Articles By Dr Kalinian
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THE VALUE OF NEUROPSYCHOLOGICAL EVALUATION
Diseases of the brain commonly produce changes in behavior, including impairment of cognitive, sensory, perceptual, and motor abilities. These behavioral changes aid in the diagnosis, management, and long-term care of patients with central nervous system diseases. Neuropsychological evaluation can characterize cognitive, behavioral, and emotional disturbances and help the clinician in the course of diagnostic assessment, rehabilitation planning, or development of a management plan.
Central Nervous System disorders of differing etiologies can have markedly different behavioral ramifications. Neuropsychological testing may be obtained by the physician when 1) there is a need to quantify the patient’s deficits, particularly when the information will be useful in predicting or following the course of a disorder (recovery or decline), 2) there is a need to differentiate between organic vs psychiatric disorder, 3) there are only mild or questionable deficits on mental status testing and more precise evaluation is needed to establish the presence of abnormalities or distinguish them from changes that may occur with normal aging, 4) when there is a need to characterize the strengths and weaknesses of a patient, as part of constructing a management or rehabilitation plan or when making recommendations about returning to school or work, 5) when neuropsychological data can provide a more comprehensive profile of function that, when in conjunction with clinical, laboratory, and imaging data, may assist in diagnosis; 6) when the patient is being considered for epilepsy surgery and 7) when there is litigation that concerns the patient’s cognitive status.
Neuropsychological testing is considered medically appropriate to establish or confirm the diagnosis of brain damage or brain disease when there has been a mental status change, behavior change, memory loss or organic brain injury, under any of the following conditions:
- Concussion/head injury (open or closed)
- Cerebrovascular accident
- Brain tumor
- Cerebral anoxic or hypoxic episode
- CNS infection (e.g., herpes encephalitis, HIV infection)
- Neurodegenerative disorders (e.g., dementia)
- Demyelinating disease (e.g., Multiple Sclerosis)
- Extrapyramidal disease (e.g., Parkinson’s or Huntington’s disease)
- Metabolic encephalopathy (associated with hepatic or renal disease)
- Exposure to agents known to be associated with cerebral dysfunction (e.g., lead poisoning, intrathecal methotrexate, cranial irradiation)
- To provide a differential diagnosis from a range of neurological psychological disorders that present with similar constellations of symptoms (e.g., differentiation between pseudodementia and depression) when the diagnosis has been unable to be made by a complete psychiatric and/or psychological assessment.
Neuropsychological examinations have the advantage of being objective, safe, portable, and relevant to the functional integrity of the brain.
Results of neuropsychological assessment is considered in the context of the patient’s age, education, socioeconomic status, and cultural background. Neuropsychological tests are interpreted by a clinical neuropsychologist, in conjunction with other clinical, imaging, and laboratory information.
A typical neuropsychological assessment includes a clinical interview with the patient, records review, and testing. Based on the information gathered during the interview and from the documentation and referral questions, the neuropsychologist then decides what cognitive and emotional domains need to be assessed and will select the tests to be in the battery. A typical neuropsychological examination includes the following functions:
• Current and premorbid intellect
• Attention and concentration
• Learning and memory
• Language
• Visual-spatial and perception
• Motor and sensory skills
• Higher level executive function (e.g., reasoning, problem-solving, sequencing)
• Mood and personality
CONCUSSION
Post Concussive Syndrome Following Minor Motor Vehicle Accident or Sports-Related Concussion:
Signs, Symptoms, and Course of Recovery
WHAT IS A CONCUSSION AND POSTCONCUSSIVE SYNDROME?
A blow to the head or sudden jerky motion of the neck, as in a “whiplash” type injury (head does not need to hit something or be hit); can disrupt normal function of the brain. This type of brain injury is called a Concussion or Mild Traumatic Brain Injury. Concussions are not life threatening, and in most cases, there are no lasting effects from injury to the brain. Eight out of ten patients with a mild head injury show some sings of the syndrome during the first 3 months after the accident. However, 15% of patients with mild head injury continue to experience symptoms of PCS 1 year after the injury.
The brain is made up of millions of long, thin nerve fibers. Some of these fibers can stretch, snap, or break as a consequence of a head injury. Like any other part of the body, the brain also has blood vessels that can tear and bleed. This happens soon after the injury, it often stops on its own and heal like any cut will. Moreover, due to the microscopic size of these nerve fibers, modern technology has yet to visualize them. Therefore, CT/MRI scans of the brain of a patient with PCS are typically normal. Snapped nerves and broken blood vessels are the cause of symptoms after a head injury
WHAT ARE THE SIGNS AND SYMPTOMS OF POST CONCUSSIVE SYNDROME?
Following a Concussion, a wide variety of cognitive (thinking abilities), physical, and psychological symptoms occur, typically in stages. The symptoms may not develop until days or even weeks after the injury. Few patients will experience all of the symptoms, but even one or two can be unpleasant. Some patients find that at first, PCS makes it hard to work, attend classes, get along at home, or reach short-term goals. Most patients with PCS don’t develop symptoms until days or even weeks after the accident, but the syndrome can begin sooner.
I Early Stage
- Headaches
- Nausea and Vomiting
- Dizziness
- Drowsiness
- Blurred or Double Vision
II. Late Stage
- Continual Headaches
- Dizziness
- Irritability and Anger
- Anxiety, Depression
- Insomnia
- Fatigue
- Short-term Memory Loss
- Attention and Concentration Problems
- Planning and Organizing Difficulties
- Decision Making and Problem Solving
- Disorientation
- Confusion
- Ringing in Ears
- Change in Behavior (impulsive)
- Change in Personality
WHAT IS THE COURSE OF RECOVERY?
The recovery process depends on several factors; 1) age (longer if older than 30), 2) severity of symptoms, 3) the location of the injury (area in the brain injured), 4) mental and physical health before the accident (if you had emotional or medical challenges before the injury, it may take longer for you to recover), 5) any prior head injuries (the accumulated effects of brain injury influences the course of recovery), and 6) alcohol or drug use (interferes with healing process). The most rapid recovery happens the first 6 months after mild head injury, and most patients will be back to normal after 1-3 months. If symptoms get worse or new symptoms develop after a month, than this is a sign to consult with a doctor specialized in diagnosing and treating brain disorders (i.e., neuropsychologists).
CASE EXAMPLE
Ani (fictitious name of a patient) was 19-year-old when she was involved in a mild “fender-bender” type of motor vehicle accident. While driving in a traffic congested California freeway, she was rear ended by a driver talking on the cell phone. Since the damage to the car was so minor and there was no need for medical services, they decided to just exchange insurance information and proceed to drive off. Ani was a student at the local college, and she needed to get to school. The first sign that something was wrong was when she began experiencing difficulty navigating her way around to the school. She had driven this path on numerous occasions, there was no reason for her to get lost and forgetful. She attempted to call her mother but could not remember her phone number. She became dizzy, confused, began experiencing pain in her neck and head. She wondered whether the accident could have caused her difficulties…. but it was so minor…. what did she have??? As the days went by, Ani’s health deteriorated, to a point, where her mother finally took her to see her family doctor who referred her to a Neuropsychologist for proper diagnosis and treatment. Subsequently, Ani was diagnosed with Post Concussive Syndrome (PCS).
If you or a loved one has experienced sport-related concussion and you are looking for concussion specialists in Orange County CA (Dana Point, Laguna Beach, Laguna Niguel, Mission Viejo, San Clemente, San Juan Capistrano CA), please contact our office to schedule consultation with our experts. Call 949-481-8414
MILD TRAUMATIC BRAIN INJURY
Is There Evidence for Mild Traumatic Brain Injury?
A Case for the Expert Neuropsychologist
BACKGROUND
An independent forensic neuropsychological examination (INE) also referred to as an independent medical examination (IME), is performed by a forensic neuropsychologist who is hired as an independent contractor by a third party (i.e., attorney) seeking answers to specific questions related to brain-behavior relationships. Examinees undergo Neuropsychological Evaluation to answer a legal question. The forensic neuropsychologist is typically involved in four types of legal issues/settings:
1) Administrative (i.e., Social Security Disability, Worker’s Compensation)
2) Probate (i.e., Testamentary capacity, capacity to make will, trust)
3) Civil (i.e., causation, damage)
4) Criminal
Referral questions in civil litigation typically involve determination of the presence or absence of neurological and/or psychiatric disorders, causality related to a specific event or injury, prognosis, medical necessity of treatment, and /or disability status. The most frequent cases are those involving closed head injury although there has been an increasing demand for evaluation of the neuropsychological effects of neurotoxic exposure (i.e., Carbon Monoxide, pesticides, solvents), and effects of electrical injury. In criminal litigation the neuropsychological examination may be used to assist in determining competency to stand trial, issue of responsibility for the crime, or in sentencing/mitigation. The scope of this paper focuses primarily on personal injury cases particularly those related to one of the most controversial, yet persistently disabling injuries involved in litigation; Mild Traumatic Brain Injury (mTBI).
Mild Traumatic Brain Injury is typically defined as, an injury to the head resulting in brief or no loss of consciousness, post-traumatic amnesia, and negative neuroimaging scans. Those suffering mTBI typically evidence a range of impairments and levels of disability that in the long run, are often poorly associated with injury severity. Few neurological disorders are as prevalent as mTBI, which has an estimated incidents of 350,000 new cases each year and according to the National Center of Health Statistics, approximately 85% of all traumatic brain injuries are classified as mild. While most go unnoticed by the legal community, a large number of claimants seek legal representation for compensation of their sufferings.
BRAIN DAMAGE VS COGNITIVE DYSFUNCTION
In personal injury litigation, the presence, extent, and nature of cognitive dysfunction may be central to an individual’s claim of damage. The assumption that any and all kinds of brain damage led to similar behavior, and limitations in function are due primarily to severity of damages, is as erroneous as believing all roads lead to Rome. It is crucial to distinguish between brain damage and cognitive dysfunction. A brain damage is a pathological alteration of brain tissue identified by brain imaging techniques. It implies clear and structural injury to the brain. However, classification of changes in brain physiology that is not reflected in structural modification of the brain is defined as cerebral dysfunction. You may have had the misfortune of buying a brand-new plasma television that did not work (despite having no physical damage). Typically, a technician is called to evaluate and test the parts causing it to malfunction. As in the case of the technician, the expert neuropsychologist administers test sensitive to even mild cognitive impairments. By administering these standardized tests, we can document the areas of the brain malfunctioning and its effects on quality of life. While the neuropsychologist job is more complicated than a television technician’s, the principal task is the same-determine the cause and extent of dysfunction.
The brain controls how we think, behave and feel. Just because there is no structural damage to the brain, does not mean there is no cognitive dysfunction or disability. A person may have negative neuroimaging scans such as computerized tomography (CT), magnetic resonance imaging (MRI), electroencephalogram (EEG), single-photon emission computerized tomography (SPECT), functional MRI (fMRI), and positron emission tomography (PET), and continue to experience cognitive or behavioral difficulties. As advanced and technologically sophisticated as they may be, neuroimaging cannot explain why a claimant is reporting difficulty returning to work or managing daily responsibilities or making decisions. The forensic neuropsychologist, trained and experienced in assessment of cerebral dysfunction and its impact on quality of life, could answer those and other questions. When a patient sustains a mTBI from an accident, the damage to the brain may be none or minimal, but the consequences could still be catastrophic.
BRAIN TRAUMA 101
Traumatic brain injury occurs in many forms, ranging from a fall or blow to the head resulting in concussive injury, gun shot or other penetrating wounds or in a classic automobile or motorcycle impact. There are constellations of symptoms produced by different kinds of injuries, including neurological, psychological, affective, cognitive, and behavioral. When there is impact to the head, the scalp, skull, the covering of the brain (meninges), and the brain itself are affected to some degree and respond to the insult differently. The manner, in which these various parts react, depends on many factors. All of these are combined to produce the final product or result. This phenomenon is sometimes called “waterfall” because the physical event may produce primary injuries to one or more components of the brain. The primary injury produces local injuries that may be insignificant and can be repaired or resolved over a longer period of time, and those that cannot be repaired. As a result of primary injuries, secondary injuries may appear which may or may not be resolved over time. Those injuries produce various types of events, such as increased intracranial pressure, compromised blood circulation, and decrease oxygen in the brain. This domino effect may prevent resolution of the primary injury or complicate consequences of the original traumatic event.
EXERCISE AND THE AGING BRAIN
The Positive Effects of Aerobic Exercise on The Aging Brain
You know the benefit of exercise on the body, but did you know physical exercise is good for the brain, as well? The human brain continues to grow and improve with mental and physical exercise. Physical exercise has a protective effect on the brain and its mental processes and may even help prevent Alzheimer’s disease. Based on exercise and health data from nearly 5,000 men and women over 65 years of age, those who exercised were less likely to lose their mental abilities or develop dementia, including Alzheimer’s. Inactive individuals were twice as likely to develop Alzheimer’s, compared to those with the highest levels of activity (exercised vigorously at least three times a week). But even light or moderate exercisers cut their risk significantly for Alzheimer’s and mental decline.
Aerobic fitness has a favorable effect on cognitive functions. For example, physically active seniors are less prone to aging-related cognitive decline than those who lead a sedentary lifestyle. An increase in physical activity raises both aerobic capacity and learning ability in both humans and animals. Seniors who regularly exercise at a moderate to intense level may be less likely to develop the small brain lesions, sometimes referred to as “silent strokes,” that are the first sign of cerebrovascular disease. These ‘silent strokes’ are more significant than the name implies, because they have been associated with an increased risk of falls and impaired mobility, memory problems and even dementia, as well as stroke. Encouraging seniors to take part in moderate to intense exercise may be an important strategy for keeping their brains healthy.
By improving cardiovascular health, exercise increases the flow of oxygen-rich blood to the brain. Over a lifetime, this makes a big difference to brain function. Increased aerobic fitness (fast walking or running) can increase the number of new cells formed in the hippocampus (crucial for learning and consolidation of information from short term to long term memory, known to be affected in Alzheimer’s disease). One of the reasons why the elderly – especially those with coronary artery disease or hypertension – tend to suffer some degree of cognitive decline is in part due to a reduction in blood flow to the brain.
Exercise also has beneficial effect in specific areas of cognitive function that are rooted in the frontal and prefrontal regions of the brain, located behind the forehead. This area is involved in planning, organization, and the ability to mentally juggle different tasks at the same time. Another area is the basal ganglia (deep at the base of the brain), which coordinates commands to move muscles. Research indicates that mental exercise can improve these areas and positively affect memory and physical coordination. Exercise might be able to offset some of the mental declines that are often associated with the aging brain.
We are fortunate to live in an area of the country, where the climate is optimum for outdoor activates. Stay fit; your brain will thank you by providing years of healthy living!
ALZHEIMER VS DEPRESSION
Alzheimer Disease
Is it Dementia of Alzheimer, Depression or Normal Aging Memory Decline?
A. Overview
From time to time, you forget where you left your keys, walked into a room not knowing why you went there in the first place, or have trouble recalling what you ate last night. If you are over 50, your first thought or fear is “Am I getting Dementia or Alzheimer’s?” Not necessarily. There are over 100 conditions which mimic dementia (memory and thinking problems) that are actually reversible and treatable. These are sometimes called “pseudodementia” “pseudo” meaning “not genuine or false”. In other words, disorders or conditions that mimic dementia like symptoms. For example, reactions to medications, emotional distress (i.e., depression), vision and hearing (undetected problems of vision or hearing (may result in inappropriate responses, which may be misinterpreted as dementia), nutritional deficiencies, endocrine abnormalities, infections, brain injury, normal pressure hydrocephalus (increased pressure on the brain due to interruption of the flow of the spinal fluid), brain tumors, or stroke, are some of those “reversible” dementias. The reason your memory is not as sharp as when you were younger could also be subsequent to normal aging process of the brain. As the body ages, so does the brain. As the body ages, it becomes physically more difficult to perform so does the brain; it becomes slower and loses its ability to think efficiently. This does not mean you have a disease or illness; it may be just normal aging process.
The proportion of US citizens older than 65 years of age is growing steadily. It is estimated that 20% of the population will be over 65 years of age by 2030. This aging of the population is expected to bring an increase in the incidence of depression and dementia. It has been estimated that as many as 10-20% of people over the age of 65 may be affected by chronic brain syndromes with a rise of 25% when individuals over the age of 80 years old are considered separately. As many as 4 million people have an intellectual impairment severe enough to meet the criteria for dementia.” Although depression and dementia have many similarities, they also have important distinctions.
B. How to Differentiate Between Dementia or Depression?
It is important to know that “dementia” is a syndrome consisting of disturbances in distinct cognitive functions. The main symptom in dementia is memory loss, but other functions are also affected, such as orientation, reasoning, problem solving, judgment, visual-spatial performance, language, and change in personality and emotions. Dementia is an acquired disorder with evidence of decline in cognitive functions from a previous level of function, as demonstrated by history and Neuropsychological (cognitive) testing. As a result, social, occupational, and functional abilities can deteriorate. The most common pseudodementia and the most easily misdiagnosed is that associated with depression. General internists and family practitioners fail to recognize major depression in up to 20% of their outpatients with the disorder, either as depression misdiagnosed as dementia or vice versa. The ability of primary-care physicians to recognize and correctly treat depression is important since only approximately 20% of people with depression are treated by mental health professionals. This is especially crucial since both disorders especially depression, are treatable and misdiagnosis may cause an individual with potential full cognitive function to be unnecessarily confined in long-term care faculties (Yesavage, 1993). While cognitive and behavioral difficulties (e.g., forgetfulness, sad mood, slowed thinking) in depression are similar to those with suspected dementia, performance on neuropsychological tests offers a distinct profile. To diagnose the cause of dementia, a complete medical and Neuropsychological evaluation is recommended, and a complete patient history is very important. It is of vital importance to understands the differences between depression and dementia, as the treatment for each is different.
C. What is Neuropsychological Evaluation?
A neuropsychological evaluation is a comprehensive evaluation of cognitive, behavioral, and emotional functioning performed using standardized tests and procedures. A Neuropsychologist uses a wide variety of paper/pencil and computerized tests that are very sensitive to even mild brain dysfunction. Typically, the evaluation includes 60-90 minutes of clinical interview about presenting problems, symptoms, medical history, and background, followed by 4-6 hrs. of formal testing. The evaluation can be scheduled for a single day or divided into several days, dependent upon the fatigue level of the patient and time. At the completion of the report, the Neuropsychologist reviews the results of the evaluation with the patient and his/her family and makes treatment recommendations. A copy of the report can also be forwarded to the referring physician and other health care providers.
HEART ATTACK & THE BRAIN
Heart & The Brain
THE AFFECT OF CARDIAC ARREST (HEART ATTACK) ON THE BRAIN
The heart is a muscular organ that is responsible for pumping blood throughout your body. Blood then carries oxygen and nutrients to your organs so they can function properly. When the heart stops pumping, as in the case of cardiac arrest (heart attack), oxygen is no longer able to travel to nourish the body, particularly the brain. The human brain constitutes only about 2% of the total body mass yet utilizes more oxygen than any other organ. It requires oxygen and glucose to produce energy and work efficiently. Brain neurons, or nerve cells, depend on a continuous supply of oxygen, as they are not able to store oxygen and glucose for later use. A slight decrease in oxygen delivery can have serious effects including neuronal death and/or changes in brain function and cognition. This can include anything from problems with remembering to judgment, attention, and mental speed. Changes in personality, behavior, and mood may also occur.
Brain cells are very sensitive to lack of oxygen. Some brain cells start dying less than five minutes after their oxygen supply is interrupted or ceased. As a consequence, brain hypoxia (oxygen deprivation to tissue) or anoxia (complete lack of oxygen), can severely cause brain damage or death.
What are typical causes of hypoxic/anoxic brain damage?
- Cardiac arrest (heart attack)
- Respiratory arrest
- Anesthesia related complications
- Hanging
- Near drowning
- Sleep apnea
- Chronic Obstructive Pulmonary Disorder (COPD)
- Carbon monoxide and other poisonous gas exposure
- Drug abuse/overdose
What symptoms are associated with hypoxic/anoxic brain damage?
- Headache
- Confusion
- Difficulty paying attention (inattentiveness) and concentration
- Memory loss
- Reasoning and judgment
- Mental flexibility
- Word finding difficulty- “I know the word, but can’t get it out of my mind”
- Slowed mental speed and uncoordinated movement
- Changes in behavior or personality (depression, anxiety, irritability)
- Emotional lability (uncontrolled emotional expression)
Is there any treatment for hypoxic/anoxic brain damage?
Depending on the cause, extent and severity of brain damage that occurs subsequent to loss of oxygen, there are many treatment options available. Before seeking any treatment, it is important to undergo a comprehensive Neuropsychological examination or testing of your cognitive and emotional functioning to determine which parts of your brain are damaged and which are still intact. Hypoxia/anoxia affects different parts of your brain and produces problems in different patients. Which areas of your brain are damaged, and which are still functioning? A profile of your cognitive and emotional strengths and weaknesses will assist the Neuropsychologist in planning a treatment plan to help you and your family improve quality of life. Rehabilitation, psychotherapy, medication, hyperbaric oxygen treatments are some of the treatment options. The rehabilitation team (i.e., speech therapist, occupational therapist, physical therapist, and Neuropsychologist) can manage your symptoms and improve your quality of life.
STROKE
- Stroke Is No Longer a Disease of Old Age
….. It was a day, just like any other day, when Armenouhi (a fictitious name of a patient), a 38-year-old housewife set down to have dinner with her husband and five-year-old child. Suddenly, she felt the most excruciating severe headache she had ever experienced. She asked her husband for her high blood pressure pill. Her hand just didn’t feel right. After a few minutes, she tried to get up but had trouble bearing weight on her right lower limb, she turned to her spouse and tried to tell him what was happening, but the words couldn’t come out right. Her husband went to call 911 and upon his return found Armenouhi on the floor, unconscious…….
I. INTRODUCTION
A. What is a stroke or “brain attack”? A stroke, or brain attack, is caused by the sudden loss of blood flow to the brain or bleeding inside the head. Each can cause brain cells to stop functioning or die. When nerve cells in the brain die, the function of body parts they control is harmed or lost. Depending on the part of the brain affected, people can lose speech, feeling, muscle strength, vision, or memory. Some people recover completely; others are seriously disabled or die.
B. How common is it? Every year, about 700,000 people in the United States suffer a stroke. That’s about one person every 45 seconds. And one person dies from stroke every 3 minutes, or nearly 170,000 a year. This means stroke is the nation’s number three killer after heart disease and cancer. It is the major cause of adult disability. The cost of stroke in the U.S. is between $30 and $40 billion per year.
C. What are the symptoms? Stroke symptoms may not be as dramatic or painful as a heart attack. but the results can be just as life-threatening. Stroke is an emergency. Get medical help immediately and know when the symptoms started. Common symptoms include:
- Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding speech
- Sudden difficulty seeing in one or both eyes
- Sudden trouble walking, dizziness, loss of balance or coordination
- Sudden severe headache with no known cause
D. How is it diagnosed?
- Neurological exam
- Neuropsychological evaluation, to examine how well the brain is working when it performs certain functions, such as remembering, problem solving, processing information. It is also used to document areas of weaknesses and strengths.
- Brain imaging tests (CT, or computerized tomography scan; MRI, or magnetic resonance imaging) to understand the type, location, and extent of the stroke
- Tests that show blood flow and bleeding sites (carotid and transcranial ultrasound and angiography)
- Blood tests for bleeding or clotting disorders
- EKG (electrocardiogram) or an ultrasound examination (echocardiogram) of the heart to identify cardiac sources of blood clots that could travel to the brain
II. IS STROKE PREVENTABLE?
The good news is, about 50% of all strokes can be prevented through medical attention and simple lifestyle changes.
A. How can I personally prevent it? Some risk factors, such as age (stroke risk factors double with each decade past age 55), sex (males have slightly higher stroke risk, than females), race (African Americans have double the stroke risk of most other racial groups), and a history of stroke in the family, cannot be changed. However, many others can be controlled. Most controllable factors relate to the health of the heart and blood vessels. Doing these things can help you prevent a stroke:
- Have regular medical check-ups
- Control high blood pressure
- Do not smoke– and stop if you do
- Treat heart disease, especially an irregular heartbeat called “atrial fibrillation”
- Improve your diet: Avoid excess fat, salt, and alcohol
- Exercise
- Manage diabetes
- Seek immediate medical attention for warning signs
B. How can medicine prevent it? Some people are at risk for stroke because of known health factors, such as high blood pressure, diabetes, and heart disease. Also, having had a stroke puts you at greater risk of another attack. Fortunately for people in these situations, there are medical treatments that can help prevent stroke:
1) Antiplatelets and anticoagulants. Doctors can prescribe antiplatelet medications (such as aspirin) and anticoagulants (such as warfarin) to reduce the blood’s ability to form clots.
2) Angioplasty and stents. To remove blockages, doctors may thread a balloon angioplasty through a major vessel in the leg or arm to reach the affected vessel. A steel screen called a “stent” is sometimes inserted in a vessel to expand its diameter and improve blood flow.
3) Carotid endarterectomy. In this surgical procedure, a blockage is removed from the carotid artery in the neck.
III. WHAT ARE SOME TREATMENT OPTIONS?
Once the doctor completes the diagnostic tests, the treatment is chosen. For all stroke patients, the aim is to prevent further brain damage. If the stroke is caused by blocked blood flow to the brain, treatment could include:
- t-PA (tissue plasminogen activator), a clot-busting drug that is injected within three hours of the start of a non-bleeding stroke
- Drugs that thin the blood, including anticoagulants (warfarin) and antiplatelet medications (aspirin or ticlopidine), a combination of aspirin and sustained release dipyridamole
- Surgery that opens the insides of narrowed neck blood vessels (carotid endarterectomy)
If bleeding causes the stroke, treatment could include:
- Drugs that maintain normal blood clotting
- Surgery to remove blood in the brain or decrease pressure on the brain
- Surgery to fix the broken blood vessels
- Blocking off bleeding vessels by inserting a coil
- Drugs that prevent or reverse brain swelling
- Inserting a tube into a hollow part of the brain to lower pressure
IV. WHAT ABOUT REHABILITATION?
After a stroke, a person may have some disability. The disability depends on the size and location of the stroke. The right side of the brain controls the left side of the body; in right-handed individuals it is important for attention and visual-spatial skills. The left side of the brain controls the right side of the body; in right-handed individuals (and 50 percent of left-handed people) it controls language – speaking and understanding. Language disorders are also called “aphasias.”
Rehabilitation helps regain functions lost from damage due to stroke. During rehabilitation, most people will get better. However, many do not recover completely. Unlike skin cells, nerve cells that die do not recover and are not replaced by new cells. However, the human brain is adaptable. People can learn new ways of functioning, using undamaged brain cells.
This rehabilitation period is often a challenge. The patient and family work with a team of physical, occupational, and speech therapists, along with nurses and doctors. Most of the improvement will take place in the first three to six months of the process. But some people can make excellent progress over longer periods.
ADULT ADD/ADHD
ADD/ADHD is a complex disorder, WE SPECIALIZE in evaluating complex disorders
Attention-Deficit-Hyperactivity-Disorder (ADHD) or Attention Deficit-Disorder (ADD), as it is called in adulthood, is a neurobehavioral disorder that affects about 2% of the population. In other words, the disorder is a combination of neurological (brain) dysfunction that causes behavioral problems. Research studies continually show that individuals who have ADD/ADHD evidence “brain malfunction’ in different areas that control attention, learning and memory, and executive functions. While most children with this disorder “grow out” of their symptoms, many children with ADD/ADHD continue to have trouble through adulthood.
Adults’ symptoms may manifest themselves differently from children.
Often the most prominent characteristic in ADD adults is inattention, impulsivity, and restlessness as well as frequently accompanying behavioral, learning, and emotional problems. Other symptoms observed in adults include problems with executive functioning, which is the brain’s ability to oversee the ability to monitor a person’s own behavior by planning, organizing, correcting and learning from mistakes, and reasoning through tasks.
Adults with hyperactive-impulsive symptoms feel restless and constantly “on the go” as they try to do multiple tasks at once. They are often perceived as not thinking before they act or speak.
There are over 100 reasons/conditions that mimic symptoms of ADD/ADHD, such as mood disorder, personality characteristics, bipolar, other psychiatric or medical conditions, illicit drug use, and medications, to name a few.
This is an easily treatable disorder, but without an accurate diagnosis, a person may spend years or even decades struggling and taking medication that are full of side effects, without any relief. Without accurate diagnosis, there will not be relief from symptoms. By virtue of training and experience, Neuropsychologists are best qualified in evaluating and treating neurobehavioral disorders, such as ADD. Without a comprehensive Neuropsychological evaluation/testing, you are seeing half the picture, not the whole.
ADD/ADHD is a complex disorder, WE SPECIALIZE in evaluating and treating complex disorders. Please call us to schedule consultation for adult ADD testing in Dana Point, Ladera Ranch, Laguna Beach, Laguna Niguel, San Clemente, San Juan Capistrano and beyond
If you are in need of a neuropsychologist Call Us at 949-481-8414
We specialize in the consultation and treatment of adults (18 yrs and older) with neurological issues.
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