What are brain lesions. How are brain lesions caused. What symptoms do brain lesions produce. How are brain lesions diagnosed and treated. What are the different types of brain lesions. How do brain lesions impact daily life. Can brain lesions be prevented.

Understanding Brain Lesions: Definition and Overview

Brain lesions are areas of damaged tissue within the brain, resulting from injury or disease. While this definition may seem straightforward, the complexity of brain lesions lies in their diverse nature. They can vary significantly in size, number, and potential health impacts, ranging from relatively benign to life-threatening conditions.

Are all brain lesions the same? No, brain lesions can differ greatly in their characteristics and effects on the body. Some may be small and asymptomatic, while others can be large and cause severe neurological symptoms. The severity of a brain lesion depends on its location, size, and underlying cause.

Common Causes of Brain Lesions: From Injuries to Diseases

Brain lesions can arise from various factors, including:

• Physical injuries to the head
• Infections affecting the brain
• Exposure to toxic chemicals
• Immune system disorders
• Developmental abnormalities
• Vascular problems
• Tumors (both benign and malignant)

In many cases, the exact cause of a brain lesion remains unknown. This uncertainty can make diagnosis and treatment challenging for healthcare professionals.

Traumatic Brain Injuries as a Cause of Lesions

Traumatic brain injuries (TBIs) are a significant cause of brain lesions. These can occur due to falls, vehicle accidents, sports injuries, or violent assaults. The impact can cause bruising, bleeding, or tearing of brain tissue, resulting in lesions that may have immediate or delayed effects on brain function.

Recognizing the Symptoms of Brain Lesions

The symptoms of brain lesions can vary widely depending on their type, location, and size. Common symptoms include:

• Headaches
• Seizures
• Vision problems
• Changes in speech or language abilities
• Memory difficulties
• Mood or personality changes
• Balance and coordination issues
• Weakness or paralysis in certain parts of the body

Do all brain lesions cause noticeable symptoms? Not necessarily. Some brain lesions, particularly small ones or those located in less critical areas of the brain, may not produce any observable symptoms. These are often discovered incidentally during brain imaging for unrelated reasons.

Types of Brain Lesions: A Comprehensive Overview

Brain lesions encompass a wide range of conditions, each with its unique characteristics and potential impacts on health. Here are some of the most common types:

Brain Abscesses: Pockets of Infection

Brain abscesses are localized infections within the brain tissue, containing pus and inflamed tissue. Although rare, they are potentially life-threatening. Brain abscesses often develop as a complication of infections in nearby areas, such as the ears, sinuses, or teeth. They can also occur following head injuries or surgical procedures involving the skull.

Arteriovenous Malformations (AVMs): Tangled Blood Vessels

AVMs are congenital abnormalities where arteries and veins in the brain grow in a tangled mass, connected by abnormal passages called fistulae. This condition can lead to ruptures and bleeding in the brain, potentially causing seizures as the first symptom.

Cerebral Infarction: Brain Tissue Death

Also known as a stroke, cerebral infarction occurs when a cluster of brain cells die due to insufficient blood supply. This can result from a blood clot blocking a brain artery or from bleeding within the brain.

Cerebral Palsy: Early Brain Damage

Cerebral palsy is a type of brain lesion that occurs before or during birth. It affects a child’s ability to move and can impact communication skills. However, many children with cerebral palsy have normal intellectual functioning.

Multiple Sclerosis (MS): Immune System Attack

In MS, the immune system mistakenly attacks the protective covering of nerve fibers (myelin) in the brain and spinal cord. This damage disrupts communication between the brain and the rest of the body, leading to various neurological symptoms.

Brain Tumors: Abnormal Cell Growth

Brain tumors are abnormal growths of cells within the brain. They can be benign (non-cancerous) or malignant (cancerous), and may originate in the brain itself or spread from other parts of the body (metastatic tumors).

Diagnostic Approaches for Brain Lesions

Diagnosing brain lesions often involves a combination of clinical evaluation and advanced imaging techniques. The specific methods used depend on the presenting symptoms and suspected type of lesion.

Neurological Examination

A thorough neurological examination is typically the first step in diagnosing brain lesions. This assessment evaluates various aspects of brain function, including:

• Mental status and cognitive abilities
• Cranial nerve function
• Motor strength and coordination
• Sensory perception
• Reflexes
• Balance and gait

Imaging Studies

Advanced imaging techniques play a crucial role in identifying and characterizing brain lesions. The most commonly used methods include:

• Computed Tomography (CT) scans
• Magnetic Resonance Imaging (MRI)
• Functional MRI (fMRI)
• Positron Emission Tomography (PET) scans

How do these imaging techniques differ in their ability to detect brain lesions? CT scans are often used as an initial screening tool due to their speed and availability. They are particularly useful for detecting bleeding, skull fractures, and large tumors. MRI provides more detailed images of brain tissue and is better at identifying small lesions, subtle abnormalities, and distinguishing between different types of tissue. Functional MRI can show brain activity in relation to specific tasks, while PET scans can reveal metabolic changes associated with certain types of lesions.

Laboratory Tests

Blood tests and other laboratory analyses may be conducted to look for signs of infection, inflammation, or other systemic conditions that could be causing or contributing to brain lesions. In some cases, a cerebrospinal fluid analysis may be performed to check for infections or abnormal cells in the central nervous system.

Treatment Strategies for Brain Lesions

The treatment of brain lesions varies widely depending on the type, location, size, and underlying cause of the lesion. The primary goals of treatment may include:

• Curing or removing the lesion
• Alleviating symptoms
• Preventing further damage
• Improving quality of life
• Extending life expectancy in serious cases

Watchful Waiting

In some cases, particularly with small, benign lesions that are not causing symptoms, a “wait and see” approach may be recommended. This involves regular monitoring through periodic check-ups and imaging studies to track any changes in the lesion over time.

Surgical Interventions

Surgery is often considered for brain lesions that can be safely accessed and removed. Advances in neurosurgical techniques have made it possible to treat even deep-seated or complex lesions that were once considered inoperable. Surgical options may include:

• Traditional open surgery
• Minimally invasive procedures
• Stereotactic radiosurgery (focused radiation treatment)
• Laser interstitial thermal therapy (LITT)

Radiation Therapy

Radiation therapy may be used to treat certain types of brain lesions, particularly cancerous tumors. This treatment uses high-energy beams to damage or destroy abnormal cells. It can be delivered externally (external beam radiation) or internally (brachytherapy).

Chemotherapy

For cancerous brain lesions, chemotherapy drugs may be prescribed to kill cancer cells or slow their growth. These medications can be administered orally, intravenously, or in some cases, directly into the cerebrospinal fluid.

Immunotherapy and Targeted Therapies

Newer treatment approaches, such as immunotherapy and targeted molecular therapies, are showing promise in treating certain types of brain lesions, particularly malignant tumors. These treatments work by harnessing the body’s immune system or targeting specific molecular pathways involved in tumor growth.

Medication for Symptom Management

Various medications may be prescribed to manage symptoms associated with brain lesions, such as:

• Anti-epileptic drugs for seizures
• Corticosteroids to reduce inflammation and swelling
• Pain medications
• Antidepressants or anti-anxiety medications for mood-related symptoms

Rehabilitation and Supportive Care

Depending on the effects of the brain lesion, rehabilitation services may be necessary to help patients regain lost functions or adapt to new limitations. This can include:

• Physical therapy
• Occupational therapy
• Speech and language therapy
• Cognitive rehabilitation
• Psychological counseling

Living with Brain Lesions: Challenges and Coping Strategies

Brain lesions can have profound impacts on an individual’s daily life, depending on their location and severity. Patients may face challenges in various areas, including:

• Physical functioning
• Cognitive abilities
• Emotional well-being
• Social interactions
• Work or school performance

How can individuals cope with the challenges posed by brain lesions? Coping strategies may include:

• Engaging in rehabilitation programs to maximize recovery and adaptation
• Learning compensatory techniques to work around deficits
• Using assistive technologies to support daily activities
• Participating in support groups to connect with others facing similar challenges
• Practicing stress management techniques, such as mindfulness or relaxation exercises
• Maintaining a healthy lifestyle through proper nutrition, regular exercise, and adequate sleep

It’s important for patients and their families to work closely with healthcare providers to develop a comprehensive management plan that addresses both the medical and psychosocial aspects of living with brain lesions.

Preventing Brain Lesions: Risk Reduction Strategies

While not all brain lesions can be prevented, there are steps individuals can take to reduce their risk of developing certain types of lesions:

• Wearing protective headgear during high-risk activities to prevent traumatic brain injuries
• Maintaining good cardiovascular health to reduce the risk of stroke
• Avoiding exposure to toxic substances that can damage brain tissue
• Getting vaccinated against infections that can lead to brain abscesses
• Managing chronic health conditions that may increase the risk of brain lesions
• Avoiding excessive alcohol consumption and not using illicit drugs
• Practicing good hygiene to prevent infections that could spread to the brain

Can a healthy lifestyle completely prevent brain lesions? While a healthy lifestyle can significantly reduce the risk of certain types of brain lesions, it’s important to note that some lesions may develop due to genetic factors or other uncontrollable circumstances. Regular medical check-ups and prompt attention to any neurological symptoms can help in early detection and management of brain lesions.

Future Directions in Brain Lesion Research and Treatment

The field of neuroscience is rapidly advancing, bringing new hope for improved diagnosis and treatment of brain lesions. Some promising areas of research include:

• Advanced neuroimaging techniques for earlier and more precise detection of lesions
• Gene therapy approaches for treating genetic causes of brain lesions
• Stem cell therapies for repairing damaged brain tissue
• Nanotechnology for targeted drug delivery to brain lesions
• Artificial intelligence and machine learning for better prediction of lesion outcomes and treatment responses
• Brain-computer interfaces to help patients with severe neurological deficits

What potential breakthroughs can we expect in brain lesion treatment in the coming years? While it’s difficult to predict specific breakthroughs, the integration of advanced technologies with our growing understanding of brain function holds great promise. Future treatments may be able to not only remove or shrink lesions but also stimulate the brain’s natural repair mechanisms, potentially leading to more complete recovery of function.

In conclusion, brain lesions represent a diverse and complex group of conditions that can significantly impact an individual’s health and quality of life. Understanding the causes, symptoms, and treatment options for brain lesions is crucial for both patients and healthcare providers. As research continues to advance, we can look forward to more effective and personalized approaches to managing these challenging neurological conditions.

Brain Lesions: Causes, Symptoms, Treatments

When you scrape your elbow, it leaves an area of inflamed skin, or a lesion. But what are lesions in the brain? And what causes them? How serious are brain lesions and how are they treated? Here is information about this confusing and unsettling health concern.

What Are Brain Lesions?

A lesion is an area of tissue that has been damaged through injury or disease. So a brain lesion is an area of injury or disease within the brain. While the definition sounds simple, understanding brain lesions can be complicated. That’s because there are many types of brain lesions. They can range from small to large, from few to many, from relatively harmless to life threatening.

What Causes Brain Lesions?

Brain lesions can be caused by injury, infection, exposure to certain chemicals, problems with the immune system, and more. Typically, their cause is unknown.

What Are the Symptoms of a Brain Lesion?

Symptoms of a brain lesion vary depending on the type, location, and size of the lesion. Symptoms common to several types of brain lesions include the following:

What Are the Different Types of Brain Lesions?

Although they share a common definition — injury or damage to tissue within the brain — brain lesions vary greatly. Here are some common brain lesions.

Abscesses: Brain abscesses are areas of infection, including pus and inflamed tissue. They are not common, but they are life threatening. Brain abscesses often occur after an infection, usually in a nearby area, such as an ear, sinus, or dental infection. They can also appear after injury or surgery to the skull. Read more about the causes of abscesses.

Arteriovenous malformations (AVMs): An AVM is a type of brain lesion that occurs during early development. Arteries and veins in the brain grow in a tangle and become connected by tube-like structures called fistulae. The arteries are not as strong as normal arteries. The veins are often enlarge because of the constant flow of blood directly from the arteries through the fistulae to the veins. These fragile vessels may rupture, leaking blood into the brain. In addition, the brain tissue may not receive enough blood to function properly. Damage to the brain may cause seizures as the first symptoms of an AVM.

Cerebral infarction: Infarction refers to death of tissue. A cerebral infarction, or stroke, is a brain lesion in which a cluster of brain cells die when they don’t get enough blood. Recognize the signs and symptoms of a stroke.

Cerebral palsy: This type of brain lesion occurs when a baby is still in the mother’s womb. Cerebral palsy does not progress over time. The brain lesions affect the child’s ability to move, which can also make communication and related skills difficult. However, many children with cerebral palsy have normal intellectual functioning. Read more on the symptoms and types of cerebral palsy.

Multiple sclerosis (MS): With this condition, the immune system attacks and damages the nerve linings (myelin) in the brain and spinal cord. These lesions make it difficult for messages to be sent and received properly between the brain and the rest of the body. Learn more about the symptoms of MS.

Tumors: Tumors are clumps of cells that grow abnormally from normal tissue. Some tumors in the brain are noncancerous, or benign. Others are cancerous. They may start in the brain, or they may spread from elsewhere in the body (metastatic). They may grow quickly or they may remain stable. Get more information on signs and symptoms of a brain tumor.

How Are Brain Lesions Diagnosed?

The methods used to find and diagnose brain lesions depend on the symptoms. In many cases, CT and MRI imaging studies help pinpoint the location, size, and characteristics of the lesions. Blood and other lab tests may also be done to look for signs of infection.

How Are Brain Lesions Treated?

Treatment depends on the type of brain lesion. The goals of treatment may be to provide a cure, relieve symptoms, or improve the quality or length of life. Common approaches for treating brain lesions include the following:

• “Wait and see;” if the lesion is not causing problems and is not growing, you may only need periodic checkups.
• Surgical removal of the lesion, if possible; new surgical techniques may make it possible to remove even hard-to-reach lesions.
• Chemotherapy and radiation therapy for lesions that are cancerous
• Medication to fight infections, such as antibiotics or other antimicrobial drugs
• Medication to calm the immune system or otherwise change the immune system’s response
• Medication or other therapies to relieve symptoms associated with the brain lesion

How Can I Find Out More About Brain Lesions?

Brain lesions take many forms, so diagnosing and treating them can be complex. That’s why it’s important to discuss individual questions about brain lesions with your doctor. Together, you can determine the best way to proceed in identifying, treating, and living with brain lesions.

Brain lesions Causes – Mayo Clinic

Often, a brain lesion has a characteristic appearance that will help your doctor determine its cause. Sometimes the cause of the abnormal-appearing area cannot be diagnosed by the image alone, and additional or follow-up tests may be necessary.

Among the known possible causes of brain lesions are:

1. Brain aneurysm
2. Brain AVM (arteriovenous malformation)
3. Brain tumor (both cancerous and noncancerous)
4. Encephalitis (brain inflammation)
5. Epilepsy
6. Hydrocephalus
7. Multiple sclerosis
8. Stroke
9. Traumatic brain injury

While brain trauma of any sort may result in a concussion as well as a brain lesion, concussions and brain lesions are not the same thing. Concussions more often occur without ever causing any changes on the CT or MRI and are diagnosed by symptoms rather than imaging tests.

Causes shown here are commonly associated with this symptom. Work with your doctor or other health care professional for an accurate diagnosis.

• Definition
• When to see a doctor

Jan. 11, 2018

Show references

1. Sandeman EM, et al. Incidental findings on brain MR imaging in older community-dwelling subjects are common but serious medical consequences are rare: A cohort study. PLOS One. 2013;8:e71467.
2. Magnetic resonance imaging (MRI). National Multiple Sclerosis Society. http://www.nationalmssociety.org/Symptoms-Diagnosis/Diagnosing-Tools/MRI. Accessed Aug. 14, 2017.
3. Maher CO, et al. Incidental findings on brain and spine imaging in children Pediatrics. 2015;135:e1084.
4. Cole AJ. Magnetic resonance imaging changes related to acute seizure activity. https://www.uptodate.com/contents/search. Accessed Aug. 14, 2017.
5. Sports-related concussion. Merck Manual Professional Version http://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/sports-related-concussion. Accessed Aug. 14, 2017.

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Brain lesions | Beacon Health System

Definition

A brain lesion is an abnormality seen on a brain-imaging test, such as magnetic resonance imaging (MRI) or computerized tomography (CT). On CT or MRI scans, brain lesions appear as dark or light spots that don’t look like normal brain tissue.

Usually, a brain lesion is an incidental finding unrelated to the condition or symptom that led to the imaging test in the first place.

A brain lesion may involve small to large areas of your brain, and the severity of the underlying condition may range from relatively minor to life-threatening.

Causes

Often, a brain lesion has a characteristic appearance that will help your doctor determine its cause. Sometimes the cause of the abnormal-appearing area cannot be diagnosed by the image alone, and additional or follow-up tests may be necessary.

Among the known possible causes of brain lesions are:

• Brain aneurysm
• Brain AVM (arteriovenous malformation)
• Brain tumor (both cancerous and noncancerous)
• Encephalitis (brain inflammation)
• Epilepsy
• Hydrocephalus
• Multiple sclerosis
• Stroke
• Traumatic brain injury

While brain trauma of any sort may result in a concussion as well as a brain lesion, concussions and brain lesions are not the same thing. Concussions more often occur without ever causing any changes on the CT or MRI and are diagnosed by symptoms rather than imaging tests.

When to see a doctor

If a brain lesion discovered during a brain-imaging test doesn’t appear to be from a benign or resolved condition, your doctor will likely seek more information from additional testing or consulting a specialist.

Your doctor may recommend that you see a neurologist for a specialized examination and, possibly, further tests. Even if a neurological work-up doesn’t result in a diagnosis, your doctor may recommend continued testing to reach a diagnosis or follow-up imaging tests at regular intervals to monitor the lesion.

Last Updated: January 11th, 2018

Brain Lesions – an overview

Secondary dystonias caused by focal brain lesions

Focal brain lesions can cause various movement disorders, with dystonias being the most common (Scott and Jankovic, 1996). Dystonia can occur if relevant brain structures are affected. These include the basal ganglia (putamen, globus pallidum, striatum), thalamus, parietal cortex, and cerebellum. The basal ganglia and thalamus are most often involved in the development of dystonia (Marsden et al., 1985; Obeso and Giménez-Roldan, 1988; Kostić et al., 1996). Especially in hemidystonia there is a close relationship between lesions of the basal ganglia, mostly the putamen, and contralateral hemidystonia (Perlmutter and Raichle, 1984; Pettigrew and Jankovic, 1985; Quinn et al. , 1985; Chuang et al., 2002). Thalamic lesions seem to produce predominantly limb dystonia (Lee and Marsden, 1994). Lesions associated with blepharospasm are sometimes localized within the brainstem (Jankovic and Patel, 1983; Powers, 1985; Jankovic, 1986). However, lesions in atypical localizations point to the enormous degree of interconnectivity within the brain. Parietal lesions and cerebellar lesions have also been associated with secondary dystonia (Krauss et al., 1991; Coria et al., 2000; Alarcón et al., 2001). Correlating focal brain lesions with dystonia becomes difficult when the localization of the lesion is atypical or multiple, when the resulting dystonia is pure, and when the delay between the insult and the dystonia onset is long.

As with diffuse brain damage, the latency between the focal brain lesion and dystonia onset is very rarely immediate. Typically, the latency is months, but more often it can be years (Factor et al., 1988; Lee et al., 1994). Secondary progression may occur.

There is no particular etiology to the focal brain lesion which induces dystonia (Table 38.1). Cardiovascular processes producing infarction (Demierre and Rondot, 1983; Russo, 1983; Keane and Young, 1985; Alarcón et al., 2004) and hemorrhage (Esteban Muñoz et al., 1996; Hamasaki et al., 2008; Agrawal et al., 2009; Loher and Krauss, 2009), trauma producing neuronal damage, gliosis, or calcification (Lee et al., 1994), tumors of all kinds (Seet and Lim, 2005; Kumandaş et al., 2006; Klein et al., 2007; Mutsaers et al., 2007), encephalitis (Ferraz and Andrade, 1992; Scott and Jankovic, 1996; Kalita and Misra, 2000; Grippo and Grippo, 2001; Ashtekar et al., 2003; Factor et al., 2003; Shah and Chudgar, 2005) due to viral and bacterial infections, encephalitis as in encephalomyelitis disseminata (Jankovic and Patel, 1983; Coleman et al., 1988a; Plant et al., 1989; Minagar et al., 2002; Rüegg et al., 2004; Renganathan et al., 2005), paraneoplastic encephalitis (Albin et al., 1988; Golbe et al. , 1989), and postinfectious encephalitis after streptococcus infection (Dale, 2005) all may produce focal brain lesions resulting in secondary dystonias.

Approximately 30% of patients with motor stroke will develop muscle hyperactivity in their paretic limb (Adib Saberi and Dressler, 2009). Traditionally, this muscle hyperactivity was labeled spasticity. Recently, it became clear that this muscle hyperactivity consists of various forms of muscle hyperactivity syndromes, including dystonia, rigidity, and spasms, with spasticity sensu strictu (Lance, 1980) being only one of them. The combination of paresis with muscle hyperactivity was therefore named ‘spastic condition’ (Dressler, 2000). Dystonia in spastic conditions usually is tonic and may be intensified by muscle activation in the affected limb or elsewhere (overflow phenomenon). No specific structures other than pyramidal and extrapyramidal corticospinal pathways have been associated with the occurrence of muscle hyperactivity in spastic conditions. With the enormous incidence of stroke, dystonia in spastic conditions is the most common symptomatic dystonia.

Tumor-like lesions of the brain

Abstract

Differentiation between tumors and tumor-like lesions of the central nervous system is essential for planning adequate treatment and for estimating outcome and future prognosis. Neuroimaging fulfills an essential role in the correct differentiation between both entities. The radiologist should be aware of all non-neoplastic pathologies and diseases that may mimic tumors. High-end anatomic and functional neuroimaging tools integrating multiple modalities and clinical correlation is mandatory. In the current review, frequent tumor-like lesions are discussed.

Keywords: Tumor-like, brain, central nervous system, advanced magnetic resonance imaging

Introduction

Differentiation between tumors and tumor-like lesions of the central nervous system (CNS) is essential for planning adequate treatment and for estimating outcome and future prognosis. By definition, tumor and tumor-like lesions are lesions that look alike on ultrasound (US), computer tomography (CT) or magnetic resonance imaging (MRI) studies. Typically, tumor-like lesions are reported as: findings compatible with a tumor-like lesion, however neoplasm cannot be ruled out. Clinical correlation and follow-up examinations are recommended to rule out malignancy. In practice, a tumor (e.g. astrocytoma) is a lesion that should be treated aggressively, whereas a tumor-like lesion (e.g. multiple sclerosis (MS) plaque) can be treated more conservatively. Misinterpretation may lead to a significant delay of adequate treatment of malignant tumors or may result in over-treatment of a tumor-like, benign lesion. The essential question is how does a radiologist reliably differentiate between both entities? Typically, anatomic imaging studies such US, CT or MRI are used. A tumor is suspected when a focal density or signal alteration is seen displacing or infiltrating adjacent structures with or without a matching contrast enhancement and possibly surrounded by vasogenic edema. Unfortunately, many tumor-like lesions including tumefactive MS plaques, abscesses, resolving hematomas, vascular malformations, giant Virchow–Robin spaces, and even metabolic disorders may have similar imaging features. In addition, a frequent, difficult question is the differentiation between postsurgical changes and residual tumor after recent brain tumor surgery. The recent development of functional MRI sequences such as diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), ¹H magnetic resonance spectroscopy (MRS), susceptibility-weighted imaging (SWI) and pH-weighted MRI facilitates the differentiation between tumor and tumor-like lesions.

It is impossible to present a complete list of tumor-like lesions, however, this article reviews the most frequent tumor-like lesions, their so-called characteristic neuroimaging presentation and how to differentiate them from tumors.

Diagnosis and clinical presentation

Infectious tumor-like lesions

The classic tumor-like lesion is an intracranial abscess. Abscesses may occur as complications of a meningo-encephalitis, from direct extension from paranasal sinus and temporal bone infections and may result from hematogenous spread (septic emboli) of an extracranial infection. In addition, abscesses may result from penetrating traumas or as a result of a neurosurgical procedure. Abscesses are especially frequent seen in immuno-compromised patients. Most intracranial abscesses are bacterial (staphylococcus, streptococcus and pneumococcus). Intracranial abscesses may present with imaging features that are identical to high-grade neoplasms such as a glioblastoma multiforme. Differentiation has been difficult for many years. On conventional imaging abscesses are round, mass lesions with various degrees of adjacent vasogenic white matter edema and a strong peripheral contrast enhancement. The ring of enhancement is usually closed and may appear thicker towards the direction of the cortex. With the advent of diffusion-weighted imaging (DWI), the identification of restricted diffusion within the center of the abscess facilitated differentiation from necrotic high-grade malignancies significantly. The pus within the abscess typically shows a restricted diffusion, whereas necrosis in the center of malignant tumors typically shows an increased diffusion.

Several infectious diseases involving the CNS like TORCH (Toxoplasmosis, Rubella, Cytomegalovirus and Herpes simplex) infections, tuberculosis, neurocysticercosis and various other fungal and opportunistic infections including parasitic infections (echinococcus, schistosomiasis and paragonimiasis) may mimic metastatic disease from extracranial neoplasms in children. Typically the lesions are multiple, may show various degrees of calcifications, vasogenic edema and contrast enhancement. The clinical history and laboratory tests are usually sufficient to differentiate between metastatic and infectious causes. In addition, if migrational abnormalities, cerebellar hypoplasia, orbital lesions including microphtalmia and microcephaly are noted, congenital infections that interfered with the brain development should be considered.

Intracranial tumor-like hemorrhage

Intracranial hemorrhages may result from a variety of intrinsic and/or extrinsic causes^[1]. Extrinsic causes include accidental head trauma as well as surgical interventions. Intrinsic causes are manifold and include hemorrhagic stroke, vascular malformations, aneurysms, hematological disorders, bleeding diathesis, anticoagulation treatment, intracranial neoplasms, dural sinus thrombosis and complications from infections (e.g. herpes encephalitis).The imaging features of intra-axial hematomas can be heterogeneous and vary over time. Factors that influence hematoma evolution include location (gray versus white matter), size (punctuate versus confluent, unifocal versus multifocal), etiology (arterial versus venous, trauma versus hypertension), temporal occurrence of hemorrhage (acute event versus multi-staged, recurrent hemorrhage) as well as many biologic factors such as the patient’s general physical condition, associated systemic diseases, hematocrit level, tissue oxygenation level (pO₂), pH and protein concentration (hemoglobin (Hb)). In addition, medical treatment and interventions may influence evolution of the hematoma. Transformation of hematomas may show imaging features very similar to tumors. Especially in the subacute to chronic phase, the spontaneous clot evolution with peripheral contrast enhancement and surrounding edema may mimic a tumor. The clinical history is usually helpful; most patients present with a sudden onset of symptoms. Careful evaluation of the imaging results and the use of functional sequences, in particular SWI for identifying blood products, DWI and MRS are helpful for differentiation. If an underlying vascular malformation is suspected MR angiography (MRA) and MR venography (MRV) may reveal dilated supplying and/or draining veins. If a cavernoma is suspected, SWI is helpful to exclude additional lesions. Despite all high-end anatomic and functional sequences, a hemorrhage within a tumor remains challenging on imaging. The tumor can be hidden within the hemorrhage.

Ischemic tumor-like stroke

Similar to intracranial hemorrhages, ischemic arterial or venous strokes may mimic tumors on neuroimaging. Ischemic strokes may have a significant mass effect with irregular contrast enhancement. The clinical history with an acute onset of symptoms and a matching clinical history is usually highly suggestive of a stroke. In addition, most lesions are located within a vascular territory with simultaneous involvement of cortex and the adjacent white matter. Finally, the imaging characteristics as seen on anatomic MRI as well as functional MRI with restricted diffusion on DWI and hypoperfusion on PWI usually prevent misinterpretation. Occasionally, hemorrhagic infarctions may be challenging. Especially during the spontaneous resolution of ischemic brain tissue, various patterns of contrast enhancement due to the blood–brain barrier disruption may mimic tumors. If a focal lesion crosses arterial vascular territories, a venous infarction should be considered.

Tumefactive tumor-like demyelination

Various demyelinating diseases, including MS, acute disseminated encephalomyelitis (ADEM) and progressive multifocal leucoencephalopathy (PML) may present tumor-like, also known as tumefactive, areas of demyelination. On imaging, these lesions may show imaging features suggestive of a brain tumor or abscess displaying solitary or multiple focal areas of signal alteration with an irregular peripheral enhancement and a mild to moderate mass effect on adjacent brain structures. Differential diagnosis may also include parasitic infections. Pathologic studies report large areas of confluent demyelination with an inflammatory response, often associated with perilesional edema and mass effect. Correlation with the clinical history usually prevents misdiagnosis. However, even in patients with established diagnosis of MS, the diagnosis of tumefactive demyelination can occasionally be difficult^[2]. Patients with MS frequently receive immunosuppressive medications putting them at risk for opportunistic infections, abscesses or even neoplasm. Tumefactive demyelination should be suspected if multiple lesions are present, if multiple areas of the CNS are involved including the spinal cord, if the lesions are periventricular and if they follow the course of the intramedullary veins (Dawson fingers, named after the Scottish pathologist James Walker Dawson). In addition, the kind of enhancement may help to differentiate between tumefactive MS plaques and abscesses. Typically, MS plaques show an incomplete ring of contrast enhancement towards the cortex, whereas an abscess shows a complete ring of enhancement. In addition, DWI is helpful in differentiating both entities. Finally, a rapid response of the lesion to corticosteroid treatment is suggestive of demyelinating diseases. Tumors and abscesses do not respond quickly.

Phakomatoses and tumor-like malformations

Phakomatoses, also known as neurocutaneous syndromes, are disorders of histiogenesis affecting derivates of the neuroectoderm and ectoderm. The best known and most frequently diagnosed examples are neurofibromatosis type I and II, tuberous sclerosis complex, Sturge–Weber syndrome, von Hippel–Lindau syndrome and hereditary hemorrhagic teleangiectasia syndrome. The imaging features of these syndromes are well known and are frequently considered to be diagnostic in the correct, matching clinical setting. However, the diagnosis is not always suspected clinically and lesions identified on neuroimaging may mimic tumors. In neurofibromatosis type I, the so-called mass-like T2-hyperintense, non-enhancing unidentified bright objects (UBOs) also known as non-specific bright foci (NSBF) within the brainstem, basal ganglia and cerebellum and the cortical and subcortical T2-hyperintense tubers as seen in tuberous sclerosis may mimic low-grade gliomas. Correlation with the clinical findings and identification of additional characteristic lesions usually point towards the correct diagnosis.

Rarely, disorders of organogenesis, which include disorders of neuronal migration and cortical development, may present as tumor-like lesions. A cluster of heterotopic gray matter within the white matter or focal Taylor type cortical dysplasia may present as a focal mass-like lesion. The imaging characteristics on high-resolution anatomic and functional MRI and the lack of blood–brain barrier disruption will prevent misinterpretation.

Vascular malformations including arterio-venous malformations (AVM), arterio-venous fistulas (AVF), and aneurysms may present as tumor-like lesions. These vascular malformations may be especially challenging if partial thrombosis is present. The varying signal characteristics of the intravascular thrombus and related, frequently inhomogeneous contrast enhancement may mimic tumors. Vasogenic edema may be observed resulting from direct mass effect as well as from the arterial and venous hemodynamic effects of the vascular malformation. Venous edema is frequently observed in AVMs or AVFs; cytotoxic edema may result from complicating ischemia. Finally, a large spontaneous hemorrhage may compress the vascular malformation making it virtually impossible to identify the lesion on early imaging. Differentiation between a hemorrhage within a highly perfused tumor and a vascular malformation can be difficult. Follow-up imaging or an angiography may be necessary for differentiation. In uncomplicated vascular malformations, identification of dilated supplying arteries and draining vessels as well as pulsation artifacts on MRI and MRA confirm diagnosis.

Tumor-like vasculitis, angiitis

Systemic lupus erythematosus (SLE) is reported to involve the CNS in up to 70% of patients. Neurologic dysfunction may result from ischemic stroke, acute hemorrhage or transverse myelitis. Ischemic stroke results from immune complex vasculitis and thrombosis associated with antiphospholipid antibodies. Huang et al.^[3] reported of a 14-year old boy with known SLE who was admitted in a subcomatous condition. MRI showed a large tumor-like temporal mass lesion with midline shift, brainstem compression, obstructive hydrocephalus and internal streaks of hemorrhage. Brain biopsy showed extensive perivasculitis with marked perivascular infiltration of eosinophils, macrophages and neurtrophils. No tumor was detected. Correlation of imaging findings and the clinical history suggested diagnosis.

Tumor-like mass lesions have also been reported in patients with a primary angiitis of the CNS (PACNS). Vasculitis of the CNS usually occur secondary to systemic vasculitis or as part of other systemic inflammatory disorders. PACNS is defined as a solitary affection of the CNS. Several subgroups have been identified based on clinical, laboratory, angiographic and pathologic findings. Granulomatous angiitis is the most severe form; a less severe form is known as benign angiopathy of the CNS. Molloy et al.^[4] described a subset of PACNS who presented on imaging with solitary tumor-like mass lesions (ML-PACNS). The 38 patients they studied presented with non-specific clinical features including headache (74%), focal neurologic deficits (64%), diffuse neurologic deficit (50%), seizures (47%), nausea and vomiting (21%) and constitutional symptoms (12%). MRI showed focal, tumor-like mass lesions with various degrees of edema, contrast enhancement and hemorrhage within the hemispheric white matter. The imaging features did not allow a reliable differentiation from neoplastic lesions. If patients fail to respond to aggressive immunosuppressive therapy, diagnosis of PACNS should be re-evaluated. Biopsy may be necessary to exclude malignancy or infection.

Tumor-like metabolic disorders

Metabolic disorders and inborn errors of metabolism like the various leukodystrophies usually present with the typical clinical history of a delayed/arrested development or with developmental regression characterized by a progressive loss of previously mastered developmental milestones. Many different diseases can be diagnosed by identifying the pattern of de- and dysmyelination on MRI (pattern recognition) especially when analyzed in combination with ¹H MRS. Typical examples include Canavan disease, Alexander disease, van der Knaap disease and the various adrenoleukodystrophies. However, in several metabolic diseases, mass-like lesions may be observed that mimic tumors. The typical example is the contrast enhancing enlargement of the optic chiasm and forniceal columns in Alexander disease. To avoid misinterpretation, the radiologist should be aware of the full extent of lesions that may be observed in the various inborn error of metabolism.

The radiologist may be confronted with many other less or more frequent tumor-like lesions including true intra-axial lesions, such as primary and secondary giant tumefactive perivascular Virchow–Robin spaces, inflammatory pseudotumors, Behcet-like disease, as well as extra-axial lesions that may mimic intra-axial lesions such as tumors originating from the leptomeninges and adjacent skull that displace or invade the adjacent brain. Large osteosarcomas from the skull may mimic intra-axial malignant, partially calcified tumors. Another challenging issue is the differentiation between post-operative changes and residual/recurrent tumor after brain tumor surgery versus post-radiation changes. Frequently, only follow-up imaging may answer these questions. With the continuing advances in the development of functional sequences (DWI, DTI, ¹H MRS, spectroscopic imaging, PWI, SWI, pH-weighted MRI) and the multimodality approach combining data from CT, MRI, PET-CT and molecular imaging, a reliable differentiation may become possible in the near future.

Brain Tumors – Classifications, Symptoms, Diagnosis and Treatments

Types of Brain Tumors

A brain tumor, known as an intracranial tumor, is an abnormal mass of tissue in which cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. More than 150 different brain tumors have been documented, but the two main groups of brain tumors are termed primary and metastatic.

Primary brain tumors include tumors that originate from the tissues of the brain or the brain’s immediate surroundings. Primary tumors are categorized as glial (composed of glial cells) or non-glial (developed on or in the structures of the brain, including nerves, blood vessels and glands) and benign or malignant.

Metastatic brain tumors include tumors that arise elsewhere in the body (such as the breast or lungs) and migrate to the brain, usually through the bloodstream. Metastatic tumors are considered cancer and are malignant.

Metastatic tumors to the brain affect nearly one in four patients with cancer, or an estimated 150,000 people a year. Up to 40 percent of people with lung cancer will develop metastatic brain tumors. In the past, the outcome for patients diagnosed with these tumors was very poor, with typical survival rates of just several weeks. More sophisticated diagnostic tools, in addition to innovative surgical and radiation approaches, have helped survival rates expand up to years; and also allowed for an improved quality of life for patients following diagnosis.

Types of Benign Brain Tumors

• Chordomas are benign, slow-growing tumors that are most prevalent in people ages 50 to 60. Their most common locations are the base of the skull and the lower portion of the spine. Although these tumors are benign, they may invade the adjacent bone and put pressure on nearby neural tissue. These are rare tumors, contributing to only 0. 2 percent of all primary brain tumors.
• Craniopharyngiomas typically are benign, but are difficult tumors to remove because of their location near critical structures deep in the brain. They usually arise from a portion of the pituitary gland (the structure that regulates many hormones in the body), so nearly all patients will require some hormone replacement therapy.
• Gangliocytomas, gangliomas and anaplastic gangliogliomas are rare tumors that include neoplastic nerve cells that are relatively well-differentiated, occurring primarily in young adults.
• Glomus jugulare tumors most frequently are benign and typically are located just under the skull base, at the top of the jugular vein. They are the most common form of glomus tumor. However, glomus tumors, in general, contribute to only 0.6 percent of neoplasms of the head and neck.
• Meningiomas are the most common benign intracranial tumors, comprising 10 to 15 percent of all brain neoplasms, although a very small percentage are malignant. These tumors originate from the meninges, the membrane-like structures that surround the brain and spinal cord.
• Pineocytomas are generally benign lesions that arise from the pineal cells, occurring predominantly in adults. They are most often well-defined, noninvasive, homogeneous and slow-growing.
• Pituitary adenomas are the most common intracranial tumors after gliomas, meningiomas and schwannomas. The large majority of pituitary adenomas are benign and fairly slow-growing. Even malignant pituitary tumors rarely spread to other parts of the body. Adenomas are by far the most common disease affecting the pituitary. They commonly affect people in their 30s or 40s, although they are diagnosed in children, as well. Most of these tumors can be treated successfully.
• Schwannomas are common benign brain tumors in adults. They arise along nerves, comprised of cells that normally provide the “electrical insulation” for the nerve cells. Schwannomas often displace the remainder of the normal nerve instead of invading it. Acoustic neuromas are the most common schwannoma, arising from the eighth cranial nerve, or vestibularcochlear nerve, which travels from the brain to the ear. Although these tumors are benign, they can cause serious complications and even death if they grow and exert pressure on nerves and eventually on the brain. Other locations include the spine and, more rarely, along nerves that go to the limbs.

Types of Malignant Brain Tumors

Gliomas are the most prevalent type of adult brain tumor, accounting for 78 percent of malignant brain tumors. They arise from the supporting cells of the brain, called the glia. These cells are subdivided into astrocytes, ependymal cells and oligodendroglial cells (or oligos). Glial tumors include the following:

• Astrocytomas are the most common glioma, accounting for about half of all primary brain and spinal cord tumors. Astrocytomas develop from star-shaped glial cells called astrocytes, part of the supportive tissue of the brain. They may occur in many parts of the brain, but most commonly in the cerebrum. People of all ages can develop astrocytomas, but they are more prevalent in adults — particularly middle-aged men. Astrocytomas in the base of the brain are more prevalent in children or younger people and account for the majority of children’s brain tumors. In children, most of these tumors are considered low-grade, while in adults, most are high-grade.
• Ependymomas are derived from a neoplastic transformation of the ependymal cells lining the ventricular system and account for two to three percent of all brain tumors. Most are well-defined, but some are not.
• Glioblastoma multiforme (GBM) is the most invasive type of glial tumor. These tumors tend to grow rapidly, spread to other tissue and have a poor prognosis. They may be composed of several different kinds of cells, such as astrocytes and oligodendrocytes. GBM is more common in people ages 50 to 70 and are more prevalent in men than women.
• Medulloblastomas usually arise in the cerebellum, most frequently in children. They are high-grade tumors, but they are usually responsive to radiation and chemotherapy.
• Oligodendrogliomas are derived from the cells that make myelin, which is the insulation for the wiring of the brain.

Other Types of Brain Tumors

• Hemangioblastomas are slow-growing tumors, commonly located in the cerebellum. They originate from blood vessels, can be large in size and often are accompanied by a cyst. These tumors are most common in people ages 40 to 60 and are more prevalent in men than women.
• Rhabdoid tumors are rare, highly aggressive tumors that tend to spread throughout the central nervous system. They often appear in multiple sites in the body, especially in the kidneys. They are more prevalent in young children, but also can occur in adults.

Pediatric Brain Tumors

Brain tumors in children typically come from different tissues than those affecting adults. Treatments that are fairly well-tolerated by the adult brain (such as radiation therapy) may prevent normal development of a child’s brain, especially in children younger than age five.

According to the Pediatric Brain Tumor Foundation, approximately 4,200 children are diagnosed with a brain tumor in the U.S. Seventy-two percent of children diagnosed with a brain tumor are younger than age 15. Most of these brain tumors grow in the posterior fossa (or back) of the brain. Children often present with hydrocephalus (fluid build up in the brain) or the face or body not working properly.

Some types of brain tumors are more common in children than in adults. The most common types of pediatric tumors are medulloblastomas, low-grade astrocytomas (pilocytic), ependymomas, craniopharyngiomas and brainstem gliomas.

The World Health Organization (WHO) has developed a grading system to indicate a tumor’s malignancy or benignity based on its histological features under a microscope.

• Most malignant
• Rapid growth, aggressive
• Widely infiltrative
• Rapid recurrence
• Necrosis prone

Brain Tumor Causes

Brain tumors are thought to arise when certain genes on the chromosomes of a cell are damaged and no longer function properly. These genes normally regulate the rate at which the cell divides (if it divides at all) and repair genes that fix defects of other genes, as well as genes that should cause the cell to self-destruct if the damage is beyond repair. In some cases, an individual may be born with partial defects in one or more of these genes. Environmental factors may then lead to further damage. In other cases, the environmental injury to the genes may be the only cause. It is not known why some people in an “environment” develop brain tumors, while others do not.

Once a cell is dividing rapidly and internal mechanisms to check its growth are damaged, the cell can eventually grow into a tumor. Another line of defense may be the body’s immune system, which optimally would detect the abnormal cell and kill it. Tumors may produce substances that block the immune system from recognizing the abnormal tumor cells and eventually overpower all internal and external deterrents to its growth.

A rapidly growing tumor may need more oxygen and nutrients than can be provided by the local blood supply intended for normal tissue. Tumors can produce substances called angiogenesis factors that promote the growth of blood vessels. The new vessels that grow increase the supply of nutrients to the tumor, and, eventually, the tumor becomes dependent on these new vessels. Research is being done in this area, but more extensive research is necessary to translate this knowledge into potential therapies.

Brain Tumor Treatment

Brain tumors (whether primary or metastatic, benign or malignant) usually are treated with surgery, radiation, and/or chemotherapy — alone or in various combinations. While it is true that radiation and chemotherapy are used more often for malignant, residual or recurrent tumors, decisions as to what treatment to use are made on a case-by-case basis and depend on a number of factors. There are risks and side effects associated with each type of therapy.

Surgery

It is generally accepted that complete or nearly complete surgical removal of a brain tumor is beneficial for a patient. The neurosurgeon’s challenge is to remove as much tumor as possible, without injuring brain tissue important to the patient’s neurological function (such as the ability to speak, walk, etc. ). Traditionally, neurosurgeons open the skull through a craniotomy to insure they can access the tumor and remove as much of it as possible. A drain (EVD) may be left in the brain fluid cavities at the time of surgery to drain the normal brain fluid as the brain recovers from the surgery. 

Another procedure that is commonly performed, sometimes before a craniotomy, is called a stereotactic biopsy. This smaller operation allows doctors to obtain tissue in order to make an accurate diagnosis. Usually, a frame is attached to the patient’s head, a scan is obtained, and then the patient is taken to the operating area, where a small hole is drilled in the skull to allow access to the abnormal area. Based on the location of the lesion, some hospitals may do this same procedure without the use of a frame. A small sample is obtained for examination under the microscope.

In the early 1990s, computerized devices called surgical navigation systems were introduced. These systems assisted the neurosurgeon with guidance, localization and orientation for tumors. This information reduced the risks and improved the extent of tumor removal. In many cases, surgical navigation systems allowed previously inoperable tumors to be excised with acceptable risks. Some of these systems also can be used for biopsies without having to attach a frame to the skull. One limitation of these systems is that they utilize a scan (CT or MRI) obtained prior to surgery to guide the neurosurgeon. Thus, they cannot account for movements of the brain that may occur intraoperatively. Investigators are developing techniques using ultrasound and performing surgery in MRI scanners to help update the navigation system data during surgery.

Intraoperative language mapping is considered by some as a critically important technique for patients with tumors affecting language function, such as large, dominant-hemisphere gliomas. This procedure involves operating on a conscious patient and mapping the anatomy of their language function during the operation. The doctor then decides which portions of the tumor are safe to resect. Recent studies have determined that cortical language mapping may be used as a safe and efficient adjunct to optimize glioma resection while preserving essential language sites.

Ventriculoperitoneal shunting may be required for some patients with brain tumors. Everyone has cerebrospinal fluid (CSF) within the brain and spine that is slowly circulating all the time. If this flow becomes blocked, the sacs that contain the fluid (the ventricles) can become enlarged, creating increased pressure within the head, resulting in a condition called hydrocephalus. If left untreated, hydrocephalus can cause brain damage and even death. The neurosurgeon may decide to use a shunt to divert the spinal fluid away from the brain and, therefore, reduce the pressure. The body cavity in which the CSF is diverted usually is the peritoneal cavity (the area surrounding the abdominal organs). The shunt usually is permanent. If it becomes blocked, the symptoms are similar to that of the original condition of hydrocephalus and may include headaches, vomiting, visual problems and/or confusion or lethargy, among others. Another method that may be used to control obstruction of the brain fluid pathways is called an Endoscopic Third Ventriculostomy. This helps the brain fluid be diverted around the obstruction without the need for a shunt. 

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill cancer cells and abnormal brain cells and to shrink tumors. Radiation therapy may be an option if the tumor cannot be treated effectively through surgery.

• Standard External Beam Radiotherapy uses a variety of radiation beams to create a conformal coverage of the tumor while limiting the dose to surrounding normal structures. The risk of long-term radiation injury with modern delivery methods is very low. Newer techniques of delivery aside from 3-dimensional conformal radiotherapy (3DCRT) include intensity-modulated radiotherapy (IMRT).
• Proton Beam Treatment employs a specific type of radiation in which protons, a form of radioactivity, are directed specifically to the tumor. The advantage is that less tissue surrounding the tumor incurs damage.
• Stereotactic Radiosurgery (such as Gamma Knife, Novalis and Cyberknife) is a technique that focuses the radiation with many different beams on the target tissue. This treatment tends to incur less damage to tissues adjacent to the tumor. Currently, there is no data to suggest one delivery system is superior to another in terms of clinical outcome, and each has its advantages and disadvantages.

Chemotherapy

Chemotherapy generally is considered to be effective for specific pediatric tumors, lymphomas and some oligodendrogliomas. While it has been proven that chemotherapy improves overall survival in patients with the most malignant primary brain tumors, it does so in only in about 20 percent of all patients, and physicians cannot readily predict which patients will benefit before treatment. As such, some physicians choose not to use chemotherapy because of the potential side effects (lung scarring, suppression of the immune system, nausea, etc.).

Chemotherapy works by inflicting cell damage that is better repaired by normal tissue than tumor tissue. Resistance to chemotherapy might involve survival of tumor tissue that cannot respond to the drug, or the inability of the drug to pass from the bloodstream into the brain. A special barrier exists between the bloodstream and the brain tissue called the blood-brain barrier. Some investigators have tried to improve the effect of chemotherapy by disrupting this barrier or by injecting the drug into the tumor or brain. The goal of another class of drugs is not to kill the tumor cells but, rather, to block further tumor growth. In some cases, growth modifiers (such as breast cancer treatment drug Tamoxifen) have been used to attempt to stop the growth of tumors resistant to other treatments.

In 1996, the U.S. Food and Drug Administration approved the use of chemotherapy-impregnated wafers, which can be applied by the neurosurgeon at the time of surgery. The wafers slowly secrete the drug into the tumor, and the patient receives chemotherapy with the systemic side effects of treatment.

Laser Interstitial Thermal Therapy (LITT)

Laser Thermal Ablation is a newer technique that some centers are using to treat smaller tumors particularly in areas that may be more difficult to reach using previous open surgery procedures. This involves placing a tiny catheter within the lesion, possibly completing a biopsy, then using laser to thermally ablate the lesion. This technique is only more recently used in brain tumor treatments, therefore the long term efficacy has not been established. 

Investigational Therapies

Many types of new therapies currently are being studied, especially on tumors for which the prognosis is generally poor through existing conventional therapies. It is unknown whether these therapies will work. Such therapies are given according to a protocol and include various forms of immunotherapy, therapy using targeted toxins, anti-angiogenesis therapy, gene therapy and differentiation therapy. Combinations of treatments also may be able to improve the outlook for patients, while lowering the adverse side effects.

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon”online tool.

Brain tumors: overview of types, diagnosis, treatment options

Overview

A brain tumor is an abnormal growth of cells inside the brain or skull; some are benign, others malignant. Tumors can grow from the brain tissue itself (primary), or cancer from elsewhere in the body can spread to the brain (metastasis). Treatment options
vary depending on the tumor type, size and location. Treatment goals
may be curative or focus on relieving symptoms.
Many of the 120 types of brain tumors can be successfully treated. New therapies
are improving the life span and quality of life
for many people.

What is a brain tumor?

Normal cells grow in a controlled manner as new cells replace
old or damaged ones. For reasons not fully understood,
tumor cells reproduce uncontrollably.

A primary brain tumor is an abnormal growth that starts in the brain
and usually does not spread to other parts of
the body. Primary brain tumors may be benign
or malignant.

A benign brain
tumor grows slowly, has distinct boundaries,
and rarely spreads. Although its cells are
not malignant, benign tumors can be
life threatening if located in a vital area.

A malignant brain tumor grows
quickly, has irregular boundaries, and spreads
to nearby brain areas. Although they are often
called brain cancer, malignant brain tumors
do not fit the definition of cancer because
they do not spread to organs outside the brain
and spine.

Metastatic (secondary)
brain tumors begin as cancer elsewhere
in the body and spread to the brain. They form
when cancer cells are carried in the blood stream. The most common cancers that spread
to the brain are lung and breast.

Whether a brain tumor is benign,
malignant, or metastatic, all are potentially
life-threatening. Enclosed within the bony skull,
the brain cannot expand to make room for a growing
mass. As a result, the tumor compresses and
displaces normal brain tissue. Some brain tumors
cause a blockage of cerebrospinal fluid (CSF)
that flows around and through the brain. This
blockage increases intracranial pressure and
can enlarge the ventricles (hydrocephalus).
Some brain tumors cause swelling (edema). Size,
pressure, and swelling all create “mass
effect,” which cause many of the symptoms (Fig. 1).

Figure 1. Brain tumors may grow from nerves (neuroma), dura (meningioma), or pituitary gland (craniopharyngioma or pituitary adenoma). They may also grow from the brain tissue itself (glioma). As they grow they may compress normal tissue and cause symptoms.

Types of brain tumors

There are over 120 different types
of brain tumors. Common brain tumors include:

Gliomas

• Astrocytoma
• Pilocytic Astrocytoma (grade I)
• Diffuse Astrocytoma (grade II)
• Anaplastic Astrocytoma (grade III)
• Glioblastoma Multiforme (grade IV)
• Oligodendroglioma (grade II)
• Anaplastic Oligodendroglioma (grade
  III)
• Ependymoma (grade II)
• Anaplastic Ependymoma (grade III)

Craniopharyngioma
Epidermoid
Lymphoma
Meningioma
Schwannoma
(neuroma)
Pituitary
adenoma
Pinealoma (pineocytoma, pineoblastoma)
Medulloblastoma

The World Health Organization (WHO) developed
a classification and grading system to standardize
communication, treatment planning, and predict
outcomes for brain tumors. Tumors are classified
by their cell type and grade by viewing the
cells, usually taken during a biopsy, under
a microscope.

Cell type. Refers to the
cell of origin of the tumor. For example,
nerve cells (neurons) and support cells (glial
and schwann cells) give rise to tumors. About
half of all primary brain tumors grow from
glial cells (gliomas). There are many types
of gliomas because there are different kinds
of glial cells.

Grade. Refers to the way
tumor cells look under the microscope and
is an indication of aggressiveness (e.g.,
low grade means least aggressive and high
grade means most aggressive) (Table 1). Tumors
often have a mix of cell grades and can change
as they grow. Differentiated and anaplastic
are terms used to describe how similar or
abnormal the tumor cells appear compared to
normal cells.

Table 1. Glioma Grading Scale

Grade	Characteristics
I	Slow growing cells Almost normal appearance Least malignant Usually associated with long-term survival
II	Relatively slow growing cells Slightly abnormal appearance Can invade nearby tissue Sometimes recur as a higher grade
III	Actively reproducing abnormal cells Abnormal appearance Infiltrate normal tissue Tend to recur, often as a higher grade
IV	Rapidly reproducing abnormal cells Very abnormal appearance Area of dead cells (necrosis) in center Form new blood vessels to maintain growth

What causes brain tumors?

Medical science neither knows what causes
brain tumors nor how to prevent primary tumors
that start in the brain. People most at risk
for brain tumors include those who have:

• cancer elsewhere in the body
• prolonged exposure to pesticides, industrial
  solvents, and other chemicals
• inherited diseases, such as neurofibromatosis

What are the symptoms?

Tumors can affect the brain by
destroying normal tissue, compressing normal
tissue, or increasing intracranial pressure.
Symptoms vary depending on the tumor’s
type, size, and location in the brain (Fig.
2). General symptoms include:

• headaches that tend to worsen in the morning
• seizures
• stumbling, dizziness, difficulty walking
• speech problems (e.g., difficulty finding
  the right word)
• vision problems, abnormal eye movements
• weakness on one side of the body
• increased intracranial pressure, which
  causes drowsiness, headaches, nausea and vomiting,
  sluggish responses

Figure 2. Brain tumor symptoms are related to the functional
areas of the brain in which they are located.

Specific symptoms include:

• Frontal
  lobe tumors may cause: behavioral and emotional
  changes; impaired judgment, motivation or inhibition; impaired sense of smell or vision loss;
  paralysis on one side of the body;
  reduced mental abilities and memory loss.
• Parietal lobe tumors
  may cause: impaired speech;
  problems writing, drawing or naming;
  lack of recognition; spatial disorders and eye-hand coordination.
• Occipital lobe tumors
  may cause: vision loss in one
  or both eyes, visual field cuts; blurred vision, illusions, hallucinations
• Temporal lobe tumors
  may cause: difficulty speaking and understanding language; short-term and long-term memory problems; increased aggressive behavior
• Brainstem tumors may
  cause: behavioral and emotional
  changes, difficulty speaking and swallowing,
  drowsiness, hearing loss, muscle weakness on one side of the face
  (e. g., head tilt, crooked smile), muscle weakness on one side of the body, uncoordinated gait,
  drooping eyelid or double vision, and vomiting.
• Pituitary gland tumors
  may cause: increased secretion
  of hormones (Cushing’s Disease,
  acromegaly), a stop in menstruation, abnormal secretion of milk, and decreased libido.

Who is affected?

The American Brain Tumor Association estimates
that about 80,000 people will be diagnosed with
a primary brain tumor in the US this year. Metastatic (secondary)
brain tumors are five times more common than primary brain
tumors and they occur in
10% to 30% of cancer patients. People are surviving cancer longer than ever before. As a result, metastatic brain tumors will likely increase in the years to come. Although brain tumors can occur at
any age, they are most common in children 3
to 12 years old and in adults 40 to 70 years
old.

How is a diagnosis made?

First, the doctor will obtain your personal
and family medical history and perform a complete
physical examination. In addition to checking
your general health, the doctor performs a neurological
exam to check mental status and memory, cranial
nerve function (sight, hearing, smell, tongue
and facial movement), muscle strength, coordination,
reflexes, and response to pain. Additional tests
may include:

• Audiometry, a hearing test performed by
  an audiologist, detects hearing loss due to
  tumors near the cochlear nerve (e.g., acoustic
  neuroma).
• An endocrine evaluation measures hormone
  levels in your blood or urine to detect abnormal
  levels caused by pituitary tumors (e.g., Cushing’s
  Disease).
• A visual field acuity test is performed
  by a neuro-ophthalmologist to detect vision
  loss and missing areas in your field of view.
• A lumbar puncture (spinal tap) may be performed to examine cerebrospinal fluid for tumor cells, proteins, infection, and blood.

Imaging tests

• Computed
  Tomography (CT) scan uses an X-ray beam and a computer
  to view anatomical structures.
  It views the brain in slices,
  layer-by-layer, taking a picture of each slice.
  A dye (contrast agent) may be injected into
  your bloodstream. CT is very useful
  for viewing changes in bony structures.
• Magnetic
  Resonance Imaging (MRI) scan uses a magnetic field and radiofrequency
  waves to give a detailed view of the soft
  tissues of the brain. It views the brain 3-dimensionally
  in slices that can be taken from the side
  or from the top as a cross-section. A dye
  (contrast agent) may be injected into your
  bloodstream. MRI is very useful to evaluate
  brain lesions and their effects on surrounding
  brain (Fig. 3).

Figure 3. MRI scans of a benign and malignant brain tumor. Benign tumors have well defined edges and are more easily removed surgically. Malignant tumors have an irregular border that invades normal tissue with finger-like projections making surgical removal more difficult.

Biopsy

If a diagnosis
cannot be made clearly from the scans, a biopsy
may be performed to determine what type of tumor
is present. Biopsy is a procedure to remove
a small amount of tumor cells to be examined by a
pathologist under a microscope. A biopsy can
be taken as part of an open surgical procedure
to remove the tumor or as a separate diagnostic
procedure, known as a needle biopsy. A small
burr hole is drilled in the skull so that a hollow needle can be
guided into the tumor and a tissue sample
removed (Fig. 4). A stereotactic
frame and a computer are often used to help precisely locate
the tumor and direct the needle to deep tumors in critical
locations.

Biomarkers or genetic mutations found in the tumor may help determine prognosis. These include: IDh2, IDh3, MGMT, and 1p/19q co-deletion.

Figure 4. During a needle biopsy, a hollow cannula is inserted into the tumor. Small biting instruments remove bits of tumor for the pathologist to examine and determine the exact tumor cell type.

Who treats brain tumors?

Because there are so many kinds of brain tumors
and some are complex to treat, many doctors
may be involved in your care. Your team may
include a neurosurgeon, oncologist, radiation
oncologist, radiologist, neurologist, and neuro-ophthalmologist.

What treatments are available?

Treatment options vary depending on the type,
grade, size and location of the tumor; whether
it has spread; and your age and general health.
The goal of treatment may be curative or focus
on relieving symptoms (palliative care). Treatments
are often used in combination with one another.
The goal is to remove all or as much of the
tumor as possible through surgery to minimize
the chance of recurrence. Radiation therapy
and chemotherapy are used to treat tumors that
cannot be removed by surgery alone. For example,
surgery may remove the bulk of the tumor and
a small amount of residual tumor near a critical
structure can later be treated with radiation.

Observation

Sometimes the best treatment is observation.
For example, benign, slow growing tumors that
are small and have few symptoms may be observed
with routine MRI scans every year until their
growth or symptoms necessitate surgery. Observation
may be the best option for people who are older or with
other health conditions.

Medication

Medications are used to control
some of the common side effects of brain tumors.

• Steroids, such as dexamethasone
  (Decadron), are used to reduce swelling
  and fluid build-up (edema) around the tumor. Because
  steroids can cause stomach ulcers
  and gastric reflux, famotidine (Pepcid) or
  pantoprazole (Protonix) are prescribed to
  reduce the amount of acid produced in the
  stomach.
• Furosemide (Lasix) or mannitol (Osmitrol)
  may be used to control edema and swelling.
• Anticonvulsants are used to prevent
  or control seizures. The most common ones
  include phenytoin (Dilantin), valproic acid
  (Depakote), carbamazepine (Tegretol), and
  levetiracetam (Keppra).

Surgery

Surgery is the treatment of choice for brain tumors that can be reached without causing major injury to vital parts of the brain. Surgery can help to refine the diagnosis, remove as much of the tumor as possible, and release pressure within the skull. A neurosurgeon performs a craniotomy to open the skull and remove the tumor (Fig 5). Sometimes
only part of the tumor is removed if it is near critical areas of the brain. A partial removal can still relieve symptoms. Radiation or chemotherapy may be used on the remaining tumor cells.

Image-guided surgery technologies, tumor fluorescence, intraoperative MRI/CT, and functional brain mapping have improved the surgeon’s ability to precisely locate the tumor, define the tumor’s borders, avoid injury to vital brain areas, and confirm the amount of tumor removal while in the operating room.

Figure 5. Surgery involves cutting a window in the skull (craniotomy) to remove the tumor.

Laser Interstitial Thermal Therapy

Laser ablation is a minimally invasive treatment that transmits heat to “cook” brain tumors from the inside out. A probe is inserted to the tumor through a burr hole in the skull. The laser catheter is guided with real-time MRI.

Radiation

Radiation
therapy uses controlled high-energy rays
to treat brain tumors. Radiation damages
the DNA inside cells, making them unable to divide
and grow. The benefits
of radiation are not immediate but occur with
time. Aggressive tumors, whose cells divide
rapidly, tend to respond quickly to radiation.
Over time, the abnormal cells die and the tumor may shrink. Benign tumors, whose cells divide slowly, may take months to show an effect.

Pinpoint accuracy is critical so that the lethal dose is applied only to the tumor and not to surrounding healthy tissues. There are two ways to deliver radiation, external and internal beams.

External beam radiation is delivered from outside
the body by a machine that aims high-energy
rays (x-rays, gamma rays) at the tumor (Fig. 6).

Figure 6. A machine rotates around the patient, aiming radiation beams at the tumor. The radiation beams are shaped to match the tumor and minimize exposure to normal brain tissue.

• Stereotactic radiosurgery (SRS) delivers a high dose of radiation during a single session. Frames and masks are used to keep the patient immobile.
• Fractionated radiotherapy
  delivers lower doses of radiation
  over many visits. Patients return daily over
  several weeks to receive the complete radiation
  dose.
• Proton beam therapy delivers accelerated proton energy to the tumor at a specific depth. The radiation beam does not go beyond the tumor.
• Whole brain radiotherapy (WBRT) delivers the radiation dose to the entire brain. It may be used to treat multiple brain tumors and metastases.

Internal radiation (brachytherapy)
is delivered from inside the body by radioactive seeds surgically placed inside the
tumor. After the patient undergoes a craniotomy
to remove the tumor, the radioactive implants are placed inside the empty tumor cavity. The radiation
dose is delivered to the first few millimeters
of tissue in the cavity where
malignant cells may still remain. Patients have
no risk of radiation injury to other parts of
their own body or to others around them because
the dose is
short lived.

Chemotherapy

Chemotherapy drugs work by disrupting cell division. Over time, chemotherapy causes the abnormal cells to die and the tumor may shrink. This treatment can also damage normal cells, but they can repair themselves better than abnormal cells. Treatment is delivered in cycles with rest periods in between to allow the body to rebuild healthy cells.

Chemotherapy drugs can be taken orally
as a pill, intravenously (IV), or as a wafer
placed surgically into the tumor. The drugs most commonly used to treat brain tumors are temozolomide (Temodar) and bevacizumab (Avastin). The most common side effects are nausea, low blood counts, infections, fatigue, constipation, and headaches. Chemotherapy is also used to increase tumor cell death during radiation therapy.

Some chemotherapy drugs (BCNU wafer) are applied locally to the tumor bed after the tumor has been removed. By applying it directly to the diseased area of the brain, side effects are limited and the drug has a more beneficial effect.

Chemotherapy is typically used for high-grade gliomas; it is not routinely used for benign tumors.

Figure 7. Chemotherapy for high-grade gliomas is usually taken as a pill daily for a set period of time called a cycle. The drug circulates through the bloodstream to the brain where it crosses the blood-brain-barrier to the tumor.

Adjunct therapies

• Immunotherapy or biotherapy activates the
  immune system (T-cells and antibodies) to
  destroy tumor cells. Research
  is exploring ways to prevent or treat cancer
  through vaccines.
• Gene therapy uses viruses or other vectors
  to introduce new genetic material into tumor
  cells. This experimental therapy can cause
  tumor cells to die or increase their susceptibility
  to other cancer therapies.
• Hyperbaric oxygen uses oxygen at higher
  than normal levels to promote wound healing
  and help fight infection. It may also improve
  the tumor’s responsiveness to radiation
  and is being studied experimentally. Currently
  it is being used to help the body naturally
  remove dead tumor cells and treat radiation
  necrosis.

Tumor Treating Fields or TTFields

TTFields slows and reverses tumor growth by keeping cells from dividing. TTFields is used for the treatment of glioblastoma multiforme (GBM) in combination with temozolomide in adults who have been newly diagnosed. It is also approved for treatment of recurrent GBM after surgical and radiation options have been exhausted. Treatment involves wearing a device resembling a bathing cap that delivers electromagnetic energy to the scalp.

Clinical trials

Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see clinicaltrials.gov) as well as private industry and pharmaceutical companies (see www.centerwatch.com).

Recovery & prevention

Self care

Your primary care doctor and oncologist should
discuss any home care needs with you and your
family. Supportive measures vary according to
your symptoms. For example, canes or walkers
can help those having trouble walking. A plan
of care to address changes in mental status
should be adapted to each patient’s needs.

Driving privileges may be suspended while taking
anti-seizure medication. As each state has
different rules about driving and seizures,
discuss this issue with your doctor.

It may also be appropriate to discuss advance
medical directives (e.g., living will, health
care proxy, durable power of attorney) with
your family to ensure your medical care and
wishes are followed.

Rehabilitation

Because brain tumors develop in parts of the
brain that control movement, speech, vision
and thinking, rehabilitation may be a necessary
part of recovery. Although the brain can sometimes
heal itself after the trauma of treatment, it
will take time and patience. A neuropsychologist
can help patients evaluate changes caused by
their brain tumor and develop a plan for rehabilitation.
A neuropsychological evaluation assesses the
patient’s emotional state, daily behavior, cognitive
(mental) abilities, and personality.

Physical therapy, occupational therapy, and
speech therapy may be helpful to improve or
correct lost functions.

Recurrence

How well a tumor will respond to treatment,
remain in remission, or recur after treatment
depends on the specific tumor type and location.
A recurrent tumor may be a tumor that still
persists after treatment, one that grows back
some time after treatment destroyed it, or a
new tumor that grows in the same place as the
original one.

When a brain tumor is in remission, the tumor
cells have stopped growing or multiplying. Periods
of remission vary. In general, benign tumors
recur less often than malignant ones.

Since it is impossible to predict whether or
when a particular tumor may recur, lifelong
monitoring with MRI or CT scans is essential
for people treated for a brain tumor, even a
benign lesion. Follow-up scans may be performed
every 3 to 6 months or annually, depending on
the type of tumor you had.

Sources & links

If you have more questions, please contact
Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Support groups provide an opportunity for patients
and their families to share experiences, receive
support, and learn about advances in treatments
and medications.

Links

anaplastic: when cells divide
rapidly and bear little or no resemblance to
normal cells in appearance or function.

astrocytoma: a tumor arising
in the supportive cells (astrocytes) of the
brain or spinal cord; most often in the cerebrum.

benign: does not invade nearby
tissues or spread; noncancerous.

biopsy: a sample of tissue
cells for examination under a microscope to
determine the existence or cause of a disease.

brachytherapy: a type of radiation
therapy where capsules containing radioactive
substances are surgically implanted into the
tumor to deliver radiation; also called internal
radiotherapy.

cancer: generic term for more than
100 different diseases caused by uncontrolled,
abnormal growth of cells. Cancer cells can invade
and destroy normal tissue, and can travel through
the bloodstream and lymphatic system to reach
other parts of the body.

chemotherapy: treatment with
toxic chemicals (e.g., anticancer drugs).
chondrosarcoma: a rare, malignant bone tumor
arising from primitive notochord cells and composed
of cartilage.

chordoma: a rare, bone tumor
arising from primitive notochord cells; usually
occurs at the base of the spine (sacrum) or
at the skull base (clivus).
craniopharyngioma: a benign tumor arising from
cells located near the pituitary stalk.

differentiation: refers to how developed
cancer cells are in a tumor. Well-differentiated
tumor cells resemble normal cells and tend to
grow and spread at a slower rate than undifferentiated,
which lack the structure and function of normal
cells and grow uncontrollably.

edema: tissue swelling caused
by the accumulation of fluid.

ependymoma: a tumor arising
from the ependyma cells lining the ventricles
of the brain and central canal of the spinal
cord.

epidermoid: a benign, congenital tumor
arising from ectodermal cells; also called pearly
tumor.

glioma: any tumor arising
from glial tissue of the brain, which provides
energy, nutrients, and other support for nerve
cells in the brain.

hydrocephalus: an abnormal
build-up of cerebrospinal fluid usually caused
by a blockage of the ventricular system of the
brain; also called “water on the brain.”

immunotherapy: treatment designed
to improve or restore the immune system’s
ability to fight infection and disease.

intracranial pressure (ICP): pressure within the skull. Normal ICP is 20
mm HG.

lesion: a general term that
refers to any change in tissue, such as tumor,
blood, malformation, infection, or scar tissue.

lymphoma: a rare tumor arising
from lymph cells; may metastasize to the brain
from lymphoma tumor elsewhere in the body.

malignant: having the properties
of invasive growth and ability to spread to
other areas.

mass effect: damage to the brain due
to the bulk of a tumor, the blockage of fluid,
and/or excess accumulation of fluid within the
skull.

medulloblastoma: a tumor arising
from primitive nerve cells; most often in the
cerebellum.

meningioma: a tumor arising
from the meninges, the membrane that surrounds
the brain and spinal cord.

metastasis: the spreading of
malignant cells.

metastatic: cancerous tumor
that has spread from its original source through
the blood or lymph systems.

oligodendroglioma: a tumor
arising from the support cells (oligodendroglia)
that produce myelin, the fatty covering around
nerve cells.

pituitary adenoma: a tumor
arising from cells in the pituitary gland; tumor
may be hormone-secreting (prolactin, adrenocorticotropic,
growth hormone) or not.

radiation: high-energy rays
or particle streams used to treat disease.

schwannoma (also called neuroma): a tumor arising from Schwann cells that produce
myelin.

stereotactic: a precise method
for locating deep brain structures by the use
of 3-dimensional coordinates.

tumor: an abnormal growth of
tissue resulting from uncontrolled multiplication
of cells and serving no physiological function;
can be benign or malignant.

updated > 9.2018
reviewed by > Ronald Warnick, MD, Christopher McPherson, MD, Yair Gozal, MD, PhD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.

90,000 Brain Damage – What is Brain Damage?

The concept of “brain damage” can be defined as brain damage regardless of when it occurred. Brain damage can create significant obstacles to the sufferer and can cause different types of cognitive impairments, such as problems with attention, memory or movement.

All types of vascular damage are also referred to as brain lesions , provided that we are not talking about any external influence that provoked this damage.This type of lesion differs from traumatic brain injury in that, in the latter, the injury occurs under the influence of an external force that traumatically damages the brain.

Traumatic brain injury, also known as intracranial injury, can be classified according to severity, origin of injury (internal or external), and other characteristics such as area of ​​injury . When we talk about brain or head injury, we usually mean traumatic brain injury.

Most common causes

• Traumatic brain injury: occurs as a result of a strong blow to the skull, causing loss of consciousness, and in some cases – a skull fracture.

• Stroke or cerebral infarction: occurs due to various disorders of the cerebral circulation, in particular due to blockage of blood vessels. We are talking about thrombosis of cerebral veins or thrombosis of cerebral vessels.

• Brain anoxia: Brain damage occurs due to lack of oxygen in the brain, the most common cause is cardiac arrest.

• Tumors: Brain tumors provoke brain lesions that interfere with the control of the whole body.
  Tumor soft tissues grow locally inside the human brain or can form metastases.

• Encephalitis: occurs due to a herpes infection. This infection damages the brain, namely the temporal and frontal lobes. With this brain damage, emotional, cognitive and behavioral changes occur.

Today traumatic brain injury is the main cause of disability and cognitive impairment, especially in children and young people. In addition, men are more likely to suffer from brain injuries than women. Causes and symptoms are numerous, depending on the type of lesion. Among them – falls, road accidents, violence, sports.

Various brain lesions can significantly affect cognitive function and ability.Maintaining cognitive skills is essential for brain health and a high quality of life.

Cerebrovascular diseases

Cerebrovascular diseases, or vascular diseases of the brain, are a group of diseases that are manifested by damage to the vessels of the brain and vessels of the neck and lead to damage to the substance of the brain. Among acute cerebrovascular diseases, the most dangerous is stroke, which is the second most frequent cause of death and one of the main causes of disability in the world.

The Clinic of Neurology and Neurosurgery of the European Medical Center offers its patients a full range of diagnostics and treatment of cerebrovascular diseases. For the treatment of acute vascular cerebral disasters in our clinic, an emergency service, neuroresuscitation, a radiation diagnostics department (CT and MRI of the brain in all necessary modalities) function around the clock, neurologists and neurosurgeons are on duty. We work according to the most modern treatment protocols, including effective drug therapy, high-tech neurosurgical and endovascular techniques, and rehabilitation of impaired functions.

Chronic cerebrovascular disease

The Clinic of Neurology and Neurosurgery of the European Medical Center provides assistance to patients with chronic cerebrovascular disease. Our clinic is often visited by patients diagnosed with dyscirculatory encephalopathy. This is a controversial term that is not used in Western countries, under which completely different vascular diseases with brain damage can be hidden. Examination of such patients includes a consultation with a neurologist, who determines the need for laboratory tests, functional studies of blood vessels and the nervous system, neuroimaging (CT or MRI of the brain, angiography of cerebral vessels, and others).A complete examination allows you to clarify the nature of the condition and existing symptoms, determine the prognosis and the necessary treatment.

Cerebrovascular diseases

• Ischemic stroke
• Hemorrhagic stroke
  • Intracerebral hemorrhage
  • Subarachnoid hemorrhage
• Chronic cerebrovascular disease, discirculatory encephalopathy
• Memory impairment due to vascular diseases
  • Vascular dementia
  • Vascular cognitive impairment without dementia
• Atherosclerosis of the cerebral and cervical arteries
• Dissection (dissection) of the cerebral and cervical arteries
• Embolism of cerebral vessels (sources of which may be the heart, aorta, other arteries, or with an unknown source)
• Vascular anomalies of the brain
  • Arteriovenous malformations
  • Cavernous malformations
  • Dural arteriovenous fistulas
  • Aneurysms of the vein of Galen
  • Venous angiomas
  • Capillary telangiectasias
  • Intracranial aneurysms
  • Mycotic aneurysms
• Thrombosis of cerebral veins and sinuses
• Cerebral amyloid angiopathy
• Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, or CADASIL syndrome (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
• Disorders of the cerebral and cervical arteries in systemic vasculitis
• Primary angiitis of the central nervous system, PACNS (primary angiitis of the central nervous system).
• Disorders of the cerebral and cervical arteries in connective tissue diseases
• Moyamoya Syndrome
• Disorders of the cerebral and cervical arteries in infectious diseases
• Syndromes of reversible cerebral vasospasm
  • Poorly controlled arterial hypertension
  • Pheochromocytoma
  • Benign CNS angiopathy
  • Drug-related vasculopathy
  • Postpartum angiopathy
  • Migraine vasospasm
  • Thunderous headache
  • Call-Fleming Syndrome

PKB number 5 – Organic personality disorder

This mental illness is caused by damage to the brain as a result of trauma, intoxication, infection.Thus, here we are dealing with the consequences of gross damage to the tissue of the central nervous system.

This type of mental pathology is little known among the general public. Meanwhile, among patients in our hospital, organic personality disorder is only slightly inferior in frequency to schizophrenia. This is not surprising, because adverse effects on the brain are extremely common, especially among the male population (take at least chronic alcohol intoxication and brain trauma).

Common diagnosis: “Organic personality disorder due to mixed diseases.” A similar formulation of the diagnosis has been used in Russia since the 1990s, as the International Classification of Diseases of the Tenth Revision (ICD-10) was introduced into practice. It means that the patient has organic brain damage due to a combination of two or more reasons.

As the name of this disease implies, organic psychosyndrome is the leading one in its clinical picture.

In its mildest form, this syndrome is an asthenic state with weakness, fatigue, instability of attention, decreased performance. There is emotional lability, a tendency to sentimentality, tearfulness, which is combined with irritability. The patient often complains of headaches, especially in unstable weather (- meteorological dependence). There are also frequent complaints about poor transport tolerance, stuffiness, that is, situations when the oxygen concentration in the room air is reduced.In children and adolescents with this syndrome, sleepwalking or sleep-speaking is sometimes noted.

As the psychoorganic syndrome aggravates, disturbances in thinking, memory, and emotions are increasing. Thinking becomes viscous, detailed. When talking about something, the patient begins to go into insignificant specific details, distracting from the main topic. The vocabulary becomes poor, in speech there is a tendency to unjustified repetition of the same phrases and words, sometimes there is a tendency to primitive rhyming of everyday speech.The mental processes in these patients are characterized by inertia, with slow workability when performing any tasks. Decreased memory – both recent and distant events. Critical abilities are impaired. The patient can correctly distinguish between good and bad, but in relation to others he easily commits wrong actions, makes tactless statements. Emotions are distinguished by rudeness, primitiveness, negative characterological traits that were characteristic of a person in the past, but which he previously tried not to flaunt, are sharpened.Boastfulness, exaggeration of one’s own merits is characteristic, which is sometimes associated with euphoria. It can be replaced by a sad, spiteful, gloomy mood. From time to time, violent affective outbursts occur (that is, states of strong emotional arousal), even for minor reasons. Often this happens unexpectedly to others. In this state, the patient loses control over his actions, his consciousness seems to narrow, – the person does not pay attention to anything except the momentary task of “punishing” the imaginary or real offender.It is by this mechanism that many of our patients commit socially dangerous acts, including murders.

With aggravated organic changes in personality, social maladjustment occurs. Children and young people have learning difficulties, and adults are reduced in professional terms or lose their jobs. Relationships with loved ones deteriorate. Patients use alcohol or drugs as a distraction from their problems. Meanwhile, patients with psychoorganic syndrome more often than others experience pathological forms of alcoholism and drug addiction, including amnesia (memory) of events associated with intoxication, alcoholic delirium (“delirium tremens”).Thus, the risk of criminal acts of patients increases even more.

Against the background of the progression of the psychoorganic syndrome, neurological disorders, including seizures (paroxysms), are added. Children have nocturnal diuresis, which is a form of paroxysmal disorders.

Treatment includes drugs that improve metabolism and blood supply in the brain, in particular, nootropics. In addition, anticonvulsants are used. Some of them not only prevent epileptic seizures, but also act as normotimics, that is, they bring down repetitive mood swings and correct behavior.These anticonvulsants include gabapentin, carbamazepine, and lamotrigine. With psychomotor agitation, aggressive behavior, antipsychotics have to be used. After the removal of acute symptoms, psychotherapy, occupational therapy, which should be systematic, join.

The prognosis for organic personality disorder largely depends on how strong the patient’s attitude to abstain from harm that aggravates the underlying disease will be. First of all, this concerns the use of alcoholic beverages and drugs.The very same damage to the brain is practically impossible to eliminate and restore the initial fine architecture of the central nervous system.

Treatment of anoxic brain damage

Neonatologists in Moscow – latest reviews

The reception went well, all my expectations were met.The doctor prescribed treatment and made recommendations. Dmitry Nikolaevich is friendly and competent. I have an appointment with him.

Natalia,

October 15, 2021

At the reception, the doctor listened to me, made a diagnosis and gave her recommendations, which are already helping me.The doctor is attentive, treats patients well, explains everything clearly and easily. I can recommend this specialist to my friends, if necessary, and if necessary, I can apply again. I was satisfied with the quality of the reception.

Danil,

02 October 2021

A fairly qualified and good doctor.All liked it. I will definitely re-register when the tests are ready. She examined me, told me everything and clearly explained how to take treatment.

Valentine,

01 October 2021

Natalya Alexandrovna is a very nice woman.We talked for about 20 minutes. He is sensitive, polite, a good specialist and a professional in his field. The doctor listened patiently to all my history and symptoms that I had. The doctor figured out my situation. The doctor immediately prescribed drugs and gave them a prescription. We agreed on the next appointment. I chose a doctor for myself according to an operative appointment and was advised to me at SberZdorovye.

Dmitriy,

September 23, 2021

Wonderful, attentive specialist.Elena Igorevna knows how to listen to the patient. At the appointment, I had an MRI scan and the doctor prescribed medication, that is, injections and pills. And I believe that the doctor prescribed the right treatment for me. True, I have not yet started it, because I am looking for medications. In general, I was satisfied. As a doctor, I checked my arms and legs. And according to the result of the treatment, I will go for a second appointment.

Tatiana,

September 20, 2021

The doctor is wonderful and gave a very detailed answer and prescribed the drug, without unnecessary and imposed research.The clinic is dubious, there is one administrator for a lot of people (both for payment and for an appointment), the inability to pay by card (only transfer), which is already wild in our time.

Again, the doctor’s appointment is excellent, but there are questions about the clinic.

Peter,

August 29, 2021

Everything went well, I liked it.In principle, the problems with which I addressed were resolved. The general condition has improved. The doctor gave her recommendations. Roza Yurievna was very attentive, polite and tactful, she felt a desire to help. I will recommend the doctor to my friends and I will turn to her again.

Oksana,

20 Aug 2021

The doctor is a professional in his field.Elena Mikhailovna told me what I needed.

Marina,

01 April 2021

A good, competent doctor makes contact and explains all his actions.Olga Alikovna examined the child and gave recommendations on complementary foods, answered my questions about care, was friendly. We were pleased with the reception.

Tatiana,

September 21, 2021

Everything suited me at the reception.The doctor was attentive, explained everything in detail, told, established contact with the child, examined him. The tests were written out, according to the results of which a diagnosis will be made.

Catherine,

August 15, 2021

See all 10 reviews of 122 90,000 Neurology

Neurology is a science that studies all manifestations of the normal development and pathology of the human nervous system, as well as changes in the nervous system due to diseases of other organs and systems of the body or harmful external influences.

The main role of the nervous system is the perception and analysis of all signals outside the body and inside the body, further translation, processing and response. Thus, it is a watchdog who signals about trouble in the body or in the environment.

The human nervous system is subdivided into the central nervous system – the brain and spinal cord and the peripheral nervous system, i.e. all nerve fibers and nodes, plexuses of nerve fibers that are outside the central nervous system.The most common signal of unhappiness is pain.

The main symptoms to look out for are related to possible damage to the central nervous system, namely the brain, are:

90 020 90 021 headache, numbness, dizziness, unsteadiness, asymmetry in the face, skewed face, squint, double vision, difficulty swallowing, choking, difficulty speaking, naughty tongue, awkwardness when performing normal movements, gait disturbance, weakness or numbness in an arm or leg, there may be convulsions, loss of consciousness, etc.d.

There may also be symptoms of a violation of higher mental functions:

• impaired memory, intelligence, irritability, tearfulness, rapid mood swings, depression, anxiety, obsessive thoughts, actions, reduced criticism of the situation, yourself, your illness, etc.

In diseases of the spinal cord, most often there is pain, weakness, and numbness in the trunk, arms, legs, cramps, muscle twitching, muscle atrophy, urinary disorders, constipation, etc.d.

The most common reason for patients to visit a neurologist at an outpatient appointment is the pathology of the peripheral nervous system. Most of them are patients with spinal pathology, this is the so-called vertebral neurology. This is due to the pathology of bone structures, discs, joints, muscle and tendon formations of the spinal column.

Today, damage to the intervertebral disc, vertebra, intervertebral joints and ligamentous apparatus, i.e.That is, the so-called degenerative-dystrophic lesions of the spine are called osteochondrosis.

There are many theories explaining the occurrence of degenerative changes in the spine. But along with them, there are factors that accelerate the development of osteochondrosis. You can get information on how to move properly, how to eat, a complex of preventive gymnastics and other recommendations from our specialists.

Appointment with a neurologist is carried out through the district therapist, via the Internet, self-recording.

Basic functions of an outpatient neurologist:

• consultation, diagnostics, medical assistance to patients with diseases of the nervous system
• examination of temporary disability
• selection and referral of patients to a hospital, day hospital, OVL, high-tech examination of the nervous systems
• dispensary observation of patients
• primary prevention of diseases of the nervous system

OUR TEAM

90,000 Medical article from the specialists of the Wellbeing Rehabilitation Center.

The central nervous system ensures correct coordination of movements. But various lesions of the brain can lead to ataxia – a lack of coordination: a person cannot stand or walk along a certain trajectory, his movements become inaccurate. At the same time, there are no or practically no changes on the physical side: paralysis, paresis, changes in tone are absent.

Types of Ataxia

1. Sensitive. The cause of the disease is usually a tumor, vascular pathologies, lesions of the posterior nerves, etc.The patient may bend his legs excessively when walking, step on his feet too much (as if knocking them on the floor), or not fully feel the surface on which he walks, for example, he may have the feeling that he is not stepping on a hard floor, but on a soft one. carpet. Therefore, such patients pay special attention to visual control of their movements and constantly look under their feet in order to calculate the strength of the step.
2. Cerebellar, including hereditary cerebellar. The reason is damage to the cerebellum caused by multiple sclerosis, genetic predisposition, encephalitis, tumor, or other diseases.If the lesion is caused by a hereditary factor, the disease usually makes itself felt after 35 years.
3. Vestibular. The reason is damage to the vestibular apparatus, which can occur if the patient has a brain tumor, Meniere’s syndrome, encephalitis and other diseases. This type of ataxia is characterized by dizziness, nausea, which intensify if the patient moves his head. That is why the patient moves slowly and carefully, and tries to keep his head motionless.
4. Cork. The disease is caused by the presence of abscesses, malignant neoplasms, and cerebral circulation disorders in the patient, which ultimately lead to various lesions of the frontal region. Patients most often face dysfunctions of the lower extremities, for example, when turning, they can roll to the side, fall, sometimes completely lose the ability to walk or stand.

Cerebellar ataxia: symptoms

A patient with ataxia syndrome cannot walk fully, falls to the side, staggers, falls sideways or back.Also, the disease is characterized by wide movements: large steps, a wide range of arms when walking. Often the patient moves slowly, and if the disorders have touched the upper extremities, then the motor skills of the hands also suffer, so performing simple actions (getting dressed, washing) becomes difficult, the handwriting is very large. The disease can be accompanied by speech disorders (in this case, speech becomes slow, stretched out), visual impairment, depression and a decrease in mental abilities.

Treatment and prognosis of ataxia

Treatment is impossible without a competent diagnosis, so the doctor first of all seeks to confirm or deny the diagnosis, for this he conducts an examination, clarifies the symptoms of ataxia, prescribes an MRI of the brain, electromyography, EEG.Also, the examination allows you to determine the cause, type of disease and the degree of damage, and based on these data, draw up a course of rehabilitation procedures. It usually includes body-strengthening medication and exercise therapy to help strengthen muscles and improve motor coordination. Late cerebellar ataxia can only be treated with surgery.

The result of treatment depends on the type and cause of the disease, hereditary ataxia is the least likely to be corrected.Therapy, as a rule, does not allow the patient to return to work, but it helps to significantly improve the quality and duration of life.

Why is it worth undergoing rehabilitation at the Wellbeing Center?

The psychological state and attitude of patients is no less important for recovery than modern technologies and high qualifications of doctors. Therefore, the rehabilitation center “Prosperity” pays due attention to the quality of treatment and the conditions of stay. Comfortable single and double rooms are equipped with functional beds, they have a TV set, upholstered furniture, a telephone, a bathroom, and a staff call button.All corridors are spacious enough so that even patients with mobility impairments can easily move around the center; the premises have ramps and handrails. Our staff regularly improves their qualifications: we combine experience and innovation to achieve high results in rehabilitation, and the quality of medical care at “Prosperity” has always remained at its best.

EEG (electroencephalogram) of the brain – what is this examination and what does it show?

How is EEG performed? When is this examination necessary? Are there any contraindications for the examination? How to Prepare for Diagnosis? These and many other questions are answered by the specialists of the Admiralty Shipyards Medical Center.

What is the essence of the EEG procedure?

The electroencephalogram registers the electrical signals of the brain cells and allows detecting epilepsy, trauma, neoplasms, inflammatory processes, changes in the vessels. Pathology is indicated by disturbances in the electrical activity of neurons, which are recorded using special sensors placed on the patient’s head.

Using an electroencephalogram, a doctor can:

• Analyze the performance of the brain;
• to determine the foci of pathologies;
• to assess the nature and extent of damage;
• to confirm or clarify the diagnosis;
• to monitor the effectiveness of the treatment.

In what cases is EEG prescribed?

After talking with the patient and studying the medical history, the specialist decides on the appointment of encephalography. Typical indications for an EEG are frequent headaches, trouble sleeping, fainting, fatigue, and chronic fatigue.

Deterioration in well-being can be a sign of disturbances in the functioning of the brain. The aforementioned ailments often occur due to:

• vegetative dystonia;

90,021 disorders of the heart;

• pathology of the vessels of the neck and head;

90,021 inflammatory processes in meningitis and encephalitis;

90,021 endocrine disorders;

• malignant or benign neoplasms.

For patients with epilepsy who have undergone neurosurgical surgery and head trauma, EEG monitoring is mandatory.

How to prepare for an electroencephalograph examination?

Monitoring the electrical activity of the brain does not require complex training. During the examination, it is important to simply follow the doctor’s instructions and remain calm. Flashes of light and noise are part of the procedure.

It is recommended to stop taking tranquilizers, anticonvulsants and sedatives three days before the examination. For 24 hours before the examination, do not drink tea, coffee and energy drinks, do not eat chocolate. Wash your hair on the eve of monitoring. Have a snack one hour before the examination. Before starting, loosen your hair and remove metal jewelry.

How is EEG performed?

The survey takes place in several stages.

Preparatory stage

• the patient enters the office, protected from the penetration of light and sounds;
• a “cap” of the encephalograph, consisting of special sensors, is put on it;
• sensor wires are connected to a device that records bioelectric impulses from the brain.

Diagnostic step

• the encephalograph transmits data to the monitor in the form of a graph;
• records the power of electric fields and its distribution in different parts of the brain;
• functional tests are carried out: the patient is asked to blink, look at the flashes of light, breathe less frequently or deeper, and listen to a sharp sound.

Final stage

• electrodes are removed from the patient;
• prints the results obtained.

Contraindications

The study has practically no contraindications. But lesions of the surface of the head, inflammation and postoperative sutures make it impossible or difficult to conduct an electroencephalogram of the brain. In addition, the patient should not move during the diagnostic process.Pregnancy and too young age are not contraindications.

How long does it take for an electroencephalogram of the brain?

A routine encephalogram (routine EEG or paroxysmal diagnosis) takes 20 to 30 minutes. A number of tests are carried out during the survey:

• rhythmic photostimulation;
• hyperventilation;
• load in the form of slow blinking.

If it is necessary to assess certain brain functions, the specialist adds additional tests, which he informs the patient about in advance.These tests include:

• clenching the fingers into a fist;
• being in the dark;

90,021 sleep deprivation for a specified period;

• monitoring of night sleep.

Interpretation of survey results

Even a qualified specialist is not always able to name with absolute accuracy the reason for the patient’s poor health and immediately make a diagnosis. The doctor may be alerted by focal changes in the EEG.In this case, magnetic resonance imaging will be required to exclude a tumor or cyst.

When you contact the medical center “Admiralty Shipyards” you can go through all the examinations as quickly as possible, without delaying the trip to the specialists.

If you need to do an EEG of the brain and you want to do it on modern expert-class equipment and as soon as possible, call the phone number listed on the website or leave a request in the feedback form.

The staff of the medical center “Admiralty Shipyards” will answer your questions and carry out all the necessary examinations within one working day.