Stroke/TIA Clinic

Cerebrovascular Accidents (CVA) or brain attack in short is a stroke. When a brain attack eventuates, it interrupts the flow of blood to the cells of the brain, thereupon depriving the brain of oxygen, consequently the cells of the brain die. The interruption of blood flow happens when an artery is blocked and prevents blood from reaching the cells in the brain. When an artery ruptures either inside or outside the brain, it can cause a hemorrhage. Just as a heart attack requires immediate treatment, similarly a stroke should also be attended to immediately as every second is critical to the care of the patient’s survival and consequent quality of life.

Strokes are of two types: Ischemic and Hemorrhagic.

Ischemic

80% of all strokes suffered are Ischemic in nature. When fat is deposited on the inner walls of the artery, it clogs the artery, causing an ischemic stroke. Transient Ischemic Strokes occur when symptoms similar to an ischemic stroke attack occur prior to the ischemic stroke. Vision loss in a transient ischemic attack is usually temporary and will improve in a few minutes (approx. 10/20 minutes).

Hemorrhagic

When an artery in the inner recesses of the brain or outside it ruptures, or when an aneurysm situated at the base of the brain bursts, it causes hemorrhaging. Symptoms more specific to this kind of stroke include nausea, headache, vomiting, stiffness in the neck, seizures and unforeseen alteration in the mental state coupled with lethargy. The symptoms generally begin suddenly and accelerates with the passage of time. These types of strokes occur during any physical activity and during the day.

A few indications that you or somebody you know is having a stroke:

  • Unexplainable, severe and sudden headache
  • Decreased or blurry vision in either one eye or both
  • Weakness, numbness and paralysis of the face, either partially or entirely
  • Speech enunciation difficulties
  • Loss of balance, dizziness or an unexplained falling
  • Difficulty swallowing
  • Difficulty in understanding or speaking
  • Appears to be incoherent

One of the foremost causes leading to adult disability and death is stroke. Emergent, time-sensitive and supportive care is crucial when treating a stroke patient. Within an hour of a stroke patient’s arrival in our emergency room, our trained emergency care team swing into action to initially evaluate, assess, and complete all imaging and diagnostic, laboratory tests, so as to provide information on the cause of the stroke and extent of damage.

One of the most important imaging, a stroke patient will undergo, is the computed tomography, in short a CT scan. This scan will help detect the type of stroke. Blood tests will also be done together with an EKG (electrocardiogram). These evaluations are necessary to enable the treating doctor to decide on the best course of treatment. An IV (intravenous line) may be inserted and oxygen may be given. The patient’s blood pressure and body fluids will be monitored. The patient will also be monitored for signs of drowsiness, confusion, and headache, as these are all early signs of pressure on the brain. Since a stroke can interfere with the patient’s ability to swallow, no intake through the mouth will be allowed, until it is clear that the patient can swallow.


Epilepsy Clinic

The multidisciplinary team from the Department of Neurosciences at Kauvery Hospital provide regular and complete care for adults and children with epilepsy. Epilepsy is a central nervous system disorder and it affects the activity of the nerve cells in the brain, which results in seizures. When such a seizure occurs, an epileptic patient may exhibit abnormal behavior, symptoms and sensations, and sometimes may even lose consciousness.

The symptoms can range from the simple to the complicated in an epileptic seizure. It is estimated that about 10 percent of individuals will experience one or more unprovoked seizures. However, one incident does not constitute that a person is epileptic. To diagnose a patient to be epileptic, there have to be two or more incidents of seizures.

Epileptic seizures can occur either due to injuries or due to medications. Sometimes the cause of the seizure can even be unknown.

Known causes attributed to epilepsy are:

  • Traumatic brain injury
  • Brain injury that has occurred near the time of birth or during birth
  • Infections which include brain abscesses, encephalitis, HIV / AIDS or meningitis
  • Strokes
  • Dementia (Alzheimer’s disease)
  • Brain tumor
  • Abnormal blood vessels in the brain
  • Any other illnesses that affect or causes brain damage

The Epilepsy team at the Department of Neurosciences at Kauvery Hospital, includes neurologists, radiologists (imaging specialists), neurosurgeons, neuropsychologist and other professionals. Our experts work effectively to provide the best of care to patients with epileptic disorders. All of our subspecialized and expert care is provided under one roof, therefore, your case will be discussed among our team of experts, based on the test results which will be quickly available. Appointments will then be scheduled and coordinated with our highly specialized epilepsy experts, so that you get the best treatment, in the shortest period of time and without any long delays involved. We even manage and treat refractory epilepsies and also provide neuro-surgical evaluation on patients with intractable epilepsy. Further we provide information and advice with reference to marriage, pregnancy and genetic disorders for women with epilepsy.

The Department of Neurosciences team use avant-garde technology, including electroencephalography, subtraction ictal SPECT, computerized tomography, positioning emission tomography, magnetic resonance imaging and other tests to meticulously diagnose epilepsy. We even provide inpatient EEG epilepsy monitoring.

In some cases, even mild seizures may at times require treatment, as they could be dangerous, especially if the patient’s activities involve driving or swimming. The Neurosciences epilepsy team at Kauvery Hospital, have considerable expertise in treating epilepsy to completely oust it so as to reduce the frequency and intensity of the seizures, whether it occurs in adults or in children. The treatment choices may include medications, surgery, vagus nerve stimulation, ketogenic diet, awake brain surgery and much more.

In case it is diagnosed that surgery is the best option to treat a patient, then you can rest assured that you are in the best hands of the most experienced neurosurgeons who can provide you with the best of results. Neurosurgery requires precise expertise as it is one of the most complex of surgeries and our team of neurosurgeons perform epilepsy surgeries to precision with the aid of computer-assisted brain surgery instruments.


Dementia Clinic

Since the late 1990s, incidences of dementia have been increasing steadily in developing countries. In addition to the challenges posed by the ailment to the patient, there is not enough awareness of the issue, which makes it difficult for the patient’s family members or caregivers.

Dementia, which manifests as memory loss, is quite a complex neurological problem and can take on many forms such as Alzheimer’s disease, Pick’s disease, Vascular dementia and dementia with Lewy bodies. Family members of patients often dismiss it as symptoms of old age, which does not help them or the patient. Further, dementia cannot be fully cured but its symptoms can be controlled, if the ailment is detected at an early stage. Once detected, treating dementia requires a sustained and specialized program which is what a Dementia Clinic offers.

A Dementia Clinic, also called Memory Clinic, is a multidisciplinary approach where, a team of specialists conduct various neurological tests and memory assessments and design a customized program for the patient. Accordingly, KION’s dementia clinic is staffed by psychologists, geriatricians and dementia specialist nurses.

To begin with, we will conduct a CT or MRI scan of your brain followed by a PET scan to understand the underlying cause of the dementia in a particular patient. This is followed by a thorough psychiatric evaluation to determine if depression or any other mental condition is the contributing factor. We will then design an in-depth program that will also involve the family members or caregivers of the patient.


Parkinson’s and Movement Disorders Clinic

KION’s Parkinson’s and Movement Disorders Clinic is a specialized centre that offers multidisciplinary care for a wide range of movement disorders such as:

  • Parkinson's disease, essential tremor, Diffuse Lewy body disorders, Huntington's disease, etc.
  • Conditions like tremor, dystonia, hemifacial spasm, ballism, myoclonus, etc.
  • Secondary movement disorders such as kernicterus, hypoxia, birth asphyxia, etc.
  • Psychogenic movement disorders

The clinic undertakesthorough evaluations, diagnosis and treatment of these disorders. To begin with, the patient will undergo an MRI scan and other clinical evaluation conducted by a physician specialized in movement disorders. This will be followed by an electrophysiology and screening for metabolic disturbances all of which are aimed at understanding the patient’s movement, mood and sleep patterns.

Then based on the analysis, we may advise surgical interventions like deep brain stimulations, or lesional surgeries like thalamotomy and pallidotomy. Once the surgery is over, we will look at all aspects of the patient’s rehabilitation which covers his/her physical pain, emotional trauma and perceived social stigma. To achieve this, the centre is staffed by certified physicians who specialize in movement disorders, a nursingpractitioner, a physical therapist, an occupational therapist, a speech therapist and a social worker.

These specialists will evaluate the patient’s movements and ability to manage his/her day-to-day activities.They will help the patient speak coherently and be as independent as possible. Family memberswill be counseled to help them cope with the patient. Considering the hassle faced by family members and their lack of awareness, all our programs involve family members and offer special counseling for them.


Migraine and headache clinic

In medical parlance, headache is that pain that arises from the upper regions of the neck and originates from the structures and tissues that surround the brain. A headache occurs when there is inflammation or irritation of the following parts of the tissue and structures:

  • Muscles that encase the skull
  • Periosteum, a membrane that covers the bones
  • Sinuses
  • Meninges, comprises of 3 layers of connective tissue that cover the surface of the brain and spinal cord
  • Eyes and ears
  • Nerves
  • Arteries
  • Veins

The nature of the pain can be of varying degrees such as dull , throbbing, intense, constant or mild. Headaches have been classified into 3 categories – primary, secondary, cranial neuralgias and facial pain, and other headaches.

Primary headaches can be debilitating and could possibly affect the quality of life. It can even be occasional, in which case the headache will resolve quickly. Primary headaches are not life threatening, but the symptoms are similar to headaches associated with strokes. Primary headaches are categorized into 4 categories and they are – tension headaches, traction and inflammatory headaches, migraine headaches and cluster headaches.

Muscular contraction or tension headaches are prone to occur more in women than in men and it is the most common of all headaches. In a muscle contraction or tension headache the facial and neck muscles tighten or tense up causing the headache.

Traction and inflammatory headaches are symptoms of disorders arising from other medical conditions that could be anything from a simple sinus infection to a complex medical condition, like stroke.

Vascular or migraine headaches affect men, women and children and they are the second most common of headaches. Both boys and girls before puberty may suffer from migraine headaches but after puberty the migraines do not affect the boys as much as the girls, who may continue to have it even after.

Cluster headaches are also a type of vascular headaches and affects both adults and children.It is a very rare type of headache. Men are more prone to suffer from this type of a headache. Cluster headaches are repetitive, that is there will be numerous episodes of headaches with intense pain, and spikes in blood pressure.

Migraines

The most common of vascular headaches is the migraine which are usually identified with severe pain on either one side of the head or on both sides. Migraine headaches also cause nausea and at times disrupts vision.

Secondary headaches are precursors to more serious medical disorders, such as aneurysms (rupturing of weakened blood vessels), diseases of the spine, sinuses, neck, teeth and ears. Traumatic and post-concussion headaches, substance abuse and excess use of medications (rebound headaches) all fall into this category.

Part of our neurology services include diagnostic and treatment of persistent primary, secondary, neuralgic, facial/ neck pain and other headaches. Our team of expert neurology doctors will consider historical and recent diagnostic data before creating an individualized treatment plan for the patient. The treatment options for migraines and vascular headaches include, drug therapy, stress reduction, elimination of certain types of food from the diet and biofeedback. The treating doctors will determine the nature of the headacheusing the best diagnostic techniques, simultaneously looking for red flags that may herald something more serious. The most advanced laboratory equipment are used to provide the best diagnostic results and they are:

  • Computed Tomography (CT) head scan
  • Electroencephalogram (EEG)
  • Laboratory testing
  • Magnetic Resonance (MR) head scan

Peripheral Neuropathy Clinic

Peripheral Neuropathy and similar conditions such polyneuropathy, sensory neuropathy and motor neuropathy is a class of disorders associated with the nervous system. Peripheral nerves send messages to the central nervous system, the brain and spinal cord to innervate muscles, skin, glands and organs of the body. These messages tell the individual about his/her sensory environment such as a feeling of hot or cold.

When a person suffers from any of these neuropathies, these messages are not properly conveyed and result in multiple symptoms such as pain, numbness, tingling and burning sensation, hypersensitivity, weakness in the arms and legs, acute pain or no pain at all, poor coordination, etc. Causes for peripheral neuropathy can vary from excessive alcohol intake, diabetes, chronic kidney disease, Guillain Barre syndrome, injuries, infections and certain autoimmune disorders.

At KION, our Peripheral Neuropathy clinic is staffed by physicians who specialize in neuropathies. To begin with, they will take full stock of your medical history, followed by a thorough neurological examination to evaluate your strength, posture, muscle coordination, flexibility etc. This is followed by a series of tests such as a blood test to rule out vitamin deficiency and diabetes, MRI or CT scans, nerve function tests, autonomic reflex screen, sensory test, sweat test, skin biopsy and nerve biopsy.

If these tests do not reveal any underlying cause, the physician will prescribe medication which includes pain relievers, anti-seizure medications, topical treatments, and antidepressants. Or therapies such as Transcutaneous Electrical Nerve Stimulation (TENS), plasma exchange and Intravenous Immune Globulin (IVIG),physical therapy and surgery.


Neuromuscular disorders clinic

Neuromuscular disorders impact the nerves that control the voluntary muscles in the body. Voluntary muscles are those muscles that help with movement. Neurons are nerve cells present in the nerves and these neurons send messages to the muscles to act. The communication between the muscles and the neurons ceases, when the neurons become unhealthy and die. Consequently, the muscles become weak and dissipate as a result of which problems such as cramps, twitching, joint movement, pains and aches, will develop. Neuromuscular disorders can even affect the functioning of the heart causing breathing problems.

Some neuromuscular disorders are:

  • Multiple sclerosis
  • Amyotrophic Lateral Sclerosis (ALS) or progressive neurodegenerative disease or Lou Gehrig’s Disease
  • Spine muscular atrophy
  • Myasthenia Gravis (MG)

Neuromuscular diseases are either inherited or genetic, which means that it is a part of family history or occurs due to genetic mutations. Sometimes immune system disorders have been known to cause neuromuscular diseases too. Most of the known neuromuscular diseases have no cure but can be treated to improve the conditions, so as to increase mobility and life expectancy.

The affliction of neuromuscular diseases can affect any age group, even people as young as 18. Some diseases are present from birth, others become evident during childhood and yet others come to light in adulthood. Life expectancy varies from short to normal, depending on the disease and the severity. Secondary effects of muscle degeneration that affect the heart and the respiratory system, can be the cause of death.

Bladder and bowel control is generally normal in most patients with neuromuscular diseases, though they will need help in the bathroom, due to their physical inabilities.

At our Institute of Orthopaedics and Neurosciences, our multidisciplinary team works together to provide the best of care to patients diagnosed with neuromuscular diseases. Our trained and experienced experts follow the international code of medicine safety and care for each patient under their care. Treatments offered by our neurology services are:

Therapy through drugs – certain forms of muscle and nerve diseases can be treated successfully with medication, such as immunosuppressive drugs while to treat neuropathy, drugs such as anticonvulsants and antidepressants may be used.

Our team of physiotherapists and nutritionists will continue to evaluate patients. Strengthening of muscles through exercises does not help prevent degeneration of muscle in patients affected by neuromuscular disease, hence being guided by our physiotherapists and doctors is important. They will be able to guide the patient with moderate and gentle exercises that will help maintain muscle tone and flexibility.

At The Kauvery Institute of Orthopaedics and Neurosciences, we have specialists in various disciplines of medicines. Therefore if necessary, the consulting doctor will refer the patient to surgeons from our Neurological, Orthopaedic or Thoracic Department for further evaluation and diagnosis. Referrals may even be made to our sub specialty team comprising speech-language pathologists, physical therapists, occupational and rehabilitation therapists, psychiatrists, ophthalmologists, and pulmonary medicine specialists.

Patients and their family members will be counselled and educated in the management of the disease.


Vertigo clinic

Vertigo is the sudden sensation of spinning, falling or the feeling that the inside of your head is spinning. It could even be a tilting or an unbalanced feeling. Benign paroxysmal positional vertigo is the most common type of vertigo with brief episodes of mild to intense dizziness. It may get triggered by changes in the head position. It might hit you when you move your head up and down, when you lie down, or when you turn over or sit up in bed.

What causes BPPV?

  • Inner ear imbalance
  • Minor to severe blow to your head
  • Disorders that damage your inner ear
  • Migraines
  • Your ear and your sense of balance

Your ear contains structures that monitor the rotation of your head. The structures in your ear are related to your sense of gravity. If these structures get dislodgedor damaged, it can make you sensitive to gravity.

This causes the semicircular canal to become sensitive to head position changes making you feel dizzy.

Symptoms of BPPV

  • Dizziness
  • Spinning sensation
  • Loss of balance
  • Nausea
  • Vomiting
  • Unsteadiness
  • Abnormal rhythmic eye movements

The symptoms can last between a few seconds to longer periods. The frequency of episodes may become more over a period of time or they may decrease and disappear.

When to see a doctor?

Many people experience BPPV and it is generally not very serious. But you should see a doctor if you experiencethese symptoms:-

  • Recurrent episodes
  • Severe or prolonged dizziness
  • Severe headache
  • Fever with dizziness
  • Double vision or loss of vision
  • Hearing loss with tinnitus
  • Trouble speaking
  • Leg or arm weakness
  • Loss of consciousness
  • Falling or difficulty walking
  • Numbness or tingling
  • Treatment for BPPV

BPPV can be treated quite easily in the ENT‘s office by moving the loose crystals in your ear into a spot that will cause less trouble. You may have to rest in the office for about 10 minutes before you can go home to make sure you don’t have any quick episodes of vertigo as the crystals resettle.

Very rarely, you might need surgery to cure the problem. It involves plugging part of your inner ear to prevent the small calcium crystals from moving in your ear canal.


Neuropsychiatry

As the name implies, Neuropsychiatry is a science or form of medical treatment that eliminates the distinction between neurology and psychiatry and instead combines learnings from both. The need to do so has arisen from the spurt in neuropsychiatric conditions in recent years.

These conditions are mental disorders attributed to conditions originating from the nervous system. These conditions affect the person’s ability to work or live a normal, healthy life. At Kion, ourNeuropsychiatry Clinic aims to understand these disorders based on how various neurobiological, social and psychological factors come together in a person, and contribute to the disorder.

Some of these disorders are:

  • Addiction: This deals with substance abuse and why there is a dependency on this substance, as well as other addictions such as gambling, compulsive lying, kleptomania etc.
  • Childhood and development related: This covers conditions arising from impaired development during childhood and includes Attention Deficit Hyperactivity Disorder (ADHD), autism, fetal alcohol syndrome, etc.
  • Eating disorders: Most common examples are anorexia and bulimia
  • Degenerative Diseases: These refer to conditions like dementia, Alzheimer’s and Parkinson’s disease where there is steady decline in memory and cognitive ability in elderly people
  • Mood disorders: This includes conditions such as bipolar disorder, depression, mania, etc.
  • Neurotic disorders: This refers to conditions such as social anxiety, mental distress, Obsessive Compulsive Disorder, etc.
  • Psychosis: Patients suffering from these conditions are disconnected from reality and exhibit symptoms such as hallucinations, delusions, schizophrenia and disorganized thinking
  • Sleep disorders: An increasingly common phenomenon, and includes conditions such as insomnia, sleep apnea and parasomnia

Neuro-ophthalmology

Neuro-opthalmology is a sub-specialty of neurology and ophthalmology. This branch of medicine deals with vision problems arising not from the eyes themselves, but due to neurological conditions or conditions in the nervous system. If left untreated, it can cause loss of vision in the patient.

A neuro-opthalmologist will run a series of tests on the patient to study the underlying conditions causing the disorder and then prescribe a suitable form of treatment. Specialists in neuro-opthalmology combine learning from neurology, neurosurgery, radiology and opthalmology, to diagnose and treat these conditions.

At KION, our Neuro-opthalmology Clinic is able to treat a wide range of conditions such as:

  • Abnormal eye movements
  • Adult strabismus
  • Bell’s palsy
  • Diplopia or double vision
  • Eyelid abnormalities
  • Giant cell arteritis
  • Headache
  • Ischemic optic neuropathy
  • Multiple sclerosis
  • Myasthenia gravis
  • Optic atrophy
  • Optic neuritis
  • Stroke
  • Thyroid eye disease
  • Transient visual loss
  • Unequal pupil size
  • Unexplained visual loss
  • Visual disturbances
  • Visual field loss
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