and acoustic neuroma (small tumors of the acoustic nerve). Evoked potentials are also used to monitor brain activity among coma patients, and confirm brain death.

Testing may take place in a doctor’s office or hospital setting. One set of electrodes is attached to the person’s scalp with conducting paste. The electrodes measure the brain’s electrical response to stimuli. A machine records the amount of time it takes for impulses generated by stimuli to reach the brain.

X-rays of a person’s chest and skull may be taken as part of a neurological work-up. X-rays can be used to view any part of the body, such as a joint or major organ system. In a conventional X-ray, a concentrated burst of low-dose ionized radiation passes through the body and onto a photographic plate. Since calcium in bones absorbs X-rays more easily than soft tissue or muscle, the bony structure appears white on the film. Any vertebral misalignment or fractures can be seen within minutes. Tissue masses such as injured ligaments or a bulging disc are not visible on conventional X-rays. This fast, noninvasive, painless procedure is usually performed in a doctor’s office or at a clinic.

PREVENTION of NEUROLOGY PROBLEMS:

While epilepsy, brain tumors, and other brain disorders are typically not preventable, there are some neurological problems that you can take action against.

  • DIET RECOMMENDATION: Adopting a balanced, low-fat diet reduces the chance that arteries will become clogged, a factor that often contributes to “brain attack”, or stroke. In particular, minimizing your fat intake will help prevent clogs from forming in arteries surrounding the heart as well as those leading to the brain.
  • FAT CONTROL: A gram of fat contains more calories than a gram of carbohydrate or protein, some types of fat in moderation may serve useful purposes, such as insulting internal organs or transporting vitamins. But, in reality, the human body needs very little fat. In fact, the entire amount of fate the human body requires on a daily basis is only a single teaspoon. However, most people take in almost four times this amount. Here are some tips for creating a healthy diet:
    • Eat more fruits, vegetables and grains.
    • Reach for non-fat or low-fat dairy products.
    • Substitute tomato sauces for heavy, cream sauces.
    • Cut back on fats and sweets.
    • By lean meat.
    • Remove the skin from the poultry.
    • Avoid fried foods and fast food.
    • Cook soup and stew in advance. Cut off the congealed fat before serving.
    • Use fat-free salad dressing and low-fat mayonnaise.
    • Reduce your alcohol intake.
    • Drink at least eight glasses of water each day
    • Eat smaller portions.
  • EXERCISE RECOMMENDATIONS: Exercise is also important in keeping arteries clear as well as strengthening heart muscles, and it has been shown to increase HDL cholesterol levels. This type of cholesterol is the GOOD cholesterol and helps keep LDL cholesterol, the BAD cholesterol, in check.

Your body needs exercise to stay healthy. Regular exercise helps you maintain your optimal weight. Exercise can also reduce depression and lower your blood pressure.

Anaerobic exercise focuses on building muscle strength, while aerobic exercise gets your heart pumping. Both anaerobic and aerobic exercise must be part of an exercise program.

Running, Swimming, biking, skiing and tennis are examples of aerobic activities. During aerobic exercise, the heart works hard to pump blood throughout the body, and the lungs work hard to take more oxygen. The ideal exercise program is one in which your heart stays pumping for at least 20 minutes, three times a week.

Weight-bearing exercise involves lifting weights and building muscle mass. These types of exercises have also been shown to build bone density, which helps prevent osteoporosis, a condition causing bones to become porous and brittle.

  • VISIT A DOCTOR BEFORE BEGINNING AN EXERCISE PROGRAM: Many people can get back into shape on their own. However, some will need to consult a physician first. BHAVNAGAR INSTITUTE OF MEDICAL SCIENCES (BIMS HOSPITAL) recommends that the following people visit our doctor before undertaking an exercise program:
    • Men over 40 years old
    • Women over 50 years old
    • People with heart disease, diabetes, high blood pressure, lung disease or arthritis
    • Heavy Smokers
  •  PREVENT ANEURYSMS: I) Although not all aneurysms are hereditary, there is some evidence that people are more likely to develop an aneurysm if a family member has had one. Frequent screening tests are recommended if aneurysms have occurred in your family. II) Lifestyle changes to maintain healthy blood vessels can help prevent aneurysms, including not smoking, exercising regularly, and eating a balanced, low-fat diet.
  • PREVENT CARPAL TUNNEL SYNDROME:
    • Avoid repeated stress on the hands.
    • Do hand and wrist exercises and stretches periodically.
    • Use proper hand and wrist positioning and pay attention to ergonomics.
    • Take breaks during work.
    • Set your computer monitor at eye level, and keep elbows and a 70-to 90-degree angle and wrists in a neutral position.
    • Wear splints at night
    • Use tools and equipment in your daily tasks that are designed to minimize the risk of wrist and hand injury.
    • Use cold treatments (Such as ice packs) to reduce inflammation in the hands.
  • PREVENT STROKE:
    • Monitor blood pressure to keep it at a healthy level.
    • Maintain a healthy weight through a balanced diet and exercise.
    • Avoid smoking.
    • Get screened for carotid stenosis.

Proper counseling of the patients and rehabilitation are ensured by the neurologists at BIMS Hospital so that the best results can be achieved. The quality of the highly advanced medical treatments along with the accessibility and affordability of these treatments makes patients visiting our stroke unit in Bhavnagar feel relaxed and satisfied at the end of the treatments.

Neurosurgeons in Bhavnagar
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