Brain tumor can affect any age group starting from paediatric to geriatric age groups. The tumors vary in their origin, clinical presentation biological behaviour and prognosis in different age groups. By and large brain tumor can arise from all the structures in the cranium that includes skull bones, cartilages, meninges, brain parenchyma blood vessels choroid plexus, pituitary, spineal gland and the cranial nerves. In addition metastatic tumor can come to brain from various systemic malignancies.

Over the years several phenomenal advances have taken place in the comprehensive management of brain tumor improving the safety, efficacy, longevity as well as the overall functional outcome of these tumors. The technology and innovations have improved the visibility, accessibility, receptibility and overall ability to treat. Brain tumor outcomes are no longer dismal. However, there are few malignant brain tumors which need definitive answers. The improvements are in several spheres.

1. Diagnosis – MRI has revolutionized the diagnosis of brain tumors. Even the smallest tumors can be diagnosed with Gadolinium contrast. MR Spectroscopy can reasonably predict the nature of the tumor. Diffusion Tensor Imaging of the brain can give valuable information about the displacement of important structure in the brain by the tumor. Similarly in eloquent areas including the brain stem, PET CT or MRI will be very useful in accurately determining the size of the tumor, particularly in metastatic brain tumor.

2. Surgery – Microsurgery has provided magnification depth illumination and visibility making the tumor accessible to the surgery regardless of the location. Intra-operative ultrasound can accurately locate the deep seated tumors and guide the surgeons to reach all the shortest trajectory. Intra operative MRI can help the surgeons to get real time information about the extent of removal thereby facilitating gross total resection of these tumors.

Radio frequency bipolar and laser systems can make the total removal as well as supramaximal resection in selective intra-parenchymal tumors. Ultra-sonic surgical aspirator will help the surgeons to break the hard tumors into pieces and remove step by step without disturbing the surrounding parenchyma. Neuro-navigation systems provides real time imaging guidance all through the surgery keeping the three dimensional orientation to the surgeon and helps to prevent transgressing into normal brain tissues.

The intra operative fluorescence will highlight the tumor with a different colour under the fluorescent microscope. One should be able to resect the tumor hidden as islands between the normal tissues thus achieving complete removal. Complete removal of brain tumor  has been proven to offer better longevity and lesser chances of recurrence beyond doubt. Finally, neuroleptanalgesia will facilitate awake brain surgery in all eloquent areas making sure of brain function throughout the surgery .A variety of  haemostats are now available to control the bleeding and to achieve haemostasis quickly. Advances in neuro-anaesthesia have made all these techniques including the intra operative brain function monitoring possible.

3. Molecular Diagnosis – Brain tumor diagnosis has gone much beyond the simple histological cell based diagnosis. In the present day battery of tests provides information on gene modification, mutation, deletion, proliferative index, molecular markers, enzymes, factors that up regulate or down regulate the molecular pathways and immuno histological data that helps in deciding upon the type of treatment as well as prediction of outcomes (prognosis as well as chances of recurrence). This research has identified several abnormal genes that facilitates the formation of tumors as well as influences the recurrence.

This has the future implications and will enable successful gene editing that can alter the profile and course of the tumor. Significant research is on the way to make this as a notable therapy. The molecular mechanisms and its understanding are paving the way for the introduction of targeted therapy for the tumors. Several such molecules and the nucleotides are already in the market and several others are under clinical research and trials.

It is the hope that this will be the future gold standard of therapy for many tumors. Immunological modulation is another method of combating the brain tumor growth. This is also in the experimental phase. Enzyme intervention and blocking the metabolic pathways of the tumors to prevent them from growing is another notable method to fight these tumors.

4. Tumor Stem Cell Concepts – Tumor Stem cell concepts that nurtures and propagates the tumors as well as responsible for recurrence is another target for the future treatment of brain tumor. The tumor cells escape the natural immunological surveillance within the body thereby surviving in the safe hideouts to cause recurrence as well as to metastasize. Targeting these cells will technically provide the eradication and elimination of the tumorogenic process within the system. Brain tumor vaccine is customized and tailor made to each individual, is another method that is being tried in some of the management of brain tumors.

 5. Adjuvent Therapy – Many malignant tumors require adjuvant therapy to enhance the progress and reduce the chances and recurrence.

6. Radiotherapy – Several advances have taken place in the delivery of radiation to the brain tumor. The image guidance, stereotactic system has improvised precise delivery of high dose radiation purely to the tumor protecting the surrounding brain tissues from the effects of radiation. Thus stereotactic radio therapy delivers high dose radiation to the tumor as a single fraction or divided as small fraction.

This technique is proved to improve the overall outcomes as well as the progression in many tumors. This technique is particularly useful for the elderly, for those who cannot undergo surgery as well as patient with recurrence. This can be offered as a primary treatment in small benign tumors in small children. Similarly, after the surgery the tumor bed can be radiated to prevent regrowth or recurrence. Proton beam therapy is a new addition that can provide better result with lesser toxicity and are particularly useful to treat children with brain tumors.

Several molecular mechanisms are being unravelled by continuous research and this has contributed to the current understanding of various brain tumors and their histological as well as biological behaviour. It has also paved the way for the current understanding as well as newer classification of the brain tumors. The on-going research is expected to provide much more insight that will guide the clinicians to make more accurate diagnosis as well as add many therapeutic options in the years to come.

Also Read: Brain : The King and a King maker 

Dr. NK Venkataramana

Founder Chairman & Director Neurosciences

Brains Super Speciality Hospital, Bengaluru.

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Subarachnoid haemorrhage is a severe form of brain haemorrhage that occurs around the brain substance normally within the subarachnoid space. Subarachnoid space is a thin space between arachnoid membrane that covers the brain and the brain substance. In this space normally all the major blood vessels of the brain traverse to different locations. Any leak of blood from these vessels into this designated space is called SAH.

What is the cause?

Majority of the times it is caused by an abnormal local enlargement on these blood vessels which eventually rupture called “Aneurysm”. These are localized enlargements like berries on these blood vessels. They enlarge with time and burst with slightest strain causing massive bleeding. They can be singular or multiple or identical on both sides called mirror aneurysms.

How does it develop?

Most of them are from birth or occur in later part of life due to weakness or thinning if the vessel wall that increases in size and with time due to flow dynamics. Depending upon the size and the rate of enlargement they can rupture any time. Some remain as it is and are diagnosed by scans done for some other purpose called “Incidental or Unruptured Aneurysms”. These are of importance that these aneurysms grow with time and eventually rupture with time. So it is important to treat such incidental aneurysms before they really rupture. The outcomes are much better when we treat before they really burst.

How do they rupture?

They are like small time bombs in the head in a literal sense. As the blood is flowing through the vessel it enters the aneurysm causing turbulence within. This in turn will slowly enlarge the aneurysm like a balloon and also make the vessel wall thinner with time. Beyond a particular level of stretching the vessel wall gives way either due to blood pressure or by any physical strain, straining in the toilet for hard motion or during coitus making them rupture. Once aneurysm ruptures it can bleed considerably inside the brain. At times bleeding can be so severe causing an instant death. So a good number of subarachnoid haemorrhage patients do not reach the hospital.

The risk of re – rupture persists while on transport or even after reaching the hospital, till it is treated. Therefore they need to be treated as an emergency as early as possible. The primary goal is to prevent bleeding from the ruptured aneurysm. Soon after the rapture body tries to protect by forming a clot around the aneurysm. But this clot cannot prevent re-bleeding nor give total security. So it is mandatory to identify the aneurysm and seal it before it bleeds again. If unfortunately bleeds second time the life risk increases by many fold.

 How common is this?

This accounts for about 10% of Brain attacks in general. Commonly affects adults, slightly more common in women. It can rarely manifest in childhood.

 What are the symptoms?

Presentation of a ruptured aneurysm is classical. Sudden severe headache that has never been experienced before, with vomiting, neck pain and loss of consciousness. That’s why this headache is called “Thunderbolt Headache” or “thunder clap headache”.

How to diagnose?

With the typical history and clinical examination showing neck stiffness is classical to make a diagnosis. CT scan confirms the diagnosis by showing presence of blood in subarachnoid spaces around the brain. The amount of blood, at times helps in guessing the possible location of aneurysm. Cerebral angiography is definitive and gold standard in establishing diagnosis. Angiography gives information about size, shape, location, status of blood flow including presence of multiple aneurysms. It is necessary to study all the blood vessels of the brain in order to identify presence of multiple aneurysms CT Scan of the Brain will provide the quickest diagnosis for Subarachnoid bleeding. Presence of blood in the basal cisterns and around the brain is classical and diagnostic.

What can precipitate a rupture?

High blood pressure, any strenuous work can rupture an aneurysm. However, sudden rupture during sexual intercourse in men and during labour among women is well known.

What is the effect of pregnancy on aneurysm?

Aneurysms are known to enlarge during pregnancy. Mostly due to hemodynamic changes that happens in the 2nd trimester. Increased blood volume and associated high blood pressure is the cause. That’s why rupture is also common in the mid trimester or during delivery due to the physical strain associated. It is preferable to avoid normal labour in such situations.

What should be the IMMEDIATE action?

One can easily suspect this condition by the nature of the headache itself. They should be hospitalised immediately. Once the aneurysm ruptures, there is nothing to hold the bleeding except the nature’s protection by formation of blood clot around. This can give way at any time. That’s why most often they do bleed again within no time. Nearly 20% die instantly with first bleed. The second bleed doubles the death rate further. Hence the patient should be admitted to ICU, immediately, sedated to prevent strain, control blood pressure, provide pain relief, and treat other problems like seizures if present. Prevent a re-bleed by all means, and quickly investigate and treat.

What is the definitive treatment?

Sure way of preventing re-bleed is by eliminating the blood circulating through the aneurysm. This can be done by clipping or coiling based on the character of the aneurysm and the technical feasibility. Rest is mostly medical management.

What is clipping?

It is a definitive obliteration of aneurysm by placing a titanium clip around its neck, so that blood can’t enter into the sack further. This needs an open micro surgery. Neurosurgeon goes through the subarachnoid space and traces the location of the aneurysm and place the clip preserving the parent vessel. Advantage is we can wash out the blood in the subarachnoid spaces at the same time. These clips are permanent and stay inside for life time. Titanium clips do not interfere with future investigations like MRI.

Will they interfere with future imaging?

Presently these clips are made out of Titanium. They are inert biologically and do not react with the body. Only when we do a CT scan after surgery an artefact can be seen at the site of the clip. These clips are MRI compatible. One can undergo MRI safely after aneurysm surgery. However it is worthwhile informing the radiologist at the scan centre before the imaging starts.

What is coiling?

Coiling is an Endovascular treatment, where in a special coil is deployed into the aneurysmal sac or cavity to obliterate the aneurysm completely. This is done through angiography by using specialised catheters. Neurovascular lab and trained Endovascular specialist is mandatory. Advantage of this is no open surgery. This can be done for all aneurysms and in all age groups except in some special locations and types due to the technical difficulties.

What are the advantages of coiling?

 It is a minimally invasive procedure. This avoids open surgery. Aneurysms in the critical areas of the brain can be treated. Age is no bar. Coiling can be done as early as possible, even in persons whose conscious levels are altered or not normal.

 Can they be used for all Aneurysms?

Now a days most sophisticated catheters and coils are available. Majority of the aneurysms can be treated by coiling. There may be few technical reasons that one may defer this and prefer clipping. Nevertheless every aneurysm is different and the plan of treatment should be decided based on the individual merits. Often it is tailor made based on many factors. What are the Giant Aneurysms? As the name suggests they are big aneurysms more than 1 centimetre, sometimes can be huge in size. They are more common in women and in children. By virtue of their size they often behave like tumors causing progressive neurological problems or epilepsy. At times blood clots develop within the sac causing multiple strokes. Rarely they do rupture.

 How to treat Giant Aneurysms?

Bigger the size of the aneurysm more are the challenges in treatment. Ideally can be treated by Endovascular methods by using flow diverters. If not by open surgery. They are technically challenging and each one need to be dealt with a different strategy. Surgical treatment needs proper planning. The technique depends upon the complexity of the aneurysm.

What are flow diverters?

 They are special devices that can be placed inside the blood vessel through angiographic methods. This will divert the blood from entering into the Aneurysm sac so that gradually it will shrink. They are expensive devices. If the giant aneurysm is complex and in a critical location, a planned bye pass to divert the blood flow to the brain and later on surgical occlusion of main vessel itself have to be done to prevent a rupture. At times complex clipping methods are used to reconstruct the blood vessel.

Can multiple aneurysms be treated together?

Yes. More than one aneurysm can be treated in both methods depending upon the patient’s condition. First already ruptured one will be treated always. If accessible it can be done during the single surgery also.

Can aneurysm recur after surgery?

 If the aneurysm is treated totally they don’t re occur. But if the occlusion is partial then the residual part might enlarge with time. That should be watched over the years. But aneurysms can occur at a different location. By and large repeat angiogram will detect the presence of any other smaller aneurysms.

What are the incidental aneurysms?

 Now a days imaging of Brain has become very common due to the availability of diagnostic facilities. If aneurysm is found before its rupture while investigating for any other reason it is called incidental aneurysms. These require very close follow-up and treatment at an appropriate time. No aneurysm should be neglected are left alone. We now know the natural course of these aneurysms. With time all of them increase in size and rupture eventually. So they deserve a definitive treatment.

Do they require treatment?

Yes. On a long term study we know that every aneurysm enlarges with time till to the point of rupture. We have observed the results are far better if we treat them before they rupture. It is like any other surgery and they can be totally normal. Otherwise every year the risk of bleeding increases, putting them to higher risk over the time. In addition once diagnosed it is a big psychological fear as well. It is like sitting with a time bomb inside the head.

What are infective aneurysms?

Due to the presence of infection in the blood from either septicaemia or infective endocarditis the blood vessel wall itself will get infected. As a result it becomes soft and weak and gradually enlarges becoming an aneurysm. They are also called Mycotic aneurysms. They are generally rare now due to the aggressive treatment of infections and availability of good antibiotics.

What are the rare presentations?

Aneurysms in special locations can present with odd symptoms that can be completely misleading.

1. Sudden onset vision loss in one eye due to ophthalmic artery aneurysm

2. Sudden closing of one eye due to PCOM aneurysm

3. Frozen eyeball due to intra cavernous aneurysm

4. Double vision due to carotid aneurysm at the skull base

5. Bleeding from the nose due to Giant aneurysm eroding the anterior skull base

6. Hoarseness of voice due to vertebral artery aneurysm

7. Facial paralysis due to vertebral aneurysm

8. Facial pain due to Basilar artery aneurysm

9. Intra cerebral clot due to Mycotic aneurysm

Also Read: Brain : The King and a King maker 

Dr. NK Venkataramana

Founder Chairman & Director Neurosciences

Brains Hospital, Bengaluru.

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Bengaluru 14^th August 2021: In a bid to raise the awareness about stroke, stroke related death and disability, a book titled “Brain Attack- Facts& Realities” authored by renowned Neurosurgeon, Founder Chairman & Director Neurosciences, Brains Hospitals,Dr. NK Venkataramana was released on Friday.

Releasing the book, Mrs Malini Krishnamurthy, Principal Secretary to Government, Home Department, Karnataka, spoke about the unique features of the brain. She said, there is always a scope for improvement, learning more and more, and the need for holistic improvement of the brain. She also spoke about how the author of the book “Brain Attack- Facts& Realities” has written about the importance and benefits of allied therapies like pranayama and aqua therapy in the well-being of one’s brain.

Stroke is considered to be one of the leading causes of disability. “About 37 percent of neurological problems are related to stroke, but due to the lack of awareness the patients are not getting the correct treatment at the right time. This has been one of the biggest challenges in terms of stroke treatment”, said Dr.NK Venkataramana.

If stroke patients get the correct treatment at the right time,a considerable number of deaths and disability can be prevented.As per the recent study conducted by ICMR, the number of neurological cases has doubled over a decade (2009-2019). This alarming number is a major cause of concern and needs to be addressed quickly with correct approach, further added Dr. Venkataramana.

Eminent figure MN Venkatachaliah, Former Chief Justice of SupremeCourt, has written the Foreword for the book.He said “ Brain Attack (Stroke) is an important public health problem facing the country. Approximately 1.75 million are affected every year with stroke making it a huge health and economic burden. World over stroke is the leading cause of disability.”

The book deals with different types of strokes, how each of the symptoms differ and what are the best treatment procedures.There have been several reports as to how following the Covid pandemic has led to a surge in the stroke cases. Hence, this book aims to empower people to make the right decision and generate awareness regarding stroke, its prevention and treatment.

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Disability is a word for which the meaning that encompasses a larger territory in general than expected. In simpler terms there’s are considered as deviations from the average normal from what the standard of society that is expected. The Oxford English Dictionary defines it as “The physical or mental condition that limits person’s movements, senses or activities”. So it is individualistic, but collectively can have a greater impact on the family or society.

December 3rd – Disability Awareness Day

Hence, it is very important to recognise at every level to anticipate, recognise and modify the situation that is congenial to modify the disability. This needs a collective effort. Fortunately, December 3rd has been declared as Disability Awareness Day. This awareness must percolate to many levels that include medical, social, educational and finally to the governmental level to create proper planning. Education and awareness play a significant role.

Primarily disabilities are considered to two gross reasons. One from the birth whatever may be the reason and the other is Acquired during life. For the first reason all parents must take the responsibility to the best extent possible till the child becomes independent in life. The latter becomes purely individual and social responsibility. Advocacy, policy making, implementation should be the role of the government for both.

Otherwise disability will be used rather misused to gain some special benefits only. Oxford dictionary also defines disability as “A disadvantage or handicap especially one imposed or recognised by law”. In reality the later definition is more often used and has better awareness in the society. Least importance is given for the first two causes and their prevention. Therefore awareness is the need of the hour.

Developmental birth defects or birth related insults are common causes of disability. Folic acid usage in the peri conceptual stage can prevent major Neurological defects. Fortification in the diet of expectant mothers, proper ultrasound screening, safe motherhood and delivery, good neonatal care, identification of high-risk group and proper attention can reduce the disability to a greater extent.

Proper diet, immunisation to prevent infections, early detection and treatment of many treatable conditions in time such as epilepsy can prevent the permanent disability. We need to create awareness about all these possibilities to all the parents regardless of their geographical or social background. Government must initiate suitable programmes to all such preventable disabilities and must implement successfully.

A host of causes can lead to permanent disability later in life. Road accidents, Stroke, Brain haemorrhage tops the list. There are many other medical diseases that follow. Indirectly Diabetes, Hypertension, Obesity, Alcoholism, smoking, drug abuse and Depression have become the leading causes. Interestingly many of them are preventable. This requires a multi prong approach where in each individual, family, society takes primary ownership amply supported by the government, law and the policies of the Nation.

Medical profession should remain the back bone of the entire process, in identifying all the regional problems, finding suitable solutions to prevent, diagnose and treat and support the government’s in forming appropriate policies. These must be nationwide and should be comprehensive. Last but not the least is the support programmes such as Rehabilitation, devices, technology adoption to amplify the ability, social structure that respects and offers equal rights to them to lead a contemporary life. The ultimate goal should be to make everyone independent and lead an active life.

Allovedas offers rehabilitation services

“Allovedas” is an integrated Neuro- Rehabilitation utilizing the combination of modern techniques and traditional methods to spring the best potential in every individual, with a goal to bring them back to the society with their best abilities. These therapies are tailor made to suite the individual illnesses, physique, mental & social abilities and to nurture them to come back to the fullest functional capabilities.

A combination of strategic interventions that are designed by highly experienced Neurologists and Neurosurgeons will be executed by skilled therapists to enable such distinct goals. The modern gadgets, technologies and specific physical interventions will be used to bring out the best in every neurological condition. Allovedas offers both inpatient and outpatient Rehabilitation services. The inpatient services are specifically meant to take care of people who cannot be managed at home. The family will be trained along to enable them to manage further. They remain with us till such confidence is gained. We want everyone to “Bounce Back” in life regardless of their illness.

Dr NK Venkataramana
Founder Chairman – Head of Neurosciences
BRAINS – Bengaluru

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Bangalore, October 29th: In a bid to mark the World Stroke Day, Brains Hospital, Richmond Road, on Thursday inaugurated a comprehensive “Stroke Unit”. At the moment the health care burden due to stroke is huge. Every year 2 million people are getting affected.

Stroke is the leading cause of disability in the world as on today.  With the increasing life span as well as risk factors like Diabetes and Hypertension the burden is only increasing further year after year. At the same time all the advanced research and understanding is not getting translated to the benefit of society. Also it is to be noted that primarily stroke is preventable.

Secondly, the disability following a stroke is again preventable. Thirdly, stroke isn’t a onetime event in life. It can strike again and again making the matters worse. The recovery rate continues to be poor in our country due to lack of awareness and timely action. Time is very crucial factor that determines the ultimate outcome, extent of recovery as well as time taken to it.

“In the light of above mentioned problems BRAINS Hospital has launched the first of its kind Stroke Unit that provides 360 degree care for this condition. The dedicated Stroke team at BRAINS is committed to fight this burning problem addressing all relevant factors influencing the management currently. We have established technology, process, protocol, systems, training, call centre, awareness, advocacy, continuity of care in acute, chronic and long term including rehabilitation, follow up and monitoring. The single most aim is to prevent a stroke in high risk people, if not get them back to the society as normal as possible” Said Dr NK Venkataramana, Founder Chairman & Chief Neurosurgeon, Brains Hospital, Bangalore.

The unit is operational 24/7. In case of any emergency one could contact: The emergency helpline: 9483240925.

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Alzheimer’s is a devastating ‘Brain Disease’ that affects recent memory and learning mechanisms of the brain eventually debilitating an individual. Recent surge in the incidence has been attributed to an increase in the life span which is an average learning of 80 years today. Loss of memory disables by losing identity, personality and eventually losing the self of the affected. They can’t identify anything including the most loved ones leading to horrifying experiences to the persons affected and to their families.

How is it caused?

At present 50 million are affected in the world and the numbers are expected to rise rapidly leading to severe social,economic and global health challenges soon. It is estimated that 40% of people will be affected at the age of 80 years with this condition. Originally it was described in a patient named August Deter by Dr Alois Alzheimer.

The memory store called Hippocampus (sea horse in Greek ) located in the temporal lobe of the brain gets affected first and eventually spreads to the rest of the brain. The loss of neurons and the synapses will set the progression of the disease. Normally the sensory information from the sense organs are received in the form of electrochemical energy and then the brain compiles and computes the data and projects it as information based on the stored memory and information.

Due to the loss of connectivity in the brain , such computation fails and hence the failure of recognition. It can start with difficulty in remembering simple things, misinterpretations and eventually to serious failure of recognition and remembrance of everything. The neurons in the brain are riddled with beta amyloid plaques which eventually form tangles that kill the neuron itself.

The cell death triggers an inflammatory reaction and the Microglial cells which normally do housekeeping and upkeep of the brain by removing the toxins, gets activated and turns against the brain cells itself. They will in turn destroy and clean up the entire neurons and axons progressively shrinking the brain structurally and functionally.

Best ways to prevent Alzheimer’s

Recently 30 new genes have been identified that are responsible for activating abnormal immune response by microglia as well as the Neuro inflammation. Advances in MRI imaging can identify the plaques in the brain very early. It takes nearly 10 to 15 years for the symptoms to manifest after the appearance of the plaques. Hence early diagnosis can help to identify and stall the onset of the disease.The only hope for the future lies in early prediction in those with strong family history and testing them for abnormal genes, early detection by MRI imaging and on suspicion treating Neuro inflammation aggressively.

Recent research indicates that the beta amyloid protects the brain from the invaded microbial agents. It forms the plaque to trap the microbes to protect nerve cells from any subclinical infection. CD 33 gene has been found to be responsible for triggering Neuro inflammation. So future goals should be to prevent all subclinical infections that can affect the brain, understand the microbial relations with the brain, treat the tangles with appropriate interventions and control the inflammation in order to avoid Alzheimer’s.

Ways to preserving brain health :

Lifestyle modification, good sleep for 7-8 hours, managing stress with meditation, healthy interactions with people, avoiding loneliness, walking with barefoot at least for 20 minutes in a day, good exercise, proper diet with high fibre and keep learning new things can go a long way in preserving brain health and preventing Alzheimer’s disease.

In a bid to facilitate early diagnosis of Alzheimer’s and to provide comprehensive treatment, Brains has also started a unique “Memory Clinic”. This step by Brains is to mark the World Alzheimer’s Day (September 21st).

Dr. NK Venkataramana,
Founder Chairman & Chief Neurosurgeon,
Brains Hospital.

The post What is Alzheimer’s?- Best ways to prevent Alzheimer’s appeared first on Health Vision.

Brain is the crown jewel of a human body responsible for internal demands and external responses, special interactions, environmental adaptations and spiritual connectivity. Human brain has evolved over millions of years as the most sophisticated, intricately engineered machine with the capability of performing multiple task parallelly as well as sequentially.

Brain has two big hemispheres – right and left cerebral, two small hemispheres called right and left cerebellum (big and small brain). All the areas of the brain are interconnected through the white matter located deep inside the brain contributing to major substance. This in turn directly communicates to body through the spinal cord eventually transmitting the electrical signals to each and every specific parts of the body. At the same time all the sensory organs like eye, ear, tongue, nose and the skin will be transmitting information including the feedback to the brain about the light, sound, smell and other sensations continuously. Brain in turn processes the entire information, takes cues from the past experience and memory to interpret and act.

Brain has 100 billion neurons which are connected through millions of cables through the spinal cord. These neurons have the ability to establish innumerable connectivity with other neurons to the tune of 300 trillion synapses. Brain is protected by skull bones and tough membrane called dura. Brain is the powerhouse of the body that generates electricity throughout the day and night.

Brain has distinct area that serves distinct functions. However, both right and left brain and different areas of brain work in tandem and perfect co-ordination to make every action perfect. Due to its high metabolic activity, the brain demands highest amount of blood supply for skull from the heart.

1. Nervous System is the first to develop in the embryo. By the time the pregnancy is detected the neural tube is already formed so the brain development is quite complex therefore any alterations can lead to serious birth defects both in the brain as well as in the spinal cord therefore the expectant mothers should take folic acid much before they plan for the pregnancy.

2. Brain continues to work both at day and at night. The electrical activity can be recorded by electroencephalogram (EEG). The electrical activity can vary depending upon the activity of the brain. Any abnormal electrical discharges can create a spark with a high voltage leading to convulsions. Epilepsy or fits is nothing but an abnormal electrical discharge from the brain.

3. Brain requires highest amount of blood supply to meet the demand. Blood vessels of the brain are arranged in a circular fashion like one of the best water circulatory system. Inspite of this arrangement if there is a reduction in blood supply this can lead to brain attack (stroke). Similarly, a rupture or damage to the blood vessel can cause brain haemorrhage.

4. Brain tumor is the growth that happens from any structure inside the brain. Any such additional component can occupy the space meant for the brain and cause suppression as well as increased pressure inside the head. This can lead to headache associated with vomiting. All headaches do not mean a tumor. Headache can be caused by many other conditions.

5. Brain utilizes only glucose for its nutrition. Reduction in glucose can make the brain hungry leading to irritability, lack of concentration, convulsions and unresponsiveness if not corrected.

6. Sleep is an important function of the brain. Every one requires 6-7 hours of sleep to maintain proper health. During the sleep brain eliminates all the toxins and restores all the chemical substances that are needed for the normal function of the brain during the day. Sleep are of two types – REM (Rapid Eye Movement) sleep and NREM (Non-rapid Eye Movement) sleep. Every cycle of NREM sleep will be followed by a short period of REM sleep. The maximum amount of REM sleep will be in the early hours of morning and during this sleep one experiences vivid dream.

7. Throughout life we learn through the sensory experience are stored in the brain in different locations and finally as a permanent memory in the hippocampus. In day-to-day life the memory is used from different sources to respond to the events of life. The memory can be immediate, remote, long-term, rote memory and genetic memory. The disturbance of this memory system can lead to various kinds of memory loss.

8. Brain grows throughout the fetal life and reaches its peak in the first two years of life wherein the number of neurons will get interconnected and the white matter will get a coating called myelination. These coating helps in maintaining the speed of conduction and prevents cross talking within the brain area. As the myelination progresses child attains the physical as well as mental milestone.

9. On the contrary when a person ages the number of brain cells gradually disintegrate making the brain smaller (atrophy). This natural process can start quite early in life at a higher magnitude called cerebral degeneration wherein the programmed cell death will rapidly disturb the brain connectivity leading to all degenerative conditions like dementia and alzheimer’s.

10. Healthy brain requires proper diet, exercise, physical activity and sleep. Brain is highly sensitive and prone to damage and hence it is mandatory to avoid all the toxins that can impair the brain function like smoking, excessive alcohol, sedentary life, substance abuse or physical abuse. Brain and the gut are interconnected and the diet can influence the brain growth, brain activity as well as the personality. Nutrition plays a significant role right from pregnancy time all the way upto the end of life. Maternal nutrition, later on breast milk during infancy and appropriate nutrition will keep the brain healthy.

The capacity of brain is enormous, one can use only 7-10 % effectively in the entire lifetime. Brain is like a timer, the more the use the more it shines. Continuous usage will continue to keep the nervous system active and also sustains the connectivity within, keeping the efficiency despite ageing. One must nourish the abilities of the brain and put effort to avoid damage by all means.

Dr.NK Venkataramana
Founder Chairman & Chief Neurosurgeon,
Brains Neuro Spine Hospital, 8, Ideal Homes HBCS Layout, RR Nagar, Bengaluru- 560098.
Ph:+91 9148080000

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