Dr. Amitabha Das

There are mild, moderate and severe head injuries. A person sustaining a mild head injury may or may not lose consciousness, but may experience some symptoms, even days after the injury which often go untreated. Moderate head injury may be characterized by being unconscious less than 24 hours and may require rehabilitation. Severe head injury survivors usually experience a coma, require rehabilitation, and often need outpatient care and/or long term care.

The most frequent causes of brain injury are motor vehicle accidents, pedestrian accidents, gunshot injuries, stabbing injuries, and falls.

Causes of brain injury in children include falls, abuse, recreation accidents, and motor vehicle accidents. The youngest children are more often injured due to falls and abuse. For example, “Shaken Baby Syndrome” can cause brain injury in infants. Other examples include falls from shopping carts, accidents involving children in “walkers,” and falls from windows. Elementary school-age children are more often injured in recreational accidents, such as all-terrain vehicle and bicycle accidents (helmets significantly reduce the severity of injury in these cases). Teens and young adults are most often injured in motor vehicle crashes. Alcohol is a significant factor in many of these incidents.

Rehabilitation is the process of helping a person achieve his/her maximum functional potential. This process begins immediately, even when the injured person is in a coma. There may be problems related to movement, memory, attention, slowness of thinking, difficulties with speech and language, behavior problems, and personality changes. These problems, which may persist for a long time, are dealt with during rehabilitation.

Yes, in contrast to the short time it takes to injure the brain, recovery is measured in weeks, months and even years. Recovery is most rapid shortly after the injury and slows down with the passage of time. Many people with severe head injuries end up with almost no noticeable problems, but others require constant care for the rest of their life.

No. A helmet provides protection against skull fracture, so it’s a good idea to wear one when engaging in activities and sports where there is a high risk of head injury. But although a helmet can cushion your skull, it can’t prevent your brain from moving within the skull and sustaining a concussion or other traumatic brain injury.

No. A helmet provides protection against skull fracture, so it’s a good idea to wear one when engaging in activities and sports where there is a high risk of head injury. But although a helmet can cushion your skull, it can’t prevent your brain from moving within the skull and sustaining a concussion or other traumatic brain injury.

At the time of injury, the spinal cord swells. When the swelling goes down, some functioning may return. Especially in incomplete injuries, functioning may return as late as 18 months after the injury. However, only a very small fraction of people with SCI recover all functioning. There are major advances happening in the research field today.

Most body parts and organs can repair themselves after they are injured. However the central nervous system cannot. Attempting to repair the damage caused by a brain or spinal cord injury is a puzzle that has not yet been solved. Nevertheless the damage caused by an SCI can be reduced by limiting immediate cell death and reducing the inflammation of the injured cord. Attempts to regenerate function in the damaged area are focusing on regrowing nerves, blocking the mechanism that stops neurons from re-growing themselves, inserting new cells and bypassing the damaged area

This depends on your level of injury and degree of completeness. The lower your injury is and the more sensation/movement you have, the greater your chances are of regaining some mobility.

Right now there is no clear-cut medical cure for spinal cord injury. Administration of IV steroids at the time of the injury may prevent further damage to the nerves that is caused by the natural inflammation process following trauma. This can improve the long-term functional outcome. There is exciting research at several spinal cord centers throughout the country and abroad, which focus on ways to regenerate or reconnect nerve pathways.

We are all sexual humans with or without a disability. After a spinal cord injury, a person can continue to be sexually active and experience a satisfying intimate relationship. Your injury, however, may mean there is a change in how your body can respond. Good Shepherd's nurses and physicians can help you understand how your body works and how you can continue to enjoy intimacy.

Medications such as Viagra are used successfully with many men who experience impotence as a result of SCI. Men and women with SCI can become parents. SCI does not affect a female's ability to conceive but males may need the assistance of a fertility clinic to impregnate their partner.

Incompleteness of injury, preserved movement and sensation in your buttocks may indicate that you can regain control of these functions. Diagnostic testing can give you more accurate answers.

There are numerous adaptive resources and computer-assisted technologies that can enable you to perform activities independently. Creative problem solving and networking with peers and rehab care specialists can help you continuously improve function and enhance your quality of life

Yes, unless you have a very high spinal cord injury (C4 and above). However, you need to complete a driver training program with an adaptive vehicle under the supervision of a special rehab driving instructor and pass the state license test. For information on Good Shepherd's driver training program,

People in wheelchairs can participate in many recreational sports including basketball, tennis, track, fishing, hunting, and golf. Therapeutic recreation specialists and occupational therapists can help you obtain or improvise adaptive devices designed for many activities. Many individuals with spinal cord injuries return to work or school.

The types of disability associated with SCI vary greatly depending on the severity of the injury, the segment of the spinal cord at which the injury occurs, and which nerve fibers are damaged. Most people with SCI regain some functions between a week and 6 months after injury, but the likelihood of spontaneous recovery diminishes after 6 months. Rehabilitation strategies can minimize long-term disability.

The types of disability associated with SCI vary greatly depending on the severity of the injury, the segment of the spinal cord at which the injury occurs, and which nerve fibers are damaged. Most people with SCI regain some functions between a week and 6 months after injury, but the likelihood of spontaneous recovery diminishes after 6 months. Rehabilitation strategies can minimize long-term disability.

Of course, any comments I can make are only general suggestions, and you will need to check with your doctor for specifics. However, in my patients, it is very common to utilize tegrotal or other similar medications to prevent seizures. Sometimes indefinitely, depending on how concerned I am with the particular location. I do not generally recommend that my patients stop exercising or participating in exercise related activities. Seizures are often unpredictable, and I believe the benefit of exercise outweighs the potential for increased seizure activity.

One of the primary roles for surgery in patients with newly recognized lesions of the brain is to confirm a diagnosis. It is relatively uncommon to be able to predict with great accuracy the type of tumor or even whether a tumor is present without at least a tissue diagnosis. What that means is most patients will require at least a biopsy in the majority of cases. In the instances where there is little or no doubt about the identity of a tumor such as in a patient with known breast or lung cancer and a new lesion of the brain, either standard or focused radiation treatments can be considered without surgery. Very infrequently similar approaches could be considered using chemotherapy.

One of the primary roles for surgery in patients with newly recognized lesions of the brain is to confirm a diagnosis. It is relatively uncommon to be able to predict with great accuracy the type of tumor or even whether a tumor is present without at least a tissue diagnosis. What that means is most patients will require at least a biopsy in the majority of cases. In the instances where there is little or no doubt about the identity of a tumor such as in a patient with known breast or lung cancer and a new lesion of the brain, either standard or focused radiation treatments can be considered without surgery. Very infrequently similar approaches could be considered using chemotherapy.

When I describe the type of tumors that we see in the brain to patients, I try to give a feeling for two major aspects: First of all, some tumors can be "benign" in terms of their growth potential, but behave very "malignantly" because of their location making them difficult to treat. The other aspect is how fast will these tumors grow despite our best treatments. Brain tumors in general do not tend to spread throughout the body, but are a problem due to their continued growth inside the brain. If you think of the potential for re-growth, approximately 50 to 70 percent of all intracranial tumors will require additional treatment other than surgery alone.

In terms of general activities, as I mentioned I don't specifically restrict patients from their usual activities. Patients who have a tendency towards seizures with any specific activity in a repetitive manner should strongly consider stopping those activities.

Amitripyline or Elavil has been a very good medicine for doctors attempting to help patients with chronic pain, including headaches. If headaches or other pain symptoms persist, a variety of medications can be attempted. It is often very difficult to predict which will work the best for any one individual. However, amitriptyline is a good choice in many cases because it is not a narcotic medication.

Most SCT are benign or slow growing tumors. Malignant tumors account for less than 10% of all these tumors. Once the diagnosis is made, you should see a neurosurgeon who specializes in these tumors. Most tumors are amenable to surgery and adjuvant radiation and chemotherapy are withheld.

The role of radiotherapy should only be reserved for tumors which are malignant or those tumors which are not surgically operable. This accounts for very few tumors. Radiography should not be administered for intramedullary ependymomas.

Most of the pain before surgery should improve with the operation. However following surgery some patients develop new numbness or tingling pain which sometimes is worse than the pain before surgery. These type of burning sensation is more common following epemdymomas than astrocytomas. It will subside over several months, but some patients may require medicine to help control this type of pain.

Usually these tumors are benign and slow growing. However, they can cause symptoms of pain and weakness. Most of these spinal tumors are: Meningiomas that occur in the membranes surrounding the spinal cord and are usually benign but may be malignant.

At times, pain, bowel or bladder problems, sexual dysfunction, change in sensation, or muscle weakness of the arms or legs may alert you to the problem. This often means that the tumor is compressing the spinal cord or nerve root. Tumors that originate in the spinal cord itself may not cause pain.

Fewer than 10 percent of spine tumors begin in the spine. ... They can be benign (noncancerous), low-grade malignant (cancerous) tumors that grow slowly, or high-grade tumors that grow aggressively. Most spine tumors are metastatic — they spread from cancer in a different part of the body.

Recovery after Surgery for Low Back Pain or Leg Pain. After a spine fusion surgery, it takes 3 to 12 months to return to most normal daily activities, and the success rate in terms of pain relief is probably between 70% and 90%, depending on the condition the spine surgery is treating.

Surgery may be required if patients do not improve. ... Surgery may be required to prevent further damage to the cord itself and prevent paralysis. In the lower back,spinal stenosis symptoms may cause radiculopathy. This may result in pain in a leg with weakness, numbness and tingling.

Exercises are very important to reestablish the normal motion and strength in the spine. A daily hamstring stretching program is key to help relieve pain from degenerative disc disease. Also important are stabilization exercises and aerobic conditioning.

Because degenerative disc disease (DDD) can weaken your spine significantly, you may need to work on strengthening your back, neck, and core muscles. Then they will help support your spine better, which may lead to reduced pain. Your doctor may recommend physical therapy to help treat DDD.

DDD involves your intervertebral discs. ... But with DDD, these discs become stiff and rigid, which can cause back pain. That's why it's so important for you to takegood care of your spine, especially when you run. Like other forms of aerobic exercise, running is good for us—mentally and physically

If you have been diagnosed with degenerative disc disease and it makes working impossible, you may be eligible to receive monthly disability benefits from the Social Security Administration (SSA).

Many of the exercises should be avoided for individuals with significant back pain or degenerative disc disease. ... The exercise may be too difficult, or the person may need additional help to do it correctly. Finally, it may take awhile for the full benefits of a Pilates exercise program to be realized.

Super specialization is a combination of in-depth training and experience in a particular area of neurosurgery. Goodman Campbell surgeons who sub specialize in vascular neurosurgery have international training and experience in blood vessel abnormalities of the brain and spinal cord. If a procedure is being successfully performed somewhere in the world, it is available to our patients. Our specialists were first in the state to coil an aneurysm, to use glue in the treatment of AVMs and to place stents in intracranial vessels. For over thirty years, our vascular neurosurgeons and neuroradiologists have been actively involved in international technique and disease process research and education.

Vascular neurosurgery focuses on the following conditions:
Aneurysms: A ballooning blood vessel wall at a branching site causing weakness and potential bleeding (hemorrhage)
AVMs: Arteriovenous malformations are abnormal tangles of weakened blood vessels present from birth which may cause seizures or hemorrhage
Cavernous Angiomas: Abnormal weak blood vessels that can cause seizures or hemorrhage
Dural Arteriovenous Malformations: Abnormal connections between arteries and veins that may cause hemorrhage or neurological injury, such as stroke or weakness in the extremities
Ischemic and Hemorrhagic Strokes: A narrowing or complete blockage of a blood vessel to the brain (ischemic) or a rupture of blood vessels (hemorrhagic) potentially due to high blood pressure

It is important to recognize and treat a stroke within three hours of the onset of symptoms. Symptoms may include the abrupt onset of:
• Numbness, weakness, or tingling on one or both sides of the body
• Blurred vision in one or both eyes
• Slurred speech or difficulty understanding speech
• Dizziness or vertigo
• Severe headache

If you have a craniotomy (instead of transphenoidal surgery) you can't drive for 6 months. The DVLA will need medical evidence before you get your license back .You won't be able to drive for a year after treatment if you have a grade 1 or 2 (slow growing) glioma. Your situation will be reviewed after a year.

Our five main areas of pediatric focus are hydrocephalus (excess fluid in the brain), spina bifida (a birth defect in which the spinal cord doesn't close properly during pregnancy), craniosynostosis (facial disorders of the skull),brain tumors and trauma. Whenever possible, these conditions are treated with minimally invasive procedures, a specialty of Goodman Campbell neurosurgeons that normally means briefer hospital stays and faster recoveries.

A group of pediatric neurosurgeons who partner with experts in neuro-oncology, neurosurgery, and physiatry at brain tumor clinics at Riley Hospital for Children, St Vincent Hospital - 86th St. Campus and Methodist Hospital. Neurosurgeons also work closely with neurosurgeons, ENTs, plastic surgeons, pediatric dentists, and physical therapists at cranio-facial clinics at these same hospitals. Patients make one appointment and have access to a full, collaborative team of experts.

A craniotomy is performed to gain access to the brain for surgery by removing a portion of the skull. After the surgery, the bone that was removed from the skull is usually replaced using sutures or metal plates. An example of a situation where a surgeon may choose to perform a craniotomy is for removal of a brain tumor. A craniectomy is performed when a portion of the skull is removed but not replaced. Some examples of situations where a surgeon may choose to perform a craniectomy are: to create room for the brain to swell after trauma, to remove the bone due to an infection in the skull or a severely damaged skull with multiple fragments.

A cranioplasty is performed to correct a deformity or defect of the skull. The deformity/defect could be congenital, as a result of trauma or acquired for example after a previous surgery involving the skull. There are a variety of surgical materials and prosthetics used for a cranioplasty. Your child’s neurosurgeon will review what materials will be used for your child’s specific cranioplasty procedure.

Immediately after surgery you may notice that your child is slightly swollen at the craniectomy site. As your child heals and swelling subsides, the craniectomy site will become less swollen and may even appear sunken in.

Immediately following surgery where a craniotomy is performed, it usually takes at least 6 weeks for the bone to completely heal. You should not allow your child to participate in any activity that may risk a hit to the head or fall since the skull bone may not be adequately healed or following a craniectomy, there to protect the underlying brain. This includes such activities as biking, recreational sports, and or using playground equipment. Many times even after the bone has been repaired, it is not recommended to be involved in contact sports that may risk injury to the head. In instances of a craniectomy, your child also may be sent home from the hospital with a protective helmet. Washing can be done gently, you do not want to vigorously scrub the incision or comb over the incision. Once the incision is well-healed normal washing and hygiene are important.

Hydrocephalus occurs in two out of every 1,000 births in the World. It is not known how many people develop it after birth. Approximately 125,000 persons are living with cerebrospinal fluid (CSF) shunts, and 33,000 shunts are placed annually in the World.

The most common causes of pediatric hydrocephalus in children in the United States are brain bleeds as a result of prematurity, spina bifida, brain tumors, infection and head injury. Acquired hydrocephalus is caused by head injury or an obstruction in the brain, such as a tumor.

Hydrocephalus can be very serious, and even fatal, if left untreated. Fifty percent of those who fail to have their hydrocephalus treated will die. The other half survive with what is called arrested hydrocephalus. Those who are not treated and survive may have serious brain damage and physical disabilities.

In small children and infants, hydrocephalus can affect the head by increasing its size to accommodate the excess fluid buildup. Hydrocephalus may also slow growth in children as well have an impact on facial formation and eye spacing.

Hydrocephalus can be very serious, and even fatal, if left untreated. Fifty percent of those who fail to have their hydrocephalus treated will die. The other half survive with what is called arrested hydrocephalus. Those who are not treated and survive may have serious brain damage and physical disabilities.

In small children and infants, hydrocephalus can affect the head by increasing its size to accommodate the excess fluid buildup. Hydrocephalus may also slow growth in children as well have an impact on facial formation and eye spacing.

No. Almost everyone who has ever had a stroke could be said to have been under stress or to have been overworking at some time before the onset of the stroke. So could almost anyone who has not had a stroke. It is natural to think of stroke and stress as being related -they even sound alike- but this is not so, and indeed many strokes occur during sleep. However, there is a relationship between stress and high blood pressure. It is almost impossible to take the stress out of life, but it is possible to reduce high blood pressure.

Yes. A stroke is to the brain what a coronary thrombosis is to the heart, and the brain is always damaged in a stroke, just as the heart is always damaged in a coronary. All the symptoms of a stroke are due to brain damage. But this does necessarily mean that patients with a stroke lose their 'brains' in the ordinary sense of the word. If the brain damage is very extensive or affects special areas there may be impairment of memory, concentration and learning ability or some confusion of thought. Control of the bladder and bowels may be lost. Patients may be slower to grasp new ideas and relatives have to learn to make allowances for these changes. Some patients are vague or unrealistic, or have impaired judgement in their assessment of their own capabilities or in their relationships with other people. But in most cases, even when aralysis is severe, there is no discernible effect on the intellect and memory, and the patient's 'brain power' is as good as ever.

Each stroke is different. The timetable for recovery depends on the extent of the stroke. Other medical complications also determine the length of the recovery process. Most of the recovery that is going to take place happens in approximately six months to one year. Patients continue to heal after that, but more slowly.

At the onset of the stroke the muscles of the face, trunk, arm and leg on either the left or right side of the body are weak and lax. In most cases the power gradually returns, first to the leg and then to the arm. However, unless the limbs are placed in the correct position and are frequently put through a range of movements, there is a danger that they may stiffen, so that, even if the power returns, the limbs could be practically useless. This is why so much importance is attached to maintaining the limbs in the correct position and allowing recovery to take place in the best way. The simple rule is to let the leg bend but to keep the arm straight. It is also vital to treat the body as a whole, not just the paralysed limbs in isolation.

A stroke can cause permanent loss of function. Just what functions will be affected and how badly depends on what part of the brain the stroke was in and the speed and success of treatment. Strokes in the left side of the brain affect the right side of the body. A stroke in the right side of the brain results in signs and symptoms on the left side of the body.

Common long-term effects include impaired vision or speech, severe weakness or paralysis of limbs on one side of the body, swallowing difficulties, memory loss, depression and mood swings.

You can greatly reduce your chance of having a stroke by controlling risk factors. Strokes are usually the result of a combination of factors that have been present or developing for a long period of time. If someone has two or more known stroke risk factors the chances of having a stroke can dramatically increase.

After stroke, a patient's ability to move themselves around their home environment may change. The physical and occupational therapists can usually educate the primary caregiver in methods for adapting the home and how to help their loved ones with basic mobility tasks.

Usually the physician will not allow you and your loved one to drive right after stroke. This is because injury to the brain may cause slow reflexes, decreased attention and memory, poor insight, vision and perception problems. Due to these issues, driving without your physician's permission is not recommended.

Over the last decade, new surgical techniques have been pioneered at UPMC that allow the majority of skull base surgeries to be performed through the nasal passages using an endoscope: the Endoscopic Endonasal Approach (EEA).

An endoscope is a lighted instrument that provides visualization within a cavity. All three stages of surgery (approach, resection or tumor removal, and reconstruction) are performed through the nasal passages without the need for scalp or facial incisions. While these types of surgeries are described as minimally invasive, they often allow the surgeons to perform more complete surgeries.

The concept of modern skull base surgery comes from doing a less invasive procedure that can result in a more effective outcome for the patient. While EEA can be the solution for most tumors at the skull base, it is not the answer for all of them. The modern skull base surgeon needs to be versatile in order to offer the best approach for each situation.

From speaking with patients post-operatively, it appears to be much less painful and much less uncomfortable than comparable traditional approaches. Most patients don't need strong medication to control pain, and are discharged on mild pain relievers, such as acetaminophen. The most common complaint is the post-operative nasal packings, which are not used all the time and are removed within one week.

After you leave the recovery room you are transported to one of our step-down units. Rarely, there are specific situations that will require you to go to an intensive care unit (ICU). These situations are related to the patient's age, other diseases they have, and complexity of the surgery.

Once you are awake and oriented in the step-down unit, your family will be notified and they can join you at your bedside. Usually that happens within several hours after the end of the surgery.

In general, our patients are up and about the day after surgery. However, any time after brain surgery, it is important to rest in order to have good wound healing. The time to go back to work varies, depending on whether the lining of the brain was opened. If it was not, as with pituitary surgery, then the patient often can return to work within days. If it was opened, we generally recommend avoiding heavy lifting for a few weeks to allow for the reconstruction to seal. These questions can be discussed with our team upon follow-up and a decision will be made at that time.

Surgery should always be the last resort when it comes to treating spinal conditions in the neck and back. However, if various non-operative treatments have been attempted without improvement or worsening over a 6-12 month period, then surgical treatment seems reasonable for certain specific conditions such as spinal stenosis, sciatica, spondylolisthesis or degenerative scoliosis. The decision for surgery should be individualized to the patient and the patient’s symptoms, along with their level of function.

The field of minimally invasive spine surgery continues to grow. Most surgeries today can be treated with some aspect of minimally invasive surgery. However, there are certain conditions that require standard open treatment, such as high-degree scoliosis, tumors and some infections. The best options should be individualized to the patient’s diagnosis and overall patient condition. At UCSD we perform both minimally invasive spine surgery, as well as open-surgery, and choose the type of treatment that is best suited for the individual patient.

During an open surgery procedure, in order to view the spine, the orthopedic surgeon needs to move the back muscles over to the side. This retraction of the muscles can actually damage the soft tissue and/or injure the muscle. Furthermore, retracting the muscle usually affects areas of the patient’s anatomy that are not required to complete the surgery. Thus, causing the patient to experience additional pain. While performing a MISS, the orthopedic doctor can target the problem area directly. This allows the surgeon to treat the patient’s spinal problem with less injury to his or her normal spinal structures, including the muscles. Additional benefits include spending less time in the hospital and very little concern related to excessive bleeding (due to the shorter incisions).

Every patient is unique; however, the majority of patients can walk around relatively soon following their procedure. Moreover, a MISS is usually an outpatient procedure, which means patients return home on the same day of their surgery. Within two weeks, you should be able to return to performing light physical activities. Depending on the spinal issue that was addressed during your surgery and your overall health, you may fully recover in as little as six weeks.

Yes, by performing physical therapy exercises that target the part of the spine that was addressed during surgery, you increase the blood flow to that particular area. This blood flow increase assists your body as it heals.

The decision to return to work should be individualized to the patient, as well as the patient’s occupation. For patients with sedentary jobs, such as office work, a minimally invasive discectomy would allow that patient to begin part-time work within 1-2 weeks. For a larger surgery such as a fusion, this may take 4-6 weeks. Again, return to work is much faster using minimally invasive surgery vs. standard open surgery but this decision is individualized to special needs of each patient