Brain tumours are abnormal growths of cells within the brain or the surrounding structures. They can be benign (non-cancerous) or malignant (cancerous) and can affect people of all ages. Symptoms: Brain tumours may remain asymptomatic for a long time. Common manifestations include headaches, vomiting, diminished or double vision, imbalance, seizures, weakness in limbs, and cognitive deficits. Types of Brain Surgery Craniotomy: A bone flap is temporarily removed to locate and remove the tumour Once the tumour is removed, the bone flap is reattached with plates and screws. It is the most common type of brain tumour surgery. Burr hole: A small trephine hole is made in the skull to access a brain cyst, an abscess or haematoma which are aspirated with the help of a syringe. Endoscopic Surgery: This minimally invasive procedure involves the use of an endoscope, a small, flexible or stiff tube with a camera and light source, to access and remove the tumour through smaller incisions. Stereotactic surgery: In this, a trajectory for the tumour is calculated in 3 dimensions and is approached through a burr hole. A small biopsy forceps reaches the centre of tumour to collect sample of the tumour. Stereotactic radiosurgery-based procedures including Gamma Knife and CyberKnife, use focused radiation beams to target the tumour without making an incision often used for small tumours or tumours in hard-to-reach areas. Brain tumour surgery carries inherent risks, which may include: Infection Bleeding: during surgery or in the post-operative course could be life-threatening. Neurological Deficits: temporary or permanent neurological deficits, depending on the tumour's location and difficulty in resection. Brain Swelling: can occur during or after the surgery and could damage the brain. Seizures: Surgery can lead to postoperative seizures. Recovery after brain tumour surgery is usually rapid. The patient comes out of the operation theatre in a conscious state.

Disruption of blood supply to any part of the brain due to rupture of blood vessel carrying oxygen and nutrients to the brain, or blockage of the blood vessel due to the formation of a clot is termed as Stroke. When the supply of oxygen and nutrients is disrupted, brain cell gets damaged. As the brain cells or neurons, once damaged are incapable of self regeneration, they die quickly sometimes causing damage beyond repair to the person. Stroke is a medical emergency and needs urgent medical attention. What is Stroke? What are the causes of Stroke? The main types of Stroke are Ischemic and Hemorrhagic. Ischemic Stroke – caused by a blood clot – Ischemic means a reduced blood and oxygen supply to a part of the body. It is usually caused by a blood clot in an artery, which blocks the flow of blood into the brain. Hemorrhagic Stroke – caused by bleeding – A damage or weakened artery may burst and bleed. What are the symptoms of a Stroke? The functions of the different parts of the body are controlled by different parts of the brain. So, the symptoms vary depending on which part of the brain is affected and on the size of the damaged area. Symptoms develop suddenly and usually include one or more of the following: Symptoms What should one do if a patient develops the symptoms? “TIME IS BRAIN” because every minute delay in stroke treatment leads to death of approximately 2 million neurons. Therefore, the patient should be rushed to a hospital immediately which has a Stroke Unit with CT / MRI facility. How is Stroke diagnosed? A Doctor usually diagnoses a Stroke by symptoms and signs which develop suddenly. Tests which are commonly done to diagnose: How is Stroke diagnosed? How to prevent Stroke? Certain risk factors increase your risk of having a Stroke (and heart attack). The risk factors that can be modified are: LIVING AFTER STROKE COMMUNICATION ISSUES Post-stroke, communication issues are common. Patients may find that they are using wrong word or unable to form sentences or repeating the words. Patients may misunderstand what people are saying, hence sometimes patients may come with slurred speech. Tips for staying connected Focus on a single task. Write things down before saying them. Try using short written notes. Keep a pencil and paper handy. Not able to write? Try gestures or hand signals. Get the individual’s attention. Say slowly and clearly. Don’t interrupt. Pay attention to body language. Give one idea at a time. Use yes or no questions. Repeat or re-word the sentences. CHALLENGES WITH ARMS AND LEGS Stroke can leave one side of the body paralyzed or weakened. Muscles Problems Stroke can affect muscles of arms, legs, hands and feet. Muscles can shorten and become very tight, a condition called spasticity. Or sometimes they might become limp and soft. These muscle changes may cause problems with the joints they support. Treatment with muscle difficulties / issues may involve: Using splints or orthotics Proper positioning Exercise Physiotherapy Muscle may lead to uncontrolled, awkward movements SWALLOWING DIFFICULTIES (DYSPHAGIA) Stroke can leave one side of the body paralyzed or weakened. A problem in swallowing food / drink is called Dysphagia. This happens when one has trouble using the muscles in one’s throat or mouth. Dysphagia may cause malnutrition or dehydration. Following are some of safe eating tips: Don’t talk while chewing. Make sure to sit in right position (Straight up). Cut food into small bites. Chew food completely on the stronger side of your mouth. Getting adequate fluids Due to difficulty in swallowing, people avoid drinking water. This may cause problems like dehydration or constipation. Make sure to drink decent number of cups a day of noncaffeinated, non-carbonated fluids that are easiest to swallow. Keep a water bottle filled with the right liquid close by at all times.

Dr. Dilip S. Kiyawat has wide experience in treating spinal disorders. cervical disc prolapse, lumbar spine disc prolapse, spinal trauma, spinal tumors, osteoporotic vertebral collapse. MRI is the choice of investigation to clinch the correct diagnosis. The large majority of back problems can be treated with nonsurgical methods usually referred to as conservative therapy. This includes bed rest, pain medications, muscle relaxants, lumbar traction, IFT (Interferential therapy) and spinal exercises. A majority of cases get good benefit from such therapy. Recurrence of pain and discomfort needs further treatment in the form of surgical intervention. Surgical treatment : 1. Microdiscectomy- through a 20 to 25 mm opening with the help of a microscope the abnormal disc is approached and nerve root is relieved of compression by removing the offending part of the disc. Patient can be discharged the next day 2. Endoscopic discectomy- through a tiny 10 to 12 mm opening the abnormal disc is approached using an endoscope and the nerve root is relieved of compression by removing the abnormal part of the disc. 3. Spinal stabilization - In cases of spinal instability due to fracture or degenerative disease the spinal segment needs to be stabilized. This procedure involves inserting titanium screws into the safe areas of the vertebrae at two or more levels and are fixed with titanium rods to stabilize the spinal segments. 3. Vertebroplasty- Osteoporosis in old subjects with trivial trauma often leads to vertebral collapse, a condition rendering the patient bed bound due to extreme intensity of pain they suffer. Such patients are dramatically benefitted by the procedure vertebroplasty where a biocompatible cement is injected in to the collapsed vertebral body. This offers immediate dramatic relief to pain and enables the patient to mobilize the same day.