Neurological Disorders

Learn about Neurological Disorders

Neurological illnesses are many and it has profound impact of the life and wellbeing of an individual. Nervous system unlike other parts of the body cannot regenerate and many times the damage is permanent. Hence early identification, smart diagnosis and prompt treatment is required. Luckily today we know much more about these conditions and hence many diseases can be treated promptly.

The following neurological disorders effect individuals more commonly even though there are many neurological conditions which may be birth related, infective, metabolic, deficiency related or degenerative.

Seizures and Epilepsy

A seizure is a sudden, abnormal uncontrolled burst of electrical activity in the brain which can manifest as sudden tonic changes or jerky movements of the arms and or legs or just up rolling of the eyes. It may be associated with loss of consciousness following an event. Having two or more seizures at least 24 hours apart that don’t have a known cause is considered to be epilepsy.

There are many types of epilepsy and it can manifest in any irrespective of age gender or socio-economic background. In some people, the cause can be identified but not always. Epilepsy is common and at times it is unprovoked. Hence it requires prompt investigations and treatment.

Late onset seizure in an otherwise healthy adult needs prompt assessment. Seizure disorder in children may be due to developmental abnormality of brain or due to degeneration. A detailed history taking and neurological clinical assessment is the first step in evaluation followed by specific tests like an MRI brain with seizure protocol and an EEG apart from many common blood tests.

Treatment with medicines or sometimes surgery can control seizures for most people with epilepsy. Some people require lifelong treatment. Some children with epilepsy may outgrow the condition with age.

Stroke

Stroke or “Brain attack” occurs when the blood supply to the brain is reduced or stopped altogether and the brain cells die.

There are two types of strokes:

  • Ischemic stroke is more common and it occurs when a blood vessel either narrows due to atheroma plaque or blockage by a thrombus which prevents blood flow to that part of the brain.
  • Hemorrhagic stroke which is caused by breakage of blood vessels inside the brain. There is bleeding in the brain caused by a blood vessel that bursts within the brain. The most common is due to uncontrolled hypertension.

The symptoms vary depending on the part of the brain involved. Most commonly it can cause weakness or numbness of one half or particular part of the body, seizures, memory loss, not able to speak, giddiness or imbalance and at times total loss of consciousness.

Prompt medical attention is important t to identify what has gone wrong and to initiate treatment without delay. A CT Scan or MRI is the first step in arriving at a diagnosis. Many treatment options vary from medical management and endovascular interventions, and sometimes as a lifesaving mode surgery is recommended.

 

Parkinson’s Disease (PD)

PD is a progressive degenerative disease of the brain effecting older individuals which effects individual’s movements. This is mainly due to deficiency of a neuro transmitters called Dopamine in certain parts of the brain. As a result, patient will have coarse tremors of the hands with paucity of movement and slow walking along with mask like facies.

In progressive disease without treatment patient’s movement will be very much restricted and have severe rigidity of the body parts. The patient will have slowness of movement and will be very stiff with pin rolling movements of the hand. This is primarily a clinical diagnosis but at times PD is complicated by other degenerative diseases called multi system atrophy, corticobasal degeneration and dementia complex. Then special scan called DOTA PET scan is useful to arrive at right diagnosis.

Dementia

Dementia generally involves memory loss. It’s often one of the early symptoms of the condition. But having memory loss alone doesn’t mean you have dementia. Memory loss can have different causes.

Alzheimer’s disease is the most common cause of dementia in older adults, but there are other causes of dementia. Depending on the cause, some dementia symptoms might be reversible.

Common symptoms include:

  • Memory loss, which is usually noticed by someone else.
  • Problems communicating or finding words.
  • Trouble with visual and spatial abilities, such as getting lost while driving.
  • Problems with reasoning or problem-solving.
  • Trouble performing complex tasks.
  • Trouble with planning and organizing.
  • Poor coordination and control of movements.
  • Confusion and disorientation.
  • Personality changes and inappropriate behavior
  • Anxiety and agitation

Causes of Dementia is not clearly known and is suspected to be multi factorial.

Encephalopathy

Encephalopathy is a term for any diffuse disease of the brain that alters brain function or structure. Encephalopathy can be due to diverse causes and can be a reason for significant morbidity or mortality in susceptible individuals. 

It may be caused by infectious agent (bacteria, virus, or prion), metabolic states like high blood sugar, liver and kidney failure, excessive alcoholism or mitochondrial dysfunction, brain tumor or increased pressure in the skull, prolonged exposure to toxic elements (including solvents, drugs, radiation, paints, industrial chemicals, and certain metals), chronic progressive trauma, poor nutrition, or lack of oxygen or blood flow to the brain.

The hallmark of encephalopathy is an altered mental state. Depending on the type and severity of encephalopathy, common neurological symptoms are memory and, cognitive disturbances which may be sudden or progressive, personality changes, difficulty to concentrate, lethargy, and loss of consciousness. Patient may progress to coma if not intervened on time. Other neurological symptoms may be progressive vision loss, muscle twitching, nystagmus (rapid, involuntary eye movement), tremor, muscle atrophy and weakness, dementia, seizures, and loss of ability to swallow or speak. Blood tests, spinal fluid examination, imaging studies, electroencephalograms, and similar diagnostic studies may be used to differentiate the various causes of encephalopathy.

Peripheral Neuropathy

Peripheral neuropathy happens when the nerves that are located outside of the brain and spinal cord (peripheral nerves) are damaged. This condition often causes weakness, numbness and pain, usually in the hands and feet. It also can affect other areas and body functions including digestion and urination.

Symptoms of peripheral neuropathy might include:

  • Gradual onset of numbness, prickling, or tingling in your feet or hands. These sensations can spread upward into your legs and arms.
  • Sharp, jabbing, throbbing or burning pain.
  • Extreme sensitivity to touch.
  • Pain during activities that shouldn’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket.
  • Lack of coordination and falling.
  • Muscle weakness.
  • Feeling as if you’re wearing gloves or socks when you’re not.
  • Inability to move if motor nerves are affected.

If autonomic nerves are affected, symptoms might include:

  • Heat intolerance.
  • Excessive sweating or not being able to sweat.
  • Bowel, bladder or digestive problems.
  • Drops in blood pressure, causing dizziness or light headedness

Peripheral neuropathy can affect one nerve, called mononeuropathy. If it affects two or more nerves in different areas, it’s called multiple mononeuropathy, and if it affects many nerves, it’s called polyneuropathy. Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.

Diabetes, Alcoholism, metabolic causes, autoimmune causes, medicines, infections and tumours are some of the common causes.

Multiple Sclerosis (MS)

MS isan immune disorderthat affects a person’s central nervous system and occurs when the protective outer layer of one’s nerves is attacked by one’s own immune system leading to nerve damage and loss of conduction. As the disease progresses the nervous system’s ability to effectively communicate with other areas of the body becomes hindered as nerve fibers begin to die off and as scar tissue begins to accumulate because of the ongoing deterioration of the central nervous system.

Patient presents with many symptoms which are difficulty in vision, muscle weakness, numbness, memory and cognitive impairment, mood disturbances, and speech difficulties. Prompt diagnosis and treatment is required to prevent serious complications. MRI is mainstay in the diagnosis. Hospitalization may be requiring many times.

Amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS), sometimes called Lou Gehrig’s disease, is a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells (neurons) responsible for controlling voluntary muscles.  In ALS, both the upper motor neurons and the lower motor neurons degenerate or die, ceasing to send messages to muscles. Unable to function, the muscles gradually weaken, waste away, and twitch. Eventually the ability of the brain to start and control voluntary movement is lost.  Symptoms are usually first noticed in the arms and hands, legs, or swallowing muscles.  Individuals with ALS lose their strength and the ability to move their arms, legs, and body. When muscles in the diaphragm and chest wall fail to function properly, individuals lose the ability to breathe without ventilator support.  

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