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.

Continued

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: Symptoms, Causes, Treatments

Overview

What are brain lesions?

Brain lesions are a type of damage to any part of brain. Lesions can be due to disease, trauma or a birth defect. Sometimes lesions appear in a specific area of the brain. At other times, the lesions are present in a large part of the brain tissue. At first, brain lesions may not produce any symptoms. As lesions worsen with time, the symptoms become more noticeable.

How does the brain work?

The brain controls thoughts, memory, speech, movements of the limbs, and organ function. There are many parts to the brain, and each section has a specific role to play in the human body.

Four lobes make up the brain:

Frontal lobe – the largest of the four lobes, is responsible for the body’s motor skills, such as voluntary movement, language, and intellectual and behavioral functions. This area controls memory, intelligence, concentration, temper and personality.

Temporal lobe – located on each side of the brain at ear level, is important for hearing, memory and speech.

Parietal lobe – at the center of the brain, is where sensory information like heat, pressure and pain is received and interpreted.

Occipital lobe – found at the back of the brain, is primarily responsible for vision.

Symptoms and Causes

What causes brain lesions to develop?

Brain lesions can be caused by many different triggers. The following factors put a person at greater risk to get brain lesions:

• Aging
• Family history of brain lesions. The risk increases if someone else in the family has had the condition.
• Vascular conditions, such as stroke, high blood pressure, and cerebral artery aneurysms
• Trauma to the brain, which can cause internal bleeding. If not remedied, it could lead to death.
• Infections, harmful germs or bacteria in the brain. These can cause diseases like meningitis and encephalitis (both types of swelling (inflammation) of the brain).
• Tumors that either start in the brain (primary tumors) or travel there (metastatic) via blood or lymphatic vessels
• Autoimmune diseases, such as lupus and multiple sclerosis. These result when the body’s antibodies start to attack the body’s own tissues, such as those tissues in the brain.
• Plaques, or excess build-up of abnormal protein in the brain tissues or in the blood vessels, slowing down the supply of blood to the brain, as seen in clogged arteries. Alzheimer’s disease, a condition that affects a person’s memory, thinking and behavior, develops because of plaques in brain tissues. Multiple sclerosis can also cause plaques in the brain secondary to damaged tissue.
• Exposure to radiation or certain chemicals that increase the chance of tumors and lesions in the brain
• Toxins, such as excessive amounts of alcohol or cigarette smoke, in the body. Other toxic substances are elevated levels of ammonia and urea in the body due to kidney issues (can affect brain function but may not show discrete brain lesions).
• Poor diet, especially eating foods with excess fats and cholesterol

What diseases cause brain lesions?

• Stroke, vascular injury, or impaired supply of blood to the brain is perhaps the leading cause of lesions on the brain.
• Multiple sclerosis, or MS, is a disease where brain lesions are located in multiple sites of the brain. Those suffering from MS have significant problems with motor and sensory functions.
• Lupus, an autoimmune disease, affects almost all systems of the body ranging from skin to heart, liver, muscles and brain. Brain lesions are typically a symptom of this disease.
• Tumors are also a cause of brain lesions and abnormal growth of brain cells.

What are the symptoms of brain lesions?

Symptoms of brain lesions vary depending on the type of lesion, its extent, and where it is found. Everyone is different and symptoms will vary in individual cases. Many lesions, however, may be in areas of the brain that don’t produce symptoms.

Typical symptoms may include:

• Headaches are usually the first symptom to appear with brain lesions. The pain appears suddenly and worsens as time passes. Over-the-counter medicine usually offers no relief for the pain.
• Nausea and possible vomiting
• Impaired movement, if the lesion affects the part of the brain responsible for motor skills
• Lack of concentration, the inability to make quick decisions, and agitation
• Delayed speech, blurred vision, and impaired hearing
• Involuntary movements of body parts, which may progress to convulsions in severe cases

The following symptoms are specific to lesions of the frontal lobe:

• Absence of sense of smell, usually limited to one nostril
• Speech impairment
• Loss of motor activity on one or both sides of the body
• Behavioral changes

The following symptoms are specific to lesions of the temporal lobe:

• A change in behavior and emotions
• Disruption in the sense of smell, taste, and hearing
• Language and speech disorders
• Problems with field of vision
• Forgetfulness and the inability to focus

The following symptoms are specific to lesions of the parietal lobe:

• Loss of sensations like touch
• Astereognosis, or the inability to identity things placed in the hand
• Weakening of language development

The following symptoms are specific to lesions of the occipital lobe:

Diagnosis and Tests

How are brain lesions diagnosed?

If symptoms suggest that a person may be suffering from a brain lesion(s), it is important to contact the doctor for an appointment. A doctor will help diagnose and offer treatment options for each patient depending on the extent of the condition.

The doctor will ask questions about the patient’s symptoms and medical history and then perform a physical examination.

In order to find the location of the lesion, the doctor may touch the patient’s skin with hot, cold or vibrating objects, and also may pinch the patient to check for the feeling of pain. Additional tests may also be recommended by the doctor to further assess the condition.

What tests diagnose brain lesions?

After a physical examination, the doctor may also recommend that the patient schedule a diagnostic test, such as a computed tomography, or CT or CAT scan, or magnetic resonance imaging, or MRI. These tests will help the doctor pinpoint the location of the lesion and will also help assess the extent of damage the lesion has caused the brain.

Computed tomography (CT or CAT scan) is a diagnostic image used to evaluate bone, blood and brain tissue. Sometimes, a medication is injected through the patient’s vein to help highlight brain structures. A CT scan uses radiation.

Magnetic resonance imaging (MRI) is a diagnostic test that produces three-dimensional, or 3D, images of the inside of the body using magnetic fields and computer technology. It shows brain tissue detail as well as the brain stem, and cerebellum (posterior brain) better than a CT scan. An MRI of the brain can help determine whether there are signs of prior mini-strokes. A medication (contrast) can also be injected to help high light structures.

Management and Treatment

How are brain lesions treated?

Treatment varies in each individual case depending on the type of lesion, its location, and cause. It is important that a thorough examination be completed by a doctor to develop the appropriate treatment plan.

The treatment options depend on the type of lesions and severity of symptoms. Usually medicines can be used to treat the underlying cause. Surgery may be an option in some cases, such as when the lesions are caused by a brain tumor.

Sometimes, lesions and symptoms don’t improve even after appropriate diagnosis and proper treatment and the goal is to manage symptoms.

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 (a bulge in an artery in your brain)
2. Brain AVM (arteriovenous malformation) (arteriovenous malformation) — an abnormal formation of brain blood vessels
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: Overview and More

A brain lesion is a type of abnormality in the brain, usually caused by a disease or injury. There are several kinds of brain lesions, and they can be distinguished by their symptoms, physical examination findings, and diagnostic tests.

If you have neurological symptoms, it is important that your doctors determine whether you have a brain lesion, how many you have, and the type because the treatment and prognosis of each type of brain lesion differs. 

Rafe Swan / Getty Images

Brain Lesion Symptoms

The effects of brain lesions correspond to the area of the brain where they are located. Usually, the region of the brain where a lesion is located will not function as it normally would. 

Symptoms can be gradual or sudden and may be intermittent or constant. Each type of lesion has an emblematic pattern when it comes to the timing of symptoms.

Common symptoms of brain lesions may include a combination of general and focal symptoms.

General Symptoms 

General symptoms include:

• Head pain 
• Fatigue 
• Dizziness 
• Behavioral changes 
• Cognitive impairment 

Focal Neurological Deficits 

Focal neurological deficits include:

• Weakness of one side of the face, or the arm and/or leg on one side of the body 
• Diminished sensation and/or paresthesias (unusual sensations) on one side of the face, or the arm and/or leg on one side of the body
• Vision changes
• Impaired balance 
• Neck stiffness 
• Ear pressure 
• Seizures

A large brain lesion may cause head pain along with substantial focal neurological deficits (such as weakness of the face, arm, and leg on one side). Multiple lesions tend to cause behavioral changes, cognitive changes, fatigue, and/or dizziness along with one or more focal neurological deficits.

Causes and Types 

The different types of brain lesions are each associated with certain causes and risk factors.

Stroke

An interruption in blood flow within the brain can cause a stroke, which is a small or large area of brain damage. Risk factors include heart disease, high blood pressure, uncontrolled diabetes, and high cholesterol. This lesion usually consists of a central area of ischemia (death of cells due to deficient blood supply).

Right after a stroke occurs, the lesion may be surrounded by swelling and inflammation, which subside within a few weeks. The ischemic part of the lesion remains, with permanent damage to the affected area of the brain.

Demyelination

Some conditions, such as multiple sclerosis (MS), are caused by temporary or lasting demyelination—loss of the protective myelin coating that surrounds nerves in the brain. This causes one or more demyelinating brain lesions. The condition is usually idiopathic (without a known cause).

A more serious condition, progressive multifocal leukoencephalopathy (PML), is considered a demyelinating inflammatory response to a virus that is usually harmless. PML generally affects people who are severely immunocompromised, and it has a high mortality rate.

Infection

Bacterial, fungal, viral, or parasitic brain infections can cause one or more areas of damage and inflammation. Many types of brain infections can resolve with appropriate treatment.

Inflammation

Inflammatory lesions in the brain can develop due to conditions like lupus, sarcoidosis, therapeutic brain radiation, and more. 

Cancer

Brain tumors and metastatic tumors from elsewhere in the body can cause one or more lesions throughout the brain. The cause of brain tumors is usually unknown. Tumors that metastasize and cause lesions in the brain may have known risk factors. For example, smoking increases the risk of lung cancer, which can spread to the brain.

Vascular Malformations

Vascular malformations such as brain aneurysms and arteriovenous malformations (AVMs) are usually idiopathic. They can be congenital (present from birth) or develop later in life.

These lesions can cause focal neurological deficits when they are small, but they may cause rapid bleeding and severe swelling in the brain if the malformed blood vessels bleed—and could lead to death.

Contusion

Head trauma can lead to a bruise in the brain, which may cause a combination of generalized and focal effects. Contusions in the brain usually partially or fully heal over time. However, repeated blows to the head with multiple lesions can cause chronic traumatic encephalopathy (CTE), with persistent changes.

Hemorrhage

Bleeding in the brain can cause a hemorrhagic lesion. These lesions are more life-threatening than non-hemorrhagic lesions. A number of problems can lead to hemorrhagic lesions, including a bleeding vascular malformation, hemorrhagic conversion of an ischemic stroke, brain tumors that bleed, and head trauma.

Atrophy and Ventricular Dilatation

Sometimes the brain can shrink in size due to damage or dying of the brain cells. This is usually a result of dementia or extensive strokes. This can lead to enlarged spaces within the skull, often noted as atrophic lesions.

Congenital Malformation

Developmental compromise during fetal development can lead to lesions in which areas of the brain are shaped differently than they would be in a healthy brain. Sometimes these malformations lead to impaired physical and cognitive deficits and seizures.

Congenital malformation of the brain can result from genetics or issues such as toxins or insufficient oxygen supply during fetal growth.

Diagnosis 

The diagnosis of brain lesions is based on the history and pattern of symptoms, family history, physical examination, neurological examination, and brain imaging.

There are several types of diagnostic brain studies and brain imaging studies, and some can detect certain brain lesions, while others are better at detecting other brain lesions.

For example:

• Brain computerized tomography (CT) is traditionally considered a good test for detecting hemorrhage.
• Brain magnetic resonance imaging (MRI) is considered a good test for detecting demyelination.
• Vascular malformations are often well visualized with diagnostic studies that examine the blood vessels, such as magnetic resonance angiography (MRA).
• Contrast dye helps to define certain lesions, such as tumors and infections.
• Electroencephalogram (EEG) is often used to detect seizure activity caused by brain lesions, some of which cannot be seen on brain imaging studies.

Some lesions, such as demyelinating lesions in MS, can come and go on brain imaging, despite persistent symptoms and physical examination findings. But the condition must be controlled even when lesions are not visibly present. Lesions due to trauma may cause symptoms and physical examination changes with minimal imaging changes.

Brain aneurysms and AVMs might not be visible except with vascular studies focused on the specific area of the lesion. Your doctor would order your imaging study based on the findings of your physical examination—which can consist of very subtle changes in the context of vascular malformations.  

Treatment 

Brain lesion treatment depends on the cause. Some lesions, such as infections and cancer, can be treated with medication with the goal of a complete cure. Vascular malformations may need to be surgically treated to prevent a rupture. Other lesions, such as demyelination and chronic inflammation, are managed and controlled with medication, but they are not typically curable.

And lesions that cause permanent damage, such as brain contusions, infarct, and hemorrhage, are not curable—but the effects should be managed with rehabilitation. Various types of therapy—physical therapy, speech therapy, cognitive therapy, and more—can help in the recovery and maximizing abilities.

A Word From Verywell

Lesions in the brain usually cause symptoms and can cause lasting damage unless they are treated. Brain lesions can occur for a variety of reasons, and once you know which type of brain lesion you have, you will know what to expect for the long term and the short term.

Advice from a Radiologist: Navigating Brain Lesions

Brain lesions are complex and can appear for a multitude of reasons.

Some occur suddenly, while others develop over a period of time. Medical imaging helps healthcare providers determine their origin, cause, and nature so that appropriate treatment – if necessary – can be pursued.

But while a CT or MRI provides clarity for doctors, the medical reports patients receive after getting their scans often include technical terms that can cause confusion and anxiety.

“I find that, more often than not, patients have a lot of questions about their reports that they don’t typically have the opportunity to ask their radiologist, “ says Dr. WIntermark, Chief of Neuroradiology at Stanford University and Second Opinion Radiologist for DocPanel.

In this exclusive interview, we sat down with Dr. Wintermark to explore the most common questions patients have about brain lesions and find out how a second opinion can help provide clarity for those navigating a diagnosis.

DocPanel is committed to making sure every patient receives excellent care. If you would like an expert second opinion on your medical imaging scan from Dr. Wintermark or one of our other neuroradiology subspecialists, you can learn more here.

What Is a Brain Lesion?

[DocPanel] What is a brain lesion?

[Dr. Wintermark]

A brain lesion refers to any type of abnormal tissue in or around the brain tissue.

[DocPanel] What are the different types of brain lesions and what causes them?

[Dr. Wintermark]

There is a wide array of brain lesions. Some are related to the normal aging process of the brain. Others are related to trauma, inflammation, or infection. Brain lesions also include vascular abnormalities and benign and malignant brain tumors.

Brain CTs and MRIs are often needed to elucidate the nature of brain lesions.

Common Appearances of Brain Lesions on Medical Scans

[DocPanel] What are some of the biggest indicators on a CT or MRI that reveal what type of brain lesion has been detected?

[Dr. Wintermark]

CT and MRI scans allow radiologists to identify the exact location of brain lesions. This enables us to see how they relate to the adjacent brain structures, often helping us to understand patients’ symptoms.

CT and MRI scans also show different feature sets that can help determine the type of brain lesion. Along with the clinical presentation and the other tests obtained, such as blood tests, a diagnosis can be made based on the combined analysis of all the information available.

[DocPanel] Are there any specific characteristics that indicate a brain lesion is benign? Malignant? How is this determined?

[Dr. Wintermark]

The first step when interpreting a CT or an MRI of the brain is to determine where the lesion is located compared to the brain tissue. Next, based on the imaging features, the nature of the brain lesion can usually be determined, as well as whether it is a benign or a malignant lesion. However, the distinction is frequently not straightforward and this requires the experience of a neuroradiologist.

With brain lesions, the location determines the symptoms rather than the lesion’s nature. But the nature of the lesions can influence how fast the symptoms come on, what the patient’s prognosis is, and what treatment options are available.

How to Navigate a Brain Lesion Diagnosis

[DocPanel] What advice do you have for patients who have been diagnosed with brain lesions?

[Dr. Wintermark]

My advice would be to have an open conversation with your physician to understand exactly the nature of the brain lesion, its prognosis, and what care options are available.

There are so many things people find on the internet that can be really overwhelming. I did a second opinion for a patient who, in doing online research, came to a place where he was extremely worried. In this case, his research brought him in the wrong direction. I was able to help him frame what he’d learned in a better way so that he could more accurately relate the information to his own brain lesion diagnosis. I was able to help him distinguish what was relevant and orient him in the right direction.

Second opinions are also an opportunity for me to interact with patients more closely, and directly address their questions and concerns in a more personal way compared to how standardized radiological reports are typically written.

[DocPanel] Is there anything patients should be aware of before beginning treatment?

[Dr. Wintermark]

Patients should develop a great relationship with their physician and understand their treatment options. The diagnosis will, of course, greatly influence treatment – so ensuring you have an accurate diagnosis is crucial.

Preventing Misdiagnosis of Brain Lesions

[DocPanel] What are some common pitfalls in imaging of brain lesions that patients should be aware of?

[Dr. Wintermark]

Brain imaging is complex and many lesions can look almost the same – while representing different entities. The radiologist typically works closely with the patient’s physicians to make sure the latter has the best information to make their care decisions with their patient.

Because brain lesions can be tricky, interpretation from a neuroradiologist with subspecialty training and experience is very important in avoiding potential pitfalls.

[DocPanel] How can patients help ensure they are not misdiagnosed?

[Dr. Wintermark]

The most important element in my mind is good communication with their physician. Patients should ask their doctors as many questions as they have, until they have all been answered.

Uncovering the hidden side of brain lesions

Much of our existing knowledge about the workings of the healthy brain comes from studying patients who have suffered brain injuries, for example, due to a stroke. However, despite this, we still have little idea of the impact which brain damage has on the networks of neuronal connections across the whole brain which underlie key cognitive functions. Dr Michel Thiebaut de Schotten and colleagues at the ICM Institute in Paris have developed a software package called BCBtoolkit which can help researchers and clinicians understand the effects of brain damage on brain connections. In future, this could help evolve our understanding of higher brain processes, as well as helping neurologists to predict whether a patient will recover or not from a stroke or other brain injuries.
Example of the pathway, highways of the brain, connecting the front with the posterior part of the brain.

Brain lesions are areas of abnormal tissue that have been damaged due to injury or disease, which can range from being relatively harmless to life-threatening. Clinicians typically identify them as unusual dark or light spots on CT or MRI scans which are different from ordinary brain tissue.

But while conventional neuroimaging analyses can detect the location and structure of a lesion, they tell us little about the wider impact of a particular lesion on the brain’s neuronal circuitry. Understanding this is crucial to being able to quantify the effects of brain damage on the whole brain, as well as exploring the effects of such lesions on a person’s behavioural and cognitive abilities. This could improve our understanding of brain function, and lead to better clinical care for patients suffering from brain damage.

How do brain lesions impact brain function?
Traditionally, if a patient has a lesion in a certain part of their brain, and displays a particular set of symptoms, such as reduced spatial awareness or impaired language production, neurologists deduce that these symptoms are a direct result of functional changes in the visibly damaged area.

Phineas Gage (1823-1860), survived a terrible incident in which his left frontal lobe was blown away by a tamping iron bar. As a result, Gage’s personality changed and he became the index case of acquired ‘sociopathy’. Analyses of the neuronal circuitry impaired by the lesion revealed that areas outside the frontal lobe were also disconnected (chances of disconnection indicated in % in the left panel). Importantly, these areas are classically involved in social cognition including decision-making and emotions (right panel). In sum, these areas may well have contributed to the change of personality shown in Phineas Gage as much as the areas damaged by the passage of the tamping bar.

Studying these patients and what happens when damage occurs to individual brain areas has improved our overall understanding of the brain in healthy individuals over the past two centuries. One famous example is the case of Louis Leborgne, who ultimately spent 21 years in Bicêtre Hospital, Paris, having lost the ability to produce coherent speech despite retaining many other faculties such as intelligence and language comprehension. Upon Leborgne’s death in 1861 at the age of 51, an autopsy revealed a large lesion in the part of his frontal lobe known as the posterior inferior frontal gyrus. This specific region became directly associated with our ability to produce meaningful sounds, and ever since it has remained one of the most widely studied language regions in cognitive psychology.

How variable are the brain connections? Recent results developed by the team of Michel Thiebaut de Schotten, demonstrate that long deep connections of the brain are the most invariant while short connections at the surface of the brain, show a great deal of difference from one person to another.

Through similar case studies, many other high-level cognitive processes such as attention, memory, and problem solving have become associated with different localised brain regions. However, while this may appear to be a logical way to determine how the brain operates, some scientists have long suspected that this has painted a picture of the brain which is rather too simplistic.

The problem is that different neurological processes are not purely confined to individual specialised regions. Instead, many of the brain’s estimated 100 billion neurons form connections between very distant parts of the brain, and it may be that the real impact of brain lesions is through interrupting these complex networks. Disconnections in the brain’s circuitry could have functional and anatomical consequences for brain regions located a long distance away from the lesion. For example, if certain regions are no longer receiving a signal because of a lesion, they can no longer take part in the function they were involved in. This can result in many of the neurons in these regions becoming subject to atrophy, as well as reductions in dendrite and synapse density, and ultimately neuronal death through a programmed cellular mechanism called apoptosis. Because of this, lesions may well have a wider impact in the brain which extends far beyond the visible damage apparent on imaging scans.

Some scientists have long suspected that our current understanding of the brain has painted a picture which is rather too simplistic.

However, there are relatively few technologies available which researchers can utilise to capture and analyse the long-range effects resulting from lesion-induced brain disconnections. Scientists have previously attempted to use a variety of 3D modelling and image analysis techniques for exploring the nonlocal effects of lesions. However few of these methods are open-access, making them inaccessible to many scientists. In addition, much of the research conducted so far has lacked a standardised way of determining what these techniques are actually measuring, and how they should be combined, affecting the reproducibility of these studies.

Artistic impression of the minimalistic understanding of the brain as a mosaic of separated functional areas. However, current research aims at demonstrating that the brain works as an interconnected unity.

A new method for exploring the impact of brain lesions
Dr Michel Thiebaut de Schotten – principal investigator at the Brain Connectivity and Behaviour Lab at the ICM Institute in Paris – and colleagues have developed a new open-access software package called BCBtoolkit which consists of a set of programs for analysing the long-range effects of brain disconnections.

These programs measure the brain circuitry, estimate the subsequent changes within these circuits which have been caused by a particular lesion and use this information to deduce which changes are contributing to the patient’s symptoms.

Part of the development undertaken by the team of Dr Michel Thiebaut de Schotten is the Atlas of Human Brain connection which maps systems of interconnected areas in the brain.

This is important as studies have suggested that the extent of a patient’s ability to recover from a lesion depends on the exact patterns of change induced within their brain circuitry. For example, one 2014 study of 16 stroke patients found that the ability of these patients to recover from speech impairment following a stroke in the left brain hemisphere, depended on the number of connections remaining between the equivalent of Broca’s area and Wernicke’s area – two of the most important regions for language use – in the right hemisphere.

To prove that BCBtoolkit could be clinically useful for studying patients with brain lesions, Thiebaut de Schotten’s lab have used the package to study the brain connections of 37 patients with frontal lobe lesions resulting from a stroke, infection, hematoma or surgical removal of a brain tumour or of an epileptogenic area.

Initially, they applied the software to map the patient’s lesions onto virtual brain scans of hundreds of healthy individuals, showing every neural connection going to and from the damaged areas. These representations enabled them to visualise which brain regions had been structurally disconnected by the lesions.

To understand the link between these disconnections and the patients’ symptoms, they then conducted various neuropsychological assessments on each patient, such as category fluency testing where patients undergo different exercises such as naming as many animals as they can in two minutes.

How variable are the brain connections? Recent results developed by the team of Michel Thiebaut de Schotten, demonstrate that long deep connections of the brain are the most invariant while short connections at the surface of the brain, show a great deal of difference from one person to another.

The results of these tests suggested that the patients were suffering from cognitive problems such as impaired language, working memory and verbal fluency, related to brain disconnections in major networks associated with processes such as executive function, as well as language and semantic production.

Having identified the precise regions affected by brain disconnections in these patients, the researchers used BCBtoolkit to analyse data collected on these regions from MRI scans. By measuring cortical thickness, they were able to estimate the total neuronal loss in these areas. This provided further evidence that many of the patients’ cognitive impairments were at least partially linked to a loss of cortical neurons in regions located far away from the original lesion.

“For the very first time, using our program, we were able to measure disconnections within the brain of a group of patients and associate neuropsychological deficit with disconnection,” Michel Thiebaut de Schotten explained. “We hope to better understand the brain’s underlying mechanisms and increase symptom predictability in patients with brain lesions.”

Brain connections are the highways of the brain conducting information at more than 300km/h.

The future
Patients with brain lesions have always provided researchers with a unique opportunity to understand the functioning of the human mind. Through BCBtoolkit, scientists working in this field now have, for the first time, a scientifically validated set of methods for capturing the impact of brain damage on the whole brain.

This allows scientists to try and discern the natural history of events which occurred in the brain following a lesion, as well as exploring the relationship between these damaged areas and behavioural and cognitive symptoms.

But while this is currently just a research tool, in future it could have considerable clinical benefit for patients themselves. Every year, more than 2 million people across Europe suffer a stroke, often resulting in persistent lesions which affect their personality, quality of life and prevent them from being able to return to work. As a result, there is a considerable clinical need for diagnostic technologies which allow neurologists to inform these patients and their families in a timely manner, the extent to which their symptoms will resolve.

BCBtoolkit allows scientists to discern the natural history of events which occurred in the brain following a lesion.

However, despite decades of scientific studies describing the symptoms resulting from different lesions, neurologists still typically have little idea of how well a patient will recover from a particular lesion. The only option available is simply to observe how that patient progresses over the course of weeks and months.

But through BCBtoolkit and other similar packages being developed for lesion-symptom mapping, this could soon change. By using these techniques to study the impact of different sized lesions in different locations in the brain, neurologists will be able to stratify patient populations more accurately than ever before. This will allow them to predict the patients who are more likely to make a partial or full recovery, enabling them to act much sooner with treatment and rehabilitation plans for patients who have sustained lasting damage. Such knowledge will allow patients and their families to begin making appropriate arrangements with employers and in many countries, health insurance providers, at a much earlier stage than usual, reducing the burden and stress associated with stroke.

Can you describe how neurologists could use BCBtoolkit to predict how well a patient will recover from a particular brain lesion?
Neurologists can use our software to estimate the extent of the brain disconnection. The more the disconnection of the brain, the less likely the patient will recover. We are now implementing new open tools which will not only decode the patient symptoms but also provide a tailor-made indication of potential recovery for any stroke patient no matter where their lesion occurs. We plan to apply the same technology in the future for the planning of brain surgery and the early identification and the stratification of neurodegenerative disorders such as Alzheimer.

What are your future plans for research in this area?
Future plans include understanding how the brain can change its functioning to compensate for impairment and how we can help the brain to better achieve these compensatory changes. Additionally, we wish to understand what the differences are between patients in term of anatomy and functioning of the brain that drives their differences in recovery.

References

• Foulon C, Cerliani L, Kinkingnéhun S, Levy R, Rosso C, Urbanski M, Volle E, Thiebaut de Schotten M. (2018).‘Advanced lesion symptom mapping analyses and implementation as BCBtoolkit’. Gigascience, 7(3), giy004. PMID: 29432527.
• Thiebaut de Schotten M, Dell’Acqua F, RatiuP,Leslie A, Howells H, Cabanis E, Iba-Zizen MT, Plaisant O, Simmons A, Dronkers NF, Corkin S, Catani M. (2015).‘From Phineas Gage and Monsieur Leborgne to H.M.: Revisiting Disconnection Syndromes’. Cereb Cortex, 25(12),4812–4827. PMID: 26271113.

Brain Lesions | Types, Facts, Symptoms & Causes

A lesion is basically any area of the body that has suffered damage due to trauma or disease. The damaged area in any tissue of the body is called a lesion. Lesion is a broader term generally used for an ulcer, wound, abscess or tumor. This term may be used specifically for the damaged area in a particular organ; such as cardiac lesions, brain lesions, lesions in lungs and liver, etc.

Our main focus in this article will be on the different
brain lesions, their types, causes, symptoms, and complications. We will also
compare brain lesions with lesions occurring in other parts of the body.

Brain Lesions

Brain lesions are the areas of damage inside the brain. Brain is the most important organ in the body. It is involved in the processes of judgment, thinking, learning and memory. All the movements are performed with the aid of the brain.

Many crucial body functions necessary for the maintenance of life are under the control of the brain.  There is not a single process in the body that is not controlled by the brain; either directly or indirectly. Brain lesions can affect all these processes.

Brain is a complex organ having different regions. The regions in the brain overlap with one another. Each region is responsible for controlling the specific function of the body. Lesions in the brain may be localized occurring in a particular region or they may be diffused, affecting different regions of the brain.

As two types of cells are present in the brain;
neurons and the supporting cells called glial cells. Brain lesions can involve
either neurons or glial cells or both.

Types of Brain lesions

Brain lesions are of several types. The type of brain
lesion depends on the type of injury occurring to the brain.

Vascular lesions

These occur due to disturbances in the blood supply to the brain. They may occur due to stroke or cerebral artery aneurysm.

Genetic lesions

They are associated with the genetic makeup of the person. Hereditary diseases cause genetic lesions such as neurofibromas.

Aging lesions

These occur as a result of the aging process. The normal aging process of the body causes loss of brain cells. These lesions present with the symptoms of loss of memory, poor judgment and loss of sight as a person ages.

Abscesses

These are the brain lesions that occur in infectious
diseases. They include the localized areas of the brain containing pus and
inflamed tissue.

Plaques

These are the abnormal deposits in the brain that act
as space-occupying lesions. They can cause the death of brain cells. They also
compress the neighboring tissue severely affecting the normal functioning of the
brain. 

Tumors

Tumors also act as brain lesions. They may be benign
or malignant. Brain tumors may also be metastatic spreading to the brain from
other organs of the body.

Causes of Brain Lesions

Brain lesions can occur due to trauma or a disease
process. They may occur spontaneously or develop over a period of time. A brief
detail of different conditions that can cause brain lesions is given below:

Trauma

The most common cause of brain lesions is trauma to the brain. Injury to the brain can occur either due to fall from height or blowing off some hard object on the head of a person. Trauma to the head can cause bleeding in the brain or swelling of the brain tissue. Bleeding and swelling can cause the death of brain cells forming brain lesions.

Infections

Brain infection by different microbes can cause meningitis or encephalitis. These infections can cause inflammation within the brain tissue leading to brain lesions. Some microbes can cause calcified deposits in the brain.

These calcified deposits act as space-occupying lesions, compressing other areas of the brain.

Autoimmune disease

Autoimmune diseases can cause damage to the brain cells or form space-occupying lesions in the brain. These diseases include amyloidosis, sarcoidosis, and rheumatoid arthritis.

Stroke

Stroke, also called brain infraction, is a condition in which blood supply to the entire brain or part of the brain is stopped. If the blood supply is not established within a few seconds, it can cause irreversible brain damage and cell death.  Depending on the area of brain deprived of blood supply, it can cause brain lesions or complete loss of brain functions.

Bleeding

It can occur either due to brain trauma or cerebral
artery aneurysm.

Specific disease

Certain diseases can cause lesions in the specified
areas of brain. For example; in Parkinson’s disease, lesions occur in
substantia nigra, a part of the midbrain. 

Symptoms of Brain Lesions

Symptoms of brain lesions depend on the part of the brain affected the most. Not all brain lesions show symptoms. Many cases have been reported in which brain lesions spread to larger areas of the brain without causing any disease signs or symptoms.

On the other hand, some lesion affecting only a small region of the brain show severe symptoms as in Parkinson’s disease.

General symptoms seen with all non-specific brain
lesions include:

• Headache
• Nausea and vomiting
• Dizziness
• Fever
• Neck pain and stiffness
• Generalized weakness
• Altered gait and posture
• Altered speech
• Short-term memory loss

Specific brain lesions cause specific symptoms such as
dyskinesias and altered movements in Parkinson’s disease and dementia (memory
loss) in Alzheimer’s disease.

Complications of Brain Lesions

Brain lesions, if left untreated, can cause severe complications. They can expand to the other areas of the brain causing complete loss of brain functioning.

Loss of brain functioning decreases the quality of life causing paralysis, speech and hearing abnormalities. Involvement of the brain stem can interfere with the process of respiration and cardiac control leading to the death of the person. Bleeding lesions inside the brain can cause severe blood loss.

This can also cause circulatory shock and sudden death. Brain tumors can spread to other areas of the brain. If left untreated, brain tumors are the most lethal brain lesions having a much higher mortality rate.

Lesions in other organs of the body:

As said earlier, lesion is any area of damage or
injury in the body. However, in medical science, the term lesion is most
commonly used to describe any type of injury to the brain tissue. For other
organs of the body, the term lesion is used only for a specific illness or
disease.

Skin Lesion

Area of skin having abnormal appearance. They may be
primary lesions present at birth or acquired later in life. Secondary skin
lesions develop by modification of primary lesion.

Liver Lesions

These are the group of abnormal cells in the liver.
The term liver lesion is specifically associated with some tumors of the liver.
They may be benign tumors or malignant tumors of the liver.

Lung Lesion

Pulmonary nodules or cancerous cells in the lung are
sometimes called lesions in the lungs.

Cardiac Lesions

The term cardiac lesion is specific to the calcified
or fibroid deposits in the heart which can cause obstructive anomalies of the
heart.

Diagnosis of Lesions

The diagnosis of lesions depends on their location. Diagnosis always begins with the history and examination. History of progression of the lesion can give a clue about the type of the lesion and the underlying cause.

Some lesions such as skin lesions can be diagnosed
upon proper examination.

For the diagnosis of lesions occurring in deeper
tissue areas, such as brain lesions, cardiac lesions, etc. radiological methods
are used. These include MRI or CT Scans. The cardiac lesions can be diagnosed
by echocardiography. Ultrasonography can give a clue about the lesions in the liver.

Prevention

Medical specialists are of the opinion that brain
lesions and other lesions occurring in the body can not be predicted or
prevented. However, a person can follow some general guidelines that can help
prevent a number of diseases including brain lesions. These include:

• Quit Smoking (can prevent cancerous
  lesions)
• Keep blood pressure under control(can
  prevent aneurysm)
• Control cholesterol levels in blood
  (can prevent stroke)
• Using helmet while driving a bike,
  or playing some sports such as baseball, cricket, etc. (can reduce the chances
  of trauma to head)
• Avoid unnecessary exposure to
  radiations (this will prevent cancer)

Conclusion/Summary

Lesions are the areas of injury or damage in different
tissues of the body. The term lesion is most commonly used to describe the
damage to the brain tissue. Brain lesions may be

• Vascular
• Genetic
• Aging-related
• Space occupying lesions
• tumors
• Plaques.

Different conditions that can cause brain lesions
include:

• Trauma or injury to brain
• Decreased blood supply to brain
  tissue
• Infectious diseases such as
  meningitis
• Auto-immune disorders
• Certain diseases of the brain such
  as Parkinson’s disease

Symptoms of brain lesion vary depending upon the area
of the brain most severely affected. The general symptoms are nausea, headache,
and loss of concentration.

There is no specific way to predict or prevent brain
lesions. However, following a general guideline can help a person prevent the
underlying diseases that lead to brain lesions.

Once diagnosed, the brain lesions must be treated
immediately. Otherwise, they can cause severe complications and can even lead
to the death of the person.

Brain Lesions (Lesions on the Brain) Benjamin Wedro, MD, FACEP, FAEEM
https://www.medicinenet.com/brain_lesions_lesions_on_the_brain/article.htm#brain_lesions_facts
Lesion, Wikipeida Web Page
https://en.wikipedia.org/wiki/Lesion

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 cause significant disruption 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.

Perinatal CNS lesions – ProMedicine Ufa

The diagnosis of “perinatal CNS damage” unites a large group of brain and spinal cord lesions, different due to the cause and origin, that occur during pregnancy, childbirth and in the first days of a baby’s life.

From 5 to 55% of children in the first year of life receive this diagnosis, since this number sometimes includes children with mild transient disorders of the nervous system.Severe forms of perinatal lesions of the central nervous system are observed in 1.5–10% of term infants and in 60–70% of premature infants.

Severe perinatal brain lesions (including intracranial hemorrhages, severe cerebral ischemia) pose a real threat to the life and health of a child, even with timely provision of highly qualified medical care in a perinatal center. Moderate and mild forms of brain damage do not pose an immediate threat to life, but they can cause mental disorders and the development of motor activity in a child.

Reasons

The main cause of perinatal damage to the central nervous system in the fetus and newborn is hypoxia (oxygen deficiency), which occurs under the influence of various factors. Unfavorable conditions for the development of the fetus in the womb can be laid long before the onset of pregnancy due to various diseases in a teenage girl, a future mother. Infectious and non-infectious diseases, hormonal disorders, bad habits, industrial hazards during pregnancy cause increased hypoxia of the unborn child.Previous abortions lead to impaired blood flow between the mother and the fetus and, consequently, to intrauterine hypoxia.

Sexually transmitted infections (chlamydia, herpes, syphilis) play an important role in the development of perinatal lesions of the central nervous system.

Acute asphyxia during labor can be caused by various disturbances in the normal course of labor, rapid or protracted labor, incorrect position of the umbilical cord loops. Mechanical trauma to the child less often leads to perinatal damage to the central nervous system (especially the brain).

Symptoms

With mild CNS damage in newborns, the syndrome of increased neuro-reflex excitability is most often noted, which is manifested by flinching, increased or decreased muscle tone, increased reflexes, tremors (tremors) of the chin and extremities, restless superficial sleep, frequent “causeless” crying.

With moderate central nervous system damage in the first days of life, children often have central nervous system depression in the form of decreased motor activity and decreased muscle tone, weakening of newborn reflexes, including reflexes of sucking and swallowing.By the end of the 1st month of life, depression of the central nervous system gradually disappears, and in some children it is replaced by increased excitement.

With an average degree of damage to the central nervous system, disturbances in the work of internal organs and systems are observed in the form of uneven skin coloration (marbling of the skin) due to imperfect regulation of vascular tone, disturbances in the rhythm of respiration and heart contractions, dysfunction of the gastrointestinal tract in the form of unstable stool, constipation, frequent regurgitation, flatulence. Less often, convulsive syndrome may occur, in which there are paroxysmal twitching of the limbs and head, episodes of tremors and other manifestations of seizures.

Prolonged muscle tone disorders often lead to delayed psychomotor development in children. With a delay in motor development, the child later begins to hold his head, sit, crawl, and walk. Poor facial expressions, late appearance of a smile, decreased interest in toys and environmental objects, as well as a weak monotonous cry, a delay in the appearance of humming and babbling should alert parents in terms of mental retardation in the baby.

By the age of one year, in most children, the manifestations of perinatal lesions of the central nervous system gradually disappear or their minor manifestations persist.Frequent consequences of perinatal lesions include: delayed mental, motor, or speech development; cerebroasthenic syndrome (manifested by mood swings, motor restlessness, disturbed restless sleep, meteorological dependence), attention deficit hyperactivity disorder.

The most unfavorable outcomes are epilepsy, hydrocephalus, infantile cerebral palsy, indicating severe perinatal damage to the central nervous system.

Diagnostics

The diagnosis is based on medical examination data, anamnestic data and is confirmed by instrumental studies.Ultrasound examination (ultrasound) of the brain with an assessment of the state of its vessels (Doppler ultrasound) is of great importance. If necessary, use X-ray examination of the skull, spine, computed tomography (CT), magnetic resonance imaging (MRI).

Treatment

In the acute period of severe perinatal brain lesions, treatment is carried out in the intensive care unit and intensive care of newborns. First of all, they eliminate disturbances in the work of the respiratory, cardiovascular systems and metabolic disorders, eliminate convulsions (if necessary, artificial lung ventilation, intravenous infusions, parenteral nutrition are carried out).Then the newborns are transferred to a special department, where they continue individual treatment depending on the nature and severity of the brain damage: they use anticonvulsants, with developing hydrocephalus – dehydration drugs, as well as drugs that stimulate the growth of capillaries and improve the nutrition of damaged brain tissues. The same drugs, as prescribed by a neurologist, can be used during the first year of life by repeated courses.

For moderate and especially light lesions of the central nervous system, mainly non-drug therapy is used.

In the recovery period (from the end of the first year of life), non-medicinal methods of rehabilitation are of decisive importance: therapeutic massage and gymnastics, exercises in water, physiotherapy, pedagogical methods of music therapy (healing and treatment of the body with the help of music).

90,000 | Organic brain damage in children

Symptoms of organic brain damage in children

The main symptom of organic brain damage in children is psychoorganic syndrome.
This condition is expressed in the violation of three aspects of the brain at once.

1. Problems with memory – the child does not remember new information well and loses part of the information already learned (partial amnesia)
   Moreover, with OPM, unreal (invented) memories may appear.
2. Decreased intelligence – such children concentrate poorly, their thinking is impaired, they find it difficult to orient themselves in space.
3. Affective disorders and reduced neurodynamics – babies with organic brain lesions constantly experience weakness, dizziness and headaches, they are prone to depression, irritability.Often, babies show inappropriate emotions and “field” behavior.
4. Delay in speech and intellectual development is another symptom of organic brain damage, which is characterized by impaired cognitive activity.
   This condition is not congenital, like mental retardation, but acquired. The functions of the child’s damaged brain begin to decay.
   Sometimes the developmental delay is so severe that the child cannot learn to care for himself on his own.

There are also a number of focal symptoms , which depend on which area of ​​the brain the disorder is located in.

Frontal lobe – facial and eye muscles are paralyzed, sense of smell is impaired and words are difficult to pronounce, difficulty in performing purposeful movements, strange behavior on the verge of euphoria.

Parietal lobe – violation of sensitivity, inability to perform purposeful meaningful actions, as well as inability to learn to read and count.Seizures with convulsions are not uncommon.

Temporal lobe – impaired sense of smell and hearing, problems with taste, there are hallucinations, emotionally unstable mood, partial or complete lack of understanding of speech.

Occipital lobe – visual impairment up to blindness, problems with coordination of movements and balance, hallucinations, convulsions during seizures.

Naturally, therapy and correction of APM should be prescribed based on the cause of its occurrence and development.
For example, doctors recommend treating infections caused by antibiotics, antiviral drugs and immunostimulants.
If OPM has developed as a result of a tumor, then, first of all, you need to take care of its removal. You can’t argue with that.

Ischemic diseases of the brain, official medicine suggests treating with nootropic drugs , as well as using decongestant and vascular therapy.

It must be remembered that drug therapy cannot but have side, sometimes harmful effects .

Elimination of consequences is often more difficult and longer than the main violation.

But without psycho-corrective therapy, even in the case of successful drug therapy, DO NOT DO IT.

If your child:

• very picky and capricious in the choice of food
• reacts sharply to weather changes
• he gets rocked in the car
• he is inattentive
• speaks badly
• restless
• cries often
• clumsy
• lazy

Do you think these are all personality traits? In fact, these are neurological problems that can be associated with organic brain damage.If these violations are ignored now, then in the future they can cause serious behavioral disorders, delayed speech and general development, and subsequently difficulties in school.

The fact is that at an early age the consequences of many neurological disorders can be easily corrected and forgotten forever. But in adolescence, small problems often turn into big ones and it is already very difficult to cope with them.

Therefore, it is better not to postpone a visit to a neurologist and neuropsychologist.

It is especially important to conduct neuropsychological diagnostics in children before entering the 1st grade, to identify and correct neuropsychological disorders in time so that children do not develop “school failure”, which will affect not only the learning process, but also the psychological state of the child.

For example, in the temporal lobe of the left hemisphere there are areas that are “responsible” for speech analysis. If neuropsychological tests that check the state of this area of ​​the brain are performed incorrectly, it is possible not only to diagnose its immaturity, but also to predict the appearance of certain types of errors in speech, writing, reading and memorizing information.

Vascular diseases of the brain

Vascular diseases account for more than 40% of all pathology of the nervous system; this is one of the most common diseases in neurology. Everyone is well aware of such formidable diseases as strokes and heart attacks, but these are only complications of long-term progressive vascular diseases of the brain. The most common causes of the development of progressive discirculatory encephalopathy is a combination of cerebral artery atherosclerosis and hypertension.Other possible causes are vasculitis in systemic inflammatory diseases, congenital anomalies in the structure of the heart, blood vessels, spine, venous disorders, pathology of the vertebral arteries, hereditary blood diseases, constitutional features of the autonomic nervous system with arterial hypotension, and rarely other causes. Cerebrovascular insufficiency develops in stages.

At the 1st stage discirculatory encephalopathy, subjective unstable complaints of headaches, impaired performance, sometimes swaying and other mild nonspecific symptoms in the form of irritability, sleep disturbances predominate.

At the 2nd stage , the symptoms become more pronounced and prolonged, objective symptoms in the form of crises join, more often against the background of an unstable increase in blood pressure, impaired coordination, changes in reflexes and other symptoms.

At the 3rd stage there can be persistent organic manifestations – memory impairment, impaired coordination, transient cerebral circulation disorders, complications in the form of strokes and their consequences are possible.

Diagnostics

Diagnosis of cerebrovascular insufficiency is carried out by a neurologist. Methods such as collecting anamnesis, assessing cardiac hemodynamics – blood pressure, pulse and other indicators are used, cognitive (mental) activity is checked both during a conversation with a patient, and using specially designed questionnaires and conducting test tasks with a quantitative assessment of the points scored.

Laboratory tests – the content of cholesterol and its fractions, blood glucose levels and other biochemical parameters help in assessing the general condition.

An important method for assessing cerebral circulation is Doppler ultrasound with color Doppler mapping of the vessels of the neck and brain. This method allows you to identify atherosclerotic changes in the arteries and assess the blood flow in all major arteries of the brain.

In modern conditions, it is also necessary to visualize the brain using magnetic resonance imaging or computed tomography with angiography of the cerebral arteries, which will make it possible to assess the structural changes in the brain and identify the consequences of stroke.

At a late stage of the disease, a multifocal vascular lesion of the brain is diagnosed on magnetic resonance imaging in the form of zones of atrophy and leukoaraiosis, which clinically, as a rule, manifests itself as a decrease in memory and impaired cognitive functions.

Treatment

Methods of treatment of cerebrovascular insufficiency are varied, you just need to remember that vascular accidents are easier to prevent. Taking vascular, lipid-lowering, antihypertensive and metabolic therapy should be persistent and long-term.

The most important role belongs to lifestyle modification – this is smoking cessation, rational sports activities, diet and sleep.

Be healthy! 90,000 Perinatal lesions of the central nervous system at the Central Clinical Hospital of the Russian Academy of Sciences

Perinatal lesions of the central nervous system (PN CNS) or hypoxic-ischemic encephalopathy are a group of pathological conditions associated with brain damage during the perinatal period.

The main causes of PN of the central nervous system:

• Fetal hypoxia (chronic intrauterine; acute during labor)
• Birth trauma
• Intoxication (bilirubin encephalopathy)
• Hypoglycemia
• Infectious factor

Clinical manifestations of PN CNS

• Syndrome of excitability of the nervous system: excessive and multiple movements, tremor of the chin, tongue, extremities, regurgitation, sleep disturbances (excessive wakefulness), spontaneous Moro reflex (throwing out the arms in the supine position)
• Syndrome of depression of the nervous system: decreased spontaneous motor activity, short-term wakefulness, excessive sleep, weakness of the sucking reflex, insufficient emotional response when interacting with a child.
• Autonomic-visceral dysfunction syndrome: thermoregulation disorders, transient cyanosis, impaired heart rate and respiratory rhythm, marbling of the skin, hypothermia of the extremities, vegetative-vascular spots on the skin, regurgitation, vomiting, unstable stools.
• Syndrome of intracranial hypertension, hydrocephalic syndrome: excessive increase in head circumference, bulging fontanelle, throwing the head back, loud monotonous crying (cerebral cry), tilting the head back up to arching the trunk (opistotonus), persistent vomiting and regurgitation not associated with food intake, increased sensitivity to sound stimuli (hyperesthesia), spontaneous bulging of the eyes (Graefe syndrome), difficulty falling asleep (wants to sleep, but cannot fall asleep), short-term and superficial sleep, excitability.
• Convulsive syndrome: various sudden and repetitive contractions of the eyelids, facial muscles, eye abduction, paroxysmal chewing, swallowing, sucking, protruding tongue, swimming movements of the hands, pedaling, tonic tension of the trunk or limbs, single or group twitching of the limb muscles, accompanied by convulsive movements eyes or “stop” gaze, apnea.
• Dysregulation of muscle tone (muscular dystonia) increased, decreased, mixed muscle tone in the limbs, range of motion in the joints, spontaneous posture during sleep and wakefulness, position of hands and feet, support during verticalization, head position during traction (pulling) by the handles …

Outcomes and consequences of PN CNS

The consequences of PN of the central nervous system can be determined by the age of 1 year. Below are their main manifestations:

• Violation of motor development: a delay in the acquisition of the skills of holding the head, turning over, sitting, crawling, standing up, independent walking in relation to the physical age of the child.
• Formation of paresis and paralysis of both one and several limbs (monoplegia, diplegia, hemiparesis, tetraparesis), which refer to various forms of cerebral palsy.
• Violation of psycho-speech development: delay in acquiring the skill of humming, babbling, the first words and phrases, the quality of the sounds pronounced, the timing of the formation of the tweezers grip and pointing gesture, understanding of the addressed speech, interest in surrounding objects and their intended use, the nature of the game, memorization of a new one information, concentration of attention with the formation of attention deficit hyperactivity disorder.
• Disorders of behavior and emotions: the timing of the formation of a complex of revitalization, differentiation of relatives and strangers, emotional resonance, the severity of emotions, communication with peers and adults, the possibility of playing together, the formation of neatness skills, possibly leading to autism spectrum disorders.
• Hydrocephalus: excessive increase in head circumference, head deformity, severity of saphenous veins in the temporal regions, signs of hypertensive and hydrocephalic syndromes.
• Paroxysmal states of non-epileptic origin: affective-respiratory seizures, benign myoclonus of infancy (Figerman syndrome), benign neonatal sleep myoclonus, Sandiffer syndrome, infant torticolis, restless sleep, night fears, rhythmic movements in sleep (swinging fingers, swinging the head gnashing of teeth).
• Age-related epileptic syndromes: early infantile epileptic encephalopathy (Otahar syndrome), early myoclonic encephalopathy, Dravet syndrome, West syndrome, benign neonatal epileptic syndromes, benign myoclonic epilepsy of infancy, benign partial epilepsy of infancy.

Instrumental diagnostics

In the CDC Research Institute of Pediatrics and Rehabilitation, instrumental diagnostics are carried out in order to clarify the diagnosis:

• Ultrasound of the brain (neurosonography)
• EEG of daytime sleep and wakefulness
• CT of the brain
• MRI of the brain and spine

Our Help

Specialists of the Department of Development Neurobiology of the Research Institute of Pediatrics and Health Protection of the Central Clinical Hospital of the Russian Academy of Sciences work on the basis of the CDC:

• Diagnostics, observation and treatment are carried out by experienced neurologists, candidates of medical sciences with 20 years of experience in this problem.Our specialists are the authors of the book “Modern Neurobiological Aspects of Perinatal CNS Lesions”, published by the publishing house of the Russian Academy of Sciences.
• Defectologists and clinical psychologists are involved in the diagnosis to help clarify the presence of developmental disorders. Development assessment is carried out according to unified development tables.
• If necessary, children can receive specialized treatment and correction, developmental classes with specialists in early development, aimed at stimulating sensory, visual, auditory, tactile, coordinating functions.
• There is a possibility of complex observation of children with perinatal CNS lesions with the involvement of qualified specialists, candidates of medical sciences.
• Accompanying an experienced pediatrician who will answer all questions about care, nutrition, prevention of rickets and ARVI, hardening.
• Vaccine prophylaxis department: consultation of a vaccinologist-immunologist in order to draw up an individual vaccination schedule and direct vaccination under his control.
• Involve any other pediatric specialist, including orthopedists and ophthalmologists.

90 025 90 000 types of disorders and possible treatment

Regardless of what caused the brain damage, they all entail the manifestation of neurological dysfunctions in relation to hearing, speech, vision or movement. Elimination of these disorders requires a complex of restorative measures, which, alas, is almost impossible to pass at home or in a non-specialized clinical hospital, or it will not give a positive effect.Why this is so, we will try to explain in this article.

Various brain lesions due to stroke, traumatic brain injury or other diseases lead most often to neurological disorders: motor, speech, cognitive and others.

Depending on the severity of the disease and the location of the damage in the brain, the intensity and reversibility of these neurological disorders can be different. In any case, after receiving emergency medical care and treating the underlying disease, a period of rehabilitation begins, designed to restore the lost functions or, if this turns out to be impossible for medical reasons, to teach a person to live a full life after the transferred diseases.

In the scientific medical community, most neurologists and other specialists agree that the period of active rehabilitation of victims of brain lesions should begin in the first two to three weeks after the acute phase of the disease. And the greatest effectiveness of rehabilitation treatment falls on the first three to six months, in the next six months the gains are consolidated. In fact, depending on the nature and severity of the consequences, rehabilitation can last up to two years – often this is how long it takes to restore speech.

Rehabilitation of movement disorders

Here we will focus on warnings against common mistakes that people make when they decide to undergo home rehabilitation after injuries and other brain diseases that have caused movement disorders.

• As already mentioned, early rehabilitation after brain damage is indicated, but many patients and their relatives take this too literally. Indeed, usually, for example, after ischemic strokes, motor rehabilitation begins in a week (if there are no contraindications), after hemorrhagic strokes – after two to three weeks.Therefore, it is impossible to start it until there is confidence in its timeliness with the attending physician, with whom you agree on the volume and time of the beginning of rehabilitation measures.
• Choose your doctor carefully, because in Russia very many of them are inclined to prescribe treatment according to the standard prescribed scheme, performing a certain “ritual”, without taking into account the individual characteristics of the organism. So, many began treatment after the words: “The massage has not harmed anyone yet,” and then they discovered spasticity and further deterioration of motor functions.
• Continuing the topic of treatment “according to the scheme”, let’s say about the prevention of contractures, which prescribes one or two times a day to deal with the position of the duration of up to one and a half to two hours. However, if the remaining twenty-two hours of the arms and legs are in the wrong positions, then the benefit from this two-hour procedure will be zero.
• Intense and prolonged passive limb development can be not only useless, but also dangerous. In addition to the fact that it is not so much the victim who trains as the person giving him the massage, the intensified active massaging movements create the risk of dislocation and loosening of the joints – with paresis, and the risk of microtrauma and paraarticular ossification – with spastic paralysis.Rotational massage of the joints of the legs, which is carried out by a non-specialist, is extremely dangerous.
• Ideomotor gymnastics, or the representation of one’s own movement without the movement itself, can turn out to be not only useless, but also harmful: if the patient only “dreams” of movement, without making any internal efforts for this, volitional muscle reconstruction of the imaginary movement does not occur , forming the so-called central sprouting.
• In view of the fact that in cases with spastic paralysis the presence of muscle atrophy is not observed, active or power load on the intact arms or legs will lead to “robbing” the affected side, and in spastic muscles – to increased spasticity.So, after strokes, training of the quadriceps muscles of the thigh and biceps is strictly contraindicated.
• When prescribing a massage, it is not enough to indicate the area of ​​massage, but it is also necessary to recommend its nature, type of impact and, of course, set a task. So, the types of massage include: acupressure, structuring, resorption, soothing, hydrodynamic and others. And the tasks can be, for example, the following: mobilization of muscles and tendons, elimination of trigger zones, or mild edema, and others.
• Training on simulators involves not only carrying out certain exercises, but also performing them correctly. The person being rehabilitated can adapt to perform certain exercises using the healthy side or strong muscles. For example, when exercising on stationary bicycles, the exercises may be performed by the patient with only one leg, or using only the extensor or flexor muscles, and from the outside it may seem that the exercise is being performed correctly while it is harmful.
• Underestimating the patient’s mental and psychological state is another typical mistake people make when trying to restore motor functions. But the overwhelming majority of patients after brain injuries and serious illnesses are immersed in depression, in which they remain for several years, if they are not provided with the proper psychological assistance. Depression takes away from the affected people the moral strength to engage in therapeutic gymnastics, for the motivated and volitional participation of patients in their rehabilitation treatment.
• Ignorance or underestimation of the importance of an integrated approach in motor rehabilitation, which implies a rational combination of various methods of restorative medicine: where drug treatment is only a background for physiotherapy, followed by prevention of contractures, massage, psychotraining, and so on.
• And finally, the brain is in close “contact” with all parts and organs of a person, and any actions in the brain send them certain “commands”, and vice versa, any processes in the body are reflected in the activity of the corresponding areas of the brain.That is why motor exercises train not only muscles and tendons, and are the prevention of concomitant diseases, but also contribute to the speedy regeneration of nerve connections.

The above information is provided in this section in order to understand the importance of professionalism in assisting in the recovery of people who have suffered brain injury, strokes or other serious illnesses resulting in motor dysfunctions. At the forefront of any medical appointment should be a task or a set of interrelated tasks, to the solution of which various methods of restorative treatment are directed, and aimless or “chaotic” treatment at home not only will not lead to the desired results, but will also shift the vector of recovery in the other direction.

Restoration of speech dysfunctions

Organic lesions of the speech areas of the cerebral cortex can be the result of a tumor, stroke, trauma or inflammation. They lead to a systemic speech disorder called aphasia.

In total, there are about eight types of aphasia, which can be conditionally divided into two groups: sensory aphasia and motor aphasia. The first group is characterized by the fact that a person ceases to understand speech, but is able to pronounce words and phrases.Motor aphasia is manifested in the fact that a person hears and understands speech, but cannot pronounce words and phrases. Speech problems occur in a quarter of stroke survivors.

Speech dysfunctions entail a whole complex of negative mental states in people who have suffered organic lesions of the cerebral cortex, such as tearfulness, irritability, aggression, inadequate assessment of reality and depression.

Therefore, when restoring speech functions, several specialists are involved, these can be speech therapists, neuropsychologists, teachers, psychiatrists and psychologists.Recovery of speech takes a long time, much more than it takes for motor rehabilitation – two years, and in some cases, five to six years.

It is important to remember that often people with organic brain lesions do not understand that they have impaired counting, writing or speech, and if they do, then they believe that over time everything will work out by itself. In such cases, it is important to explain the situation to them, set a task for them and convince them of the achievability of the goal. You should also show the connection between the efforts made and the successful result, tell that the desire to achieve the goal and optimism will do more on the way of recovery than any drug therapy.

A typical mistake in speech rehabilitation with non-specialists is the wrong choice of exercises and training regime. This will not directly harm the victim, but it will deprive him of faith in success after many unsuccessful activities. This is why it is so important to seek professional help.

To work on restoring the patient’s speech requires fantastic patience, it is very important not to get annoyed while studying with him and constantly maintain the rehabilitated person’s interest in them. As a rule, daily leisurely calm conversations are recommended, as well as singing melodious songs, reciting simple children’s poems, and reading an ABC book.

If you nevertheless decide to deal with the victim on your own, be sure to buy literature, find out from a speech therapist and other specialists about existing techniques, use them in a comprehensive manner and in accordance with the existing instructions of specialists.

Correction of cognitive impairments

Most often, cognitive disorders are caused by ischemic strokes occurring against the background of diabetes, arterial hypertension and atrial fibrillation.

In the last decade, the results of many studies have appeared that convincingly prove that cognitive disorders negatively affect the entire process of rehabilitation, the restoration of all impaired functions: motor, visual, speech and others.Undoubtedly, other factors also affect the rehabilitation process:

• Age,
• Size of the focus of organic brain damage,
• Localization of injuries,
• Severity of the disease
• Time of initiation of treatment and rehabilitation,
• Presence of concomitant diseases.

But previously, cognitive impairment was not considered an aggravating factor in rehabilitation.

The rates of rehabilitation treatment are significantly influenced by such affective states as emotional lability, apathy, mania, anxiety and depression.Moreover, it was previously believed that depression is only a reaction to a past illness, although now it is known that, firstly, in frequency it exceeds all other mental disorders, and secondly, it is also formed due to personal, social and other factors.

For this reason, in the rehabilitation treatment of patients who have received organic brain lesions, it is important to involve various specialists from the field of medicine, pedagogy, psychology and other fields of knowledge.An integrated approach to rehabilitation, a rational combination and rotation in the application of many different methods, becomes obvious. Since today the fact of the interconnection of all possible neurological disorders after the resulting brain lesions can be considered proven, we inevitably come to the conclusion how unsuccessful can be rehabilitation at home and even in an ordinary clinical hospital. After all, complex rehabilitation is not just a set of various restorative techniques – it is an individual approach, agreement and approval by the community of doctors of a whole range of rehabilitation measures and further multistage targeted restorative treatment.

Perinatal lesions of the central nervous system

What are perinatal lesions of the central nervous system?

Perinatal lesions of the central nervous system (CNS) is a general term for the suffering of the nervous system in newborn children, caused by various causes.

How common are perinatal lesions of the central nervous system?

From 5 to 55% of children in the first year of life receive this diagnosis, since this number sometimes includes children with mild transient disorders of the nervous system.Severe forms of perinatal lesions of the central nervous system are observed in 1.5–10% of term infants and in 60–70% of premature infants.

Why do perinatal lesions of the central nervous system occur?

The main cause of perinatal damage to the central nervous system in the fetus and newborn is hypoxia (oxygen deficiency), which occurs under the influence of various factors. Unfavorable conditions for the development of the fetus in the womb can be laid long before the onset of pregnancy due to various diseases in a teenage girl, a future mother.Infectious and non-infectious diseases, hormonal disorders, bad habits, industrial hazards during pregnancy cause increased hypoxia of the unborn child. Previous abortions lead to impaired blood flow between the mother and the fetus and, consequently, to intrauterine hypoxia. Sexually transmitted infections (chlamydia, herpes, syphilis) play an important role in the development of perinatal CNS lesions. The cause of acute birth asphyxia can be various violations of the normal course of labor, rapid or protracted labor, incorrect position of the umbilical cord loops.Mechanical trauma to the child less often leads to perinatal damage to the central nervous system (especially the brain). The risk of child injury and acute asphyxia increases if childbirth takes place outside a medical facility, including during childbirth in water. In premature babies, due to their immaturity, perinatal damage to the central nervous system is observed more often.

Are perinatal lesions of the central nervous system dangerous?

Severe perinatal brain lesions (including intracranial hemorrhages, severe cerebral ischemia) pose a real threat to the life and health of the child, even with timely provision of highly qualified medical care in the perinatal center.Moderate and mild forms of brain damage do not pose an immediate threat to life, but they can cause mental disorders and the development of motor activity in a child.

How are perinatal lesions of the central nervous system manifested?

Features of disorders in perinatal CNS damage depend on the nature of the brain damage (hemorrhage in various brain structures, ischemia, infectious lesions), their severity, the degree of maturity of the child, the stage of the disease.

For example, in premature babies with severe brain lesions, general deep depression with impaired breathing, sometimes with short-term convulsions, prevails. In full-term newborns, both depression and increased excitability (motor restlessness, irritated screaming), prolonged convulsions are possible. By the end of the first month of a child’s life, lethargy, apathy can be replaced by increased excitability, muscle tone increases (muscles are too tense), an incorrect position of the limbs is formed (clubfoot, etc.). In addition, the development of internal or external dropsy of the brain (hydrocephalus) is possible. The manifestation of a spinal cord injury depends on the location and extent of the lesion. For example, if the cervical spinal cord or nerve plexuses are damaged, “obstetric paralysis” occurs – drooping or inactivity of the hand on the affected side.

With moderate brain lesions, vegetative-visceral manifestations may predominate: persistent regurgitation, delayed or increased stool, bloating, thermoregulation disorders (body reactions to heat and cold), pallor and marbling of the skin, lability of the cardiovascular and respiratory systems, etc.d.

In children with severe perinatal damage to the central nervous system, from the end of the first month of life, a delay in the development of the psyche and movements is noted: the reaction to communication is sluggish, a monotonous cry (emotionally not colored). Possibly early (at 3-4 months) formation of persistent movement disorders of the type of infantile cerebral palsy.

It should be noted that moderate (and sometimes severe) lesions of the central nervous system can be asymptomatic and appear at 2–3 months of life. Parents should be alerted to insufficient physical activity or its excess, bouts of unreasonable anxiety, lack of a clear reaction to sounds and visual stimuli in a full-term baby older than 2 weeks, as well as a persistent (habitual) position of the torso with a turn to one side, crossing the legs in an upright position, support “On tiptoe”, persistent throwing back of the head, bulging or pulsation of the fontanel, divergence of the cranial sutures, habitual squint or rolling of the eyes (symptom of the “setting sun”).

How is a perinatal lesion of the central nervous system diagnosed?

The diagnosis is based on medical examination data, anamnestic data and is confirmed by instrumental studies. Ultrasound examination (ultrasound) of the brain with an assessment of the state of its vessels (Doppler ultrasound) is of great importance. If necessary, use X-ray examination of the skull, spine, computed tomography (CT), magnetic resonance imaging (MRI).

What methods of treatment and prevention of perinatal lesions of the central nervous system are there?

In the acute period, severe perinatal brain lesions are treated in the intensive care unit of newborns. First of all, they eliminate disturbances in the work of the respiratory, cardiovascular systems and metabolic disorders, eliminate convulsions (if necessary, artificial lung ventilation, intravenous infusions, parenteral nutrition are carried out).Then the newborns are transferred to a special department, where they continue individual treatment depending on the nature and severity of the brain damage: they use anticonvulsants, with developing hydrocephalus – dehydration drugs, as well as drugs that stimulate the growth of capillaries and improve the nutrition of damaged brain tissues. The same drugs, as prescribed by a neurologist, can be used during the first year of life by repeated courses. With moderate and especially mild lesions of the central nervous system, non-drug therapy is mainly used.

In the recovery period (from the end of the first year of life), non-medicinal methods of rehabilitation are of decisive importance: therapeutic massage and gymnastics, exercises in water, physiotherapy, pedagogical methods of music therapy (healing and treatment of the body with the help of music).

Prevention of perinatal brain lesions can be primary and secondary

Primary prevention implies strengthening the health of adolescents (future parents), routine monitoring of pregnant women in order to identify abnormalities in the course of pregnancy as early as possible, competent obstetric care (including a planned caesarean section with a high risk of birth trauma).

Secondary prevention is the prevention of adverse consequences for the child of perinatal pathology, comprehensive treatment and effective restoration of his health.