Neurological Conditions We Manage

A stroke happens when the blood supply to part of the brain is cut off by a clot, or when a blood vessel bursts and bleeds into the brain. The first hours decide how much function can be saved. The common signs come on suddenly: the face droops on one side, an arm or leg goes weak, speech becomes slurred or confused, or vision is lost in one eye. Any of these means an emergency, and the patient should be taken at once to a hospital with a CT scanner.

In hospital a CT scan shows whether the stroke is a clot or a bleed, because the treatment is opposite for the two. Dr. Salman Falak manages the medical side: blood pressure and sugar control along with medicines to prevent a second stroke, and he starts physiotherapy early. Surgery is needed in a minority, to remove a large blood clot or to relieve pressure when the brain swells. Afterwards the work is rehabilitation and prevention, and most of it can be reviewed by video.

Epilepsy is a tendency to have repeated seizures, or fits, caused by sudden bursts of abnormal electrical activity in the brain. A seizure can be the familiar collapse with stiffening and jerking, but it can also be a brief blank stare or jerking of one hand while the person stays awake. A single seizure does not mean epilepsy, and a first fit often has a cause such as high fever in a child or a head injury.

The assessment rests on a good description of the event, ideally from a witness, a neurological examination, an EEG and usually an MRI of the brain. Most patients are controlled well on a single daily medicine, taken regularly and never stopped suddenly. Dr. Salman Falak adjusts the dose at follow-up, often by video, and advises on driving and work safety. A seizure that goes on for more than a few minutes, or one seizure after another without waking in between, is an emergency. Surgery is considered only when seizures continue despite several medicines and a scan shows a removable cause such as a tumour or a scar.

Dementia is a gradual loss of memory and thinking that becomes bad enough to interfere with daily life. It usually begins with forgetting recent conversations, missing appointments, repeating questions and getting muddled with money or familiar routes. Later, judgement and the ability to manage at home are affected, and families often notice a change in personality first.

Not all memory loss is dementia, and this is the most important part of the assessment. Depression, thyroid and vitamin deficiencies, side effects of medicines, and poor sleep can all look like dementia and are reversible. So can two problems in a neurosurgeon's own field: fluid building up inside the brain, called normal pressure hydrocephalus, and a slow-growing tumour or old blood clot pressing on it. Dr. Salman Falak examines the patient and orders blood tests and a brain scan, and whatever can be treated is treated. Where the cause is Alzheimer's disease or another degenerative illness, he prescribes medicines that help with symptoms and guides the family on safety and routine, with follow-up by video where travel is hard.

Depression is a medical illness in which low mood and loss of interest persist for weeks and change sleep, appetite, concentration and the will to carry on. In Pakistan it often arrives in a neurosurgery clinic disguised as something else: constant headache, dizziness, poor memory, body aches or trouble sleeping. It is also common after a stroke and in anyone caring for a relative with dementia.

Dr. Salman Falak's first task is to make sure nothing else is going on. A careful history and examination, and a brain scan where the story warrants it, separate depression from thyroid disease or a structural brain problem. Mild to moderate depression is treated in the clinic with medicine and practical advice, and follow-up by video suits it well. Severe depression or any thought of self-harm is referred to a psychiatrist, and the family is told to stay with the patient until that appointment. If someone you love is talking about ending their life, treat it as an emergency today.

Meningitis is infection of the membranes that cover the brain and the spinal cord. Most families in Punjab know it as gardan tor bukhar, and the name describes it well. It begins with high fever, a severe headache, a stiff neck and dislike of bright light, and the patient may vomit or become drowsy and confused. In babies the signs are vaguer, such as a high-pitched cry and refusal to feed.

Bacterial meningitis can kill within hours, so this is never an OPD diagnosis. Anyone with fever and a stiff neck goes to the emergency department, where blood tests and usually a lumbar puncture identify the germ, and antibiotics are started through a drip straight away. Tuberculous meningitis is common in Pakistan, develops more slowly over weeks and needs a long course of treatment. Dr. Salman Falak treats the complications. A collection of pus inside the skull may need to be drained, and fluid building up in the brain may need a shunt. He also manages the fits or weakness that can remain after recovery.

Bell's palsy is sudden weakness of the muscles on one side of the face, caused by swelling of the facial nerve where it passes through a narrow bony canal. The eye on that side does not close fully, the corner of the mouth droops, smiling is lopsided, and water dribbles from the mouth when drinking. Most cases follow a viral infection, and it is more common in pregnancy and in people with diabetes.

The fear in every family is stroke. In Bell's palsy the forehead is weak too, so the patient cannot raise the eyebrow on that side, whereas a stroke usually spares the forehead and brings other signs such as arm weakness or slurred speech. Dr. Salman Falak makes this distinction on examination and arranges a scan only when something does not fit. Treatment is medicine started within the first days to reduce the swelling in the nerve, and protection of the eye with drops by day and taping at night; facial exercises are added as the nerve recovers. Most patients recover well over weeks to months, and anyone not improving is reviewed again to exclude another cause pressing on the nerve.