Introduction

Hello and welcome to brain disease weblog. Well introductions first. I am a qualified neurologist in NYC with interests in general clinical neurology and epilepsy. The human brain has always fascinated me from a young age and hence after finishing my residency in internal medicine, I decided to further specialize in Neurology and sub specialize in Epilepsy. Whenever I go on the internet looking for information about specific neurological diseases and conditions, it always bothers me that there are very few patient oriented sites. The ones which do exist either disseminate rudimentary information or charge a fee for it.

Patient’s are usually not able to access quality review articles written by experts in the field published in leading neurology journals like Neurology, Journal of Neurology Neurosurgery and Psychiatry, European Neurology or New England Journal of Medicine. Of course these articles are more scientific and difficult for a lay person to understand.

Hence the purpose of this blog. It is my attempt in a small way to disseminate information regarding common neurological conditions in a way that you can understand. Information which is current, comprehensive and mostly importantly accurate.

Before we start I want to remind you what I was taught in my medical school:

” not reading ( your textbooks) is like sailing on uncharted seas but not seeing the patient is like not going to the sea at all”

There is no substitute to an actual visit to your physician. You can read about the disease you feel you have but always always do consult your physician.

Hope you find the information here useful.

Personal Regards,

NS

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2 thoughts on “Introduction

  1. Dear Dr. Nitin
    How are you doing ? Well I came across your blog while surfing google regarding epilepsy issues. I don’t know if I am an epileptic sufferer or with seizure. either 30th may or 1st june 2012, while I was working over the computer in my room, suddenly I felt that my eyes started seeing everything being gloomy and my neck started turning to the right hand side while trembling very faster which I could not control and fell down on earth. And after that my dad came near to me and set and asked what happened I told him every thing and the same day or constant two three days at large it might have happened 3-4 times and then I started forgetting everything then he took me to the local physician who gave me an injection (I do not know the name) and told my dad that it was epilepsy attack or fit hence take me to a neurologist as soon as possible and next day I was admitted to a nearby hospital where were done many a test which are elaborated herein for your kind pursuance:
    X-RAY REPORT OF CHEST
    Lung fields are clear.
    Cardiac size and configuration normal
    Apices and cp angles are clear
    (Please correlate clinically and further investigate to assess if need be)

    EEG REPORT
    awake EEG shows background consisting of 8-9Hz posteriorly dominant alpha rhythm.
    no focal slowing is seen
    left frontoparietal slow and sharp waves discharges are seen
    no epileptiform discharges are seen
    sleep not obtained

    IMPRESSION-: abnormal awake EEG record suggestive of localization related epilepsy arising from LEF frontoparietal area.
    suggestive neuroimaging
    to be correlated clinically

    MRI REPORTS
    Both orbits are normal.
    note is made of mild pansinusitis.
    IMPRESSION-:
    MR IMAGING OF BRAIN REVEALS FOCAL HYPOINTENSE NODULE LOCATED SUPERFICIALLY AT GREY WHITE MATTER INTERFACE IN LEFT FRONTAL LOBE WITH SURROUNDING MILD EDEMA/GLIOSIS, SUGGESTIVE OF INFLAMMATORY GRANULOMA.
    ADVISED: CLINICAL CORRELATION.

    MRI BRAIN
    FLAIR T1W AND FAST SPIN ECHO T2W HIGH RESOLUTION AXIAL IMAGES OF BRAIN WERE OBTAINED ON A HIGH RESOLUTION DEDICATED PHASED ARRAY SURFACE COIL USING TWIN GRADIENT 8 CHANNEL HIGH DENSITY 1.5 TESLA SYSTEM WITH ZOOM GRADIENT COIL AND CORRELATED WITH T2W SAGITTAL,CORONAL,FLAIR AND DIFFUSION AXIAL IMAGES.
    SUPRATENTORIAL:
    THE STUDY REVEALS FOCAL HYPOINTENSE NODULE LOCATED SUPERFICIALLY AT GREY WHITE MATTER INTERFACE IN LEFT FRONTAL LOBE WITH SURROUNDING MILD FLAIR HYPERINTENSITY SUGGESTIVE OF EDEMA.
    REST OF THE CEREBRAL PARENCHYMA IS NORMAL IN SIGNAL INTENSITY WITH MAINTAINED GEY AND WHITE MATTER DIFFERENTIATION.
    BILATERAL BASAL GANGLIA AND THALAMI ARE NORMAL IN VOLUME AND SIGNAL INTENSITY.
    VENTRICLES ARE NORMAL IN SHAPE,SIZE OUTLINE AND VOLUME. SEPTUM IS IN MIDLINE.
    BASAL CISTERNS AND SYLVIAN FISSURES ARE NORMAL.
    SELLA AND PARASELLAR REGION ARE NORMAL.
    POSTERIOR FOSSA:
    BRAINSTEM IS CENTRAL AND NORMAL IN SIGNAL INTENSITY.
    FOURTH VENTRICLE IS CENTRAL AND NORMAL.
    CEREBELLUM IS NORMAL IN SIGNAL INTENSITY.
    MAJOR INTRACRANIAL FLOW VOIDS PRESERVED.
    HAEMATOLOGY
    complete blood count
    Haemoglobin 14.3%
    total leucocyte count 9600
    DIFFERENTIAL LEUCOCYTE COUNT (DLC)

    Neutrophils 75

    Basophils 00

    Eosinophils 02

    Lymphocytes 20

    Monocytes 03

    RBC count 5.11

    PACKED CELL VOLUME (PCV) 44.8

    MCV 87.67

    MCH 27.98

    MCHC 31.92

    PLATELET COUNT 1.86

    KIDNEY FUNTION TEST (KFT)

    UREA-13.85
    SERUM CREATININE-0.75
    SERUM URIC ACID-7.55
    CHOLESTEROL-148
    ALKALINE PHOSPHATASE-93
    SODIUM-140
    POTASSIUM-3.7
    CALCIUM-9.0
    PHOSPHORUS (PO4)-3.81
    TOTAL PROTEINS-7.94
    SERUM ALBUMIN-4.94
    GLOBULIN-3

    LIVER FUNCTION TEST

    TOTAL BILIRUBIN-0.87
    DIRECT BILIRUBIN-0.39
    INDIRECT BILIRUBIN-0.48
    S.G.O.T-52
    S.G.P.T-77
    G.G.T-123
    ALKALINE PHOSPHATASE-93
    TOTAL PROTEINS-7.94
    SERUM ALBUMIN-4.94
    GLOBULIN-3
    A/G RATIO-1.65
    (note: the results which were obtained have been only mentioned just before every organical or test work name and those which have been underlined and are in bold font having the same expression as mentioned in the report )

    DISCHARGE SUMMARY
    case summary
    patient admitted with complaints of seizurex4 days at 3 episodes cannot movement of body towards right at the time of seizure.
    initial examination revealed…………………….
    conscious , oriented
    afebrile
    BP 130/80 mmHg
    PR 100/min
    chest-bilateral air entry (+)
    CVS-S1 S2 (+)
    PA-soft, BS (+)
    after initial clinical assessment treatment initiated and all necessary investigations were sent. patient shifted to ward for further management under neurologist Dr. R.K .Gupta.
    in the ward patient was reassessed and treatment continued with supportive care and enteral nutrition. gradually patient’s condition stabillised and is being discharged in a stable condition with follow up medical advice.
    TREATMENT GIVEN

    INJ-FOSOLIN
    INJ-DEXONA
    INJ-PANTOCID
    INJ-ONDEM
    TAB-FRISIUM
    TAB-ZEPIZ 0.5MG
    TAB-OLIZA
    TAB-EPTOIN
    TAB-PANTOCID
    TAB-OLANZAPINE 2.5MG

    INVESTIGATIONS
    LFT- S.BIL-NORMAL, SGOT52, SGPT77, GGT123
    KFT-NORMAL, URIC ACID 7.55 , HB 14.3 , TLC9600, P/C1.86
    ECG-S/O LOCALIZATION RELATED EPILEPSPSY ARISING FROM LEFT FRONTO PARIETAL AREA
    X-RAY CHEST
    MRI S/O INFLAMMATORY GRANULOMA

    MY PRESENT STATE OF MIND
    sir at present I have been taking the following medicines as referred by my doctor:
    TAB-FRISIUM
    TAB-ZEPIZ 0.5MG
    TAB-OLIZA
    TAB-EPTOIN
    TAB-PANTOCID
    TAB-OLANZAPINE 2.5MG
    and there is another one which is rolled shape small resembles eggs

    MY DOCTOR’S SUGGESTIONS
    1- I cannot drive at least for 6 months
    2- I need to take these medicines at least for 6 months
    3- I cannot drink
    4- I can’t do exercises or yoga

    ALL THAT IS SPECIAL AND SECRET THAT I WISH TO SHARE WITH YOU SO THAT YOU COULD HELP ME OUT
     I do exercise and yoga at home for an our everyday
     I go to my bed around 4-5 am every night
     I take half bottle of whisky everyday (just from few months back only) and I have such a capacity and self confidence that if I want I can leave it instantly and I have tested it many a time
     the nature of my job entitles only be waken till late in night
     few years ago I suffered from the infection in my LS joints or say BONE T.B
     while I was in 5th standard the same attacks or say fits I experienced and the same way neck kept moving right hand side but that time I had easily controlled but this time it became uncontrollable for me. why ?
     I have been yoga instructor for the long time till date
     some times I feel that my mind has become overactive which I cannot control
     I take tobacco everyday
     I am in contacts with lots of women and girls and keep thinking about them
     I have lots of tensions in my mind regarding my family and my enemies
     I feel that most of the time my mind keeps thinking unnecessarily .
     I am a role model for all of my friends, students, relatives and neighbors as well as I am honored at large
     Some times I feel that I must commit suicide since my mother passed away few months ago only and she comes in my dreams everynight

    WELL THESE ALL ARE THE POINTS WHICH ARE ABSOLUTELY TRUE SINCE IF A PATIENT HIDES ANY THING FROM HIS DOCTOR THEN HE/SHE CANNOT BE EVER PROPERLY TREATED AND THESE ARE THE FACTS WHICH I EVEN NEVER SHARED WITH MY NEAR AND DEARONE….PLEASE HELP ME OUT AND CLEARLY TELL ME WHY THIS PROBLEM HAPPENED TO ME AND WHY DOCTOR HAS PUT SUCH RESTRICTIONS ON ME…PLEASE SIR HELP ME OUT.. I DON’T KNOW BUT SOMETIMES I FEEL THAT I MUST SUICIDE AND THUS MUST HAVING FREEDOM FROM ALL THESE DISEASES AND MENTAL TENSIONS…..THOUGH I HAVE DONE 11 MASTERS IN DIFFERENT DISCIPLINES FROM INDIA BESIDES M.PHIL FROM UNITED KINGDOM AND INTENDS TO DO PH.D FROM THE SAME UNIVERSITY OF UK……..BUT AFTER THESE FITS I FEEL TENSED AND BLOWER OF DEPRESSION ALL THE TIME…PLEASE HELP ME OUT ………… I FEEL VERY LONELY SINCE MY MOTHER PASSED AWAY SIX MONTHS AGO AND KEEP THINKING ABOUT THE EASIEST WAYS TO DIE..PLEASE BEING LAST HOPE..I AM WRITING TO YOU…PLEASE HELP ME DOCTOR

    1. Dear Mr. Kumar,
      thank you for writing in to me. I was concerned when I read your email and hence this urgent reply to you. After reading your history more than likely you suffer from epilepsy (seizure disorder) due to the inflammatory granuloma in the brain. In countries of South East Asia the most common cause of inflammatory granulomas in the brain is neurocysticercosis (pork tapeworm) though other infectious and inflammatory conditions such as tuberculosis (tuberculomas) need to be ruled out. You need to remain on the anticonvulsant medication started by your doctor and bring the other points you mention above to his attention. You are drinking excessively and as you know alcohol lowers the seizure threshold. So this is ill advised. I understand you are passing through a very difficult time and miss your mother very much. You should bring to your doctor’s attention these depressive thoughts and sucidial ideations at the earliest. Please do not delay seeking help Rahul. I send you my best wishes and hope to hear back from you in happier times.

      Personal Regards,

      Nitin K Sethi, MD

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