Ataxia Ataxia Home A Overview Ataxia is a neurological disorder that causes imbalance while walking or incoordination while using hands and legs. It may be due to disorders of cerebellum and its pathways. Causes Toxins such as- alcohol, drugs like phenytoin and lithium, mercury, cyanide, and othersVascular- ischemic or haemorrhagic strokeInflammatory- demyelinating disordersMalignancy- primary brain tumours/ metastasis/ paraneoplastic syndromesInfections- herpes/ measlesNeuro-degenerative diseases like Multiple System Atrophy Cerebellar type (MSA-C) and Spinocerebellar Ataxias (SCAs)Nutritional- vitamin E deficiency, Wernicke’s encephalopathyLoss of joint position sense secondary to involvement of peripheral nerves or spinal cordChronic inflammatory demyelinating polyneuropathyParaproteinemic neuropathyDisorders of metabolism- Refsum’s diseaseSensory ganglionopathy- paraneoplastic or Sjogren’s syndromeSpinal cord disorder- spondylosis or demyelination Risk factors Excessive and chronic alcohol intakeHypothyroidism/hypoparathyroidismCeliac disease (an illness due to immune reaction to gluten)Sarcoidosis (a disease that causes inflammatory cells to build up in parts of the body)Multiple system atrophyMultiple sclerosisIntake of anti-seizure sedatives and medicationsCancer-triggered paraneoplastic syndromeExposure to heavy metals (mercury or lead) or solvents (paint thinner)Deficiency of vitamin E, B6, B12, or B1Getting too much vitamin B-6 Specialist to approach Neurologist Diagnosis Physical and neurological examsBlood testsGenetic testingImaging studies Treatment Treatment is based on the underlying conditions Read more about Ataxia Filter Alphabet A
Aphasia Aphasia Home A Overview Aphasia and dysphasia are language function disorders, whereas dysarthria is disorder of articulation, which is abnormal motor production of speech. Aphasia may be associated with various neurological conditions affecting the brain cortex such as stroke, demyelination, and dementia. Causes Aphasia occurs due to damage in the part of the brain responsible for language comprehension and expression. Symptoms Spontaneous speech disturbance such as difficulty in articulation, fluency, grammar, word substitution, and loss of intonationDifficulty in remembering the names of objects or peopleInability to comprehend words or instructions or conceptsInability to repeat words or phrasesDifficulty in reading and writing Risk factors Learning disabilities such as dyslexiaRare gene changes Specialist to approach Neurologist Diagnosis Clinical examinationMRI brain to detect the underlying cause of aphasia or dysphasia Treatment Treatment of underlying disorderSpeech therapy to improve comprehension and verbal output Read more about Aphasia Filter Alphabet A
Amyotrophic Lateral Sclerosis (ALS) Amyotrophic Lateral Sclerosis (ALS) Home A Overview Amyotrophic lateral sclerosis (ALS), also referred to as motor neuron disease, is a progressive neurological condition that impacts the nerve cells responsible for regulating muscle movement. The average life expectancy is 2–5 years, but the actual prognosis varies on an individual basis. Causes Unknown aetiology, but mutations in certain genes are responsible for 5–8% of cases Symptoms Progressive weakening of muscles in various body partsProgressive muscle thinning and wastingDifficulty in speaking or swallowingFlickering and twitching of musclesWeakness of muscles involved in respiration, causing respiratory failure and aspiration of food and oral secretions, ultimately leading to death Risk factors Trauma to the head, neck, or spineTraumatic brain injuries Specialist to approach Neurologist Diagnosis Clinical examinationElectrophysiological tests like electromyography (EMG)/nerve conduction study (NCV)MRI of spinal cord and other blood tests to eliminate possible conditions causing similar complaints like cervical myopathy, IGLON5 disease, and paraneoplastic syndromes Treatment Clinical management of symptomsRiluzole and edaravone can prolong the life expectancy by a few months Read more about Amyotrophic Lateral Sclerosis (ALS) Filter Alphabet A
Alzheimer’s Disease Alzheimer’s Disease Home A Overview Alzheimer’s disease accounts for one of the most prevalent causes of dementia among people aged ≥65 years (with a prevalence rate of 4.4%) and is presented more commonly in females than in males. Familial cases are observed at a younger age. Genes involved in Alzheimer’s disease include APP, presenilin 1 and 2, and apolipoprotein E4. The initial stage of dementia is manifested as mild cognitive impairment, and presents a progression risk of 10–15% to Alzheimer’s disease. Causes Deposition of abnormal amyloid proteins in brain Symptoms Memory impairment involving recent memory and daily eventsChallenges in acquiring and remembering new informationVisuospatial impairment (such as getting lost while driving)Difficulty in doing learned motor activities (apraxia) like wearing clothesDifficulty in finding wordsRepetitiveness or asking the same thing repeatedlyForgetfulness of past events in advanced stagesBehavioural changes in the form of decreased social interaction, aggressiveness, and occasionally hallucinations Risk factors Family historyAgeCardiovascular diseasesSedentary lifestyleHead injuriesLoneliness and depressionDown’s syndrome Specialist to approach Neurologist Diagnosis Clinical scores like detailed neurocognitive assessment, mini-mental state examination (MMSE), and Montreal cognitive assessment (MOCA)MRI brain to evaluate loss of hippocampal volume and temporal lobe atrophyFDG PET scan to check hypometabolism in these areas Treatment Cognitive rehabilitationMedical management through acetylcholine receptor inhibitors, N-methyl-D-aspartate receptor antagonistsManaging behavioural and psychiatric complications Read more about Alzheimer’s Disease Filter Alphabet A
Acute Disseminated Encephalomyelitis (ADEM) Acute Disseminated Encephalomyelitis (ADEM) Home A Overview ADEM is an acquired condition wherein demyelination takes place in the brain and spinal cord secondary to antecedent infection or immunization. It generally affects younger population, is usually monophasic, and does not tend to recur. Symptoms FeverHeadacheMeningismSeizuresAltered mental stateMultiple neurological deficits Risk factors More common among children than adultsOne is more likely to get ADEM soon after having an infection Specialist to approach Neurologist Diagnosis CSF examination to determine the number of white blood cells, protein levels, and oligoclonal bandsMRI to check lesions involving grey matter, mass effect and enhancement after instilling contrastOther diseases such as multiple sclerosis, myelin oligodendrocyte glycoprotein antibody disease (MOGAD), neuromyelitis optica, neurosarcoidosis, malignancy, and granulomas need to be ruled out Treatment Five-day-course of intravenous immunoglobulin. Read more about Acute Disseminated Encephalomyelitis (ADEM) Filter Alphabet A
Acute Ischemic Stroke Acute Ischemic Stroke Home A Overview Acute ischemic stroke is a neurological pathology caused due toa blocked blood vessel in the brain, resulting in decreased blood flow and hence, reduced oxygen supply in the area supplied by that blood vessel. It is a medical emergency and requires immediate medical attention to reverse the symptoms and dissolve the clot. In severe cases, the condition can prove to be life threatening or result in permanent neurological deficit in the patient. Causes High blood pressure/ cholesterolObesityDiabetesSmoking habitsFamily history/ geneticsSleep disorders Risk factors High blood pressureHigh cholesterolDiabetesSmokingObesityFamily history/ geneticsSleep disorders Symptoms Sudden numbness or weakness in arm, face, or legDifficulty in talking with slurring of speechconfusion or imbalanceVisual disturbanceSevere headache Specialist to approach Neurologist/ Neurosurgeon/ Neuro-interventionist Diagnosis Computed tomography (CT)Magnetic resonance imaging (MRI)-brain with angiography of brainCT/ MRI perfusion2D Echo, Holter monitoring and blood tests to determine the underlying cause of stroke Treatment Thrombolysis of clot using injection alteplase or tenecteplase within 4.5 hours of symptom onsetSurgical treatment involves clot lysis or aspiration using thrombectomy devices within 24 hours of onset of symptomsMedical management is attempted the using blood thinner medications to minimize the risk of future episodes Read more about Acute Ischemic Stroke Filter Alphabet A
Acoustic Neuroma Acoustic Neuroma Home A Overview Acoustic neuromas, also known as vestibular schwannomas, are benign (non-cancerous) tumours that develop from the Schwann cells, responsible for insulating the eighth cranial nerve (vestibulocochlear nerve). Acoustic neuromas rarely turn malignant. Causes Acoustic neuromas may occur suddenly. Bilateral occurrence may be associated with Neurofibromatosis type 2, which is a genetic disorder. Risk factors Genetic risk factor: A family history of the rare genetic condition neurofibromatosis type 2 significantly increases the risk.Environmental risk factor: Exposure to radiation, particularly the head, has been conclusively associated with a higher risk of acoustic neuroma. However, there is currently no evidence suggesting a link between the use of cell phones and the development of these tumours. Symptoms Hearing loss on the side of the lesionRinging in the ear (Tinnitus)GiddinessImbalance on walkingFacial weaknessHeadache, nausea, or vomiting, if the tumour is large or is compressing the ventricular outflow system. Specialist to approach Neurologist/ Neurosurgeon Diagnosis Audiogram- For high frequency hearing lossCT scan- For contrast enhancing lesion with expansion of internal auditory canalMRI brain- For detecting ice cream cone appearance in posterior fossa Treatment Usually, conservative treatment is required with monitoring through serial MRIExpanding or large lesions may be excised (through suboccipital or translabyrinthine or middle fossa approach)Excision carries the risk of morbidities such as hearing loss, facial nerve injury or vertigoStereotactic radiotherapy has low morbidity risk compared with surgery Read more about Acoustic Neuroma Filter Alphabet A
Alcoholic Liver Disease (ALD) Alcoholic Liver Disease (ALD) Home A Overview Alcoholic liver disease (ALD) or alcohol-related liver disease is an umbrella term for a group of liver diseases caused due to excessive alcohol consumption over time. ALD is a progressive condition and individuals with early ALD may be asymptomatic (not outwardly show any symptoms), with simple steatosis (fat accumulation in liver also known as alcoholic fatty liver disease) or alcoholic steatohepatitis (an advanced stage of alcoholic steatosis associated with inflammation and cell damage) and early-stage fibrosis (reversible accumulation of collagen in the liver), while patients with advanced ALD may have advanced fibrosis (irreversible, widespread fibrosis), which can cause cirrhosis and associated complications (hepatocellular carcinoma), alcohol-associated hepatitis with jaundice, portal hypertension, and/or acute-on-chronic liver failure. Thus, ALD includes a range of conditions, including alcoholic fatty liver disease (alcoholic steatosis), alcoholic steatohepatitis, fibrosis, portal vein hypertension, alcohol-associated hepatitis, cirrhosis, liver failure, and hepatocellular carcinoma. Causes and risk factors Excess and prolonged consumption of alcohol is the primary cause of ALD. The liver breaks down alcohol into smaller molecules, leading to detoxification but drinking too much alcohol over a prolonged duration can overwhelm this ability, leading to the development of ALD.Heavy drinkingGenetic factors Nutritional deficiencies: Alcohol interferes with the absorption of essential nutrients, a phenomenon that can contribute to liver disease.Coexisting conditions: Pre-existing conditions, like metabolic syndrome, viral hepatitis, or obesity, can increase the risk of developing ALD. Symptoms Symptoms may vary depending on disease severity. Common symptoms have been enumerated below:Fatty liver (alcoholic steatosis) Slight discomfort in the upper abdomen.JaundiceSwelling of the lower limbs (oedema)Fluid buildup in the abdomen (ascites)Itchy skinFever and shiveringExcessively curved fingernailsMuscle weaknessBlood in vomit or stoolsEasy bleeding and bruising More sensitive reactions to alcohol or drugsHigh blood pressure in the liver (portal hypertension)Bleeding from veins in the oesophagus (oesophageal varices)Confusion and behavioural changes (hepatic encephalopathy)Enlarged spleen Diagnosis One of the first steps in the diagnosis of ALD involves going through an individual’s medical history (alcohol consumption patterns, including the quantity and frequency of drinking). The other steps include:Physical examinationLaboratory tests: Several blood tests help assess liver function and detect ALD-associated damage.Liver function tests (LFTs):ALT and AST: High ALT and AST values indicate liver damage. Further, in case of liver damage, AST values are generally higher than ALT values.ALP and GGT: Increased ALP and GGT values can indicate liver damage or biliary obstruction.Bilirubin: High levels of bilirubin may indicate liver dysfunction that can lead to jaundice.CBC: A low platelet count or anaemia in a complete blood count test can suggest liver damage.Coagulation studies (PT, INR): The liver produces clotting factors, so a longer blood clotting time (i.e., prolonged PT (prothrombin time) or elevated INR (international normalized ratio)) indicates liver dysfunction.Serum albumin: Low albumin levels can be a sign of chronic liver disease.Ammonia level: Elevated levels of ammonia may indicate hepatic encephalopathy, a severe complication of advanced liver disease.Imaging studies:UltrasoundCT and MRIElastography (FibroScan)Magnetic resonance elastography (MRE)Liver biopsy: In some cases, a liver biopsy—removing a small piece of liver tissue for examination under a microscope—may be used to assess the degree of liver damage. It helps determine the extent of liver inflammation, presence of fat in the liver (steatosis), the degree of fibrosis or scarring (cirrhosis), and whether alcohol is responsible for the damage observed.Exclusion of other liver diseases: As the symptoms of ALD can overlap with those of liver disease arising from other causes (e.g., viral hepatitis, fatty liver disease unrelated to alcohol, or autoimmune liver diseases), doctors may conduct additional tests to rule out other conditions:Hepatitis B and C tests: To rule out viral hepatitis as the cause of liver disease.Autoimmune markers: To rule out autoimmune hepatitis.Iron tests: To exclude hemochromatosis (excess iron accumulation in the liver).Alpha-1 antitrypsin deficiency test: To rule out genetic liver diseases. Assessing the severity of ALD Once ALD is diagnosed, the severity of liver damage is assessed. This is typically done through:MELD score: Used to determine the severity of cirrhosis and predict survival by considering bilirubin levels, creatinine levels, and INR.Child‒Pugh score: Used to determine the prognosis of liver disease (prediction of the likely disease course, including the probability of recovery/recurrence), particularly cirrhosis, by looking at factors, like serum albumin and bilirubin levels, encephalopathy, and ascites. Treatment The most important step in managing ALD is to completely stop drinking alcohol (abstinence), which may stop the progression of liver damage and, in some cases, allow the liver to heal; however, a drastic decrease in alcohol consumption can result in severe withdrawal symptoms, for which medicine may be prescribed. Other strategies include:Nutritional support: Individuals with ALD often suffer from malnutrition and deficiencies. A balanced diet with vitamin supplementation (especially B vitamins) is therefore crucial for recovery.Liver transplantation: A liver transplant may be necessary in cases of advanced ALD. However, it is generally only considered for people who have stopped drinking for at least six months.Management of complications: This may include:Diuretics: To counter fluid buildup.Lactulose: To prevent encephalopathy.Endoscopic treatments: For variceal bleeding.Medications: For managing complications, like infections, bleeding, or ascites (fluid accumulation). Prevention Preventing ALD involves reducing or eliminating alcohol consumption and taking steps to protect liver health. Limiting the alcohol intake: Adhering to recommended guidelines for alcohol consumption can significantly reduce the risk of developing ALD.Maintaining a healthy diet: A balanced diet and regular exercise are necessary for maintaining liver health and prevent malnutrition, which is common in ALD.Early intervention: Regular check-ups and liver function tests for high-risk individuals (e.g., individuals with heavy drinking habits) can help detect liver damage early, thereby improving the chances of recovery.Vaccinations: For individuals with ALD, vaccination against hepatitis A and B is recommended as infections can further harm the liver.Avoiding other liver toxins: Limiting the use of over-the-counter medications like acetaminophen (which can be toxic to the liver) and avoiding exposure to harmful chemicals can help protect the liver. Read more about Alcoholic Liver Disease (ALD) Filter Alphabet A
Acute Kidney Injury (AKI) Acute Kidney Injury (AKI) Home A Overview AKI or acute kidney injury is a sudden and often reversible decline in renal function over a short period of time. If identified and treated promptly, kidney function can frequently be restored. AKI can result from acute dehydration such as in cases of severe diarrhoea or burns, secondary sepsis, certain medications, or following surgical procedure. Causes and Risk Factors The underlying causes of AKI can be classified as follows:Pre-Renal AKI: Pre-renal AKI is caused by reduced blood flow to the kidneys due to dehydration, low blood pressure, or heart failure.Intrinsic Renal AKI: Results from direct damage to the kidney tissue, such as infections, toxins, or autoimmune diseases.Post renal AKI: Occurs due to the obstruction in the urinary tract, such as from kidney stones, tumours, or an enlarged prostate. Symptoms The presentation of AKI can vary:Mild cases may be asymptomatic and identified only during laboratory investigations.Severe cases of AKIs may present with:reduced urine outputswelling in the face and feetreddish discoloration of urineAabdominal pain Specialist to approach A kidney specialist (nephrologist) should be consulted for the diagnosis and management of AKI. Diagnosis Accurate diagnosis of AKI involves:Urine testsBlood tests to assess renal functionImaging studies, such as an ultrasound, to confirm normal kidney size and identify potential structural abnormalities. Treatment The management of AKI is tailored to address the underlying cause, including:Rehydration therapy for patients suffering from diarrhoea or burns,Antibiotic therapy for treating sepsisDiscontinuation of nephrotoxic medications, i.e. drugs that cause AKI.In some severe cases, advanced interventions such as immunosuppressive therapy or temporary dialysis may be necessary to support kidney function until recovery. Read more about Acute Kidney Injury (AKI) Filter Alphabet A
Acne Scars Acne Scars Home A Overview Acne scars are the result of inflammation of acne blemishes, leading to permanent textural changes in the skin. Types Atrophic scars: These are sunken or “pit” like scars that occur when the skin does not regenerate tissue properly, resulting in a loss of collagen and tissue Ice pick, boxcar, and rolling scars.Hypertrophic scars: These are raised scars, wide and thickened, that form as a result of excessive collagen production where the skin is injured. Symptoms Sunken or elevated scars on the skin. Causes Severe acnePicking or squeezing pimplesDelayed treatment Diagnosis Visual assessment by a dermatologist. Treatment Laser treatments (Clear + BrilliantHarmony XL Pro)MicroneedlingFillersPRP, depending on the cause Read more about Acne Scars Filter Alphabet A