The Dr. Achanta Lakshmipathi Neurosurgical Centre and Postgraduate Institute of Neurological Surgery at the VHS Hospital and Research Centre, Adyar, has been at the forefront of neurosurgical care, education, innovation and research for the past 40 years (1978-2018).
The institution has been a recognised postgraduate training centre by the National Board of Examinations. Since 1984, there have been 33 postgraduates who have undergone strenuous training of 5 years before writing the National Board examinations. The institution is currently allowed one candidate per year and the course is now for 6 years. The candidates are selected by the National Board on the basis of an all-India examination and counselling done centrally.
Treating a huge number, of neurosurgical patients, that were managed both conservatively and surgically is the main achievement of this institution. The creation of a distinct Indian school of Neurosurgery has been its hallmark. Multi-author textbooks published by the Department are the main source of educational material for neurosurgery postgraduates.
Dr. A. LAKSHMIPATHI NEUROSURGICAL CENTRE has grown in the last 41 years to be one of the finest in the country, setting standards for other departments. It has become a tertiary referral centre, for complex cranial and spinal cases.
The department has a 20-bedded general ward with separate male and female wards and two intensive care units with monitors and ventilators. In addition, our special wards have been renovated lately (click for a tour of the department).
At the VHS, 2 dedicated operation theatres function five days a week, and are open 24 hours for emergencies with in house CT scan facilities. Trained theater staff, complete sets of microsurgical instruments, 2 Zeiss microscopes, endoscopes, CUSA and stereotaxy have made excellent modern neurosurgery possible.
The basic concept of the department is that no patient is to be turned away because of financial consideration. This allows us to treat a great variety of patients from different strata of society. All welfare schemes, including CM fund, are accepted. Patients, who cannot afford are supported by our well wishers.
‘ To reach the unreachable star
This is my quest To follow the star’
– Man of La Mancha
Neurosurgeon…one who cannot afford a mistake
The Department has benefited all sections of the society by providing free neurosurgical service and care to the poor, subsidised for the middle income groups, and appropriately charged neurosurgical service for the higher income groups.
Providing an educational opportunity to
- Neurosurgical postgraduates
- General surgery postgraduates
- Neuro-anaesthesia training
- MS neuroscience students
- B.Sc., M.Sc. Nursing students
Dr. M.C. Vasudevan, MD, DNB (NS)
Mon – Fri
Dr. A. Vincent Thamburaj, MBBS, DNB, FRCS
Mon – Fri
Dr. Shyamsunder Krishnan, MBBS, MS (GS), M.Ch (NS)
Mon – Fri
Dr. Bhavinkumar R. Patel, MBBS, (DNB(NS))
Mon – Fri
Dr. Prithika Chary, MD, DM (Neuro,Neurosurgery,Endocrinology)
Mon – Fri
M.C.Vasudevan M.D, D.N.B
A. Vincent Thamburaj D.N.B, F.R.C.S
Dr. M. Adarsh Manuel
Dr. Poonam Mohanty
Dr. Gaddam Sai Harish
Dr. Mangal Kumar Rachatte
Dr. Divya Swaminathan
|1||Dr. M C Vasudevan||1979 – till date|
|2||Dr. E V Ravishankar||1984 – 1990|
|3||Dr. K Sridhar||1985 – 2005|
|4||Dr. M Bhaskara Rao||1987 – 1992|
|5||Dr. Nirmal Palit||1989 – 1994|
|6||Dr. P V Ramana||1991 – 1996|
|7||Dr. Arjun Srivasta||1992 – 1997|
|8||Dr. Charulatha Hastak||1992 – 1993|
|9||Dr. Manoj||1992 – 1992|
|10||Dr. D Mukherjee||1993 – 1998|
|11||Dr. V S Hari||1993 – 1994|
|12||Dr. S. Shajehan||1994 – 1999|
|13||Dr. Anil Pande||1994 – 2012|
|14||Dr. Asha Bakshi||1994 – 1999|
|15||Dr. Praveen Sharma||1997 – 2000|
|16||Dr. Balasenthil Kumaran M R||1997 – 2004|
|17||Dr. Satish K||1997 – 2002|
|18||Dr. Jagdish Chattanali||2001 – 2002|
|19||Dr. Bobby Jose||1999 – 2005|
|20||Dr. Nigel Peter Symss||1999 – 2005|
|21||Dr. Vikram M||2000 – 2006|
|22||Dr. Sanjeev Dhanuka||2000 – 2005|
|23||Dr. Koshy Kochuman||2001 – 2006|
|24||Dr. A N Prasad||2001 – 2007|
|25||Dr. Venugopal||2002 – 2007|
|26||Dr. Murali Mohan||2003 – 2008|
|27||Dr. Amit Kapoor||2003 – 2008|
|28||Dr. Manish Singh||2004 – 2009|
|29||Dr. Santhosh Mohan Rao||2005 – 2010|
|30||Dr. Goutham Cugati||2005 – 2010|
|31||Dr. Pradeep Kumar Jain||2007 – 2012|
|32||Dr. Ravindranath Kapu||2007 – 2012|
|33||Dr. Bojja Venkata Sivaram||2009 – 2014|
|34||Dr. Harinivas||2009 – 2014|
|35||Dr. Gowtham Devareddy||2010 – 2016|
|36||Dr. Omar Bachh||2010 – 2016|
|37||Dr. Pulak Nigam||2011 – 2019|
|38||Dr. Bhavin Kumar Patel||2011 – 2019|
|39||Dr. V.S. Satish Anand||2012 – 2018|
|40||Dr. M. Shanmugham||2013 – 2019|
|41||Dr. M. Adarsh Manuel||2014 – 2020|
|42||Dr. Poonam Mohanty||2016 – 2022|
|43||Dr. Gaddam Sai Harish||2017 – 2023|
|44||Dr. Mangal Kumar Rachatte||2018 – 2024|
|45||Dr. Divya Swaminathan||2019 – 2025|
The best way to teach and learn surgery was to watch live surgery being performed and to have an active interaction between the surgeon and the watching delegates. This way, there would be a good discussion, as well as the chance for surgeons to see, discuss and learn from other surgeons.
The workshops extend over three days, over the second weekend of September. Two guest surgeons and our surgeons for the faculty. Each workshop starts with lectures on the relevant anatomy and with clinical discussions. This is followed by presentation of the cases to be operated that morning. The live video transmission from the operation theatre allows for the discussion to start from the OT setting, positioning, incision, to anesthetic requirement etc. A two way audio system enables the delegates to directly ask the surgeon questions regarding the surgery. There is therefore an excellent discussion which carries on throughout.
The workshops also include ALNC oration, by eminent physicians.
|2||1995||PROF. SUNIL PANDYA
DR.BASANT K MISRA
|NEUROLOGICAL ILLNESSES AND BEHAVIOUR|
|THE NEW MILLENIUM: UNFINISHED AGENDA AND TASKS AHEAD|
|TRIALS AND TRIBULATIONS OF A NEUROSURGEON|
|7||DR.SUNIL K PANDYA
|PATCH ADAMS: SERVICE TO HUMANITY|
|RECENT CONCEPTS IN ANEURYSM TREATMENT|
|CURRENT CONCEPTS IN THE MANAGEMENT OF BRACHIAL PLEXUS INJURY|
|ANEURYSMS – CLIPPING Vs COILING|
|NEUROENDOSCOPY IN THE ERA OF MICROSURGERY|
|13||PROF.ZAHEER AHMED SYED
|TOUGH CALLS – TOUGH OPTIONS|
|EVOLUTION OF NEUROSCIENCES …A REMOTE EVOLUTION|
|CANCER CARE – WHERE ARE WE?|
|BIOLOGY OF EPILEPSY – PATHOLOGIST PERSPECTIVE|
|17||DR.A.P.J. ABDUL KALAM
|WHAT YOU WILL BE REMEMBERED FOR|
|EPILEPSY – AN OVERVIEW|
Textbooks of Neurosurgery
- Textbook of Neurosurgery, 1st Edition, 1980—National Book Trust of India—Orient Longman Ltd.—2vols.
- Textbook of Neurosurgery,2nd Edition—1996—National Book Trust of India—BI Churchill Livingstone Ltd.—2vols.
- Textbook of Neurosurgery, 3rd Edition—2011—Jaypee Brothers Medical Publishers—3vols.
- Manual of Text Book of Neurosurgery—2014—Jaypee Brothers Medical Publishers—2vols.
Textbook of Operative Neurosurgery
- Textbook of Operative Neurosurgery, 1st Edition—2005—B I Churchill Livingstone Publications Ltd.—2 vols.
- Textbook of Operative Neurosurgery, 2nd Edition—currently in progress
Publication of following papers:
- “Prof.B.Ramamurthi: The Legend and his Legacy” K Sridhar, Neurology India, 52: 27-31, 2004
- “Total Traumatic Dislocation of the Upper Thoracic Spine – Lessons Learnt” Surgical Neurology 61: 343-346, 2004
- “Cystic Tuberculomas of the brain – report of two cases” Neurologica Medico Chirurgica, (Japan) 44:438-441, 2004
- Idiopathic Hypertrophic Pachymeningitis of the thoracic Spine” British Journal of Neurosurgery 18:515-517, 2004
- Balasubramaniam Ramamurthi” in Biographical Memoirs of Fellows of the Indian National Science Academy, (ed) Prof B Ramamurthi, Indian National Science Academy, Vol.27, 207-248, 2005.
- Vikram Muthusubramanian, Pande A, Vasudevan M.C, Ravi R. Suprasellar Arachnoid Cyst With Bobble-Head Doll Movements: A Management Option. J Pediatr Neurosci 2006;1:24-26
- Vikram Muthusubramanian, Anil Pande, Madhabushi Chakravarthy Vasudevan, Ravi Ramamurthi, Concomitant Cervical and Lumbar Intradural Intramedullary Lipoma – A Case Report submitted to Surgical Neurology Journal.
- Vikram Muthusubramanian, Anil Pande, Madhabushi Chakravarthy Vasudevan, Ravi Ramamurthi, An Unusual Stab Wound Of The Cervical Spine Due To Casurina Stick: A Case Report submitted to British journal of neurosurgery.
- Dr.Nigel Peter Symss, Anil Pande, Madhabushi Chakravarthy Vasudevan, Ravi Ramamurthi, Glioblastoma in a child irradiated for ALL: Journal of Indian Society of Paediatric Neurosurgery.
- Suprasellar epidermoid presenting with precocious puberty – Dr.Nigel Peter Symss, A.N.Prasad, Ravi Ramamrthi, M.C.Vasudevan, Pediatr Neurosci, Vol.2, 75 : July- Dec 2007
- Surgical Management of brainstem hydatid cyst – an unusal site –Dr.Vikram M, Dr.Anil Pande, Dr.M.C.Vasudevan, Dr.Ravi Ramamurthi, Surgical Neurology,accepted in June 2007
- An unusual stab wound of the cervical spine caused by a casurina stick – Dr.Vikram M, Dr.Anil Pande, Dr.M.C.Vasudevan, Dr.Ravi Ramamurthi, British Journal of Neurosurgery, February 2007, 21(1):1-2
- Concomitant cervical and lumbar intradural intramedullary lipoma – Dr.Vikram M, Dr.Anil Pande, Dr.M.C.Vasudevan, Dr.Ravi Ramamurthi, Surgical Neurology, March 2008
- Exophytic choroids plexus papilloma of the fourth ventricle presenting with cerebrospinal flid rhinorrhea: a Case report – Dr.Nigel Peter Symss, Dr.A.N.Prasad, Dr.M.C.Vasudevan, Dr.Ravi Ramamurthi, Surgical Neurology, Feb 2008
- Pediatric Medulloblastoma: A Review of 67 cases at a single institute Dr.Murali Mohan S, Dr.Anil Pane, Dr.M.C.Vasudevan, Dr.Ravi Ramamurthi, Asian Journal of Neurosurgery 2008: 2: 63-69
- Extradural with intradural extramedullary and intramedullary tuberculoma of the spine without bony involvement. A rare case report. Accepted by Pan Arab Journal of Neurosurgery – Dr.Nigel Peter Symss
- Theories of cerebrospinal fluid dynamics and hydrocephalus: Historical trend – Submitted to journal of Neurosurgery – Dr.Nigel Peter Symss
- Invasive rhino-cerebral fungal granuloma – Neurology India, Mar-Apr 2010, Vol 58, Issue 2- Dr.Murali Mohan, Dr.Anil Pande, Dr.M.C.Vasudevan, Dr.Ravi Ramamurthi
- Intracranial Rosai Dorfman Disease: report of three cases and literature review – Asian Journal of Neurosurgery 2010, 11:19-30 – Dr.Nigel Peter Symss, Dr.Goutham Cugati, Dr.Vasudevan, Dr.Ravi Ramamurthi
- Extra axial adult cerebellopontine angle medulloblastoma: An extremely rare site of tumor with metastasis – Surgical Neurology International – Dr.Manish Singh, Dr.Goutham Cugati, Dr.Nigel Peter Symss, Dr.Anil Pande, Dr.Vasudevan, Dr.Ravi Ramamurthi
- Multiple burr hole surgery as a treatment modality for pediatric moyamoya disease – Journal of Pediatric Neurosciences, Vol.5, Jul-Dec: 115, 2010 – Dr.Ravindra Kapu, Dr.Nigel Peter Symss, Dr.Goutham Cugati, Dr.Anil Pande, Dr.Vasudevan, Dr.Ravi Ramamurthi
- Malignant Course of a Metastatic Melanoma During Pregnancy: A case report World J Oncol:2011;2(2):79-82 – Dr.Goutham Cugati, Dr.Pradeep Kumar Jain,Dr.Anil Pande, Dr.Nigel Peter Symss, Dr.Ravi Ramamurthi, Dr.Vasudevan
- Extradural with intradural – extramedullary and intramedullary tuberculoma of the spine without bony involvement : Pan Arab Journal of Neurosurgery, Vol.14, No.2, October 2010
- Abscess within a meningioma: Pathogenesis and rare case report – Dr.Shyam Sundar Krishnan, Manas Panigrahi, et al: Letters to Editor, Neurology India, Mar-Apr 2014, Vol.62, Issue 2
- Spinal accessory nerve schwannomas masqueriding as a fourth ventricular lesion: Case Report – Dr.Shyam Sundar Krishnan, Dr.Sivaram Bojja, Dr.M.C.Vasudevan: On Print , Journal of Neurosciences in Rural Practice
Extracranial infrasellar craniopharyngioma: Letter to Editor, Neurology India, Jan-Feb 2014, Vol.62, Issue 1
- Senthilvel HN, Krishnan SS, Vasudevan MC, Extracranial infrasellar craniopharyngioma, Neurol India. 2014 Jan-Feb;62(1):100-3
- Krishnan SS, Bojja S, Vasudevan MC, Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion, J Neurosci Rural Pract. 2015 Jan;6(1):112-5
- Krishnan SS, Panigrahi M, Pattanagare SG, Varma RD, Rao SI, Abscess within a meningioma: pathogenesis and rare case report, Neurol India. 2014 Mar-Apr;62(2):196-8
- Spinal accessory nerve schwannomas masquerading as a fourth ventricular lesion
Krishnan SS, Bojja S, Vasudevan MC Journal of Neurosciences in Rural Practice 2015 Jan; 6(1):112-5
- An observational study on outcome of hemispherotomy in children with refractory epilepsy
Panigrahi M, Krishnan SS, Vooturi S, Vadapalli R, Somayajula S, Jayalakshmi S
Accepted for publication in International Journal of Surgery
- Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia
Chidambaram S, Nair MN, Krishnan SS, Cai L, Gu W, Vasudevan MCWorld Neurosurgery 2015 Dec; 84(6):1668-73
- An observational study on outcome of hemispherotomy in children with refractory epilepsy – Panigrahi M, Krishnan SS, Vooturi S, Vadapalli R, Somayajula S, Jayalakshmi S, International Journal of Surgery 2016 Dec;36, 477-482
- Falx Stitch for retraction of the superior sagittal sinus – A technical note – Shyam Sundar Krishnan, Gowtham Devireddy, MC Vasudevan. Published in Neurology India 2016:64(5):1080
- Rare case of Intra-meatal Tuberculoma – Gowtham Devireddy, Shyam Sundar Krishnan, MC Vasudevan, Mohan Kameswaran. Accepted for publication in Neurology India, 2016
- Concurrent multilevel spinal intramedullary with extensive intracranial tuberculomas: A rare case report – Shyam Sundar Krishnan, Bhavinkumar R Patel, M C Vasudevan, AJNS, 2016: Online Publication.
‘To study the phenomena of disease without books is to sail an uncharted sea,while to
study books without patients is not to go to sea at all.’
– Sir William Osler
This page takes you to a selection of ‘online Journals’, with free texts and /or abstracts;
May require some browsing !!
Some of them require only a free online registration.
Some may need a paid subscription for full access.
Neurology & Neurosurgery
- Journal of Neurosurgery & Neurosurgical focus
- World Neurosurgery
- Neurology India
- Journal of Neurology, Neurosurgery, & Psychiatry
- British Journal of Neurosurgery
- European Neurology
- Clinical Neurology and Neurosurgery
- Canadian Neurological Sciences
- Acta Neurologica Scandinavica
- Russian Neurosurgery
- Pan Arab journal of Neurosurgery
- Korean Neurosurgery
- On the brain
- Reviews in Neurosurgery
- Critical Reviews in Neurosurgery
- Neurology Reviews
- Current treatment options
- Clinical Neurology & Neurosurgery
- BMC Neurology
- Trends in Neurosciences
- Journal of Neuroscience Research
- Journal Watch Neurology
- Internet Journal of neurology
- Neurosurgical Clinics of North America
- Indian Neurosurgery
- Archives of Neurology
- Annals of Neurosurgery
- Journal of the American Academy of Neurology
- Neurology Clinics of North America
- Surgical Neurology
- Acta Neurochirurgica
- African Neurological Sciences
- Turkish Neurosurgery
- Polish Neurosurgery and Neurology
- Neurosurgery Review
- Annual reviews-Neurosciences
- The Journal of Neuroscience
- Current opinions in Neurology
- Internet Journal of Neurosurgery
- Brain & Behaviour
- Nature Neuroscience
- Clinical & Translational Neurology
- European Spine Journal
- Journal of Spinal disorders & Techniques
- Journal of Plastic & reconstructive and aesthetic surgery
- American Journal of Neuroradiology
- Neuroimaging Clinics of North America
- Journal of emergency medicine
- Pain Physician Journal
- Journal of American Physical Therapy Association.
- Journal of Rheumatology
- Neurosurgical nursing
- Journal of Neuro-Oncology
- Neuropsychology Review
- Behavioral neurosciences
- Chemical neuroanatomy
- Cellular and Molecular Neurobiology
- Journal of Neuromonitoring
- Computational Neuroscience
- International Journal Neural systems
- Spinal Frontiers
- Journal of Peripheral nerves
- Aesthetic Plastic surgery
- Neurosurgical anesthesiology
- Journal of Pain, Symptom Control and Palliative Care
- Neurourology and Urodynamics
- Brain pathology
- Journal of Neuropathology and Experimental Neurology
- The Journal of Neuropsychiatry
- Brain and Mind
- The Journal of Mind and Behavior
- Audiology and Neuro-otology
- Neurochemical Research
- Journal of Cellular Neurocytology
- Brain Topography
- Computation in Neural systems
- The New England Journal of Medicine
- The Journal of American Medical Association
- Journal of Postgraduate Medicine
- Indian Surgery
- Indian Critical Care
- Indian Pediatrics
- Critical care Medicine
- Medical and Pediatric Oncology
- The Internet Journal of Pathology
- Law, Healthcare, and Ethics
- Medical principles, & practice
- Medical Literature guide
- British Medical Journal
- The Lancet
- The American Journal of Surgical Pathology
- World Journal of Surgery
- Mayo Clinic Proceedings
- Cambridge Journals
- Post graduate Medical Journal
- Cancer control
- Postgraduate Medicine online
- Journal of Microbiology
- Journal of Surgical Oncology
- History of Medicine
- Merck manual
- Science daily
- Pharmacy World, & Science
|1||National Medical Library||world’s largest medical library, includes Medline and Pubmed.|
|2||Neurosurgical Atlas||a must for every neurosurgical trainee|
|3||WFNS||website of the World federation of Neurosurgeons|
|4||CNS||website of the Congress of Neurological surgeons.|
|5||AASNS||website of the Asian Australasian Neurosurgeons.|
|6||NSI||website of the Neurological society of India.|
|7||NBRC||website of the National Brain Research Centre of India|
|8||Clinical evidence||for evidence based medicine.|
|9||Neurological Examination||Clinical examination guide to young neurosurgeons|
|10||Young Neurosurgeons||for selected programs and offerings of special interest to young neurosurgeons|
|11||Cochrane Reviews||for systematic reviews & evidence based health care|
|12||Guide to Brain and Mind||for a collection of links to explore brain and mind|
|13||Indmedica||for an Indian medical portal.|
|14||MedInd||for information needs of Indian medical community|
|15||Doctor’s guide||for comprehensive source for peer-reviewed literature, case studies, webcasts and more.|
|16||Neurovideos||for You tube neuro videos|
|17||Clinical trials||for recent clinical trials.|
|18||Brain-life||for a comprehensive brain tumor database|
|19||Spine Universe||spinal disorders and surgical videos.|
|20||Neurogate||for a quick neurosurgical search|
|22||NINDS||for biomedical research on disorders of the CNS|
|23||Medical News||for the latest medical news|
|24||TTMeD||for timely topics in Medicine.|
|25||Networked||for a quality blog|
|26||World Press||for an interesting blog|
|27||Medscape||for a useful blog|
|28||MD linx||for latest articles.|
|29||Merckmedicus||web resources, & e-tools for the patients and the physicians.|
|31||Medical Student||for a digital library for medical students & patients|
Brief notes on common neurological symptoms
with links to useful websites
The best prescription is knowledge
– Dr. C. Everett Koop
Tension headaches are the most common. They are from no apparent disease and are triggered by emotional stress. Women are more commonly affected. Persisting tension headaches must be investigated to rule out eye strain, dental problems, sinusitis, jaw-occlusion problems or cervical arthritis which are normally not symptomatic but present as headache precipitated by stress and should not be dismissed as psychological. Your local doctor can help.
Vascular headache is produced by a variety of blood vessel problems. Extraordinary swings in blood pressure may cause transient headache. Acute severe headache with or without disturbance in consciousness is usually due to bleeding in the brain precipitated by acute profound rise in blood pressure; or aneurysms (abnormal ballooning of blood vessel); or arteriovenous malformations (abnormal bunch of blood vessels) and requires immediate hospitalization. Inflammation of scalp blood vessels cause headache with tender spots, usually on the sides and require further investigations.
Migraine usually occurs on the one side of the head. The classic type starts with a premonitory sign such as blind spots, localized weakness or numbness which clears as the headache disappears. Nausea or vomiting may be associated. Women are more susceptible. The problem may run in families. Various medications are available for effective control. Only your doctor can select the one that suits you.
Headache is the late symptom of brain tumor. Typically the patient wakes up with headache which gets worse day by day and is associated with nausea, vomiting, visual problems and/or progressive weakness of limbs. It requires urgent investigations.
Facial pain may be sharp, short-lived and confined to one side of the face and is usually due to involvement of the nerve supplying that part of the face. They are often mistaken for tooth-ache. It is easily controlled with medication. If medication fails surgery may help.
More diffuse and chronic pain, usually called atypical facial pain, must be evaluated for more malignant causes such as throat cancer or tooth abscess..
Backache – Neck Pain
Nagging aches with no apparent precipitating cause, are usually diagnosed as ‘spondylosis’ which means aging spine. A sudden change in lifestyle may be a cause. Active sports people who give up sports abruptly and those who suddenly become health conscious and take up vigorous ‘gym-works’ are more prone. Weight reduction and graded exercises will help. Maintenance of erect posture, using a firm mattress, going down on knees to pick-up things from the floor and using western toilets instead of Indian toilets will help. If performing regular daily excercises it is essential to stretch to avoid these injuries. Adding a yoga session to your routine can be a great way to add stretching to your week.
In addition to yoga has many health benefits of yoga, as proven by science.
Persisting pain must be investigated to rule out serious problems such as cancer or infection. Investigation should also be undertaken, if the backache is associated with leg or arm pain or belt like pain around the trunk which may suggest nerve involvement. Some tumors in the spinal cord also present this way and may be associated with progressive weakness and/or numbness of limbs. Women must obtain a gynecologist’s assessment as well.
Many diseases cause transient or permanent visual loss. Transient loss (amaurosis fugax) occurs most often as a result of blood flow problem to the eye and may precede a stroke. Inflammation of the eye nerve (optic neuritis) is associated with eye pain and causes transient loss of vision, which if unattended may proceed to permanent loss. Diabetes and glaucoma (increased intra eye pressure) are other common causes of disturbed vision.
Eyes look at objects, but the brain sees them. Many disorders of the brain cause blindness. Either the whole of the visual field, or more typically part of it, is lost depending on the area of the brain involved. The brain also controls the eye ball movement which is essential for identical images in both eyes or else double vision is the result.
Obviously every visual disturbance, even if it is a transient one, should be evaluated.
Dizziness & hearing problems
Dizziness is a complaint of postural instability. Vertigo is the perception of illusory environmental rotation. Standing may be difficult with dizziness, but virtually impossible with vertigo. Either of them may result from brain or ear disease with hearing loss and/or tinnitus.
Labrynthitis (inflammatory ear disease) is presumed to be caused by viruses. It is self limiting, but can recur. Disturbance in blood flow to the brain, some brain tumors and tumors of the ear nerve are some of the serious problems that present with vertigo or dizziness and must be ruled out.
One needs an intact brain to perceive what the ears hear. Inability to recognize specific types of noise and auditory hallucinations result from involvement of specific areas in the brain and requires neurological assessment.
Tinnitus is the perception of ringing or whistling noises independent of external stimuli and usually associated with diminished hearing in one ear which may disappear when the hearing loss is total. A wide variety of medications including aspirin may induce tinnitus as a side effect. Unusual cause is a tumor in the hearing nerve.
Any patient with a personality disorder must be evaluated, even at old age. The disorder may be acute or chronic and the settings for the same involve trauma, fever, intoxication or a genetic predisposition. Excessive brain fluid accumulation in the brain (hydrocephalus) may be the cause in some. On occasions a brain tumor or blood collection inside the head may be diagnosed during evaluation of a personality disorder and requires urgent surgical attention.
Personality changes may be transient or permanent after severe head injury. Memory impairment especially for recent events is common in severe head injury. Various brain fevers may produce severe thought disorders. Hormonal disturbances such as severe hypothyroidism produce impaired memory, inattention and depression.
Degenerative diseases of the brain (Alzheimer’s the most common) slowly produce progressive dementia
Sexual & urological problems
Many sexual problems are either psychological, urological or neurological. Neurological dysfunction may arise from damage to the regional nerve, the spinal cord or the brain by trauma, infections, tumors or stroke. Diabetes and alcoholism may disturb neurological control.
Hormonal problems resulting in sterility and unsatisfactory sex may be due to a brain tumor. Impotence is the most common presenting problem. Antihypertensives and antiepileptics rarely cause impotence. In some brain problems, patients exhibit hyper sexuality and inappropriate sexual activities.
Urinary bladder control is affected in many neurological problems and associated with sexual dysfunction. As the bladder fills beyond it’s capacity, the patient develops over flow incontinence as happens in lumbosacral spinal cord or in peripheral nerve involvement. Higher spinal cord involvement results in a shrunken bladder, premature contraction of the bladder and incontinence.
Brain decides when to pass urine. When specific areas in the brain are involved incontinence results. Incontinence at sleep may be an early sign of seizure
‘Stroke’ is a sudden loss of neurological function.
Stroke is due to disturbance in blood flow to the brain. Atherosclerosis (thickening of the blood vessel wall), long standing hypertension, some heart diseases, high cholesterol, smoking and diabetes are some of the well known predisposing factors. Intracranial bleeding due to various causes can result in stroke. Inflammation of blood vessels in the brain may lead to blockage and stroke.
Stroke may be lethal if massive brain swelling or clot is associated. Some people recover completely, but most are left with residual deficit. If the patient reaches a specialized center within 6 hours of the event, newer medicines that promise complete recovery are available. In any case, especially in people under 60 years of age, every stroke must be investigated and not assumed to be due to diabetes and hypertension. Effective measures must be taken to prevent a recurrence
Seizures are episodes of disorganized electrical activity in the brain resulting in loss of consciousness and involuntary jerking of limbs with frothing in the mouth, tongue biting and urinary incontinence. The so-called ‘minor ones’ may have just abnormal behavior or sensations with no convulsions or unconsciousness.
The tendency to have recurrent seizures is called epilepsy.
During an attack the patient should be put on his side so that the froth does not go into his lungs. Some hard object in the mouth will prevent tongue biting. Convulsing limbs should not be restrained. Repeated or persistent attacks need hospitalization. Any disturbance in the brain, be it injury, tumor, stroke, infection or even a post operative scar may produce seizure.
In these days of CT & MRI scans, everyone with seizure should be investigated. Effective medications are available. In selected cases where medication does not provide adequate control, surgery may help.
Weakness may be generalized or localized to a part of the limb, whole limb or more than one limb. The muscles, regional nerve, spinal cord or brain may be involved.
In Myasthenia gravis, the patient complains of generalized weakness and/or blurred vision due to weakness of the eye muscles. The conditions can be effectively treated, unlike hereditary involvement of the muscles (various myopathies) which show up later in life and has no satisfactory treatment.
A regional nerve may be involved locally or at the exit from the spinal cord, as happens in prolapsed discs. The part of the limb supplied by the nerve is usually affected with numbness and/or pain. When the whole limb or more is involved, usually the spinal cord or the brain is at fault.
Causes may be toxins and diabetes. Surgically amenable causes may be local entrapment of nerves, prolapsed discs, and tumors of nerves and/or the spinal cord and brain disorders. Infections may require surgery.
Trauma to the muscle, nerve, spinal cord or the brain is another obvious cause and healing may be facilitated with immediate medical attention. A thorough assessment by a neurologist will help.