What are the common causes of multiple brain lesions. How are brain metastases diagnosed. What treatment options are available for metastatic brain tumors. Can multiple brain lesions be treated effectively. What are the risk factors for developing metastatic brain cancer. How do brain metastases affect neurological function. What is the prognosis for patients with multiple brain lesions.

Understanding Multiple Brain Lesions: An Overview

Multiple brain lesions are a serious medical condition that can significantly impact a person’s neurological function and overall health. These lesions, which are abnormal areas of tissue within the brain, can have various causes and manifest in different ways. One of the most common and concerning causes of multiple brain lesions is metastatic brain cancer, where cancer cells from other parts of the body spread to the brain.

Metastatic brain tumors, also known as secondary brain tumors, are actually five times more common than primary brain tumors that originate in the brain itself. This prevalence underscores the importance of understanding the causes, symptoms, and treatment options available for patients facing this challenging diagnosis.

Common Causes of Multiple Brain Lesions

While metastatic brain cancer is a significant cause of multiple brain lesions, it’s not the only one. Other potential causes include:

• Multiple sclerosis
• Stroke
• Traumatic brain injury
• Infections (e.g., meningitis, encephalitis)
• Vasculitis
• Neurodegenerative disorders

However, given the focus on metastatic brain tumors in the provided information, we’ll delve deeper into this particular cause.

Metastatic Brain Tumors: A Primary Concern

Metastatic brain tumors occur when cancer cells from a primary tumor elsewhere in the body travel to the brain, typically through the bloodstream. The most common types of cancer that can spread to the brain include:

• Lung cancer
• Breast cancer
• Melanoma (skin cancer)
• Colon cancer
• Kidney cancer
• Thyroid cancer

These metastatic tumors can grow rapidly, crowding or destroying nearby brain tissue. In some cases, a patient may develop multiple metastatic tumors in different areas of the brain, leading to a variety of neurological symptoms.

Recognizing the Symptoms of Brain Metastases

Identifying the symptoms of brain metastases is crucial for early detection and treatment. The signs and symptoms can vary depending on the location and size of the tumors, but common indicators include:

• Headaches
• Seizures
• Weakness in the arms or legs
• Loss of balance
• Memory loss
• Speech disturbances or problems talking
• Behavior and personality changes
• Blurred vision or vision disturbances
• Numbness
• Hearing loss

Do these symptoms always indicate brain metastases? Not necessarily. Many of these symptoms can be shared by non-metastatic brain tumors or other neurological conditions. However, if you experience any of these symptoms, especially if you have a history of cancer, it’s essential to consult with a healthcare professional promptly.

Risk Factors for Developing Metastatic Brain Cancer

Understanding the risk factors for metastatic brain cancer can help in early detection and prevention strategies. Some key risk factors include:

• Age: The risk for metastatic brain tumors begins to increase after age 45 and is highest in those over 65.
• Primary cancer type: Certain cancers, such as lung, breast, and melanoma, are more likely to metastasize to the brain.
• Stage of primary cancer: Advanced stages of cancer have a higher risk of metastasis.
• Genetic factors: Some genetic mutations may increase the risk of certain cancers spreading to the brain.

Is there a way to prevent brain metastases? While it’s not always possible to prevent cancer from spreading to the brain, early detection and treatment of primary cancers can significantly reduce the risk. Regular check-ups and following recommended cancer screening guidelines are crucial steps in prevention.

Diagnostic Approaches for Metastatic Brain Tumors

Diagnosing metastatic brain tumors often involves a combination of physical examinations, neurological assessments, and advanced imaging techniques. The diagnostic process may include:

1. Physical exam: The doctor will gather information about symptoms and medical history, followed by vision and reflex tests.
2. Neurological exam: This assesses cognitive function, balance, and coordination.
3. Computed tomography (CT or CAT scan): Provides detailed images of the brain structure.
4. Magnetic resonance imaging (MRI): Offers high-resolution images of the brain and can detect small tumors.
5. Diffusion tensor imaging (DTI): A specialized MRI technique that visualizes water molecule movement in brain tissue, revealing microscopic differences in tissue structure.
6. Biopsy: In some cases, a sample of the tumor may be collected through surgery for definitive diagnosis.

How accurate are these diagnostic methods? While imaging techniques like MRI and CT scans are highly effective in detecting brain lesions, a biopsy remains the gold standard for definitively diagnosing metastatic brain tumors and determining their origin.

Treatment Options for Metastatic Brain Tumors

The treatment of metastatic brain tumors has advanced significantly in recent years, offering patients a range of options to manage their condition. The choice of treatment depends on factors such as the number and location of tumors, the primary cancer type, and the patient’s overall health. Common treatment approaches include:

Surgery

Surgical removal of brain metastases can provide rapid relief from symptoms caused by increased intracranial pressure. The most common surgical procedure is a craniotomy, which can be performed through various approaches, including the minimally invasive keyhole craniotomy.

When is surgery recommended for brain metastases? Doctors typically recommend surgery when:

• There’s a clear link between symptoms and the tumor’s location
• The primary cancer is treatable and under control
• The tumor can be safely removed without causing significant neurological deficits

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. Two main types of radiation therapy are used for brain metastases:

• Whole-brain radiation therapy (WBRT): Treats the entire brain, addressing both visible and microscopic tumors.
• Stereotactic radiosurgery (SRS): Delivers precise, high-dose radiation to specific tumor sites, sparing healthy brain tissue.

How effective is radiation therapy for brain metastases? Radiation therapy can be highly effective in controlling brain metastases, with stereotactic radiosurgery offering excellent local tumor control rates of up to 80-90% in many cases.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body. While traditionally less effective for brain tumors due to the blood-brain barrier, newer chemotherapy drugs and delivery methods have improved its efficacy in treating brain metastases.

Targeted Drug Treatments

These therapies target specific molecules involved in cancer growth and spread. Some targeted therapies can cross the blood-brain barrier more effectively than traditional chemotherapy, offering new hope for patients with brain metastases.

Immunotherapy

Immunotherapy harnesses the body’s immune system to fight cancer cells. Recent advances in immunotherapy have shown promising results in treating certain types of brain metastases, particularly those from melanoma and lung cancer.

Clinical Trials

Participation in clinical trials can provide access to cutting-edge treatments not yet widely available. These trials are crucial for advancing our understanding and treatment of brain metastases.

Can multiple brain lesions be treated effectively? Yes, in many cases, a combination of these treatment modalities can effectively control multiple brain lesions, improving symptoms and quality of life for patients.

Prognosis and Quality of Life Considerations

The prognosis for patients with multiple brain lesions, particularly those caused by metastatic cancer, can vary widely depending on factors such as:

• The number and location of brain metastases
• The type and stage of the primary cancer
• The patient’s overall health and performance status
• The availability and response to treatment options

While historically, the diagnosis of brain metastases often carried a poor prognosis, advancements in treatment have significantly improved outcomes for many patients. Some patients now live for years with well-controlled brain metastases, maintaining a good quality of life.

What factors contribute to a better prognosis? Early detection, prompt initiation of treatment, and a multidisciplinary approach to care are key factors in improving outcomes. Additionally, ongoing research into novel therapies continues to expand treatment options and improve prognosis for patients with brain metastases.

Living with Multiple Brain Lesions: Supportive Care and Management

Managing multiple brain lesions extends beyond just treating the tumors themselves. Comprehensive care often includes:

• Symptom management: Addressing headaches, seizures, and other neurological symptoms
• Rehabilitation: Physical, occupational, and speech therapy to maintain or improve function
• Psychological support: Counseling and support groups to help cope with the emotional impact of diagnosis and treatment
• Palliative care: Focusing on improving quality of life and managing symptoms, regardless of the stage of disease

How can patients and caregivers best navigate the challenges of living with multiple brain lesions? Open communication with the healthcare team, seeking support from loved ones and support groups, and focusing on quality of life goals are essential strategies for coping with the challenges of brain metastases.

Future Directions in Research and Treatment

The field of neuro-oncology is rapidly evolving, with ongoing research aimed at improving outcomes for patients with multiple brain lesions. Some promising areas of research include:

• Liquid biopsies: Developing blood tests to detect and monitor brain metastases
• Personalized medicine: Tailoring treatments based on the genetic profile of tumors
• Novel drug delivery methods: Improving the ability of drugs to cross the blood-brain barrier
• Combination therapies: Exploring synergistic effects of different treatment modalities
• Artificial intelligence: Using AI to enhance diagnosis and treatment planning

What can patients expect from future treatments? While it’s difficult to predict specific breakthroughs, the overall trend is towards more personalized, less invasive, and more effective treatments for multiple brain lesions, offering hope for improved outcomes and quality of life for patients in the future.

In conclusion, multiple brain lesions, particularly those caused by metastatic cancer, present significant challenges for patients and healthcare providers. However, with advancements in diagnostic techniques, treatment options, and supportive care, many patients can achieve good control of their condition and maintain a meaningful quality of life. As research continues to unveil new insights and therapies, the outlook for patients with multiple brain lesions continues to improve, offering hope for better outcomes in the years to come.

Metastatic Brain Tumors | Johns Hopkins Medicine

Featured Expert:

When cancer that began somewhere else in the body spreads to the brain and causes a mass or brain tumor, it’s called metastatic brain cancer. The resulting tumors are called brain metastases or “brain mets.” Johns Hopkins neurosurgeon Chetan Bettegowda offers insight into metastatic brain cancer and the treatment options.

What You Need to Know

• Metastatic brain cancer (also called secondary brain tumors) is caused by cancer cells spreading (metastasizing) to the brain from a different part of the body.
• The most common types of cancer that can spread to the brain are cancers of the lung, breast, skin (melanoma), colon, kidney and thyroid gland.
• Metastatic brain tumors are five times more common than primary brain tumors (those that originate in the brain).
• Metastatic brain tumors can grow rapidly, crowding or destroying nearby brain tissue. Sometimes a patient may have multiple metastatic tumors in different areas of the brain.

What happens when cancer spreads to the brain?

Cancer cells can break away from the primary tumor and travel to the brain, usually through the bloodstream. They commonly go to the part of the brain called the cerebral hemispheres or to the cerebellum, where they form a mass.

Some metastatic brain tumors appear many years after the primary cancer. Others metastasize so quickly that they are identified before the primary cancer.

When the cancer cells reach the brain and form a tumor, it may lead to a variety of symptoms that can be shared by nonmetastatic brain tumors as well.

What are the symptoms of brain metastases?

Common signs and symptoms of brain metastases include:

• Headaches
• Seizures
• Weakness in the arms or legs
• Loss of balance
• Memory loss
• Speech disturbance/problems talking

Other symptoms may include:

• Behavior and personality changes
• Blurred vision/vision disturbance
• Numbness
• Hearing loss

Who is at risk of developing metastatic brain cancer?

About one-third of patients with another type of cancer will develop one or more metastatic brain tumors. The risk for metastatic brain tumors begins to increase after age 45, and is highest in those over 65.

How are metastatic brain tumors diagnosed?

Metastatic brain and spine tumors are not usually diagnosed until symptoms appear. Here are some ways doctors may diagnose a metastatic brain tumor:

• Physical exam: After gathering information about your symptoms and personal and family health history, the doctor proceeds with a physical exam and vision and reflex tests.
• Neurological exam
• Computed tomography (CT or CAT scan)
• Magnetic resonance imaging (MRI)
  • Diffusion tensor imaging (DTI) is a type of MRI that visualizes how water molecules pass through parts of the brain. It reveals microscopic differences of tissue structure, including very early infiltration of cancer cells.
• Biopsy: Collecting a piece of the tumor through surgery may be necessary when the diagnosis is unclear based on the other tests.

Metastatic Brain Cancer Treatment

It is important to know that metastatic brain tumors are often treatable, and can be well-controlled. Generally, the faster you start treatment, the better the chances of killing or controlling the disease.

The treatment options for brain metastases may include:

• Surgery
• Radiation therapy
• Chemotherapy
• Targeted drug treatments
• Immunotherapy
• Clinical trials

In many cases, surgery or radiation therapy can improve — or entirely get rid of — symptoms. Read more about brain tumor treatment.

Metastatic Brain Tumor Surgery

Surgery provides fast relief of “mass effect” — pressure inside the skull resulting from a growing metastatic tumor and swelling of the brain. Some patients may find improvement of symptoms as early as within hours of surgery if mass effect is what is causing your symptoms.

The goal of surgery is to minimize the amount of space the tumor takes up by debulking, which means removing as much of the tumor as possible while maintaining neurological function.

In general, doctors recommend surgery for metastatic brain cancer when:

• There is a clear link between the symptoms and the tumor’s location.
• The primary cancer is treatable and under control.
• The tumor can be safely removed.

The most common type of surgery to remove metastatic brain tumors is called a craniotomy, which can be performed through a variety of approaches, including the keyhole craniotomy.

Learn more about brain tumor surgery and recovery.

Radiation Therapy for Metastatic Brain Tumors

Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation (light energy) to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.

These painless treatments involve passing beams of radiation through the brain, which can treat cancers in areas that are difficult to reach through surgery. Procedures may include any one or a combination of the following:

• External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
  • Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
  • Stereotactic radiosurgery (e.g., Cyberknife) directs a high dose of radiation targeted to the specific shape of the tumor, sparing surrounding healthy tissue from unnecessary radiation exposure.
  • Proton therapy uses protons (instead of X-rays) to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
• Brachytherapy is radioactive material implanted within a tumor to prevent further growth.

These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.

Choosing radiation therapy is complex, and often involves working closely with your care team. For some people, stereotactic radiosurgery may offer a better prognosis than surgery. Others may receive whole-brain radiation or a combination of both therapies. You will have a risk-benefit conversation with your radiation team to weigh the potential benefits against the possible risks and side effects.

Because radiation therapy has been so successful in treating brain metastases — and because many live long lives after treatment — studies are now looking at how to manage the long-term effects of treatment.

Chemotherapy for Metastatic Brain Tumors

Because traditional chemotherapy cannot cross the blood-brain barrier, newer treatments called targeted therapy are used as the primary type of chemotherapy for treating metastatic brain tumors.

These drugs identify and attack cancer cells (the target) with minimal harm to normal cells while preventing the growth and spread of cancer cells. Targeted therapy can be administered after surgery or in conjunction with radiation therapy to destroy remaining cancer cells.

Targeted therapies used to treat metastatic brain tumors include:

• Trastuzumab for breast cancer that has spread to the brain
• Erlotinib for the most common type of lung cancer (non-small cell lung cancer) that has spread to the brain

Immunotherapy for Metastatic Brain Tumors

Cancer immunotherapy is a fast-growing field of research that seeks to develop drugs, vaccines and other therapies that trigger the immune system’s natural abilities to fight cancer. Many immunotherapy drugs for metastatic brain tumors act as “checkpoint inhibitors.” Normally, tumor cells can evade attack by activating certain proteins (called checkpoint proteins) that disarm your immune system. Checkpoint inhibitors prevent tumor cells from exploiting this process.

Immunotherapy drugs to treat metastatic brain tumors include:

• Atezolizumab
• Ipilimumab
• Pembrolizumab
• Nivolumab

Clinical trials for new treatments

Researchers are always finding new ways to treat metastatic brain tumors. These new methods are tested in clinical trials. Talk with your health care provider to find out if there are any clinical trials you should consider.

Johns Hopkins Comprehensive Brain Tumor Center

Every metastatic brain tumor, and every patient, is different. The specialists at Johns Hopkins take the time to determine which treatment or combination of treatments will be the most effective for you.

Metastatic Brain Tumor Care at Johns Hopkins

How do you decide which metastatic brain cancer treatment is right for you?

Your neurosurgeon will discuss the most appropriate treatment approach with you by considering these and other factors:

• The type of primary cancer, your response to treatment and current status
• The location and number of metastatic tumors within the brain or spine
• Your general health and preferences regarding potential treatment options
• Your current symptoms

Along with benefits, doctors also consider the potential risks and side effects of any treatment. Many patients are worried about the effects of radiation. Others hesitate about the idea of surgery. Tell your doctor about your concerns — they are important to consider.

Metastatic Brain Cancer Prognosis

Prognosis for metastatic brain cancer varies greatly. Keep in mind that each patient is unique, and with newer treatments, many patients live longer. Speaking with your care team about your unique diagnosis can provide an accurate prognosis.

Palliative Care at Johns Hopkins

Palliative care is specialized medical care that helps patients facing serious illnesses and their families by adding an extra layer of support.

Palliative care teams can help with the symptoms and the stress of living with a serious illness, including controlling pain, providing support for the mental and emotional effects of an illness, and managing other symptoms.

Palliative Care at Johns Hopkins

Metastatic brain tumors | Cincinnati Ohio

Overview

This fact sheet provides a brief overview of brain metastases.
Please see Brain Tumors: An Introduction for more information.

What is a brain metastasis?

Metastatic brain tumors begin as cancer in another part of the body and spread to the brain through the blood stream. There can be one tumor (metastasis) or multiple tumors (metastases is plural). The most common cancers that spread to the brain are lung (50%), breast (15-20%), skin melanoma (10%), kidney and colon (5%). A metastatic brain tumor may also be referred to as a “secondary” tumor. When a skin cancer metastasizes to the brain, this “brain tumor” is actually a mass of skin cancer cells (Fig. 1).

Figure 1. Illustration and MRI of multiple metastatic brain tumors that have spread from the melanoma skin cancer on the face.

Some brain metastases appear years after the primary cancer. Others metastasize so quickly that they are discovered before the primary cancer. If the primary cancer cannot be found, it is called an “unknown” primary. A diagnostic work-up with imaging scans may be done to look for the primary cancer site. Treatment options vary depending on the location and number of brain lesions along with the location and severity of the primary cancer.

What are the symptoms?

Symptoms of a metastasis are related to the location of the brain in which they occur and may include headaches, physical numbness or weakness, disorientation, imbalance, and seizures. Cognitive problems may include short-term memory difficulty, problems talking (aphasia), or personality and behavior changes. A metastatic brain tumor is usually found when a cancer patient begins having neurologic symptoms and a brain scan is ordered.

Who is affected?

Metastastic (secondary) brain tumors are five times more common than primary brain tumors. About 10% to 30% of people with cancer develop a brain metastasis. There has been an increase in metastatic lesions as people are surviving cancers for longer periods of time.

How is a diagnosis made?

An MRI scan of the brain is the diagnostic tool of choice. An MRI showing multiple lesions is very suggestive of metastatic tumors. A diagnostic work-up may be performed to look for the primary cancer site.  This work-up often includes a chest x-ray, CT scan of the chest, abdomen, and pelvis, or a mammogram. A PET scan may be performed.

If a suspicious site for primary cancer is identified, oftentimes that site is biopsied first to help direct treatment. If there is a prior history of cancer, a biopsy may not be necessary. If the primary cancer cannot be identified, then a brain biopsy or surgery to remove the tumor may be performed to determine the diagnosis.

What treatments are available?

Treatment options vary depending on the patient’s overall health, number and location of brain/spine lesions, location and severity of the primary cancer, and the type of primary cancer.

Medications may be used to relieve some of the side effects of brain tumors. These include steroids to reduce swelling and edema around the tumor, and anticonvulsants to prevent or control seizures.

Radiation
Radiation therapy uses controlled high-energy rays to damage the DNA inside cells, making them unable to divide and grow. The goal of radiation therapy is to maximize the dose to abnormal cells and minimize exposure to normal cells (Fig. 2).

Figure 2. The radiation beams are shaped to match the tumor and minimize exposure to normal brain. Colored lines around the tumor indicate the radiation dose to the tissue.Figure 3. During radiosurgery, the patient lies on the table with their head held perfectly still with either a head frame or facemask in the treatment field. This photo shows Gamma Knife radiosurgery delivered through 192 openings in the machine.

Pinpoint accuracy is critical so that the lethal dose is applied only to the tumor and not to surrounding healthy tissues. External beam radiation is delivered from outside the body by a machine that aims high-energy rays (x-rays, gamma rays) at the tumor. The two main radiosurgery technologies are the Leksell Gamma Knife and linear accelerator systems, such as the BrainLab Novalis. A head frame or facemask is attached to the patient’s head to precisely localize the tumor on an MRI scan and to hold the head perfectly still during treatment. Types of radiation include:

• Stereotactic radiosurgery (SRS) delivers a high dose of radiation during a single or 5 daily sessions. Although it is called surgery, no incision is made. Frames and masks are used to keep the patient immobile while beams are aimed at the tumor(s) (Fig. 3).
• Fractionated stereotactic radiotherapy delivers lower doses of radiation over many visits. Patients return daily over several weeks to receive the complete radiation dose.
• Whole brain radiotherapy (WBRT) delivers the radiation dose to the entire brain, even to healthy tissue. It may be used to treat multiple brain metastases that are seen on the scan plus those that are microscopic and not yet visible.

Patients with few, smaller metastatic lesions (< 3 cm) can be treated with a single treatment (stereotactic radiosurgery). Patients with multiple metastatic lesions are typically treated with radiosurgery given in 5 daily sessions. Delivering a fraction of the total radiation dose gives normal cells time to repair themselves between treatments and may reduce side effects.

Surgery
Surgery is typically recommended for patients who have 1 or 2 metastatic brain lesions and are in good health, with primary cancer that is treatable. To remove a brain tumor, a neurosurgeon performs a craniotomy to open the skull (Fig. 4). If the tumor is near critical areas of the brain, the surgeon may remove only part of the tumor. A partial removal can still relieve symptoms. After the tumor is removed, the bone flap is replaced and secured to the skull with plates and screws. Radiation or chemotherapy may be used on the remaining tumor cells. Radiation seeds may be placed at the time of surgery to help prevent tumor recurrence.

Figure 4. Surgery involves cutting a window in the skull (craniotomy) to remove the tumor.

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

Chemotherapy
Chemotherapy drugs work by interrupting cell division. They can be given orally as a pill, intravenously (IV), or as a wafer placed surgically into the tumor cavity. Chemotherapy is delivered in cycles, with rest periods in between to allow the body to rebuild healthy cells. Unfortunately, chemotherapy given to treat cancer in the body (systemic) cannot pass through the blood-brain barrier. In cases of brain metastasis, the brain tumor must be treated differently than the primary cancer.

Brain metastases from certain cancers are sensitive to targeted therapies that bind to tumor-specific receptors and work with your immune system (personalized medicine).

Sources & links

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

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

Links

American Brain Tumor Association, ABTA.org

National Brain Tumor Society, BrainTumor.org

updated > 6.2018
reviewed by > Christopher McPherson, MD and Ronald Warnick, MD, Mayfield Clinic, Cincinnati, Ohio

Mayfield services

Mayfield Brain & Spine treats more than 1,250 patients with brain tumors each year. Of those patients, about 217 are diagnosed with a brain metastasis, a tumor that has spread to the brain from another part of the body.

We are affiliated with premier hospital systems in the Greater Cincinnati-Northern Kentucky Region. Our neurosurgeons collaborate with neuroradiologists, pathologists, medical oncologists, radiation oncologists, and neurointensivists. Together, we are capable of controlling many brain tumors with a combination of treatments, including chemotherapy, immunotherapy, surgery, implant therapy (radiation seeds), radiosurgery, and whole brain radiotherapy.

Advances in technology give Mayfield’s neurosurgeons unprecedented access to brain tumors. Image-guided systems enable us to navigate precisely in remote areas and to remove tumors with minimum impact to our patients.

Intraoperative diagnostics, including the Mayfield MobileSCAN CT and intraoperative MRI, give up-to-date images of an operation and help surgeons confirm that every bit of tumor has been removed.

Radiation technologies like Gamma Knife allow us to eradicate some tumors without making any incision at all.

To make an appointment call 513-221-1100.

Brain Metastasis: A Documentary, presented by the American Brain Tumor Association and BrainLab

support groups

Wellness Community of Greater Cincinnati
513-791-4060

Wellness Community of Northern Kentucky, 859-331-5568

Pediatric Brain Tumor Support Group at Cincinnati Children’s Hospital, 513-636-6369

Related: Early Treatment, Baseline Mental Health Are Predictors of Quality of Life Following Radiosurgery for Brain Metastasis

multifocal lesion in the white matter of the brain (demyelinating process or foci of vascular origin) / Consultation

Question

Anna, 40 years old. High blood pressure, decided to have an MRI of the brain. weighted by T2 and T1 in three projections. In the white matter of the brain subcortically, periventricularly, multiple foci of a confluent nature, irregular and rounded, 4-6 mm in size, hyperintense on T2WI, FLAIR and isointense on T1WI. Focal lesions of the brain stem. the cerebellum, the corpus callosum was not identified. The median structures are not displaced. The lateral ventricles are not dilated, symmetrical. The holes of Monro, the Sylvian passage are passable. The 3rd and 4th ventricles are not changed. The subarachnoid spaces are not changed. The cisterns of the base are not deformed. paranasal sinuses are airy. Data for the presence of a volumetric process was not obtained. An MRI picture of a multifocal lesion in the white matter of the brain (differentiate between the demyelinating process and foci of vascular origin). Help decipher! urgently need to go to the doctor?

Anna,
12/25/2018

Reply

Hello, Anna!
If something bothers you, then you should go to the doctor, regardless of the results of the MRI. If you currently have high or elevated blood pressure, start by consulting a therapist.
According to the description of the MRI, there is nothing wrong with you. But in order to exclude the demyelinating process, you are shown an internal consultation with a neurologist. You can sign up for a consultation with a neurologist at our Center by phone – +7(812)558-23-18 or +7(901)370-45-03.

Responsible

Shcherbinin Anton Vladimirovich
Neurosurgeon, candidate of medical sciences

Work experience since 1998

The mother’s blood pressure is very high, she loses consciousness, according to MRI: foci of chronic ischemia, liquorodynamic disturbances in the form of a slight expansion of the convexital subarachnoid spaces of the cerebral hemispheres, hypoplasia of the vertebral artery

Hello! Tell me, please, what kind of examination is necessary in this situation and what could be the reason for the condition described below: mother 59years. In 2012, there was a strong increase in blood pressure, she lost consciousness, after which partial …

Dizziness, noise in the head, according to MRI: intraventricular mass formation in the lateral ventricle, focal changes in the substance of the frontal lobes of a dystrophic nature, retrocerebellar arachnoid cerebrospinal fluid cyst, external replacement hydrocephalus

Hello. I am 37 years old. Recently, my blood pressure has risen 150/110 140/100 maybe 120/100, accompanied by dizziness, noise in the head, nausea, hands begin to shake. I turned to a neurologist for a consultation, and it was issued …

Severe headaches, high blood pressure, on MRI: dyscirculatory encephalopathy, external hydrocephalus of substitution genesis, diagnosis – cervicolumbalgia

Good day! I am 38 years old, since 2010 I have been registered with arterial hypertension (pressure reaches 190/150), sometimes accompanied by a severe headache. There is also SHOH, 2 protrusions of the same spine. A week ago …

Increased blood pressure, according to MRI: Dandy-Walker anomaly, focal degenerative changes in the white matter of the brain

Hello! I am 40 years old. The neurologist sent me for an MRI of the head. Description: On a series of MR tomograms weighted by T1 and T2 in three projections, sub- and supratentorial structures are visualized. A retrocerebellar cyst is visualized, 45x26x20 in size …

Headaches, severe back pain, according to MRI: Arnold-Chiari anomaly, syringohydromyelic cyst, degenerative-dystrophic changes in the cervical and lumbosacral spine, disc herniation, hemangioma in the vertebral body

Good afternoon. I am 38 years old, I have headaches and severe back pain. I have suffered from headaches since childhood, but my back has been bothering me for about 5 years. I did an MRI, in the conclusion it is written: MR picture of the Arnold-Chiari anomaly of the 1st degree …

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Cerebral circulation disorders: symptoms, types, MRI diagnostics

Violation of cerebral circulation is the most urgent medical and social problem of the present time, which is a group of diseases manifested by chronic or acute hemodynamic disturbances in the vessels of the brain, leading to a decrease in cerebral blood supply.

Due to the progressive general aging of the population, i.e. an increase in the number of elderly people in the population, the total number of patients with acute or chronic cerebrovascular accident increases from year to year.

One of the most informative among modern methods of neuroimaging is the method of MRI diagnostics.

Only thanks to modern programs used in MRI diagnostics, it became possible to recognize signs of cerebrovascular accident in the first 24 hours.

• Acute disorders of cerebral circulation: ischemic stroke, hemorrhagic stroke, transient disorders of cerebral circulation.
• Chronic disorders of cerebral circulation (dyscirculatory encephalopathy of hypertensive and atherosclerotic origin.

1. Acute cerebrovascular accidents

Transient cerebrovascular accidents are acute cerebrovascular accidents manifested by cerebral or focal symptoms lasting no more than 24 hours. They are also called transient ischemic attacks (TIA) due to the fact that they are based on transient ischemia in the pool of one or more cerebral vessels.

First ONMK watch. Changes in the area of ​​the right insula are shown only by the DW insult program.

In contrast to transient disorders of cerebral circulation, strokes are characterized by persistent disorders of brain functions of varying severity.
Strokes according to the nature of the pathological process are divided into ischemic and hemorrhagic.

In the list of diseases leading to the formation of ischemic stroke, atherosclerosis is in the first place, often against the background of diabetes mellitus. In addition, hypertension is a common cause, also in combination with atherosclerosis.

Meanwhile, there are many diseases that can be complicated by stroke, among which valvular heart disease with embolism, hematological diseases (leukemia, erythremia), vasculitis with collagenoses should be mentioned.

An etiopathogenetic factor that directly leads to a decrease in blood flow through the vessels is stenosis and occlusion of cerebral vessels. In some cases, vascular malformations and (rarely enough) cervical osteochondrosis with pathology of the intervertebral discs play a role in strokes in the vertebrobasilar basin.

The trigger factor in the development of a stroke is often mental and physical overstrain (stress, overwork, overheating, hypothermia).

The main pathogenetic condition for the development of a stroke is the lack of blood flow to a certain area of ​​the brain substance with the formation of a zone of hypoxia and further necrosis. The size of the area of ​​ischemic stroke depends on the degree of development of collateral circulation.

Clinically, ischemic stroke is characterized by the predominance of focal symptoms over the general cerebral, as well as a close relationship of focal symptoms with the blood supply pool of a particular cerebral vessel.

Symptoms develop gradually over several hours or sometimes days. It is possible to change the increase in symptoms by their weakening (flickering of symptoms in the initial stages of a stroke).

Ischemic stroke most often develops in the carotid system. In the vertebrobasilar – somewhat less frequently.

When large (main) arteries are damaged, extensive, territorial strokes develop corresponding to the blood supply zone of the affected vessel. Due to damage to small arteries, lacunar strokes with small lesions are formed.

Circulation pool of the left superior cerebellar artery, acute stage of NCC.

Area of ​​subacute ischemic CVD, in the basin of the right middle cerebral artery. In T1 mode, the “veiling” symptom is visualized – the iso-intensity of the MR signal.

Subacute stage of ischemic CVD. With intravenous contrasting, the accumulation of CV in the furrows at the level of the ischemic zone is determined (gyral type of enhancement).

Zone of chronic ischemic CVD, in the basin of the left posterior cerebral artery.

Ischemic stroke, brainstem (subacute period)

One of the advantages of MRI in assessing the consequences of a stroke is the ability to visualize descending Wallerian degeneration of axons in the brainstem and cortico-spinal tract on the side of the lesion.

Cortical ischemic stroke

Lacunar ischemic stroke against the background of chronic vascular insufficiency.

Some infarcts in dyscirculatory encephalopathy are asymptomatic. These are “silent” heart attacks, which, as a rule, are localized in the deep parts of the brain and are diagnosed only with MRI. This case shows the possibility of identifying a focus of limited ischemic stroke of the basal ganglia on the left against the background of chronic ischemia.

DWI

Severe vascular encephalopathy with the presence of multiple foci of chronic ischemia, lacunar postischemic cysts. The DWI program clearly shows the focus of acute stroke in the basal ganglia on the right against the background of leukodystrophy.

Ischemic stroke in the basin of the left middle cerebral artery. Absence of the phenomenon of flow emptiness at the level of the intracranial section of the left ICA (signs of slowing blood flow).

Ischemic stroke in the VBB on the left. The absence of the phenomenon of flow emptiness at the level of the extracranial section of the left vertebral artery (signs of slowing blood flow).

Postischemic lacunar cyst with perifocal gliosis (middle third of the corona radiata on the right)

The development of hemorrhagic stroke is most often caused by hypertension against the background of atherosclerosis. In some cases, the cause of hemorrhages can be the pathology of the vessels (congenital angiomas, vascular aneurysms), as well as other causes of arterial hypertension (pheochromocytoma, kidney disease, SLE, pituitary adenoma, etc. ).

impregnation of the vessel wall with blood plasma occurs with a violation of its trophism and subsequent destruction, the formation of microaneurysms, ruptures of blood vessels and the release of free blood into the substance of the brain, i.e. development of a stroke by the type of hematoma. In addition, it is possible to form a stroke by the type of hemorrhagic impregnation, which is based on the mechanism of diapedesis.

In cases of cerebral hemorrhage due to rupture of the vessel, there is often a breakthrough of blood into the ventricles of the brain or the subarachnoid space.
Often, a large hemorrhagic stroke is accompanied by severe edema, which leads to displacement of the median structures of the brain, various types of herniation, deformities of the brain stem, followed by the development of secondary small hemorrhages.

The development of hemorrhagic stroke occurs, as a rule, during the day, during active physical activity. The appearance of both cerebral and focal symptoms is characteristic. Sudden sharp headache, impaired consciousness, tachycardia, rapid loud breathing, development of hemiparesis or hemiplegia are typical initial symptoms of hemorrhage. Disturbance of consciousness varies from stupor to deep coma with loss of all reflexes, disturbance of the rhythm of breathing, a significant increase in blood pressure, hyperemia of the skin, sweating, intense pulse. Anisocaria, divergent strabismus, gaze paresis, hemiplegia are sometimes noted, rarely meningeal symptoms.

Intracerebral hematoma (border of acute and early subacute stages – 3 days), complicated by intraventricular hemorrhage.

Intracerebral hematoma, late subacute period (14-21 days) with perifocal edema around the hematoma.

Intracerebral hematoma of the right parietal lobe. Border of late subacute and early chronic stage. In T2-WI, a hemosiderin rim is visible (arrow).

I would like to emphasize the possibility of MRI in detecting the consequences of hemorrhagic lesions – there remains a hemosiderin rim that is well differentiated by T2, which is inaccessible for visualization with other methods of neuroimaging.

The arrows show the rim of hemosiderin along the periphery of the postischemic cyst.

2. Chronic cerebrovascular accident

Chronic cerebrovascular disease is a progressive form of cerebrovascular pathology characterized by multifocal or diffuse ischemic brain damage with gradual development of neurological and psychological disorders.

The main causes of chronic cerebrovascular accident are arterial hypertension, cerebral atherosclerosis, heart disease accompanied by heart failure.
Clinically, chronic disorders of cerebral circulation are manifested by disorders in the emotional sphere, imbalance, walking, memory impairment and other cognitive functions, pseudobulbar disorders, neurogenic urination disorders, which eventually lead to maladjustment of patients.
A characteristic manifestation of DEP on MRI is the presence of multiple foci of gliosis.

In the white matter of the left frontal and both parietal lobes, mainly subcortically, multiple small foci of chronic ischemia were found (most of them were localized in the basin of the right middle cerebral artery).