Cerebrovascular disease is a condition that affects the flow of blood to the brain. It is characterized by ischemia (lack of oxygen) or bleeding in an area of the brain and involves one or more cerebral (of the brain) blood vessels. Two major sets of blood vessels (arteries) regulate the blood flow to the brain. Any kind of damage to these arteries in the form of blockage or rupture affects this flow and can cause bleeding or deprive the brain cells of oxygen and important nutrients present in the blood. The nutrient-deprived brain cells either are damaged or die within a few minutes.
Cerebrovascular disease is a broad term and includes disorders such as stroke (blocked arteries), stenosis (narrowing of arteries), aneurysms (bulging out of the arteries), and vascular malformations (change in diameter of the arteries). The diagnosis of these disorders is done through imaging techniques. These may involve the use of contrast dye (cerebral angiography), ultrasound (carotid duplex), scans (CT or MRI), or metal discs (EEG).
Severe headache is a characteristic symptom of all cerebrovascular diseases. Some of the other symptoms include issues with vision, problems with co-ordination and balance as well as speech and comprehension difficulties.
Risk factors include both controllable and non-controllable risk factors. They include smoking, high blood pressure, diabetes, sedentary habits and obesity, age, gender, race and heredity factors.
Treatment to be adopted depends on the type of cerebrovascular disorder. If the disorder involves a blocked artery, tPA (“clot bursting” drug) is administered to the patient. Anti-platelet medications are provided when there is a risk of clot formation and stroke, and surgical interventions involving wire mesh stents are conducted in conditions such as carotid stenosis.
Encephalopathy is a functional or structural disorder of the brain that is considered to develop from a primary problem, such as brain tumor, kidney problem, or liver disease. The chief characteristic feature of encephalopathy is an altered mental state. Encephalopathy is best described by terms that precede the word “encephalopathy”. Each of these terms gives an idea about the reason, cause, or special conditions of the patient that lead to malfunctioning of the brain. For example, the term anoxic in anoxic encephalopathy means lack of oxygen. Hence, anoxic encephalopathy is damage to the brain caused due to lack of oxygen.
Encephalopathy symptoms vary depending on the type and severity of the condition. Common neurological symptoms include loss of high-level brain functions such as thought processing and remembering information, subtle personality changes, concentration issues, lethargy, and progressive loss in consciousness.
There are numerous and wide range of causes for encephalopathy. They include
Encephalopathy is diagnosed based on physical examination and medical history review. Your doctor may order tests such as blood tests, spinal tap, scans (CT, MRI), and EEG.
Treatment is decided based on the type and severity of the encephalopathy. Symptom-specific medication along with vitamins or supplements may be given. Nutritional supplements and diet changes may be recommended for some patients. In conditions such as an excess of toxins in the body, dialysis or organ transplant would be required.
Prevention is better than cure. Some of the preventive steps that can be taken include avoiding over dose of alcohol, drugs and medicines, opting for early treatment in conditions such as liver disease, and taking precautions to avoid exposure to poisons or toxins.
A headache is pain or discomfort anywhere in the region of the head or neck. Headaches are the most common health complaints experienced by every person at some point during their life. Most headaches are not serious and can be treated with medications and lifestyle changes. There are many different types of headaches and it is important to know the particular type of headache you have and also methods to treat the same.
Depending upon the cause, headaches can be divided into three major categories:
Primary headaches: Primary headaches are those headaches that are not associated with other medical conditions. The most common types of primary headaches include:
Secondary headaches: Secondary headaches are those that are caused by other underlying diseases. Some medical conditions that can cause secondary headaches include bleeding in the brain, brain tumors, meningitis and encephalitis.
Cranial neuralgias, facial pain, and other headaches: Cranial neuralgia is pain or discomfort in the head or neck caused by inflammation of the nerves located in the head and upper neck. Facial pain can be caused from a nerve disorder, an injury, or an infection in a structure of the face or it may occur for no known reason.
People with tension headaches have generalized pain in the head and neck described as a band-like tightness or pressure.
Migraine headaches often cause a throbbing or pulsating sensation usually on one side of the head. It may occur with symptoms such as nausea, vomiting, visual disturbances, and sensitivity to light and sound. The pain can last a few hours or even up to one or two days.
Cluster headaches have a characteristic grouping or clustering of attacks. People with cluster headaches usually have pain lasting for 30 to 90 minutes, once or twice daily, for weeks or months, followed by pain free periods. Attacks tend to occur at the same time each day and often wake the person from sleep. The pain is extremely painful and may occur behind and around one eye.
Your doctor will question you about your headache, its location, length, duration, causative factors and associated symptoms. Your doctor will also review your family history, medical history, diet and lifestyle. The following diagnostic procedures may be ordered:
Your doctor may suggest keeping a headache diary to help identify your headache type and recommend effective treatment.
To control tension type headaches, over-the-counter (OTC) pain medications are prescribed.
Medications for migraine headache fall into two categories:
The treatment of cluster headaches is very difficult. Your doctor may treat cluster headache with oxygen inhalation, triptan medicines (constrict blood vessels and block pain pathway to brain), and the use of intranasal applications of a local anesthetic agent. Medications used to prevent additional headaches include blood pressure medications, antidepressant medications, and drugs used to treat seizures.
Hydrocephalus is a condition in which the primary characteristic is excessive accumulation of fluid in the brain. Although hydrocephalus was once known as "water on the brain," the "water" is actually cerebrospinal fluid (CSF) — a clear fluid that surrounds the brain and spinal cord. The excessive accumulation of CSF results in an abnormal widening of spaces in the brain called ventricles. Ventricles are hollow cavities within the brain that are constantly producing CSF. This widening creates potentially harmful pressure on the tissues of the brain.
Hydrocephalus may be of the following types:
Symptoms of hydrocephalus vary with age, disease progression, and individual differences in tolerance to the condition. Symptoms may include:
The causes of hydrocephalus are still not well understood. However, some of the common causes include inherited genetic abnormalities, developmental disorders, complications of premature birth, meningitis, tumors, and traumatic head injury.
To diagnose hydrocephalus, your physician will perform a physical exam with emphasis on neurological evaluation and medical history. Your physician may order imaging tools such as MRI, CT scan and ultrasonography depending on your age, clinical presentation, and the presence of known or suspected abnormalities of the brain or spinal cord.
After surgery your surgeon will give you guidelines to follow to ensure a good outcome. You will be transferred to the recovery room after surgery for monitoring. You will be given pain medications to keep you comfortable and antibiotics to prevent infection. Keep the incisions clean and dry. You may shower once the stitches and/or staples are removed unless otherwise directed by your surgeon. Do not scratch the incision areas as this can lead to infection. If the incision areas become red, painful or draining, call your surgeon as these are signs of infection. If you experience headache, vomiting, visual problems, confusion, fever, or increased lethargy, call your surgeon right away.
As with any major surgery there are potential risks involved.
The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.
The nervous system consists of the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS is comprised of the brain and spinal cord, while the PNS comprises of nerves that carry information to and from the brain to the rest of the body. Peripheral neuropathy is a condition characterized by damaged peripheral nerves that cause pain. When this condition affects one nerve, it is called mononeuropathy; when several nerves are affected, it is polyneuropathy; and when 2 or more nerves are involved in different areas, it is termed as multiple mononeuropathy.
Peripheral neuropathy is a comparatively common disease that usually affects older people.
Diabetes is the most common cause of peripheral neuropathy. At least half of all diabetics develop some form of neuropathy during the course of the disease.
Other factors that can cause peripheral neuropathy are:
Symptoms depend on the type of the affected nerve. Common signs and symptoms include:
Peripheral neuropathy involves the exact detection of nerve damage and its cause, which is difficult to diagnose. Your doctor will review your medical history and family history for neurological diseases, and will conduct physical and neurological examinations for muscle strength, sensation, posture and coordination.
Your doctor may order other tests including:
The main aim of treatment is to control the underlying cause of peripheral neuropathy and manage pain. Symptoms of peripheral neuropathy can be relieved with:
Peripheral neuropathy can be prevented by:
Pain is an unpleasant feeling or discomfort caused by injury, illness or emotional disorder. Pain can be differentiated into two basic types including:
Your doctor will make a diagnosis based on the history of pain you have narrated such as type of pain –
whether sharp or dull aching pain, duration and location of pain.
There are various diagnostic techniques used to find the cause of pain, and some of them include:
The ultimate goal of pain management is to improve the function of an individual by enabling him to carry out his day-to-day activities in a normal way. Pain management involves treatment of the underlying disease and pain relief using medications and alternative techniques. The many ways by which pain can be treated include:
Paraneoplastic syndromes are disorders of the nervous system that can occur from the presence of cancer in a remotely located organ or tissue. They are placed in a class of rare disorders that are sometimes seen in people with cancer. Cancers of the lung, breast and ovary are commonly associated with pareneoplastic syndromes.
Symptoms usually develop rapidly over days or weeks and often occur even before a tumor is diagnosed by the physician. Symptoms of paraneoplastic syndromes are believed to be the result of the body’s immune response to the cancerous tumor that not only attacks the tumor but also parts of the nervous system. Some of the symptoms associated with paraneoplatic syndrome include muscle weakness, muscle cramps, memory loss, vision problems, and slurred speech.
There are several types of paraneoplastic disorders, and each one is named depending on the area of the nervous system affected, nature of symptoms, and the kind of immune response elicited. A few of them are listed below:
Paraneoplastic syndromes are caused by T cells (cancer fighting antibodies) produced by the body against the cancer. These cells also attack nerve or muscles cells leading to gradual nerve damage and associated motor symptoms.
Diagnosis of paraneoplastic syndrome is difficult as the symptoms develop even before the cancer is detected. Also, the symptoms closely resemble other cancer and non-cancer related neurological problems, thereby delaying the final diagnosis. Diagnosis is carried out by identifying antibodies in the serum that may be active against the nerve tissue. For this, the physician may order
imaging tests such as CT scan, MRI, PET, and PET-CT after carrying out a general physical examination. He or she may also include laboratory tests that include blood tests, and spinal tap (lumbar puncture).
Treatment follows a two-prong strategy of treating the cancer and suppressing the immune response producing the symptoms. Medications include corticosteroids and immunosuppressants. Symptom specific medication may be used depending on the type of paraneoplastic disorder. Physical therapy may be used to regain muscle function and speech therapy may be employed to correct impaired speech developed during the course of the ailment.
A seizure is a sudden, brief attack caused by changes in the brain’s electrical activity. It is quite common in people with a brain tumor. During a seizure, a person’s brain cells misfire releasing electrical energy in an uncontrolled manner. This results in a sudden buildup of energy through the brain, causing unconsciousness and contractions of the muscles. The person may cry, become unconscious, or twitch involuntarily.
A seizure may develop due to a severe head injury, or a very high fever, or meningitis (brain infection). In people with a brain tumor, seizures can be caused due to increased pressure in the brain, stress, lack of sleep, altered medication levels, and scar tissue developed after surgery. Also, there are certain types of seizures whose causes are unknown.
Symptoms depend on the area of the brain that is affected. If the entire brain is affected, then the symptoms would be those of a generalized or grand mal seizure. When seizures appear to result from abnormal activity in just one area of the brain, then the symptoms would be those of a partial or focal seizure.
In a generalized seizure, the patient is completely unresponsive and may blink his eyes rhythmically. The patient often stiffens which is followed by convulsions. However, in the case of a partial seizure, only an isolated part of the body is affected such as one side of the face. Also, the patient may not necessarily become unconscious.
The diagnosis is difficult due to lack of obvious signs and non-availability of first-hand information from the patient. As the patient does not remember the seizure, it can be helpful to have information from someone who was witness to the seizure. Your doctor may order blood tests, scans (MRI and CT), and EEG (Electroencephalogram).
As seizures are common in patients with a brain tumor, anti-convulsion or antiepileptic medications form an essential component of a standard treatment plan. Seizures may continue despite the treatment but with reduced severity and frequency. If satisfactory relief is not experienced with medications and the physical cause of the epilepsy is restricted to just one area of the brain, then epilepsy surgery may be considered as a treatment option.
Thromboembolism is a condition in which a blood clot formed inside a blood vessel breaks free and is carried in the bloodstream to block a blood vessel inside another organ, causing organ damage. The affected organs can be lungs (pulmonary embolism), brain (stroke), gastrointestinal tract, kidneys, or legs.
Two diseases typical to thromboembolism include DVT or deep vein thrombosis (blood clot in a deep vein) and PE (pulmonary embolism). These conditions may develop as a result of complications of cancer-related surgery.
Several risk factors for the development of thromboembolism in cancer patients have been identified and include site and stage of cancer, type of cancer, advanced disease, patient comorbidities, specific therapeutic agents, surgery, chemotherapy and hospitalization.
Nearly 50 percent of patients with thromboembolism do not show any symptoms. Also, symptoms of thromboembolic diseases such as DVT may go unnoticed for a while as they are similar to various other health problems. Typical symptoms include swelling, tenderness, change in skin color, and warmth over the affected area. Additional symptoms such as coughing up blood, sharp chest pain, and shortness of breath may be noticed if a blood clot breaks free and travels to the lungs, leading to pulmonary embolism.
As a part of the diagnosis, your doctor will conduct a physical examination. They may ask questions related to your overall health and assess your medical history to exclude other causes. Your physician may also order tests specific to DVT such as a Duplex ultrasound, venography, and MRI.
Treatment options involve the use of blood thinning medications such as heparin and warfarin. In severe cases, clot-buster medications such as tissue plasminogen activator (TPA) may be prescribed. Other treatment measures include inserting filters into veins to prevent clots from breaking loose and going to the lungs. Also, compression stockings may be worn for preventing blood from pooling and clotting.