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Collection of pus inside a closed capsule is known as an abscess. Brain abscess occurs in the brain.

Introduction

 

Collection of pus inside a closed capsule is known as abscess. It can be found in any part of the body. It usually results from an infection present in the same organ. But on occasions, the infection can spread from another part of the body.

Compared to abscess in other parts of the body, abscess in the brain is considered very serious. Despite the improved treatments available today, 5% to 10% patients affected by a brain abscess may die.

Unfortunately, this disease is very common in India.

Causes of Brain Abscess

Infection from surrounding areas may spread via blood, lymph (a fluid that cleanses the body from infection), or by direct extension and settle down in the brain, to form an abscess. They include:

  • Ear Infection

    Untreated ear infection can gradually seep into the brain, forming a brain abscess. In India, this is the cause of more than 50% of the brain abscess.

  • Sinusitis

    Sinuses are empty air spaces in the skull that make the skull feel light. Sinuses also secrete mucous, which helps in keeping the nose moisturized. Any infection in th enose or sinus can enter the brain and result in abscess formation.

  • Tooth Infection

    Infection in the teeth can quickly spread to the brain. Hence, teeth infections must be attended to immediately.

  • Meningitis

    This is a common bacterial infection of the brain, usually seen in children. Very rarely, this can also be a source of brain abscess.

Here are few other assorted causes of a brain abscess:

  • Open Head Injuries

    When an open head injury happens, pieces of bone, hair and dirt particles can get inside the head. If these particles are not properly washed away through a surgery, they act as a focus of injection. In the course of many years, they form a brain abscess.

  • Metastatic Abscess

    Microorganisms from other parts fo the body (chest, skin, bone, abdomen, etc.) can travel through the blood, get lodged in the brain and form an abscess. This is more common in people with an odd heart condition wherein their blood bypasses the filteration by lungs.

  • Cryptogenic Abscess

    Crypto = Uknown. Genic = Of origin. In some cases, the source of a brain abscess may not be identifyable. These cases are called Cryptogenic Abscess.

  • Post-Operative Abscess

    Improper healing of surgical wounds after a brain surgery can result in a brain abscess formation.

Complication due to Brain Abscess

Epilepsy is a common complication of brain abscess. So, all patients with a brain abscess are given anti-seizure drugs for at least 1 to 2 years after the treatment for the abscess has ended.

Symptoms of a Brain Abscess

Symptoms of a brain access depend on the size, location and number of abscesses, on the virulence of the micro organism forming the abscess and the immune power of the affected individual.

Here is the long list of common symptoms seen in individuals with Brain Abscess. The exact symptom seen in an individual depends on the part of the brain affected by the abscess:

  • Headache
  • Seizures
  • Inability to move one or more parts of the body
  • Improper co ordination or gait
  • Speech problems
  • Visual problems
  • Nausea
  • Vomiting
  • Mild confusion to coma, depending on severity of infection
  • Bulged out eyes, which is often a late sign. It indicates increased pressure inside the brain.

In infants, the usual presenting signs are as follows:

  • Enlarging head
  • Bulging fontanelle
  • Separation of sutures
  • Vomiting
  • Seizures
  • Irritability
  • Poor feeding

Diagnosis of a Brain Abscess

The only useful blood test to ascertain the presence of a Brain Abscess is an elevated CRP (C-Reactive Protein). But elevated CRP only says that there is an infection somewhere in the body. Additional imaging studies are required to pin point the infection to a brain abscess.

Here are usual imaging studies carried out to study a brain abscess:

  • Skull X-Ray

    Infection of the sinuses and ear infection, which often result in a brain abscess, can be easily seen in a skull X-Ray. Also, presence of air inside the skull, if seen, indicates brain abscess that has resulted in prior traumatic event.

  • Skull CT Scan

    A CT scan can provide information like the stage of the abscess, number of abscesses, incresed intracranial pressure, surrounding infection, etc.

  • MRI of the Brain

    MRI is more sensitive than a CT scan in identifying an abscess in its earliest stage.

  • Magnetic Resonance Spectroscopy (MRS)

    MRS is a newly emerging diagnostic tool. It can tell between a brain abscess and other type of brain tissue damages.

Treatment for the Brain Abscess

Depending on age, neurological condition, location, number, size and severity of the abscess, the doctor decides whether to go for a medical or surgical treatment option.

Medical Treatment

Small abscesses in its early stages can be treated with antibiotics. After a treatment round, a follow up CT scan is usually advised to check for recurrence.

Surgical Treatment

When the brain abscess is estimated to be in an advanced stage or if it is through of life threatening, a surgery is performed to remove the abscess. Depending on the nature of the abscess, many surgical procedures have been described for the treatment of abscess.

Go here for more information on surgical treatment for the Brain Abscess

Treatment Window

Early diagnosis, appropriate treatment and proper control of the primary and secondary infection, helps achieve a good outcome and complete cure.

Till properly treated, bacteria causing the brain abscess literally eat into the brain.

Based on their location in the spine, an injury to the spine has different effects. In order to minimize the damages, spinal injuries must be attended to quickly.

Introduction

 

A set of 33 stacked-up bones make up the human vertebra or the human backbone. These 33 bones can be divided into 4 sets:

  • Cervical Vertebrae

    These are 5 vertebrae, named C1 to C5. Among these, C1 and C2 are the most critical as they support the skull and help in head movemenet. Unfortunately, this region is prone to injury and fracture.

  • Thoracic Vertebrae

    There are 12 thoraciv vertebrae, named from T1 to T12. The thoracic vertebrae join with the ribs and help protet the heart, lungs and other vital structures.

  • Lumbar Vertebrae

    These are a set of 5 veertebrae, named from L1 to L5. These bones help sustain the body’s weight and help with movement. This region is also prone to fracture and degeneration with age.

  • Sacral Vertebrae

    These are located at the level of the hip. They are a set of 5 bones, fused together as one. The sacral vertebra helps connect the spine to the hipbones.

Spinal Cord injuries can strike any region of the spine. Patient’s symptoms vary based on the location of the spinal cord injury. The symptoms can range from minor loss of sensation to total paralysis.

Depending on the location and mode of injury, following are types of spinal injuries commonly seen:

  • Craniovertebral Junction Injury

    Starting from the base of the skull, ending at C2 vertebrae, is called the Craniovertebral Junction.

  • Upper Cervical Spine Injury

    C1 and C2 vertebrae come under the Upper Cervical Vertebrae group.

  • Sub-Cervical Spine Injury

    Injury to the middle and lower cervical spine, that is C3 to C7 vertebral level, is known as sub-cervical spine injury.

  • Thoracic and Thoracolumbar Injuries

    Injuries to the thoracic vertebrae or T12-L1 junction vertebrae fall under this category.

  • Lumbar and Lumbosacral Injuries

    Injury to the Lumbar vertebrae is called a Lumbar Injury. Injur to the L5-S1 junction vertebrae is known as Lumbosacral Injury.

  • Penetrating Injuries

    These are very common in areas of violent crimes. These injuries are sustained after a gunshot or a stab wound in the spinal cord.

Causes of Acute Spinal Injuries

Many things can lead to a spinal trauma. Some of the most common causes are:

  • Road Traffic Accidents: Worldwide, they remain the leading cause of spine trauma.
  • Rural Accidents: In an agricultural economy like India, falling from trees, falling into uncovered wells, coconuts falling on the head of a passerby are the common causes of spinal injuries.
  • Sports Injuries
  • Gunshot Injuries

Complication due to Spinal Injuries

If Spinal Injuries are not identify early and treated, they can lead to Neurogenic Shock and Aspiration.

Neurogenic Shock

In more than half the people who undergo a spinal injury above the level of 6th thoracic vertebra, severe nervous system damage can result in dilation of the blood vessels. This can lead to severe drop in blood pressure, slowing of heart rate and breathing. If it is detected early and treated adequately, a patient may come out of this condition in one to three weeks.

However, if it is not attended to adequately, neurogenic shock can lead to organ failure and even death.

Aspiration

In severe injuries involving the cervical spine, movement and sensation of the patient below the neck region is affected. This includes the function of swallowing. If this complication is not recognized early on, food enters the airway, which leads to chocking and difficulty with breathing.

Spinal Shock

This condition arises out of nerves partly or fully losing their ability to communicate below the level of the spinal injury. Timely treatment of Spinal Injury can, at the very least, arrest the condition from getting any worse.

Symptoms of an Acute Spinal Injury

Symptoms of a spine injury are closely related to the location of such injury. However, few common symptoms of spine injury include:

  • Neck pain
  • Back pain
  • Weakness in one or more parts of the body
  • Paralysis of arms and/or legs or gait changes
  • Loss of reflexes
  • Uncontrolled urination
  • Uncontrolled passage of stools
  • Breathing difficulty
  • Swallowing difficulty

Diagnosis of Acute Spinal Injuies

These are the standard tools used to diagnose an acute spine injury

  • X-Ray of the Spine

    Plain X-Ray is the initial investigation tool of choice to identify a spine injury.

  • CT Imaging

    A CT produces better images than an X-Ray. From a CT image, additional information like bone, blood, bruises, cervica-thoracin juntion, etc., can be better visualized. As a matter of fact, X-Ray can even fail to pickup certain types of spine fractures.

  • CT Angiogram

    This tool is useful to study blood vessel injuries in the spine.

  • MRI Imaging

    MRI is currently the investigation of choice for spinal trauma. Disc injuries, nerve compression, fluid accumulation in the spine, bleeds, bruises and injury to other important structures in the spinal cord can be clearly spotted using an MRI.

Treatment of the

Injury of the spinal cord involves mechanical forces like compression, penetration, cuts and dislocation. So, medical management is not the main stay in management of spinal trauma.

Medical Treatment

If the patient is seen within 8 hours of injury, the patient can be put on steroid medications. This can help in recovery and in reducing the fluid accumulation that follows a spine injury. In case an infection is seen or suspected, the patient is also put on antibiotics and pain medication.

Traction

Controlled pulling of a dislocated bone back to its original position, with the help of special pins, is known as traction. Closed fractures of cervical spine can be easily corrected with the help of traction.

Surgical Treatment

Spinal Cord Decompression and Fixation

Fractures and spinal injuries that compress on nerves require early surgery. In the surgery, fractures are fixed with screws and compressed nerves are released.

 

Treatment Window

With early identification of spinal injuries, irreversible complications of spinal injury can be prevented. Early surgical intervention also helps in speedy recovery and prevents deformities.

Weak blood vessels in the brain tend to balloon at the points of their weakness. This is called an aneurysm.

Introduction

Sometimes, weak blood vessels in the brain can bulge out like a balloon, causing a condition called aneurysm. When an aneurysm ruptures, it spills the blood it carries in to the brain, causing a life threatening condition.

About 1 in 50 people are thought to have an unruptured aneurysm. When an aneurysm ruptures, it can kill 40% of the people in whom the rupture occurs.

Causes of Aneurysm

Here are some common causes that lead to aneurysm:

  • High Blood Pressure

    The presence of high blood pressure weakens the blood vessel walls and make it vulnerable to bulging under any kind of stress or uncontrollable increase in blood pressure.

  • Smoking

    Smokers, particularly the ones who have been smoking for years, end up with their blood vessels weakening, making them susceptible for formation of aneurysm.

  • Blood Vessel Abnormalities

    When malformed blood vessels face any kind of internal stress, they can lead to formation of aneurysms.

  • Hereditary

    In some cases, aneurysm runs in the family. These patients are usually affected by aneurysm at a much younger age.

  • Congenital Disorders

    Some disorders that are present since birth are known to be associated with multiple brain aneurysms.

  • Gender

    When women hit menopause, the level of estrogen in their blood drops. This drop in estrogen makes them vulnerable for aneurysm.

Complication due to Aneurysm

The single most critical complication of aneurysm is rupture. Rupture of an aneurysm is dangerous to life. It can lead to irreversible brain damage and death.

Symptoms of Aneurysm

Small aneurysms rarely produce any symptoms. However, a large aneurysm may press upon important structures in the brain, causing symptoms like

  • Headache
  • Vision problems
  • Nausea
  • Weakness
  • Speech disturbance

If the aneurysm bursts, the patient may immediately fall unconscious and/or present with the following:

  • Sudden and severe headache
  • Sudden loss of vision
  • Sudden paralysis
  • Vomiting
  • Nausea
  • Stiffness of the neck
  • Seizures

Diagnosis of Aneurysm

These are the common tools used for diagnosing the presence of aneurysm

  • Angiography

    This is the best imaging modality for visualizing abnormally dialated blood vessels.

  • CT Imaging

    A CT Image plays an important role in localizing the site of rupture of an aneurysm.

  • MRI Imaging

    An MIR also helps to locate the exact site of aneurysm and to identify any bleed in the brain that occurs due to a ruptured aneurysm. Fluid accumulation in the brain can also be appreciated with the help of an MRI.

Treatment of the Aneurysm

Following are the treatment options available for aneurysm

Medical Treatment

There are no medical management options available for aneurysm. The best that can be done is to put the patient on pain relievers till they are surgically managed.

Surgical Treatment

There are two treatment choices available for aneurysm: Clipping and Coiling

Aneurysm Clipping

In this procedure, the skull is opened and the bulging blood vessel is identified. After identifying the vessel, the surgeon clips it just below the aneurysm, thereby preventing the aneurysm from rupturing.

Coiling of an Aneurysm

This is a minimally invasive procedure in which a catheter (tube) is into an artery at the groin. The tube is gently pushed forward till such time it reaches the blood vessel with the ballooning. At the site of the ballooning, a coil is inserted and the catheter is removed. Blood clot forms around the coil, which in turn heals the aneurysm.

Treatment Window

If an aneurysm is identified and the patient is symptomatic, immediate intervention is warranted so as to fix it before the aneurysm ruptures.

 

 

Tumor of the Glial Cells in Brain and Spinal Cord:

In our brain and spinal cord, there are housekeeping cells called the glial cells. There are 3 types of glial cells. One of them is called astrocytes. Cancer of the astrocytes is called astrocytoma.

Introduction

Astrocytes are star-like cells in the brain and spinal cords. It is one of the three type of glial cells. While neurons do all the thinking/feeling work, glial cells are the housekeepers.

Cancer of the astrocytes is called astrocytoma.

Astrocytomas come in different flavors. Based on how aggressive they are, World Health Organization (WHO) has classified astrocytomas into the following four grades (1 being the least aggressive and 4 being the most).

 

  • Grade 1

These are slow growing tumors and they do not penetrate into surrounding cells. So, it is safe to surgically remove cancerous cells and start chemotherapy. Since there remaining cells grow very slowly, they usually do not pose a life threat. Cancers like Pilocytic astrocytoma, Pleomorphic Xanthoastrocytoma, Subependymal Giant Cell Astrocytoma and Subependymoma fall into this category.

 

  • Grade 2

These are slow growing cancers. Unlike Grade-1 cancers, Grade-2 penetrate into surrounding cells. So, surgery ends up leaving some tumor cells. Even through surgery is always followed by chemo and radio therapies, chances of these cancers recurring is very high. Cacers like Low-grade (fibrillary) Astrocytoma and Mixed Oligoastrocytoma fall into this category.

 

  • Grade 3

Grade-3 astrocytomas grow faster than Grades 1 and 2. Grade-3 also diffuse into surrounding cells. So, surgery must always be following up by radiotherapy. The only type of cancer that falls in to this category, namely Anaplastic Astracytoma, doesn’t respond much to chemotherapy.

 

  • Grade 4

These cancers grow rapidly and they infiltrate the surrounding tissue. Surgery is the main tool against this cancer. However, since it infiltrates into surrounding cells, surgery cannot remove this cancer in entirity. Radiotherapy is taken up after the surgery. Unfortunately, about 75% of astrocytomas fall in this category.

Complication due to Astrocytoma

Based on the WHO grading given above, some astrocytomas can be easily defeated if they are diagnosed and treated early. Whereas, fighting against a Grade-3 or Grade-4 astrocytomas is usually a futile.

Symptoms of an Astrocytoma

Symptoms of an astrocytoma varies depending on the location of the tumor. Here are some of the symptoms that are seen often:

  • Clumsiness
  • Headache
  • Nausea
  • Vomiting
  • Gait problems
  • Vision problems
  • Seizures
  • Movement problems
  • Speech problems
  • Difficulty understanding new things

Diagnosing an Astrocytoma

Here are the standard tools for diagnosing an astrocytoma:

  • CT Imaging

    In order to locate the tumor and determine its exact size, a CT imaging is taken up. This is only the initial line of investivation.

  • MRI Imaging

    In case of a tumor that infiltrate the surrounding tissue, then an MRI imaging may be required to get nerve and soft tissue involvement in the suspected tumor.

  • Tissue Biopsy

    CT and MRI are useful only to tell that there is a tumor and where it is situated. To identify the exact nature of a tumor cell, we must obtain a tiny bit of the tumor tissue using a needle and look at it using a microscope. This procedure, called a tissue biopsy, can tell everything about the tumor cell.

Treatment of an Astrocytoma

Surgery is usually the first line of treatment for an astrocytoma, always followed by radiotherapy. Based on the the nature of the astrocytoma, a chemotherapy may or may not be recommended.

Surgical Treatment

Surgical removal of the tumor tissue is the preferred first action against astrocytoma. In case of Grade-1 tumors, timely surgery followed up by radiation therapy will most certainly guarantee a complete remission or a long term relief. Whereas with Grade-4 tumors, surgery greatly delays the progress of the disease.

Go here for more information on

Radiation Therapy

In order to destroy residual cancer cells left behind after a surgery (if the tumor is an invasive/diffusive type, which are Grade-2, 3 & 4 tumors, it becomes impossible to remove the cancer without any residue), a radiation therapy is always taken up after the surgery.

Medical Treatment

Patients with astrocytoma are usually given medicines to prevent them from getting brain seizures.

The tumor in the brain can press on other structures and cause excess fluid retention. These patients may be prescribed steroids.

Other than these, if the tumor cells are expected to respond to chemotherapy (special kind of medication that are used for treating cancers), then the patient will be prescribed these medication too.

Treatment Window

When a cancerous tumor is diagnosed, the recommended thing to do is to have it have it remove surgically as quickly as possible. This reduces the chances of it spreading to other parts of the body.

Once a cancerous cells starts to move into other parts of the body, it become impossible to locate all the sites and remove the cancerous cells.

 
 
Edit

Brain Abscess 

Collection of pus inside a closed capsule is known as an abscess. Brain abscess occurs in the brain.

Introduction

 

Collection of pus inside a closed capsule is known as abscess. It can be found in any part of the body. It usually results from an infection present in the same organ. But on occasions, the infection can spread from another part of the body.

Compared to abscess in other parts of the body, abscess in the brain is considered very serious. Despite the improved treatments available today, 5% to 10% patients affected by a brain abscess may die.

Unfortunately, this disease is very common in India.

Causes of Brain Abscess

Infection from surrounding areas may spread via blood, lymph (a fluid that cleanses the body from infection), or by direct extension and settle down in the brain, to form an abscess. They include:

  • Ear Infection

    Untreated ear infection can gradually seep into the brain, forming a brain abscess. In India, this is the cause of more than 50% of the brain abscess.

  • Sinusitis

    Sinuses are empty air spaces in the skull that make the skull feel light. Sinuses also secrete mucous, which helps in keeping the nose moisturized. Any infection in th enose or sinus can enter the brain and result in abscess formation.

  • Tooth Infection

    Infection in the teeth can quickly spread to the brain. Hence, teeth infections must be attended to immediately.

  • Meningitis

    This is a common bacterial infection of the brain, usually seen in children. Very rarely, this can also be a source of brain abscess.

Here are few other assorted causes of a brain abscess:

  • Open Head Injuries

    When an open head injury happens, pieces of bone, hair and dirt particles can get inside the head. If these particles are not properly washed away through a surgery, they act as a focus of injection. In the course of many years, they form a brain abscess.

  • Metastatic Abscess

    Microorganisms from other parts fo the body (chest, skin, bone, abdomen, etc.) can travel through the blood, get lodged in the brain and form an abscess. This is more common in people with an odd heart condition wherein their blood bypasses the filteration by lungs.

  • Cryptogenic Abscess

    Crypto = Uknown. Genic = Of origin. In some cases, the source of a brain abscess may not be identifyable. These cases are called Cryptogenic Abscess.

  • Post-Operative Abscess

    Improper healing of surgical wounds after a brain surgery can result in a brain abscess formation.

Complication due to Brain Abscess

Epilepsy is a common complication of brain abscess. So, all patients with a brain abscess are given anti-seizure drugs for at least 1 to 2 years after the treatment for the abscess has ended.

Symptoms of a Brain Abscess

Symptoms of a brain access depend on the size, location and number of abscesses, on the virulence of the micro organism forming the abscess and the immune power of the affected individual.

Here is the long list of common symptoms seen in individuals with Brain Abscess. The exact symptom seen in an individual depends on the part of the brain affected by the abscess:

  • Headache
  • Seizures
  • Inability to move one or more parts of the body
  • Improper co ordination or gait
  • Speech problems
  • Visual problems
  • Nausea
  • Vomiting
  • Mild confusion to coma, depending on severity of infection
  • Bulged out eyes, which is often a late sign. It indicates increased pressure inside the brain.

In infants, the usual presenting signs are as follows:

  • Enlarging head
  • Bulging fontanelle
  • Separation of sutures
  • Vomiting
  • Seizures
  • Irritability
  • Poor feeding

Diagnosis of a Brain Abscess

The only useful blood test to ascertain the presence of a Brain Abscess is an elevated CRP (C-Reactive Protein). But elevated CRP only says that there is an infection somewhere in the body. Additional imaging studies are required to pin point the infection to a brain abscess.

Here are usual imaging studies carried out to study a brain abscess:

  • Skull X-Ray

    Infection of the sinuses and ear infection, which often result in a brain abscess, can be easily seen in a skull X-Ray. Also, presence of air inside the skull, if seen, indicates brain abscess that has resulted in prior traumatic event.

  • Skull CT Scan

    A CT scan can provide information like the stage of the abscess, number of abscesses, incresed intracranial pressure, surrounding infection, etc.

  • MRI of the Brain

    MRI is more sensitive than a CT scan in identifying an abscess in its earliest stage.

  • Magnetic Resonance Spectroscopy (MRS)

    MRS is a newly emerging diagnostic tool. It can tell between a brain abscess and other type of brain tissue damages.

Treatment for the Brain Abscess

Depending on age, neurological condition, location, number, size and severity of the abscess, the doctor decides whether to go for a medical or surgical treatment option.

Medical Treatment

Small abscesses in its early stages can be treated with antibiotics. After a treatment round, a follow up CT scan is usually advised to check for recurrence.

Surgical Treatment

When the brain abscess is estimated to be in an advanced stage or if it is through of life threatening, a surgery is performed to remove the abscess. Depending on the nature of the abscess, many surgical procedures have been described for the treatment of abscess.

Go here for more information on surgical treatment for the Brain Abscess

Treatment Window

Early diagnosis, appropriate treatment and proper control of the primary and secondary infection, helps achieve a good outcome and complete cure.

Till properly treated, bacteria causing the brain abscess literally eat into the brain.

Concussion of the Brain

“Concusses” in Latin means “action of striking together”. Damage caused to the brain by the head hitting against something hard is called the Concussion of Brain.

Introduction

When the head strikes or struck by something very hard, it tends to move forward and backward or sideways. The force of the movement shakes the brain vigorously. This disrupts various energy and chemical pathways in the brain. The force also stretches and damages nerves in the brain, leading to momentary loss of consciousness, visual and memory problems or difficulty maintaining balance.

Usually, within seconds after the impact, the patient is back on their legs, but they have forgotten what happened to them. They might also find it difficult to remember any new information given to them. This is called retrograde and anterograde amnesia. Increased secretion of a chemical called acetylcholine is responsible for this. Acetylcholine in high quantities can block transmission of signals within the brain. So there is a temporary disruption of the signaling networks in the brain.

With time, as the acetylcholine levels fall down, and the signaling network is re-established. Usually, in less than two weeks, the amnesia resolves, and the patient recovers completely.

Complication due to Brain Concussion

Second Impact Syndrome: First incidence of traumatic concussion in a person resolves easily. However, the severity of concussion and its symptoms may worsen with successive injuries. This often happens to American Football players, boxers, etc. With repeated concussion, the changes in the brain can become permanent.Patients may suffer from memory loss, depression, difficulty in thinking and concentration.

Symptoms

Here are some of the typical symptoms of a brain concussion:

  • Brief loss of consciousness
  • Slow breathing
  • Weak pulse
  • Fall in blood pressure
  • Confusion
  • Headache
  • Short term memory
  • Mental disturbance
  • Dizziness
  • Blurred vision
  • Tiredness
  • Sluggishness
  • Difficulty concentrating
  • Irritability
  • Depression
  • Nervousness

Investigations

Functional MRI (fMRI) is the best tool available for diagnosing a brain concussion.

  • Functional MRI and Blood Oxygen Level Dependent (BOLD) Activity

    Concussion mainly causes functional disturbances in the brain. MRI and CT scans almost always show normal brain picture. fMRI and BOLD Activity show increased activity in some brain areas and decreased activities in others. This helps a doctor/surgeon to identify the pattern of injury in the brain.

Treatment for Brain Concussion

Symptoms of a brain concussion resolve spontaneously in a week or two. However, till such time the concussion resolves, the patient may have to be kept under close observation to watch out for untoward deterioration.

Medical Treatment

Patients who suffer from symptoms giddiness, light-headedness, or difficulty in concentration are treated symptomatically, and nerve protective medications are given.

Surgical Treatment

A pure concussion resolves on its own and does not need any surgical intervention.

Treatment Window

When a concussion occurs along with other brain injuries, patient should be observed closely for deterioration and appropriate treatment must be initiated immediately, based on CT findings.

Brain Stem Hematoma

Brain stem manages many functions vital to sustaining life. So, blood leakage or blood clot here can be life threatening.

Introduction

“Brain Stem” is the stem like portion of the brain at its lower most part, where the brain connects with the spinal cord. Brian Stem controls and regulates vital functions like breathing, heart rate, regulation of body temperature, etc. So, a hematoma here can be seriously life threatening.

Brain Stem Hematoma is also known as “Duret Hemorrhate”, after the surgeon who first identified it.

Causes of Brain Stem Hematoma

Here are some of the common causes of hematoma or hemorrhage in the brain stem

  • Head Injuries

    Cuts and bruises over the brain stem during a severe head injury can result in blood leakage (hemorrhage) and blot clotting (hematoma)

  • Neck Fracture

    In an automobile accident, passenger in the front seat can have their head violently bump against the dashboard of the car. This can cause a forward and backward movement of the neck at high force, resulting in the fracture of the neck. Such neck fractures almost always end up causing a brain stem hematoma.

  • High Blood Pressure

    High blood pressure can result in rupture of the blood vessels in any part of the body, including the brain stem.

Complication due to Brain Stem Hematoma

Brian stem controls and regulates breathing. As the blood leakage or blood clot in the brain stem worsens, the breathing first becomes irregular, then slows down and ultimately stops. So, patients with a brain stem injury often require external breathing support in the form of a mechanical ventilator.

Symptoms of a Brian Stem Hematoma

Brain stem hematomas usually occur along with brain injuries. Only when the trauma to the brain is so severe, the brain stem is also injured. So, this is a severely debilitating condition. Less than 25% of the patients are conscious when they are brought for medical help. Many of them are:

  • Unconscious
  • Unresponsive
  • Comatose
  • Have shallow/irregular breathing
  • Have increased body temperature

Investigations for a Brain Stem Hematoma

Here are the the most common tool used to diagnose a brain stem hematoma

  • CT Scan

    To identify a brain stem injure, CT Scan is the imaging technique of choice. With the help of a CT, it is possible to identify a brainstem hematoma within 4 to 8 hours of injury.

  • Cold Caloric Response

    In this test, cold water is poured in to the ear. This stimulates a nerve called the vestibular nerve, which connects the base of the brain to the ear. If the brain is functioning well, it responds by sending a signal to the eyes and rapid side to side movement is seen in both the eyes. If the rapid movement of the eyes is not seen, the brain stem is probably not functioning.

  • Brainstem Auditory Evoked Response

    Electrodes are placed under the skin of the scalp, and in front of the ears. A neurosurgeon reads the brain activity through the readings of the electrode. These readings can predict the degree of brain activity.

Treatments for Brain Stem Hematoma

Patients with a brain stem hematoma are very sick. They are likely to remain unconscious for a long period. They need:

  • Longer stay in ICU
  • Proper nursing care
  • Tracheostomy care
  • Management of temperature
  • Management of lung related issues

Medical Treatment

Patients being treated for brain stem hematomas are given medication to decrease the patient’s body temperature, seizure preventing drugs, and nerve protectors.

High dose of antibiotics may also be given to treat infections that may result from tracheostomy, lunc infection, urine infection and general infection.

All of these lead to longer hospital stay.

Surgical Treatment

Surgeries in the brain stem have very low success rate. So, surgeries to remove bleed in the brain stem are not recommended. However, surgeries may be conducted to treat brain injuries in other parts of the brain or to enable artificial breathing through a tracheostomy.

Treatment Window

As mentioned earlier, brain stem hematoma is a life threatening condition. An immediate CT scan, early diagnosis and close follow dramatically increase the survival rate of the patient.

Brain TB (Tuberculosis) 

Tuberculosis (TB) is an infectious disease caused by a bacterium called Mybacterium Tuberculosis (MTB). It usually affect the lungs. With time, the bacterium can spreads to other parts of the body including the brain. TB can affect people all ages and sexes.

Introduction

In the brain, tuberculosis forms what we call a tuberculoma. Tuberculomas vary in size and shape. They may be single or multiple. In the mature form, a tuberculoma is firm, hard to touch, and grayish-yellow in color. Tuberculoma usually does not contain any blood vessel. A capsule of tuberculoma is a piece of compressed, damaged brain tissue. A neurosurgeon’s job is to take out these tuberculomas.

Types of Tuberculoma

If the TB proves difficult to deal with medically, then a neurosurgeon works on physically removing the tuberculomas from the brain. To do that, it is important to know what kind of tuberculoma one is dealing with.

  • Tuberculoma en plaque

    This tuberculoma looks like a plaque. This type of tuberculoma has increased blood vessels (other tuberculomas don’t have blood vessels). Surgeon must keep this in mind while removign the plaque-like tuberculomas.

  • Tuberculous Abscess

    These tuberculomas contain pus and resemble a brain abscess. This type of tuberculoma is common in India

  • Cystic Tuberculoma

    These tuberculoma are in the form of a cyst. They are filled with clear yellow or cloudy green fluid, depending on the stage of infection. These tuberculomas are relatively rare.

  • Multiple Grape-like Tuberculomas

    Very rarely, multiple, immature tuberculomas are observed. They group together, resembling a cluster of grape.

  • Mictotuberculomas

    This type of tuberculoma is seen as a small disc or ring around 5mm to 7mm in diameter. These are common in India.

  • Calcified Tuberculomas

    With time, a tuberculoma can calcify into a hard mass. Although calcified, they are still infectious.

  • Tuberculous Encephalopathy with an “Inconsequential” Tuberculoma

    Sometimes, brain damage is seen in children with a small or no lession at all. This is usually because of an allergic reaction to some proteins relseased by the TB bacteria. In these cases, a biopsy of the brain tissue usually help to confirm the presence of TB.

Symptoms

Here are some of the common symptoms of Brain TB:

  • Fever
  • Seizures
  • Headache
  • Vomiting
  • Nausea
  • Gait problems
  • Speech Disturbances
  • Vision Problems
  • Weakness
  • History of exposure to lung TB
  • Evidence of TB elsewhere in the body

Investigations

Here is the usual set of investigations carried out to find out of one has TB and how it has affected the body.

  • Blood Test

    ESR (Erythrocyte Sedimentation Rate) is usually raised when there is any kind of infection in the body, including TB. So, a doctor orders a blood test to determine the ESR. But TB is a tricky one. One can have TB even with normal ESR.

  • Mantoux Test

    A protein component of TB bacteria is injected into the skin of the forearm. If one has TB, the injection site becomes red in color. Trouble with this test is that it can give false-positive results.

  • Chest X-Ray

    TB very rarely occurs without a lung infection. So, when the doctor suspects presence of TB, they always order a Chest X-Ray to determine if there is evidence of TB in the lungs.

  • CT of the Brain

    CT imaging of the brain helps the doctor/surgeon to idenitfy she size, shape, location and number of lesions (damaged patches of tissue) in the brain. CT can also visualize calcification clearly.

  • MRI of the Brain

    MRI images help the doctor/surgeon to see the stages of brain lesions clearly.

  • Stereotactic Biopsy

    Under the CT guidance, using a fine needle, a small portion of the affected brain tissue (lesion) is taken out and studied under a microscope. This help in definitive diagnosis of TB in the brain.

Treatment of the Brain TB

Doctors usually prefer to deal with TB medically. When that fails, or when the TB has already spread dangerously, a decision to surgically remove the TB affected tissue is preferred.

Medical Treatment

Medication that kill or stop the growth of TB bacteria are known as anti0tubercular drugs. Usually, an anti-tuberculor drug, combined with steroidal medications, lead to healing of the TB affected tissue in 10 to 12 weeks’ time. If the patch of affected tissue is large, then complete healing might take up to 6 to 8 months.

Surgical Treatment

  • Small and easily accessible tuberculomas (tissue hardened by TB) can be removed by excision.
  • With large tuberculomas, an ultrasonic aspirator (or CUSA) is used to suck out the TB affected tissue, without affecting the surrounding normal area.

Go here for more information on surgical treatment of Brain TB.

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The large, wrinkly part of the brain is called the cerebrum. Cerebrum handles most sensory as well intellectual activities. Bruise formed in the crebrum is called “Cerebral Contusion”.

Introduction

The wrinkly, red color portion of the brain in the GIF animation is called the cerebrum. Many major functions of the brain is handled by the cerebrum. Brain is a soft material, with the consistency of table butter, sitting inside a hard skull that has pointy ridges and stuff.

When the head goes through a violent movement, like in the case of a head injury, the forces cause the brain to move withing its enclosure and strike or squeeze itself against the outer covering protecting it, called the dura mater. This bruises the brain.

Types of Contusion

A contusion can occur at the site directly underneath the force of trauma, the opposite side, or at a remote location inside the brain. Based on how a contusion is formed, it is categorized into the following types:

  • Coup

    When the bruise occurs directly underneath the area of impact, it is called a “Coup”

  • Countercoup

    When the bruise occurs in an area opposite to the site of impact, it is called a “Counter Coup”

  • Intermediat Coup

    Sometimes, the bruise in the brain can occur within the brain, at a location between the coup and the counter coup. This is called an “Intermediate Coup”

  • Gliding Contusion

    This involves bruising of the deeper layers of the brain.

  • Herniation

    Portion of the bruised brain is displased and pushed into a surrounding space, causing herniation.

  • Fractured Contusion

    When a buised are lies directly underneath a portion of the skull that was fractured during a trauma, it is called a Fractured Contusion.

Complication

A deep cut or tear (laceration) of the brain usually accompanies a contusion. This causes extensive damage to brain tissues, fluid accumulation and may even result in infection. Multiple areas of contusions may bleed, join together and  form  large hematomas.

Symptoms

Not all symptoms are seen in every patient. Symptoms manifest depending on the part of the brain affected. Here are some of the common symptoms of a contusion:

  • Weakness of hands and/or legs
  • Lack of co ordination of movements
  • Speech problems
  • Memory and Learning problems
  • Disorientation
  • Local or generalized fits
  • Facial weakness
  • Weakness of handgrip
  • Dragging of feet while walking

Sometimes, the contusion is too small to produce any symptoms; but at times the contusion is large enough to cause a bleed in the brain, leading to rapid deterioration. In extreme cases, reactions in the brain can also lead to accumulation of fluid, brain swelling and increased pressure inside the brain. This can pull the patient to coma or even death. Hence, a well-trained neurosurgeons eye is the key to good clinical outcome.

Moreover, a single traumatic event can lead to more than one contusion. Based on the patients symptoms and CT finding, all bruised areas of the brain are identified and appropriate treatment given.

Investigations

Imaging studies are leading tools for investigating and diagnosing contusions.

  • CT Scan

    A CT Scan is the imaging tool of choice to diagnose a cerebral contusion. It can also easily identify the presence of fluid accumulation in the brain or bleeding in the brain.

  • MRI Scan

    MRI helps to visualize the bleeds in the brain more clearly than a CT image.

Available Treatments

Management of Cerebral Contusion depends on the location and severity of the it.

Medical Treatment

Small contusions can be managed with nerve protective medications and bed-rest.

Surgical Treatment

Large contusions require immediate surgical intervention. Here are a some additional reasons that demand immediate surgery:

  • When the contusion is growing in size
  • When the brain swells up with fluid accumulation. This leads to increased pressure within the brain and compression of important brain structures.

Decompressive Craniectomy: In this procedure, a part of the skull is removed, allowing the brain to expand and then heal itself. This prevents the important structures in the brain from being compressed. It also relieves the pressure inside the brain.

Go here for more details on decompressive craniectomy.

Treatment Window

When a contusion is noted to be growing or patients clinical status starts deteriorating, immediate surgical intervention is warranted.

Chondrosacroma: Tumor of the Cartilage in the Backbone

Cancerous Tumor of the cartilage cells is called chondrosarcoma. It usually affects the backbone first and then spreads to other parts of the body.

Introduction 

Chondro = cartilage, sarcoma = cancerous tumor.

Cartilages are rubber-padding like tissue. It covers and protects ends of long bones. Cartilage is softer than bones, but stiffer than muscle tissue. Body parts like ear lobes, noses, disc like padding in between the spinal bones (vertebral discs) are made with cartilage. Abnormal growth of the cartilage tissue leads to chondrosarcoma.

Chondrosarcoma affects people from all age groups. Chondrosarcoma is seen more often in the bones of the axial skeleton (head, ribs, spine, etc.). This disease may have a genetic component.

If this disease is identified during early stage (i.e. when it is still localized) and if it also happens to be of low grade, chances of survival after an appropriate treatment is very good.

Complication of Chondrosarcoma

This disease causes pain, limitation of movement and sensation. In some of the people affected by it, it can lead to death.

Symptoms of Chondrosarcoma

Symptoms of chondrosarcoma depend upon the size and location of the tumor. However, few general symptoms include:

  • Back pain, increasing upon lying down
  • Tingling sensation and pain radiating to the legs
  • Limited movement because of the tumor
  • Swelling at the site of tumor growth

Diagnosing a Chondrosarcoma

These are the standard tools used for diagnosing chondrosarcoma:

  • X-Ray

    An X-Ray image shows the area of the bone destruction because of cancer.

  • CT Imaging

    Since CT provides an image with better resolution, it is used to assess the spred of the tumor more accurately. While ordering a CT scan, it is advisable to image the lungs as this disease has high chances of spreading to the lungs.

  • MRI Imaging

    Involvement of the nerves and blood vessels can be better visualized with an MRI image. If this tumor is located in the spine, an MRI imaging is mandatory before the treatment is commenced.

  • Needle Biopsy

    A needle can be inserted into the tumor. A tiny bit of tumor cells is sucked in by the needle and observed under the microscope. This can help in identifying the exact type of tumor.

Treatment for Chondrosarcoma

Here are the standard treatments for chondrosarcoma:

Surgical Treatment

Complete Surgical Excision: In this procedure the tumor, along with some areas of surrounding normal tissue, is scraped off. This is the treatment of choice for chondrosarcoma.

Cryosurgery: Sometimes, ever after tumor excision, some tumor boundaries are left behind. In such cases, controlled cold produced by nitrogen gas is used to destroy the abnormal tissue.

Spine Stabilization Surgery: When chondrosarcoma is taken out of an affected spine, the rest of the spine must be stabilized using implants, fastened to the vertebral columns with screws.

Go here for more details on each of these procedures:

  • Complete Surgical Excision of Spinal Tumor
  • Cryosurgery
  • Spine Stabilization Surgery

Radiation Therapy

Conventional radiation therapy is not very effective to treat this type of cancer. However, proton beam therapy, where a narrow proton beam is used to destroy the cancerous tissue, seem to be showing promises.

Medical Treatment

Chondrosarcoma doesn’t respond to medication, including the chemotherapy drugs.

But doctors do administer pain relievers to temporarily alleviate the patient’s pain.

 

Treatment Window

Since surgery produces best results with this type of cancers, it is always advised to start the treatment started while the tumor volume is small and localized.

Concussion of the Brain

“Concusses” in Latin means “action of striking together”. Damage caused to the brain by the head hitting against something hard is called the Concussion of Brain.

Introduction

When the head strikes or struck by something very hard, it tends to move forward and backward or sideways. The force of the movement shakes the brain vigorously. This disrupts various energy and chemical pathways in the brain. The force also stretches and damages nerves in the brain, leading to momentary loss of consciousness, visual and memory problems or difficulty maintaining balance.

Usually, within seconds after the impact, the patient is back on their legs, but they have forgotten what happened to them. They might also find it difficult to remember any new information given to them. This is called retrograde and anterograde amnesia. Increased secretion of a chemical called acetylcholine is responsible for this. Acetylcholine in high quantities can block transmission of signals within the brain. So there is a temporary disruption of the signaling networks in the brain.

With time, as the acetylcholine levels fall down, and the signaling network is re-established. Usually, in less than two weeks, the amnesia resolves, and the patient recovers completely.

Complication due to Brain Concussion

Second Impact Syndrome: First incidence of traumatic concussion in a person resolves easily. However, the severity of concussion and its symptoms may worsen with successive injuries. This often happens to American Football players, boxers, etc. With repeated concussion, the changes in the brain can become permanent.Patients may suffer from memory loss, depression, difficulty in thinking and concentration.

Symptoms

Here are some of the typical symptoms of a brain concussion:

  • Brief loss of consciousness
  • Slow breathing
  • Weak pulse
  • Fall in blood pressure
  • Confusion
  • Headache
  • Short term memory
  • Mental disturbance
  • Dizziness
  • Blurred vision
  • Tiredness
  • Sluggishness
  • Difficulty concentrating
  • Irritability
  • Depression
  • Nervousness

Investigations

Functional MRI (fMRI) is the best tool available for diagnosing a brain concussion.

  • Functional MRI and Blood Oxygen Level Dependent (BOLD) Activity

    Concussion mainly causes functional disturbances in the brain. MRI and CT scans almost always show normal brain picture. fMRI and BOLD Activity show increased activity in some brain areas and decreased activities in others. This helps a doctor/surgeon to identify the pattern of injury in the brain.

Treatment for Brain Concussion

Symptoms of a brain concussion resolve spontaneously in a week or two. However, till such time the concussion resolves, the patient may have to be kept under close observation to watch out for untoward deterioration.

Medical Treatment

Patients who suffer from symptoms giddiness, light-headedness or difficulty in concentration are treated symptomatically, and nerve protective medications are given.

Surgical Treatment

A pure concussion resolves on its own and does not need any surgical intervention.

Treatment Window

When a concussion occurs along with other brain injuries, patient should be observed closely for deterioration and appropriate treatment must be initiated immediately, based on CT findings.

Cerebral Contusions

The large, wrinkly part of the brain is called the cerebrum. Cerebrum handles most sensory as well intellectual activities. Bruise formed in the crebrum is called “Cerebral Contusion”.

Introduction

The wrinkly, red color portion of the brain in the GIF animation is called the cerebrum. Many major functions of the brain is handled by the cerebrum. Brain is a soft material, with the consistency of table butter, sitting inside a hard skull that has pointy ridges and stuff.

When the head goes through a violent movement, like in the case of a head injury, the forces cause the brain to move withing its enclosure and strike or squeeze itself against the outer covering protecting it, called the dura mater. This bruises the brain.

Types of Contusion

A contusion can occur at the site directly underneath the force of trauma, the opposite side, or at a remote location inside the brain. Based on how a contusion is formed, it is categorized into the following types:

  • Coup

    When the bruise occurs directly underneath the area of impact, it is called a “Coup”

  • Countercoup

    When the bruise occurs in an area opposite to the site of impact, it is called a “Counter Coup”

  • Intermediat Coup

    Sometimes, the bruise in the brain can occur within the brain, at a location between the coup and the counter coup. This is called an “Intermediate Coup”

  • Gliding Contusion

    This involves bruising of the deeper layers of the brain.

  • Herniation

    Portion of the bruised brain is displased and pushed into a surrounding space, causing herniation.

  • Fractured Contusion

    When a buised are lies directly underneath a portion of the skull that was fractured during a trauma, it is called a Fractured Contusion.

Complication

A deep cut or tear (laceration) of the brain usually accompanies a contusion. This causes extensive damage to brain tissues, fluid accumulation and may even result in infection. Multiple areas of contusions may bleed, join together and  form  large hematomas.

Symptoms

Not all symptoms are seen in every patient. Symptoms manifest depending on the part of the brain affected. Here are some of the common symptoms of a contusion:

  • Weakness of hands and/or legs
  • Lack of co ordination of movements
  • Speech problems
  • Memory and Learning problems
  • Disorientation
  • Local or generalized fits
  • Facial weakness
  • Weakness of handgrip
  • Dragging of feet while walking

Sometimes, the contusion is too small to produce any symptoms; but at times the contusion is large enough to cause a bleed in the brain, leading to rapid deterioration. In extreme cases, reactions in the brain can also lead to accumulation of fluid, brain swelling and increased pressure inside the brain. This can pull the patient to coma or even death. Hence, a well-trained neurosurgeons eye is the key to good clinical outcome.

Moreover, a single traumatic event can lead to more than one contusion. Based on the patients symptoms and CT finding, all bruised areas of the brain are identified and appropriate treatment given.

Investigations

Imaging studies are leading tools for investigating and diagnosing contusions.

  • CT Scan

    A CT Scan is the imaging tool of choice to diagnose a cerebral contusion. It can also easily identify the presence of fluid accumulation in the brain or bleeding in the brain.

  • MRI Scan

    MRI helps to visualize the bleeds in the brain more clearly than a CT image.

Available Treatments

Management of Cerebral Contusion depends on the location and severity of the it.

Medical Treatment

Small contusions can be managed with nerve protective medications and bed-rest.

Surgical Treatment

Large contusions require immediate surgical intervention. Here are a some additional reasons that demand immediate surgery:

  • When the contusion is growing in size
  • When the brain swells up with fluid accumulation. This leads to increased pressure within the brain and compression of important brain structures.

Decompressive Craniectomy: In this procedure, a part of the skull is removed, allowing the brain to expand and then heal itself. This prevents the important structures in the brain from being compressed. It also relieves the pressure inside the brain.

Go here for more details on decompressive craniectomy.

Treatment Window

When a contusion is noted to be growing or patients clinical status starts deteriorating, immediate surgical intervention is warranted.

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Subdural Empyema

The outermost layer of protective tissue around the brain and the spinal cord is called dura mater. Bacterial infection and formation of pus underneath this layer is called Subdural Empyema.

Introduction

 

Three thin tissue layers, namely the dura mater, arachnoid mater and pia mater, protect and nourish the brain and spinal cord. “Dura mater” in Latin means “hard mother”. It is the outermost layer and protects the brain. Below the dura is the arachnoid (spiderweb like) mater. It contains blood vessels and supplies nutrition to the brain. The pia mater attaches itself to the brain and spinal cord, covering it.

Infection from other organs like the ear, nose or throat, may disintegrate from their location, travel through the blood vessels to the arachnoid space and from there seeps into the dura mater, forming a collection of pus. This collection is called subdural empyema. Children are more commonly affected than adults.

Complication due to Subdural Empyema

Subdural empyema is a rare, but serious illness. This is because bacteria entering the brain lead to the following complications:

  • Release toxins that directly damage the brain tissue.
  • Forms pus collection that obstructs blood vessels, leading to loss of blood supply to the brain, and formation of blood clots, hence damaging the brain.
  • The brain tissue starts fighting the bacteria by releasing various inflammatory substances, which ultimately cause the brain to retain fluid, leading to brain swelling and increased pressure within the brain.
  • Superficial abscess over the skull.

Because the disease affects the brain in more than one way, the patients may quickly progress to coma and death, if left untreated. This calls for early diagnosis and treatment.

Symptoms

Symptoms of the Subdural Empyema depend on the part of brain affected by the infection. They include:

  • Inability to think clearly or concentrate
  • Headache
  • Nausea
  • Vomiting
  • Speech problems
  • Weakness
  • Seizures

Investigations

These are the standard investigations, of escalation clarity, carried out to assess the existence and status of Subdural Empyema:

  • Ultrasound Sonography

    An Ultrasound Scan is the choice of investigation, particuarly with children who are suspected to have a subdural empyema.

  • Radio Isotope Scan

    A small dose of radioisotope is injected into the patient’s vein and the movement/acumulation of the radioisotope in the head is pictured using a special camera. If there is empyema, it shows up in the picture as a patch of radioisotope.

  • CT Scan

    A CT Scan can also be used to locate a subdural empyema. Sometimes, in order to enhance the CT image, the patient may be given a contrast die before the imaging is done.

  • MRI Imaging

    MRI imaging is used to image the soft tissue, particularly the nerves, etc.

Treatment for Subdural Empyema

Antibiotics is the first line of treatment for a subdural empyema. However, in more severe cases, or when the empyema refuses to respond to antibiotics sufficiently, a surgery may be preferred in order to physically remove the cavity of pus.

Medical Treatment

Bacteria causing infection is identified using blood tests, and appropriate antibiotic therapy is given to kill the offending organism. Medications either heal the lesion completely or help prevent spread to surrounding areas.

Surgical Treatment

There are two main surgical solutions available to treat a Subrual Empyema:

  • Surgeon may perform a Craniotomy (cutting through the skull bone), reach underneath the dura mater, and then remove the empyema.
  • Alternatively, the surgeon can also suck out (aspirate) the pus using a suitable equipment.

Go here for more information on surgical treatment for <he ailment

Treatment Window

If the diagnosis or treatment of subdural empyema is delayed, it can lead to serious neurological complications like paralysis, coma or death.

Ependymoma: Tumor of the Glial Cells in Brain and Spinal Cord

In our brain and spinal cord, there are housekeeping cells called the glial cells. There are 3 types of glial cells. One of them is called ependyma. Cancer of the ependyma is called ependymoma.

Introduction

A type of cells called glial cells do most of the housekeeping work in the brain and spinal cord. Glial cells are divided into three types: Astrocytes, Ependymal cells and Oligodendrocytes. Toxins, radiation exposure, drugs, nutrition imbalance or genetic load can cause alterations in these cells, resulting in uncontrolled growth in the form of a tumor. Tumors originating in the ependymal cells are called endymomas.

Ependymomas are usually slow growing tumors. They are usually found in the fluid-filled hollow spaces in the brain (called ventricles) and the spinal cord. At times, floating in the fluid, the tumor can also spread. Around this tumor, hardening of the tissue or some bleeding may be seen around this type of tumors.

Ependymomas of the brain is common among children. Whereas endymomas of the spinal cord are usually seen in older adults. Some times, these tumors are non-cancerous.

Complication due to Ependymomas

About 10% ependymomas are non-cancerous. They won’t spread to other parts of the body and cause trouble at multiple sites. Even with a tumor that doesn’t spread, its growth can put pressure on adjoining structures and cause complications. Lastly, some of the non-cancerous growth can eventually turn cancerous.

Symptoms of Ependymomas

Symptoms of an ependymoma depends on its location in the brain or spinal cord. Common symptoms are:

  • Headache
  • Nausea
  • Vomiting
  • Movement issues
  • Gait issues
  • Weakness
  • Loss of sensation

Diagnosing an Ependymoma

These are the standard tools used for diagnosing an ependymoma:

  • CT Imaging

    A CT scan is used in order to locate the tumor and determine its size. Bleeding in the surrounding areas, thickening of tissues and fluid filled sacs can also be identified using a CT image.

  • MRI Imaging

    An MRI image is needed to clearly visualize nerve and soft tissue involvement. MRI can also be used to locate a tumor that was missed out by the CT.

Treatment of Ependymomas

Following is the preferred order of treatment for ependymoma:

Surgical Treatment

Excision of tumor: For an ependymoma, the treatment of choice is a surgery. The surgeon removes the tumor, along with a portion of surrounding normal tissue, is carefully removed without damaging the surrounding nerves.

Tumor Debulking: Large tumors, particularly the ones that invade the surrounding tissue, are partially removed. This relieves the compression caused by the tumor on neighboring structures.

Radiation Treatment

In case of large tumors and the tumors that have spread into surrounding tissue, radiation therapy is started after debulking the tumor. This helps to destroy the remaining tumor cells as much as possible.

Chemotherapy

Chemotherapy stands for special class of drugs that are specially designed to destroy cancer cells. Chemotherapy is not very effective for most of the ependyomas.

Medical Treatment

Pharmachology is not very helpful in treatment endymomas. However, for a patient who has ependymomas, the doctor may prescribe drugs to reduce the fluid accumulation and to relieve the pain.

 

Treatment Window

Like with any cancer, detecting it early and treating it aggressively is the key to extending the longevity of patients with this disease.

Extradural Hematoma

The brain is a delicate organ. It is protected by a thick outer covering, known as dura mater. A bleed in between the dura mater and the skull is known as an External Hematoma.

Introduction

Some head injuries result in fracture of the skull bone. This causes separation of the dura mater from the skull it is attached to. The stress results in disruptions of the blood vessels that come in between the dura mater and the skull bone. Thus resulting in an extradural hematoma or a bleed.

Complication of an Extradural Hematoma

 

Symptoms of Extradural Hematoma

Here are some of the symptoms of an external hematoma:

  • Conscious throughout
  • Unconscious throughout
  • Initially conscious but unconscious few hours later
  • Initially unconscious but later in a dreamy state
  • Weakness in one half of the body
  • Headache
  • Nausea
  • Vomiting

Diagnosing Extradural Hematoma

Here are the standard tools used for diagnosing an external hematoma:

  • X-Ray

    An X-Ray image of the skull shows evidence of a fracture

  • CT Scan

    40% of the time a fracture can be missed on X Ray. As much as possible, an urgent CT is important. In a CT Scan, a fracture is seen much clearer and the bleed is seen as a white patch in the shape of a lens.

  • MRI Imaging

    MRI images can be taken but they are in no way superior to CT in identification of an extradural bleed.

  • Infrared Spectroscopy

    This is a newer diagnostic modality that uses infrared radiation to identify the damaged tissue in the brain within a short span of time.

Treatment of Extradural Hematoma

Minor cases of hematoma are always managed medically. Severe cases need surgical intervention.

Medical Treatment

Small Extradural Hematomas with minimal symptoms can be managed medically with fluid management and nerve protective medications.

Surgical Treatment: Burr Hole

In this surgical treatment of choice for extradural hematoma, a small hole is drilled through the skull and a tube is inserted. Blood is drained out through this tube after which the hole is sutured back.

Go here for more information on burr hole treatment

Treatment Window

If the size of an extradural hematoma increases rapidly, or if the condition of the patient worsens clinically, then an immediate surgery is recommended to manage the condition.

Edit

Pediatric Head Injuries

Children keep growing and their brain is still developing. So, injuries sustained by their little brain may have lasting effects.

Introduction

No age group is exempt from head injuries. However, the cause of head injury varies among age groups and from one region to another. For example, in India, fall from height is common. Whereas in the West, child abuse is the common cause of head injury in children.

Common Causes

Few common causes of head injury among children include:

  • Fall

    From balcony, cot, or while the child learns to walk or is engaged in play.

  • Road Traffic Accident

    Among children, road accidents are more common on the way to school and back.

  • Injury During Birth

    Injuries can happen to the baby’s head when instruments are used to pull th ebaby out of the birth canal or if the baby’s soft skull presses agains the mother’s pelvic bones, while pushing its way out.

  • Child Abuse

    Shaking a child vigorously results in injury to the nerves and blood vessels in the brain, sometime cause tiny bleeds in the brain.

Type of Head Injuries

Even through the injuries in children are the same as that in adults, children present with unique features. The clinicial picture and management are different too. Following are few types of injuries sustained by the pediatric age group:

  • Scalp Injury

    In infants, injury to the scalp is usually sustained during birth, as the child passes through the birth canal. In other age groups, scalp injury is very common during the child’s playtime, mainly due of falls.

  • Fracture

    Fractures are uncommon in children because children’s skull are softer than adults and can mold easily. But when the injury is too severe, two types of fractures may result. Linear or a straight line fracture and depressed fracture, where a small part of the skull gets distorted or deformed, as it tries to mold itself.

  • Hematomas

    A bleed in the brain is known as hematoma. This can occur when a vein or artery is damaged, as a result of head trauma. The bleed can occur above (extradural) or below (subdural) the dura mater (a touch sheath covering the brain), or within the brain (intra cerebral).

  • Contusion

    A bruise on the surface of the brain is known as contusion. When the head goes through a violent movement, the forces cause the brain to move within its enclosure and strike or squeeze itself against the outer covering protecting it. This bruises the brain. Children don’t show symptoms immediately after a contusion. So a careful observation for a delayed deorientation is required.

  • Diffused Brain Swelling

    This condition is 2-5 times more common in children than in adults as a child’s brain is so delicate. This usually happens when any head injury initiates fluid accumulation in the brain and hence brain swelling. Even a mild head injury might result in diffuse brain swelling. A CT scan should be performed to recognize the condition early, for immediate intervention.

  • Diffuse Axonal Injury

    Diffuse means ‘scattered’. Axon is the part of a brain cell that is involved in transferring information within the brain. During a fall or a traffic accident where the child is knocked down by the vehicle, brain shakes vigorously, causing damage to the axons. The injury is scattered across the brain, hence the term ‘diffuse axonal injury’. This often occurs together with a concussion.

Complications due to Pediatric Head Injuries

Disseminated Intravascular Coagulation (Disseminated: widespread, intra: inside, vascular: blood vessel, coagulation: Clotting of blood) is a common complication arising out of head injuries.

The brain tissue is a rich source of thromboplastin, a protein that helps in the clotting of blood. When the brain is injured there is an outpouring of thromboplastin from the brain into the blood. This causes a widespread clotting cascade throughout the body. Small vessels get blocked because of random clots obstructing the flow of blood. This compromises blood supply to various regions.

However in time, all the proteins that help with the clotting process is consumed and deficiency results. When there is deficiency, the opposite happens. There is random bleeding from different sites. Bleeding may be so profuse that it becomes difficult to control. If it is not treated early, this lead death of the child.

To prevent this, all children who sustained severe head injury must be monitored closely and their blood parameters should be measured regularly.

Symptoms

Common symptoms after a head injury are:

  • Vomiting
  • Nausea
  • Headache
  • Vision problems
  • Fits
  • Loss of consciousness
  • Irritability
  • Restlessness
  • Agitation
  • Low heart rate
  • Weakness of one or more parts of the body
  • Difficulty concentrating

Not all symptoms are seen in every child with a head injury. Depending on the type and severity of the condition, symptoms vary.

Some minor traumas don’t present with any symptom. Children return to their play immediately after the hit, but come back with complications later. So, apart from symptoms, further diagnostic investigations are required to evaluate the child and provide appropriate management.

Investigations

Here are the standard tools used for diagnosing a head injury in a child and possibly its effects:

  • X-Ray

    This is an useful diagnostic tool that shows skull fractures clearly at a Glance. A swelling resulting from head injury can also be appreciated easily appreciated.

  • CT Scan

    To get a detailed view of the brain, a CT scan is required. Minor fractures missed by an X ray can be spotted by a CT scan. Bleeding or changes in brain structure can also be identified using this imaging modality.

  • MRI Imaging

    To get a clearer view of blood vessels and exact location of a bleed, an MRI image is required. Since brain is a soft tissue, minor changes in brain structure can also be easily picked up in an MRI.

Treatment for Pediatric Head Injuries

Treatment to Pediatric Head Injury depends on its type and severity. Minor concussions and contusions can be left untreated and injuries that don’t show up on imaging and don’t produce symptoms can be left without a treatment. As a child’s brain is growing, minor injuries heal on their own in the course of time.

Hematomas that are seen at birth also heal on their own in two weeks. However, large hematomas, fluid accumulation in the brain, brain swelling and expanding fractures need to be addressed immediately.

Medical Treatment

Most of the medical treatment for Pediatric Head Injuries are administered for moving the fluid accumulation from the brain. Nerve protecting medication and drugs that prevent seizures are also given.

Surgical Treatment

Surgical treatment for pediatric head injuries fall in to the following categories:

  • Evacuation of Hematoma: A small hole is drilled into the skull and the accumulated blood is removed.
  • Shunt Placement: When there is brain swelling because of fluid accumulation, a metallic tube is placed in the brain that sucks excess fluid from the brain and directs it to any other space in the body that can absorb the incoming fluid. This relieves the pressure inside the brain and prevents further damage.

Go here for more information on surgical treatment for the ailment

Treatment Window

Recovery of the child with head injury depends on the child’s age at the time of injury, severity of the injury and its location. Early identification of the injury and initiation of appropriate treatment helps to save the child’s brain.

Hemangioma, Vertebral: Tumor of the Blood Vessels in Backbone

Non-cancerous tumors of the blood vessels are called hemangiomas. When they occur in the backbone, they are called vertebral hemangiomas.

Introduction

When a type of cells in the blood vessels called the endothelial cells grow abnormally, they form a type of tumor called hemangioma. Hemangiomas are non-cancerous (benign). Most of the time, they don’t even cause any symptoms. Often, a hemangioma is discovered accidentally during a CT Scan carried out for some other purpose.

A hemangioma in the backbone is called a vertebral hemangioma. It is usually found in the mid or lower back (i.e. lumber or thoracic) regions. Vertebral hemangiomas are more common in women.

Complication due to Vertebral Hemangioma

When a vertebral hemangioma occurs together with hemangiomas elsewhere in the body, they can create problem by bleeding.

If it is present in pregnant women, the tumor enlarge during the 7th to 9th month and may complicate pregnancy. Even though they usually resolve after delivery, if they are not surgically removed, they most probably recur during the subsequent pregnancies.

Symptoms of Vertebral Hemangioma

Hemangiomas usually do not produce any symptoms. They are often identified during a CT or an MRI scan conducted for some other purpose.

In a rare occasion where a patient with a vertebral hemangioma produces symptoms, they include:

  • Back pain, radiating to the legs
  • Weakness or numbness of muscles

Diagnosis of Vertebral Hemangioma

Here are the standard tools used for detecting and diagnosing a vertebral hemangioma:

  • X-Ray

    As the vertebral hemangioma erodes the bone, a honeycomb like appearnace is seen in the X-Ray

  • CT Imaging

    As the tumor invates the backbone, various changes happen inside. In a CT image, this looks like a polka dot (white dots on black background).

Treatment of Vertebral Hemangioma

There is no medical treatment for hemangiomas. But if the tumor causes pain, a doctor may prescribe medication to temporarily relive the pain.

Surgical Treatment

Embolization, followed by Radical Excision: In embolization, the blood vessels feeding the tumor are sealed by injecting a glue, plastic material or a metallic coil into them. This stops the blood flow to the tumor and ultimately the tumor dies. After the tumor death, the remnant can be removed surgically.

Treatment Window

Since this is a benign tumor, it is treated only when it gives some trouble (like back pain, etc.). Otherwise, the risk of surgery far outweighs the benefits of having the tumor removed.

Hematomas

Hemorrhage is a fancy word for leakage of blood (out of blood vessels). And hematoma is a fancy word for blood clot.

Blood clot in the brain is a nasty thing because it an compress other parts of the brain, affect their blood circulation and kill those brain cells. Blood clots can also stop the blood from reach portions of the downstream brain tissues, resulting in their death.

Based on where they occur, there are three major types of hematomas of the brain:

  • Brain Stem Hematomas

    These are blood clots in the brain stem (tissue at the bottom of the brain, connecting it to the spine). Since brain stem controls many vital life keeping functions (breathing, heart rate, body temperature), brain stem hematoma can be life threatening.
    More…

  • Extradural Hematomas

    There is a shrink-wrap like tough tissue surrounding the brain (and the spine). It is called the “dura mater”. Blood clot between the dura mater and the skull is called extradural hematoma. This is usually a result of skull injury. When it is serious, a surgeon usually drills a hole into the skull and release the pressure built up by the blood clot.
    More…

  • Subdural Hematomas

    There is a shrink-wrap like tough covering around the brain. It is called the dura mater. Immediately under the dura mater, there is a layer filled with blood vessels. When the head shakes vigorously, as if in an accident, the brain bashes against the dura mater, causing leakage of blood and blood clot underneath the dura mater. This is called subdural hematoma.
    More…

Brain Stem Hematoma

Brain stem manages many functions vital to sustaining life. So, blood leakage or blood clot here can be life threatening.

Introduction

“Brain Stem” is the stem like portion of the brain at its lower most part, where the brain connects with the spinal cord. Brian Stem controls and regulates vital functions like breathing, heart rate, regulation of body temperature, etc. So, a hematoma here can be seriously life threatening.

Brain Stem Hematoma is also known as “Duret Hemorrhate”, after the surgeon who first identified it.

Causes of Brain Stem Hematoma

Here are some of the common causes of hematoma or hemorrhage in the brain stem

  • Head Injuries

    Cuts and bruises over the brain stem during a severe head injury can result in blood leakage (hemorrhage) and blot clotting (hematoma)

  • Neck Fracture

    In an automobile accident, passenger in the front seat can have their head violently bump against the dashboard of the car. This can cause a forward and backward movement of the neck at high force, resulting in the fracture of the neck. Such neck fractures almost always end up causing a brain stem hematoma.

  • High Blood Pressure

    High blood pressure can result in rupture of the blood vessels in any part of the body, including the brain stem.

Complication due to Brain Stem Hematoma

Brian stem controls and regulates breathing. As the blood leakage or blood clot in the brain stem worsens, the breathing first becomes irregular, then slows down and ultimately stops. So, patients with a brain stem injury often require external breathing support in the form of a mechanical ventilator.

Symptoms of a Brian Stem Hematoma

Brain stem hematomas usually occur along with brain injuries. Only when the trauma to the brain is so severe, the brain stem is also injured. So, this is a severely debilitating condition. Less than 25% of the patients are conscious when they are brought for medical help. Many of them are:

  • Unconscious
  • Unresponsive
  • Comatose
  • Have shallow/irregular breathing
  • Have increased body temperature

Investigations for a Brain Stem Hematoma

Here are the the most common tool used to diagnose a brain stem hematoma

  • CT Scan

    To identify a brain stem injure, CT Scan is the imaging technique of choice. With the help of a CT, it is possible to identify a brainstem hematoma within 4 to 8 hours of injury.

  • Cold Caloric Response

    In this test, cold water is poured in to the ear. This stimulates a nerve called the vestibular nerve, which connects the base of the brain to the ear. If the brain is functioning well, it responds by sending a signal to the eyes and rapid side to side movement is seen in both the eyes. If the rapid movement of the eyes is not seen, the brain stem is probably not functioning.

  • Brainstem Auditory Evoked Response

    Electrodes are placed under the skin of the scalp, and in front of the ears. A neurosurgeon reads the brain activity through the readings of the electrode. These readings can predict the degree of brain activity.

Treatments for Brain Stem Hematoma

Patients with a brain stem hematoma are very sick. They are likely to remain unconscious for a long period. They need:

  • Longer stay in ICU
  • Proper nursing care
  • Tracheostomy care
  • Management of temperature
  • Management of lung related issues

Medical Treatment

Patients being treated for brain stem hematomas are given medication to decrease the patient’s body temperature, seizure preventing drugs, and nerve protectors.

High dose of antibiotics may also be given to treat infections that may result from tracheostomy, lunc infection, urine infection and general infection.

All of these lead to longer hospital stay.

Surgical Treatment

Surgeries in the brain stem have very low success rate. So, surgeries to remove bleed in the brain stem are not recommended. However, surgeries may be conducted to treat brain injuries in other parts of the brain or to enable artificial breathing through a tracheostomy.

Treatment Window

As mentioned earlier, brain stem hematoma is a life threatening condition. An immediate CT scan, early diagnosis and close follow dramatically increase the survival rate of the patient.

Hematoma Extradural

The brain is a delicate organ. It is protected by a thick outer covering, known as dura mater. A bleed in between the dura mater and the skull is known as an External Hematoma.

Introduction

Some head injuries result in fracture of the skull bone. This causes separation of the dura mater from the skull it is attached to. The stress results in disruptions of the blood vessels that come in between the dura mater and the skull bone. Thus resulting in an extradural hematoma or a bleed.

Complication of an Extradural Hematoma

 

Symptoms of Extradural Hematoma

Here are some of the symptoms of an external hematoma:

  • Conscious throughout
  • Unconscious throughout
  • Initially conscious but unconscious few hours later
  • Initially unconscious but later in a dreamy state
  • Weakness in one half of the body
  • Headache
  • Nausea
  • Vomiting

Diagnosing Extradural Hematoma

Here are the standard tools used for diagnosing an external hematoma:

  • X-Ray

    An X-Ray image of the skull shows evidence of a fracture

  • CT Scan

    40% of the time a fracture can be missed on X Ray. As much as possible, an urgent CT is important. In a CT Scan, a fracture is seen much clearer and the bleed is seen as a white patch in the shape of a lens.

  • MRI Imaging

    MRI images can be taken but they are in no way superior to CT in identification of an extradural bleed.

  • Infrared Spectroscopy

    This is a newer diagnostic modality that uses infrared radiation to identify the damaged tissue in the brain within a short span of time.

Treatment of Extradural Hematoma

Minor cases of hematoma are always managed medically. Severe cases need surgical intervention.

Medical Treatment

Small Extradural Hematomas with minimal symptoms can be managed medically with fluid management and nerve protective medications.

Surgical Treatment: Burr Hole

In this surgical treatment of choice for extradural hematoma, a small hole is drilled through the skull and a tube is inserted. Blood is drained out through this tube after which the hole is sutured back.

Go here for more information on burr hole treatmen>

Treatment Window

If the size of an extradural hematoma increases rapidly, or if the condition of the patient worsens clinically, then an immediate surgery is recommended to manage the condition.

Hematomas Intracerebral Traumatic

When a head injury sets off bleeding inside the brain, the blood tends to accumulate and even clot. This is called Traumatic Intracerebral Hematoma.

Introduction

Intracerebral Hematoma usually happens as a result of closed head injury. Often, this occurs together with other brain injuries like contusion, subdural hematoma or extradural hematoma.

Types of Intracerebral Hematomas

Based on the time lag between hematoma and the injury causing it, Intracerebral Hematomas are divided into two categories.

  • Immediate Type

    A depressed fracture of the skull, or a deep cut (laceration) on the brain following a head injury, results in an immediate intra-cerebral hematoma. These can be minor hematomas when they are caused by rupture of minor blood vessels. Massive bleeds from rupture of large blood vessels is usually common in older age group.

  • Delayed Type

    Delayed hamatomas usually occur in 24 to 48 hours after an injury. These hematomas don’t appear in an brain imaging made immediately after an injury. Delayed hematomas usually happen in patients with weak or diseased blood vessels. Delayed hematomas can be dangerous. They usually need immediate surgical intervention.

Complication due to Traumatic Intracerebral Hematoma

If it is not identified early, an intra-cerebral bleed becomes very dangerous.

  • The bleed can enlarge in size, compressing important structures inside the brain.
  • It can also lead to fluid accumulation in the brain.

All these changes lead to irreversible brain damage and respiratory failure. Coma or worse must be expected if an intra-cerebral hematoma is not attended to immediately.

Symptoms of Traumatic Intracerebral Hematomas

Symptoms of traumatic intra-cerebral hematomas depend on the clinical stage of the condition. The symptoms of the condition worsen with each escalating stage

1: Stage of Initial Compression

In this stage, the hematoma presses upon the surrounding blood vessels, leading to accumulation of fluid inside the brain. Initially, the brain tries to fight against further damage by pushing the excess fluid out of the brain. However, at a point, the natural mechanism is overwhelmed. When this happens, the following symptoms are seen:

  • Brian seizure
  • General irritability
  • Headache, increasing in severity and not relieved with pain medication
  • Vomiting
  • Drowsines
  • Confusion
  • Lack of alertness
  • Paralysis of one side fo the body

2: Stage of Anemia and Neuronal Paralysis

At this stage, the pressure inside the brain rises high enough to cause a decrease in blood flow to the brain. This starts to damage the nerves. Due to internal regulatory mechanisms, more spontaneous bleeding occurs within the brain, which only makes the matters worse. At this stage, the following symptoms are seen:

  • Unconsciousness
  • High blood pressure
  • Irregular breathing
  • Spasm of muscles
  • Stiffening of arms and legs
  • Excessive secretions in the body

3: Stage of Irreversible Neuronal Failure

At this stage, the patient goes into coma. Death may result because the damage to the brain becomes irreversible.

Diagnosis of Traumatic Intracerebral Hematoma

These are the preferred tool to diagnose an intracerebral hematoma

  • CT Imaging

    This is the first step to identify a hematoma in the brain. Repeated CT images at frequent intervals help the physician to spot out hematomas that grow in size with time.

Treatments for Traumatic Intracerebral Hematoma

Patients with small bleed, with no prominent symptoms are managed non-surgically. However repeated CT imaging and close monitoring are required to ascertain the effectiveness of the medical treatment.

Medical Management

Nerve protecting medications and pain relievers are given to patients with intracerebral hematomas. In some patients with previous history of seizures, medication to prevent seizures are also given.

Surgical Treatment

In major cases of intracerebral hematomas, couple of surgical techniques can be used to make the symptoms improve

Craniotomy and Evacuation of the Bleed

In this procedure, a part of the skull is removed and blood inside the brain is scooped out.

Decompressive Craniectomy

In this procedure, part of the skull is removed to release the pressure inside the brain. The brain heals itself and further compression of important structures can be prevented.

Hematoma Subdural

The brain is a delicate organ. It is protected by a thick outer covering, known as dura mater. A bleed, in the space beneath the dura mater is known as a subdural hematoma.

Introduction

When the head lands against a hard object, small vessels below the dura mater are injured, causing a bleed, leading to a hematoma.

A hematoma often occurs along with a brain contusion. Men are two to four times more likely affected than women.

Complication due to Subdural Hematoma

A subdural hematoma can expand or compress important structures in the brain, sometimes causing death of certain brain tissues.

Another complication is its tendency to cause fluid accumulation in the brain. This leads to brain swelling and increased pressure within the brain. This is a serious complication as it can lead to coma or death when it is not treated early.

Symptoms of Subdural Hematoma

Symptoms depend on the severity of the bleed. Here are the typical symptoms of a subdural hemotam, listed in the order of escalating severity:

  • Headache
  • Nausea
  • Vomiting
  • Stiffness of neck
  • Changes in gait
  • Loss of balance
  • Seizures
  • Weakness in one half of the body
  • Unconsciousness
  • Coma

Diagnosis of Subdural Hematoma

Here is the list of typical tools used for diagnosing an incident of Subdural Hematoma:

  • CT Scan

    On CT scan, a subdural bleed appears as a whitish patch, with a crescent shape. The presence of contusions in other parts of the brain and any fluid accumulation can also be identified in a CT scan.

  • MRI Scan

    A MRI is very quick in taking pictures of the brain (in an irritable, restless patient with head injury, a CT can give erroneous results as the patient moves). Moreover, an MRI can easily pick up even small contusions and bleed, which may be missed on a CT. However, if the patient is known to have metallic implants inside the body, an MRI should be avoided.

  • Radionuclide tracers

    There is a specialized CT imaging technique in which certain harmless radionuclide chemicals are injected through the vein. This enters the blood vessels in the brain and helps the surgeon clearly visualize the blood flow inside the brain.

Treatment of Subdural Hematoma

Small hematomas can be left untouched. They heal on their own in time. Hematomas that cause swelling of the brain can first be treated with medications. But, hematomas that keep growing in size, and that do not respond to medications, need surgical intervention.

Medical Treatment

Drugs that take away fluids from the brain and drugs that maintain the blood pressure are the main stay of treatment for hematoma. Other than that, nerve protective medications are also given.

Surgical Treatment

Surgical treatments for subdural hematoma fall into two categories:

  1. Decompressive Hemicraniectomy: With this surgery, a small portion of skull above the area of bleed is remove. This relieves the pressure inside the brain. The damaged tissue in the brain is allowed to heal without getting squeezed inside the skull. Often, when the skull is opened, the surgeon also sucks out the bleed.
  2. Craniotomy with or without Duraplasty: Under this procedure, a large opening is made in the skull and the hematoma is evacuated. Any point of bleed is burnt using controlled heat. Once the bleed is removed, the dura mater is repaired using a muscle path and the skull is closed.

Treatment Window

Large, expanding hematomas can compress on vital blood vessels in the brain, leading to death of the brain tissue in the affection part of the brain. So, a subdural hematoma must be identified and treated early before complications arise.

Hemorrhages

Ongoing bleeding, which is blood escaping from the circulatory system of the body, is called a hemorrhage.

Internal hemorrhage is where the blood escapes inside the body either due to rupture of a blood vessel or due to damage or infection to an internal organ.

An external hemorrhage is bleeding on the outer surface, which usually happens due to damage to the skin and the tissue underneath.

Anyone can easily lose 10% to 15% of blood without serious medical complications. While donating blood, one typically gives away about 8% of the circulating blood.

A hemorrhage can occur in any part of body. But at Chennai Neuroscience Foundation, our special interest is in the hemorrhage in the head and spine.

They typically fall into the following category:

  • Intracerebral Hemorrhage

    This is bleeding within the brain tissue, usually caused by ruptured blood vessels in the brain or a bleeding disorder.

Hemorrhage Intracerebral Spontaneous

An ongoing bleeding is called a hemorrhage. Sometimes, this can suddenly occur in the brain. It is called a “Spontaneous Intracerebral Hemorrhage”.

Introduction

Hemorrhage is an ongoing bleeding. When the bleeding has already happened, it is called a hematoma.

Hemorrhage in the brain causes the blood to seep into the brain tissue, causing many inflammatory reactions to take place. This ultimately interrupts the blood flow to some parts of the brain. This leads to a condition called stroke, where brain tissue starving blood supply starts to die out and corresponding brain function is suddenly lost. Such loss of function an be permanent or temporary.

This condition, called a Spontaneous Intracerebral Hemorrhage, accounts for 10-30% of all stroke cases. However, the leading cause of stroke is blockage of blood vessels by blood clot, fat, etc.

Causes of Spontaneous Intracerebral Hemorrhage

Here are the common causes of Spontaneous Intracerebral Hemorrhages

  • High Blood Pressure

    A sudden uncontrollable increase in blood pressure can cause arteries to burst, leading to a hemorrhage. This can also happen to the arteries in the brain. Patients who often skip their blood pressure medication are at an increased risk for this type of event.

  • Weak Blood Vessels

    Blood vessels weakend by normal aging and other causes can sometimes expand like a balloon. These blood vessels are always in the verge of bursting anytime, leading to a hemorrhage.

  • Trauma

    Severe head traumas (injuries) can lead to bleeding inside the brain.

  • Bleeding Disorders

    Patients with bleeding disorders like hemophilia are very prone to intracerebral hemorrhage. This can happen due to reasons like minor head injuries, uncalibrated consumption of blood thinners, etc.

Complication due to Spontaneous Intracerebral Hemorrhage

If left untreated, an intracerebral hemorrhage can grow in size, leading to injury and swelling (inflammation) of the brain. It leads to extensive damage and death to the brain tissue.

If the treatment is delayed, damage to the brain tissue becomes irreversible. Based on the part of the brain tissue affected, the patient can lose speech, movement control, weakness of limbs, paralysis, etc.

Symptoms of Spontaneous Intracerebral Hematomas

Common symptoms of intracerebral bleed are:

  • Severe Headache
  • Vomiting
  • Increased blood pressure
  • Altered level of consciousness
  • Sudden loss of function in one part of the body
  • Seizure
  • Confusion
  • Trouble with vision

Tools to Diagnose an Intracerebral Hemorrhage

These are the standard tools to diagnose and further investigate an intracerebral hemorrhage:

  • CT Scan

    This is the best imaging modality to confirm the presence of intracerebral hemorrhage. By frequently making CT images of the injured portion, doctors can also ascertain growth in hemorrhage, if any.

  • MRI Imaging

    An MRI is as sensitive as CT in detecting a bleed. It also helps to locate abnormal blood vessels, bleeding tumors, blood vessel obstructions, etc.

  • Angiography

    This is a more sensitive tool to diagnose blood vessel abnormalities. When a patient comes up with no obvious causes for a bleeding, the doctor may order for an angiography.

Treatment for Intracerebral Hemorrhage

Here are the standard treatments for a intracerebral hemorrhage.

Medical Treatment

All intracerebral patients with high blood pressure are treated to bring it down. Additional medication is also given to reduce the pressure within the brain and to divert fluid out of the brain.

Additionally, these patients may also be given supplements containing Vitamin K, which helps to stop bleeding.

Lastly, as an additional precaution, seizure control medication is given to these patients at least for a month following a hemorrhaging event.

Surgical Treatment

There are two common surgical treatments to manage an intracerebral hematoma

Decompressive Craniotomy

This technique is most helpful to treat an intracerebral bleed. In this technique, the skull is opened with special equipment and the leaking blood is drained out. Bleeding points are also identified and the bleeding is arrested using controlled heat. Go to this page to learn more about decompressive craniotomy.

Endoscopic Aspiration

Specilized flexible tubes are inserted into the brain. A camera is attached at the end of this tube, which helps the surgeon to identify the exact bleeding point and suck the bleed out.

With the help of specialized fine flexible tubes inserted into the brain, small bleeds are effectively sucked out. A camera

Treatment Window

If surgical intervention happens within 4 hours of the bleed, there are high chances of re-bleeding.

However, if an attempt is made to remove the bleed within 12 hours, particularly when it is performed using less invasive techniques like endoscopy, there are high chances of an improvement of the condition.

Edit

Intracerebral HematomasTraumatic  

When a head injury sets off bleeding inside the brain, the blood tends to accumulate and even clot. This is called Traumatic Intracerebral Hematoma.

Introduction

Intracerebral Hematoma usually happens as a result of closed head injury. Often, this occurs together with other brain injuries like contusion, subdural hematoma or extradural hematoma.

Types of Intracerebral Hematomas

Based on the time lag between hematoma and the injury causing it, Intracerebral Hematomas are divided into two categories.

  • Immediate Type

    A depressed fracture of the skull, or a deep cut (laceration) on the brain following a head injury, results in an immediate intra-cerebral hematoma. These can be minor hematomas when they are caused by rupture of minor blood vessels. Massive bleeds from rupture of large blood vessels is usually common in older age group.

  • Delayed Type

    Delayed hamatomas usually occur in 24 to 48 hours after an injury. These hematomas don’t appear in an brain imaging made immediately after an injury. Delayed hematomas usually happen in patients with weak or diseased blood vessels. Delayed hematomas can be dangerous. They usually need immediate surgical intervention.

Complication due to Traumatic Intracerebral Hematoma

If it is not identified early, an intra-cerebral bleed becomes very dangerous.

  • The bleed can enlarge in size, compressing important structures inside the brain.
  • It can also lead to fluid accumulation in the brain.

All these changes lead to irreversible brain damage and respiratory failure. Coma or worse must be expected if an intra-cerebral hematoma is not attended to immediately.

Symptoms of Traumatic Intracerebral Hematomas

Symptoms of traumatic intra-cerebral hematomas depend on the clinical stage of the condition. The symptoms of the condition worsen with each escalating stage

1: Stage of Initial Compression

In this stage, the hematoma presses upon the surrounding blood vessels, leading to accumulation of fluid inside the brain. Initially, the brain tries to fight against further damage by pushing the excess fluid out of the brain. However, at a point, the natural mechanism is overwhelmed. When this happens, the following symptoms are seen:

  • Brian seizure
  • General irritability
  • Headache, increasing in severity and not relieved with pain medication
  • Vomiting
  • Drowsines
  • Confusion
  • Lack of alertness
  • Paralysis of one side fo the body

2: Stage of Anemia and Neuronal Paralysis

At this stage, the pressure inside the brain rises high enough to cause a decrease in blood flow to the brain. This starts to damage the nerves. Due to internal regulatory mechanisms, more spontaneous bleeding occurs within the brain, which only makes the matters worse. At this stage, the following symptoms are seen:

  • Unconsciousness
  • High blood pressure
  • Irregular breathing
  • Spasm of muscles
  • Stiffening of arms and legs
  • Excessive secretions in the body

3: Stage of Irreversible Neuronal Failure

At this stage, the patient goes into coma. Death may result because the damage to the brain becomes irreversible.

Diagnosis of Traumatic Intracerebral Hematoma

These are the preferred tool to diagnose an intracerebral hematoma

  • CT Imaging

    This is the first step to identify a hematoma in the brain. Repeated CT images at frequent intervals help the physician to spot out hematomas that grow in size with time.

Treatments for Traumatic Intracerebral Hematoma

Patients with small bleed, with no prominent symptoms are managed non-surgically. However repeated CT imaging and close monitoring are required to ascertain the effectiveness of the medical treatment.

Medical Management

Nerve protecting medications and pain relievers are given to patients with intracerebral hematomas. In some patients with previous history of seizures, medication to prevent seizures are also given.

Surgical Treatment

In major cases of intracerebral hematomas, couple of surgical techniques can be used to make the symptoms improve

Craniotomy and Evacuation of the Bleed

In this procedure, a part of the skull is removed and blood inside the brain is scooped out.

Decompressive Craniectomy

In this procedure, part of the skull is removed to release the pressure inside the brain. The brain heals itself and further compression of important structures can be prevented.

Intracerebral Hemorrhage Spontaneous

An ongoing bleeding is called a hemorrhage. Sometimes, this can suddenly occur in the brain. It is called a “Spontaneous Intracerebral Hemorrhage”.

Introduction

Hemorrhage is an ongoing bleeding. When the bleeding has already happened, it is called a hematoma.

Hemorrhage in the brain causes the blood to seep into the brain tissue, causing many inflammatory reactions to take place. This ultimately interrupts the blood flow to some parts of the brain. This leads to a condition called stroke, where brain tissue starving blood supply starts to die out and corresponding brain function is suddenly lost. Such loss of function an be permanent or temporary.

This condition, called a Spontaneous Intracerebral Hemorrhage, accounts for 10-30% of all stroke cases. However, the leading cause of stroke is blockage of blood vessels by blood clot, fat, etc.

Causes of Spontaneous Intracerebral Hemorrhage

Here are the common causes of Spontaneous Intracerebral Hemorrhages

  • High Blood Pressure

    A sudden uncontrollable increase in blood pressure can cause arteries to burst, leading to a hemorrhage. This can also happen to the arteries in the brain. Patients who often skip their blood pressure medication are at an increased risk for this type of event.

  • Weak Blood Vessels

    Blood vessels weakend by normal aging and other causes can sometimes expand like a balloon. These blood vessels are always in the verge of bursting anytime, leading to a hemorrhage.

  • Trauma

    Severe head traumas (injuries) can lead to bleeding inside the brain.

  • Bleeding Disorders

    Patients with bleeding disorders like hemophilia are very prone to intracerebral hemorrhage. This can happen due to reasons like minor head injuries, uncalibrated consumption of blood thinners, etc.

Complication due to Spontaneous Intracerebral Hemorrhage

If left untreated, an intracerebral hemorrhage can grow in size, leading to injury and swelling (inflammation) of the brain. It leads to extensive damage and death to the brain tissue.

If the treatment is delayed, damage to the brain tissue becomes irreversible. Based on the part of the brain tissue affected, the patient can lose speech, movement control, weakness of limbs, paralysis, etc.

Symptoms of Spontaneous Intracerebral Hematomas

Common symptoms of intracerebral bleed are:

  • Severe Headache
  • Vomiting
  • Increased blood pressure
  • Altered level of consciousness
  • Sudden loss of function in one part of the body
  • Seizure
  • Confusion
  • Trouble with vision

Tools to Diagnose an Intracerebral Hemorrhage

These are the standard tools to diagnose and further investigate an intracerebral hemorrhage:

  • CT Scan

    This is the best imaging modality to confirm the presence of intracerebral hemorrhage. By frequently making CT images of the injured portion, doctors can also ascertain growth in hemorrhage, if any.

  • MRI Imaging

    An MRI is as sensitive as CT in detecting a bleed. It also helps to locate abnormal blood vessels, bleeding tumors, blood vessel obstructions, etc.

  • Angiography

    This is a more sensitive tool to diagnose blood vessel abnormalities. When a patient comes up with no obvious causes for a bleeding, the doctor may order for an angiography.

Treatment for Intracerebral Hemorrhage

Here are the standard treatments for a intracerebral hemorrhage.

Medical Treatment

All intracerebral patients with high blood pressure are treated to bring it down. Additional medication is also given to reduce the pressure within the brain and to divert fluid out of the brain.

Additionally, these patients may also be given supplements containing Vitamin K, which helps to stop bleeding.

Lastly, as an additional precaution, seizure control medication is given to these patients at least for a month following a hemorrhaging event.

Surgical Treatment

There are two common surgical treatments to manage an intracerebral hematoma

Decompressive Craniotomy

This technique is most helpful to treat an intracerebral bleed. In this technique, the skull is opened with special equipment and the leaking blood is drained out. Bleeding points are also identified and the bleeding is arrested using controlled heat. Go to this page to learn more about decompressive craniotomy.

Endoscopic Aspiration

Specilized flexible tubes are inserted into the brain. A camera is attached at the end of this tube, which helps the surgeon to identify the exact bleeding point and suck the bleed out.

With the help of specialized fine flexible tubes inserted into the brain, small bleeds are effectively sucked out. A camera

Treatment Window

If surgical intervention happens within 4 hours of the bleed, there are high chances of re-bleeding.

However, if an attempt is made to remove the bleed within 12 hours, particularly when it is performed using less invasive techniques like endoscopy, there are high chances of an improvement of the condition.

Intracranial Aneurysms Multiple

Weak blood vessels in the brain tend to balloon at the points of their weakness. This is called an aneurysm.

Introduction

Sometimes, weak blood vessels in the brain can bulge out like a balloon, causing a condition called aneurysm. When an aneurysm ruptures, it spills the blood it carries in to the brain, causing a life threatening condition.

About 1 in 50 people are thought to have an unruptured aneurysm. When an aneurysm ruptures, it can kill 40% of the people in whom the rupture occurs.

Causes of Aneurysm

Here are some common causes that lead to aneurysm:

  • High Blood Pressure

    The presence of high blood pressure weakens the blood vessel walls and make it vulnerable to bulging under any kind of stress or uncontrollable increase in blood pressure.

  • Smoking

    Smokers, particularly the ones who have been smoking for years, end up with their blood vessels weakening, making them susceptible for formation of aneurysm.

  • Blood Vessel Abnormalities

    When malformed blood vessels face any kind of internal stress, they can lead to formation of aneurysms.

  • Hereditary

    In some cases, aneurysm runs in the family. These patients are usually affected by aneurysm at a much younger age.

  • Congenital Disorders

    Some disorders that are present since birth are known to be associated with multiple brain aneurysms.

  • Gender

    When women hit menopause, the level of estrogen in their blood drops. This drop in estrogen makes them vulnerable for aneurysm.

Complication due to Aneurysm

The single most critical complication of aneurysm is rupture. Rupture of an aneurysm is dangerous to life. It can lead to irreversible brain damage and death.

Symptoms of Aneurysm

Small aneurysms rarely produce any symptoms. However, a large aneurysm may press upon important structures in the brain, causing symptoms like

  • Headache
  • Vision problems
  • Nausea
  • Weakness
  • Speech disturbance

If the aneurysm bursts, the patient may immediately fall unconscious and/or present with the following:

  • Sudden and severe headache
  • Sudden loss of vision
  • Sudden paralysis
  • Vomiting
  • Nausea
  • Stiffness of the neck
  • Seizures

Diagnosis of Aneurysm

These are the common tools used for diagnosing the presence of aneurysm

  • Angiography

    This is the best imaging modality for visualizing abnormally dialated blood vessels.

  • CT Imaging

    A CT Image plays an important role in localizing the site of rupture of an aneurysm.

  • MRI Imaging

    An MIR also helps to locate the exact site of aneurysm and to identify any bleed in the brain that occurs due to a ruptured aneurysm. Fluid accumulation in the brain can also be appreciated with the help of an MRI.

Treatment of the Aneurysm

Following are the treatment options available for aneurysm

Medical Treatment

There are no medical management options available for aneurysm. The best that can be done is to put the patient on pain relievers till they are surgically managed.

Surgical Treatment

There are two treatment choices available for aneurysm: Clipping and Coiling

Aneurysm Clipping

In this procedure, the skull is opened and the bulging blood vessel is identified. After identifying the vessel, the surgeon clips it just below the aneurysm, thereby preventing the aneurysm from rupturing.

Coiling of an Aneurysm

This is a minimally invasive procedure in which a catheter (tube) is into an artery at the groin. The tube is gently pushed forward till such time it reaches the blood vessel with the ballooning. At the site of the ballooning, a coil is inserted and the catheter is removed. Blood clot forms around the coil, which in turn heals the aneurysm.

Treatment Window

If an aneurysm is identified and the patient is symptomatic, immediate intervention is warranted so as to fix it before the aneurysm ruptures.

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Meningioma: Non-Cancerous Tumors of the Brain and Spine

Non-cancerous, slow growing, tumors arising from the sheath covering the brain and spinal cord is called meningioma.

Introduction to Meningioma

Three layers of coverings wrap around the brain and the spinal cord. The outermost layer is the toughest and it is called the dura mater. The middle layer carries blood vessels and it is called the arachnoid mater. The inner most is a soft layer that is practically stuck to the brain and the spinal cord. It is called the pia mater.

A slow growing, mostly non-cancerous tumor, arising out of the arachnoid mater, is called a meningioma. They can form over the brain or the spinal cord. These tumors are soft, fleshy and rubbery to stony masses. They can crumble easily.

Meningiomas can occur without symptoms and they are rarely discovered. If meningioma without symptoms is discovered by chance, the patient is put under periodical observation. A patient is treated for meningioma only when it produces troublesome symptoms.

The following increase the risk of meningioma:

  • Radiation exposure
  • Dental X-Ray
  • Head injury
  • Excess body weight
  • Neurofibromatosis type-2 (about 50% of the patients with NF-2 develop meningioma)

About 8% of meningiomas can turn cancerous.

Complication due to Meningioma

If a growing meningioma starts to compress adjoining brain tissue or nerve fibers, it can cause complications ranging from severe pain to numbness to loss of control of various bodily functions.

About 8% of meningiomas can turn into cancerous tumor.

Symptoms of Meningioma

Symptoms of meningioma depend on the location and size of the tumor.

If the tumor arises in the sheath wrapping the brain, the following symptoms are seen:

  • Headache
  • Nausea
  • Vomiting
  • Seizures
  • Tremors
  • Gait problems
  • Speech disturbances

If the tumor occurs in the sheath wrapping the spinal cord, symptoms vary depending on the region of the spinal cord affected by the tumor. Common symptoms in these patients include:

  • Back pain, increased while lying down
  • Muscle weakness
  • Lack of sensation in one or more parts of the body
  • Difficulty moving arms and/legs
  • Thinning of the muscles of the hand
  • Hip pain
  • Pain radiating to the legs
  • Tingling or pricking sensation of legs
  • Gait problems
  • Loss of control over stools
  • Loss of bladder control
  • Impaired sexual functions
  • If the meningioma is sighted in the region of the nape, then the usual symptoms include headache, nausea and vomiting.

Diagnosis of Meningioma

The following imaging studies are useful in diagnosing a meningioma:

  • MRI

    MRI images are an excellent tool for diagnosing a meningioma. Even small tumors in early stage are seen in an MRI image.

  • MR Neurography

    MRN is used to visualize the nerves. When a meningioma is located in the sheath covering the spinal cord, an MRN is used to picture how the tumor is interacting with the nerves.

Treatment of Meningioma

Here are the treatment options available for meningiomas:

Medical Treatment

Medication can’t reduce the size of meningiomas. However, steroidal medications are used to reduce any fluid accumulation that is seen around the tumor. If the tumor happens to pinch on a nerve and cause pain, pain relievers may be used.

Surgical Treatment

Total Microsurgical Resection: The treatment of choice for meningioma is careful removal of tumor, without causing damage to the surrounding nerves, using tiny surgical instruments and microscopes. Go here for more information on Total Microsurgical Resection.

After surgery, in order to prevent recurrence of the tumor in the future, the surgery is followed by radiotherapy.

Treatment Window

Till such time a meningioma starts to grow rapidly, or it causes undue pain and discomfort, the patient doesn’t have to be worried. Otherwise, arranging for an immediate surgery is the most prudent thing to do.

Multiple Intracranial Aneurysms

Weak blood vessels in the brain tend to balloon at the points of their weakness. This is called an aneurysm.

Introduction

Sometimes, weak blood vessels in the brain can bulge out like a balloon, causing a condition called aneurysm. When an aneurysm ruptures, it spills the blood it carries in to the brain, causing a life threatening condition.

About 1 in 50 people are thought to have an unruptured aneurysm. When an aneurysm ruptures, it can kill 40% of the people in whom the rupture occurs.

Causes of Aneurysm

Here are some common causes that lead to aneurysm:

  • High Blood Pressure

    The presence of high blood pressure weakens the blood vessel walls and make it vulnerable to bulging under any kind of stress or uncontrollable increase in blood pressure.

  • Smoking

    Smokers, particularly the ones who have been smoking for years, end up with their blood vessels weakening, making them susceptible for formation of aneurysm.

  • Blood Vessel Abnormalities

    When malformed blood vessels face any kind of internal stress, they can lead to formation of aneurysms.

  • Hereditary

    In some cases, aneurysm runs in the family. These patients are usually affected by aneurysm at a much younger age.

  • Congenital Disorders

    Some disorders that are present since birth are known to be associated with multiple brain aneurysms.

  • Gender

    When women hit menopause, the level of estrogen in their blood drops. This drop in estrogen makes them vulnerable for aneurysm.

Complication due to Aneurysm

The single most critical complication of aneurysm is rupture. Rupture of an aneurysm is dangerous to life. It can lead to irreversible brain damage and death.

Symptoms of Aneurysm

Small aneurysms rarely produce any symptoms. However, a large aneurysm may press upon important structures in the brain, causing symptoms like

  • Headache
  • Vision problems
  • Nausea
  • Weakness
  • Speech disturbance

If the aneurysm bursts, the patient may immediately fall unconscious and/or present with the following:

  • Sudden and severe headache
  • Sudden loss of vision
  • Sudden paralysis
  • Vomiting
  • Nausea
  • Stiffness of the neck
  • Seizures

Diagnosis of Aneurysm

These are the common tools used for diagnosing the presence of aneurysm

  • Angiography

    This is the best imaging modality for visualizing abnormally dialated blood vessels.

  • CT Imaging

    A CT Image plays an important role in localizing the site of rupture of an aneurysm.

  • MRI Imaging

    An MIR also helps to locate the exact site of aneurysm and to identify any bleed in the brain that occurs due to a ruptured aneurysm. Fluid accumulation in the brain can also be appreciated with the help of an MRI.

Treatment of the Aneurysm

Following are the treatment options available for aneurysm

Medical Treatment

There are no medical management options available for aneurysm. The best that can be done is to put the patient on pain relievers till they are surgically managed.

Surgical Treatment

There are two treatment choices available for aneurysm: Clipping and Coiling

Aneurysm Clipping

In this procedure, the skull is opened and the bulging blood vessel is identified. After identifying the vessel, the surgeon clips it just below the aneurysm, thereby preventing the aneurysm from rupturing.

Coiling of an Aneurysm

This is a minimally invasive procedure in which a catheter (tube) is into an artery at the groin. The tube is gently pushed forward till such time it reaches the blood vessel with the ballooning. At the site of the ballooning, a coil is inserted and the catheter is removed. Blood clot forms around the coil, which in turn heals the aneurysm.

Treatment Window

If an aneurysm is identified and the patient is symptomatic, immediate intervention is warranted so as to fix it before the aneurysm ruptures.

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Osteoblastoma: Non-Cancerous Tumor of the Backbone

This is a non-cancerous tumor, almost like Osteoid Osteoma. Except these tumors are larger.

Introduction

To understand this tumor, first read about Osteoid Osteoma.

Osteoblastoma is a non-cancerous bone forming tumor, similar to osteoid osteoma. It appears as red to purple granular mass that easily crumbles. It has rich blood supply.

Almost 40% of this tumor occurs in the spine. Men get this more often than women.

Complication due to Osteoblastoma

This condition is usually not life-threatening. But it can cause severe pain. When it is spine, the deformations can start compressing the nerves and make things worse.

Symptoms of Osteoblastoma

Symptoms of this disease are similar to an osteoid osteoma, with two exception. (1) These symptoms are much more aggressive and (2) the back pain does not occur at night.

Following are the common symptoms of osteoblastoma:

  • Back pain
  • Muscle pain
  • Muscle weakness
  • Pain, tingling or weakness that travel from the back towards the legs (symptoms of nerve compression)

Diagnosis of Osteoblastoma

Since symptoms are similar for most vertebral tumors, imaging modalities are required to identify the type of tumor.

  • CT Imaging

    CT Scan is the investigation of choice for this tumor.CT image can help to identify the tumor in its early stage as the bone changes can be clearly observed.

  • X-Ray

    X-Ray can miss small tumors in their early stages. So, X-Ray imaging is not recommeneded for initial diagnosis. But once the treatment has started, X-Ray images can be used to monitor the improvement.

Treatment for Osteoblastoma

Following are the standard treatments available for osteoblastoma patients

Medical Treatment

There are no medications available to stop or reverse the tumor. But doctors often prescribe pain relievers to temporarily alleviate the pain.

Surgical Treatment

Complete Surgical Resection: This is the treatment of choice for Osteoblastoma. Successful removal of the complete tumor provides immediate pain relief and good neurological recovery for the patients.

Treatment Window

Patients with symptoms of nerve compression must undergo immediate surgery to relieve the compression and prevent permanent loss of functions.

Oligodendroglioma: Tumors of Glial Cells in Brain (mostly) and Spine

In our brain and spinal cord, there are housekeeping cells called the glial cells. There are 3 types of glial cells. One of them is called oligodendrocytes. Cancer of the oligodendrocytes is called oligodendroglioma.

Introduction to Oligodendroglioma

Glial cells are the housekeeping cells of the brain and the spinal cord. There are three types of glial cells: astrocytes, ependymas and oligodendrocytes. Toxins, radiation exposure, drugs, nutrition imbalance or genetic load can make them grow without control. When oligodendrocytes grow without control, the growth (also called a tumor) is called a oligodendroglima.

Oligodendrocytes (also called oligodendroglia) are somewhat like an octopus. They have a central body and multiple arms shooting from it. Each arm reaches out to the nearest axon, wraps around it, forming a layer of insulation called myelin sheath around the axon. Each oligodendrocyte can have as much as 50 arms.

Oligodendrogliomas always spread into other neighboring tissue. Only when the tumor is very small, surgery can take out these cancers completely. When the tumor has grown to become large, surgery can help in making it smaller so that it doesn’t crush the adjoining structures.

Fortunately, oligodendroglioma responds well to chemotherapy and/or radiation.

Complication due to Oligodendroglioma

There are no known ways to make an oligodendroglioma go away. Provided that the tumor is detected early enough and a rigorous treatment protocol is taken up, many patients successfully outlive this disease.

Symptoms of Oligodendroglioma

The most common symptoms of this disease are

  • Seizure
  • Headache

Other symptoms may include

  • Speech disturbances
  • Vision problems
  • Nausea
  • Vomiting
  • Sudden uncontrolled movemenets
  • Problems with thinking and understanding

Investigations of Oligodendroglioma

In a CT or an MRI image, oligodendroglioma appears like any damaged brain tissue (lesion). Only way to to know if the lesion is an oligodendroglioma is to obtain a small sample of the tissue and investigate it under a microscope.

Treatment of Olidodendroglioma

For this type of cancer, chemotherapy is the first choice of treatment. Chemotherapy is often followed by radiation therapy.

Chemotherapy

This tumor responds well to PCV chemotherapy (Procarbazine, CCNU and Vincristine). It also responds reasonably well to a chemotherapy drug called Temozolomide. However, this tumor must be treated aggressively and monitored closely.

Surgical Treatment

Because this type of growth diffuses into neighboring tissue, surgery usually cannot remove it completely. Only when the tumor is very small, surgical removal is worth trying.

On the other hand, when the tumor has grown up to be very large and it starts crushing the adjoining tissue, a surgeon will try to remove as much of the tumor tissue as possible. This process is called debulking.

Treatment Window

This tumor responds well to aggressive chemotherapy with close monitoring. If the tumor is detected at an advanced stage, so much better. Patients who have been treated this way have lived for several decades.

Osteochondroma: Non-Cancerous Tumor of the Backbone

This is a non-cancerous tumor, growing from the cartilaginous part of growing bones.

Introduction

Osteo = bone. Chondro = Soft bone or Cartilage.

This tumor develops from the soft part of growing bone. It shoots out like a branch from a tree. It has a broad base, a stalk and a cartilage cap at the tip.

Since the tumor occurs in growing bones, it is usually seen in patients younger than 20. The tumor stops increasing in size once the bone reaches maturity.

Men are more affected by this condition than women. This tumor can develop in any part of the body, including the spine.

Complication due to Osteochondroma

 

Symptoms of Osteochondroma

Most patients with this condition do not have any symptom.

When a large tumor is seen in the spine and it starts compressing the surrounding structures, the following symptoms can occur:

  • Back pain
  • Muscle aches
  • Muscle weakness

As mentioned above, an osteochondroma stops growing once the bone reaches maturity. In case of persistent increase in size, other cancerous conditions may be suspected.

Diagnosing Osteochondroma

Here are the standard tools of diagnosis:

  • MRI Imaging

    An MRI imaging study is preferred over CT or X-Ray as the former helps to clearly visualize the soft tissue margins surrounding the tumor

Treatment for Osteochondroma

There are no known ways to medically stop or reverse this growth.

Medical Treatment

Pain killers are often prescribed to relieve the pain symptoms of this condition.

Surgical Treatment

Complete Surgical Excision: This is the treatment of choice for this condition. The tumor is completely cut off below the stalk and removed. Further follow up is required to watch for recurrence.

Treatment Window

Surgery is recommended for patients in whom the growth seem to continue unabated.

Osteosacroma: Tumor of the Backbone

Osteosarcoma is the second most common form of bone cancer.

Introduction

Osteo = bone. Sarcoma = Cancerous tumor.

These are large tumors made up of immature bone cells, provided with a rich blood supply. The tumor has disorganized masses on the surface, making it gritty. The bone in which the tumor grows may even be fractured by the tumor.

The tumor is highly aggressive. If it is not treated early, it can rapidly invade the whole bone and other areas. Since the tumor invades blood vessels, bleeding or tissue death may be seen in the area surrounding the tumor.

Even though they are a common form of cancer, they seldom affects the vertebra. The disease strikes both men and women equally.

Complication due to Osteosarcoma

If untreated or treated inadequately, this can lead to several complications, including death.

Symptoms of Osteoblastoma

Symptoms of this tumor vary depending on the location and severity. Common symptoms of this tumor appearing in the spine include:

  • Back Pain
  • Joint pains
  • Weakness
  • Numbness
  • Gait problems
  • Loss of bowel and bladder control (in severe cases)
  • Paralysis (In severe cases)

Since the tumor is cancerous, patients may experience:

  • Rapid loss of weight
  • Loss of desire to eat food
  • Excessive tiredness

Diagnosis of Osteoblastoma

Here are the standard tools used to diagnose this disease:

  • X-Ray

    An X ray shows damaged areas of bone, and some areas of abnormal new bone formation. Fractures of the bone caused by the tumor can also be appreciated on X Ray.

  • CT Imaging

    A CT scan helps to visualize the bone structure as a whole. Any lesion missed out on X ray can be seen on a CT scan.

  • MRI Imaging

    An MR image helps to identify the whole extent of the tumor, along with soft tissue involvement. Nerve compression can also be seen with help of an MRI.

  • Bone Scan

    If multiple lesions are suspected, a bone scan is helpful to view all the lesions, by injecting a dye into the bone. The defective areas pick up the dye and when a picture of the bone is taken, these are seen as patches.

  • Needle Biopsy

    In order to identify the exact type of the tumor tissue, a needle is inserted into the tissue and a tiny bit of the tumor is sucked out and examined under a microscope.

Treatment of the Osteosarcoma

Here are the standard treatments available:

Medical Treatment

Prior to a surgery to be carried out to remove the cancer, two or three cycles of chemotherapy is administered. This reduces the size of the tumor. Chemotherapy will be continued even after the surgery.

Other than this, these patients are always on pain relievers.

Surgical Treatment

Radical Tumor Excision: After 10 to 15 weeks of medical treatment with chemotherapy drugs, the tumor shrinks. At this time, the mass can be easily cut and taken out without damaging the surrounding nerves and blood vessels.

Radiation Therapy

Following surgery, radiation therapy may be given as determined by the doctor.

Treatment Window

Since the tumor is cancerous, if left untreated, it can invade and destroy the whole spinal cord, sometimes leading to paralysis. The tumor can also spread to other parts of the body.

Hence immediate treatment is recommended.

Osteoid Osteoma: Non-Cancerous Tumor of the Backbone

Non-cancerous bone growth, formation of new bone from immature bone cells depositing on existing bone is called Osteoid Osteoma.

Introduction

Osteoid = Immature bone. Osteoma = Formation of new bone upon existing tissue (usually existing bone tissue).

An osteoid osteoma is a non-cancerous bone tumor that arises from immature bone cells, and results in the formation of new bone over the existing bones.

This tumor is soft, dark red or yellowish white mass surrounded by thickened areas of new bone formation.

It can arise in the backbone or any of the long bones of the body. In backbone, the lumbar (lower back) area is most commonly affected. Men are more commonly affected  by this than women.

Complication due to Osteoid Osteoma

Except when this occurs in bone joints, difficulties due to this is limited to constant or periodic pain. In spine, this can cause spinal deformation, which must be treated before they become irreversible.

Symptoms of Osteoid Osteoma

Due to the formation of new bone over the existing bone, the affected vertebral bone starts to thicken. This thickening causes deformity of the backbone and compresses the nerves in that area, resulting in the following:

  • Back pain, much severe at night
  • Deformity of the spinal cord (scoliosis)
  • Pain, tingling or weakness that travel from the back towards the legs

Diagnosing Ostoid Osteoma

Following are the standard tools for diagnosing an incidence of Osteoid Osteoma:

  • X-Ray Imaging

    A normal bone is translucent under X-Ray. In an X-Ray image, normal bones appear grey in color. Because this disease increases the thickness of the bone in patches, the tumor is seen as whiter patches.

  • CT Imaging

    A CT Scan is the investigation of choice for osteoid osteoma. In a CT image, the tumor is seen as a well defined oval shaped area of abnormal tissue, surrounded by whitish patches of newly formed bone tissue.

  • Bone Scan

    A dye injected into the body gets collected over the area of abnormal bone formation like ink blots. This helps in identifying areas affected by osteoid osteoma.

Treatment for Osteoid Osteoma

Following treatments are available for an Osteoid Osteoma patient

Medical Treatment

At this point in time, no medications are available to stop or reverse this disease. However, patients with this disease may suffer from severe pain and they are prescribed pain medication.

Surgical Treatment

Complete Surgical Excision: This is the treatment of choice for Osteoid Osteoma. Successful removal of the complete tumor provides immediate pain relief for the patients.

Treatment Window

When this disease is seen in the spine, early surgery reduces the chances of permanent bone damage. This is because once the tumor erodes the spinal pillars, it is difficult to reverse the damage.

Edit

Pediatric Head Injuries

Children keep growing and their brain is still developing. So, injuries sustained by their little brain may have lasting effects.

Introduction

No age group is exempt from head injuries. However, the cause of head injury varies among age groups and from one region to another. For example, in India, fall from height is common. Whereas in the West, child abuse is the common cause of head injury in children.

Common Causes

Few common causes of head injury among children include:

  • Fall

    From balcony, cot, or while the child learns to walk or is engaged in play.

  • Road Traffic Accident

    Among children, road accidents are more common on the way to school and back.

  • Injury During Birth

    Injuries can happen to the baby’s head when instruments are used to pull th ebaby out of the birth canal or if the baby’s soft skull presses agains the mother’s pelvic bones, while pushing its way out.

  • Child Abuse

    Shaking a child vigorously results in injury to the nerves and blood vessels in the brain, sometime cause tiny bleeds in the brain.

Type of Head Injuries

Even through the injuries in children are the same as that in adults, children present with unique features. The clinicial picture and management are different too. Following are few types of injuries sustained by the pediatric age group:

  • Scalp Injury

    In infants, injury to the scalp is usually sustained during birth, as the child passes through the birth canal. In other age groups, scalp injury is very common during the child’s playtime, mainly due of falls.

  • Fracture

    Fractures are uncommon in children because children’s skull are softer than adults and can mold easily. But when the injury is too severe, two types of fractures may result. Linear or a straight line fracture and depressed fracture, where a small part of the skull gets distorted or deformed, as it tries to mold itself.

  • Hematomas

    A bleed in the brain is known as hematoma. This can occur when a vein or artery is damaged, as a result of head trauma. The bleed can occur above (extradural) or below (subdural) the dura mater (a touch sheath covering the brain), or within the brain (intra cerebral).

  • Contusion

    A bruise on the surface of the brain is known as contusion. When the head goes through a violent movement, the forces cause the brain to move within its enclosure and strike or squeeze itself against the outer covering protecting it. This bruises the brain. Children don’t show symptoms immediately after a contusion. So a careful observation for a delayed deorientation is required.

  • Diffused Brain Swelling

    This condition is 2-5 times more common in children than in adults as a child’s brain is so delicate. This usually happens when any head injury initiates fluid accumulation in the brain and hence brain swelling. Even a mild head injury might result in diffuse brain swelling. A CT scan should be performed to recognize the condition early, for immediate intervention.

  • Diffuse Axonal Injury

    Diffuse means ‘scattered’. Axon is the part of a brain cell that is involved in transferring information within the brain. During a fall or a traffic accident where the child is knocked down by the vehicle, brain shakes vigorously, causing damage to the axons. The injury is scattered across the brain, hence the term ‘diffuse axonal injury’. This often occurs together with a concussion.

Complications due to Pediatric Head Injuries

Disseminated Intravascular Coagulation (Disseminated: widespread, intra: inside, vascular: blood vessel, coagulation: Clotting of blood) is a common complication arising out of head injuries.

The brain tissue is a rich source of thromboplastin, a protein that helps in the clotting of blood. When the brain is injured there is an outpouring of thromboplastin from the brain into the blood. This causes a widespread clotting cascade throughout the body. Small vessels get blocked because of random clots obstructing the flow of blood. This compromises blood supply to various regions.

However in time, all the proteins that help with the clotting process is consumed and deficiency results. When there is deficiency, the opposite happens. There is random bleeding from different sites. Bleeding may be so profuse that it becomes difficult to control. If it is not treated early, this lead death of the child.

To prevent this, all children who sustained severe head injury must be monitored closely and their blood parameters should be measured regularly.

Symptoms

Common symptoms after a head injury are:

  • Vomiting
  • Nausea
  • Headache
  • Vision problems
  • Fits
  • Loss of consciousness
  • Irritability
  • Restlessness
  • Agitation
  • Low heart rate
  • Weakness of one or more parts of the body
  • Difficulty concentrating

Not all symptoms are seen in every child with a head injury. Depending on the type and severity of the condition, symptoms vary.

Some minor traumas don’t present with any symptom. Children return to their play immediately after the hit, but come back with complications later. So, apart from symptoms, further diagnostic investigations are required to evaluate the child and provide appropriate management.

Investigations

Here are the standard tools used for diagnosing a head injury in a child and possibly its effects:

  • X-Ray

    This is an useful diagnostic tool that shows skull fractures clearly at a Glance. A swelling resulting from head injury can also be appreciated easily appreciated.

  • CT Scan

    To get a detailed view of the brain, a CT scan is required. Minor fractures missed by an X ray can be spotted by a CT scan. Bleeding or changes in brain structure can also be identified using this imaging modality.

  • MRI Imaging

    To get a clearer view of blood vessels and exact location of a bleed, an MRI image is required. Since brain is a soft tissue, minor changes in brain structure can also be easily picked up in an MRI.

Treatment for Pediatric Head Injuries

Treatment to Pediatric Head Injury depends on its type and severity. Minor concussions and contusions can be left untreated and injuries that don’t show up on imaging and don’t produce symptoms can be left without a treatment. As a child’s brain is growing, minor injuries heal on their own in the course of time.

Hematomas that are seen at birth also heal on their own in two weeks. However, large hematomas, fluid accumulation in the brain, brain swelling and expanding fractures need to be addressed immediately.

Medical Treatment

Most of the medical treatment for Pediatric Head Injuries are administered for moving the fluid accumulation from the brain. Nerve protecting medication and drugs that prevent seizures are also given.

Surgical Treatment

Surgical treatment for pediatric head injuries fall in to the following categories:

  • Evacuation of Hematoma: A small hole is drilled into the skull and the accumulated blood is removed.
  • Shunt Placement: When there is brain swelling because of fluid accumulation, a metallic tube is placed in the brain that sucks excess fluid from the brain and directs it to any other space in the body that can absorb the incoming fluid. This relieves the pressure inside the brain and prevents further damage.

Go here for more information on surgical treatment for the ailment.

Treatment Window

Recovery of the child with head injury depends on the child’s age at the time of injury, severity of the injury and its location. Early identification of the injury and initiation of appropriate treatment helps to save the child’s brain.

Plasmacytoma: Tumor of the Marrow of the Backbone

When abnormal plasma cells (white blood cells) seen in any bone in the body, it is called a plasmacytoma.

Introduction to Plasmacytoma

Plasma cells are a type of white blood cells. They produce large volume of antibodies, which weapons used by the body against invading parasites. Plasma cells are produced in the bone marrow. When the plasma cells become abnormal in the bone marrow, the condition is called plastocytoma.

By definition, a plastocytoma occurs in only one location in the body, usually in an axial skeletal bone (rib cage or backbone). In 2 to 4 years, it can be seen in multiple locations, including some soft tissue. Once this condition is seen in multiple locations, it is called multiple myeloma.

As a neuro-surgery unit, CNS is concerned only with plastocytoma of the spine. The part of the spine that supports the ribs are most often affected by this condition. Men older than 50 are the frequent victims.

Complication due to Plasmacytoma

Untreated plasmatycomas spread throughout the body, causing a condition called multiple myeloma. In this condition, all the blood cells formed inside the bone are destroyed, leading to increased risk of injections, bleeding and anemia.

Symptoms of Plasmacytoma

Here are the usual symptoms of plastocytoma. Based on the location and severity of the condition, the symptoms vary:

  • Bone and joint pain
  • Muscle pain
  • Muscle weakness
  • Paralysis
  • Gait problem

Diagnosis of Plasmacytoma

These are the tools used often to diagnose a plastocytoma:

  • Serum Protein Electrophoresis

    This blood test analyses the quantity of various antibodies in the blood. A person with plastocytoma produces large quantities of a particular type of white blood cell, which in turn produces large quantities of a particular antibody. Unusually large quantities of any one antibody in the blood indicates the possibility of plastocytoma.

  • X Ray

    Large areas of bone destruction can be observed at the site of a plastocytoma. In the image, plastocytoma looks somewhat like a soap bubble.

  • CT Image

    CT image has better resolution than an X-Ray image. Hence, it is used to assess the spread of the tumor.

  • MRI Image

    An MRI image can be used to visualize the involvement of nerves and blood vessels. An MRI is also used to determine that there are no other tumor sites within the rib/spine.

  • Bone Marrow Biopsy

    A tiny bit of bone marrow tissue is extracted and analyzed. This gives information about the exact nature of the tumor cells, probability of its spreading to other locations in the body, etc.

Treatment of Plasmacytoma

Here are usual treatments offered for a plasmacytoma:

Radiation Therapy

Plasmacytomas are very sensitive to radiation therapy. They get easily destroyed when exposed to radiation. So, radiation therapy is the treatment of choice here.

Surgical Treatment

Decompression and Stabilization of Spine: As the plasmacytoma tumor grows in size, it causes destruction of backbone and compression of nerves present in that area. Surgery is usually required to relieve the nerve compression and correct the spinal deformity.

Related links:

  • Decrompression of spine
  • Spine Stabilization

Medical Treatment

Medicines do not cure plasmacytoma. However, pain killers are prescribed to reduce the pain reported by the patients.

Treatment Window

Plasmacytoma starts with a single site. When it is diagnosed, an immediate treatment with radio therapy is recommended.

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Schwannoma: Tumor of the Nerve Sheath (Myelin)

Schwann cells wrap around the peripheral nerves, offering some kind of insulation. Tumor of the Schwann cells is called Schwannoma. It is mostly slow growing and benign.

Introduction to Schwannoma

A special type of cells called Schwann cells (named after physiologist Theodor Schwann who discovered it) wrap around peripheral nervous system, acting like insulation around wires. This insulation is also called myelin sheath.

Overgrowth of the Schwann cells form into a tumor called Schwannoma. When the early surgeons realized that Schwannomas contained many nerve fibers within them. So, Schwannoma is also called neurofibroma (nerve fiber + (oma = tumor)).

Schwannomas grow very slowly and they are almost always benign. Less than 1% of Schwannomas become malignant. When they do, they are called neurofibrosacroma (nerve fiber + (sacroma = a type of cancer)).

Cells in a Schwannomas are smooth and spindle shaped, tapering on both ends and bulging in the center.

Complication due to Schwannoma

Schwannomas grow slowly. They are mostly benign. So, life-threat from Schwannomas is rather low.

However, when the tumors grow, they compress on the nerves touching the tumor, causing various complication from headache to loss of sensation.

There is also a tiny risk of a Schwannoma turning into a neurofibrosarcoma.

Symptoms of Schwannoma

The symptoms of a Schwannoma depends on the location and size of the tumor.

Following symptoms are seen if the Schwannoma occurs in the brain:

  • Headache
  • Nausea
  • Vomiting
  • Seizures
  • Tremors
  • Gait problems
  • Speech disturbances

If the tumor occurs in the spinal cord, depending on the spot, symptoms vary. Common symptoms are:

  • Back pain, increasing while lying down
  • Muscle weakness
  • Lack of sensation in one or more parts of the body
  • Difficulty moving arms and/or legs
  • Thinning of the muscles of the hand
  • Hip pain
  • Pain radiating to the legs
  • Tingling or pricking sensation of legs
  • Gait problems
  • Loss of control over stools
  • Loss of bladder control
  • Impaired sexual functions
  • If the tumor is located in the nape region, then nausea, vomiting and headache

Diagnosis of Schwannoma

When Schwannoma is suspected through clinical evaluation, one or more of the following imaging studies are ordered to ascertain the initial diagnosis:

  • MRI Imaging

    MRI is the best imagign modality to diagnose Schwannomas. Using an MRI, even small tumor can be detected at an early stage.

  • MRI Neurography

    MRI Neurography is a specialized imaging technique used to make a picture of the nerves. These reports show the extent of nerve involvement.

Treatment for Schwannoma

Here are the options available for treating Schwannomas.

Medical Treatment

Steroid medication help to an extent to remove any fluid accumulation in the location of the tumor. Pain relievers are used to reduce the pain felt by the patient when the tumor starts compressing the nerves.

Surgical Treatment

Total Microsurgical Resection: This is the treatment of choice for Schwannomas. This procedure involves careful and meticulous removal of tumor using tiny surgical instruments and microscopes. Go here for more information on Total Microsurgical Resection.

Following the surgery, a radiotherapy is usually ordered in order to prevent recurrence of the tumor in the future.

Treatment Window

Since Schwannomas are generally not life threatening, a surgeon might decide to wait out till the time the symptoms of Schwannomas become debilitating.

There is growing scientific evidence that long term usage of steroids and pain medication result in future complications. So, there is a tendency to remove the tumor sooner than later.

Spinal Cord Tumor

In our brain and spinal cord, there are housekeeping cells called the glial cells. There are 3 types of glial cells. One of them is called ependyma. Cancer of the ependyma is called ependymoma.

Introduction

A type of cells called glial cells do most of the housekeeping work in the brain and spinal cord. Glial cells are divided into three types: Astrocytes, Ependymal cells and Oligodendrocytes. Toxins, radiation exposure, drugs, nutrition imbalance or genetic load can cause alterations in these cells, resulting in uncontrolled growth in the form of a tumor. Tumors originating in the ependymal cells are called endymomas.

Ependymomas are usually slow growing tumors. They are usually found in the fluid-filled hollow spaces in the brain (called ventricles) and the spinal cord. At times, floating in the fluid, the tumor can also spread. Around this tumor, hardening of the tissue or some bleeding may be seen around this type of tumors.

Ependymomas of the brain is common among children. Whereas endymomas of the spinal cord are usually seen in older adults. Some times, these tumors are non-cancerous.

Complication due to Ependymomas

About 10% ependymomas are non-cancerous. They won’t spread to other parts of the body and cause trouble at multiple sites. Even with a tumor that doesn’t spread, its growth can put pressure on adjoining structures and cause complications. Lastly, some of the non-cancerous growth can eventually turn cancerous.

Symptoms of Ependymomas

Symptoms of an ependymoma depends on its location in the brain or spinal cord. Common symptoms are:

  • Headache
  • Nausea
  • Vomiting
  • Movement issues
  • Gait issues
  • Weakness
  • Loss of sensation

Diagnosing an Ependymoma

These are the standard tools used for diagnosing an ependymoma:

  • CT Imaging

    A CT scan is used in order to locate the tumor and determine its size. Bleeding in the surrounding areas, thickening of tissues and fluid filled sacs can also be identified using a CT image.

  • MRI Imaging

    An MRI image is needed to clearly visualize nerve and soft tissue involvement. MRI can also be used to locate a tumor that was missed out by the CT.

Treatment of Ependymomas

Following is the preferred order of treatment for ependymoma:

Surgical Treatment

Excision of tumor: For an ependymoma, the treatment of choice is a surgery. The surgeon removes the tumor, along with a portion of surrounding normal tissue, is carefully removed without damaging the surrounding nerves.

Tumor Debulking: Large tumors, particularly the ones that invade the surrounding tissue, are partially removed. This relieves the compression caused by the tumor on neighboring structures.

Radiation Treatment

In case of large tumors and the tumors that have spread into surrounding tissue, radiation therapy is started after debulking the tumor. This helps to destroy the remaining tumor cells as much as possible.

Chemotherapy

Chemotherapy stands for special class of drugs that are specially designed to destroy cancer cells. Chemotherapy is not very effective for most of the ependyomas.

Medical Treatment

Pharmachology is not very helpful in treatment endymomas. However, for a patient who has ependymomas, the doctor may prescribe drugs to reduce the fluid accumulation and to relieve the pain.

 

Treatment Window

Like with any cancer, detecting it early and treating it aggressively is the key to extending the longevity of patients with this disease.

Spinal Injuries Acute

Based on their location in the spine, an injury to the spine has different effects. In order to minimize the damages, spinal injuries must be attended to quickly.

Introduction

A set of 33 stacked-up bones make up the human vertebra or the human backbone. These 33 bones can be divided into 4 sets:

  • Cervical Vertebrae

    These are 5 vertebrae, named C1 to C5. Among these, C1 and C2 are the most critical as they support the skull and help in head movemenet. Unfortunately, this region is prone to injury and fracture.

  • Thoracic Vertebrae

    There are 12 thoraciv vertebrae, named from T1 to T12. The thoracic vertebrae join with the ribs and help protet the heart, lungs and other vital structures.

  • Lumbar Vertebrae

    These are a set of 5 veertebrae, named from L1 to L5. These bones help sustain the body’s weight and help with movement. This region is also prone to fracture and degeneration with age.

  • Sacral Vertebrae

    These are located at the level of the hip. They are a set of 5 bones, fused together as one. The sacral vertebra helps connect the spine to the hipbones.

Spinal Cord injuries can strike any region of the spine. Patient’s symptoms vary based on the location of the spinal cord injury. The symptoms can range from minor loss of sensation to total paralysis.

Depending on the location and mode of injury, following are types of spinal injuries commonly seen:

  • Craniovertebral Junction Injury

    Starting from the base of the skull, ending at C2 vertebrae, is called the Craniovertebral Junction.

  • Upper Cervical Spine Injury

    C1 and C2 vertebrae come under the Upper Cervical Vertebrae group.

  • Sub-Cervical Spine Injury

    Injury to the middle and lower cervical spine, that is C3 to C7 vertebral level, is known as sub-cervical spine injury.

  • Thoracic and Thoracolumbar Injuries

    Injuries to the thoracic vertebrae or T12-L1 junction vertebrae fall under this category.

  • Lumbar and Lumbosacral Injuries

    Injury to the Lumbar vertebrae is called a Lumbar Injury. Injur to the L5-S1 junction vertebrae is known as Lumbosacral Injury.

  • Penetrating Injuries

    These are very common in areas of violent crimes. These injuries are sustained after a gunshot or a stab wound in the spinal cord.

Causes of Acute Spinal Injuries

Many things can lead to a spinal trauma. Some of the most common causes are:

  • Road Traffic Accidents: Worldwide, they remain the leading cause of spine trauma.
  • Rural Accidents: In an agricultural economy like India, falling from trees, falling into uncovered wells, coconuts falling on the head of a passerby are the common causes of spinal injuries.
  • Sports Injuries
  • Gunshot Injuries

Complication due to Spinal Injuries

If Spinal Injuries are not identify early and treated, they can lead to Neurogenic Shock and Aspiration.

Neurogenic Shock

In more than half the people who undergo a spinal injury above the level of 6th thoracic vertebra, severe nervous system damage can result in dilation of the blood vessels. This can lead to severe drop in blood pressure, slowing of heart rate and breathing. If it is detected early and treated adequately, a patient may come out of this condition in one to three weeks.

However, if it is not attended to adequately, neurogenic shock can lead to organ failure and even death.

Aspiration

In severe injuries involving the cervical spine, movement and sensation of the patient below the neck region is affected. This includes the function of swallowing. If this complication is not recognized early on, food enters the airway, which leads to chocking and difficulty with breathing.

Spinal Shock

This condition arises out of nerves partly or fully losing their ability to communicate below the level of the spinal injury. Timely treatment of Spinal Injury can, at the very least, arrest the condition from getting any worse.

 

Symptoms of an Acute Spinal Injury

Symptoms of a spine injury are closely related to the location of such injury. However, few common symptoms of spine injury include:

  • Neck pain
  • Back pain
  • Weakness in one or more parts of the body
  • Paralysis of arms and/or legs or gait changes
  • Loss of reflexes
  • Uncontrolled urination
  • Uncontrolled passage of stools
  • Breathing difficulty
  • Swallowing difficulty

Diagnosis of Acute Spinal Injuies

These are the standard tools used to diagnose an acute spine injury

  • X-Ray of the Spine

    Plain X-Ray is the initial investigation tool of choice to identify a spine injury.

  • CT Imaging

    A CT produces better images than an X-Ray. From a CT image, additional information like bone, blood, bruises, cervica-thoracin juntion, etc., can be better visualized. As a matter of fact, X-Ray can even fail to pickup certain types of spine fractures.

  • CT Angiogram

    This tool is useful to study blood vessel injuries in the spine.

  • MRI Imaging

    MRI is currently the investigation of choice for spinal trauma. Disc injuries, nerve compression, fluid accumulation in the spine, bleeds, bruises and injury to other important structures in the spinal cord can be clearly spotted using an MRI.

Treatment of the Ailment

Injury of the spinal cord involves mechanical forces like compression, penetration, cuts and dislocation. So, medical management is not the main stay in management of spinal trauma.

Medical Treatment

If the patient is seen within 8 hours of injury, the patient can be put on steroid medications. This can help in recovery and in reducing the fluid accumulation that follows a spine injury. In case an infection is seen or suspected, the patient is also put on antibiotics and pain medication.

Traction

Controlled pulling of a dislocated bone back to its original position, with the help of special pins, is known as traction. Closed fractures of cervical spine can be easily corrected with the help of traction.

Surgical Treatment

Spinal Cord Decompression and Fixation

Fractures and spinal injuries that compress on nerves require early surgery. In the surgery, fractures are fixed with screws and compressed nerves are released.

Treatment Window

With early identification of spinal injuries, irreversible complications of spinal injury can be prevented. Early surgical intervention also helps in speedy recovery and prevents deformities.

Spine TB (Tuberculosis)

Tuberculosis (TB) is an infectious disease caused by a bacterium called Mybacterium Tuberculosis (MTB). It usually affect the lungs. With time, the bacterium can spreads to other parts of the body including the spine. TB can affect people all ages and sexes. TB of the spine is sometimes called the Pott’s disease, named after a British surgeon, Percival Pott.

Introduction

 

Types of Spinal TB

Depending on the location of the spine infected by the TB, there are four lesion (a lesion is a damaged tissue).

  • Paradiscal Type

    This type of tuberculosis start on the edges of the vertebra (bone in the spinal cord) and then spread towards the center. Hence, it is called a paradiscal (around the disc) type.

  • Central Type

    This tuberculosis starts in the centre of the spinal cord and spreads towards the edges gradually. Since the center of the vertebre is affected first, it leads to compression, collapse and deformities of the bone of the spinal cord.

  • Anterior Type

    This type of tuberculosis usually affects the structure connecting two vertebral bones. So, this type of infection can spread up or down the spinal cord. This infection eats up the front and sides of the vertebral bones.

  • Appendiceal Type

    This type of tuberculosis affects the structures providing back and side support of the vertebral bones.

Complications due to Spinal TB

Abscess (bag of pus) of the infection, inflamed (swollen) parts of the spinal cord, affected bone or vertebra can press on the nerves passing through the spine. When this happens, the part of the body served by these nerves (like arms, legs, etc.) become weak or paralyzed.

Symptoms

When the tuberculosis bacteria leave the lungs and enter the blood, infection starts. This has various responses in the body:

  • Fever
  • Weight loss
  • Muscle pain
  • Sweating at night
  • Lack of interest in eating

As the bacteria in the blood settle down on the backbone and start eating it up, the patient can experience the following:

  • Back pain
  • Spine stiffness
  • Sudden cramping pain in the back muscle
  • Mass felt in lower back
  • Angulation of the spine

If the infection is left untreated, the backbone is destroyed and pieces of the bone start pressing on the nerves of the spinal cord. This leads to symptoms like:

  • Weakness or paralysis of legs
  • Calf pain
  • Tingling sensation of the feet

Investigations

Here are the standard investigations the doctors conduct in order to assess the existence and nature of the disease:

  • X-Ray of the Spine

    A simple X-Ray of the spine can quickly identify locations of the spine destroyed by the tuberculosis bacteria.

  • CT Scan of the Spine

    Because it produces much more detailed images, aA CT Scan of the spine can pickup a spinal TB at an earlier stage than X-Ray

  • MR Imaging of the Spine

    MRI clearly shows the effect of TB on the nerves. X-Ray or CT Scan can’t provide this information.

Treatment of the Spine TB

We are fortunate indeed to be living in the era of effective antibiotics. Before antibiotics, TB killed large number of people it injected. Mathematician Ramanujan was a famous victim of tuberculosis. Even with antibiotics, eradication of TB from the body takes a long time.

Medical Treatment

If the spread of the TB is not severe, anti-tuberculosis medication is used to stop and growth of tuberculosis bacteria and then to kill them. The treatment usually stretches for 6 to 9 months to obtain a complete cure.

Surgical Treatment

  • When patients with TB of the Spine do not respond to medical treatment satisfactorily, a surgeon physically removes tissue affected by TB. After this, the drug therapy is usually more effective.
  • In advanced stages of Spinal TB, where nerves are compressed, resulting in weakness of the limb or paralysis, a spinal decompression surgery is preformed to release the compressed nerves.

Go here for more information on surgical treatment for the TB of the Spine

Treatment Window

Early treatment can save ones spine, arms and legs. If left untreated, the bacteria eats up the back bone, causing compression of spinal nerves, leading to paralysis.

Spontaneous Intracerebral Hemorrhage

An ongoing bleeding is called a hemorrhage. Sometimes, this can suddenly occur in the brain. It is called a “Spontaneous Intracerebral Hemorrhage”.

Introduction

Hemorrhage is an ongoing bleeding. When the bleeding has already happened, it is called a hematoma.

Hemorrhage in the brain causes the blood to seep into the brain tissue, causing many inflammatory reactions to take place. This ultimately interrupts the blood flow to some parts of the brain. This leads to a condition called stroke, where brain tissue starving blood supply starts to die out and corresponding brain function is suddenly lost. Such loss of function an be permanent or temporary.

This condition, called a Spontaneous Intracerebral Hemorrhage, accounts for 10-30% of all stroke cases. However, the leading cause of stroke is blockage of blood vessels by blood clot, fat, etc.

Causes of Spontaneous Intracerebral Hemorrhage

Here are the common causes of Spontaneous Intracerebral Hemorrhages

  • High Blood Pressure

    A sudden uncontrollable increase in blood pressure can cause arteries to burst, leading to a hemorrhage. This can also happen to the arteries in the brain. Patients who often skip their blood pressure medication are at an increased risk for this type of event.

  • Weak Blood Vessels

    Blood vessels weakend by normal aging and other causes can sometimes expand like a balloon. These blood vessels are always in the verge of bursting anytime, leading to a hemorrhage.

  • Trauma

    Severe head traumas (injuries) can lead to bleeding inside the brain.

  • Bleeding Disorders

    Patients with bleeding disorders like hemophilia are very prone to intracerebral hemorrhage. This can happen due to reasons like minor head injuries, uncalibrated consumption of blood thinners, etc.

Complication due to Spontaneous Intracerebral Hemorrhage

If left untreated, an intracerebral hemorrhage can grow in size, leading to injury and swelling (inflammation) of the brain. It leads to extensive damage and death to the brain tissue.

If the treatment is delayed, damage to the brain tissue becomes irreversible. Based on the part of the brain tissue affected, the patient can lose speech, movement control, weakness of limbs, paralysis, etc.

Symptoms of Spontaneous Intracerebral Hematomas

Common symptoms of intracerebral bleed are:

  • Severe Headache
  • Vomiting
  • Increased blood pressure
  • Altered level of consciousness
  • Sudden loss of function in one part of the body
  • Seizure
  • Confusion
  • Trouble with vision

Tools to Diagnose an Intracerebral Hemorrhage

These are the standard tools to diagnose and further investigate an intracerebral hemorrhage:

  • CT Scan

    This is the best imaging modality to confirm the presence of intracerebral hemorrhage. By frequently making CT images of the injured portion, doctors can also ascertain growth in hemorrhage, if any.

  • MRI Imaging

    An MRI is as sensitive as CT in detecting a bleed. It also helps to locate abnormal blood vessels, bleeding tumors, blood vessel obstructions, etc.

  • Angiography

    This is a more sensitive tool to diagnose blood vessel abnormalities. When a patient comes up with no obvious causes for a bleeding, the doctor may order for an angiography.

Treatment for Intracerebral Hemorrhage

Here are the standard treatments for a intracerebral hemorrhage.

Medical Treatment

All intracerebral patients with high blood pressure are treated to bring it down. Additional medication is also given to reduce the pressure within the brain and to divert fluid out of the brain.

Additionally, these patients may also be given supplements containing Vitamin K, which helps to stop bleeding.

Lastly, as an additional precaution, seizure control medication is given to these patients at least for a month following a hemorrhaging event.

Surgical Treatment

There are two common surgical treatments to manage an intracerebral hematoma

Decompressive Craniotomy

This technique is most helpful to treat an intracerebral bleed. In this technique, the skull is opened with special equipment and the leaking blood is drained out. Bleeding points are also identified and the bleeding is arrested using controlled heat. Go to this page to learn more about decompressive craniotomy.

Endoscopic Aspiration

Specilized flexible tubes are inserted into the brain. A camera is attached at the end of this tube, which helps the surgeon to identify the exact bleeding point and suck the bleed out.

With the help of specialized fine flexible tubes inserted into the brain, small bleeds are effectively sucked out. A camera

Treatment Window

If surgical intervention happens within 4 hours of the bleed, there are high chances of re-bleeding.

However, if an attempt is made to remove the bleed within 12 hours, particularly when it is performed using less invasive techniques like endoscopy, there are high chances of an improvement of the condition.

Subdural Empyema

The outermost layer of protective tissue around the brain and the spinal cord is called dura mater. Bacterial infection and formation of pus underneath this layer is called Subdural Empyema.

Introduction

 

Three thin tissue layers, namely the dura mater, arachnoid mater and pia mater, protect and nourish the brain and spinal cord. “Dura mater” in Latin means “hard mother”. It is the outermost layer and protects the brain. Below the dura is the arachnoid (spiderweb like) mater. It contains blood vessels and supplies nutrition to the brain. The pia mater attaches itself to the brain and spinal cord, covering it.

Infection from other organs like the ear, nose or throat, may disintegrate from their location, travel through the blood vessels to the arachnoid space and from there seeps into the dura mater, forming a collection of pus. This collection is called subdural empyema. Children are more commonly affected than adults.

Complication due to Subdural Empyema

Subdural empyema is a rare, but serious illness. This is because bacteria entering the brain lead to the following complications:

  • Release toxins that directly damage the brain tissue.
  • Forms pus collection that obstructs blood vessels, leading to loss of blood supply to the brain, and formation of blood clots, hence damaging the brain.
  • The brain tissue starts fighting the bacteria by releasing various inflammatory substances, which ultimately cause the brain to retain fluid, leading to brain swelling and increased pressure within the brain.
  • Superficial abscess over the skull.

Because the disease affects the brain in more than one way, the patients may quickly progress to coma and death, if left untreated. This calls for early diagnosis and treatment.

Symptoms

Symptoms of the Subdural Empyema depend on the part of brain affected by the infection. They include:

  • Inability to think clearly or concentrate
  • Headache
  • Nausea
  • Vomiting
  • Speech problems
  • Weakness
  • Seizures

Investigations

These are the standard investigations, of escalation clarity, carried out to assess the existence and status of Subdural Empyema:

  • Ultrasound Sonography

    An Ultrasound Scan is the choice of investigation, particuarly with children who are suspected to have a subdural empyema.

  • Radio Isotope Scan

    A small dose of radioisotope is injected into the patient’s vein and the movement/acumulation of the radioisotope in the head is pictured using a special camera. If there is empyema, it shows up in the picture as a patch of radioisotope.

  • CT Scan

    A CT Scan can also be used to locate a subdural empyema. Sometimes, in order to enhance the CT image, the patient may be given a contrast die before the imaging is done.

  • MRI Imaging

    MRI imaging is used to image the soft tissue, particularly the nerves, etc.

Treatment for Subdural Empyema

Antibiotics is the first line of treatment for a subdural empyema. However, in more severe cases, or when the empyema refuses to respond to antibiotics sufficiently, a surgery may be preferred in order to physically remove the cavity of pus.

Medical Treatment

Bacteria causing infection is identified using blood tests, and appropriate antibiotic therapy is given to kill the offending organism. Medications either heal the lesion completely or help prevent spread to surrounding areas.

Surgical Treatment

There are two main surgical solutions available to treat a Subrual Empyema:

  • Surgeon may perform a Craniotomy (cutting through the skull bone), reach underneath the dura mater, and then remove the empyema.
  • Alternatively, the surgeon can also suck out (aspirate) the pus using a suitable equipment.

Go here for more information on surgical treatment for the ailment

Treatment Window

If the diagnosis or treatment of subdural empyema is delayed, it can lead to serious neurological complications like paralysis, coma or death.

Subdural Hematoma

The brain is a delicate organ. It is protected by a thick outer covering, known as dura mater. A bleed, in the space beneath the dura mater is known as a subdural hematoma.

Introduction

When the head lands against a hard object, small vessels below the dura mater are injured, causing a bleed, leading to a hematoma.

A hematoma often occurs along with a brain contusion. Men are two to four times more likely affected than women.

Complication due to Subdural Hematoma

A subdural hematoma can expand or compress important structures in the brain, sometimes causing death of certain brain tissues.

Another complication is its tendency to cause fluid accumulation in the brain. This leads to brain swelling and increased pressure within the brain. This is a serious complication as it can lead to coma or death when it is not treated early.

Symptoms of Subdural Hematoma

Symptoms depend on the severity of the bleed. Here are the typical symptoms of a subdural hemotam, listed in the order of escalating severity:

  • Headache
  • Nausea
  • Vomiting
  • Stiffness of neck
  • Changes in gait
  • Loss of balance
  • Seizures
  • Weakness in one half of the body
  • Unconsciousness
  • Coma

Diagnosis of Subdural Hematoma

Here is the list of typical tools used for diagnosing an incident of Subdural Hematoma:

  • CT Scan

    On CT scan, a subdural bleed appears as a whitish patch, with a crescent shape. The presence of contusions in other parts of the brain and any fluid accumulation can also be identified in a CT scan.

  • MRI Scan

    A MRI is very quick in taking pictures of the brain (in an irritable, restless patient with head injury, a CT can give erroneous results as the patient moves). Moreover, an MRI can easily pick up even small contusions and bleed, which may be missed on a CT. However, if the patient is known to have metallic implants inside the body, an MRI should be avoided.

  • Radionuclide Tracers

    There is a specialized CT imaging technique in which certain harmless radionuclide chemicals are injected through the vein. This enters the blood vessels in the brain and helps the surgeon clearly visualize the blood flow inside the brain.

Treatment of Subdural Hematoma

Small hematomas can be left untouched. They heal on their own in time. Hematomas that cause swelling of the brain can first be treated with medications. But, hematomas that keep growing in size, and that do not respond to medications, need surgical intervention.

Medical Treatment

Drugs that take away fluids from the brain and drugs that maintain the blood pressure are the main stay of treatment for hematoma. Other than that, nerve protective medications are also given.

Surgical Treatment

Surgical treatments for subdural hematoma fall into two categories:

  1. Decompressive Hemicraniectomy: With this surgery, a small portion of skull above the area of bleed is remove. This relieves the pressure inside the brain. The damaged tissue in the brain is allowed to heal without getting squeezed inside the skull. Often, when the skull is opened, the surgeon also sucks out the bleed.
  2. Craniotomy with or without Duraplasty: Under this procedure, a large opening is made in the skull and the hematoma is evacuated. Any point of bleed is burnt using controlled heat. Once the bleed is removed, the dura mater is repaired using a muscle path and the skull is closed.

Treatment Window

Large, expanding hematomas can compress on vital blood vessels in the brain, leading to death of the brain tissue in the affection part of the brain. So, a subdural hematoma must be identified and treated early before complications arise.

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TB (Tuberculosis) of the Brain

Tuberculosis (TB) is an infectious disease caused by a bacterium called Mybacterium Tuberculosis (MTB). It usually affect the lungs. With time, the bacterium can spreads to other parts of the body including the brain. TB can affect people all ages and sexes.

Introduction

In the brain, tuberculosis forms what we call a tuberculoma. Tuberculomas vary in size and shape. They may be single or multiple. In the mature form, a tuberculoma is firm, hard to touch, and grayish-yellow in color. Tuberculoma usually does not contain any blood vessel. A capsule of tuberculoma is a piece of compressed, damaged brain tissue. A neurosurgeon’s job is to take out these tuberculomas.

Types of Tuberculoma

If the TB proves difficult to deal with medically, then a neurosurgeon works on physically removing the tuberculomas from the brain. To do that, it is important to know what kind of tuberculoma one is dealing with.

  • Tuberculoma en plaque

    This tuberculoma looks like a plaque. This type of tuberculoma has increased blood vessels (other tuberculomas don’t have blood vessels). Surgeon must keep this in mind while removign the plaque-like tuberculomas.

  • Tuberculous Abscess

    These tuberculomas contain pus and resemble a brain abscess. This type of tuberculoma is common in India

  • Cystic Tuberculoma

    These tuberculoma are in the form of a cyst. They are filled with clear yellow or cloudy green fluid, depending on the stage of infection. These tuberculomas are relatively rare.

  • Multiple Grape-like Tuberculomas

    Very rarely, multiple, immature tuberculomas are observed. They group together, resembling a cluster of grape.

  • Mictotuberculomas

    This type of tuberculoma is seen as a small disc or ring around 5mm to 7mm in diameter. These are common in India.

  • Calcified Tuberculomas

    With time, a tuberculoma can calcify into a hard mass. Although calcified, they are still infectious.

  • Tuberculous Encephalopathy with an “Inconsequential” Tuberculoma

    Sometimes, brain damage is seen in children with a small or no lession at all. This is usually because of an allergic reaction to some proteins relseased by the TB bacteria. In these cases, a biopsy of the brain tissue usually help to confirm the presence of TB.

Symptoms

Here are some of the common symptoms of Brain TB:

  • Fever
  • Seizures
  • Headache
  • Vomiting
  • Nausea
  • Gait problems
  • Speech Disturbances
  • Vision Problems
  • Weakness
  • History of exposure to lung TB
  • Evidence of TB elsewhere in the body

Investigations

Here is the usual set of investigations carried out to find out of one has TB and how it has affected the body.

  • Blood Test

    ESR (Erythrocyte Sedimentation Rate) is usually raised when there is any kind of infection in the body, including TB. So, a doctor orders a blood test to determine the ESR. But TB is a tricky one. One can have TB even with normal ESR.

  • Mantoux Test

    A protein component of TB bacteria is injected into the skin of the forearm. If one has TB, the injection site becomes red in color. Trouble with this test is that it can give false-positive results.

  • Chest X-Ray

    TB very rarely occurs without a lung infection. So, when the doctor suspects presence of TB, they always order a Chest X-Ray to determine if there is evidence of TB in the lungs.

  • CT of the Brain

    CT imaging of the brain helps the doctor/surgeon to idenitfy she size, shape, location and number of lesions (damaged patches of tissue) in the brain. CT can also visualize calcification clearly.

  • MRI of the Brain

    MRI images help the doctor/surgeon to see the stages of brain lesions clearly.

  • Stereotactic Biopsy

    Under the CT guidance, using a fine needle, a small portion of the affected brain tissue (lesion) is taken out and studied under a microscope. This help in definitive diagnosis of TB in the brain.

Treatment of the Brain TB

Doctors usually prefer to deal with TB medically. When that fails, or when the TB has already spread dangerously, a decision to surgically remove the TB affected tissue is preferred.

Medical Treatment

Medication that kill or stop the growth of TB bacteria are known as anti0tubercular drugs. Usually, an anti-tuberculor drug, combined with steroidal medications, lead to healing of the TB affected tissue in 10 to 12 weeks’ time. If the patch of affected tissue is large, then complete healing might take up to 6 to 8 months.

Surgical Treatment

  • Small and easily accessible tuberculomas (tissue hardened by TB) can be removed by excision.
  • With large tuberculomas, an ultrasonic aspirator (or CUSA) is used to suck out the TB affected tissue, without affecting the surrounding normal area.

Go here for more information on surgical treatment of Brain TB.

TB (Tuberculosis) of the Spine

Tuberculosis (TB) is an infectious disease caused by a bacterium called Mybacterium Tuberculosis (MTB). It usually affect the lungs. With time, the bacterium can spreads to other parts of the body including the spine. TB can affect people all ages and sexes. TB of the spine is sometimes called the Pott’s disease, named after a British surgeon, Percival Pott.

Introduction

 

Types of Spinal TB

Depending on the location of the spine infected by the TB, there are four lesion (a lesion is a damaged tissue).

  • Paradiscal Type

    This type of tuberculosis start on the edges of the vertebra (bone in the spinal cord) and then spread towards the center. Hence, it is called a paradiscal (around the disc) type.

  • Central Type

    This tuberculosis starts in the centre of the spinal cord and spreads towards the edges gradually. Since the center of the vertebre is affected first, it leads to compression, collapse and deformities of the bone of the spinal cord.

  • Anterior Type

    This type of tuberculosis usually affects the structure connecting two vertebral bones. So, this type of infection can spread up or down the spinal cord. This infection eats up the front and sides of the vertebral bones.

  • Appendiceal Type

    This type of tuberculosis affects the structures providing back and side support of the vertebral bones.

Complications due to Spinal TB

Abscess (bag of pus) of the infection, inflamed (swollen) parts of the spinal cord, affected bone or vertebra can press on the nerves passing through the spine. When this happens, the part of the body served by these nerves (like arms, legs, etc.) become weak or paralyzed.

Symptoms

When the tuberculosis bacteria leave the lungs and enter the blood, infection starts. This has various responses in the body:

  • Fever
  • Weight loss
  • Muscle pain
  • Sweating at night
  • Lack of interest in eating

As the bacteria in the blood settle down on the backbone and start eating it up, the patient can experience the following:

  • Back pain
  • Spine stiffness
  • Sudden cramping pain in the back muscle
  • Mass felt in lower back
  • Angulation of the spine

If the infection is left untreated, the backbone is destroyed and pieces of the bone start pressing on the nerves of the spinal cord. This leads to symptoms like:

  • Weakness or paralysis of legs
  • Calf pain
  • Tingling sensation of the feet

Investigations

Here are the standard investigations the doctors conduct in order to assess the existence and nature of the disease:

  • X-Ray of the Spine

    A simple X-Ray of the spine can quickly identify locations of the spine destroyed by the tuberculosis bacteria.

  • CT Scan of the Spine

    Because it produces much more detailed images, aA CT Scan of the spine can pickup a spinal TB at an earlier stage than X-Ray

  • MR Imaging of the Spine

    MRI clearly shows the effect of TB on the nerves. X-Ray or CT Scan can’t provide this information.

Treatment of the Spine TB

We are fortunate indeed to be living in the era of effective antibiotics. Before antibiotics, TB killed large number of people it injected. Mathematician Ramanujan was a famous victim of tuberculosis. Even with antibiotics, eradication of TB from the body takes a long time.

Medical Treatment

If the spread of the TB is not severe, anti-tuberculosis medication is used to stop and growth of tuberculosis bacteria and then to kill them. The treatment usually stretches for 6 to 9 months to obtain a complete cure.

Surgical Treatment

  • When patients with TB of the Spine do not respond to medical treatment satisfactorily, a surgeon physically removes tissue affected by TB. After this, the drug therapy is usually more effective.
  • In advanced stages of Spinal TB, where nerves are compressed, resulting in weakness of the limb or paralysis, a spinal decompression surgery is preformed to release the compressed nerves.

Go here for more information on surgical treatment for the TB of the Spine

Treatment Window

Early treatment can save ones spine, arms and legs. If left untreated, the bacteria eats up the back bone, causing compression of spinal nerves, leading to paralysis.

Trigeminal Neuralgia: Excruciating Facial Pain due to Nerve Damage

When something damages the trigeminal nerves, the face/forehead area becomes susceptible to severe pain. Solutions vary from chemically attenuating the pain nerves to repairing the nerve damage through surgery.

Introduction

There is a nerve bundle called trigeminal nerve. It controls the sensation and movement in our face.

The nerve bundle comes out of the rear side of the brain and divides into three branches. Each branch has two types of nerves. One for sensation and another for movement control (tri = three, geminal = two).

When something like an errant blood vessel, tumor, or an unknown reason damages these nerves, the part of the face supplied by the affected nerve become super-sensitive to pain. Even a light sensation, like washing the face or chewing something can feel like being stabbed.

This pain called by defunct trigeminal nerve is called “Trigeminal Neuralgia”.

In some cases, the pain can appear spontaneously, then vanish without warning, only to come back again after hours, days, weeks or months. This is identified as Type-1 Trigeminal Neuralgia or TN1. In other people, the pain exists as a persistent dull pain. This is called Type-2 Trigeminal Neuralgia or TN2.

People over 60 are more susceptible to it. Similarly, women have higher chances of getting this condition than men. The right of the face has 5 times higher chances of TN pain than the left.

Complication due to Trigeminal Neuralgia

Trigeminal Neuralgia is not a life-threatening disease. But when the pain attacks, patients excruciating and find it unbearable. Most of them can’t focus on day to day life. Some cannot even go to sleep.

Lack of focus, rest and sleep can seriously affect the patient’s quality of life. Also, if the patient is administered a long course of steroidal or pain-relieving medication, they have their own adverse side effects.

Symptoms of Trigeminal Neuralgia

Trigeminal neuralgia is marked by severe, sharp facial pain. Apart from this, patients may also experience:

  • Numbness over some areas of the face
  • Pins and needles sensation over the face
  • Increased facial sensitivity
  • Toothache
  • Sudden involuntary facial twitches

Investigations

Trigeminal Neuralgia is primarily diagnosed through clinical observations.

TN pain is seen in the area addressed by the trigeminal nerve. It can occur repeatedly, from fraction of a second to lasting up to 2 minutes.

The pain intense and sharp. It can be superficial or stabbing. It can be spontaneous or triggered by something specific.

Persons affected by trigeminal neuralgia try to protect their face from being touched. If the patient rubs or holds the face to lessen the pain, then it is probably not TN. The source of the pain may well be a toothache.

If there is some weakness in the jaw muscle or the eye doesn’t blink when the white of the eye is touched, then the TN is probably caused by something crushing on the Trigeminal nerve. To find out what is crushing the Trigeminal nerve, the doctor may order an MRI imaging study.

If there is no weakess in the jaw muscle, or the eye does blink when the cornea is touched, then it must be concluded that the source of TN is idiopathic (source unknown).

 

Treatment for Trigeminal Neuralgia

Based on the nature of the condition, multiple options are available for treating Trigemial Neuralgia.

Medical Treatment

All patients suffering form Trigeminal Neuralgia end up going on pain relieving drugs. This doesn’t correct the condition. It only treats the symptoms.

  • If a patient with multiple sclerosis reports of TN pain, then the MS drug lamotrigine may help them
  • If the patient has no known cause for TN, then they usually respond to anticonvulsant drugs.

Patient who don’t respond to medical treatment may be recommended for interventional or surgical treatment.

Interventional Procedures

Several interventional procedures are available for Trigeminal Neuralgia. Of these, Glycerol Rhizotomy is the most promising.

Glycerol Rhizotomy: Glycerol is injected at a particular point on the face. As the trigeminal nerve is bathed in glycerol, it selectively destroys the pain fibres that fire improper signals.

Radio Frequency Ablation: In this procedure, high frequency heat is used to target the traigeminal nerve and thereby the ability of the nerve to transmit pain is destroyed. The procedure is very effective but the pain may re-occur after 2 years.

Balloon Compression: With help of a tiny balloon, the part of the trigeminal nerve that transmits pain signals to the brain, is compressed. As the balloon is inflated, the nerve is compressed. Once the procedure is complete, the balloon is deflated and removed out of the skull. 9 out of 10 patients respond to this treatment procedure. However, recurrence is  common.

Cryotherapy: In this procedure, nerve fibers firing improper signals are frozen, and deactivated.

Accupuncture: Placing acupuncture needles at specific points on the face, provides immediate relief from symptoms of neuralgia. This technique is much effective when combined with medical treatment with anticonvulsant drugs.

Surgical Treatment

Two surgical options are available for Trigeminal Neuralgia.

Microvascular Decompression: This is a minimally invasive procedure. It is used when a blood vessel compresses upon the trigeminal nerve. In this technique, using an endoscope, the blood vessel and nerve is simply separated using a teflon patch.

Gamma Knife Radiosurgery: This is a painless minimally invasive procedure that uses precise focused radiation beams to selectively deactivate pain fibers in the trigeminal nerve.

Treatment Window

Treatment should be initiated, as soon as the condition is identified, and the diagnosis confirmed. Delayed intervention results in frequent, severe pain attacks that interferes with day-to-day activities.

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Vertebral, Hemangioma: Tumor of the Blood Vessels in Backbone

Non-cancerous tumors of the blood vessels are called hemangiomas. When they occur in the backbone, they are called vertebral hemangiomas.

Introduction

When a type of cells in the blood vessels called the endothelial cells grow abnormally, they form a type of tumor called hemangioma. Hemangiomas are non-cancerous (benign). Most of the time, they don’t even cause any symptoms. Often, a hemangioma is discovered accidentally during a CT Scan carried out for some other purpose.

A hemangioma in the backbone is called a vertebral hemangioma. It is usually found in the mid or lower back (i.e. lumber or thoracic) regions. Vertebral hemangiomas are more common in women.

Complication due to Vertebral Hemangioma

When a vertebral hemangioma occurs together with hemangiomas elsewhere in the body, they can create problem by bleeding.

If it is present in pregnant women, the tumor enlarge during the 7th to 9th month and may complicate pregnancy. Even though they usually resolve after delivery, if they are not surgically removed, they most probably recur during the subsequent pregnancies.

Symptoms of Vertebral Hemangioma

Hemangiomas usually do not produce any symptoms. They are often identified during a CT or an MRI scan conducted for some other purpose.

In a rare occasion where a patient with a vertebral hemangioma produces symptoms, they include:

  • Back pain, radiating to the legs
  • Weakness or numbness of muscles

Diagnosis of Vertebral Hemangioma

Here are the standard tools used for detecting and diagnosing a vertebral hemangioma:

  • X-Ray

    As the vertebral hemangioma erodes the bone, a honeycomb like appearnace is seen in the X-Ray

  • CT Imaging

    As the tumor invates the backbone, various changes happen inside. In a CT image, this looks like a polka dot (white dots on black background).

Treatment of Vertebral Hemangioma

There is no medical treatment for hemangiomas. But if the tumor causes pain, a doctor may prescribe medication to temporarily relive the pain.

Surgical Treatment

Embolization, followed by Radical Excision: In embolization, the blood vessels feeding the tumor are sealed by injecting a glue, plastic material or a metallic coil into them. This stops the blood flow to the tumor and ultimately the tumor dies. After the tumor death, the remnant can be removed surgically.

Treatment Window

Since this is a benign tumor, it is treated only when it gives some trouble (like back pain, etc.). Otherwise, the risk of surgery far outweighs the benefits of having the tumor removed.