Brain & Neuroscience

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.

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.

What does an aneurysm of this nature feel like?

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
• Loss of consciousness
• High blood pressure
• Loss of balance or coordination
• Sensitivity to 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.

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

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 of 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 into 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

Symptoms such as headache, back pain and seizures caused by AVM can be treated with 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.

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 flu-like 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)

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 are the most serious type of skull fracture and involve 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 fractures 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

A brain tumor is an abnormal growth of tissue in the brain. They can be either benign (non-cancerous) or malignant (cancerous). Tumors can originate in the brain itself, or come from another part of the body and travel to the brain (metastasize). Benign tumors do not contain cancer cells and when removed do not recur. Malignant tumors contain cancer cells and usually are fast growing and invade surrounding tissue. However, sometimes tumors that are not cancer are called malignant because of their size and location in the brain.

What causes brain tumors?

Most brain tumors have abnormalities of genes involved in cell cycle control, causing uncontrolled cell growth. These abnormalities are caused by alterations directly in genes, or chromosome rearrangements which change the function of a gene. Patients with neurofibromatosis, Von Hippel-Lindau syndrome, Li-Fraumeni syndrome, and retinoblastoma have an increased risk of developing tumors of the central nervous system. Also, there have been some cases of people in the same family developing brain tumors that do not have any of these genetic syndromes.

Patients who have received radiation therapy to the head as part of prior treatment for other malignancies are also at an increased risk for new brain tumors.

Symptoms of Brain Tumor

There are common symptoms for brain tumors, however each persons experience may be different and the symptoms vary depending on the size and location of the tumor. Tumors are extra tissue in the brain and can cause pressure on the brain and result in increased intracranial pressure (ICP). This may cause one or more of the ventricles that drain cerebral spinal fluid (the fluid that surrounds the brain and spinal cord) to become blocked and cause the fluid to be trapped in the brain. The increased ICP may cause the following:

• Headache
• Vomiting (usually in the morning)
• Nausea
• Personality changes
• Irritability
• Drowsiness
• Depression
• Decreased cardiac and respiratory function and, eventually coma if not treated

Symptoms of brain tumors in the front of the brain include:

• Increased intracranial pressure
• Seizures
• Visual changes
• Slurred speech
• Paralysis or weakness on half of the body or face
• Drowsiness and/or confusion
• Personality changes/impaired judgment
• Gait disturbances
• Communication problems

Symptoms of brain tumors in the brainstem or base of the brain may include:

• Increased intracranial pressure (ICP)
• Seizures
• Endocrine problems (diabetes and/or hormone regulation)
• Visual changes or double vision
• Headaches
• Paralysis of nerves/muscles of the face, or half of the body
• Respiratory changes
• Clumsy, uncoordinated walking
• Hearing loss
• Personality changes

Symptoms of brain tumors in the cerebellum or back of the brain may include:

• Increased intracranial pressure (ICP)
• Vomiting (usually in the morning without nausea)
• Headache
• Uncoordinated muscle movements
• Problems walking

Treatment of Brain Tumor

Treatment for brain tumors will be decided by your doctor based on the following characteristics:

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

Treatment for a brain tumor may rely on one or a combination of the following:

• Surgery (which is usually the first step in the treatment of brain tumors, with the goal being to remove as much of the tumor as possible while maintaining neurological function. A biopsy is done to examine the types of cells the tumor is made of for a diagnosis. This is done frequently if the tumor is in an area with sensitive structures around it that may be injured during removal.
• Chemotherapy
• Radiation therapy
• Steroids (this treats and prevents swelling especially in the brain)
• Anti-seizure medication (to treat and prevent seizures associated with intracranial pressure)
• Placement of a ventriculoperitoneal shunt (or a VP shunt) this tube is placed into the fluid filled spaces of the brain called ventricles. The other end of the tube is placed into the abdomen to help drain excess fluid that can build up in the brain and cause an increase in pressure in the brain.
• Supportive care (to minimize the side effects of the tumor treatment)
• Rehabilitation (to regain lost motor skills and muscle strength, speech, physical and occupational therapists may be involved in your treatment team)
• Antibiotics (to treat and prevent infections)
• Continuous follow-up care (to manage disease, detect recurrence of the tumor and to manage late effects of treatment)

There are also newer therapies that may be involved in your brain tumor treatment:

• Stereotactic radiosurgery. This technique focuses high doses of radiation at the tumor site from many different angles, while sparing the surrounding normal tissue, with the use of photon beams from a linear accelerator or cobalt x-rays.
• Gene therapy, which is a special gene added to a virus that is injected into the brain tumor. An antiviral drug is then given which kills the cancer cells that have been infected with the altered virus.
• Chemotherapy wafers. These are wafers containing a containing a cancer-killing drug, BCNU, which is inserted directly into the area of the brain tumor during surgery.

Rehabilitation for Brain Tumors

Valley specialists will see to it that you get the continuous follow-up care that is essential for a person diagnoses with a brain tumor. One has to be on guard against the side effects of radiation and chemotherapy, as well as second malignancies which can occur in brain tumor survivors. Lost motor skills and muscle strength will be regained through rehabilitation for an extended amount of time. Valley speech therapists and physical and occupational therapist may be involved in your treatment plan.

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 in the face, arm, or leg, especially on one side of the body
• Confusion or difficulty speaking or understanding information
• 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 9-1-1 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 you 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.

American Brain Tumor Association
Brain Injury Alliance of Washington