Christianity and the Brain: Patients Stories: 100 Stories of Hope, Faith and Courage

By RAMSIS F. GHALY MD FACS

Dr. Ramsis Ghaly is a Christian, a physician, a surgeon, and a humanitarian.
This is the fourth book by Dr. Ghaly, bringing his philosophy on patient care
and the medical profession to patients, their families, and healthcare
providers.

This book honors his patients. It includes their stories, told by them in
interviews. The book represents the voice of the patients, written for fellow
patients, to give them faith, hope and courage as they face their own illness
journey.

It is Dr. Ghalys hope that you will be better prepared to embark on an illness
journey with the words for his book. As you embark upon the illness journey, it
is important for the patient and his family to seek quality care, asking
questions and demanding only compassionate and professional healthcare from all
involved. Dr. Ghaly hopes this book will provide insight into the illness
journey, comfort for the difficult times, hope for the future, and faith that
with Gods help, all will be right.

Here are the stories of 100 of his patients. They include many who have gone on
to live healthy lives, as well as some who have passed on. Dr. Ghaly has
included his comments on most of the cases, and on the medical conditions they
faced.

• Language: English
• Publisher: iUniverse
• Release date: Jul 21, 2010
• ISBN: 9781450240444

RAMSIS F. GHALY MD FACS

Christianity and the Brain Patients Stories 100 Stories of Hope, Faith and Courage Ramsis F. Ghaly MD, FACS Neurological Surgeon and Anesthesiologist Neurointensivist and Pain Specialist Dr. Ramsis Ghaly is a Christian, a physician, a surgeon, and a humanitarian. This is the fourth book by Dr. Ghaly, bringing his philosophy on patient care and the medical profession to patients, their families, and healthcare providers. This book honors his patients. It includes their stories, told by them in interviews. The book represents the voice of the patients, written for fellow patients, to give them faith, hope and courage as they face their own illness journey. It is Dr. Ghaly’s hope that you will be better prepared to embark on an illness journey with the words for his book. As you embark upon the illness journey, it is important for the patient and his family to seek quality care, asking questions and demanding only compassionate and professional healthcare from all involved. Dr. Ghaly hopes this book will provide insight into the illness journey, comfort for the difficult times, hope for the future, and faith that with God’s help, all will be right. Here are the stories of 100 of his patients. They include many who have gone on to live healthy lives, as well as some who have passed on. Dr. Ghaly has included his comments on most of the cases, and on the medical conditions they faced.

Book preview

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DEDICATION

STORIES OF PATIENTS; SHARING THEIR ILLNESS JOURNEY EXPERIENCES

GREAT MEMORIES FROM PATIENTS THAT I LOVE MOST

MANY HAVE GONE THROUGH BRAIN AND SPINE SURGERIES AND TASTED DEATH

EVERY PATIENT IN HIS OR HER OWN WAY HAS A GOOD STORY TO TELL AND TO INSPIRE AND TEACH

TO ALL MY PATIENTS THAT GOD THE ALMIGHTLY AND OUR LORD JESUS HAS KINDLY PLACED ME IN THEIR PASSAGE.

TO THOSE CURRENTLY LIVING AND WHO LEFT US FOR NOW

TO ALL WITH ILLNESS

THANK YOU

MY SINCERE PRAYERS AND RESPECT TO YOU

GOD THE ULTIMATE HEALER BE WITH YOU

PREVIEW

We commonly forget that our patients are the customers of healthcare and to whom we owe our care to. In fact, we concentrate on what healthcare providers and news media tell us, rather than what the patients tell us about their care . This book represents the stories of 100 patients that underwent brain, spine and carpal tunnel release surgeries, what worked, what did not work and what advice they have for other patients. It is the opportunity and foundation of patient voices and their experiences. It also includes some sincere recommendations and biblical words of comfort to join their illness journey.

Contents

DEDICATION

PREVIEW

PREFACE

OVERVIEW OF THE NEUROSURGICAL ILLNESS JOURNEY AND CARE

COMFORT DURING HEALTH CRISIS: A SYNDROME OF COLLECTIVE CHALLENGES

WHAT CAN WE LEARN FROM PATIENTS’ LETTERS AND GIFTS?

HEALTHCARE PROVIDERS COMMENTS

ONE HUNDRED PATIENT STORIES ACCORDING TO THEIR DIAGNOSES AND SURGERIES

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The brain, what a sacred pearl! It weighs 1.5 kilograms, the smallest, most complex, interactive organ, constantly working through many neural network wiring and wireless connection to mankind to him, outside world and beyond. Each region has a job to do, roughly speaking, the front for personality, the sides (temporal lobes) for speech and memory, middle sides above the ear (posterior frontal and parietal lobes) for movements and sensations for the other side of the body (right side of brain controls left side of body), back of the brain (occipital lobe) for vision (right visual field controlled by the right occipital lobe, the lower part of the back of the brain (cerebellum) for balance and equilibrium and the brainstem lower front part going to the spinal cord connects the brain with the entire body and face for movements, sensation, orientation, and position. A silent looking organ but it represents everything to mankind. What a magnificent organ! Praise the Lord to his gift to our nature.

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The spinal cord and nerves supply the entire body below the head and it connects the brain inside the skull with the entire body. It travels through bony canal to keep it safe from outside forces; it is a fragile and sensitive structure. The spine consists of seven cervical vertebrae (spine of the neck portion), twelve thoracic vertebrae (spine of the upper back), five lumbar vertebrae (spine of the lower back) and five sacral vertebrae (spine of the pelvis) between one vertebrae and another, there is a disc that works like a cushion, and at each level, there is one nerve that exists at each side to supply the appropriate region of the body. The spine model represents the skeleton where spinal cord and nerves travel through below the head once it leaves the base and back of the skull.

CHAPTER ONE

PREFACE

NO ONE TO TALK TO, NO ONE TO TELL, I WAS LEFT ALONE

THE ILLNESS JOURNEY AWAY FROM HOME;

WHAT A STORY TO TELL; WHAT AN EXPERIENCE!

IN THE MIDST OF BUSY EMERGENCY ROOM

As a neurosurgeon, I was called to save a life of a patient with massive brain hemorrhage. The patient was lying comatose in a hospital bed and the family was on their way. The emergency room physician and staff were assessing the condition, yet no one knew the patient and he is one of many at that night lying unrecognized, away from home and away from his neighbors. What was in his mind and what went on with his family members and visitors.

TO THE OPERATING ROOM

Tears and cries overwhelmed the scene as the family arrived and the patient was rushed by the neurosurgeon to take the hemorrhage away and control the brain bleeding before permanent brain strangulation occurs. It was once called the decade of the brain and the fast track to care for patients with brain stroke, yet the line was not moving as fast as it should be.

TO THE INTENSIVE CARE UNIT

The surgery was stressful and patient was taken to the intensive care unit and it was his temporary home for two weeks and the family room with chairs and couches were the home of many family members. Tubes, lines and dressings and linens are covering the patient and visitors coming back and forth and various staff members caring for the patient, yet it is a foreign land. Talks about life and death, minute by minute, the fear of the eventual death gets closer and closer. A nurse to follow another and a physician to follow another and chaplain follow another and the patient was lying unresponsive in his bed away from home. The monitors are alarming; the printer was printing pages of labs and the day passed without the sun in the room and the light shining at night.

TO THE INTERMEDIATE UNIT

Some of the tubes came out and the patient was weaned from the machines but yet he was not awake. He still needed to be fed and maximum assistance. He needed help in every aspect and the help was not enough. He was like a child- wanted all the attention and care -but yet he was not speaking and could not verbalize his concerns.

LEAVING THE HOSPITAL

Once the patient was declared stable by his doctors and hospital officials, now he needs to go. The insurance will stop paying and the hospital already made its part. The discharge planner and social worker with the case manager, patient advocate and financial officials were in close contact. A nursing home accepted the patient because he was not accepted in rehabilitation unit. He was not able to carry at least three hours of active participation as a prerequisite. Once again the patient and family found themselves in another place and not welcomed any longer in the hospital. It is an anxious time. The reality is not sinking in yet. What we are going to do about work, bills, home, kids, paper daily duties and many more were going through. Who we can share with, who can give us an honest opinion?.

TO THE NURSING HOME

In the nursing home, things are radically different than the hospital, one nurse is caring for thirty patients and the calls are not returned. The family was staying with the patient as he is wakening up. What he is saying -what he is doing. No one can give us an answer. Perhaps, no one knows what goes into the mind as the brain recovers and person is wakening up.

TO THE REHABILITATION HOSPITAL

As the patient is waking up, he asks what I am doing here. The family looked around; it is depressing to be here. Many of the patients are helpless here. The family asked to be reevaluated to go to a rehabilitation unit since he was waking up. Yes, he got accepted to go to acute rehabilitation hospital. Much more goes on in the rehabilitation unit. Many therapists and staff are attending to the patient. The patient starts to be aware of things.

TO HOME AND OUTPATIENT PROGRAM

Four weeks in rehabilitation, his insurance and rehabilitation unit can keep him only for that time. Now the patient finds himself in his home but a different person and different scenario. Many things need to be explained, wounds to be healed, explanation to be given. The reality is still not sinking in. Arrangement was made to take him three times a week for daily therapy program.

VOCATIONAL REHABILITATION AND GRADUATION

As soon as patient was declared at a plateau, with no further significant improvement, another team started with a goal to graduate him and to see where he can fit in the society.

FINALLY HOME

After the winds and storms pass by, now the new place where he has ended to be will be the new home and the new friends are his friends. Some support groups are structured to help, but are not for all and the patient is at home -his new home away from his original home. What is the impact beyond the recovery remained unrecognized by many?

NO PERSON TO TALK TO AND NO EAR TO LISTEN

I looked and wondered about the entire illness path of the patient and his family. I realized, there was no ear to listen to the patient or his family. There was no heart to feel what they are going through. There were no eyes to see what we are seeing, no mouth to speak for us, no hands to reach us the extra mile and no feet to take us to where we want to be. There was no one to talk to. Everyone was running after what they are supposed to do to complete the job that they were trained to do. But with it, the patient and family remained distant and far away. The family could not talk much. To whom would they talk and what to say?. We are in shock and we do not know what to anticipate or even what to ask. We are afraid we may step on someone’s toe or say inappropriate things and hospital staff will get upset and they will not care as well for our patient. We will just be silent throughout.

THE REALITY MAY NEVER SINK IN EXCEPT TOO LATE

I wonder how much the patient and family realize the impact of the illness. The full awareness of the entire journey and the lasting change and sequence of the condition -does this really finally sink in and when.

THE FOURTH BOOK: THE VOICE OF MY PATIENTS WHOM I LOVED MOST

For that, I wrote this book in order to help many and to prepare many for the illness journey. The book represents the voice of patients, inspiration of patients to patients. You are not alone and we will never leave you alone but will stand by you.

EVERY ONE HAS A STORY TO TELL

This book is written by patients telling their story. Many patients wished to share their story with others. Many wanted to inspire others and prepare the way as their fellow men and women about to go through the illness journey. Many lessons are learned and the room for improvement is great. Many wished to leave an everlasting memory. Some are alive and some left us for now while their story and blessing are in this book. They all had gone through brain or spine and nerve surgery. The experience had changed permanently their lives. They all gathered in this book to inspire many, to teach us and give us their prospective into things. Many are wishing to change the current system for our future generation. All had neurosurgical procedures by the author. All- I love them most. It is a delicate field in surgical subspecialty, the surgery on the nervous system. Neurosurgical patients are known to suffer a great deal and longer with ever lasting impact and change on the entire person. In this book, the patients are categorized by the neurosurgical procedure had done to each; brain, spine or peripheral nerve.

The reader can be a patient or family member just starting in their illness experience or going along the way. We are with you. Some may already have gone in similar experience, hopefully the book will be of support and inspiration to them and the message, you are not alone. Some may never go through the illness passage but we thank you for reading about your fellow men and women. It is a book for all. It is the voice of my patients whom I operated on over the last two decades.

LOOKING AT PATIENTS’ GIFTS AND LETTERS MAY LEAD US TO UNDERSTAND

Over the years, patients brought gifts, letters, statues and many more precious items. Exploring all of these may lead us to go into the depth of what goes on during their illness journeys. A chapter is designated to explore the contents of letters and gifts over the years.

WHEN HEALTHCARE STAFF HEARS THE CONCERNS AND FEEDBACK OF THE PATIENT VOICE

This book may let healthcare staff reconsider their way of approaching the patient and treating him or her. When medical care provider treats a patient, he does not treat the patient by himself but the entire family and dependents. As the bible mentioned we are all one body, one limb gets hurt, the entire body suffers. (St Paul). Patients are the focus, but also the center. We do many things in our daily businesses to promote the products to the customers and many surveyors get involved. They are all centered on customer satisfaction. The current book provides to each one of us the voice of patients. Let us have the ears to hear and the eyes to see.

THE BRAIN EXPLORES WHAT IS IN THE BRAIN

Can one’s brain explore his own mind and search for the truth of things. In the daily living, the brain does not stop working, yet during the rest hour, perhaps the mind organizes things and regroups in time in subconscious. It is great to see God talked to His people in dream while asleep. It is also awesome that the Almighty creates our brain, a master engine, to search within the engine itself for the truth.

THANK YOU FOR EACH STORY WRITTEN IN THIS BOOK

In this volume, a writer interviewed all patients that underwent neurosurgical procedures over the years. There was no bias of selection, all patients who accepted were interviewed and shared their story of the illness and neurosurgical journey. A scholar -editor, named Marilyn Olson, experienced in medical stories and wrote many for newspaper and magazines. I got to know her 10 years ago when she interviewed me and my patients with the neurosurgical care. Highly ethical, she is always dedicated to the truth, she accepted to be neutral and interview each patient separately and write what they tell her without the influence of their physician, including myself. Then, I wrote the clinical summary with their history independently as well. So for the reader, each story starts by Dr Ghaly, clinical case summary and followed by patient insight and interview.

I applaud all the patients that accepted to participate in the book with their stories sharing with readers from all over their experiences and recommendation. They did it to help their fellow patients. It is meant for patients to be an advocate to their fellow patients, share their experiences and inspire many for years to come. Thank you for doing so. There was no single financial compensation given to the writers or patients. We realized that in many patients it is not easy to live again through the emotions and memory and to come of their neurosurgical illness journey. Perhaps, one of our ways is not to live in the past and keep looking for what is today and what to come

Nonetheless, it was hard for Marilyn Olson to interview each patient without tears and emotional flashbacks. It was not easy to live again what each patient and family went through. Hours and hours were spent in each story.

MEDICAL CARE GIVER TO LEARN

Over the years, I learned much from my patients. I learned how to care for them, what works and what does not. In this book, patient comments are written unedited, so also patients letters. Patients are the center of care, the customers and for them, healthcare industry exist. Patient advocacy in its real meaning should be served to the full. We hope that medical care giver at all levels find this book insightful in this aspect

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A neurosurgeon and physician after medical school and an average of 7 years residency training, has every year to attend other medical seminars, workshops and conventions to keep up the skill and learning. My mother always said that a physician is always a student. Despite the degrees and certificates, there is no special text that tells what the right thing is for this particular patient. Skill, experience and divine guidance are needed. The picture in the middle indicates our lord Jesus guiding the neurosurgeon’s hands during surgery.

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As education continues, the neurosurgeon will earn a medical school diploma after completing medical school successfully, certificate of successful completion of neurosurgery residency, board certification after completing the written and oral examination, and two years of successful practicing as a neurosurgeon, awards and certificates for postgraduate training, good work and achievements. The neurosurgical training does not stop by completing the residency; in fact the life as a neurosurgeon has just begun. The mission is to serve patients better and to do the best of our ability and not to hurt anyone through treatment received.

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The church leaders like all the Christians believe strongly that medical care is a sacred vocation handed to us honorably by God himself to help one another. Jesus Christ when he came in the flesh, he demonstrated an example to us to heal the full mankind, body, soul and spirit. Faith and medicine when together represent a great tribute to each other. As the Pope wroteInvoke abundance of divine graces in each medical care provider to heal his fellow patient. Thank you Pope Benedict the Sixteenth, May God keep your papacy and your health for many years in peace, joy and prosperity.

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Patients are searching for great dedicated physicians and they will speak up for them. The extra mile care with compassion adds tremendously to the knowledge and skill acquired. Patients represent body, mind and spirit, while suffering today and need help to ambulate and talk and care for them, tomorrow they will be talking, walking and caring for themselves and others. They were cases today, became stories later and now they are in history and what remains are the beautiful memories that God made us part of their healing.

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The story of illness journey for each patient from the beginning to the end is presented on the wall of the neurosurgeon’s office. Patients come and read and spend time to read and learn from others. Hat a great honor to represent the great stories of healing of patients! It continues to humble us as we treat patients. The impact being imprinted into our patients is for life and the everlasting memories. These stories are testimonial to other patients and help many more. The experiences that the patients talk about are endless. Medical care providers can learn from these stories. An outstanding physician should be a patient and family partner. As God taught us, while he is a master, he was a servant, so all of us should be to one another, including medical care providers and physicians.

CHAPTER TWO

OVERVIEW OF THE NEUROSURGICAL ILLNESS JOURNEY AND CARE

The nervous system is a quiet complex system and does not complain. Early on, patient may complain of general non specific problems, such as arthritis like feeling or migraine like headache. These general complaints get overlooked by the patient. It continues to progress but over time so becomes unnoticed until it reaches serious stage. Patients are the only person that can help himself or herself to get early assistance. Patient awareness of the nervous system illness therefore becomes essential for early diagnosis. The current book may assist the patient and provide a map from other patients that may guide other patients.

What a privilege God the Almighty has given to his children to be able to explore and surgically heal other fellow men! Not long ago, it was told that surgery on the fellow men is impossible and not a gift given. In the first three volumes, the author discussed the holistic brain, the master mind of mankind. Perhaps, the new technology may get signals from the brain to the outside world replacing some of the neural network. But never, ever, should it replace the brain, the person’s identity and eternal existence. The brain is a sacred irreplaceable organ so the nervous system should be handled accordingly. For generations, we realized that injury to the nervous system is limited in reparability and the best thing is prevention and if injured, act immediately. There are many new things on the horizon, but today, the brain remains almost irreparable and regeneration is very much limited. New development in the neuro-technology, neurocomputer interface where brain signals of intention to do a task can be picked up by sensor transferred wirelessly to a computer or to artificial limbs and patient able to communicate to outside world. All our deeds arise from the brain and are conducted through the nervous network, and mankind is able to navigate his daily activity in the environment. But as Our Lord said all what comes from within---et. The brain cells are ßable to generate detected electrical signals called evoked potentials and spikes. These spikes get intensified as they are activated when these specific neurons intended to do a specific task. If these neurons are picked up from the motor strip, then it is muscle movements, if from vision area, they will be activated from the scene. And so forth. The new technology may help to assess or restore some functions to stroke or spinal cord injured patients. It may allow the brain of quadriplegic patient to move an outside virtual arm but it needs the brain of the person and it will work through the mastermind.

The journey for surgery on the nervous system is scary and not easy. It was not long ago when man thought that no man survives after surgery on the nervous system. That has changed. Even currently many of patients will say you are not going to make a hole in my brain. Rightly so, many of the fears related to the neurological paralysis and loss of function. Patients understood clearly that brain and nerves are essential and damage will result in a loss of function. Surgery in the nervous system is a mark of the recent technology of the 20th century and many things are still to understand or figure out. Frequently asked concerns, will I be the same after the surgery? Will I wake up paralyzed? Will I become vegetative "vegetable alive by the machines? Will I recognize my family? And so many questions and concerns.

It is my belief that many brains will have recovered from major injury if we give enough time to heal. When we injure the brain, the patient goes back to the child’s brain and becomes dependent. The child’s brain takes 18 years to mature. So with the brain plasticity and ability to generate, perhaps time is needed to support the brain and nervous system for recovery.

CAUSES AND MANIFESTATION OF NEUROSURGICAL ILLNESS

The nervous system, brain, spinal cord and nerves do not tolerate compression. In fact, the most common reason for surgery on the nervous system is to remove the external or internal pressure. The compression can be caused by many reasons such as tumors, disc herniation or collection of blood. Magnetic reasonance imaging (MRI), computerized tomography scanner (CTSCAN) and x-rays are the diagnostic imaging to visualize the nervous system and the problems. When pressure exerts on the nervous system acutely (all of a sudden) it is not tolerated as much as if it is gradual. For that reason, sudden disc herniation (when a piece of disc get extruded and pushes on the nerve) it will produce sudden severe sciatica where pain like toothache travels all the way from the back to the leg. Also, when sudden brain hemorrhage can squeeze the brain inside the skull and the patient will drift into coma from being awake after a brief episode of headache. Removing the focal disc material will relieve the sciatica and removing the hemorrhage collection will release the pressure from the brain.

If however, the compression on the nervous system occurs gradually (chronic), the nervous system will adapt and symptoms and signs early on will be minimal. For instance, patient was hit on the head and a small hemorrhage occurred and gradually increased in size, the patient will have headache for some time, then gradually drift into confusion and he or she becomes sleepy and sleepier when it continues to reach large size.

Most common manifestations for neurosurgical lesions are headache and pain. The nervous system is tedious and difficult to diagnose because it does not complain. Paying attention to details with diary of the daily complaints is helpful when you share with your physician. Detailed history and examination is needed and early referral to specialist is recommended. Time is brain is common rule and when the problem gets diagnosed early on, more options are usually available and success of intervention is high. Early on symptoms can be confusing especially of brain problems because they are non specific and can match common daily complaints. For instance, headache occurs in more than 90% of the population and in some are daily complaints. Early on, patient may complain of general non specific symptoms, such as migraines like headaches or lightheadedness like flu. These general complaints get overlooked by the patient. It continues to progress but over time so becomes unnoticed until it reaches serious stage. The patient is the only person that can help him or herself to get early assistance. Patient awareness of the nervous system illness therefore becomes essential for early diagnosis. The current book may assist the patient and provide a map from other patients that may guide other patients.

So how can we know which one is dangerous- more than another? Usually the patient will know that the ominous headache is sudden, severe and different from all other headaches and can be associated with new complaints such as lightheadedness, sleepy, drowsy, blurry or double vision, word finding difficulty or slurred speech, confusion, ringing in the ears (tinnitus), feel like spinning (vertigo), numbness in the face, drooling of the face, starring look, difficulty swallowing, choking sensation, numbness in one side, heaviness in the arm or the leg, walking difficulty or gait disturbance, fever, neck rigidity, stiffness of the arms and legs, involuntary movements and seizures. More specific finding can be searched for like reaction of pupils to light, dancing eyes (nystagmus), and abnormal posturing. For the level of the coma, there is a scale that can evaluate the depth of the coma and standardized across the world. Glasgow coma scale is the most common and used for patient exposed to head trauma and suffered from traumatic brain injury (TBI). If there is no response, the score is 3 and if the patient is fully awake and normal is 15 and if severe <8. It includes eyes opening spontaneously and pain, speech output and response of the arms and legs spontaneously and to pain. When the coma is deep, pinching the arms or legs cause abnormal posture response, flex (decorticate or extend (decerebrate). Patient will not answer questions or follow command. As the pressure increase before the coma, the patient appear confused and disoriented where he does not know where place, when time and what person. It is not uncommon that deterioration in the mental status occurs so rapid that one minute looks awake and next minute is in coma. For that reason, head injury is taken seriously and be admitted for neuro-observation.

The brain is a quiet organ and when it reaches a certain stage, critical level drifts into coma and death occurs in no time. Be on alert and be observant is the key for salvage. Brain herniation is a terminal event which occurs when the pressure on the brain gets ignored and the brain gets squeezed more and more inside the skull where there is no room except to squeeze the essential part of the brain through rigid membranes and openings such as tentorial incisura for tentorial herniation, subfalcine herniation and tonsillar herniation. Once herniation occurs if intervention by surgical release of pressure do not take place within minutes to maximum of two hours, permanent destruction of the brain occurs and brain death. It is important to realize before declaring a person brain dead that the person is not hypothermic (temperature <95F), or has sedative drugs or neuromuscular blockade on board. It is ideal to be aggressive in the treatment of patient for the first 24 hours and in children to 72 hours and continue documentation of brain dead examination regardless of the maximum treatment received. Things change later and for that reason, doing the maximum in the beginning before it is too late is essential. The brain dead examination includes no response what so ever to pain, no cough when tube placed inside the throat and trachea, no gag when tube placed inside the mouth , no spontaneous respiration, no corneal reflex when stimulation to the cornea, no reaction to the light applied at the pupils, no eye movements when the head is moved and eyes open, no movement of the eys when iced water applied to the ears. Eyes are not open to pain, arms and legs are not moving to deep pinching pain. When the respiratory machine stops temporarily, despite good oxygenation, patient will not initiate spontaneous respiration even at arterial carbon dioxide level >60mmHg positive sleep apnea test. Electroencephalogram will show flat line or e isolectric EEG, blood flow study will show no blood flow to the brain and transcranial Doppler will show biphasic flow.

When pressure occurs on the nerve, pain and tingling and numbness sensation travels through the nerve to the area where the nerves supply. A dermatome for sensation and myotome for motor. In the neuro-anatomy, each nerve has special distribution of the human body and from following the course of the dermatome and myotome, we can know which nerve is affected. This traveling aching pain and numbness is called radiculopathy and it is known as sciatica if it affects the legs. MRI, CTscan and X-rays are the imaging ordered to look for the problem affecting the nerve root in the spine. Early one, patient may complain of general non specific such as arthritis like feeling in the arm or the leg, numbness in the hand or joint pain. These general complaints get overlooked by the patient. It continues to progress but over time so becomes unnoticed until it reaches serious stage. The patient is the only person that can help him or her get early assistance. Patient awareness of the nervous system illness therefore becomes essential for early diagnosis. The current book may assist the patient and provide a map from other patients that may guide other patients.

SURGICAL TERMS

Speed and diligent treatment go hand in hand in skilled hands during neurosurgical procedures.

BRAIN

Brain is the master region of the nervous system. All nervous signals, communications and response occur within the brain. It is the mother of the nervous system. It weights 1500 gram outside the body but inside the skull carries no weight. It attaches itself through filaments and swims in water called cerebrospinal fluid. The distal part of the brain transit to brainstem (two fingerbreadth) and spinal cord one finger breadth. Billions of tracts and fibers travel through the spinal cord and brain stem. Most of the structure within the nervous system cannot be seen or identified by the naked eye. That is why, microscopic magnification and illumination are needed when surgery is done on