Tuesday, May 9, 2017


What is Hydrocephalus?

Hydrocephalus is the abnormal accumulation of fluid (Cerebrospinal fluid) within the cavities (ventricles) of the brain. Cerebrospinal fluid or CSF is normally produced in the ventricles and absorbed such that there is almost a constant volume of the fluid in a normal person.

When there is an imbalance between the production and absorption of the CSF, it results in Hydrocephalus

Who is at risk of developing Hydrocephalus?

Hydrocephalus can occur at any age depending on the cause. However, it is most common in infants and older children. The exact incidence in India is not known. In the United States, of 1000 babies born, 1-2 develop Hydrocephalus.

What are the symptoms?


  1. Unusually large head
  2. Rapid increase in the size of the head
  3. Bulging or tense fontanelle
  4. Vomiting
  5. Poor feeding
  6. Irritability
  7. Eyes fixed downwards
  8. Delayed milestones
  1. Excessive sleepiness
  2. Irritability
  3. Declining school performance
  4. Headache, vomiting
  5. Double vision or blurred vision
  6. Difficulty in concentrating on routine tasks
  1. Urinary incontinence
  2. Imbalance while walking
  3. Memory loss
How is Hydrocephalus diagnosed?

After a thorough history and physical examination by the attending Neurologist/Neurosurgeon, one of the following tests may be performed to confirm the diagnosis
  1. Ultrasound imaging in newborns and infants
  2. Computed Tomography (CT)
  3. Magnetic Resonance Imaging (MRI)
How is Hydrocephalus treated?

Depending upon the severity and cause of hydrocephalus, your Neurosurgeon may recommend the following 
  1. Ventriculoperitoneal Shunt surgery - This surgery involves inserting a tube in the ventricles of the brain and placing it in the abdomen so that the excess fluid is drained into the abdomen where it is absorbed by the peritoneum
  2. Endoscopic Third Ventriculostomy (ETV) - In this procedure, the neurosurgeon uses a video camera to make a hole in the ventricle so that excess fluid is drained into the subarachnoid space where it is absorbed.
  3. Close observation - In rare cases, when the hydrocephalus is mild and the cause has been treated, one may just closely follow-up the serial imaging. If the cause has been treated, hydrocephalus may resolve on its own

Wednesday, February 22, 2017

Brain tumors in Children

Though rare, brain tumors are the most common form of solid tumors among children under the age of 15 and represent about 20% of all childhood cancers.  Brain tumors in children are often located in different locations and behave differently than brain tumors in adults.  Consequently, management of tumors in children varies from that in adults.  Children with tumors may also have a much better prognosis than adults with a similar condition.

Understanding Tumors
There are different brain tumor types and classifications based upon a tumor’s cell of origin, cell type, composition, rate of growth and other characteristics. 

Most pediatric brain and spine tumors are primary tumors, meaning they originated in the brain or spine.  In contrast, the most common brain tumors in adults are metastases, meaning they represent spread of a tumor located elsewhere in the body, such as the liver, breast, lung and kidney. Primary tumors are classified as “benign” or “malignant.” Both can be life-threatening.

A child’s body makes cells when they are needed for development or repair.  A tumor develops when normal or abnormal cells multiply when they are not needed.  The words “benign” and “malignant” are generally used to describe how normal or abnormal the cells are when viewed under a microscope.  Tumors with cells that are similar in appearance to normal cells are called “benign.”  Tumors with cells that appear very different than normal cells are called “malignant.” A number of factors are taken into consideration while classifying the tumor as 'benign' or 'malignant'. 

Prognosis is a prediction about the future course of the disease and the likelihood of recovery.  Prognosis is based upon many factors including the type of tumor, its location and grade, the length of time your child has exhibited symptoms, the speed of growth, and treatment options.  The age of the child and the extent to which the tumor has affected the child’s ability to function are also important factors.

Brain Tumors in Children
The most common types of brain tumors in children are astrocytoma, medulloblastoma and ependymoma, however below is a full listing of pediatric tumor types.

Malignant - Medulloblastoma, PNET, ATRT, Ependymoma, Choroid plexus carcinoma, Anaplastic astrocytoma, Glioblastoma

Benign - Pilocytic astrocytoma, craniopharyngioma, choroid plexus papilloma, ganglioglioma, neurofibroma

Treatment Options 
Treatment of brain and spine tumors in children is different than treating adults. Children’s brains and bodies are still developing, so there are different considerations and standards of care. For most children, treatment starts with surgery. Histopathological examination following surgery will help to classify and grade the tumor. 

Following surgery, additional treatment may be required.  Possible therapies include:

  • Chemotherapy
  • Conventional radiation therapy
  • Stereotactic radiosurgery
  • Interventions to address side effects of the tumor or the treatment
  • Rehabilitation to regain lost strength and skills
  • Ongoing follow-up care to detect recurrence of the tumor and manage late effects of treatment

Complications following treatment

Treatment of brain tumors, benign or malignant, may involve morbidity leading to distress in the family. Some of the complications of treatment include
  • Physical disabilities such as weakness of muscles and diminished coordination 
  • Learning disabilities including problems with memory, attention, comprehension and information processing
  • Behavioral changes and emotional issues
  • Hearing and vision problems 
  • Seizures and other neurological issues  
  • Hormonal problems including slowed growth, hypo- or hyperthyroidism, diabetes, early or late puberty, and infertility
  • Damage to internal organs and/or other body systems 
  • The possibility of developing secondary cancers in other parts of the body or a recurrence of a tumor in the brain
Timely diagnosis and treatment by a multidisciplinary team helps achieve the best possible outcomes in children with brain tumors. 

For queries please contact

Thursday, February 9, 2017

'Stroke Facts' Questionnaire

Please fill out the following questionnaire to see if you know the basics of 'Stroke'

Click on the Link Below

Stroke Literacy Questionnaire

Wednesday, February 1, 2017

Preparing for Brain Tumor Surgery

Whenever someone in the family is diagnosed with a 'Brain Tumor', it causes a lot of apprehension in in the family. Surgery is usually the first step in treating most benign and many malignant tumors. It is often the preferred treatment when a tumor can be removed without unnecessary risk of neurological damage.

Surgery might be recommended to: 
• Remove as much tumor as possible
• Provide a tumor tissue sample for an accurate diagnosis and for genomic testing
• Remove at least part of the tumor to relieve pressure inside the skull (intracranial pressure), or to reduce the amount of tumor to be treated with radiation or chemotherapy
• Enable direct access for chemotherapy, radiation implants or genetic treatment of malignant tumors • Relieve seizures (due to a brain tumor) that are difficult to control with medications

“Radiosurgery” is a type of intense radiation delivered to a tumor. It may be used instead of, or in addition to, conventional surgery. Radiosurgery is not surgery in the conventional sense, as no opening is made in the skull. In certain cases, it may offer similar benefit and lower risk or discomfort than conventional surgery.

Before surgery your doctor will consider the following: 

• Location of the tumor. Where the tumor is located will determine whether it is operable or inoperable.

• Diagnosis and size of tumor. If a tumor is benign, does not cause intracranial pressure (due to its small size) or cause problems with sensitive areas, avoiding or postponing surgery might be considered.

• Number of tumors. The presence of multiple tumors creates additional challenges to safe removal.

• The borders, or edges, of the tumor. If the tumor is poorly defined around the edges, it may be mixed with normal brain tissue and more difficult to remove completely.

• Your general health. Are your heart, lungs, liver and overall general health strong enough to endure the strains of surgery? If this is a metastatic brain tumor (one which began as a cancer elsewhere in your body), is the primary cancer controlled?

• Your neurological status. Do you have symptoms of increased intracranial pressure? Are there signs of nerve damage possibly caused by the tumor? If so, further evaluation may be needed before surgery is attempted.

• Previous surgery. If you’ve had recent surgery, it is usually necessary to recover from the previous procedure before going through another one.

• Other options. Is it likely that another treatment would provide equal or better results at comparable or lower risk? Your doctor will take these points into consideration in forming your treatment plan.


An operable tumor is typically one that your doctor believes can be surgically removed with minimal risk of brain damage.


In some cases surgery may not be possible because the tumor is so deep within the brain that it is not accessible without excessive risk of brain damage. Tumors located in the brain stem and thalamus are two examples. Other tumors may present a problem if located near a sensitive area in the brain that controls language, movement, vision or other important functions. However, with advances in technology, the so called 'INOPERABLE TUMORS" can also not be safely resected with minimal damage to the surrounding brain.

Highly sensitive scans are used for this purpose and may include:
 • Computerized Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Magnetic Resonance Spectroscopy (MRS)
• Positron Emission Tomography (PET)

Diffusion Tensor Imaging MRI’s may be used to generate maps of the nerve pathways called “fiber tracking.” Use of fiber tracking may help the surgeon avoid disrupting important nerve connections within the brain itself. Vital areas can also be defined by a procedure called brain mapping. At the beginning of the surgery, tiny electrodes are placed on the outer layer of the brain. Stimulating these electrodes helps the neurosurgeon determine the functions of those sensitive parts of the brain so they can be avoided during surgery.


A craniotomy is the most common type of surgery to remove a brain tumor. “Crani” means skull and “otomy” means cutting into. The procedure typically involves shaving a portion of the head, making an incision in the scalp, then using specialized medical tools to remove a portion of the skull. This enables the neurosurgeon to find the tumor and remove as much as possible. After the tumor is removed, the portion of skull that was cut out is replaced, and the scalp is stitched closed. Remember, all of this is done with drugs that relax you or put you to sleep. They also numb the scalp and other tissues. The brain itself does Sample of a head frame used during stereotactic biopsy Electra, LSS frame not “feel” pain, so brain surgery can be done with you awake if the surgeon believes it is necessary to minimize the risk of the procedure.

A craniectomy is similar to a craniotomy in all ways except one. While “otomy” means cutting into, “ectomy” means removal. In a craniectomy the bone removed for access to the brain is not replaced before closing the incision. The neurosurgeon may perform a craniectomy if he or she expects swelling to occur following surgery, or if the skull bone is not reusable. When the bone is reusable it can be replaced at a later date when it will not cause additional pressure. The skull piece is stored by the medical facility until a time when it might be reused. If a craniectomy is done, you will receive instructions from your health care team for protecting the soft spot created by the missing bone.

A Stereotactic biopsy. The same procedure as a needle biopsy but performed with a computer-assisted guidance system that aids in the location and diagnosis of the tumor.

Transphenoidal surgery is an approach often used with pituitary adenomas and craniopharyngiomas. The term “trans” means through and “sphenoid” refers to the sphenoid bone located under the eyes and over the nose. The entry point for the neurosurgeon is through an incision made under the upper lip and over the teeth or directly through the nostril.

If a tumor has a large number of blood vessels, surgery can be difficult due to the bleeding that could result. Embolization is a technique neurosurgeons use to stop the blood flow to the tumor prior to removing it. A diagnostic test, called an angiogram, is performed to determine if a significant amount of blood is going to the tumor. If so, the neurosurgeon or neuroradiologist can insert a small “plug” made of wire or glue-like material into the vessel. This stops the blood flowing to the tumor, but not to normal parts of the brain. Tumor removal usually follows within a few days. This technique might also be used with tumors that contain a high number of blood vessels – referred to as “vascular” or “well-vascularized” tumors. Meningiomas, meningeal hemangiopericytomas and glomus jugulare tumors are typically well-vascularized tumors.

Brain tumor surgery poses both general and specific risks. The general risks apply to anyone going through surgery for any reason and are not limited to brain tumor surgery. These include:
• Infection
• Bleeding
• Blood clot formation (hematoma)
• Blood pressure instability
• Seizures
• Weakness
• Balance/coordination difficulties
• Memory or cognitive problems
• Spinal fluid leakage
• Meningitis (infection causing inflammation of membranes covering the brain and spinal cord)
• Brain swelling
• Stroke
• Hydrocephalus (excessive fluid in the brain)
• Coma
• Death

Risks specific to brain tumor surgery depend greatly on the particular location of the tumor. Particular areas of the brain control functions such as vision, hearing, smell, movement of the arms and legs, coordination, memory, language skills, and other vital functions. The process of operating on the brain always includes some risk that nerves or blood vessels serving these areas will be damaged. This could result in partial or complete loss of sensation, vision, movement, hearing or other functions. When a tumor is located deep within the brain it increases the risk and range of possible complications.

Any type of surgery is a trauma to your body. Some people will recover faster than others. While there is no “normal” recovery period that applies to all people, your recovery time will depend on:
• The procedure used to remove your brain tumor
• The part of your brain where the tumor was located
• The areas of your brain affected by the surgery
• Your age and overall general health

Ask your neurosurgeon what you can expect as a reasonable recovery time. This will help you set realistic goals for yourself in the weeks following surgery.

Please send your queries to

Sunday, September 11, 2016

Apps for Stroke Survivors - Apps for Aphasia Part - 2

The first part of the article was published earlier at 

Apps for Stroke Survivors Part 1

Text-to-Speech Apps Apps -  

Verbally (Free)
- Has basic words programmed and the ability to speak a specific message based on typed in words. Verbally provides text to speech through its onscreen keyboard, word bank and phrase banks, though to customise these banks you need to upgrade for a price.

: (Free) Type in text and listen with the iSpeech App.

Speak It: ($1.99)
This app lets you enter text into your iPhone and then have the application say it back to you using a number of different voices. You can select between male and female American accents or rather posh sounding male and female British accents instead. You simply select the accent using a roller deck-style menu and then tap in what you want it to say in the box above it.lets you enter text into your iPhone and then have the application say it back to you using a number of different voices. You can select between male and female American and British accents. 

Predictable: ($159.99)
This is a text based Augmentative and Alternative Communication (AAC) app designed to give a voice to someone who is unable to use their own. The app is most useful for people who have good cognitive abilities but have lost the ability to speak due to a variety of reasons such as Motor Neurone Disease, ALS, Cerebral Palsy, a head injury or a stroke.

TalkPath News (Free)
Lingraphica’s TalkPath™ News is an online news source for individuals who need help reading, listening or comprehending daily news.

Assistive Express:
This is an affordable Augmentative Alternative Communication (AAC) Device, catered to people with difficulty in speech. Assistive Express is designed to be simple and efficient, allowing users to express their views and thoughts at the most express manner, with natural sounding voices.

Apart from the ones listed above, Speech Magnet and Voice Dream Recorder are other Apps that can help patients with aphasia

Wednesday, August 31, 2016

Alternative and Complimentary treatments for Stroke

Stroke is one of the leading causes of disability and death in India and across the world. Correct identification and treatment within the 'golden hour' using clot busting medicines and/or clot removal techniques can reverse or limit the disability caused by acute stroke. Stroke prevention focusses on life-style modification, healthy diet, exercise and elimination/control of risk factors.

A number of alternative therapies/treatments have been suggested in literature for prevention of stroke. However, there is NO EVIDENCE that any of these helps in the prevention or treatment of stroke.

Herbal Medicines for Stroke

1. Ginkgo Biloba (Marathi - Ginko, Jinko)

Ginkgo biloba is used both to prevent and treat stroke. It helps to prevent blood clots from developing and increases blood flow to the brain. This herb has also been shown to inhibit free-radical formation. Ginkgo is widely used in Europe to treat complications of stroke, including memory and balance problems, vertigo and disturbed thought processes. 

2. Garlic (Marathi/Hindi - Lasun)

Garlic helps prevent ischemic stroke in three ways:
  • Garlic reduces blood pressure
  • Garlic lowers cholesterol levels
  • Garlic is an anticoagulant.
Garlic is the best anti-clotting herb. It contains nine anticoagulant compounds. It is a major herb for heart attack prevention because of its blood-thinning effect and its ability to help control high blood pressure. These same effects also help prevent ischemic stroke

3. Ginger (Zingiber officinale) (Marathi - Ala; Hindi - Adrak)

Ginger is a cardiac tonic, as it decreases cholesterol and helps poor circulation. Ginger prevents blood from clotting excessively.

 4. Turmeric (Cucurma longa) (Marathi - Halad; Hindi - Haldi)

Many studies show that the compound curcumin, which is found in turmeric, helps prevent the formation of blood clots. 

5. Carrot (Marathi/Hindi - Gajar)

In a Harvard study of 87,245 female nurses, consumption of carrots (and to a lesser extent, spinach) significantly reduced stroke risk. Carrots are rich in beta-carotene and other carotenoids. Other studies show that people can reduce their risk of stroke by as much as 54 percent if they eat lots of fruits and veggies that are rich in beta-carotene and vitamins C and E.

6. Pigweed (Amaranthus) (Marathi - Cavaḷī; Hindi - Chaulaee)

A six-year Harvard study of more than 40,000 health professionals showed that compared with those who consumed the least calcium, those who got the most had just one-third the risk of succumbing to heart attack. Pigweed is an excellent plant source of calcium

7. Spinach (Marathi/Hindi - Paalak)

Studies at Tufts University in Boston and the University of Alabama in Birmingham have demonstrated that folate can help prevent both heart disease and stroke. Compared with people who consumed little folate, those who ingested the most were only half as likely to show narrowing of the carotid artery, the artery that leads to the brain.Spinach, cabbage, endive, asparagus, papaya, okra and pigweed have folate.

8. English pea (Pisum sativum), Scurfy pea (Psoralea corylifolia) (Marathi/Hindi - Matar)

Nearly all legumes contain genistein, a cancer-preventive nutrient. In addition to guarding against cancer, genistein also appears to have a significant anti-clotting effect. So, it may also help prevent ischemic stroke and heart attack.

9. Willow (Marathi - Bĕṭa; Hindi - Vilo)

Willow bark is herbal aspirin, and a low-dose aspirin has been shown in several studies to reduce the risk of ischemic stroke by about 18 percent. (Low-dose aspirin also cuts heart attack risk by about 40 percent in men and 25 percent in women.)

10. Pineapple (Marathi/Hindi- Anaanaas)

Pineapple contains an enzyme known as bromelain that is best known for its ability to break down proteins. It's a key ingredient in meat tenderizers. But bromelain also has an anti-clotting action that might help prevent ischemic stroke and heart attack.

11. Bilberry (Vaccinium myrtillus) (Marathi/Hindi - bBooberee)

Bilberries, blueberries and huckleberries contain compounds known as anthocyanidins. European studies show that these compounds help prevent blood clots and also break down plaque deposits lining the arteries. 

12. Evening primrose

Evening primrose oil is rich in gamma-linolenic acid (GLA), which has potent anti-clotting and blood pressure­lowering actions. It is believed to be useful in the prevention of stroke and heart disease. Borage oil is also rich in GLA.

13. Astragalus (Hindi - Kitara)

Astragalus improves tissue oxygenation.

14. Calamus (Marathi - Vēkhaṇḍa; Hindi - Bach)

Calamus helps restore brain tissue damaged by stroke.

15. Cayenne Pepper (Hindi/Marathi - Laal Mirch)

Cayenne pepper improves circulation and heart function without raising blood pressure. 

16. Green Tea

Green tea may act as one of the most potent free-radical scavengers to protect against the peroxidation of lipids, a contributing factor in atherosclerosis.

17. Hawthorn (Hindi/Marathi - Nagaphani)

Hawthorn has been reported to prevent or slow the progression of arteriosclerosis.

18. Horsetail (Hindi - Ashwa Pucchha)

The silica in horsetail maintains the elastic connective tissue of the arteries. It promotes arterial impermeability to harmful lipids, preventing deposits.

19. Kava kava (Marathi/Hindi -Kŏphī)

Kava kava helps to protect the brain against oxygen deprivation. Do not use kava kava if you are pregnant or nursing, if you have Parkinson's disease, or if you are taking a prescription medication for depression or anxiety.

20. Pine-bark and Grape-seed Extract

Pine-bark and grape-seed extract are high in proanthocyanidins (also known as OPCs) that increase the structural strength of weakened blood vessels. 

For more scientific information on each of these herbs, please refer to the official website of the National Center for Complementary and Integrative Health (

Saturday, August 6, 2016

Flow Diversion for Brain Aneurysms - Patient Guide

What is Flow Diversion?

It is a forma of treatment of brain aneurysms wherein a stent like device is placed in the portion of the artery from which the aneurysm arises. The flow diverter decreases the flow of blood within the aneurysm to the extent that the aneurysm is occluded.

How effective is Flow Diversion?

Results from many studies have shown that flow diversion is a safe and effective treatment for aneurysms, more so for unruptured aneurysms. Flow diversion removes the need to enter the aneurysm during surgery, which is the most dangerous part of endovascular treatment of aneurysms, according to medical experts. The risk of rupturing during surgery is greatly diminished by not placing a device inside the aneurysm.

What are the drawbacks of Flow Diversion treatment for brain aneurysms?

  1. The aneurysm does not close immediately, thus, there is a small risk of rupture until the aneurysm closes
  2. One has to be on blood thinner medications for 1-2 years or more
  3. The treatment is expensive in India (as compared to simple coiling or surgical clipping)

What questions should I ask my doctor if he/she recommends flow diversion to treat my brain aneurysm?

First of all, not all aneurysms can be treated by Flow Diversion treatment. Ans, there is a considerable number of aneurysms that can be treated by surgical clipping or simple coiling. Following factors need to be considered while choosing flow diversion treatment for an aneurysm

  1. Can the patient be on two blood thinners for 1-2 years (patients at risk of bleeding do not tolerate blood thinners well)
  2. Can the aneurysm be treated effectively by surgical clipping or simple coiling?
  3. Has the aneurysm ruptured or not?
What are the available Flow Diverting Devices in Indian market?
  1. Pipeline Embolization Device (eV3, Medtronic)
  2. Silk (Balt Extrusion, Montmorency, France)
  3. Surpass (Stryker)
  4. FRED (Microvention)