Dr Lokesh Mahajan

18/04/2025

14/07/2024

STROKE

Stroke is a disease of cerebro-vascular system. It is a disease of blood vessels that carry blood from heart to brain.

Types Of Stroke:

1. Ischemic (85% cases)
- Thrombotic
- Embolic
2. Hemorrhagic (15% cases)

Risk Factors:

- Diabetes
- Hypertension
- Hypercholesterolemia / Atherosclerosis
- Obesity
- Cigarette Smoking
- Cardiac Disease
- Old Age
- Hypercoagulable states

Symptoms:

- Sudden onset of weakness / Numbness one side of body
- Sudden onset facial weakness on one side
- Sudden onset visual disturbance, speech disturbance
- Sudden loss of consciousness, altered sensorium
- Severe headache, seizures, vomiting and other features suggestive of raised intracranial pressure (more in hemorrhagic stroke).

Investigations:

- NCCT (Noncontrast) head to rule out any hematoma. Infarct may not be seen in early stages on NCCT head.
- MRI BRAIN to see the infarct in early stages.
- Bilateral Carotid Doppler / MR ANGIO BRAIN AND NECK / CT ANGIO BRAIN AND NECK to look for the significant occlusion in neck vessels as a cause of stroke.
- ECG / 2D ECHO to look for cardioembolic stroke
- LIPID PROFILE to look for hypercholesterolemia
- Thrombophilia profile, Serum Homocysteine and Antiphospholipid antibodies to look for Hypercoagulable states

Treatment:

Early management is the key
ACT FAST :
- Face weakness
- Arm / leg weakness
- Speech disturbance
Time to call ambulance immediately.

A)Intravenous Thrombolysis:

If patient has presented within 4-5 hrs of onset of symptoms and CT head does not show any hematoma
- Can bring rapid resolution of symptoms
- Can cause hemorrhagic complications in some patients

B) Mechanical Thrombectomy:

If patient has presented within 24hrs of onset of symptoms and imaging studies show a large vessel occlusion
- Similar to thrombolysis, it can also cause hemorrhagic complications in some

C) Antiplatelets to all patients of thrombotic stroke

D) Anticoagulants in patients with cardioembolic stroke and other hypercoagulable states

E) Statins to all patients as they are cardioprotective

F) Antiedema measures may be required

G) Surgical evacuation of hematoma and decompressive craniectomy for large infarct with mass effect may be required in some patients

H) Rehabilitation in the form of regular physiotherapy is must

Prognosis:

- Time is the key
- Every minute saved is vital
- So early consultation can prove very valuable in the final outcome

07/07/2024

HEADACHE
Headache as a symptom is quite common. Most headaches are benign but some headaches can be mysterious and may require a detailed evaluation. Sometimes even a benign headache can be very severe so as to incapacitate a person from doing his routine activities. However, with proper treatment most headaches can be cured.

Migraine
- More common in young and middle aged females although males are also affected
- Pulsating / throbbing in character
- Mostly unilateral ( only on one side ) although sides may alternate
- Precipitated by hunger, stress, lack of sleep, weather changes, menstrual cycles, coffee intake, chocolate etc.
- Intensity may vary from mild to severe frequency can vary from 1 attack in a month to many attacks in a day
- Pain can be relived by rest, sleep, analgesics
- The headache may be associated with nausea vomiting
- May also complaint of intolerance to light, sound
- May be associated with flashes of light, blind spots, tingling in hand or face during an attack
- Pain increases in intensity gradually and subsides gradually
- Pain may occur at any time of the day

Cluster headache
- Similar to migraine
- Mostly seen in males
- Pain around the orbit on one side
- Usually severe in intensity
- May be associate with redness of eye on involved side, stuffy / runny nose , excessive tearing
- May have intolerance to sound / light like migraine
- Headache usually occurs in bouts with each bout lasting from a few days to months followed by a remission period which may last for few months before another bout
- Headache usually occurs every day - during a bout
- Pain mostly occurs at night , may awake from sleep
- Pain starts abruptly and stops abruptly

Tension headache
- Usually associated with stress
- Affects both males and females and all age groups
- Patient feels a tight band like compression around forehead
- Associated with muscles spasm
- May develop after long drives or after sitting in front of TV, laptops for prolonged periods
- Mild, moderate, severe

Sinus headache
- Seen in patients with sinusitis / chronic nasal obstruction
pain or fullness and around the eyes cheeks or forehead
may be aggravated by bending forward
- Lasts few days unlike other types of headache where pain lasts a few hours

31/10/2022

Act F.A.S.T. in Stroke!
F : Facial Weakness
A : Arm(Leg) Weakness
S : Speech Disturbance
T : Time to act
So, let's act FAST and save valuable lives !!..

19/09/2020

SPINAL TUMOR

Spinal cord is present inside the vertebral column and is a continuation of brain. Just like the brain, the spinal cord is covered by 3 meninges from the inside out: pia mater, arachnoid and dura mater. Spinal cord is broadly divided into 3 segments: cervical, thoracic, and lumbosacral.

Spinal tumors may be benign, malignant and metastatic.

On the basis of location, Spinal tumors can be classified as:
1) Extradural Tumors (outside dura mater ) e.g - Lipoma, metastatic from lung and breast cancer
2) Intradural (inside dura mater) :
a) Extramedullary (outside spinal cord parenchyma) e.g - Schwannoma, Neurofibroma, Meningioma.
b) Intramedullary (inside spinal cord parenchyma) e.g - Astrocytoma

SYMPTOMS :

- Often non-specific which may cause a delay in diagnosis
- Pain in the back (Often at night when patient lies down)
- Weakness in the limbs and the muscles below a particular level
- Decreased sensation, tingling, numbness in the body below a particular level
- Bladder/bowel disturbances may be present
- Pain may be totally absent in some cases

INVESTIGATIONS :

- Neurological examination
- MRI, which is the mainstay of diagnosis
- CT scan may be done to see bony involvement
- PET scan may be done to look for metastasis
- Bone scan may be done for tumors involving bone

TREATMENT :

1. Surgery: Mainstay of Treatment
- For extradural and intradural extramedullary tumors, gross total resection is attempted
- For intramedullary tumors maximum, safe resection is the goal

Specimen is sent for biopsy
Surgery should be ideally done with neuromonitoring techniques to minimize post operate deficits

2. Chemotherapy / Radiotherapy may be given in malignant/metastatic tumors depending on the nature of the tumor

3. Steroids may be given if evidence of spinal cord compression

Overall prognosis is affected if treatment is initiated late.
So early treatment is the key.

25/08/2020

Sciatica

Sciatica is the pain occurring along the path of sciatic nerve.

Sciatic nerve arises from back in the region of lumbar spine and travels downward through buttock and thigh into the leg. In sciatica, pain can be present anywhere along the path of sciatic nerve, usually on one side only.

CAUSES :-

 Herniated lumbar disc is the most common cause as it compresses the nerve in the lumbar spine.
 Other less common causes include bony spur which may cause compression of the nerve, spinal infections, neoplasm, diabetes.

RISK FACTORS :-

 Obesity / sedentary life style
 Wrong posture
 Smoking
 Lifting heavy weights
 Increasing age
 Diabetes

SYMPTOMS :-

 Pain radiating along the course of sciatic nerve may be sharp, shooting, severe pain. Sometimes the pain can be mild
 Some patients also have tingling / numbness in the affected leg
 Rarely bladder / bowel disturbances / weakness of muscles of affected leg

PREVENTION AND TREATMENT :-

 Mostly responds to medical management with the use of simple analgesics, opiates, drugs that help in relieving neuropathic pain like gabapentin, pregablin
 Vitamin B12 supplements
 Adoption of correct posture
 Quit smoking
 Reduction of extra weight
 Physiotherapy and active life style

07/08/2020

BRAIN TUMORS

Brain is a very complex organ. In spite of the advancements that have been made in the field of science over last 50 years, the brain still remains a mysterious organ. So the treatment and surgical management of brain diseases, especially brain tumors remains a challenging task. Although with the advent of latest microscopic and endoscopic brain surgery techniques, we can reach deeper areas of brain which were previously considered inaccessible, still a lot of aspects remain unexplored. Data suggests that there has been tremendous improvement in the outcome of brain tumor surgeries in last 20-30 years.

There are different types of brain tumour depending on the cell of origin. Some are benign, others are malignant / metastatic. Typical examples are Gliomas, meningimas, pituitary tumors, hemangioblastomas, Ependymomas, medulloblastomas etc. Benign tumors are those which are slow growing, remain confined to their site of origin. Malignant tumors spread to distant areas like lungs. Metastatic Brain Tumor are those in which tumor originated at a site other than brain but have spread to involve brain also eg. Lung and breast cancer, kidney cancer.

Symptoms gradually progressive

Symptoms of raised intracranical pressure like headache, vomiting, altered sensorium, blurred vision
Seizures
Weakness, paresthesias on one side of body
Cognitive impairment, Psychiatric disturbances.
Speech impairment.

Investigations

CT, MRI, MR Spectroscopy
If malignancy suspected PET-CT whole body

Treatment Options

Surgery : Surgery is the mainstay of treatment of brain tumors.

Maximal safe resection is the goal of surgery in most of the tumors especially if tumor is present in critical areas such as areas responsible for speech, movements, cognition, memory.

Now with the availability of intra operative monitoring techniques, tumors can be removed from critical areas without causing any damage. The discovery of operating microscope has made it possible to remove maximum tumor enabling Gross Total Resections.

Chemotherapy / Radiotherapy.
They are used in malignant / metastatic tumors to control the spread of tumors.