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question:In patients with brain injury, is there a higher risk for subsequent brain injuries, even if the cause of the subsequent injury is not apparent? In a long-term care facility for rehabilitation, we see patients plateau and remain stable for several years only to suddenly seem to lose memory function.

answer:Hi, welcome to our site. I am Dr Saumya Mittal, MD.Read your query. That is a very significant question and i appreciate your problem. I will try my best to answer your queryYou see, I have observed something very similar in my practice. I have some data on the same. I have not been able to find a very suitable reason for these observations. The possibilities that suit one subset of patients fails the second subset absolutelyHowever i feel, and many colleagues agree that the possibility is that people who develop fall, especially the elderly have a component of dementia left behind. Now when there is a level of dementia left back, the person always has more falls. Besides, many of these patients are old and have issues with other aspects of health too like bone health, joint health. These secondary health issues may also make them unstable on their feet and lead to them loosing their balance. And of course, elderly when they fall, often develop fractures and the bed rest that they are prescribed only further adds to the dementia and taxes their cognitive functions.A study of functional MRI may probably help us in getting to a hypothesis, but the costs are an issueI hope this helps you. Inform the reports mentioned above/if any other so I can be of help further. I have given you the answer to the maximum considering the information provided. The results of the tests could further enhance my answer to you.Please do understand that some details could be extracted from a detailed history and examination.Please feel free to ask another query. I would be glad to help you. Looking forward to your return query with the details asked so that I can help you further. (If the answer has helped you, please indicate this)Best of luck.Dr Mittal.MBBS, MD (Internal Medicine), CC (Diabetes Mellitus), DNB (Neurology)Consultant Physician and DiabetologistJS HospitalEx Apollo Hospital, DelhiEx Kailash Hospital, Noida

question:my brother is in icu and has had serveral constant sezuries for about 24 hours before it was checked. he is heavely seditated. dr say mucles are working in the brain had many different answer no one can give an answer wheither he is brain dead or not

answer:Hi, welcome to our site. I am Dr Saumya Mittal, MD.Read your query. That is a very significant question and i appreciate your problem. I will try my best to answer your queryThe concept of brain death needs some very specific features.The problem with brain death is that almost every feature that is supposed to be in favor of brain death can also be caused by another cause. So no one single sign can be confirmatory of brain death.besides, seizures also happen due to more than one cause. There may be a structural brain lesion, there may be a severe infection (sepsis), there may be sevre metabolic derangements (again of many types). And once a seizure happens, the patient may become unresponsive for a long period of time, say even upto 72 hours. The physical signs can infact mimic brain damage.I will always suggest at least an EEG if I was to declare a patient as possibly having brain death, I will suggest the same to you.Besides with heavy sedation, it is difficult to say whether there is brain death, or is it a part of the injections.I hope this helps you. Inform the reports mentioned above/if any other so I can be of help further. I have given you the answer to the maximum considering the information provided. The results of the tests could further enhance my answer to you.Please do understand that some details could be extracted from a detailed history and examination.Please feel free to ask another query. I would be glad to help you. Looking forward to your return query with the details asked so that I can help you further. (If the answer has helped you, please indicate this)Best of luck.Dr Mittal.MBBS, MD (Internal Medicine), CC (Diabetes Mellitus), DNB (Neurology)Consultant Physician and DiabetologistJS HospitalEx Apollo Hospital, DelhiEx Kailash Hospital, Noida

question:hello, doctor iam facing a sever back pain in the mid of my spinal bone for several days and i cunsulted a doctor and took my x-ray and MRI scan in which it shows some L1, L2, D11,D12, and D10 had some prob which is causing a back pain and says it could be an Spine TB so just advice me where to get the good treatment in hyderabad, India.

answer:Hi, welcome to our site. I am Dr Saumya Mittal, MD.Read your query. That is a very significant question and i appreciate your problem. I will try my best to answer your queryIdeally, I would have liked to see the film of the MRI. Your report tells me the level of the problem. However, it does not tell me the extent of the problem. For that I need to see the film of the MRI or the x ray directly. You could have uploaded the image.Your report says that the radiologist suggests that the problem may be due to tuberculosis. Now for TB, we have quite an effective treatment that you can have to cure yourself. The Tb is a bone TB, so the treatment will have to be taken for longer time than usual.As for a good hospital, you could always go to Apollo in Hyderabad. meet any physician there and you can be initiated on treatment. Of course make sure you are comfortable getting there. You may have to go there periodically for monitoring and update and modification of treatment.Do an LFT prior to starting medicines.I hope this helps you. Inform the reports mentioned above/if any other so I can be of help further. I have given you the answer to the maximum considering the information provided. The results of the tests could further enhance my answer to you.Please do understand that some details could be extracted from a detailed history and examination.Please feel free to ask another query. I would be glad to help you. Looking forward to your return query with the details asked so that I can help you further. (If the answer has helped you, please indicate this)Best of luck.Dr Mittal.MBBS, MD (Internal Medicine), CC (Diabetes Mellitus), DNB (Neurology)Consultant Physician and DiabetologistJS HospitalEx Apollo Hospital, DelhiEx Kailash Hospital, Noida

question:i have pneumonia i have been home from hospital for two days still recovering from a broken hip and pelvis but now i have this too im getting pins and needles in my upper back and shoulders mixed with a numbness sometimes or something running down my back is it any thing to worry about plz help

answer:Hello dear,The symptoms as mentioned in your post can be attributed to:1. Para-spinal spasm and entrapment of nerve fibers at the Cervico-dorsal region.2. Inadequate hydration status & electrolyte imbalance of the body3. Dietary deficiencies of certain nutrients like Iron, Calcium, Vitamin D, Vitamin B12, Folic acid, etc. which help in blood formation & nerve conduction.4. Peripheral neuropathy caused due to any fluctuation in blood pressure or blood sugar level.Symptomatic relief can be obtained by intake of nervigenic agents (like Vitamin B6, Vitamin B12, Folic acid) as well as multivitamin & multimineral supplements including iron, calcium & Vitamin D needs to be added in your diet.Physiotherapy & postural exercise will also be helpful.If symptoms still persist, kindly consult a Neurologist & get a complete Neurological examination done.Certain investigations like complete blood count, serum electrolyte estimation, fresh estimation of blood pressure & blood sugar levels & nerve conduction studies will be helpful to rule out any pathological cause for the symptoms.X ray & MRI of Cervico-dorsal spine can also be carried out to detect any nerve entrapment.Wishing you a Good Health.Take care.

question:My 15 year old daugther told me that she had experienced dizznes and black vision when she gets up in the morning, she also experiences the same symtoms when sitting in the couch and gets up is ths normal for a teenager? Really appreciate your thougts, thanks

answer:Hello dear,The symptoms as mentioned in your post can be attributed to pathology in the Vestibular Apparatus in inner ear (it is associated with maintenance of body posture & balance) most probably Labyrinthitis or Benign Paroxysmal Positional Vertigo.Symptomatic relief can be obtained with intake of Vestibular sedatives like Betahistine or Cinnarizine preparations (to be taken only under the guidance of a Physician).If it still persists, then she needs to consult her Physician/ ENT Specialist & get a complete clinical examination done.Investigations like estimation of blood pressure, blood sugar levels, serum electrolytes & vestibular function tests will be required to rule out any pathological cause for the symptoms.There is no need to worry, your daughter will be fine.Till then, maintain adequate hydration & proper nutrition status and avoid stress.And she should also take precautions of getting up from bed slowly & avoid sudden head movements.Wishing her a Good Health.Take care.

question:Hi Doctor XXXXXXX My wife who is 70 years of age,about 105 pounds in weight and five foot and two inches in height.She is on medication for high blood pressure, high cholesterol and oesteoporosis.She has mobility problem dawdling. An MRI scan shows some areas of "white matter disease". Waiting to see the consultant.Please tell me Is there any treatment for this illness? and what causes this illness.Many thanks. Srinivas

answer:Hi,Thank you for posting your query.I have noted that your wife's MRI brain report has shown features of white matter disease.White matter disease in brain is usually due to reduced blood flow to the brain.In her case, it is most likely due to her high cholesterol and high blood pressure.Treatment consists of using blood thinners such as aspirin, and controlling the risk factors (high cholesterol and blood pressure in her case).There is no need to worry, as she would improve with proper treatment.I hope it helps.Please get back if you require any additional information.Best wishes,Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology)Senior Consultant NeurologistApollo Hospitals, Hyderabad,My personal URL on this website: My blog: