Nerve Conditions

Acoustic Neuroma

Acoustic neuroma, also called vestibular schwannoma, is a noncancerous tumor usually seen in middle-aged people. It develops gradually on the main nerve leading from the inner ear to the brain. This nerve controls hearing and balance. So, as the acoustic neuroma grows, it leads to hearing loss and problems with balance.

Symptoms

The symptoms of acoustic neuroma are subtle and therefore, tend to be overlooked. The most prominent symptom is loss in hearing in one ear accompanied by a ringing sensation in the ear, called tinnitus. Other symptoms include loss of balance, dizziness, facial weakness and numbness.

Causes

There are no established causes for this condition, except for a malfunctioning gene. The reason for the malfunctioning has not been found till date.

Risk Factors

The chances of acquiring this condition are high if either of the parents has neurofibromatosis (a rare genetic disorder). Yet another risk factor is child-hood exposure to low-dose radiation of the head and neck.

Diagnosis

As the symptoms develop slowly over a period of time and resemble middle ear and inner ear problems, detection of the tumor becomes difficult. Your doctor may order a hearing test (audiometry) and scans (CT or MRI) to confirm the diagnosis.

Treatment

Treatment method to be adopted depends on factors such as size and growth of the tumor, its location, patient’s age, and physical health. If the tumor is small, then the doctor may conduct only a regular checkup. He may decide to monitor the tumor by ordering regular imaging and hearing tests at intervals of 6 to 12 months.

Other treatment methods include stereotactic radiosurgery (non-invasive treatment that delivers gamma radiation at the tumor site without making an incision) and surgical removal of the tumor.

Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is a disease characterized by the gradual breakdown and eventual death of nerve cells (motor neurons), leading to muscle weakness and impaired physical functionality. The cause of amyotrophic lateral sclerosis is mostly unknown. Genetic abnormalities, chemical imbalance and autoimmune diseases (where the body’s defense system attacks itself) have been suggested as causes.

Symptoms of ALS may begin as muscle weakness, cramps or twitching in a limb, clumsiness and tripping. Gradually, more muscles are affected and the weakness becomes more severe, leading to loss of important functions like speech, swallowing and breathing. These symptoms are similar to other neurological disorders and in order to rule out these conditions your doctor may perform blood and urine tests, MRI, electromyogram (EMG) and nerve conduction studies (tests the activities of muscles and nerves), and muscle biopsy.

There is no cure for ALS and treatment is based on slowing the advancement of symptoms, preventing complications, and improving your survival, independence and quality of life.

Your doctor may prescribe medication to treat any chemical imbalance present to alleviate symptoms. Your treatment plan includes physical therapy, to help with mobility, occupational therapy, to help you in your daily activities, and speech therapy. As breathing becomes more difficult, you may require mechanical ventilation for assistance.

Bell’s Palsy

Bell’s palsy is a condition that leads to sudden loss of control, paralysis or weakness of the muscles of the face. It is caused by damage to the facial nerve that is responsible for the movements of the facial muscles or facial expressions. The exact reason is not very clear, but the nerve damage is usually associated with infection by viruses such as herpes virus, adenovirus, influenza and mumps viruses. Bell’s palsy is more common in pregnant women, diabetics and those having upper respiratory tract infection.

The condition is usually one sided, resulting in the drooping of one half of the face with the eye on the affected side remaining open. Other symptoms may include drooling, dry eyes or excessive tearing, headache, and loss of taste sensation. The symptoms are usually temporary, improving after a few weeks to six months. Rarely symptoms may persist.

Complications of Bell’s palsy occur rarely and may include:

  • Permanent damage to facial nerve, producing paralysis of half of the face
  • Speech problems
  • Involuntary muscle contraction (synkinesis) due to regrowth of nerves in the wrong direction
  • Damage to the eye because of the dryness, leading to partial or complete blindness

Bell’s palsy is diagnosed by physical examination, tests to check the functioning of the facial nerve, and tests to rule out conditions that may exhibit the same symptoms, such as stroke. Further tests including electromyography (EMG) and imaging scans such as MRI and CT scan may be ordered if diagnosis is unclear or symptoms persist.

To treat Bell’s palsy, your doctor prescribes corticosteroid medication to reduce inflammation. It is best started within 3 days of symptoms. Facial exercises may speed up the recovery process. In case of dry eyes, artificial tears are prescribed.

Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth Disease (CMT) is a hereditary neurological disorder characterized by damage to the peripheral nervous system, especially the nerves that carry signals from the brain to and from the hands and legs. CMT is caused either by defects in the gene that codes for axons (nerve fibers) or myelin sheath (covering the axon).

Some of the symptoms of CMT include:

  • Muscle weakness and wasting
  • Loss of sensation in the hand, feet, legs and forearms
  • Stiffening of joints
  • Abnormal tightening of muscles
  • Scoliosis (curving of spine)
  • Respiratory impairment (when the nerves of the diaphragm are affected)
  • Curled toes
  • Frequent falls

CMT can be diagnosed by evaluating your medical history and performing a thorough physical examination. Your doctor checks for signs of sensory loss, reduction in reflexes, muscle weakness and deformities in your feet. Other tests such as nerve conduction tests and electromyography (measures the electric activity of nerves and muscles), nerve biopsy (laboratory examination of a piece of nerve tissue) and genetic tests, may also be performed to confirm the diagnosis.

CMT cannot be completely cured; however, it can be managed with physical therapy (exercises to prevent muscle tightening), occupational therapy (treatment to help in your day-to-day activities), orthopedic devices (use of braces or splints for mobility and to prevent leg injuries) or surgery to correct deformities. Though CMT progresses with time, it is not known to reduce your normal life span.

Foot Drop

Foot drop, also known as drop foot, is a sign of an underlying muscular, neurological or anatomical condition, where you are unable to lift the front part of your foot, resulting in foot dragging. To avoid dragging your foot, you may lift up your knee higher than usual as if you were climbing stairs or swing your leg in a wide arc, causing you to slap your foot on the ground every time you step forward. Foot drop may also produce numbness. It can affect one or both feet and may be temporary or permanent.

Foot drop is caused by weakness or paralysis of the muscles of the foot. Damage or compression of the nerve that supplies the foot muscles, or diseases of the muscles or nerves (muscular dystrophy and polio), brain or spinal cord (stroke and multiple sclerosis) may lead to foot drop.

Diagnosis is usually made by a physical exam for numbness and abnormal gait. Imaging studies may be ordered to identify any anatomic abnormalities such as overgrowths of bone or tumors that may be compressing the nerve. Nerve tests including electromyography and nerve conduction studies may be performed to examine the affected nerve and locate the area of damage.

Treatment depends on the underlying cause. Your doctor may suggest orthotics such as braces, splints and shoe inserts. Physical therapy may be ordered to strengthen the foot muscles, and improve range of motion and gait. Nerve stimulation may also be recommended. Your doctor may suggest surgery to repair the decompressed or damaged nerve. Successful treatment of the underlying cause may be able to completely cure foot drop. Chances of recovery are better with early intervention.

Guillain-Barre Syndrome

Guillain-Barre syndrome is a rare disorder in which your immune system attacks the nervous system. The cause of Gullian-Barre syndrome is unknown, but it often develops suddenly after a respiratory or gastrointestinal infection, surgery or vaccination (rare). Symptoms begin as weakness and tingling in your legs which spreads to your arms and upper body, and may progress into paralysis as the severity increases when certain muscles stop functioning. It may affect your gait, bowel and bladder control, ability to speak, chew, swallow and even breathe (a medical emergency). The syndrome may produce pain and cramping, and can affect heart rate and blood pressure.

To diagnose this condition your doctor performs a detailed history and physical examination. You may be asked to undergo an electromyography (measures the electrical activity of muscles), nerve conduction studies (measures speed of nerve impulses) or a spinal tap (cerebrospinal fluid surrounding the spinal cord is collected and examined).

Guillain-Barre syndrome cannot be cured; however, the following treatment may be suggested to lessen severity of the symptoms and speed-up the recovery process:

  • Plasmapheresis: Plasma (component of blood), which contains the self-attacking antibodies is removed from blood.
  • Immunoglobulin therapy: High doses of healthy antibodies from donors are injected into the body.
  • Medication: Medication may be prescribed for pain and to prevent blood clots, which tend to form when you are immobile.
  • Physical therapy: Physical therapy is ordered during the recovery period to help you regain strength.

Recovery from Guillain-Barre Syndrome is a long process and can take months or even years. Some patients have residual weakness after resolution of the syndrome and a small percentage of patients may experience a relapse many years later.

Hypertonia

Muscle tone (tension) is controlled by signals that travel from the brain or spinal cord to the muscles. It regulates how much a muscle should contract or relax. When motor nerve pathways become compromised or the parts of the brain and spinal cord responsible for this function get damaged, it results in a condition known as hypertonia. Hypertonia is characterized by increased tension in the muscles causing rigidness and stiffness, and difficulty in movement. Motor nerve damage may be caused by a blow to the head, brain tumors, stroke, toxins, or conditions such as cerebral palsy, multiple sclerosis and Parkinson’s disease. Spasticity is a type of hypertonia in which muscles react in an exaggerated manner by spasming to stimulus received by movement.

Hypertonia may be mild or severe, and may sometimes progressively worsen. In cases of moderate hypertonia, there are increased incidents of falls or accidents due to lack of muscle control. More severe cases of hypertonia lead to joint contracture (frozen joints) and immobility, and may lead to problems such as bed sores, infection and bone fragility.

If left untreated hypertonia can result in loss of function or deformity. Treatment for hypertonia involves the administration of muscle relaxants. Your doctor may also give Botulinum toxin (Botox) injections to treat hypertonia of a specific body part. Exercise and physical therapy are recommended to preserve movement.

Myopathy

Myopathy is a group of neuromuscular disorders, characterized by muscle weakness and dysfunction of muscle fibers, caused by abnormalities in the structure and metabolism of muscle cells. Myopathy may be associated with inflammatory conditions, endocrine and infectious diseases, drugs or toxic causes. There are many types of myopathies and they may be either acquired (such as muscle cramps) or inherited (muscular dystrophy).

Symptoms may also include muscle pain, fatigue, dark colored urine and muscle atrophy (breakdown). Myopathy in children may show symptoms such as cardiac abnormalities, dyspnea (breathlessness), contractures (stiffness of muscle and joints) and skeletal deformities.

To diagnose myopathy your doctor will collect a detailed medical history and perform a thorough physical examination. Blood tests, urine studies and thyroid tests may be ordered. Genetic studies may be suggested. You may have to undergo a muscle biopsy (sample of muscle tissue is removed for microscopic examination) and electromyogram (electric activity of muscle is measured).

If you have inherited myopathy your treatment is mostly supportive and may include medications, occupational therapy, physical therapy (to improve strength and flexibility of muscles and prevent muscle contractures), nutrition and genetic counseling. In cases of acquired myopathy, the underlying condition is treated with medication. You will be asked to withdraw from any medication causing your myopathy.

Myotonia

Myotonia is a condition characterized by delayed relaxation of muscles. Any muscle group can be involved. Myotonia is associated with trouble releasing the grip on objects, difficulties in gait and getting up from a seated position. Repeated contraction or “warm up” is required to relax the muscles. Myotonia occurs as a result of an abnormality in the muscle membrane. It is associated with inherited neurological disorders such as myotonic muscular dystrophy and myotonia congenita, and channelopathies, in which the regulation of the muscle membrane is affected. Cold exposure can also trigger myotonia.

To diagnose myotonia, your doctor reviews your medical history and performs a thorough physical examination. An electromyography may be ordered to test the electric activity in muscles and blood samples are taken for a genetic test to confirm the diagnosis. Treatment for myotonia includes the administration of anticonvulsant drugs, physical therapy and rehabilitation. Myotonia is a chronic condition though symptoms may improve later in life.

Neurofibromatosis

Neurofibromatosis is an inherited disorder characterized by the formation of tumors on nerve tissue as a result of a disturbance in cell growth. Any part of your nervous system may be involved. The tumors are usually benign and can form in children to young adults. Symptoms depend on the nerves that the tumors compress, and may include loss of motor or sensory function.

Neurofibromatosis is of three types:

  • Neurofibromatosis 1 (NF1): NF1 is usually accompanied by characteristic light brown skin lesions, freckling in the armpits or groin, small bumps on/under the skin or in the eyes, bone deformities, large head, short stature and learning disabilities.
  • Neurofibromatosis 2 (NF2): Tumors form on the auditory, visual, cranial, spinal and peripheral nerves, causing hearing loss, balance issues, pain, weakness and numbness in the arms or legs, facial drop as well as cataract formation and other problems with vision. It is less common than NF1.
  • Schwannomatosis: Tumors develop on the cranial, spinal and peripheral nerves causing pain, but not on the auditory nerve that carries information on balance and sound. It is a rare form of neurofibromatosis.

Your child’s doctor performs a thorough medical and family history and physical examination to diagnose neurofibromatosis. Your vision and hearing are examined, and imaging tests may be ordered to study deep tumors and bone deformities. Genetic tests may also be performed.

There is no cure for neurofibromatosis. The doctor monitors your child’s condition and treats complications as they arise. If pain is present, your child’s doctor may prescribe appropriate medication. Surgery may be recommended to remove tumors compressing nerves and surrounding tissue. Stereotactic radiation may be helpful for removing tumors in the ear without affecting hearing and balance. In case of hearing loss, your child’s doctor may recommend implanted or external hearing aids. If the tumors are cancerous and have spread to other parts of the body, a combination of surgery, chemotherapy and radiation is performed.

Central Pain Syndrome

Central pain syndrome is a neurological condition where you experience pain in a particular part of your body, but is not related to any injury to that part. It occurs as a result of damage to your brain, brainstem or spinal cord, brought about by trauma, stroke, seizures, infection or a tumor. The syndrome can show immediately, or after months or even years.

The pain can be of different types: aching, burning, numbing or sharp shooting pain. It is usually constant and increases with touch, temperature (cold), stress and change in emotions. You may experience pain in a restricted region or a larger area of the body. The ends of the hands and feet are common areas of complaint. Diagnosis of central pain syndrome is difficult as it may be unrelated to injury or trauma. Your doctor will perform a thorough medical history review and physical examination to identify and diagnose central pain syndrome.

Your doctor may prescribe pain, muscle relaxing, antiepileptic and antidepressant medications to treat symptoms of central pain syndrome. Surgery involving deep brain stimulation may be recommended if conservative treatments fail to relieve symptoms.

Paresthesia

Paresthesia is a tingling sensation described as “pins and needles”, which is usually felt in the arms, hands, legs and feet. Other symptoms include itching, burning or numbness. It may be associated with spasms, sensitivity to touch and frequent urination. Paresthesia is usually temporary, occurring due to pressure applied on a nerve, as when you sit or lie down in a certain position for a prolonged period of time. However, if the sensation is persistent, it may indicate an underlying neurological condition such as stroke, multiple sclerosis and encephalitis. Other causes of paresthesia include tumors that compress nerves, nerve entrapment (carpel tunnel), alcoholism, diabetes, and Vitamin B12 deficiency.

To diagnose the cause of paresthesias, your doctor reviews your medical history and performs a thorough physical examination. Laboratory, imaging tests and nerve conduction studies (measures nerve activity) are ordered.

Your doctor will determine treatment based on your underlying condition. In mild cases, your doctor may prescribe pain medication and Vitamin B12 supplements, and may suggest acupuncture and massage therapy.

Periodic Paralyses

Periodic paralyses are a group of neurological disorders characterized by episodes of muscles weakness, flaccidity and paralysis. Muscle function returns to normal after the episode of weakness. Periodic paralysis is mostly hereditary and caused by a disruption in the ion channels of the nerve cells which are required for nerve impulses to travel. Attacks may occur following strenuous exercise, eating a diet rich in carbohydrates or following epinephrine or insulin injections. It may also be associated with high levels of thyroid hormone in the blood (thyrotoxicosis).

Periodic paralyses are of 2 types:

  • Hypokalemic form: low potassium levels in the blood. The symptoms appear during the teen years, may be mild or severe, and can last from a few hours to many days. You may develop persistent muscle weakness as you grow older.
  • Hyperkalemic form: high potassium levels. It is seen in infants and children and the symptoms occur for shorter and more frequent durations, and are less severe. Muscle spasms are more common.

When you present with the above symptoms, your doctor will study your history and perform a physical examination. Blood tests and urine tests may be ordered to assess for change in potassium levels. Electrocardiography may be performed, as it shows characteristic findings of periodic paralyses.

Treatment is aimed at reducing the severity of your symptoms and frequency of further attacks. Your doctor may prescribe medications, and advise you to avoid strenuous physical activity and avoid a carbohydrate-rich diet.

Primary Lateral Sclerosis

Primary lateral sclerosis is a slowly progressing degenerative disease of the nerve cells that control your voluntary muscles, causing them to weaken. It occurs mostly between the ages of 40 to 60 and is more prevalent in men. The cause is unknown, but a subtype called juvenile primary lateral sclerosis develops due to an inherited genetic mutation.

Symptoms first start in the legs then progress upwards to the trunk, hands, tongue and jaw. Movement requires effort and is slow. There may be muscle tightness, spasms, clumsiness, and problems with gait and balance. Later, muscles of speech and swallowing may be affected.

Diagnosis of primary lateral sclerosis is difficult because its symptoms are similar to that of other conditions such as amyotrophic lateral sclerosis, which has a more aggressive course. Your doctor reviews your medical and family history, performs a physical and extensive neurological examination. Tests may include MRI, electromyography (assess muscleactivity), nerve conduction studies (assess nerve activity), lumbar puncture (assess spinal fluid for diagnostic significance) and PET scans (identify brain degenerative changes).

In order to treat primary lateral sclerosis, your doctor will focus on alleviating your symptoms as there is no cure for this condition. You may be prescribed medication to reduce your spasms. Antidepressants may be administered. Physical therapy is advised to improve muscle strength and prevent joint stiffness. Speech therapy and the use of a wheelchair and other assistive devices may be necessary as the condition progresses.

Sciatica

Sciatica is a painful condition caused by the irritation of the sciatic nerve. The sciatic nerve is the longest nerve in our bodies. It begins in the lower back and extends through the buttocks down the back of each leg to the thighs and feet.

Sciatica can be acute (short term) lasting a few weeks or chronic (long term) persisting for more than 3 months. It is important to understand that most sciatica will resolve itself   within a few weeks or months and rarely causes permanent nerve damage.

Anyone can develop sciatica at some point in their lives; however there are certain risk factors that may predispose you to develop sciatica. These include the following:

  • Increased age
  • Poor physical fitness or inactive lifestyle
  • Occupational risks
  • Genetics
  • Poor nutrition
  • Medical conditions such as diabetes or cancer that has metastasized to the spine can cause sciatica
  • Smoking

It is important to know sciatica is a symptom but not a medical diagnosis. Some medical conditions that can cause sciatica include herniated discs, lumbar spinal stenosis, piriformis syndrome, Spondylolisthesis, degenerative disc disease, diabetes, tumors, and trauma.

The most common symptom of sciatica is pain. The pain can vary from mild to debilitating depending on the degree of pressure exerted on the sciatic nerve. Patients having sciatic nerve experience other symptoms such as:

  • Pain in the buttock area and leg
  • Sharp, intense, shooting pain down the leg
  • Numbness, burning or tingling sensation in the leg or foot
  • Weakness of the leg or foot
  • Low back pain that radiates down to the buttock and leg
  • Pain increases with coughing, sneezing or straining
  • Pain increases with bending backward and with prolonged sitting or standing

Sciatica will be diagnosed by taking complete medical history, physical examination, assessment of neuromuscular function and diagnostic procedures such as X-ray, MRI, CT scan, CT scan with myelogram, electromyogram and nerve conduction tests.

Sciatica can be treated with conservative treatment approaches such as physical exercises, over the counter drugs, ice or hot packs, prescription medications, epidural steroid injections, massages and manual manipulation. In some cases surgery may be recommended to treat the underlying condition causing sciatica and these conditions include herniated discs, lumbar spinal stenosis, Spondylolisthesis and degenerative disc disease.

Spasticity

Spasticity is an involuntary contraction of your muscles that produces stiffness and loss of control, leading to difficulty with movement and speech. Other symptoms of spasticity include pain, jerking movements, hyperactive reflexes, muscle spasms, bone and joint deformity, and abnormal posture. It is caused by injury to the region of the brain that controls movement or damage to the nerves that carry impulses between the brain and the muscles due to trauma. Spasticity may also be associated with diseases such as multiple sclerosis, stroke and cerebral palsy.

To diagnose spasticity your doctor reviews your family and medical history, and performs a thorough physical examination to identify associated muscular or neurologic disorders. Your doctor may order tests to assess muscular activity, range of motion, and movement of your arms and legs.

It is necessary to seek treatment early as spasticity can lead to contractures (hardening of the muscles), joint stiffness, and pressure ulcers from immobility. Spasticity treatment includes medication, Botulinum toxin injections, occupational and physical therapy, use of braces, or surgery. In rare cases, your doctor inserts a pump into the spinal fluid to directly administer medications to the nervous system.

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