"We are fortunate to have an exceptionally talented team to provide multi-disciplinary neuroscience services for the region." David Vossler, MD, Medical Director, Neuroscience Institute.
Each year 1.4 million people in the U.S. experience brain injury. VMC's Neuroscience Institute is equipped to handle your brain injury needs from mild concussion to the severe. An acquired brain injury occurs when a sudden, external physical assault damages the brain. Also called a traumatic brain injury, the injury may be confined to one area of the brain or more than one area. Brain injuries may be closed, meaning there is a non-penetrating injury to the brain, with no break in the skull; or, they can be penetrating, meaning an open head injury, a break in the skull.
Some common brain disorders the Neuroscience Institute treats are brain aneurysm, stroke, brain AVM (arteriovenous malformation), brain tumors, and brain injury.
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:
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:
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.
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
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:
Symptoms of Brain Infection
Symptoms of bacterial brain infection may vary by condition, the age of the person, and the acuteness of the disease:
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:
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:
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:
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:
Moderate to severe head injury (requires immediate medical attention) symptoms may include any of the above plus the following:
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:
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:
Symptoms of brain tumors in the front of the brain include:
Symptoms of brain tumors in the brainstem or base of the brain may include:
Symptoms of brain tumors in the cerebellum or back of the brain may include:
Treatment of Brain Tumor
Treatment for brain tumors will be decided by your doctor based on the following characteristics:
Treatment for a brain tumor may rely on one or a combination of the following:
There are also newer therapies that may be involved in your brain tumor treatment:
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:
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:
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.