TREATMENTS

Stroke

A stroke, sometimes referred to as a cerebrovascular accident (CVA), is the rapid loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood flow) caused by blockage (thrombosis, arterial embolism), or a hemorrhage. As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to seeone side of the visual field. A stroke is a medical emergency and can cause permanent neurological damage and death. Risk factors for stroke include old age, high blood pressure, previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, tobacco smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke. It is the second leading cause of death worldwide. An ischemic stroke is occasionally treated in a hospital with thrombolysis (also known as a "clot buster"), and some hemorrhagic strokes benefit from neurosurgery. Treatment to recover any lost function is termed stroke rehabilitation, ideally in a stroke unit and involving health professions such as speech and language therapy,physical therapy and occupational therapy. Prevention of recurrence may involve the administration of antiplatelet drugs such as aspirin and dipyridamole, control and reduction of high blood pressure, and the use of statins. Selected patients may benefit from carotid endarterectomy and the use of anticoagulants.

Stroke

Ischemic Stroke

Acute Ischemic Stroke What is an Ischemic Stroke? A stroke happens when the blood supply to part of the brain is cut off because atherosclerosis or a blood clot has blocked a blood vessel. Blood clots can travel to the brain from another artery (artery-to-artery embolization) or they can come from the heart (cardioemblic stroke). Loss of blood to the brain can be due to many reasons, here are a few:

Ischemic Stroke

Brain Aneurysm

A brain aneurysm is a balloon or bubble-like growth that typically develops where a major artery branches into smaller arteries, often at the base of the brain.

Aneurysms have the potential to leak or rupture, causing bleeding into the brain or the surrounding area called the subarachnoid space. This subarachnoid hemorrhage can cause a stroke, leading to brain damage or death.

About 3 percent to 5 percent of the American population is affected by a brain aneurysm. The condition most commonly affects adults between the ages of 35 to 60 years old, although children can develop aneurysms. Aneurysms affect women more frequently than men. They can develop from continuous wear and tear on the artery walls and can be caused by factors such as genetics, injury or infection

Carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is a median entrapment neuropathy that causesparesthesia, pain, numbness, and other symptoms in the distribution of the median nervedue to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression of the median nerve traveling through the carpal tunnel. It appears to be caused by a combination of genetic and environmental factors. Some of the predisposing factors include: diabetes, obesity, pregnancy, hypothyroidism, and heavy manual work or work with vibrating tools. There is, however, little clinical data to prove that lighter, repetitive tasks can cause carpal tunnel syndrome. Other disorders such as bursitis and tendinitis have been associated with repeated motions performed in the course of normal work or other activities.

The main symptom of CTS is intermittent numbness of the thumb, index, long and radial half of the ring finger. The numbness often occurs at night, with the hypothesis that the wrists are held flexed during sleep. Recent literature suggests that sleep positioning, such as sleeping on one's side, might be an associated factor. It can be relieved by wearing awrist splint that prevents flexion. Long-standing CTS leads to permanent nerve damage with constant numbness, atrophy of some of the muscles of the thenar eminence, and weakness of palmar abduction.

Pain in carpal tunnel syndrome is primarily numbness that is so intense that it wakes one from sleep. Pain in electrophysiologically verified CTS is associated with misinterpretation of nociception and depression.

Conservative treatments include use of night splints and corticosteroid injection. The only scientifically established disease modifying treatment is surgery to cut the transverse carpal ligament.

Migraine

Migraine is a chronic neurological disorder characterized by recurrent moderate to severeheadaches often in association with a number of autonomic nervous system symptoms. The word derives from the Greek ἡμικρανία (hemikrania), "pain on one side of the head",from ἡμι- (hemi-), "half", and κρανίον (kranion), "skull".

Typically the headache is unilateral (affecting one half of the head) and pulsating in nature, lasting from 2 to 72 hours. Associated symptoms may include nausea, vomiting,photophobia (increased sensitivity to light), phonophobia (increased sensitivity to sound) and the pain is generally aggravated by physical activity. Up to one-third of people with migraine headaches perceive an aura: a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur. Occasionally an aura can occur with little or no headache following it.

Migraines are believed to be due to a mixture of environmental and genetic factors.About two-thirds of cases run in families. Fluctuating hormone levels may also play a role, as migraines affect slightly more boys than girls before puberty, but about two to three times more women than men. Propensity for migraines usually decreases during pregnancy. The exact mechanisms of migraine are not known. It is, however, believed to be a neurovascular disorder. The primary theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem.

Initial recommended management is with simple analgesics such as ibuprofen andparacetamol (also known as acetaminophen) for the headache, an antiemetic for the nausea, and the avoidance of triggers. Specific agents such as triptans or ergotaminesmay be used by those for whom simple analgesics are not effective. Globally, approximately 15% of the population is affected by migraines at some point in life.

Sleep disorder

sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental and emotional functioning. Polysomnography is a test commonly ordered for some sleep disorders.

Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) tonight terrors. When a person suffers from difficulty falling asleep and staying asleep with no obvious cause, it is referred to as insomnia. Dyssomnia refers to a group of sleep disorders with the symptoms of trouble falling asleep or maintaining sleep, which may cause an elevated sense of sleepiness during the day. Insomnia is characterized by an extended period of symptoms including trouble with retaining sleep, fatigue, decreased attentiveness, and dysphoria. To diagnose insomnia, these symptoms must persist for a minimum of 4 weeks. The DSM-IVcategorizes insomnias into primary insomnia, insomnia associated with medical or mental diseases, and insomnia associated with the consumption or abuse of substances. Individuals with insomnia often worry about the negative health consequences, which can lead to the development of anxiety and depression. In addition, sleep disorders may also cause sufferers to sleep excessively, a condition known as hypersomnia. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.

Radiculopathy

Radiculopathy refers to a set of conditions in which one or more nerves is affected and does not work properly (a neuropathy). The emphasis is on the nerve root (radix = "root"). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles. In a radiculopathy, the problem occurs at or near the root of the nerve, along the spine. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacralspine can be manifested with symptoms in the foot.

The radicular pain that results from a radiculopathy should not be confused with referred pain, which is different both in mechanism and clinical features.

Peripheral neuropathy

Peripheral neuropathy (PN) is damage or disease affecting nerves, which may affect sensation, movement, gland or organ function, and other aspects of health, depending on the type of nerve affected. Common causes include systemic diseases (such as diabetesor leprosy), vitamin deficiency, medication (e.g., chemotherapy), traumatic injury, excessive alcohol consumption, immune system disease or infection, or it may be inherited (present from birth). In conventional medical usage, the word neuropathy(neuro- + -pathy) without modifier usually means peripheral neuropathy.

Neuropathy affecting just one nerve is called "mononeuropathy" and neuropathy involving multiple nerves in roughly the same areas on both sides of the body is called "symmetrical polyneuropathy" or simply "polyneuropathy." When two or more (typically just a few, but sometimes many) separate nerves in disparate areas of the body are affected it is called "mononeuritis multiplex," "multifocal mononeuropathy" or "multiple mononeuropathy."

Peripheral neuropathy may be chronic (a long term condition where symptoms begin subtly and progress slowly) or acute (sudden onset, rapid progress and slow resolution). Acute neuropathies demand urgent diagnosis. Motor nerves (that control muscles),sensory nerves, or autonomic nerves (that control automatic functions such as heart rate, body temperature and breathing), may be affected. More than one type of nerve may be affected at the same time. Peripheral neuropathies may be classified according to the type of nerve predominantly involved, or by the underlying cause. Where the cause is unknown it is described as idiopathicneuropathy.

Neuropathy may cause painful cramps, fasciculations (fine muscle twitching), muscle loss, bone degeneration, and changes in the skin, hair, and nails. Additionally, motor neuropathy may cause impaired balance and coordination or, most commonly, muscle weakness; sensory neuropathy may cause numbness to touch and vibration, reduced position sense causing poorer coordination and balance, reduced sensitivity to temperature change and pain, spontaneous tingling or burning pain, or skin allodynia (severe pain from normally nonpainful stimuli, such as light touch); and autonomic neuropathy may produce diverse symptoms, depending on the affected glands and organs, but common symptoms are poor bladder control, abnormal blood pressure or heart rate, and reduced ability to sweat normally.

Neuromuscular disease

Neuromuscular disease is a very broad term that encompasses many diseases and ailments that impair the functioning of the muscles, either directly, being pathologies of the muscle, or indirectly, being pathologies of nerves or neuromuscular junctions.

Neuromuscular diseases are those that affect the muscles and/or their direct nervous system control. In general, problems with central (or upper motor neuron) nervous control can cause either spasticity (from upper motor neuron conditions) or some degree of paralysis (from both lower and upper motor neuron disorders, upper motor neuron conditions usually being associated with concurrent hyperreflexia), depending on the location and the nature of the problem. A large proportion ofneurological disorders leads to problems with movement. Some examples of central (or upper motor neuron) disorders includecerebrovascular accident (stroke), Parkinson's disease, multiple sclerosis, Huntington's disease (Huntington's chorea) and Creutzfeldt–Jakob disease. Spinal muscular atrophies are disorders of lower motor neuron while amyotrophic lateral sclerosis is a mixed upper and lower motor neuron condition. Neuropathies involve dysfunction of the peripheral nerves, which consist of: motor neurons, which carry the electrical signals directly from the spinal cord and brain stem to activate muscle movement; the sensory neurons which convey sensory information such as pain, temperature, light touch, vibration and position to the brain; and the autonomic neurons which go to the internal organs and control blood vessel reflexes. Myasthenia gravis and Lambert–Eaton syndrome are examples of neuromuscular junction disorders. Muscular dystrophies and inflammatory myopathies such as polymyositis are examples of primary muscular (myopathic) disorders.

Amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS), often referred to as "Lou Gehrig's Disease," is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their death. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. With voluntary muscle action progressively affected, patients in the later stages of the disease may become totally paralyzed.

A-myo-trophic comes from the Greek language. "A" means no or negative. "Myo" refers to muscle, and "Trophic" means nourishment–"No muscle nourishment." When a muscle has no nourishment, it "atrophies" or wastes away. "Lateral" identifies the areas in a person's spinal cord where portions of the nerve cells that signal and control the muscles are located. As this area degenerates it leads to scarring or hardening ("sclerosis") in the region.

As motor neurons degenerate, they can no longer send impulses to the muscle fibers that normally result in muscle movement. Early symptoms of ALS often include increasing muscle weakness, especially involving the arms and legs, speech, swallowing or breathing. When muscles no longer receive the messages from the motor neurons that they require to function, the muscles begin to atrophy (become smaller). Limbs begin to look "thinner" as muscle tissue atrophies.

Epilepsy

Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes EEG testing, clinical history, family history and outlook are similar among a group of people with epilepsy. In these situations, their condition can be defined as a specific epilepsy syndrome. The human brain is the source of human epilepsy. Although the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, how it spreads and how much of the brain is affected, and how long it lasts all have profound effects. These factors determine the character of a seizure and its impact on the individual. Having seizures and epilepsy also can also affect one's safety, relationships, work, driving and so much more. How epilepsy is perceived or how people are treated (stigma) often is a bigger problem than the seizures.

Dementia

Dementia is a collective term used to describe the problems that people with various underlying brain disorders or damage can have with their memory, language and thinking. Alzheimer's disease is the best known and most common disorder under the umbrella of dementia. Dementia is not a single disease in itself, but a general term to describe symptoms such as impairments to memory, communication and thinking. While the likelihood of having dementia increases with age, it is not a normal part of aging. Before we had today's understanding of specific disorders, "going senile" used to be a common phrase for dementia ("senility"), which misunderstood it as a standard part of getting old.

Light cognitive impairments, by contrast, such as poorer short-term memory, can happen as a normal part of aging (we slowly start to lose brain cells as we age beyond our 20s). This is known as age-related cognitive decline, not dementia, because it does not cause the person or the people around them any problems.

Myopathy

In medicine, a myopathy is a muscular disease in which the muscle fibers do not function for any one of many reasons, resulting in muscular weakness. "Myopathy" simply means muscle disease. This meaning implies that the primary defect is within the muscle, as opposed to the nerves ("neuropathies" or "neurogenic" disorders) or elsewhere (e.g., the brain etc.). Muscle cramps, stiffness, and spasm can also be associated with myopathy. Muscular disease can be classified as neuromuscular or musculoskeletal in nature. Some conditions, such as myositis, can be considered both neuromuscular and musculoskeletal. Because different types of myopathies are caused by many different pathways, there is no single treatment for myopathy. Treatments range from treatment of the symptoms to very specific cause-targeting treatments. Drug therapy, physical therapy, bracing for support, surgery, and even acupuncture are current treatments for a variety of myopathies.

Headache

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain as it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Nine areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes. There are a number of different classification systems for headaches. The most well-recognized is that of the International Headache Society. Headache is a non-specific symptom, which means that it has many possible causes. Treatment of a headache depends on the underlying cause, but commonly involves pain killers.

Movement Disorders

Movement disorders are neurological syndromes where they may be excess of movement or a paucity of movement that is not connected to weakness, paralysis of spasticity of the muscles. They affect the speed, fluency or smoothness, quality, and ease of movement.

Most movement disorders begin slowly and progress to a more severe form if left untreated. Sometimes they begin as weakness or stiffness of muscles or there may be twitches and tics. Given that movement and gait are complex phenomenon, problems with them are widespread since minor changes in the pathways and components of movement may affect smooth workings of motion. The most common movement disorder is essential tremor. It affects one in 20 people under the age of 40 and one in five people over 65. The disorder is characterized by shaking of the hand or fingers when it attempts to perform a task.