Ask a Neurosurgeon & Spine Surgeon: Dr Gerard Arvind Martin from Sunway Medical Centre Velocity Malaysia

Ask a Doctor ForumCategory: NeurologyAsk a Neurosurgeon & Spine Surgeon: Dr Gerard Arvind Martin from Sunway Medical Centre Velocity Malaysia
dr. Gerard Arvind Martin asked 3 years ago
I am Dr. Gerard Arvind Martin, Neurosurgeon & Spine Surgeon at Sunway Medical Centre Velocity, a comprehensive private hospital in Kuala Lumpur, Malaysia. My clinical focus covers:
  • Cerebral (Brain) and Spinal tumours
  • Cerebral Aneurysms, arteriovenous malformations (AVM), Intracerebral haemorrhages (haemorrhagic strokes) and other cerebrovascular pathologies
  • Degenerative spine disease
  • Headaches and Facial pains
  • Neurological infections, brain abscesses, etc
  • Neurotrauma
My procedural focus includes:
  • Brain tumor resections
  • Aneurysm clipping, AVM resections, Intracerebral haemorrhage evacuations
  • Degenerative spine disease management
  • Neuroendoscopy
  • Spinal related pain relief employing radiofrequency ablative techniques
My educational qualifications include:
  • Member of the Royal College of Surgeons in Ireland ( 2009)
  • Masters of Surgery ( Neurosurgery) (USM) (2013)
I currently hold memberships in the Neurosurgical Association of Malaysia (NAM), European Association of Neurosurgical Societies (EANS) and the American Association of Neurological Surgeons. Learn more about Sunway Medical Centre Velocity here: Learn more about me here: I am excited to be here to share/discuss conditions and disorders that affect the nervous system with everyone. Whether you've got questions about brain tumours, spine diseases, strokes, ask me anything! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
17 Answers
Nengsih Sri Sitinjak answered 3 years ago
Doctor, what should I do to treat cysts in the brain stem?
dr. Gerard Arvind Martin replied 3 years ago

First of all cysts in the brainstem area may be due to causes that may be harmless or harmful to the patient and the first thing to identify is where in this area does the cyst lie, i.e. is it within the brainstem or outside the brainstem and what symptoms did the patient experience that made them see a doctor in the first place.

For this a detailed history and examination with a neurosurgeon or neurologist is important, followed by a good brainscan, typically an MRI. Cysts around a brainstem are harmless (e.g. arachnoid cyst) but may irritate the nerves around the brainstem causing symptoms. Often they can be left alone or operated to release pressure and therefore lessen the irritation to the nerves. If a cyst is found within the brainstem, an MRI will tell us what that cyst is caused by i.e. tumor being most common. Whether it is benign ( not harmful) or malignant depends on the tissue result obtained from surgery. The majority of tumors affecting the brainstem are benign ( more likely to be harmless) but because it is the brainstem that is involved, it makes surgery very risky, often outweighing the benefit.

Therefore the answer to the question "what should I do to treat cysts in the brainstem" the answer depends on the findings of the brain MRI. Brainstem function is extremely important
for human beings and surgery can be very risky in this part of the brain.

Imus answered 3 years ago
Doctor, my body is shaking as fast as my heart rhythm, there's a throbbing sensation in my stomach, my upper back hurts. Sometimes if I stand for too long, I feel as if I am going to fall, and my right chest feels full of gas. My electrocardiogram and echocardiogram results are normal. Is this a neurological disease, Doc?
dr. Gerard Arvind Martin replied 3 years ago

I am assuming you are at least of middle age as you have stated that you had a cardiac assessment carried out for these symptoms you mentioned. However in view of these "shakes" and problems on standing it is best for you to be seen by a neurologist and an endocrinologist. A neurologist is a doctor who specialises in nerve disorders. An endocrinologist is a doctor who specialises in hormone problems.

Yuliana Kadobo answered 3 years ago
Good afternoon, Doctor. I have felt giddiness from the back of my head since 1984. I have never undergone surgery because I am afraid. Is there any non-surgical treatment for this, Doc?
dr. Gerard Arvind Martin replied 3 years ago

Longstanding giddiness (since 1984) may be due to a number of causes, and oral (tablets, taken by mouth) medications can be helpful once the cause has been determined properly.
Along with brain MRI scans, this may require an ENT / ophthalmological assessment also if the neurological assessment turns out to be normal.

Fanly answered 3 years ago
Why am I having sleeping problems everyday? I cannot sleep soundly. Thank you
dr. Gerard Arvind Martin replied 3 years ago

How old are you and what sort of work do you do? Apart from age ( the older a person gets, the less sleep they tend to require and this is normal) and actual long standing pain conditions already existing different parts of the body that can disrupt sleep themselves, sleep issues are not uncommon and the cause can be attributed to breathing problems that occur during sleep, resulting in poor sleep patterns that make the person feel lethargic and restless and unable to concentrate the next day. A respiratory physician ( a doctor who specialises in lung and breathing disorders) will be able to diagnose these conditions using sleep studies. Very rarely, a stroke in the brainstem also cause breathing related issues which can disrupt sleep patterns. Finally psychological stress can additionally burden a person and this may manifest with poor sleep quality at night.

Neli Hasani answered 3 years ago
Doctor, I often have vertigo, sometimes I cannot stand up when it hits. How do I treat it?
dr. Gerard Arvind Martin replied 3 years ago

For humans, a specialised region in the inner ear is responsible for providing balance and it communicates with the cerebellum through the brainstem to achieve this. When you have vertigo spells, a problem may be occuring in these regions and this is common in older age group patients. Vertigo itself can be benign however it can be disruptive in everyday life and can be treated using oral medications. However you should see an ENT specialist ( a doctor who sees patients with ear/hearing/nose/throat problems) before starting them. Sometimes however, patients report imbalance when they close their eyes or additionally they develop shaking symptoms in their arms and seem to lack coordination. It is important to differentiate between these symptoms as the problem may instead involve the spinal cord or cerebellum rather than
just the inner ear only.

Arya Wibawa answered 3 years ago
If I feel stressed, the right side of my head hurts so much that it makes it hard for me to walk and my sight becomes blurred. Is this due to nerve problems? What should I do?
dr. Gerard Arvind Martin replied 3 years ago

If a headache causes you much pain, affecting your walk and blurring your vision, you should get it checked immediately as it may be related to a brain problem. A visit to a neurosurgeon or neurologist is required.

neli answered 3 years ago
I am a 45 year old female. I have been feeling discomfort in my head for 1 year. It feels stuffy, like something is pressing, and I am afraid to lose my balance and black out. 6 months earlier, I checked with a neurologist and cardiologist - I did a blood test. The lab test’s results were good, including cardiology, neurology, but I didn’t do MRI, and was only given vitamin B2, magnesium and amitriptiline. I took vitamins for 1 year and then stopped and I stopped consulting with a doctor due to COVID-19. Not long after that, I had vertigo, in the early morning, and took flunarizin, betaserc.  If I consume ginkgo and multivitamins, sometimes I feel better, though not entirely recovered. I had a check for my eyes, and my eyes pressure is high, 26mmhg. These three days I took paracetamol 500mg and felt a bit light, but again not entirely recovered. I have also pressure in the head, forehead, and the back of my head. What disease is this? Is it stress? Thank you
dr. Gerard Arvind Martin replied 3 years ago

Please get yourself checked once again by a neurosurgeon and an opthalmologist, and this time please also do a brain scan. High eye pressure is not good and may be revealing or lead to something else more distressing if not checked properly. A brain problem cannot be ruled out based on your history and you should be examined thoroughly along with an MRI brain scan if required.

Nurhilman answered 3 years ago
Doctor, I have a problem with my facial nerves that makes the tip of the right corner of my lips twitch. It has been like this for years. Some said this is due to nerve problems. Can it be cured?
dr. Gerard Arvind Martin replied 3 years ago

Problems with facial nerves, called hemifacial spasm, need to be assessed using an MRI brain scan to see if there is anything irritating the nerve in the brain. Once an MRI is done and there is no condition within the brain that is causing the twitches, injections can be used to control the twitches, but complete cure is less likely. If something is found in the brain that is causing the twitches, surgery can help to address the problem.

Mariati answered 3 years ago
Doctor, my daughter is 17 years old. She has had epilepsy since she was a kid. Please give me your advice on how to treat this condition permanently so it won’t recur in the future. Thank you
dr. Gerard Arvind Martin replied 3 years ago

Your daughter may need an MRI brain to discover what is causing her seizures. Once a problem has been found in her brain, we use medications first to fully control her seizures and when that is no longer helpful, surgery to address the brain problem may be considered. Her medications will still be continued after the surgery. Permanent cure without anymore future medications can be difficult but not impossible.

Enny answered 3 years ago
Doctor, my husband is 70 years old . He is healthy but his body shakes in certain positions and conditions, eg: writing, signing, holding something, even when he sleeps his hands and feet are moving spontaneously as if in shock every 20 seconds. I consulted a neurologist and he's already had an ECG examination. This past year, his condition is getting worse. The doctor has given him Parkinson's medication because the symptoms are leading in that direction. Currently his medication involves:
  • MADOPAR 2X1 morning and evening
  • SIFROL 0,375mg 1x1 morning
The check up result was fine, T3 T4 are all fine. The question is: is it true that he has Parkinson's? Can it be cured with the above mentioned medications? Are there any side effects of those medications? Please give me your advice Doctor. I can only ask you online because I am afraid to go to the hospital in this pandemic. 
dr. Gerard Arvind Martin replied 3 years ago

From what you have mentioned about your husband, yes it is quite likely that he has Parkinsons disease and the medications given are to help his symptoms and restless legs syndrome. It is advised that he continues his medicaions and follow-up with his neurologist. As I am a neurosurgeon I would not be of much help to a patient who has Parkinsons disease.

lisa answered 3 years ago
Hello doctor. I always get migraines. Is that dangerous? Thank you
dr. Gerard Arvind Martin replied 3 years ago

Although migraines can be very debilitating to a person, they are themselves not dangerous. However they are said to carry a higher risk of stroke and so it would be best to have them treated and controlled. Before a person is diagnosed with migraine however, an MRI brain would be recommended to make sure there is nothing else sinister in the brain that is causing these headaches, conditions such as brain tumors and vessel problems cannot be treated by medicines alone and may need surgery.

Juniar S answered 3 years ago
Doctor, my left cheek nerve often twitches followed by the pulling on my mouth. It has been a year. My right hand often shakes a lot. I wonder what the doctor's solution is. 
dr. Gerard Arvind Martin replied 3 years ago

It is worthwhile for you to visit a neurologist or neurosurgeon who will examine you thoroughly and have a brain MRI scan done for you to determine the cause of your problems and advise you accordingly

Lany Rosilawati answered 3 years ago
I have a friend who's diagnosed with epilepsy - when he sleeps or wakes up, he often gets seizures. He is 40 years old. Ever since he was 30, he began to be indicated. He has went for an MRI with good results. The only issue is with his feces. He takes medication daily: Depakot, 500mg 2 times a day, globazam 2 times a day, penitoin 100mg 3 times a day, but there is still no change. Are there any other better medicines? 
dr. Gerard Arvind Martin replied 3 years ago

Since the results of his MRI is good, the combination of his medication to help his epilepsy is rightly determined by his treating neurologist. If his epilepsy is not being controlled satisfactorily, perhaps you could visit another neurologist to seek his opinion

Zhoenie Yach answered 3 years ago
Doctor, five years ago I had surgery for my grade 1 meningioma typed brain tumor. But why do I still have strain now?
dr. Gerard Arvind Martin replied 3 years ago

1 meningioma has very low recurrence rate, which means it does not return back easily, if it is completely removed in the first surgery itself. Sometimes removing it completely may not be possible if the tumour is stuck to important structures like nerves or blood vessels which is risky to the patient if harmed. In these cases, some tumor may be left behind and watched over time. Regular MRI scans may be required to follow these tumours and operated again to safely remove more tumor if required. Can you describe more what you mean by strain?

Sakarias Rias answered 3 years ago
Doctor, how would you treat the pain on the right side of the head that radiates to the back?
dr. Gerard Arvind Martin replied 3 years ago

Pain on the right side of head radiating to the back can be due to many things and it is most important to determine where the pain is coming from. An MRI scan will tell you if the pain is coming from within the head, skull, the area surrounding the eye and ear or even the neck spine. Pain arising from different structures may need different approaches in terms of treatment.

Derni Rajagukguk answered 3 years ago
Doctor, my right side of the head aches if I sleep on my right side. Why is this so? How do I treat this?
dr. Gerard Arvind Martin replied 3 years ago

Do you have any other symptoms such as seizures, blurring of vision or weakness or numbness in your limbs along with this headache you describe? If so you will need to see a neurologist or neurosurgeon for a complete evaluation and brain scan. Problems arising from the sinuses, such as sinusitis can also cause one sided headache that can be brought about by changes in head position, and if this is present, you may need to see an ENT specialist to help you with this.

Rehan Oktaviguna answered 3 years ago
Doctor, the left side of my head and the left side of my body hurts. The pain radiates to the bone, like something is stabbing me. What should I do?
dr. Gerard Arvind Martin replied 2 years ago

How old are you and how long have you had this experience? Were you involved in any accident before and did you injure your head or neck? Complex regional pain syndromes may involve one side of the head and body. In the absence of any history of injury, problems in the thalamus ( a structure deep in the brain) may also give these sort of problems, involving the same half of the head and body. Please see a neurologist or neurosurgeon as it may require a thorough examination and an MRI brain scan to evaluate your condition.

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