Brain diseases blog: it is up and running again

To the readers of my blog and my website ( thank you for your continued support and positive feedback as well as constructive criticism.  I apologize for my delay in replying to your questions. No good excuse apart from that I was really busy the last few months. The blog though is now up and running and I shall be answering all your questions as well writing a few new posts.

Personal Regards,

Nitin Sethi, MD


Please do read my disclaimer. The purpose of my blog is purely educational and to disseminate information about neurological and neurosurgical diseases and condition. It is not meant to diagnose yourself over the Internet.

The information provided in this blog should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 if you have a medical emergency.

Links to other sites are provided for information only — they do not constitute my endorsements of those  sites.

 Any duplication or distribution of the information contained herein is strictly prohibited.



Nitin Sethi, MD

Pearls and perils of cyberchondria

Pearls and perils of cyberchondria


Nitin K Sethi, MD

Assistant Professor of Neurology

New York-Presbyterian Hospital

Weill Cornell Medical Center

New York, NY 10065



Cyberchondria is a relatively new term used at times to describe the behavior of some individuals who use the Internet to gather information about health or a disease which they feel they may have based on their signs and symptoms. The Internet search results leads to an unfounded concern, preoccupation and worry about their health status.

The term is derived from the more commonly used term hypochondria. Hypochondriasis is excessive preoccupation or concern about having a serious often incurable illness.

Nowadays more and more people are turning to the Internet for health and disease related information. In my practice I frequently come across patients who have already “Googled” their diagnosis even before they come to see me. Some even “Google” their MRI results.

Cyberchondria can have its pearls as well as its perils. Let us start with the pearls first. No one doubts the power of the Internet. It has and continues to revolutionize the way medicine is practiced. There is an abundance of information on the Internet about common and even esoteric neurological conditions. All one has to do is type the relevant key words into a popular search engine like Google and low and behold, Dr. Google starts churning out answers-pages and pages of it. The Internet houses many blogs and sites exclusively devoted to a particular condition. Some of these sites are run by reputable organizations like American Academy of Neurology ( and Centers for Disease Control and Prevention ( Thus sitting in the comfort of one’s home, useful and credible information can be readily accessed. Is there any new treatment for multiple sclerosis or ALS? If yes, where is it been offered? Where are the best doctors in NYC? Which is the nearest hospital for acute stroke care? Are there any caregiver organizations for neurodegenerative conditions like Alzheimer’s disease? Pretty much whatever you type in, Dr. Google shall have an answer.

But in this pearl itself, are the perils of the Internet. There are ample sites where in the information content is not standardized. These include blogs run by patients themselves, some by care-givers and yet others by pharmaceutical companies or companies which manufacture medical equipment. The abundance of information leads to many falling prey to cyberchondria. Let us take an example. Your doctor gets a MRI scan done because you have headaches. The MRI report reads “non-specific white matter hyperintensities are seen. These have been noted in ischemic, inflammatory and demyelinating conditions like multiple sclerosis. Clinical correlation is advised.” Now you get this report in front of you and of course what do you do? You go to the Internet and page Dr. Google for help. In you type “white matter lesions, headache and multiple sclerosis” Dr. Google hums for a nanosecond and churns out pages and pages which talk about multiple sclerosis, white matter lesions on MRI and at times headache.

THERE THE GROUND HAS BEEN SET FOR CYBERCHONDRIA!!! You are now convinced you have multiple sclerosis and spend another couple of hours in cyberspace getting worried, confused and finally panicky.

It is indeed easy to get cyberchondria. The Internet is a powerful tool. By all means use it to get health and disease related information. It is way easier than going to a library and searching for it there. BUT THE CATCH IS TO USE IT WISELY!!! If rightly used it is a slave working tirelessly on our behalf. Random searches with random key words about signs and symptoms of a disease you feel you have, risk leading to cyberchondria giving you many sleepless nights and needless worry.

What do you want to learn about?

I would like to request the readers of my blog or the visitors to my website to tell me what they would like to read or learn more about. I am trying to get more information about MS and ALS out there. I would appreciate if you either drop me an email or write a post about conditions pertaining to you even a very specific question. That would enrich this discussion and make it more worthwhile to all the readers at large.

Please read my new posts about issues pertaining to MS treatment on my website .

Personal Regards,

Nitin Sethi, MD

HIV related neurological conditions

HIV or human immunodeficiency virus causes AIDS or acquired immunodeficiency syndrome. The HIV virus affects every level of the neural axis, by that I mean that the virus affects the brain, the spinal cord, the nerves as well as the muscles. I shall discuss the neurological manifestations associated with HIV infection in this section starting with the brain.

HIV manifestations in the brain: the brain may be affected soon after the patient gets infected with the HIV virus. Research has shown that soon after entering the human body, HIV virus can be found in the brain. Its first manifestation may be in the form of an aseptic meningitis. The patient has characteristic signs and symptoms of a viral meningitis with headache, neck stiffness, photophobia, body aches and myalgias but when the spinal fluid is analysed no organisms are seen, though the cell count in the spinal fluid may be elevated. This attack of aseptic meningitis subsides on its own (no antibiotics are required).  All that is needed is bed rest and some hydration. The HIV virus then enters a dormant state in the brain, remaining silent, causing no overt manifestations.

In the later stages of HIV infection (when the virus has multiplied extensively in the body and the patient’s viral load is high and CD4 counts are low) the virus again manifests in the brain clinically. Viral load refers to the amount of virus in the body usually expressed as the number of viral copies in the blood. CD4 count refers to the number of CD4 cells present in the blood. The CD4 cells are a group of immune cells, the HIV virus selectively destroys CD4 cells and thus makes a patient immunodeficient and prone to opportunistic infections.  Opportunistic infections refers to infections which normally do not occur in a person with an intact immune system, in people who have immunodeficiency these infections are a major cause of morbidity and mortality. A number of these infections have been associated with late stage infection with HIV. These include:

1) CNS toxoplasmosis

2) Cryptococcal meningitis

3) Progressive multifocal leukoencephalopathy (PML)

4) Cytomegalovirus infections (CMV infections)

5) Tubercular infections of the brain–tubercular meningitis and tuberculoma

6) Various fungal meningitis

HIV affects other levels of the neural axis. It involves the spinal cord causing a vacuolar myelopathy causing stiffness and weakness of the legs and bladder/ bowel problems.

It affects the peripheral nerves and can cause painful neuropathies. The neuropathy associated with HIV infection is usually distal, painful and symmetrical. The drugs used to treat HIV infections are quite strong and some of them too have been implicated in causing neuropathies. HIV can also cause a Gullian Barre Syndrome like presentation. This is an acute peripheral inflammatory demyelinating polyneuropathy (AIDP) which at times can prove fatal due to involvement of the respiratory muscles.

HIV can also involve the muscles causing diffuse proximal muscle weakness (HIV myopathy). Some of the antiretroviral drugs have again been implicated in causing a toxic myopathy.

HIV infection can also involve the brain diffusely (by that I mean no focal or mass lesions are found). This diffuse involvement of the brain causes AIDS dementia complex or what is also referred to as HIV encephalopathy. The virus involves the subcortical parts of the brain and causes psychomotor slowing, cognitive deficits and memory problems.


Let us now discuss the above one by one.


1) CNS toxoplasmosis: CNS toxoplasmosis is one of the most common opportunistic infections seen with HIV/AIDS. It is caused by Toxoplasma gondii and usually presents with intracranial space occupying lesions. By that I mean, it causes lesions in the brain that occupy space much like any other mass such as tumor (cancer). The lesions due to Toxoplasma may either be single or multiple in number and clinically may present with a seizure (as they irritate the brain) or if they lie near the motor strip they may present with weakness or numbness on one side of the body. If they are multiple in the brain they may cause encephalopathy (patient is obtunded and poorly responsive). How is the diagnosis secured? The diagnosis of CNS toxoplasmosis is usually quite easy as the lesions are readily seen on either a CT scan of the brain or an MRI. Your doctor may order the test with contrast to see the surrounding edema and to differentiate them from other similar appearing lesions.

As I stated earlier the diagnosis is relatively easy if there are multiple lesions. The problem arises when there is only one lesion. Then CNS toxoplasmosis has to be differentiated from other disease processes which too may present with a solitary intracranial lesion, especially primary CNS lymphoma. It is important that the correct diagnosis be made as the treatments for the two differ widely. So in cases like these, we neurologists may order other tests such as a Thallium SPECT (single photon emission computed tomography) which is a special type of scan able to differentiate between infection (toxoplasmosis) and tumor (CNS lymphoma) or a biopsy of the lesion may be attempted. Biopsy of course is an invasive procedure and hence we try hard to avoid it.

At times we emprically treat the patient for CNS toxoplasmosis (as treatment is relatively simple and free from side-effects). The CT scan is repeated after 2 weeks of therapy, if the size of the lesion has regressed then it implies that we are dealing with CNS toxoplasmosis. If the lesion has not regressed in size after treatment for 2 weeks or has increased in size, then the possibility of it representing a solitary CNS lymphoma increases.


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