The Rukmani Birla Hospital treats a wide range of neurological conditions. The nervous system and how nerves affect cognition are both affected by neurological illnesses. RBH's clinical purpose is to provide the finest quality care and treatment for patients with neurological disorders, while also learning more about the causes and cures of neurological diseases.

Treatment offered for

Stroke Stroke is a condition in which the arteries leading to and inside the brain get blocked. When a blood vessel carrying oxygen and nutrients to the brain is either clogged or bursts, a stroke occurs. Stroke is one of the largest causes of adult disability in the country.

There are three main types of stroke:

• Transient ischemic attack (TIA)
• Ischemic stroke

• Hemorrhagic stroke

Signs & Symptoms of Stroke

• Sudden confusion or difficulty in speaking or understanding speech
• Sudden numbness, weakness or paralysis in the face, arm or leg, often on one side of the body
• Sudden trouble seeing in one or both eyes. This can include blurred, blackened or double vision.
• Sudden severe headache with no known cause, possibly accompanied by vomiting
• Sudden trouble walking, dizziness or a loss of balance or coordination

Identify Stroke emergency with this acronym- B.E.F.A.S.T

• Balance or dizziness
• Eyesight is blurry or lost in one or both eyes
• Face or smile is uneven
• Arm is suddenly weak
• Speech is slurred or hard to understand
• Time is critical; call an ambulance.

Treatment option for Stroke :

• Thrombolysis
• Intervention - Thrombectomy
• Medical Management.

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Brain Haemorrhage A brain bleed (also known as a brain haemorrhage or a brain bleed) can occur as a result of an accident, a brain tumour, a stroke, or high blood pressure caused by congenital or other medical disorders. A bleed in the brain can limit oxygen delivery, increase pressure in the brain, and destroy brain cells. It's critical to seek treatment as soon as possible if you're experiencing signs of a brain bleed.

Symptoms of brain haemorrhage may include:

• Sudden or severe headache
• Weakness, tingling or numbness in the arms or legs (often on one side)
• Nausea or vomiting
• Changes in vision
• Changes in balance
• Difficulty speaking or understanding speech
• Difficulty using fine motor skills
• Seizures
• Loss of consciousness

There are various types of brain hemorrhages, like:

• Intracerebral hemorrhage
• Subarachnoid hemorrhage
• Subdural hemorrhage
• Epidural hemorrhage

A significant brain hemorrhage might necessitate surgery. Surgical intervention could be used to reduce some of the strain on the brain. A surgeon may remove portion of the skull and clip the artery if a burst cerebral aneurysm causes a bleed, known as craniotomy.

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Movement Disorders The loss of voluntary movement is a symptom of movement disorders, which are a range of neurological conditions. Excessive movement is a symptom of some movement disorders, whereas reduced movement is a symptom of others, and some other movement disorders have both.

RBH offers comprehensive care for a range of movement disorders including:

• Parkinson’s disease: Parkinson's disease is a degenerative ailment that affects the nerve cells, or neurons, that control movement in the brain. A group of nerve cells in the brain that generate the neurotransmitter deteriorate in Parkinson's disease. The basic symptoms of Parkinson's disease are tremors, slowness of movement, muscle stiffness, and balance issues.
• Ataxia: Ataxia refers to a lack of coordination. When executing voluntary movements, people with ataxia have trouble with balance and coordination. The term "ataxia" does not refer to a specific condition.
• Dystonia: Dystonia is a movement disorder in which muscles tense and spasms involuntarily. Opposing muscles frequently contract at the same time, putting the affected body part into unpleasant and painful repetitious and even forceful twisting movements or abnormal, uneven postures.
• Essential Tremor: Essential tremor is a neurological condition characterised by repetitive shaking of the hands, legs, voice, trunk, and head. Essential tremor is not linked to any other disorder, despite the fact that it is frequently confused with Parkinson's disease. Except for stroke, it is the most frequent of all neurologic illnesses. It's even more prevalent than Parkinson's.
• Tic Disorders: Tic disorders are characterised by quick, rapid movements and sounds that are involuntary and generally recurrent. They can affect any region of the body. Their cause is unknown, though it is possible that they are hereditary. Tics are classified as simple (affecting one set of muscles) or complicated (affecting numerous groups of muscles) depending on where they occur on the body (affecting multiple muscle groups).

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Epilepsy Epilepsy is a neurological disorder that causes seizures, which are brief periods of twitching and convulsions. When the brain's electrical impulses function inappropriately and produce unpredictable messages, seizures occur.

The primary symptom of epilepsy is a seizure. But there are different types of seizures with different symptoms. These are some symptoms of seizures:

• Slight twitching of all or parts of the body, including arms, hands, and legs
• Convulsions that affect the entire body
• Loss of consciousness
• Twitching of the face
• Affected speech
• A sudden stillness with a blank stare
• Temporary loss of control of your bladder or bowels

Treatment of epilepsy may include:

•Lifestyle modifications
• Diet therapy
• Medical management
• Surgery - Responsive neurostimulation (RNS), Vagus nerve stimulation (VNS) & Deep brain stimulation (DBS)

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Headaches & Migraine Headache: The pain or discomfort in your head or face is known as a headache. Most individuals get mild headaches now and then, but they can sometimes be severe, chronic, and debilitating. Headaches come in a variety of forms: Tension, sinus, cluster, rebound & migraine.
Headaches have a variety of symptoms, depending upon the type of headache.

Symptoms of Tension headache:

• Slow onset of head pain
• Pain in both sides of the head
• Dull pain that feels like a band or vice
• Pain in the back of the head or neck

Symptoms of migraine headache

• Lightheadedness
• Light sensitivity and other visual disturbances
• May occur with or without an aura phase, meaning it may involve:
• Hallucinations
• Numbness
• Changes in speech or weakness

Symptoms of cluster headache:

• Severe pain on one side of the head, usually behind one eye
• A droopy, red or swollen eyelid or a small pupil
• Runny nose or congestion
• Swelling of the forehead

Treatment offered:

• Lifestyle changes
• Avoiding migraine triggers
• Stress management
• Medication
• Oxygen therapy to stop attacks
• Nasal spray
• Rest

Migraine: Migraines are a form of headache that occurs on a regular basis. They generate throbbing or pulsing pain that ranges from mild to severe. Usually, the pain is on one side of your head. Other symptoms, such as nausea and weakness, may also be present. You can be light and sound sensitive.

Symptoms of Migraine:

• Prodrome This stage can begin up to 24 hours before you get a migraine. Food cravings, inexplicable mood swings, uncontrolled yawning, fluid retention, and increased urination are early signs and symptoms.
• Aura You may notice flashing or brilliant lights, as well as zig-zag lines if you are experiencing this phase. Muscle weakness may occur, as well as the sensation of being touched or gripped. A migraine aura might occur just before or during the headache.
• Headache A migraine usually starts gradually and then becomes more severe. It typically causes throbbing or pulsing pain, which is often on one side of your head. But sometimes you can have a migraine without a headache. Other migraine symptoms may include increased sensitivity to light, noise, and odours, Nausea and vomiting
• Postdrome: After a migraine, you may feel weary, weak, and disoriented. This can linger for several hours or even a day.

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The RBH Neurosurgery team is dedicated to delivering excellent, holistic, comprehensive care to patients needing neurological intervention, utilising cutting-edge technology and emerging treatment approaches.

Treatment offered for

Brain Tumor A brain tumor is a mass or growth of abnormal cells in your brain. Many different types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant). Brain tumors can begin in your brain (primary brain tumors), or cancer can begin in other parts of your body and spread to your brain (secondary, or metastatic, brain tumors). How quickly a brain tumor grows can vary greatly. The growth rate as well as location of a brain tumor determines how it will affect the function of your nervous system. Brain tumor treatment options depend on the type of brain tumor you have, as well as its size and location.

Symptoms
The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor's size, location and rate of growth.
General signs and symptoms caused by brain tumors may include:

• New onset or change in pattern of headaches
• Headaches that gradually become more frequent and more severe
• Unexplained nausea or vomiting
• Vision problems, such as blurred vision, double vision or loss of peripheral vision
• Gradual loss of sensation or movement in an arm or a leg
• Difficulty with balance
• Speech difficulties
• Confusion in everyday matters
• Personality or behavior changes
• Seizures, especially in someone who doesn't have a history of seizures
• Hearing problems

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Spinal Tumors A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign (non-cancerous) or malignant (cancerous). Primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from cancer spreading from another site to the spine.

Spinal tumors may be referred to by the region of the spine in which they occur. These basic areas are cervical, thoracic, lumbar and sacrum. Additionally, they also are classified by their location in the spine into three major groups: intradural-extramedullary, intramedullary and extradural.

Symptoms
Non-mechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumors. This back pain is not specifically attributed to injury, stress or physical activity. However, the pain may increase with activity and is often worse at night. Pain may spread beyond the back to the hips, legs, feet or arms and may worsen over time — even when treated by conservative, nonsurgical methods that can often help alleviate back pain attributed to mechanical causes. Depending on the location and type of tumor, other signs and symptoms can develop, especially as a malignant tumor grows and compresses on the spinal cord, the nerve roots, blood vessels or bones of the spine. Impingement of the tumor on the spinal cord can be life-threatening in itself.

Additional symptoms can include the following:

• Loss of sensation or muscle weakness in the legs, arms or chest
• Difficulty walking, which may cause falls
• Decreased sensitivity to pain, heat and cold
• Loss of bowel or bladder function
• Paralysis that may occur in varying degrees and in different parts of the body, depending on which nerves are compressed
• Scoliosis or other spinal deformity resulting from a large, but benign tumor

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Aneurysm An aneurysm occurs when an artery's wall weakens and causes an abnormally large bulge. This bulge can rupture and cause internal bleeding. Although an aneurysm can occur in any part of your body, they're most common in the:

• Brain
• Aorta
• Legs
• Spleen

What causes an aneurysm? Although the exact cause of an aneurysm is unclear, certain factors contribute to the condition. For example, damaged tissue in the arteries can play a role. The arteries can be harmed by blockages, such as fatty deposits. These deposits can trigger the heart to pump harder than necessary to push blood past the fatty build-up. This stress can damage the arteries because of the increased pressure.

Atherosclerotic disease Atherosclerotic disease can also lead to an aneurysm. People with atherosclerotic disease have a form of plaque buildup in their arteries. Plaque is a hard substance that damages the arteries and prevents blood from flowing freely.

High blood pressure High blood pressure may also cause an aneurysm. The force of your blood as it travels through your blood vessels is measured by how much pressure it places on your artery walls. If the pressure increases above a normal rate, it may enlarge or weaken the blood vessels.
Blood pressure for an adult is considered normal at or below 120/80 mm Hg, or millimeters of mercury.
A significantly higher blood pressure can increase the risk for heart, blood vessel, and circulation problems. Higher-than-normal blood pressure doesn’t necessarily put you at risk for an aneurysm.

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AVM (Arteriovenous Malformation) Arteriovenous malformation is an abnormal connection between arteries and veins, bypassing the capillary system. This vascular anomaly is widely known because of its occurrence in the central nervous system (usually cerebral AVM), but can appear in any location. Although many AVMs are asymptomatic, they can cause intense pain or bleeding or lead to other serious medical problems.

AVMs are usually congenital and belong to the RASopathies. The genetic transmission patterns of AVMs are incomplete, but there are known genetic mutations (for instance in the epithelial line, tumor suppressor PTEN gene) which can lead to an increased occurrence throughout the body.

Signs and symptoms Symptoms of AVM vary according to the location of the malformation. Roughly 88% of people with an AVM are asymptomatic; often the malformation is discovered as part of an autopsy or during treatment of an unrelated disorder (called in medicine an "incidental finding"); in rare cases, its expansion or a micro-bleed from an AVM in the brain can cause epilepsy, neurological deficit, or pain.

The most general symptoms of a cerebral AVM include headaches and epileptic seizures, with more specific symptoms occurring that normally depend on the location of the malformation and the individual. Such possible symptoms include:

• Difficulties with movement coordination, including muscle weakness and even paralysis;
• Vertigo (dizziness);
• Difficulties of speech (dysarthria) and communication, such as aphasia;
• Difficulties with everyday activities, such as apraxia;
• Abnormal sensations (numbness, tingling, or spontaneous pain);
• Memory and thought-related problems, such as confusion, dementia or hallucinations.

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Spinal Fracture Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can cause bone fragments to pinch and damage the spinal nerves or spinal cord. Most spinal fractures occur from car accidents, falls, gunshot, or sports. Injuries can range from relatively mild ligament and muscle strains, to fractures and dislocations of the bony vertebrae, to debilitating spinal cord damage. Depending on how severe your injury is, you may experience pain, difficulty walking, or be unable to move your arms or legs (paralysis). Many fractures heal with conservative treatment; however severe fractures may require surgery to realign the bones.

What are spinal fractures? Spinal injuries can range from relatively mild ligament and muscle strains (such as whiplash), to fractures and dislocations of the bony vertebrae, to debilitating spinal cord injuries. Spinal fractures and dislocations can pinch, compress, and even tear the spinal cord. Treatment of spinal fractures depends on the type of fracture and the degree of instability.

Whiplash Whiplash is a common injury to the neck caused by hyperextension or rapid back and forth motion of the head - most often in a car accident. The jerking motion strains the muscles and ligaments of the neck and may cause the discs to bulge. Whiplash can lead to headaches, stiff muscles, or neck pain. It is important that a doctor examine a spine injury carefully. Whiplash is different than a spinal fracture or spinal cord injury and the symptoms usually improve with conservative treatment.

Spinal instability Spinal instability is the excessive motion between vertebrae caused by stretched or torn ligaments and broken bone. Abnormal slipping and rubbing motions can cause pain and damage the spinal nerves or spinal cord. Stable fractures can usually be treated with bracing and rest. Unstable fractures usually require surgery to realign the bones and prevent spinal cord or nerve injury.

What are the symptoms? Symptoms of a spinal fracture vary depending on the severity and location of the injury. They include back or neck pain, numbness, tingling, muscle spasm, weakness, bowel/bladder changes, and paralysis. Paralysis is a loss of movement in the arms or legs and may indicate a spinal cord injury. Not all fractures cause spinal cord injury and rarely is the spinal cord completely severed.

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Head Injury Head injuries are dangerous. They can lead to permanent disability, mental impairment, and even death. To most people, head injuries are considered an acceptable risk when engaging in sports and other types of recreational activities. But there are steps you can take to lower the risk and protect yourself and your children.

What Are Head Injuries? Head injuries are injuries to the scalp, skull, or brain caused by trauma. Concussions are the most common type of sports-related brain injury with an estimated 1.6 million to 3.8 million sports-related concussions a year. A concussion is a type of traumatic brain injury (TBI) that happens when the brain is jarred or shaken hard enough to bounce against the skull. This can happen when two athletes collide or when someone falls and hits his or her head. It can also result from being hit in the head with a piece of sporting equipment. In a sport such as soccer, even "heading" the ball can cause a concussion. A concussion causes an alteration of a person's mental status and can disrupt the normal functioning of the brain. Multiple concussions can have a long-lasting, cumulative life-changing effect.

You don't have to be hit in the head to experience a concussion. An impact elsewhere on the body can create enough force to jar the brain. You also won't necessarily lose consciousness with a concussion. Concussions range from mild to severe. The effects may be apparent immediately, or they may not show up until hours or even days later.

Other types of TBIs are a contusion, which is a bruise on the brain that can cause swelling, and a hematoma, which is bleeding in the brain that collects and forms a clot. A skull fracture is another type of head injury that can affect the brain. Sometimes with a fracture, pieces of bone can cut into the brain and cause bleeding and other types of injury.

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