What is Drooling?

Drooling is the involuntary leakage of saliva from the mouth due to difficulty controlling facial muscles, lips, tongue, or swallowing mechanisms.

Common Causes

• Bell's Palsy
• Stroke
• Parkinson's disease
• Neurological disorders
• Facial nerve injury 

Investigations

• Neurological examination
• Swallowing assessment
• MRI Brain
• Speech evaluation 

Treatment Options

• Facial exercises
• Speech therapy
• Medications
• Treatment of neurological condition 

Red Flags

• Difficulty swallowing
• Choking episodes
• Stroke symptoms
• Sudden onset 

FAQs

Can Bell's Palsy cause drooling?

Yes.

Is drooling a neurological symptom?

Often, yes.

Can therapy improve symptoms?

Yes.

When to Consult

Persistent drooling should be evaluated to identify underlying neurological or swallowing disorders.

What is Difficulty with Balance?

Difficulty with balance refers to an inability to maintain stability while standing, walking, turning, or performing routine activities. Patients may feel unsteady, dizzy, lightheaded, or as though they are about to fall. Balance depends on proper functioning of the brain, inner ear, spinal cord, nerves, muscles, and vision. Any disruption in these systems can lead to balance problems.

Balance issues can develop gradually or occur suddenly. In neurological conditions, they may indicate disorders affecting the cerebellum, brainstem, spinal cord, or peripheral nerves.

Common Causes

• Concussion and traumatic brain injury
• Stroke
• Inner ear disorders
• Parkinson's disease
• Multiple sclerosis
• Peripheral neuropathy
• Cervical spine disorders
• Brain tumors
• Vestibular disorders
• Medication side effects 

How is it Diagnosed?

A physician will evaluate:

• Walking pattern (gait)
• Coordination
• Muscle strength
• Sensation
• Vision
• Ear function
• Neurological status 

Investigations

• MRI Brain
• CT Brain
• Vestibular testing
• Hearing assessment
• Blood tests
• Nerve conduction studies
• Spine imaging 

Treatment Options

Treatment depends on the underlying cause and may include:

• Balance rehabilitation
• Vestibular therapy
• Medications
• Physiotherapy
• Treatment of neurological conditions
• Surgical intervention in selected cases 

When Should You Consult a Doctor?

Seek medical evaluation if balance problems:

• Persist for several days
• Cause falls
• Interfere with daily activities
• Occur suddenly 

Red Flags

• Sudden inability to walk
• Stroke symptoms
• Severe dizziness
• Limb weakness
• Double vision
• Loss of consciousness
• Recent head injury 

FAQs

Can poor balance indicate a stroke?

Yes. Sudden balance difficulty can be an early sign of stroke.

Are balance problems related to ear disorders?

Yes. The inner ear plays a major role in maintaining balance.

Can physiotherapy help?

Yes. Specialized balance therapy often improves stability.

When to Consult:

Persistent balance problems should be evaluated by a neurology specialist to identify the cause and reduce the risk of falls and injuries.

What is Loss of Consciousness?

Loss of consciousness occurs when a person becomes unresponsive and unaware of their surroundings. It can last seconds, minutes, or longer.

Common Causes

• Head injury
• Concussion
• Seizures
• Stroke
• Cardiac disorders
• Metabolic abnormalities 

Investigations

• CT Brain
• MRI Brain
• ECG
• Blood tests
• EEG 

Treatment

Emergency stabilization and treatment of the underlying cause.

Red Flags

All episodes require urgent medical assessment.

FAQs

Is brief unconsciousness serious?

It can be, especially after trauma.

Can concussion cause unconsciousness?

Yes.

Should I go to the hospital?

Yes.

When to Consult:

Loss of consciousness is a medical emergency and should never be ignored.

What is a Stroke?

A stroke (cerebrovascular accident) occurs when blood flow to a region of the brain is suddenly interrupted, either by arterial occlusion (ischemic stroke — approximately 85% of cases) or by rupture of a blood vessel (hemorrhagic stroke — approximately 15% of cases). Deprivation of oxygen and glucose leads to neuronal death; it is estimated that approximately 1.9 million neurons die per minute during an untreated ischemic stroke.

"Time is brain" — early reperfusion therapy with intravenous thrombolysis (tPA) within 4.5 hours and mechanical thrombectomy within 24 hours in selected patients significantly improves functional outcomes.

Powers WJ, et al. 2019 AHA/ASA Guidelines for the Early Management of Patients with Acute Ischemic Stroke. Stroke. 2019;50(12):e344–e418. doi:10.1161/STR.0000000000000211

The BE-FAST Acronym (Updated from FAST)

Recent evidence supports the expanded BE-FAST acronym to identify additional stroke symptoms often missed by FAST alone:

• B — Balance: sudden difficulty with balance or coordination
• E — Eyes: sudden vision change, double vision, or loss of vision
• F — Face: facial drooping (ask patient to smile)
• A — Arms: arm or leg weakness (ask patient to raise both arms)
• S — Speech: slurred, confused, or no speech
• T — Time: time to call emergency services immediately

Transient Ischemic Attack (TIA)

Stroke symptoms that resolve completely within 24 hours (and typically within 1 hour) may represent a Transient Ischemic Attack (TIA). TIA is NOT benign — it carries a high short-term risk of completed stroke (up to 10–15% within 90 days, with highest risk in the first 48 hours). All TIA patients require urgent evaluation and secondary prevention.

Johnston SC, et al. Transient ischemic attack: part 1. Diagnosis and evaluation. N Engl J Med. 2002;347(21):1714–1721. doi:10.1056/NEJMcp020190

Treatment

• IV alteplase (tPA): eligible patients within 4.5 hours of symptom onset
• Mechanical thrombectomy: eligible patients within 6–24 hours depending on imaging criteria
• Blood pressure management per guidelines
• Antiplatelet therapy (aspirin / dual antiplatelet in TIA)
• Anticoagulation (in cardioembolic stroke/AF)
• Stroke unit admission
• Rehabilitation: physiotherapy, speech therapy, occupational therapy