Neurology

At Health City we treat a wide range of neurological disorders, including around the clock management of acute ischemic stroke and other neurological emergencies. Our neurology services form part of the Neuroscience department, which is comprised of neurology and interventional neurology, neurosurgery and spine surgery, psychiatry and neuro-rehabilitation.

Health City Cayman Islands is the only facility in the Cayman Islands and surrounding Caribbean to offer interventional neurology services. These are backed by an electrodiagnostics and radiodiagnostics lab, as well as a hybrid cathlab.

Below are some common neurological disorders:

Migraine
A migraine is a primary headache disorder characterized by recurrent throbbing headaches that are moderate to severe. These occur due to the way the brain deals with incoming sensory information. Migraines are usually worsened by lack of sleep, hunger and other trigger factors. There are several extremely effective medications that may be used in the management of migraines.

When treating migraines it is important to identify red flags which may require immediate attention, such as a change in the character of the headache as compared to before or the development of other neurological deficits during the headache.

At our Headache Clinics, we put the focus on your comfort and winning your battle against migraines and other types of headaches. Appropriate diagnosis and treatment can go a long way to improving your quality of life. Find out more about our Headache Clinics and upcoming dates here.

Epilepsy
Epilepsy is a disorder in which a patient has recurrent unprovoked seizures. It is among the most common neurological disorders and affects people of all ages. Depending on which part of the brain the seizure is developing from seizures may be generalized or partial seizures. Every person who experiences a seizure is not automatically epileptic. It is only if a person has two or more unprovoked seizures that would he or she would be considered epileptic. Classification of the type of seizure is important in choosing the type of medication the patient will need.
Dementia
Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. One of the most common types of dementia seen is Alzheimer’s dementia.
Movement Disorders
Movement disorders are a group of neurological conditions in which a patient has abnormal movements, which may be voluntary or involuntary or just slowness of movements.

One of the most commonly seen movement disorders is Parkinson’s disease, characterized by slowness of activities of daily living, stiffness and tremors more prominent at rest. This is due to a depletion of dopamine in the brain. Medical management for Parkinson’s is quite effective, but if it fails some patients may be candidates for surgical intervention.
Multiple Sclerosis
Multiple sclerosis is a demyelinating disease in which the insulating cover over the nerves  cells in the brain and spinal cord are damaged or destroyed. It is estimated that nearly 2.5 million people worldwide have this disorder. Commonly MS affects people in the age group of 20-40 years. Common symptoms of MS are blurred or double vision, clumsiness or a lack of coordination, loss of balance, Numbness, tingling etc. There are four major types of MS depending on the course of the disease and the imaging findings. There are drugs available to prevent the progression of the disease depending on the type of disease.
Myasthenia Gravis
Myastheina Gravis is a chronic disorder of the neuromuscular junction (junction between the nerve and muscle) characterized by varying degrees of weakness of the voluntary muscles of the body. The cause of myasthenia is an autoimmune defect (patient’s immune system attacking healthy cells in the body) and its most common symptoms are fatigue, which gets worse as the day progresses. Some of the tests needed for the confirmation of myasthenia including a repetitive nerve stimulation, tensilon test, CT Thorax with Contrast, antibody test etc. which are all available at Health City Cayman Islands.
Peripheral Neuropathy
Peripheral Neuropathy is a disorder affecting the peripheral nervous system, which occurs due to damage of the nerves that carry impulses to and from the brain and spinal cord. Common symptoms of a peripheral neuropathy are pains or numbness in the extremities. Some of the common causes are drugs, diabetes, and vitamin deficiency. Many causes of peripheral neuropathy can be successfully treated or prevented.
Stroke
Stroke is a sudden onset of neurological deficit and is one of the leading causes of morbidity in the world. A common misconception is that stroke only affects the elderly. Increasingly stroke is affecting the younger population including patients in their thirties.

Along with the physiotherapy department each stroke survivor has a rehabilitation plan drawn up which is individualized to the patient. Post stroke rehabilitation is important in the recovery of a stroke patient especially during the first three months to prevent a stroke recurrence, which may be more devastating than the initial stroke.

Interventional Neurology Services


Diagnostic Cerebral and Spinal Angiogram
These procedures are done for the diagnosis and evaluation of vascular malformations or abnormalities in the blood vessels supplying the brain and spinal cord. Some of these disorders are carotid artery stenosis, aneurysms, dural arterio venous fistulas, arteriovenous malformations and spinal cord vascular malformations.
Endovascular Treatment for Stroke
Endovascular treatment of stroke involves the opening of blocked blood vessels within the brain. This can be done using retrieval devices or by aspiration. It is important that a stroke patient receives the correct therapy as soon as possible.
Carotid Artery Stenting
One of the major causes of an ischemic stroke is a blockage in one of the vessels supplying the brain. Carotid artery stenosis may be diagnosed on a carotid doppler, CT Angiogram, MR Angiogram or a cerebral angiogram. Depending on the severity of the stenosis, it can be treated either by minimally invasive carotid stenting, which is done under local anesthesia, or by a surgical approach, called carotid endarterectomy. The choice of procedure depends on other comorbidities that the patient may be experiencing.
Aneurysms
An aneurysm is a weakness in a blood vessel that balloons and fills with blood. An aneurysm occurring within the brain needs to be treated depending on its size, location and symptoms. The most common symptom of a brain aneurysm is a sub arachnoid haemorrhage where the aneurysm bursts and the patient presents with a severe headache. Emergency treatment involves locating the aneurysm and performing either a minimally invasive procedure called coiling, or a surgical intervention called clipping. In unbled aneurysms, flow diverter stenting may be conducted depending on the aneurysm’s size and if there is any change in the shape or location upon follow up scans.
Arteriovenous Malformations (AVM / DAVF)
Arteriovenous malformations and dural arteriovenus fistulae are malformations, which occur in the brain or spinal cord. Depending on the symptoms, which they cause, many require treatment. This can be done by an endovascular approach where small catheters are negotiated into the arteries supplying the malformation and blocked using either coils or liquid embolic agents, which are injected into the vessels.
Tumor Embolization
This procedure may be requested by a neurosurgeon prior to surgery to reduce the blood supply to the tumor they are going to operate on to reduce the blood loss during surgery.

Electro diagnostic Lab at Health City Cayman Islands:

Neurodiagnostics (EDX) analyzes and monitors nervous system function to promote the effective treatment of neurological diseases and conditions. Technologists record electrical activity arising from the brain, spinal cord, and peripheral nerves using a variety of techniques and instruments. The recordings become data that are analyzed by a qualified Neurologist to determine abnormalities.

Procedures performed in Health City electro-neurophysiology lab:

  • EEG: Adults for in-patients and out-patients.
  • Video EEG long term monitoring: Adults.
  • NCS: Adults for in-patients and out-patients.
  • Repetitive nerve stimulation (RNS): Adults for in-patients and out-patients.
  • Blink reflex study: Adults for in-patients and out-patients.
  • EMG: Adults for in-patients and out-patients.
  • VEP& BAER: Adults for in-patients and out-patients
  • SSEP: Adults for in-patients and out-patients.

EEG
An EEG is a test that detects and records electrical activity in the brain using small, flat metal discs attached to your scalp. Highly sensitive and accurate computerized digital monitoring systems record the activity through an array of electrodes placed at measured intervals on the patient’s scalp. EEGs are the only available diagnostic tool to diagnose seizure disorder.

The test is non-invasive and painless for the patient. Electrodes are placed on the scalp with a lanolin type conductive paste that washes off with ease. While testing, the patient may be asked to do a deep breathing exercise (hyperventilation) and may be shown a strobe light that flashes at various frequencies. These activities are helpful in revealing brain patterns useful for diagnosis. The patient is asked to remain still, relaxed and is made as comfortable as possible.
Evoked Potentials
Evoked Potentials are useful in evaluating neurological problems, including acoustic neuroma, optic neuritis, spinal cord injuries, and multiple sclerosis. They record electrical activity from the brain in response to external stimulation.

Three types of Evoked Potentials are done in our lab the visual evoked potentials (VEP), the Brainstem Auditory Evoked Response (BAER), and the Somatosensory Evoked Potentials (SSEP).
Visual Evoked Potentials (VEP)
The VEP is a measurement of the electrical signal recorded at the scalp over the occipital cortex in response to light stimulus. It requires the patient to stare at a pattern on a screen while electrodes are applied to the scalp using conductive paste. This test is used to evaluate the optic nerves.
BAER
The BAER evaluates the acoustic nerve and brainstem auditory pathways. Electrodes are applied to the scalp and either earphones or ear inserts (much like foam earplugs) are used to deliver a series of clicks to each ear separately.
Somatosensory Evoked Potential (SSEP)
This test measures the electrical activity of the brain that results from the stimulation of sight, sound, or touch. Electrodes are applied to the scalp, spinal column as well as other places on the body, and a small electrical current (creating a tingling sensation) is applied to the skin over the specific nerves on the arms or legs. This test is used to assess the pathways from the nerves in the arms (median) or legs (post-tibial) through the spinal cord. Sometimes, patients having surgical procedures involving the spinal cord or acoustic nerve will have Evoked Potential monitoring throughout their operation to assist in nerve function.
Nerve Conduction Study (NCS)
Nerve Conduction Studies [NCS] evaluate electrical potentials from peripheral nerves by taking the measurement of the speed of conduction of an electrical impulse through a nerve. NCS can determine nerve damage and destruction.
Technicians stimulate the nerve with an electrical current and then record how long it takes the nerve impulse to reach the muscle. Patients referred for NCS tests suffer from nerve conditions which produce numbness, tingling, muscle pain, muscle weakness, muscle cramping, abnormal movements, pain or loss of sensation, or neurological diseases affecting primarily the feet, legs, hands, arms, back, and neck.
Electromyography
Electromyography is the study where the specialized neurologist will insert a needle in to the specific muscles to identify the on-going denervation changes or any re-innervation potentials or signals of the particular muscles. The needle has two attached electrodes where the outer cover of the needle acts as reference and the tip of the needle acts as active phase to pursue the signals of the muscles. In this test patient may feel discomfort due to electrical stimulus, where doctor is not supposed to give any kind of anesthesia as the patient has to move and contract their muscles where it is required during the study. EMG study is mainly done to localize myopathy, neuropathy, carpal tunnel syndrome, radiculopathy, brachial plexopathy, lumbosacral plexopathy, motor neuron diseases, peripheral neuropathy etc.

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Please call us at 1 (345) 945-4040 or fill out our simple contact form to find out more about the neurology and interventional neurology services offered at Health City Cayman Islands.