Neuro Sciences

The department of Neuro Sciences at Poona Hospital is centered on a foundation of academic, clinical & research excellence and is committed to provide the highest quality of patient care.

Poona Hospital boasts of the only dizziness and balance disorders unit with Neuro-Otological expertise to deal with even the most challenging cases of dizziness, vertigo and balance disorders.

The Neurologists, ENT surgeons and physical therapists all within the same facility offer a true multidisciplinary approach for balance disorders.

The hospital has the first dedicated Neuro ICU and Stroke unit in the city.
The Neuro surgical teams perform complicated stereotaxy procedures, surgery for aneurysms, tumors of brain and spinal microsurgery.

The department of neurology has grown to be one of the major centres of excellence in the state. The Neurology Department offers comprehensive consultation, evaluation, clinical diagnostic studies and treatment of Neurological diseases.

Dizziness and balance disorders clinic:
The neurology team specializes in “curing” Benign positional vertigo in minutes by simple repositioning maneuvers and have treated more than 1000 cases with almost 90 % success rate.

Emergency Services:
The Emergency unit handles the most demanding cases 24 x 7 . The largest group of patients seen at the emergency department are the stroke patients. Other typical emergency cases are status epileptics, convulsions, loss of consciousness, severe headache, and inflammation of the nervous system.

Stroke unit:
The hospital offers a comprehensive stroke prevention and treatment program. Patient education, risk, screening, and acute and secondary prevention therapies are also offered. Facilities for intravenous and intra arterial thrombolytic therapy are available. The multidisciplinary team offers the state of the art treatment and diagnostic technologies in a warm and compassionate environment. All care is co-coordinated by highly specialized professional staff, which is well supported by an excellent rehabilitation unit. Emergency ambulance services are also available.

Intensive care:
The department has a well-equipped ICU to deal with all neurological emergencies. The ICU is equipped with infusion pumps, Intracranial pressure monitoring devices, bed side monitors and critical care ventilators and manned by trained staff.

General Neurology:
General Neurology clinic and outpatient department operates all days and is staffed by highly qualified and experienced neurologists .It provides a ready access for patients with all neurological problems.

Headache clinic:
A multidisciplinary team consisting of Neurologist, Ophthalmologist, Dental, Psychiatrist and ENT specialist evaluates and offers treatment to patients with headaches. The team makes certain that the diagnosis is accurate. The clinic is dedicated to quality diagnosis, comprehensive and individualized management in cooperation with the patient. A number of complementary and alternative therapies are available for appropriate individuals such as physical therapy, relaxation training, nerve blocks, life style counseling, biofeed back techniques and diet counseling.

Epilepsy clinic:
We offer extensive experience in diagnosing and treating epilepsy, syncope and related conditions.

Botox clinic:
Botox treatment if available for patients with blepharospasm, hemifacial spasm, torticollis, cerebral palsy, hemiplegics and spasticity, and other disorders.

Lab services:
The Neuro lab is complete with a wide range of diagnostics for accurate pathological diagnosis of muscle, nerve diseases and brain lesions.
 

SERVICES offered


Vertigo and balance disorders clinic: The Poona Dizzy and Balance Center (PDBC) is a unique outpatient clinic. A combination of Neurologists, ENT surgeons and physical therapists all within the same facility offer a true multidisciplinary approach for balance disorders. State-of-the-art diagnostic machines, including VNG and Dynamic posturography , are used for an accurate diagnosis in our patients.

Conditions treated: At PDBC we see a wide variety of dizziness and balance impaired patients.
Dizziness/vertigo Due To:
  • Vertigo or dizziness due to diseases and infections
  • Benign Paroxysmal Positional Vertigo (BPPV), both typical and atypical
  • Stroke & brain injury related dizziness
  • Vestibular disorders like Vestibular Neuritis
  • Migraine associated dizziness
  • Meniere’s disease
  • “Cervical spondylosis”
Balance / Gait Problems Due To:
  • Vestibular disorders
  • Diabetic and other Peripheral neuropathies
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Stroke & brain injury related balance problems
  • Post-aminoglycoside therapy, chemotherapy, or inner ear surgery with persistent symptoms
  • Spondylotic and other myelopathies
  • Stroke and TIA unit
  • Memory disorders clinic
  • Botox and movement disorders clinic
  • Migraine and Headache clinic
  • Epilepsy clinic
  • Neuro-ophthalmology clinic
  • Sleep disorders clinic

Following are the Investigations:

EEG

  •  What is an EEG ?
    An EEG (electroencephalogram) is a test that records the electrical activity of your brain. (The nerve cells in your brain work by carrying tiny electrical charges.)
  •  When is it used?
    An EEG can help your healthcare provider diagnose medical problems such as epilepsy, sleep apnea, encephalitis (infection in the brain), dementia, and brain tumors.
  •  How do I prepare for an EEG?
    Your head doesn’t need to be shaved for an EEG. Some EEG labs ask that your hair be clean and free of hair products such as oil, hairspray or mousse. Ask your doctor if there are any special instructions you need to follow. Also ask if there are any substances or medicines that you should avoid before the test.

    Sometimes a sedative is given just before the test to help you relax during the EEG. In case this happens, plan to have someone drive you home after the test.
  •  How It Is Done:
    The EEG is done by a trained EEG technician. The EEG record is read by the neurologist and a report prepared for interpretation and use of your doctor.
    You will be asked to lie on your back on a bed or table or relax in a chair with your eyes closed. The EEG technologist will attach 16 to 25 flat metal discs (electrodes) to different places on your head, using a sticky paste to hold the electrodes in place. The electrodes are hooked by wires to a computer that records the electrical activity inside the brain as a series of wavy lines on the computer screen, which later is printed out.
  •  What happens during the test?
    An EEG is painless and normally takes 45 minutes. During the test you will relax in a bed. Small metal plates (electrodes) are pasted or taped to your head. The electrodes send information to a machine that records brain waves on paper.

    EEGs may be done while you are:
    • sleeping
    • resting with your eyes closed
    • resting with your eyes open
    • breathing rapidly (and just after)
    • looking at a flashing light
    The EEG records how the brain responds to these changes.
    Lie still with your eyes closed during the recording, and do not talk to the technologist unless you need to.
    An EEG takes 1 to 2 hours.
  •  How It Feels :
    There is no pain with an electroencephalogram (EEG).
    If you are asked to breathe rapidly, you may feel lightheaded or have some numbness in your fingers. This reaction is normal. It will go away a few minutes after you start breathing normally again.
  •  What are the Risks :
    An electroencephalogram (EEG) is a very safe test. The electrical activity of your brain is recorded, but at no time is any electrical current put into your body. An EEG should not be confused with electroshock (electroconvulsive) therapy.
  •  What happens after the test?
    After the test, you may do your normal activities. You can usually go home as soon as the test is done. The report will usually be available the next day.
  •  What are the benefits of this test?
    Diagnose epilepsy and see what type of seizures are occurring. EEG is the most useful and important test in confirming a diagnosis of epilepsy.
    Check for problems with loss of consciousness or dementia.
    Help find out a person’s chance of recovery after a change in consciousness.
    Find out if a person who is in a coma is brain-dead.
    Study sleep disorders, such as narcolepsy.
    Watch brain activity while a person is receiving general anesthesia during brain surgery.
    Help find out if a person has a physical problem (problems in the brain, spinal cord, or nervous system) or a mental health problem.
  •  What is Video EEG :
    Video EEG records a video of the patient along with the EEG activity on the computer so that the doctor can see what happens just before, during, and right after a seizure. This test can be very helpful in finding the specific area of the brain that the seizures may be coming from. It is also helpful in diagnosing psychogenic seizures, which may look like real seizures but do not affect the electrical activity in the brain.

EMG & NCV

  •  Electromyogram (EMG)
    An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. Nerve conduction studies measure how well and how fast the nerves can send electrical signals.
    Measuring the electrical activity in muscles and nerves can help find diseases that damage muscle tissue or nerves. EMG and nerve conduction studies are often done together to give more complete information

    PLEASE NOTE: Your testing could include either just one of the procedures (Nerve Conduction Study or Needle EMG) or both of the procedures. Often for hand studies like carpal tunnel or just numbness in the feet, it may only require the Nerve Conduction Study.
  •  Nerve Conduction Studies :
    NCSs show how well the body’s electrical signals are traveling to a nerve. This is done by applying small electrical shocks to the nerve and recording how the nerve works. These shocks cause a quick, mild, tingling feeling. The doctor may test several nerves.
    • Needle EMG (Electromyography)
      For this part of the test, a small, thin needle is put in several muscles to see if there are any problems. A carefully sterilized needle is used for each patient. You may also insist on a new needle ( disposable) for a nominal extra charge. There may be a small amount of pain when the needle is put in. The doctor tests only the muscles necessary to decide what is wrong. The doctor will look at and listen to the electrical signals that travel from the needle to the EMG machine. The doctor then uses his medical knowledge to figure out what could be causing your problem.
    • Evoked Potentials
      Evoked potentials are painless tests that check the nerve pathways through the spinal cord or from the eyes and ears. The signals for these tests can come from small electrical shocks, light pulses, or clicks of sound in the ears. The nerve responses are recorded over the scalp and other areas of skin.

VNG - Video Nystagmometry and Eye Movement Studies

This test has supplanted the older ENG (Electronystagmometry) test in most advanced dizziness and balance centres around the world.

We have the first VNG installed in India; and are the pioneers in the use of this advanced technology in patients of dizziness, vertigo and balance disorders.

The VNG measures various normal eye movements and involuntary rapid eye movements called nystagmus. We can easily look for and document disorders of saccadic intrusions, saccading latencies and velocities, gaze holding and following and detect various types of nystagmus.

It also checks the muscles that control eye movements. ENG checks how well the eyes, inner ears and brain help you keep your balance and position (such as when you change from lying down to standing).It is done to help see whether there is damage or a problem in how the inner ear, brain, or nerves connecting them work. These problems may cause dizziness, vertigo, or loss of balance.
During ENG, electrodes are attached to the face near the eyes to record eye movements. But with VNG a simple goggle is placed over your eyes, which records the eye movements directly with an infra-red camera. The movements are recorded on the computer for analysis and later printout. A series of recordings is done.
Baseline recordings are taken with your head at rest.

More recordings are done:
  • While you move your head up and down, left and right.
  • While you look at a moving object.
  • Rarely after warm or cold water is placed inside your ears.
  •  How do I Prepare for the test?
    For 2 to 5 days before the test, you will be asked to stop taking :
    • Medicines that help your vertigo.
    • Sedatives and tranquilizers
    • Drinks with alcohol
    • Foods that contain caffeine, such as coffee, tea, cola, and chocolate
    Your doctor may ask you to eat a light meal or not eat for 3 to 4 hours before the test, because the test can cause nausea and vomiting.
    Do not wear facial makeup during the test so the electrodes can attach to the skin.
    If you normally wear glasses, contact lens, or hearing aids, carry them while coming for the test.
    If you have a neck or back problem, tell your doctor, so your neck and back will be protected during the test.
  •  How does It Feel?
    You may feel weak, dizzy, or nauseated during an electronystagmogram. You may feel as if you are going to fall down during the test, but don’t worry, the doctor or technician will make sure you do not fall. These feelings will go away when the test is done. If you are having the test because you have dizziness or vertigo, you may find that the test causes your condition to be worsen for a short time.
    During the caloric test, you may feel nauseous and may vomit. You may need to lie down until the nausea and vomiting or vertigo ease off.

The Balance Master

  •  The Balance Master
    The Neurocom Balance Master is the FIRST machine of its kind installed in India.

    The machine prescribes training protocols to target the specific impairments in an individual patient and offers corrective exercises tailored for these impairments.

    It can pinpoint the functional defect, whether sensory, motor or cerebral integration, also suggests a remedial exercise program to help the patient adapt to his balance disorders.
    Diagnostic Uses:
    In patients who have balance problem due to:
    • Otological, neurological or cardiovascular causes
    • Head injury / Concussion
    • Stroke
    • Parkinson’s Disease
    • Peripheral Neuropathy
    • Spondylotic Myelopathy [not ’spondylosis’]
    • Orthopaedic disorders
    • Chronic low back pain
    • Drugs

Tilt table testing

  •  Tilt table testing
    A tilt table test is used to check the cause of fainting spells or severe lightheadedness by watching how your body responds to changes in position. Syncope (sink-o-pee) or fainting occurs for different reasons. It can be from a nervous system reaction that causes the heart to slow, the blood vessels to expand and the blood pressure to drop. When the blood pressure drops, the blood flow to the brain is less. This can cause fainting. This condition is called postural hypotension. Tilt table testing may also be useful for people who have severe lightheadedness or dizziness which does not cause them to faint but forces them to sit or lie down. The test involves being tilted, always with your head up, at different angles for a period of time. Your heart rhythm and rate, blood pressure and other symptoms will be closely checked with changes in position. The test takes about 45 minutes. You will be in the pre-procedure area for about 2 hours and post-procedure recovery area for another hour.

    Before the Test
    • Check with your doctor to see if there are any medicines that you should not be taking for 2 to 3 days before the test.
    • If you are to take medicine the morning of your test day, take the medicine with as little water as possible.
    • If you have diabetes and take medicine to control your blood sugar, check with your doctor about how to adjust your diabetes medicine.
    • Do not eat or drink anything at least 4 hours before the test. This helps reduce the chance of nausea.
    • You will wear a hospital gown during the test.
    • Do not wear or bring any jewelry or valuables with you.
    • Arrange for someone to drive you home after the test if you are an outpatient. You will not be allowed to drive right after the test.
    • Bring all of your medicines with you so the doctor can check the names and doses for each medicine. Be sure to tell the doctor if you take any herbal or dietary supplements and any over the counter medicines as well.
    • You will be asked to sign a consent form for this test. Please be sure to ask any questions you have about the test.
  •  How is the test done?
    The tilt table is a special bed with a footboard and a motor that can be controlled to tilt at different angles. You will lie down on the tilt table, flat on your back. You will be tilted so that your head is always above your feet. You will never be tilted upside down. The nurse will start an intravenous (IV) line in your arm to give you fluids and medicines during the test. You will be connected to monitors to check you heart rate, blood pressure, breathing and oxygen levels during the test. Three or more safety straps will be placed across your chest and legs to hold you in place on the table.
    You will be awake but you will be asked to lie quietly and keep your legs still. During the test, you may have no symptoms or you may feel very uncomfortable. You may feel lightheaded, sick to your stomach, dizzy, heart palpitations or fluttering in the chest, vision changes or you may faint. Be sure you tell the nurse or doctor about any symptoms you have during the test as they occur.
    If you become very uncomfortable and cannot go on, the test will be stopped. If you should faint, the table will be returned to the flat position and the test stopped.
    • Part 1
      The test starts with a quiet period. Then the table will be slowly tilted to an almost standing position. Your head will be up and the footboard will support you. You will be checked at several positions and then returned to a flat position.
    • Part 2
      The second part of the test begins after giving you a medicine to stress your heart. Nitroglycerine or Isuprel are often used to cause the same affect as adrenaline. Adrenaline is a hormone produced by the body when you exercise or when you are angry or feel stress. The medicine is given slowly into the IV and increased based on how your heart responds to the medicine. This medicine may make you feel nervous, jittery or you may feel that your heart is beating faster or stronger. These symptoms will stop quickly as the medicine wears off.
  •  How long does the test take?
    Expect to be in the test area about 1 ½ to 2 hours. The length of the test will depend on how you respond, but it is often done in 45 minutes.

    After the Test
    • It is best to rest for several hours after the test. You can start back on your regular foods and fluids. Most patients return to feeling normal within 15 minutes after the test, but the test is quite tiring.
    • Take your medicines that you were told to hold before the test.
    • Have someone drive you home.
    Test Results
    • If you faint during the test, it is considered ’positive’. Your doctor will be sent your test results.
    • If you do not faint during the test it is considered ’negative’. You and your doctor will discuss other tests that you may need to find the cause of your fainting.
  • Transcranial Doppler
  • Sleep Lab with polysomnography
  • MRI and MR angiography
  • CT scan with CT angiography
  • DSA
  • Evoked Responses: BERA and VEP

Consultants

Dr. Pradeep Bafna
M.Ch (Neurosurg)
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Dr. Sushil Patkar
M.Ch (Neurosurg)
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Dr. Anand Alurkar
MD, DM (Neuro), DNB (Neuro)
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Dr. Vivek Bonde
MS (Gen Surg), MCh (NeuroSurgery)
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Dr. Rajendra Chavan
DM (Neuro Radiology)
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Dr. Anand Doshi
MBBS,DNB (NeuroSurgery)
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Dr. Sachin A Gandhi
MBBS, DNB (General Surgery), Mch Neurosurgery, DNB (Neurosurgery)
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Dr. Sujit Jagtap
MD Paed, DM Neuro, Fellowship in Epilepsy
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Dr. Praveen Jain
MBBS, DNB (Gen Surgery)
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Dr. Anand Katkar
M.S, DNB Neurosurgery
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Dr. Sanjay Pawar
MS (Gen Surg), MCh (Neuro Surg)
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Dr. Vishal Rokade
MS General Surgery, DNB Neurosurgery
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Dr. Sarang Rote
MBBS, MCH (Neuro Surgery)
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Dr. Nikhil Talathi
M.Ch Neurosurgery
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