Prof. (Col) Dr Bipin Walia
Neurosurgeon specialists diagnose and treat diseases and disorders relating to the body’s spine, brain, and nervous system. They also help to manage conditions affecting the blood flow to the brain. Neurosurgeons can also be involved in rehabilitation after surgery. Severe neurological conditions like Spine & Brain cancer, aneurysms, etc. require the expertise of a neurosurgeon to be treated properly. A neurologist may be able to detect these diseases, but he is not trained to perform complex surgeries. Neurosurgeons sometimes collaborate with pediatricians and other general physicians to provide their patients with the best possible care.
Symptoms
Specific symptoms may indicate a long-due visit to a neurosurgeon; some of them are:
Dizziness, Chronic headaches, Frequent migraines, Imbalance, Nausea, Numbness and tingling of arms and legs, Seizures, Pain in Spine & Limbs.
When to see a neurosurgeon?
Patients may need to see a neurosurgeon if they are experiencing:
● Persistent headache: If the patient is suffering from severe headaches which last for hours or days, one must consult a neurosurgeon immediately. Patients suffering from constant headaches usually have nausea and vomiting too.
● Seizures: Most people with seizures lose consciousness. If the patient is suddenly experiencing episodes of seizures , one must consider visiting a neurosurgeon to prevent seizures from occurring again.
● Impaired movement: Clumsiness, tremors, and involuntary body movements are different types of impaired movements. This occurs due to a defect in the central nervous system of the body or arises as a side effect of certain medications or head injury.
● Memory loss: If the patient is suddenly experiencing brain fog or is unable to recall events that occurred in the recent past, then one must need to visit a neurosurgeon immediately.
● Numbness: If the patient is experiencing numbness in the arms and legs, which lasts for several hours or days, then the patient will require immediate medical attention.
● Severe pain: In this, the patient requires immediate medical attention If the patient is suffering from severe pain in the head, which does not go away after consuming painkillers and medication and is quite persistent.
● Imbalance: If the patient loses balance and cannot move or stand upright without support due to unexplained reasons, one must consider visiting a neurosurgeon.
● Weak grip: Sometimes, people lose the ability to hold and grasp objects due to a loss of sensation or pain. This happens due to a swelling in the wrist resulting from an injury or illness. This condition is called carpal tunnel syndrome.
Conditions treated by neurosurgeons
Neurosurgeons treat several conditions. Some of them are:
● Spinal arthritis: It is an inflammation in the spine. This causes the spinal cord to compress and causes severe pain and numbness. A laminectomy is performed to relieve patients of this pain.
● Spondylolisthesis: Here, one slips onto another one right below it. Symptoms include severe pain in the thighs and legs, which worsens while attempting to stand up.
● Spine cancer: Spinal cancer is abnormal cell growth in the spinal canal. Chemical exposure, hereditary diseases, and a compromised immune system cause spine cancer.
● Osteoporosis: It is a condition where the bones become very brittle and weak. They become soo weak that they tend to fall off due to the mildest stress like coughing and standing up.
● Congenital defects: Neurosurgeons treat genetic diseases like spina bifida. Spina bifida is a condition that occurs when the spine is not formed adequately. Patients suffering from spina bifida lose feelings in their legs and are unable to move them.
● Carpal tunnel syndrome: Here, the patient cannot feel sensations due to pain in the wrist. This pain occurs due to swelling caused by an injury or disease. Lack of grip and inability to hold objects properly are a few symptoms associated with this condition.
● Sciatic nerve injuries: This occurs due to a trauma affecting the nerve. Symptoms include severe pain in the back, numbness in the leg and difficulty moving.
● Intracranial haemorrhages: It is bleeding inside the skull or brain. This bleeding leads to extremely life-threatening brain damage. Symptoms may include severe headache, paralysis of the face and legs, numbing and tingling, extreme weakness, etc.
● Parkinson’s disease: It’s a disorder that affects the central nervous system of the body. This disorder is often associated with weakened movement of the body and constant tremors.
● Stroke: Stroke occurs when there’s a lack of blood supply to the brain. This interruption of blood supply damages the brain extensively. Patients who’ve suffered from a stroke must be admitted to a hospital immediately.
● Encephalitis: It is an inflammation occurring due to an infection in the brain. This disorder could be life-threatening.
● Trigeminal neuralgia: Its a rare chronic pain. Symptoms may include severe pain in the face, usually triggered by speaking, chewing, or brushing teeth. Surgery is performed only if conventional treatments aren’t effective.
● Scoliosis: It is an abnormal curvature of the spine. Usually, patients suffering from scoliosis really require any kind of treatment. However, in a few cases, patients either wear a brace or opt for surgery.
● Meningitis: It is an inflammation occurring in the brain and spinal membranes. This is usually called infection and includes symptoms like fever, stiff neck and headache. There are chances of meningitis improving on its own, but if it progresses, it can be life-threatening.
● Trauma: Any kind of trauma-related injuries like concussions, skull fractures, spinal fractures, etc., are treated by neurosurgeons.
● Migraines: A severe headache usually accompanied by vomiting and nausea. A neurosurgeon can prescribe medications to prevent migraines’ reoccurrence and reduce the intensity of migraines if they occur again.
● Epilepsy: Here, the nerve cell activity of the brain is disturbed, leading to unconsciousness and seizures.
● Brain aneurysm: It is a bulge in a blood vessel of the brain. The primary symptom of a brain aneurysm is a severe sudden headache. In case of a ruptured aneurysm, immediate medical attention would be required.
Diagnosis
Neurosurgeons may order several diagnostic tests; some of them are:
● Biopsy: Here, a small part of brain tissue is extracted and studied under a microscope. Biopsies help to determine if the tumour is cancerous or benign.
● Imaging: Neurosurgeons may ask for imaging tests like CT scans, MRI scans, and ultrasounds to better picture the abnormal mass growth in the brain. This helps the doctors to determine the extent of progression made by the tumour in the brain.
● Electroencephalography: This test is conducted to measure the brain’s electrical activity. It is vital in diagnosing seizures and infections.
● Angiography: Angiography provides a better view of r blood vessels to the doctor. It is conducted to detect aneurysms and other abnormalities in blood vessels.
● Swallow study: Few neurological conditions can affect the patient’s ability to swallow food. Hence a swallow study is conducted to monitor the ease at which the patient can wallow food. Usually, an X-ray is taken when the patient is made to consume food.
● Thermography: This test measures the temperature changes within the body. Thermography is usually ordered to evaluate peripheral nerve disorders, pain syndrome, and nerve root compression.
● Neurologic exam: The Neurosurgeon may conduct a neurological exam to assess the health of the brain. This exam may include tests to evaluate mental health, muscle strength, coordination, vision, speech, hearing, and sensation.
● Cerebrospinal fluid analysis: Here, a sample of the fluid surrounding the brain is extracted and studied. Cerebral spinal fluid analysis can help to detect infection, metabolic diseases, multiple sclerosis, and brain bleeding.
● Positron emission Tomography: This imaging scan helps doctors to get a clearer view of the tumour and metastasis. It also helps to evaluate diseases like epilepsy.
● CT myelogram: Patients with metal devices implanted cannot go through conventional imaging tests like MRI scans. The contrast dye is injected into the patient’s cerebrospinal fluid instead of right into the blood.
(The author is Principal Director & Head- Neurosurgery, Max Super Specialty Hospital, Saket, New Delhi)
