Neurological Patient Education
Arachnoid cysts are fluid filled sacs that grow from the arachnoid membrane, a thin layer that covers the brain and spinal cord. Some arachnoid cysts are present from birth while others develop later in life as a result of head injury, tumors, meningitis or brain surgery. Symptoms are related to the size and location of the arachnoid cyst and include: headache, nausea/vomiting, seizures, hearing or visual changes, vertigo and difficulties with balance. For arachnoid cysts around the spinal cord, symptoms are different and include numbness, tingling or pain in the arms, legs or back.
Arachnoid cysts are usually diagnosed with a CT scan or MRI. Treatment depends on the size and location of the arachnoid cyst. More often, neurosurgeons are using minimally invasive techniques to drain the arachnoid cysts without large incisions or risking damage to surrounding brain tissue.
The prognosis for arachnoid cysts also depends on the size and location of the cyst. Prompt treatment can avoid some of the potential complications such as bleeding or compression of the brain or spinal cord.
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A brain tumor is an abnormal growth of cells within the brain. Brain tumors can be either primary, meaning they arise from the brain itself, or metastatic, meaning they spread from a tumor located elsewhere in the body.
Brain tumors cause injury by destroying normal brain cells, causing inflammation and increasing the pressure within the skull. Some brain tumors grow quickly while others develop very slowly. Brain tumors are classified by several criteria including: location, type of cells, and whether they are benign or malignant growths. Tumors occur in all age groups but in the adult population, gliomas and meningiomas are most common.
Gliomas include oligodendrogliomas, astrocytomas and gliobastomas. There is great variability within this group as to invasiveness and prognosis. The second major category of brain tumor, meningioma, tends to be less aggressive and are usually classified as benign. There are several other types of brain tumors including: ependymomas, craniopharyngiomas, pituitary tumors, lymphoma of the brain, pineal gland tumors and primary germ cell tumors. Some of these tumors grow very rapidly while others grow over years and do not give any symptoms until they are very large.
The symptoms of a brain tumor are related to the size and location of the tumor as well as how much swelling is associated with it. Symptoms include: headache (especially during sleep and on wakening), vomiting (typically in the morning), seizures, weakness or change in mental function. Brain tumors may also cause sleepiness, changes in any of the senses, confusion, difficulty reading, writing or talking, tremor, loss of bladder of bowel control, loss of coordination, numbness or tingling.
Brain tumors are diagnosed with CT scans or MRIs. In addition, several other tests, including a brain biopsy, may be required to identify the specific type of tumor which will then help guide treatment. In the case of metastatic brain tumors, it is important to identify the primary tumor elsewhere in the body. Metastatic brain tumors generally come from lung cancer, breast cancer, skin cancer, kidney cancer, bladder cancer and a few others. Once the abnormal cells reach the brain and begin growing, they can cause the same brain injury as a primary brain tumor.
Treatment of brain tumors involves a team approach with a neurosurgeon, oncologist, neuroradiologist, and radiation therapist. Treatment options include surgery (typically a craniotomy), chemotherapy, medications, radiation therapy, and physical therapy. Treatment is guided by the type and location of brain tumor as is prognosis.
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A cavernous malformation is one type of blood vessel anomaly that can occur within the brain. These typically appear as a well-defined, compact mass of blood vessels that do not involve any brain tissue. Sometimes cavernous malformations cause symptoms in patients while other times, they are found incidentally on brain imaging done for other reasons.
Cavernous malformations can cause seizures or pressure on surrounding brain tissue. Typically, these lesions bleed in small amounts from time to time, months or years apart. Usually these malformations are small but if they are of larger size, they can result in more bleeding and more symptoms.
Treatment of cavernous malformations depends on the severity of symptoms as well as location and overall health of the patient. Some cavernous malformations can be resected with traditional surgical techniques or stereotactic radiosurgery.
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Chiari Malformations describes a group of conditions in which the cerebellum, the part of the brain just above the nape of the neck, sits below the opening between the skull and the spinal canal. Normally, the cerebellum sits entirely within the skull. Chiari Malformation can be a result of a smaller than usual lower portion of the skull. A Chiari Malformation can cause blockage of the flow of cerebrospinal fluid (CSF), which leads to increased pressure around the brain. Chiari Malformations usually arise during early development. There are types of Chiari Malformation, depending on how far into the spinal canal the lower parts of the cerebellum have extended.
Patients with Chiari Malformation may have any or none of the following symptoms: neck pain, balance problems, weakness, numbness, vomiting, headache or coordination problems. Chiari Malformation can also be associated with other conditions including: hydrocephalus, spina bifida, or syringomyelia to name a few. Sometimes, Chiari Malformation is diagnosed incidentally, via brain imaging done for other purposes. Chiari Malformation is usually diagnosed with an MRI or CT scan. Sometimes bony abnormalities can be seen with X-rays.
Treatment for Chiari Malformation depends on the severity of symptoms. Sometimes people are treated symptomatically with pain medications. In other instances, Chiari Decompression may be performed to create more space for the cerebellum and relieve pressure on the spinal column.
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An epidural hematoma is a collection of blood that forms between the skull and the thick membrane that covers the brain (the dura). Epidural hematomas generally result from a serious head injury, such as an automobile accident. These tend to occur in younger people and occur when a skull fracture causes rupture of a blood vessel. The ruptured blood vessel, usually an artery, quickly leads to a growing pool of blood which compresses the brain. Symptoms of an epidural hematoma develop rapidly and include: confusion, loss of consciousness, dizziness, headache, nausea/vomiting, or weakness. Epidural hematomas are diagnosed with CT scans.
Even with prompt neurosurgical treatment, which involves removing the hematoma and relieving the pressure from the brain, there is a significant risk of death and disability. Your surgeon will decide which surgical approach, craniotomy or otherwise, would best address your condition. Medications for seizure control and rehabilitation are often part of the recovery process.
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Hydrocephalus is a build-up of the cerebrospinal fluid (CSF) that surrounds the brain. This fluid generally nourishes the brain and cushions it from the skull. Normally, this fluid is produced and reabsorbed. However, if reabsorption is blocked or if too much CSF is produced, the fluid builds up and causes swelling of the brain's ventricles. When the brain is under such pressure, it is pushed against the skull and can result in injury to brain tissue.
Symptoms of hydrocephalus can include headaches, seizures, and balance difficulties. Hydrocephalus can be diagnosed with a CT scan. Treatment depends on the cause of the hydrocephalus, if it can be defined. Typically, treatment involves medications or shunt placement to drain the extra CSF. Shunts, however, often need to be revised because of blockages or infections.
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Pituitary tumors arise from the pituitary gland of the brain, which regulates several hormones of the body. These tumors are generally benign adenomas that do not spread to other areas. The symptoms associated with a pituitary tumor depend on the size and type of adenoma. Larger pituitary tumors can cause compression of the surrounding brain structures, leading to vision loss, headache, or nausea/vomiting.
For pituitary tumors that affect hormone levels, the symptoms experienced relate to the specific type of hormones secreted or lost because of the adenoma. These symptoms can include: fatigue, weakness, cold intolerance, sexual dysfunction, constipation, weight loss or weight gain, enlarged hands and feet, high blood pressure, changes in menstrual cycle, lactation.
Typically, pituitary tumors are evaluated with a combination of brain imaging such as MRI, vision testing and blood tests checking levels of various hormones. Treatment depends on the size and symptoms caused by the pituitary tumor. There are different treatment options which include medications and surgery to remove the tumor. Treatment is directed by a neurosurgeon and an endocrinologist in conjunction with a patient's primary care doctor.
Surgery is reserved for those pituitary tumors that are compressing nearby brain structures or those that are overproducing hormones. There are two main approaches used to remove these tumors. Surgeons can either access the tumor through the nose via Transsphenoidal Surgery, leaving no visible outside scar. For larger tumors, surgeons may opt to use a craniotomy, which involves making an incision in the scalp and open the skull.
Other treatment options include radiation therapy, stereotactic radiosurgery, medications or careful observation in which the pituitary tumor is periodically monitored without treatment. This option is typically reserved for those individuals who are not experiencing any symptoms.
The prognosis for pituitary tumors or pituitary adenomas is generally good thanks to the many effective treatment options.
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Seizures are caused by abnormal firing of electrical impulses by the neurons of the brain. There are several different types of seizures, some can cause of loss of consciousness while others cause only abnormal movements of the body. Epilepsy is a syndrome of repeated seizures that are not caused by another medical condition. The type of seizure a person experiences is related to the part of the brain where the seizure, or the abnormal impulses, began. The treatment for seizures begins with medications and a wide variety of anticonvulsants are available. For patients who do not experience adequate seizure control with medications, surgery may be an option if your neurologist is able to identify the particular area of the brain that is generating the seizure activity. A neurosurgeon can either remove, the specific area causing the seizures and typically does this without causing any major impairments. Another surgical treatment options involves implantation of a Vagal Nerve Stimulator (VNS). A Vagal Nerve Stimulator is a small device that prevents seizures by sending electrical impulses to the brain by means of the vagus nerve, a nerve that passes through the upper chest.
Seizures can often be difficult to control and may require a combination of treatment options or medications to achieve good results.
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A stroke describes a condition of lack of blood flow within the brain. Strokes can be either ischemic, meaning a blockage restricts blood flow to a part of the brain or hemorrhagic, meaning a ruptured blood vessel causes blood to leak into the brain tissue.
The most important risk factor for stroke is high blood pressure. Other risk factors include: atrial fibrillation, diabetes, family history of stroke, high cholesterol, increasing age and African-American race. In addition, strokes occur more often in people who have circulation problems, obesity, alcohol abuse, tobacco use, cocaine or other drug abuse.
Patients with stroke can present with mild to severe symptoms, depending on the size, location and type of stroke they have experienced. Symptoms include: confusion, slurred speech, weakness, headache, changes in any of the senses, balance difficulties, loss of bowel or bladder control, or personality changes.
A stroke can be diagnosed with a CT scan and sometimes by an MRI. Patients with a stroke will also require other testing to identify the cause of the event. Treatment of a stroke depends on the type and location. For example, if the stroke was caused by a blood clot, clot dissolving medications can be used in the first few hours to relieve the blockage.
The prognosis for patients after a stroke also depends on the size, location and type of stroke. Patients often require extensive rehabilitation to regain the function they lost.
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A subdural hematoma is a collection of blood between the skull and the surface of the brain. Depending on the amount of blood pooled, this can cause compression of the brain. Subdural hematomas can either be acute or chronic. Acute subdural hematomas generally are a result of a serious traumatic injury and can cause rapid decline. Chronic subdural hematomas usually result from minor traumatic injuries or from tearing of delicate blood vessels on the surface of the brain. These are more common in the elderly because, with time, the brain shrinks and makes the veins more vulnerable to injury. Risk factors for subdural hematoma include: blood thinners (aspirin, coumadin, heparin), chronic alcohol abuse, recurrent head injury, repeated falls, very young or very old age. The symptoms of a subdural hematoma can be vague and mistaken for other conditions. Symptoms include: confusion, balance trouble, headache, vomiting, slurred speech, lethargy, loss of consciousness, seizures, or change in vision.
Subdural hematomas can be diagnosed with a CT scan or an MRI. They are generally a medical emergency unless they have been present for a long time and are not causing any symptoms. The treatment of a subdural hematoma depends on the size of the blood collection and the patient's symtpoms. Typically, surgery is required to drain some of the blood and relieve the pressure caused by the hematoma. Your surgeon will choose which surgical approach, craniotomy or otherwise would best address your condition.
Prognosis varies greatly and depends on the size of the hematoma, the patient's overall health, the location of the head injury and how quickly the condition was treated. Most patients require a period of rehabilitation to help recover from the subdural hematoma.
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Traumatic Brain Injury describes any injury to the head that causes dysfunction. These injuries may or may not penetrate the skull and brain tissue and may or may not cause bleeding within the brain. Traumatic Brain Injuries range from mild to severe, and can sometimes be fatal. When skull fracutres, bleeding or hydrocephalus occurs, neurosurgical treatment may be indicated. The goal of surgery is to relieve any pressure placed on the brain by fluid or blood. A patient's prognosis is related to the extent of the original injury. Patients usually require long term rehabilitation and can have lasting neurological deficits or even subtle changes in personality or behavior.
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Trigeminal neuralgia is a condition associated with intense pain over the lower part of the face and jaw and typically affects one side of the face. Sometimes it can involve areas around the eye. This sharp, excruciating pain is caused by compression of the nerve that serves the face by a nearby artery or vein. Usually, your doctor can diagnose trigeminal neuralgia by the area affected and the type of pain experienced, not by imaging or laboratory tests. Treatment of trigeminal neuralgia usually begins with an anticonvulsant medication or a muscle relaxant. For those patients who do not achieve adequate pain control with medications, surgery may be an option. Your neurosurgeon may decide that either microvascular decompression or stereotactic radiosurgery may be best for your particular condition. Microvascular decompression is a procedure in which the blood vessel compressing the irritated nerve is moved away to relieve the pressure and pain it is causing. Stereotactic radiosurgery is another option and is performed without any incision. Stereotactic radiosurgery involves targeting the trigeminal nerve root with a concentrated dose of radiation that, after several treatments, will prevent the nerve from sending pain signals.
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A vascular malformation is an abnormal mesh of blood vessels that can occur anywhere in the body, including the brain. These tangles have a significant risk of bleeding, making them dangerous conditions to have within the brain or spinal cord. There are easily diagnosed with imaging but can often exist without causing symptoms. Vascular malformations can be treated with open surgery, stereotactic radiosurgery (concentrated, high doses of radiation targeting the lesions without incisions), and embolization with neuroendovascular approaches.
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