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Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. It begins in liver cells called hepatocytes and most often develops in people with chronic liver disease, especially cirrhosis caused by hepatitis B or hepatitis C infection. The liver sits under the right rib cage and plays a vital role in digestion, detoxification and metabolism. In HCC, genetic changes cause liver cells to grow uncontrollably, forming a tumor that can damage healthy liver tissue, invade blood vessels and spread (metastasize) to other organs. Why HCC is dangerous Often causes no symptoms in early stages Commonly occurs in people whose liver function is already poor Frequently diagnosed at an advanced stage Treatment options depend on tumor stage and liver reserve Causes HCC develops when DNA changes occur in hepatocytes, leading to uncontrolled growth. The most common underlying causes include: Cirrhosis Chronic hepatitis B or C Long-standing liver inflammation or injury In some cases, HCC develops without known liver disease, though this is less common. Risk factors Chronic hepatitis B or C Cirrhosis (any cause) Metabolic dysfunction–associated steatotic liver disease (MASLD/MASH) Diabetes and obesity Heavy alcohol use Smoking Inherited liver diseases (hemochromatosis, Wilson’s disease) Aflatoxin exposure (mold-contaminated grains and nuts) Older age Symptoms Early HCC usually has no noticeable symptoms. When symptoms appear, the disease is often advanced and may include: Unintentional weight loss Loss of appetite Upper abdominal pain or mass Abdominal swelling Jaundice (yellowing of skin and eyes) Worsening symptoms of cirrhosis Early warning signs may be detected through: Rising alpha-fetoprotein (AFP) levels New liver nodules on ultrasound during surveillance How HCC spreads Advanced HCC may spread to: Lungs Abdominal lymph nodes Bones Adrenal glands Brain Treatment options Treatment depends on tumor stage and liver function and may include: Surgical resection Liver transplantation Ablation therapies Embolization (TACE, TARE) Radiation therapy Targeted therapy Immunotherapy Prevention You can reduce the risk of HCC by: Preventing or treating hepatitis B and C Getting vaccinated against hepatitis B Avoiding heavy alcohol use Maintaining a healthy weight Managing diabetes and metabolic disease Avoiding smoking Treating cirrhosis early Screening People at high risk (cirrhosis, hepatitis B or C) may benefit from screening every 6 months with: Liver ultrasound AFP blood test Screening can detect HCC earlier, when treatment is more effective. When to see a doctor See a healthcare professional if you have: New or worsening liver-related symptoms Unexplained weight loss or abdominal pain Known liver disease and changes in health status Early detection is critical for improving outcomes in hepatocellular carcinoma.

Lacunar Syndromes – Clear Clinical Overview Lacunar syndromes are a group of distinct neurological presentations caused by small deep infarcts (lacunes) in the brain. These infarcts result from occlusion of small penetrating arteries, most commonly due to chronic hypertension, but also diabetes and smoking. Unlike large strokes, lacunar strokes do not involve the cerebral cortex, which explains their characteristic pattern of symptoms. The Five Classical Lacunar Syndromes 1. Pure Motor Stroke (Pure Motor Hemiparesis) Most common lacunar syndrome Weakness or paralysis of the face, arm, and leg on one side No sensory loss Common lesion sites: Posterior limb of the internal capsule Basis pontis 2. Pure Sensory Stroke Numbness, tingling, or altered sensation on one side of the body No motor weakness Typically involves the thalamus (especially the ventral posterolateral nucleus) 3. Ataxic Hemiparesis Combination of: Ipsilateral weakness Poor coordination (ataxia), especially affecting gait Often appears as “clumsy walking” Common lesion sites: Pons Internal capsule Corona radiata 4. Dysarthria–Clumsy Hand Syndrome Slurred speech (dysarthria) Clumsiness and poor fine motor control of the hand Facial weakness may be present Lesions usually located in: Pons Internal capsule 5. Mixed Sensorimotor Stroke Motor weakness and sensory loss on the same side of the body Often due to lesions involving both: Thalamus (sensory) Internal capsule (motor) Causes & Pathophysiology Lacunar strokes result from disease of small penetrating arteries: 🔹 Main mechanisms Occlusion of a single small artery Lipohyalinosis Vessel wall thickening and degeneration from chronic hypertension Microatheroma Small atherosclerotic plaque within the penetrating artery 🔹 Resulting lesion Lacune: A small, fluid-filled cavity in brain tissue Size: 3–15 mm Common Brain Locations Involved Internal capsule Thalamus Pons Basal ganglia Corona radiata These are deep brain structures, which explains the symptom pattern. Diagnosis & Key Clinical Characteristics Diagnosis Clinical syndrome recognition is essential MRI (especially DWI) confirms diagnosis by showing a small deep infarct Key distinguishing features ✅ Deficits confined to motor and/or sensory pathways ❌ No cortical signs, such as: Aphasia Neglect Visual field loss Seizures This absence of cortical features helps differentiate lacunar syndromes from larger territorial strokes. Clinical Importance Lacunar strokes often have better short-term survival, but: Recurrent lacunes can lead to vascular dementia Associated with chronic small vessel disease Strongly linked to long-standing uncontrolled hypertension

What Is Moyamoya Disease? Moyamoya disease is a rare, progressive cerebrovascular disorder in which the main arteries supplying blood to the brain—particularly the internal carotid arteries—become narrowed or blocked. As blood flow decreases, the brain compensates by forming a network of small, fragile blood vessels at its base to maintain circulation. These abnormal collateral vessels are prone to bleeding and clotting, significantly increasing the risk of recurrent strokes and transient ischaemic attacks (TIAs). The term “moyamoya”, meaning “puff of smoke” in Japanese, refers to the characteristic appearance of these tangled vessels seen on cerebral angiography. Although moyamoya disease is more commonly diagnosed in children, it can also affect adults, often presenting with different symptoms and complications. Types of Moyamoya Disease Idiopathic Moyamoya Disease This is the primary form, with no identifiable underlying cause. Secondary Moyamoya Syndrome This form develops in association with other medical conditions, including: Neurofibromatosis Down syndrome Previous radiation therapy to the head Certain genetic or systemic disorders Symptoms of Moyamoya Disease Symptoms vary depending on the patient’s age and the severity of arterial narrowing. Common signs and symptoms include: Sudden weakness or paralysis, often affecting one side of the body Recurrent transient ischaemic attacks (TIAs) or strokes Severe or persistent headaches Seizures (more common in children) Cognitive impairment, including memory and learning difficulties Visual disturbances or sudden vision loss Speech problems, such as difficulty speaking or understanding language Involuntary movements, including chorea or dystonia When to Seek Emergency Medical Care Immediate medical attention is critical if stroke symptoms are suspected. Remember FAST: F – Face: Facial drooping when smiling A – Arms: Weakness when raising one or both arms S – Speech: Slurred speech or difficulty understanding T – Time: Call emergency services immediately Prompt treatment can be life-saving and reduce long-term disability. Causes of Moyamoya Disease The exact cause of moyamoya disease remains unknown, but several contributing factors have been identified: Genetic predisposition: The condition may run in families and is more common among individuals of East Asian descent Autoimmune conditions: Diseases such as lupus may be associated Environmental factors: Previous radiation therapy to the brain increases risk Complications and Related Conditions Progressive narrowing of cerebral blood vessels can lead to serious neurological complications, including: Recurrent TIAs Ischaemic stroke (cerebral infarction) Haemorrhagic stroke Developmental delays and learning difficulties in children Permanent weakness or paralysis Speech and language disorders Seizure disorders Emotional and behavioural changes, including anxiety, depression, and personality changes Can Moyamoya Disease Be Prevented? Currently, there is no known method to prevent moyamoya disease, as its underlying cause is not fully understood. However, proactive management can reduce complications: Regular neurological evaluations for early diagnosis Genetic counselling for families with a known history Maintaining vascular health through: Balanced nutrition Regular physical activity Avoidance of smoking Early detection and appropriate medical or surgical management are key to improving long-term outcomes.