Pediatric Neurology
Our pediatric neurologists treat the following conditions:
Brain Tumors
A brain tumor is the growth of abnormal cells in the brain. When most normal cells grow oldor get damaged, they die, and new cells take their place. Sometimes, this process goeswrong. New cells form when the body doesn"t need them, and old or damaged cells don"tdie as they should. The buildup of extra cells often forms a mass of tissue called a growth ortumor.
Types of Tumor
Brain tumors are alsoclassified as either primary or metastatic.When a brain tumor originates in thebrain it is referred to as a primary braintumor. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin. Some of the common types of primary brain tumors include:
- Astrocytoma: tumor arises from star-shaped glial cells called astocytes
- Meningioma: tumor arises in the meninges (membrane covering brain and spinal cord)
- Ependymoma: tumor arises from cells that line the ventricles or the central canal of the spinal cord
- Brain stem glioma: tumor occurs in the lowest part of the brain
Metastatic brain tumors begin ascancer elsewhere in the body and thenspread to the brain.
Brain tumors are classified as eitherbenign (non-cancerous) or malignant (cancerous).
- Benign brain tumors do not contain cancer cells, they can be removed and seldom grow back. They don"t spread to other parts of the body but may become malignant.
- Malignant brain tumors contain cancer cells and are generally more serious and often are a threat to life. They are likely to grow rapidly and crowd or invade the nearby healthy brain tissue, and may break away from malignant brain tumors, spreading to other parts of thebrain or to the spinal cord. They rarely spread to other parts of the body.
Grades of Tumor
Doctors group brain tumors by grade. The grade of a tumor refers to the way the cells look under a microscope, and include
- Grade I: tissue is benign. Cells look nearly like normal brain cells, and they grow slowly.
- Grade II: tissue is malignant. Cells look less like normal cells than do the cells in a Grade I tumor.
- Grade III: malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing (anaplastic).
- Grade IV: malignant tissue has cells that look most abnormal and tend to grow quickly.
Risk factors
The exact causes of brain tumors are not clear, but there are certain risk factors that could lead to brain tumors:
- Ionizing radiation from sources such as high dose x-rays (such as radiation therapy from a large machine aimed at the head) can cause cell damage that leads to atumor.
- Family history, although rare. Only a very small number of families have several members with brain tumors.
Symptoms
The symptoms of a brain tumor depend on tumor size, type, and location. The most commonsymptoms include:
- Problems with memory
- Problems balancing orwalking
- Headaches
- Muscle jerking ortwitching (seizures orconvulsions)
- Nausea and vomiting
- Changes in speech,vision, or hearing
- Numbness or tingling inthe arms or legs
- Changes in mood,personality or ability toconcentrate
Diagnosis
If you have symptoms that suggest a brain tumor, your doctor will conduct a physical examand ask you about your personal and family health history.You may have one or more of the following tests:
-
Neurologic exam tests for vision, hearing, alertness, muscle strength, coordination and reflexes. Your doctor also examines your eyes for swelling caused by a tumor pressing on the nerve that connects the eye and the brain.
- Imaging tests like MRI and CT scan to detect abnormalities such as a tumor
- Angiogram involves the injection of a dye into the blood stream, which is viewed on an X-ray. Tumor or blood vessels feeding into a tumor can be detected.
- Spinal tap involves the removal of a sample of the cerebrospinal fluid (fluid found in spaces in and around the brain and spinalcord) and testing for abnormalities
- Biopsy involves the removal of tissue and testing for abnormalities
Treatment
Depending on the type and grade of brain tumor, location, size, and your age and general health, your doctor will suggest the following:
- Surgery involves the removal of the tumor. It is done either as an open brain surgery or as a less invasive procedure using an endoscope (lighted instrument with a camera attached to it).
- Radiation therapy uses high-energy radiations like X-rays to kill the tumor cells. It usually follows surgery and is sometimes used if surgery is not recommended.
- Chemotherapy is the use of drugs to kill the cancer cells. They can be given through the mouth, IV or as wafers, which are inserted into the brain.
You may get a combination of these treatments.
Chiari Malformation
Chiari malformation refers to deformity of the cerebellum, the lower part of the brain associated with controlling balance. It occurs when the cerebellum and brainstem (posterior part of the brain) are pushed downwards because of lack of space in the skull that is if the back of the skull is smaller than normal. This limits the flow of cerebrospinal fluid (fluid surrounding the brain and spinal cord) causing symptoms such as dizziness, muscle weakness, numbness, headache, difficulty with vision, and coordination problems.
Chiari malformation may be caused by abnormal brain formation during fetal development. This may be caused by exposure to harmful substances during fetal development or with genetic problems that may have a tendency to run in families.
Chiari malformations are categorized into four types depending on the severity of the disorder and the parts of the brain displaced into the spinal canal
Type I is the most common type, often remains non-symptomatic and is observed during examination for another condition. In this condition the bottom portion of the cerebellum extends through the opening at the base of the skull into the spinal canal.
Type II also called as Arnold-Chiari malformation accompanies a form of spina bifida, called myelomeningocele that occurs when the backbone and the spinal canal have not closed properly before birth. A portion of the lower back part of the brain (cerebellum) along with the brainstem extends into an opening at the base of the skull.
Type III is one of the severe forms of chiari malformation that causes neurological defects. In this condition the cerebellum, brain stem, and also part of the brain"s fourth ventricle (communicating cavities filled with cerebrospinal fluid) protrudes through the opening at the base of the skull into the spinal cord.
Type IV: In this condition the cerebellum fails to develop normally.
Many people with chiari malformations often do not have symptoms and may be observed when diagnosis is done for other conditions. Diagnosis includes combination of patient history, neurological examination, and imaging tests such as X-ray, CT scan, and an MRI of the brain and spine.
Surgery is the most preferred option to treat chiari malformation. The goal of the surgery is to stop the progression of changes in the central nervous system. The surgery can reduce pressure on the structures on the base of the skull and re-establish the normal flow of the fluid in the area.
Posterior fossa craniectomy or posterior fossa decompression is the most common operation for chiari malformation. During the procedure an incision is made at the back of the head and a small portion of the bone from the skull and occasionally portion of the first or second vertebrae of the back bone is removed (spinal laminectomy). This creates room for the brain and relieves the pressure exerted on the brain. The dura, covering of the brain is then opened and a patch is sutured into place to expand the space and restore normal cerebrospinal fluid flow. The patch may be a natural tissue harvested from your own leg or neck or may be an artificial patch.
Infection and problems with healing are the risks of the surgery. Regular follow up may be needed to know the outcome of the surgery and the flow of the cerebrospinal fluid.
Comprehensive Management of Concussion
Blue Sky Concussion Clinic is the premier adult concussion center in the Denver metropolitan area. We offer comprehensive, compassionate, cutting-edge treatment for adults with concussions and traumatic brain injuries. Every patient will receive a comprehensive evaluation, including a medical exam, neurocognitive testing and, if indicated, neuropsychological testing.
The physicians at the Blue Sky Concussion Clinic have special training in concussion management. Their mission is to improve the outcomes of those who suffer from neurological injuries through complete and individualized care. Concussions are injuries with significant potential consequence if not managed correctly. More than 80% of concussions are successfully resolved if they are properly managed within the first 3 weeks after the injury has occurred.
Your Blue Sky Concussion Clinic team includes health care professionals from multiple medical specialties. They are dedicated to expediting recovery using state of the art clinical resources and utilizing the most up to date information available. Each visit is geared toward collecting information that will help individualize treatment plans. Please note that Blue Sky Concussion Clinic does not do independent medical examinations.
Our Concussion Providers
Locations
|
Beverly Gilder, M.D. |
|
|
499 E. Hampden Ave. |
|
|
|
|
|
1400 S. Potomac St. |
|
|
|
|
|
10099 RidgeGate Pkwy |
|
What Is A Concussion?
Concussion, also known as minor traumatic brain injury is the sudden and temporary loss or disturbance in nerve cell function of the brain that occurs as a result of a blow or an injury to the head. Usually, concussions may be mild and do not result in long-term damage, but repeated concussion can cause permanent brain damage. This condition can become life threatening if blood accumulates in the skull.
Some of the most common symptoms of concussion include loss of consciousness, mild to moderate headache or feeling of pressure in the head, difficulty in remembering things, slurred speech, difficulty in thinking and making decisions, lack of concentration, and feeling confused and dazed.
The ImPACT Test
 |
Blue Sky Neurology employs the use of the ImPACT Test when a concussion has occurred or is suspected. For more information about this testing program, please click here. Click here to visit the Blue Sky Concussion Clinic ImPACT page. |
 |
Dr. Cheryl Melick is a Credentialed ImPACT Consultant. For more information about this designation, please visit Dr. Melick"s page. |
Epilepsy
Epilepsy is a condition of the nervous system in which the person experiences recurrent seizures or convulsions. The seizures occur because of the abnormal signals sent by the cluster cells or neurons in the brain.
Epilepsy has no known cause, but may develop because of illness, brain injury and abnormal brain development. People with epilepsy may experience strange sensations, emotions, and behavior along with convulsions, muscle spasms, and even loss of consciousness.
Types of epileptic seizures:
Your doctor will perform physical examination and use other tests to diagnose epilepsy. Your doctor may suggest an Electroencephalogram (EEG) test to check the electrical activity in the brain. An EEG records your brain"s electrical activity via electrodes attached to your scalp. People with epilepsy can have irregular electrical activity on their EEG. Scans of the brain, such as a CT scan or MRI scan may also be done.
Epilepsy is usually not cured, but is controlled with anticonvulsant medications. If medications do not work, your doctor may suggest surgery or implanted devices such as vagus nerve stimulators. Some patients with epilepsy may benefit from brain surgery where the abnormal brain cells causing the seizures are removed in order to control the seizures. In some cases, a device called a vagus nerve stimulator (VNS) is implanted underneath the skin of your chest, similar to a heart pacemaker, to control the number of seizures experienced by patients. Some children with epilepsy are recommended to follow a special diet called a ketogenic diet to help prevent seizures.
Multiple Sclerosis
Multiple sclerosis(MS) is a disease of the central nervous system (brain and spinal cord) caused by destruction of the myelin insulation covering nerve fibers or neurons. When myelin sheath is destroyed, nerve signals between your brain and the rest of the body slow down or stop. As a result, people with MS have visual disturbances, muscle weakness in the extremities, difficulty with balance and coordination, and difficulty walking. As the disease progresses other symptoms occur such as sensations of numbness, prickling, or pins and needles, pain, tremors, dizziness, speech difficulty, hearing loss, and problems with thinking, learning and planning may also occur.
Multiple sclerosis may be an autoimmune disease, meaning a disease in which the body"s immune system attacks and destroys its own tissues. Multiple sclerosis (MS) usually appear between the ages of 20 and 40 and women are more likely to be affected than men.
In order to diagnose MS, the physician will ask your detailed medical history and perform a complete physical and neurological examination. A MRI scan of your brain and spinal cord may be done to reveal lesions in the central nervous system. An evoked potentials test may be done to determine whether electric impulse travels through nerves normally or slower. Your doctor may also perform a cerebrospinal fluid (the fluid that surrounds your brain and spinal cord) examination to look for the presence of abnormal antibodies or cells that indicate the presence of MS.
There is no known cure for multiple sclerosis, however treatment such as medications and therapies may help relieve the symptoms and relapses and slow the progression of MS. In some cases steroids may be recommended to decrease the duration and severity of attacks. Muscle relaxants are prescribed to reduce muscle spasms.
Physical therapy, occupational therapy, and assistive devices such as foot braces, canes, and walkers may also be helpful for people with MS to improve their quality of life.
Sleep Disorders
Sleep is essential for your physical health and emotional wellbeing. Everyone experiences occasional sleeping problems, but if you experience problems sleeping repeatedly, it could indicate an underlying health problem. Sleep disorders are problems associated with sleeping, including difficulty falling or staying asleep through the night, feeling sleepy during the day, or waking up feeling exhausted. Because of lack of sleep you may find it difficult to concentrate and perform activities of daily living. This lack of sleep can lead to depression, mood swings, or other health problems.
Some of the common types of sleep disorders include:
- Insomnia: Insomnia is a type of sleep disorder in which the person has difficulty falling asleep or staying a sleep.
- Sleep apnea: Sleep apnea is a common sleep disorder in which breathing stops or gets very shallow during sleep. These breathing pauses last between 10 to 20 seconds or more.
- Restless leg syndrome (RLS): Restless leg syndrome is a disorder characterized by a tingling or prickly sensation in the legs and an urge or need to move the legs.
- Narcolepsy: Narcolepsy is a sleep disorder that causes excessive daytime drowsiness and sudden onset of sleep.
- Parasomnias: This refers to abnormal behaviors that occur during sleep. Parasomnias include nightmares, night terrors, sleep walking, and sleep talking, head banging, wetting the bed and grinding teeth.
Treatment
Sleep Disorder treatment can be classified into two main categories: pharmacological treatment and non-pharmacological treatment.
Pharmacological treatment includes any prescription or non-prescription medications to help prevent the onset of the symptoms or treat the developed symptoms. Depending on the type of disorder, treatment could include sedatives (in case the condition is related to insomnia), or stimulants (in case the condition is related to narcolepsy or sleep apnea).
Non-pharmacological sleep treatment refers to those options that do not require the use of prescription or non-prescription drugs. These may include behavioral therapy, medical equipment, surgery, and other options. Surgery may be needed to correct the anatomic abnormalities of the upper airway which can lead to the onset of obstructive sleep apnea. Behavioral treatments for sleep problems may include relaxation training, cognitive therapy, stimulus control (SC), sleep restriction therapy (SRT), and sleep hygiene. Behavioral therapy can be used to treat people with insomnia, parasomnias, bedwetting, and other sleep problems. Another option is the use of different types of medical equipment such as “continuous positive airway pressure" (CPAP) and bilevel "” or BiPAP for the treatment of sleep apnea. CPAP is a device that prevents narrowing of the airway during inspiration and expiration by providing a persistent increased pressure. Another similar option is “bilevel" in which the face mask allows for two different alternating pressures: one with inhalation and one with exhalation. Other non-pharmacological treatment options for sleep disorders include mandibular advancement devices, nasal strips, positional therapy, and playing didgeridoo (a wind instrument) to strengthen the upper airway.
Lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may also be helpful.
Dr. Pearlman's Pediatric Practice Locations
499 E. Hampden Ave.
Suite #360
Englewood, CO 80113
10099 RidgeGate Pkwy
Suite #480
Lone Tree, CO 80124