Conditions & Treatments

Brain Aneurysm

A brain aneurysm is a bulging weakened area in the wall of an artery in the brain, resulting in an abnormal widening or ballooning. The weakened spot is of concern because there is a risk of rupture of the aneurysm.

Ninety percent of brain aneurysms are present without any symptoms and are small in size.

Symptoms of Brain Aneurysm

How do you know if you have a brain aneurysm? The most common initial symptom is bleeding into the space between the brain and the membranes that cover the brain. This is considered a medical emergency and may be the cause of a bleeding stroke.

So what does an aneurysm of this nature feel like?

The answer is a pressure builds up in the surrounding tissues that causes irritation and swelling. About 20 percent of strokes are caused by this hemorrhagic bleeding. The symptoms of an un-ruptured aneurysm are headaches, dizziness, eye pain and problems with seeing.

The first evidence after a rupture is as follows:

  • Rapid onset of “the worst headache ever”
  • Stiff neck
  • Nausea and vomiting
  • Changes in mental status, such as drowsiness
  • Pain in specific areas, such as the eyes
  • Dilated pupils
  • Lloss of consciousness
  • High blood pressure
  • Lloss of balance or coordination
  • Sensitivity of light
  • Back or leg pain
  • Problems with certain functions of the eyes, nose, tongue and/or ears that are controlled by one or more of the 12 cranial nerves

Always consult your doctor for a proper diagnosis, as symptoms of a brain aneurysm may resemble other medical conditions.

Treatment of Brain Aneurysm

Treatment is determined by your physician based on the following:

  • Your age, overall health and medical history
  • Extent of the condition
  • Your signs and symptoms
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

No matter what your situation, the main concern is to decrease the risk of a subarachnoid hemorrhage, either initially or from a repeated episode of bleeding. Sometimes, the aneurysm may not be treated but the patient will be closely monitored by a physician. In other cases there are two surgical approaches to treatment.

  • Surgical clipping or open craniotomy: This procedure involves the surgical removal of part of the skull. The doctor exposes the aneurysm and places a metal clip across the neck of the aneurysm to prevent blood flow into the aneurysm sac. Once the clipping is complete, the skull is sutured back together.
  • Endovascular coiling or coil emboilization: In this minimally invasive technique, no incision in the skull is required to treat the aneurysm. Instead, a catheter is advanced from a blood vessel in the groin up into the blood vessels in the brain. A special type of x-ray called fluoroscopy will be used to assist in advancing the catheter to the head and into the aneurysm. Once the catheter is in place, very tiny platinum coils are advanced through the catheter into the aneurysm. These tiny, soft platinum coils, which are visible on x-ray, conform to the shape of the aneurysm. The coiled aneurysm becomes clotted off (emboilization) preventing rupture. This procedure is performed either under general or local anesthesia.

Stroke

What is a stroke?

A stroke is when blood flow to the brain is disrupted. This occurs in one of two ways: ischemic stroke and hemorrhagic stroke. Ischemic stroke happens when disruption in the blood flow is caused by either a blood clot or a piece of plaque blocks one of the vital blood vessels in the brain. Hemorrhagic stroke is when a blood vessel in the brain bursts, spilling blood into surrounding tissues.

Symptoms of Stroke

The most common sudden symptoms are as follows:

  • Weakness or numbness of the face, arm, or leg, especially on one side of the body
  • Confusion or difficulty speaking or understanding
  • Problems with vision such as dimness or loss of vision in one or both eyes
  • Dizziness or problem with balance or coordination
  • Problems with movement of walking
  • Severe headaches with no other known cause

All of the above warning signs may not occur with each stroke. Take action immediately by calling 911 even if some of the signs go away.

Other less common symptoms include:

  • Sudden nausea, vomiting or fever not caused by a viral illness
  • Brief loss or change of consciousness such as fainting, confusion, seizures or coma
  • Transient ischemic attack (TIA) or “mini-stroke”

A TIA can cause many of the same symptoms as a stroke, but TIA symptoms are transient and last for a few minutes or up to 24 hours. This may be an indication a stroke is about to occur, however not all strokes are proceeded by TIAs.

How to Prevent a Stroke

The best way to prevent your risk of stroke is to monitor your blood pressure, track your cholesterol level, stop smoking, exercise regularly and check to find out if your should be taking a drug to reduce blood clotting. Also the American Heart Association has found eating fruits and green or yellow vegetables daily may protect against stroke.

Treatment of Stroke

Treatment for a stroke varies based on type, severity and location. It depends on whether it’s caused by a blood clot (ischemic) or by bleeding in the brain (hemorrhagic). Valley specialists use a CT (computed tomography) scan of your head and possibly magnetic resonance imaging (MRI) to determine the type of stroke you’ve had. Physicians may do further tests to discover the exact location of the clot or bleeding. Your blood pressures and breathing will be closely monitored and you might receive oxygen.

The goal of the initial treatment is to restore blood flow for an ischemic stroke or control bleeding for a hemorrhagic stroke. The faster one receives treatment the less damage will occur.

Following emergency treatment of your stroke, after stabilization, treatment will then move to rehabilitation preventing another stroke. Controlling risk factors such as high blood pressure, atrial fibrillation (irregular heartbeat), high cholesterol or diabetes play a major factor.

Your physician may want you to take aspirin or other antiplatelet medicines. You may have to take anticoagulants to prevent another stroke if you had an ischemic stroke. To control your blood pressure, you may also need to take statins to lower high cholesterol. Carotid endarterectomy surgery may be recommended to remove plaque build up in the carotid arteries.

Brain AVM (arteriovenous malformations)

A brain arteriovenous malformation is a congenital defect in which arteries and veins are tangled and not connected by capillaries. AVMs can occur anywhere in the body, but those in the brain can affect the entire body. A brain AVM prevents the nutrient rich blood in the arteries from reaching the tissues. They can rupture and cause bleeding in the brain or stroke.

According to the National Institute of Neurological Disorders and Stroke, AVMs are believed to affect approximately 300,000 Americans.

Symptoms of Brain AVM (arteriovenous malformations)

Most people are unaware they have an AVM until an incident occurs and they are discovered during treatment for an unrelated disorder. But, 12 percent of the affected population does experience symptoms of these abnormalities to varying severity. The most generalized symptoms are seizures and headaches, although no particular type of seizure or headache pattern has been identified. Seizures can be partial or total. Headaches can range in frequency, duration and intensity, sometimes turning into migraines. A headache consistently affecting one side of the head may be sometimes closely linked to the site of an AVM. But, more often the location of the pain is not specific to the lesion and may encompass most of the head.

Depending on the location of the AVM, more specific neurological symptoms can arise in and vary in person to person. They include:

Muscle weakness or paralysis in one part of the body

  • A loss of coordination (ataxia) that can lead to such problems as gait disturbances (apraxia)
  • Difficulties carrying out tasks that require planning
  • Dizziness
  • Visual disturbances such as loss of part of the visual field
  • An inability to control eye movement
  • Swelling of part of the optic nerve known as the optic disk
  • Various problems understanding  or using language
  • Abnormal sensations such as numbness, tingling or spontaneous pain
  • Memory deficits and mental confusion
  • Hallucinations or dementia

According to some researchers, AVMs may cause subtle learning or behavioral disorders in some during their childhood or adolescence.

A phenomenon called a bruit or noise in French is a more distinctive sign of an AVM. It occurs when a physician can hear the rhythmic whooshing sound caused by excessively rapid blood flow through the arteries and veins of an AVM. This can occur when an AVM is especially severe. If it is audible to individuals, the bruit can compromise hearing, disturb sleep or cause significant psychological distress.

Symptoms are most noticed in a person’s twenties, thirties or forties, after a slow build up of neurological damage over time. Pregnant women tend to notice a sudden onset or worsening of symptoms due to the cardiovascular changes, especially with increases in blood volume and blood pressure.

How are AVMs detected?

Neuroscience Institute specialists are prepared and equipped to detect the presence of AVMs using a comprehensive array or traditional and new imaging technologies. Angiography is one option that shows a picture of the blood vessel structure in AVMs. Superselective angiography calls for inserting a thin, flexible catheter in to an artery, then guiding the tip of the catheter to the site of the lesion and then releasing a small amount of contrast agent directly into the lesion.

The most common and noninvasive imaging technologies used are computed axial tomography (CT) and magnetic resonance imaging (MRI) scans.

Treatment of Brain AVM (arteriovenous malformations)

Symptoms such as headache, back pain and seizures caused by AVM can be treated by medication. But, the definitive solution to AVMs is either surgery or focused irradiation therapy.  Our specialists will carefully weigh the risks and benefits to performing surgery on an individual with an AVM. There are three options for surgery: conventional surgery, endovascular embolization and radiosurgery. Each depends on the size and location of the AVM.

Less invasive than conventional surgery, endovascular embolization and radiosurgery offer safe treatment options for some AVMs located deep inside the brain. Radiosurgery involves aiming a beam of highly focused radiation directly at the AVM.  It is an even less invasive therapeutic approach, but it may prove an incomplete option if the AVM is large and radiation poses a threat to damage surrounding normal tissue.

There are many variables involved in treating an AVM and physicians look at the risks posed to each individual on a case-by-case basis.

Brain Tumor

Neuro oncologists treat patients with benign and cancerous brain tumors. Learn more  

Brain Infection

The brain can become infected by bacteria, viruses, parasites, fungi or other germs. Common brain infections include:

  • Encephalitis
  • Meningitis
  • Toxoplasmosis (toxo)
  • Cerebral cysticercosis
  • Trichinosis
  • Cerebral abscess
  • &Spinal abscess
  • Poliomyelitis (polio)
  • Rubella (German measles)
  • Measles
  • Mumps
  • Rabies
  • AIDS / HIV

Symptoms of Brain Infection

Symptoms of bacterial brain infection may vary by condition, the age of the person, and the acuteness of the disease:

  • High fever
  • Severe headache
  • Stiff neck
  • Nausea
  • Vomiting
  • Discomfort looking at bright light
  • Sleepiness
  • Confusion
  • Seizures

Viral brain infections may evoke flulike symptoms and more mild symptoms common to each condition.

Early diagnosis and treatment are important. Seek emergency care if the affected person seems disoriented and has a high fever, is having difficulty breathing, has a severe headache with vomiting, or has a seizure. For infants, call 911 if the baby is lethargic and refuses to feed, has a high fever and vomiting.

Treatment for Brain Infections

Most viral infections go away on their own. Bacterial infections may be treated with:

  • Antibiotics
  • Medications for fever or headache
  • Anticonvulsants (to prevent seizures)
  • Steroids (if there is evidence of brain swelling)

Brain Injury

According to the Centers for Disease Control, about 1.7 million people suffer traumatic brain injuries in the United States every year and tens of thousands are fatal. A brain injury can be caused by a number of different traumas to the head, but involves a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. However, not every blow to the head results in a traumatic brain injury. Traumatic brain injuries (TBIs) range in severity.

Concussions are the most common TBI that occur every year along with mild TBIs. In a concussion a person injures their head and has an instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.

Skull fracture occurs when there is a break in the skull bone. There are four major types of skull fractures:

  • Linear skull fractures are the most common type, where there is a break in the bone, but it does not move the bone. After possible close observation in the hospital, patients of this type usually resume normal activities in a few days, with no interventions necessary.
  • Depressed skull fractures are seen with or without a cut in the scalp. In this type of incident part of the skull is actually sunken in. Depressed skull fractures may require surgical intervention, depending on the severity.
  • Diastatic skull fractures occur along the suture lines in the skull. This area is between the bones in the head that fuse when we are children. In this type of incident the normal suture lines are widened. This condition is more often seen in newborns and older infants.
  • Basilar skull fractures is the most serious type of skull fracture and involves a break in the bone at the base of the skull. This type of fracture frequently causes bruises around a patient’s eyes and behind their ear. They may also have clear liquid draining from their nose or ears due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital.

Intracranial hematoma (ICHs) or blood clots in or around the brain are classified by their location in the brain. There are several types and they range from mild head injuries to serious and potentially life-threatening injuries:

  • Epidural hematomas are when a blood clot forms underneath the skull, but on top of the dura, the tough covering that surrounds the brain. Epidural hematomas come from a tear in an artery that runs just under the skull called the middle meningeal artery. They are usually associated with a skull fracture.
  • Subdural hematomas are when a blood clot forms underneath the skull and underneath the dura, but outside of the brain. These can form from a tear in the veins that go from the brain to the dura, or from a cut on the brain itself. They are sometimes, but not always, associated with a skull fracture.
  • Contusion or intracerebral hematoma is a bruise to the brain itself. It causes bleeding and swelling inside of the brain around the area where the head was struck. They may occur with skull fratures or other blood clots such as subdural or epidural hematoma.
  • Diffuse axonal injury (DAI) is fairly common and is usually caused by shaking the brain back and forth, which can happen in car accidents, from falls or shaken baby syndrome. These injuries can be mild or may be very severe, as in DAI. In this case the patient is usually in a coma for prolonged period of time, with injury to many different parts of the brain.

Causes of Brain Injury

There are many causes for head injury in children and adults, with the most common from motor vehicle accidents, from violence, falls, or as a result of child abuse.

Symptoms of Brain Injury

Depending on the severity, a person might have varying degrees of symptoms associated with head injury. Each individual may experience symptoms differently, but the following are some common signs:

  • Mild Head Injury
  • Raised, swollen area from a bump or a bruise
  • Small, superficial (shallow) cut in the scalp
  • Headache
  • Sensitivity to noise and light
  • Irritability
  • Confusion
  • Lightheadedness and/or dizziness
  • Problems with balance
  • Nausea
  • Problems with memory and/or concentration
  • Change in sleep patterns
  • Blurred vision
  • “Tired” eyes
  • Ringing in the ears (tinnitus)
  • Alteration in taste
  • Fatigue/lethargy

Moderate to severe head injury (requires immediate medical attention) symptoms may include any of the above plus the following:

  • Loss of consciousness
  • Severe headache that does not go away
  • Repeated nausea and vomiting
  • Loss of short-term memory, such as difficulty remembering the events that led right up to and through the traumatic event
  • Slurred speech
  • Difficulty with walking
  • Weakness in one side or area of the body
  • Sweating
  • Pale skin color
  • Seizures or convulsions
  • Behavior changes including irritability
  • Blood or clear fluid draining from the ears or nose
  • One pupil (dark area in the center of the eye” looks larger than the other eye
  • Deep cut or laceration in the scalp
  • Open wound in the head
  • Foreign object penetrating the head
  • Coma (a state of unconsciousness from which a person cannot be awakened, responds only minimally, if at all, to stimuli, and exhibits no voluntary activities)
  • Vegetative state (a condition of brain damage in which a person has lost his thinking abilities and awareness of his surroundings, but retains some basic functions such as breathing and blood circulation
  • Locked-in syndrome ( a neurological condition in which a person is conscious and can think and reason, but cannot speak or move)

For an accurate diagnosis, consult your physician, as symptoms of a head injury can resemble other medical conditions.

Treatment of Brain Injury

Head injuries are first evaluated with a physical examination and then diagnostic tests. These tests may include: blood tests, x-ray, computed tomography scan (CT or CAT scan), electroencephalogram (EEG) or a magnetic resonance imaging (MRI). Treatment of a head injury will be determined by your physician and is based on your age, overall health, medical history, extent of the injury and other factors. Treatment may include the following depending on severity:

  • Ice
  • Rest
  • Topical antibiotic ointment and adhesive bandage
  • Observation
  • Immediate medical attention
  • Stitches
  • Hospitalization for observation
  • Surgery