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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