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Brain Conditions

Astrocytomas

Astrocytomas are central nervous system tumors that originate in nervous system support cells, or glial cells, called astrocytes. Astrocytomas develop in the brain or spinal cord. They may appear at any age. Astrocytomas are classified according to type and stage, and treatment and prognosis are dependent on these factors. Many of the symptoms of astrocytomas are related to the increased pressure within the brain as the tumor grows. Symptoms relate to the normal function of the part of the nervous system involved, and may include seizures, personality changes, blurry vision, double vision, mental changes, drowsiness, vomiting, headaches, weakness, numbness, or poor coordination. Diagnosis is made by CT scan, MRI, and/or biopsy. Low-grade astrocytomas are sometimes monitored without treatment. Typical treatments include radiation, surgery, chemotherapy, and corticosteroids. Surgery may be utilized to perform a biopsy, or to remove all or part of the tumor when it is safe to do so.

Brain injury

Traumatic brain injuries are classified as mild, moderate, or severe depending upon impact on level of consciousness at the time they occur. These result from the brain violently coming into contact with the skull or the skull being penetrated. Following the initial event, additional factors such as other associated injuries can cause oxygen delivery to the brain to be compromised, such as when blood pressure falls, causing the brain to be further deprived of needed nutrients. Symptoms of a mild injury, often called a concussion, include brief or no loss of consciousness, confusion, sleep problems, sensitivity to light, headache, vomiting, poor balance, fatigue, and blurry vision. Symptoms of moderate to severe brain injury include a more significant impact on level of consciousness, or dilated pupils, restlessness, slurred speech, and severe confusion. Symptoms related to a brain injury may show up immediately or not be recognizable for days or weeks. Seizures may occur. Diagnosis is typically made based on a history of events, neurological examination, and CT scan.

Brain injury may be the result of a fall, assault, accident, or even combat trauma. Surgery is often necessary to reduce pressure upon healthy brain tissue, which can become compressed within the confined space inside the skull by either blood clots or swelling damaged brain tissue. A brain injury may result in permanent physical, mental, and psychological challenges. Rehabilitation can aid in recovery from lingering effects of brain injury, and ideally involves a team approach led by a physician in physical medicine and rehabilitation, and also includes physical therapy, speech therapy, and occupational therapy.

Cerebral Vascular Malformations

Cerebral vascular malformations, certain abnormalities of the blood vessels in one or more parts of the brain, can lead to hemorrhage or abnormalities in normal brain functions. They are present at birth but may not cause problems until adolescence or adulthood. There are several types, but most have abnormal vessel walls which can tear and bleed more easily than normal blood vessels. The sufferer may have no symptoms or they may experience headaches, seizures, numbness, weakness, stiff neck, unconsciousness, vomiting, or vision problems. Cerebral vascular malformations are typically diagnosed by MRI, CT scan, or cerebral angiography. Surgery may be indicated to remove the malformation. Often, a radiation technique known as stereotactic radiosurgery can be used to obliterate the malformation slowly over time. In conjunction with this, patients will sometimes also undergo embolization of the malformation, which is a way to fill the malformation with coils or glue so that blood no longer flows through it.

Hydrocephalus

Hydrocephalus is a condition in which excess cerebrospinal fluid collects in the brain putting pressure on brain tissue, potentially damaging the brain. There are several terms commonly used when describing this condition:

  • Congenital Hydrocephalus – This type is present at birth and may be the result of genes or a problem during development such as spina bifida.
  • Acquired Hydrocephalus – This type may develop during the childbirth process or at any time in life.
  • Hydrocephalus Ex-Vacuo – This type is the result of brain shrinkage with aging, called atrophy, or may be from an old injury or a stroke.
  • Normal Pressure Hydrocephalus (NPH) – NPH is more common among older people, and may have symptoms of a decline in balance, worsened urinary control, or a decline in cognitive functions including memory disorders.

Symptoms of hydrocephalus vary widely, and may include vomiting, headache, muscle spasms, sleepiness, uncontrolled eye movements, seizures, slowed movements, memory loss, and difficulty walking. A baby may have a shrill cry and a bulging “soft spot” on top of the head. Diagnosis is made by medical history, neurological examination, and CT scan or other tests. Surgery may be required to remove a blockage, to establish proper fluid flow within the brain, or to place a shunt that drains the fluid into the abdomen or other area.

Glioblastoma Multiforme

Glioblastoma Multiforme is a grade IV astrocytoma. Put simply, it is a high-grade malignant brain tumor that grows rapidly and invades nearby brain tissue. It can occur at any age, but it most common between the ages of 45 and 70. It is somewhat more common in men. Symptoms may include headache, weakness, vomiting, seizures, difficulty understanding, and problems with concentration. Glioblastoma multiforme is usually diagnosed by CT scan or MRI.

Although surgery doesn’t cure the disease, it can lengthen the time of survival, increase the quality of life, and reduce intracranial pressure (pressure inside the skull that affects brain function). Unfortunately, it is usually impossible to completely remove the tumor and new tumors typically arise in the tumor bed regardless of the amount of tumor removed. New tumors may arise in other locations as well. Surgery is often followed by a course of radiation and chemotherapy. Steroids may be used to reduce swelling around the tumor during recovery and treatment.

Meningiomas

Meningiomas are tumors that arise from the membranes that surround and protect the brain and spinal cord. Most meningiomas are located outside the brain, but they are also found outside the spinal cord. Most are benign, or NOT a cancer, even though more than one tumor may be present. Meningiomas can occur at any age and in both genders, but are most common in older women. Many meningiomas cause no symptoms. When they do, people may complain of worsening headaches, memory problems, seizures, weak limbs, double vision, or blurry vision. This type of tumor is usually diagnosed by CT scan or MRI. Some patients need no treatment other than observation but others require surgery or specialized radiation treatments to remove or arrest growth in the meningioma.

Neurofibromatosis

Neurofibromatosis is a condition in which one or more tumors develop along a nerve. Sufferers are born with the condition or develop it due to a gene mutation. It is usually benign but can be serious depending on the size and location of the tumors. There are several types of neurofibromatosis:

  • Neurofibromatosis Type 1 – Also called von Recklinghausen disease, this condition typically affects the nerves of the peripheral nervous system (the nerves that travel throughout the body). It is the most common type of neurofibromatosis and usually appears early in life. In some cases, the tumors grow quite large, affecting more than one nerve. These tumors often develop on the skin, and less commonly on the eye, brain, or spinal cord.
  • Neurofibromatosis Type 2 – Tumors develop on the nerve for hearing in this condition, and usually do so on both sides. The primary symptom is hearing loss that can eventually lead to deafness.

Treatment for neurofibromatosis depends on tumor characteristics and includes medication, radiation, and surgery. Surgical procedures include tumor removal and treatment for severe scoliosis that results from tumors on the spinal cord.

Occipital Neuralgia

Occipital neuralgia is a condition in which the sufferer develops throbbing or piercing headaches. The headache may feel as though it begins in the neck and spreads to the head. More commonly, it is felt on one side of the head, although it may be felt on both sides. This condition is more common in women and is often thought to be due to the occipital nerve that runs from the spinal cord to the head becoming trapped in muscle. In addition to painful headaches, symptoms include sensitivity to light and a tender scalp. Causes include spinal cord compression, arthritis in the neck, tumors, diabetes, and injury, such as whiplash. Treatments include anti-inflammatory medication, muscle relaxants, pain medication, nerve blocks, steroid injections, and physical therapy. Severe cases may require surgery.

Stroke

A stroke occurs when the blood supply to the brain is interrupted, depriving a part of the brain of needed oxygen and glucose. There are two major types of stroke: ischemic and hemorrhagic. Ischemic strokes are much more common and result from an artery being blocked by a blood clot. The clot may develop in the artery leading to the brain or it may have broken off from elsewhere in the body and traveled toward the brain. Hemorrhagic strokes result from a blood vessel bursting, allowing blood to leak into the brain instead of following its normal path. Nearby brain cells are damaged by the blood that leaks from the burst vessel. Symptoms of stroke include headache, vision problems, sudden inability to speak or understand, difficulty walking, unconsciousness, and numbness, tingling, or weakness on one side of the body. Diagnosis is usually made from a physical examination, neurological examination, CT scan, and/or MRI. Immediate treatment should be sought as medication, interventional procedure, or surgery may help restore functioning. Later treatments include “blood thinning” medication and surgery to remove blood from the brain, repair blood vessels, or repair a carotid artery. Many patients require physical therapy, speech therapy, and/or occupational therapy as part of the rehabilitative process.

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