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.

Brain Cyst | Cedars-Sinai

Not what you’re looking for?

What is a brain cyst?

A brain cyst or cystic brain lesion
is a fluid-filled sac in the brain. They can be noncancer (benign) or cancer
(malignant). Benign means that the growth doesn’t spread to other parts of the body.
A
cyst may contain blood, pus, or other material. In the brain, cysts sometimes contain
cerebrospinal fluid (CSF). CSF is a clear liquid that bathes and cushions the brain
and
spinal cord. Some brain cysts begin before birth. 

Even if a brain cyst isn’t cancer,
it can still cause problems. The cyst may press against brain tissue and cause symptoms,
such as headache, vision problems, or nausea. If this happens, you may need surgery
to
remove the cyst. In some cases, if the cyst is small and not growing and isn’t likely
to
cause symptoms, your healthcare provider may advise watching it instead of surgery. 

There are different types of brain cysts: 

• Arachnoid cyst
  (leptomeningeal cyst). This is a cyst between the brain and the arachnoid
  membrane. This membrane is one of the protective coverings around the brain. An
  arachnoid cyst contains CSF. These appear most often in children, but they may also
  happen in adults. This type of cyst happens more often among males than females.
• Colloid cyst
  . This is a
  gel-filled cyst. It often forms in 1 of the 4 ventricles of the brain. The ventricles
  are the CSF reservoirs in the brain. Colloid cysts often happen in the third
  ventricle. This is in a central spot in the brain. The cysts can lead to blockage
  of
  CSF flow off and on, and cause positional headaches. These are headaches that happen
  when a person is in a certain position. These tend to appear during adulthood.
• Dermoid cyst
  . This is a
  rare type of cyst. It forms when a few skin cells get trapped when the brain and
  spinal cord form before birth. These cysts may even contain sweat gland cells or hair
  follicle cells. These often appear in children.
• Epidermoid cyst. This is also called an epidermoid tumor.
  Like a dermoid cyst, it forms from a bit of tissue that gets trapped when the brain
  and spinal cord form. Epidermoid cysts don’t contain sweat glands or hair follicle
  cells. They grow very slowly. These cysts often first appear when a person is an
  adult.
• Pineal cyst. This happens on the pineal gland in the
  middle of the brain. This type of cyst often only shows up during imaging scans done
  for another reason. Pineal cysts seldom cause problems. If they do grow large, they
  can sometimes affect vision. They can appear in people of any age.
• Brain abscess. This happens
  anywhere in the brain as a single cyst or multiple cysts. Abscesses are often caused
  by a bacterial infection. They are sometimes caused by a parasite or a fungus.
• Neoplastic cyst. This is due
  to a benign or malignant tumor. When a brain tumor starts outside the brain, it is
  called metastatic.

What causes a brain cyst?

Brain cysts are caused by the
building up of fluid in an area of the brain. Brain cysts can form during the first
few
weeks when a baby is growing in the uterus. Some cysts might form because of a head
injury or other trauma to the brain. In other cases, there may be links between a
brain
cyst and a noncancer tumor or a cancer tumor.

What are the symptoms of a brain cyst?

The symptoms generally depend on which part of the brain the cyst is growing in. In
some cases, a small cyst may not cause any symptoms. Some cysts are “silent” (cause
no symptoms) until they grow large. In some cases, you may have a problem related
to the area of the brain the cyst is growing in. In other cases, the symptoms may
be due to blockage of the normal flow of CSF. This can cause increased pressure on
the brain (intracranial pressure). 

Symptoms may be different for each
person, but can include: 

• Headache (common)
• Nausea and vomiting
• Vertigo or dizziness
• Hearing or vision problems
• Trouble with balance and walking
• Facial pain
• Seizures (not common)

How is a brain cyst diagnosed?

In some cases, your healthcare
provider may discover a brain cyst when it shows up on an imaging scan done for another
reason. In other cases, you may be having symptoms related to the cyst. Your primary
healthcare provider may refer you to a neurologist. This is a healthcare provider
who
specializes in diagnosing and treating diseases of the central nervous system. Or
you
may be referred to a neurosurgeon. This is a surgeon who does brain or spinal cord
surgery. 

The process to diagnose a cyst
starts with a health history and a physical exam. Your healthcare provider will ask
about your symptoms and past health conditions. They may also ask about your family’s
health history. The physical exam may include a nervous system exam. Imaging tests
may
be done to look at the brain. Contrast dye may be used to help show more detail in
the
images. The tests may include: 

• CT scan. This is an imaging test that uses X-rays and a
  computer to make detailed images of the body. Scans may be done of your brain and
  spinal cord.
• MRI. This test uses large magnets and a computer to create
  images of the body. MRI scans of your brain and spinal cord may be done to get more
  information about the cyst and nearby tissues.

Scans may be repeated over time to learn if the cyst is growing.

How is a brain cyst treated?

If a brain cyst is causing
problems, your healthcare provider may advise removing it with surgery. If the cyst
is
not causing symptoms and it isn’t growing, your healthcare provider may choose to
watch
it closely with repeated brain scans. Treatment can vary by the type of cyst. For
example:

• If you have an arachnoid cyst, your
  healthcare provider may puncture the cyst sac and drain the fluid. The fluid drains
  into the CSF or is pulled out with a needle. If your provider drains the cyst without
  removing part of the sac or placing a permanent draining tube, the sac may fill with
  fluid again.
• If you have a dermoid or epidermoid
  cyst, your healthcare provider will likely remove it. The complete cyst with its sac
  will likely be removed. If the cyst isn’t fully removed, it may regrow and cause
  symptoms again after a few years.
• Colloid cysts often cause a buildup of
  excess CSF. This is known as hydrocephalus. This can create a dangerous increase in
  pressure within the brain. A shunt or drainage tube can relieve some of this
  pressure. Colloid cysts can be hard to remove because they are often located deep
  within the brain. To remove these, your healthcare provider may use special surgical
  methods with tiny endoscopic tools sent through a thin tube into the brain.
• Pineal cysts often cause no problems.
  It’s often possible to manage these by watching for any changes.
• Tumor cysts can be treated with surgery, radiotherapy, or
  chemotherapy. These may be done alone or in combination.
• Abscesses are treated with antibiotics, antifungals, or
  antiparasite medicines. You may also need surgery.

Key points about a brain cyst

• Brain cysts are fluid-filled sacs that
  may form in the brain. They can be noncancer (benign) or cancer (malignant).
• Brain cysts may appear in children or adults. In some cases, brain cysts begin before
  birth but don’t cause any symptoms until much later.
• A brain cyst that doesn’t cause
  symptoms will sometimes show up during an imaging scan done for another reason.
• There are different types of brain
  cysts. These include arachnoid, colloid, dermoid, epidermoid, pineal, infectious,
  and
  tumor cysts.
• Even when brain cysts aren’t cancer,
  they may press against brain tissue and cause symptoms. Sometimes a cyst may block
  the normal flow of CSF. This can cause problems.
• Your neurologist or neurosurgeon may
  advise surgically removing the cyst. If the cyst is small and not likely to cause
  symptoms, your healthcare provider may instead advise watching it to see if it
  remains stable.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells
  you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
  or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also
  know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Joseph Campellone MD

Medical Reviewer: Marianne Fraser MSN RN

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Not what you’re looking for?

Discovery may help ID people at risk for stroke before they have symptoms — ScienceDaily

Scientists with the University of Mississippi Medical Center (UMMC) and colleagues found that very small brain lesions noted on brain imaging that would typically be disregarded by clinicians are associated with a heightened risk of stroke and death. The findings are in today’s (July 7, 2015) Annals of Internal Medicine.

The discovery about these tiny lesions — areas of the brain where tissue may have been damaged by injury or disease — may help physicians identify people at risk of stroke and death as early as middle age, even when they are displaying no symptoms of cardiovascular disease.

“The lesions on the brain imaging were very small, less than 3 millimeters, and are typically ignored in clinical practice,” said lead study author Dr. Gwen Windham, an associate professor of internal medicine and geriatrics at UMMC. “This is because we have been uncertain as to their meaning; no studies have looked to see if these very small lesions are related to important clinical outcomes. Our findings suggest they are at least as important as 3 millimeter or larger lesions that are typically considered abnormal, even in absence of other lesions.”

The researchers analyzed brain magnetic resonance imaging (MRI) data from nearly 1,900 individuals participating in the Atherosclerosis Risk in Communities (ARIC) Study who were 50 to 73 years of age with no prior history of stroke, tracking their health over about 15 years.

Risk of stroke or stroke mortality in people with small lesions was three times greater compared with people with no lesions. People with both very small and larger lesions had seven to eight times higher risk of these poor outcomes.

“Some of these lesions are so small they have the resolution of a single pixel,” said Dr. Thomas Mosley, director of the Memory Impairment and Neurodegenerative Dementia (MIND) Center at UMMC and senior scientist on the study. “In clinical practice, we would typically ignore these tiny lesions as insignificant. The assumption has been that these very small lesions probably are not particularly consequential, but, in fact, they appear to be.”

Although clinicians and researchers tend to dismiss very small cerebral lesions, the current findings suggest the practice could warrant reconsideration, the researchers said.

More than 800,000 strokes occur each year in the United States, according to the National Institute of Neurological Disorders and Strokes. Strokes are a leading cause of death in the country and cause more serious long-term disabilities than any other disease.

Knowing that these tiny areas of damaged tissue indicate increased risk of stroke in apparently healthy people will be important to help people maintain physical function and cognitive ability as they get older, said Windham, who also serves as director of the MIND Center clinic.

“We know that modifiable risk factors like hypertension and diabetes are associated with the larger structural changes in the brain, and those larger lesions are not only associated with stroke risk but with mobility impairments and cognitive impairments as well,” Windham said. “Ongoing trials may determine whether treatment of risk factors, like high blood pressure, reduce the incidence of these lesions, stroke and associated death and disability.”

The discovery about stroke risk grew from work at the MIND Center, a cutting-edge Alzheimer’s disease research institution at the University of Mississippi Medical Center.

“We are trying to identify the factors that hasten cognitive decline and the onset of Alzheimer’s disease, and it may be one of our best prevention strategies is aggressive control of cardiovascular risk factors early in life, meaning in middle age,” Mosley said. “In Mississippi, the mortality rate from heart disease and stroke is among the highest in the nation, so we’ve been interested in this connection between cardiovascular disease, brain aging, and Alzheimer’s disease for a long time.”

Prior studies have typically focused on older, largely white patient samples, but this study was aimed at understanding brain changes from an earlier age and recruited a more middle-aged, bi-racial sample.

Half of the sample participants were black, who generally have higher rates of stroke and cardiovascular disease for reasons that remain unclear. Identifying early markers of at-risk individuals could significantly impact the public health burden of cerebrovascular disease in all ethnic groups, the researchers said.

“People don’t routinely have MRIs, but when they are necessary, taking note of these small lesions could provide valuable information about future risk,” Windham said. “It’s similar to knowing about a patient’s history of high blood pressure or family history of heart disease — it may influence treatment decisions.”

In addition to researchers from UMMC, the study was co-authored by scientists from Johns Hopkins University, the University of Washington Medical Center, Mayo Clinic, and the University of North Carolina at Chapel Hill.

The study was funded by the National Heart Lung and Blood Institute of the National Institutes of Health.

Brain Tumors in Children | Johns Hopkins Medicine

Transnasal Endoscopic Surgery | Sofia’s Story

Diagnosed with a malignant skull base tumor declared inoperable by other surgeons, Sofia, a Connecticut teenager, came to Johns Hopkins and had her tumor removed with a transnasal endoscopic approach.

Symptoms of Brain Tumors in Children

The skull does not have excess room for anything other than the brain. Therefore, as brain tumors develop and expand, they cause extra pressure in this closed space. This is called intracranial pressure.

Increased intracranial pressure is caused by extra tissue in the brain as well as blockage of the cerebrospinal fluid flow pathways.

Symptoms include:

• Headaches
• Seizures
• Nausea and vomiting
• Irritability
• Lethargy and drowsiness
• Personality and mental activity changes
• Macroencephaly (enlarged head) in infants whose skull bones are not completely fused
• Coma and death, if left untreated

Brain tissue dysfunction caused by a growing tumor may cause other symptoms, depending on the tumor’s location.

For example, if a brain tumor is located in the cerebellum at the back of the head, a child may have trouble with movement, walking, balance and coordination. If the tumor affects the optic pathway, which is responsible for sight, the child may experience vision changes.

Brain Tumor Diagnosis in Children

A child experiencing brain tumor symptoms should be thoroughly evaluated by a pediatrician or pediatric neurologist, or in the emergency room to find the source of the problem.

The doctor’s evaluation usually includes imaging of the brain by an MRI scan. If the scan shows a brain tumor, the next step is a neurosurgical consultation. The pediatric neurosurgeon will work with the whole family to develop the best treatment plan for the child.

Other specialists may join the child’s treatment team, such as a pediatric oncologist (childhood cancer specialist), an ophthalmologist (if the child’s tumor affects the vision pathways), an epileptologist (to address seizures), a radiation oncologist, and advanced practitioners and technologists.

Tests for the Child with a Brain Tumor

In putting together the most appropriate treatment plan for a child with a brain tumor, the neurosurgery team will need to know:

• Tumor location: This is determined by a brain scan, using one or more types of imaging such as CT or MRI. Because there are many vital structures in the brain, there are places a tumor can grow that are not appropriate for surgery. The neurosurgeon’s careful evaluation will determine the accessibility of the tumor and the safest approach.
• Brain tumor type: Looking at the tumor cells under a microscope can reveal the brain tumor type, and give doctors insight on how the tumor is likely to grow or spread.
• Brain tumor grade: The grade refers to how aggressive the tumor cells appear to be. The higher the grade, the more aggressive the tumor.

Types of Brain Tumors in Children

Brain tumors can be categorized as:

Primary: Starting in the brain

Metastatic: Starting in other parts of the body and spreading to the brain

Benign: Slow-growing; non-cancerous. Benign tumors can still be difficult to treat if they are growing in or around certain structures of the brain.

Malignant: Cancerous. Unlike benign tumors that tend to stay contained, malignant tumors can be very aggressive. They grow rapidly and can spread to areas near the original tumor and to other areas in the brain.

Astrocytomas, Including Glioblastoma Multiforme

Astrocytomas are the most common type of glioma, accounting for about half of all childhood brain tumors. They are most common in children between the ages of 5 and 8.

The tumors develop from glial cells called astrocytes, most often in the cerebrum (the large upper part of the brain), but also in the cerebellum (the lower back part of the brain).

The grade of an astrocytoma is important. Your child’s treatment will be based on whether or not the tumor is slow-growing (low-grade, grade 1 or 2) or fast-growing (high-grade, grade 3 or 4). Most astrocytomas in children (80 percent) are low-grade. Sometimes they begin in the spine or spread there.

There are four main types of astrocytomas in children:

Pilocytic astrocytoma (Grade 1): This slow-growing tumor is the most common brain tumor found in children. Pilocytic astrocytoma is often cystic (fluid-filled). When this tumor develops in the cerebellum, surgical removal is often the only treatment necessary. Pilocytic astrocytomas growing in other locations may require other therapies.

Diffuse astrocytoma (Grade 2): This brain tumor infiltrates the surrounding normal brain tissue, making complete surgical removal more difficult. A fibrillary astrocytoma may cause seizures.

Anaplastic astrocytoma (Grade 3): This brain tumor is malignant. Symptoms depend on the location of the tumor. These tumors require a combination of treatments.

Glioblastoma multiforme (Grade 4): This is the most malignant type of astrocytoma. It grows rapidly, and often causes pressure in the brain. These tumors require a combination of treatments.

Other Pediatric Brain Tumors

Brain stem gliomas: Tumors in this location can be very challenging to treat. Most of these tumors are located in the middle of the brainstem and cannot be surgically removed, particularly the diffuse intrinsic pontine glioma, or DIPG. A few brainstem tumors are more favorably located and can be treated with surgery. These are often treated with non-surgical methods.

Choroid plexus tumors: These tumors are found in the choroid plexus — the part of the brain within the spaces in the brain, called ventricles, that makes cerebrospinal fluid, which surrounds and cushions the brain and the spinal cord. These tumors can cause a buildup of cerebrospinal fluid, resulting in hydrocephalus. They can be benign or malignant, and often require surgery as part of the treatment.

Craniopharyngiomas are benign tumors that occur near the pituitary gland.

Dysembryoplastic neuroepithelial tumors: These rare, benign tumors grow in the tissues covering the brain and spinal cord, and often cause seizures.

Ependymomas are another kind of glioma that forms from the cells that make, support, nourish, and line the ventricles (open areas of the brain’s interior that cerebrospinal fluid flows through). They require surgery plus radiation treatment in most cases.

Germ cell tumors: These tumors can be benign or malignant. They grow from germ cells, which form from eggs in women and sperm in men. During normal development of an embryo and fetus, germ cells usually become eggs or sperm.

Medulloblastomas: These malignant brain tumors account for about 15 percent of brain tumors in children. Medulloblastomas form in the cerebellum and occur primarily in children between the ages of 4 and 9, affecting boys more frequently than girls. Medulloblastomas can spread (metastasize) along the spinal cord. They typically require surgery plus other treatments.

Optic nerve gliomas: These tumors are found in or around the optic nerves — those that send messages from the eyes to the brain. Optic nerve gliomas are frequently seen in children with neurofibromatosis, a type of genetic disorder that affects the skin and nervous system. They can cause vision loss and hormone problems because of their frequent location near the base of the brain. These are typically difficult to treat due to the surrounding sensitive brain structures.

Treatment for Pediatric Brain Tumors

One or more of these approaches will be included in the child’s brain tumor treatment plan:

Surgery

Most brain tumors in infants and children require surgical removal, or at least a biopsy, as part of the treatment. The surgeon may recommend surgery to remove as much of the tumor as safely possible as a first step and to relieve intracranial pressure caused by the tumor. For low-grade or slow-growing tumors, surgery may be the only intervention necessary.

Follow-up Care after Surgery

The recovery process is different for each child. Children who received prompt diagnosis and treatment can do well after surgery.

Some pediatric patients may experience some temporary neurological deficits, such as muscle weakness. In most cases, this goes away shortly after surgery, unless there was substantial permanent damage before the child was diagnosed. Physical, occupational and speech therapy can help improve strength, function and speed of recovery.

Regular post-operative follow-up visits with the child’s neurosurgeon are also important to monitor neurological function and side effects from treatment, and to guard against recurrence of the tumor.

Radiation Therapy

This therapy focuses beams of high-energy radiation on the tumor tissue and a small amount of surrounding tissue. Some tumors, such as medulloblastoma, require additional radiation to the entire brain and spinal cord. Radiation is used very cautiously in infants and toddlers due to their growing brains.

Chemotherapy

Chemotherapy is used for many types of brain tumors including aggressive, high-grade tumors. Chemotherapy can be administered as pills (orally), intravenously (IV, by vein), injected directly into the cerebrospinal fluid, or injected directly into the cavity left after surgical removal of a brain tumor.

Are Brain Lesions an Indication of Multiple Sclerosis (MS)?

Q1. I presented to my doctor with a second episode of significant vision loss in one eye in a period of five months. After extensive testing and an MRI, the optical neurologist has indicated a high likelihood of MS. The MRI showed 10 lesions on my brain. Can you tell me if 10 lesions is a significant number to find?

Abnormal findings on an initial brain MRI occur in approximately 65 to 80 percent of patients with a first attack of optic neuritis, and follow-up of patients with an abnormal MRI showed that 80 to 90 percent of these people developed definite multiple sclerosis. This data is what compelled your neurologist to say that you have a high likelihood of MS.

In addition, there is a rough correlation between the number of lesions on the initial MRI and the time until the next attack of symptoms. In one study, patients with three or more lesions had a shorter time to the next relapse compared with patients with one or two lesions. An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.

Q2. I recently became very ill and was hospitalized. They did an MRI and discovered a lesion in my right side of my brain. They did a biopsy, lumbar puncture, visual evoked response test and a ton of blood work. After 12 days of being hospitalized, I was told they can’t say for sure that I have MS because I only have one lesion. Can I have MS with just one lesion? I am so confused.

The diagnosis of multiple sclerosis cannot be specifically made with one lesion. However, there certainly can be a very high suspicion of multiple sclerosis. What you described unfortunately is not an uncommon scenario. Many times, the diagnosis of multiple sclerosis can be very difficult and even though there may be a high suspicion based on the situation; a specific diagnosis cannot be made in spite of biopsies, lumbar punctures, MRIs, evoked potentials and blood work. The diagnosis of multiple sclerosis remains a “clinical diagnosis” meaning that all the pieces of the puzzle do have to fit together to form the picture that is consistent with multiple sclerosis. There have been a number of clinical trials with all the various treatments for multiple sclerosis in patients potentially like yourself that have what is called a “clinically isolated syndrome” which specifically means that there has only been one episode rather than “multiple episodes.” However, the MRIs or other studies including spinal fluid examination may be consistent with multiple sclerosis. Although it is very frustrating and difficult before the diagnosis is made, it may take time.

It is important to be sure that there is not some other explanation for what you described other than multiple sclerosis that could be occurring. Although it is frustrating and confusing, it sounds as though your physicians are trying to be very appropriate and trying to be certain of the diagnosis before committing you to a diagnosis of multiple sclerosis, and this may just take time.

Q3. How many new lesions before you say your drug is not working? I had five lesions when I was diagnosed five years ago. Then after another MRI I now have 22 lesions. I have been on the same drug for five years. Would you say this is normal progression? Or is it not acceptable and time to try another drug? Do we decide a drug is not working by the number of new lesions or by symptoms or is it the combination of both?

There is not necessarily a “normal” progression of multiple sclerosis. We do know that MS is a chronic progressive disease that will likely worsen over time. However, studies have shown that current treatments do work and hopefully would significantly impact the number of either acute or chronic lesions seen on MRI.

If there were five lesions five years ago and there are now 22 lesions — even if there are no clinical symptoms — this would cause concern that the present therapy is not as effective as hoped. The question is whether these lesions are new acute, inflammatory lesions — that is, they are seen after intravenous contrast with gadolinium — or are they new white matter plaques that suggest more chronic changes. In either case, with that number of new lesions, considering a change of therapy would be appropriate.

It should be noted that the number of lesions do not directly correspond to the level of disability. It really depends on where in the brain these lesions occur. We call this the “volume of disease.” Although there may not be obvious physical changes (such as weakness, paralysis, numbness or tingling, etc.) with increasing volume of disease, studies do suggest that cognitive changes do appear to be more directly related to the volume of white matter lesions on the brain. Thus, further discussion with your neurologist regarding other therapies may be appropriate.

Learn more in the Everyday Health Multiple Sclerosis Center.

Brain lesions // Middlesex Health

Definition

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

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

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

Brain lesions seen on MRI may indicate any number of possible conditions. Here the brain lesion depicts tissue damage from an ischemic stroke — a state of severely reduced blood flow to the brain, which deprives brain cells of vital oxygen and nutrients.

Causes

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

Among the known possible causes of brain lesions are:

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

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

When to see a doctor

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

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

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Meningioma Brain Tumor

What is a Meningioma?

In this section: Definition | Symptoms | Diagnosis | Treatment | Prognosis

MRI image showing a typical meningioma tumor

A meningioma is a tumor that arises from a layer of tissue (the meninges) that covers the brain and spine.

Meningiomas grow on the surface of the brain (or spinal cord), and therefore push the brain away rather than growing from within it. Most are considered “benign” because they are slow-growing with low potential to spread.

Meningioma tumors can become quite large. Diameters of 2 inches (5 cm.) are not uncommon. Meningiomas that grow quickly and exhibit cancer-like behavior are called atypical meningiomas or anaplastic meningiomas, and are fortunately rare. 

Meningiomas represent about 20 percent of all tumors originating in the head and 10 percent of tumors of the spine.

About 6,500 people are diagnosed with meningiomas each year in the United States. This type of tumor occurs more frequently in people with a hereditary disorder called neurofibromatosis type 2 (NF-2).

Lecture 31: Intracranial Meningioma from
UCLA Health System on Vimeo.

The molecular genetics and tumor pathogenesis of meningiomas and the future directions of meningioma treatments. View Meningioma Article (PDF) >

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Possible Symptoms Caused by a Meningioma

• The most common symptoms are pain (headache) for weeks to months, weakness or paralysis, visual field reduction and speech problems.
• Specific symptoms depend upon the location of the tumor. See the chart below:

 Most Common Sites and Symptoms for Meningiomas in the Head:

Location – Convexity (on the surface of the brain away from the midline)
Common Symptoms – Seizures, headache, extremity weakness, difficulty speaking, visual field deficit.

Location – Parafalcine (arising the meningeal layer between the hemispheres of the brain)
Common Symptoms – Seizures, lower extremity weakness, headache, personality changes, dementia, increasing apathy, flattening of affect, unsteadiness, tremor.

Location – Sphenoid Ridge
Common Symptoms – Eye-bulging, decreased vision, paralysis of eye movement, seizures, memory difficulty, personality change, headache.

Location – Posterior Fossa (area where the cerebellum is)
Common Symptoms – Unsteadiness and incoordination, hydrocephalus (increased pressure inside the brain), voice and swallowing difficulties.

Location – Cerebellopontine angle (on the side of the brainstem)
Common Symptoms – Loss of hearing. Facial muscle weakness. Dizziness. Unsteadiness and incoordination, hydrocephalus (increased pressure inside the brain), voice and swallowing difficulties.

Location – Olfactory Groove and sella (bony space where the pituitary gland is situated)
Common Symptoms – Loss of smell (anosmia), subtle personality changes, mild difficulty with memory, euphoria, diminished concentration, urinary incontinence, visual impairment.

Optic Sheath – Decreased vision in one eye. | Other – Variable depending on location.

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Diagnosis

• Magnetic resonance imaging (MRI) scans effectively detect most meningiomas and are best at displaying details of the brain.
• Sometimes a CT scan is obtained to evaluate whether there is any bone (skull) involvement, or if the tumor is calcified.

Treatment

The decision of whether to, and how best to, treat a meningioma is based on multiple factors, including size and location of the tumor, symptoms, growth rate, and age of the patient (among others). In general, there are three basic options: observation, surgical removal, and radiation.

• Observation: Meningiomas are often slow growing, increasing is size only 1-2 mm per year. Repeating yearly MRI scans may be appropriate in the following situations:
  • Patients with small tumors and mild or minimal symptoms, no impact on quality of life, and little or no swelling in adjacent brain areas.
  • Older patients with very slowly progressing symptoms. Related seizures can be controlled with medication.

• Surgery: Meningioma surgery varies from relatively straightforward to highly complex, sometimes requiring multiple surgeons from different specialties.
  • The ease of removal depends upon both their accessibility and the skill of the neurosurgeon. UCLA brain tumor neurosurgeons have extensive experience in removing all types of meningiomas.
  • The goals of surgery are to:
    • obtain tissue to confirm the diagnosis
      • meningiomas are classified by pathologists into three types:
        • Grade 1 – Benign: These very slow-growing tumors account for 75 percent of all meningiomas.
        • Grade 2 – Atypical: Usually slow-growing but can recur.
        • Grade 3 – Anaplastic: More malignant, faster-growing.
      • The 15 percent of meningiomas that recur often progress to a higher grade. Grade 2 and 3 tumors recur more frequently than grade 1 types
    • remove sufficient tumor in order relieve pressure or distortion of the normal brain tissue
      • When total removal of the tumor carries significant risk of morbidity (any side effect that can decrease quality of life), it’s better to leave some tumor tissue in place
      • If the tumor invades any of the large draining veins, major arteries on the brain surface, or if it is on the underside of the brain, chances of a complete resection decrease and risk of complications increases.
    • preserve and/or improve neurological function
    • if possible and safe, remove all the tumor so that it will not grow back.
      • Meningioma tumors that are near the surface and have not invaded deep structures or major blood vessels are more likely to be totally removed safely.

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Minimally invasive surgical options available at UCLA

 Endoscopic removal of meningiomas through the nose

• olfactory groove meningiomas
• tuberculum sella meningiomas
• sellar meningiomas

 Keyhole microsurgical removal using eyebrow incision

• olfactory groove meningiomas
• sphenoid wing meningiomas

Endoport removal

• intraventricular meningiomas

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• Tumor embolization prior to surgery
  • In some cases, your surgeon may choose to reduce the blood supply to the tumor by ordering an embolization procedure.
  • Embolization involves threading a thin tube (catheter) up the leg veins or arteries directly into the blood vessels that feed the tumor. Then a glue-like clotting substance is injected to choke off and shrink the tumor.

• Radiation
  • For those ineligible for surgery or with incomplete surgical removal, either conventional radiation or fractionated stereotactic radiosurgery (radiotherapy) can slow or stop the growth of meningiomas.
  • Radiation treatment is often considered for deep, surgically inaccessible tumors, or tumors in elderly patients.
    • Younger patients (< 50 years of age) need to be counselled about the risk of developing radiation-induced cancer 10 or more years after radiation treatment. Fortunately, the chances of this happenning appear to be very small.
  • Meningiomas have sharp margins and rarely invade neighboring tissue, thus they are ideal tumors for focused, shaped radiation fields using the Novalis Shaped-Beam Surgery.
  • This technique does not require actual surgery, but instead uses advanced imaging and computer technology to deliver a high dose of radiation to the tumor while limiting radiation exposure to the surrounding brain structures.
  • For many meningioma tumors, the radiation field needs to be conformed to the shape of the tumor. In addition, delivering the radiation in smaller doses over a period of weeks will reduce the risk of injuring critical brain structures next to the tumor (which may cause blindness, deafness, paralysis). Some treatment techniques, such as the Gamma Knife, cannot deliver this type of treatment.
  • UCLA neurosurgeons helped develop the Novalis Shaped-Beam Stereotactic System, one of the most advanced conformal stereotactic radiation delivery system in the world.

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Prognosis

• Surgery
  • For tumors in favorable locations, up to 85% of meningiomas are curable with surgery.
  • Location, the amount of the tumor left after surgery, and the skill of the neurosurgeon are the important elements in predicting a successful result.
• Radiation
  • Stereotactic radiosurgery stops the growth of meningiomas in up to 80 percent of cases.

The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member’s care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide

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90,000 Stroke: symptoms, first aid, prevention.

The human brain depends on a constant and sufficient supply of blood, saturated with oxygen. When blood circulation is impaired, severe brain disorders occur.

Stroke is a violation of blood circulation in the brain caused by a blockage or rupture of blood vessels. This is a condition where a blood clot – a thrombus – or blood from a ruptured vessel disrupts blood flow in the brain. Lack of oxygen and glucose leads to the death of brain cells and impairment of motor functions, speech or memory.

According to the WHO, stroke is the cause of death of 6.7 million people a year worldwide, second only to coronary heart disease. In most countries of the world, doctors attribute stroke to the most common causes of neurological disorders, leading to varying degrees of disability, and hence disability. In Russia, no more than 20% of patients return to work after suffering a stroke, and one third of those with stroke are people of working age. Recently, stroke in Russia has ceased to be a diagnosis of only the elderly, doctors more and more often fix this disease not only in 25-30-year-old Russians, but also in children.

A stroke can affect anyone. Stroke prevention is all about reducing risk factors. The disease is easier to prevent. Simple measures to help avoid a stroke will extend your life by 15-20 years. Some risk factors, such as developing an aneurysm or developing a blood clot from an injury, are difficult to control. However, a significant number of factors are mainly due to lifestyle.

These factors include:

• high blood pressure;
• high cholesterol;
• diabetes mellitus;
• obesity and overweight;
• cardiovascular diseases;

90,013 smoking;

• drug use;
• alcohol consumption.

In addition, stroke develops more often in people over 55 years of age and those whose close relatives have already suffered from a stroke. In the age range from 45 to 55 years, stroke in men occurs twice as often as in women,

Three quarters of all cases of the disease are ischemic stroke. This term refers to a condition in which a blood clot clogs a vessel and blocks blood flow to a specific part of the brain. Usually a thrombus forms somewhere in the peripheral vessels of the body, breaks off and reaches the brain through the bloodstream.There it gets stuck in small vessels of the brain and blocks the blood flow in them.

The second type of stroke – hemorrhagic – is much less common. It occurs when a blood vessel ruptures in the brain. If the vessel is on the surface of the brain, the drained blood fills the space between the brain and the skull. This is called subarachnoid bleeding. And if a vessel bursts in deeper structures of the brain, blood from it fills the surrounding tissues.

The defeat of a small area of ​​the brain leads to minor disorders – weakness of the limbs.Violation of blood circulation in large areas of the brain causes paralysis and even death: the degree of damage depends not only on the extent, but also on the location of the stroke.

In many people who have suffered a stroke, one side of the body remains partially or completely paralyzed, speech disorders and the control of urination and defecation functions appear. Intellectual abilities also suffer – memory, cognitive functions.

The onset of a stroke is usually asymptomatic. But after a few minutes, the brain cells deprived of nutrition begin to die, and the consequences of a stroke become noticeable.

Common symptoms of stroke:

• Sudden weakness in the face, arm, or leg, most often on one side of the body;
• sudden clouding of consciousness, problems speaking or understanding speech;
• Sudden vision problems in one or both eyes;
• Sudden gait disturbance, dizziness, loss of balance or coordination;
• Sudden severe headache for an unknown reason.

It is very important to immediately recognize its symptoms in order to call an ambulance as quickly as possible.After all, the earlier treatment is started, the better a person recovers from a stroke. Late seeking help leads to severe complications and disability.

Providing first aid in stroke is not just important, it is vital. And if suddenly you are next to a person who has shown clear signs of a stroke, you should immediately take several actions. The life of this person depends on them.

1. As soon as you understand that a person has all the signs of a stroke, call an ambulance immediately.This must be done immediately so as not to waste time. Cerebrovascular accident is most effectively treated in the first 3 hours. So don’t waste your time.
2. Remove unnecessary people from the room if it happens indoors. If it’s outside, ask everyone to step aside and not interfere with the flow of fresh air. Only those who can help should stay close.
3. Do not stir the person under any circumstances. This is dangerous. The patient must be left where the attack occurred.Do not transfer to the bed.
4. Raise the patient’s upper body and head (approximately 30 degrees). It is best to use a few pillows. Unbutton or remove all tight and breathing clothing (belt, collar, belt, etc.).
5. Provide fresh air.
6. If vomiting begins, turn the victim’s head to one side and clean up the vomit properly, otherwise the person may suffocate.
7. It sometimes happens that a stroke is accompanied by epileptic seizures.Moreover, they can follow one after the other. In this case, turn the person to one side, insert a spoon wrapped in a handkerchief, a comb, a stick into your mouth and, slightly holding the patient’s head with your hands, wipe off the foam. The most important thing in this case is not to pin down the person. You just need to hold it slightly and that’s it. And even more so, you can’t bring ammonia. The consequences can be dire – cessation of breathing and death.
8. It may happen that the victim’s heart stops and breathing stops.In this case, you will have to immediately start chest compressions and a session of artificial respiration.

Stroke prevention is based on the basic principles of a healthy lifestyle.

• Know and control your blood pressure – it should not be more than 140/90 mm Hg.
• Do not start smoking or quit smoking as early as possible.
• Add as little salt as possible to your food and avoid canned and processed foods that contain too much salt.
• Control your blood cholesterol level – the maximum allowable level is 5 mmol / l.
• Follow the basic principles of a healthy diet – eat more vegetables and fruits (at least 500 g per day), and cut out added sugar and saturated animal fat.
• Do not drink alcohol. The risk of developing a stroke is highest in the first hours after drinking.
• Exercise regularly. Even moderate physical activity (walking in the fresh air for 30 minutes a day) reduces the risk of developing cardiovascular diseases, including stroke.

Disease is a process that develops gradually in the body, imperceptibly forming over the years, before manifesting itself as sensations and symptoms. Only the sick person thinks that the disease has arisen suddenly. In fact, it takes a long time for painful changes in the body to become apparent. That is why prevention of diseases and knowledge of the principles of a healthy lifestyle are necessary – the basis of well-being.

Materials on various aspects of the prevention of cardiovascular diseases can be downloaded by clicking on the link: http: // www.med-prof.ru/medpr3181749.html

A stroke can touch everyone!

A stroke can touch everyone!

What is a stroke?

A stroke is a violation of blood circulation in the brain caused by a blockage or rupture of blood vessels. It leads to paralysis of the limbs, speech impairment, memory problems and disability. You can significantly reduce your risk of stroke by following the basic principles of a healthy lifestyle.

Stroke is one of the leading causes of death and disability in the world. It is impossible to predict its occurrence, but reducing the risk is simple enough.

What happens?

Three quarters of all cases of the disease – ischemic stroke . This term refers to a condition in which a blood clot clogs a vessel and blocks blood flow to a specific part of the brain.

Usually a thrombus forms somewhere in the peripheral vessels of the body, breaks off and reaches the brain through the bloodstream.There it gets stuck in small vessels of the brain and blocks the blood flow in them.

The second type of stroke – hemorrhagic – is much less common. It occurs when a blood vessel ruptures in the brain.

If the vessel is on the surface of the brain, the drained blood fills the space between the brain and the skull. This is called subarachnoid bleeding. And if a vessel bursts in deeper structures of the brain, blood from it fills the surrounding tissues.

But the result of both types of bleeding is the same – a violation of blood flow to the nerve cells and the pressure of the accumulated blood on the brain tissue.

What does it lead to?

The defeat of a small area of ​​the brain leads to minor disorders – weakness of the limbs. Violation of blood circulation in large areas of the brain causes paralysis and even death: the degree of damage depends not only on the extent, but also on the location of the stroke.

Many people who have had a stroke remain partially or completely paralyzed one side of the body, speech and control of urination and defecation functions appear.Intellectual abilities also suffer – memory, cognitive functions.

Stroke symptoms

The onset of a stroke is usually asymptomatic. But after a few minutes, the brain cells deprived of nutrition begin to die, and the consequences of a stroke become noticeable.

It is very important to immediately recognize its symptoms in order to call an ambulance as quickly as possible. After all, the earlier treatment is started, the better a person recovers from a stroke.

Common Stroke Symptoms :

• Dizziness, loss of balance and coordination of movement
• Speech problems
• Numbness, weakness or paralysis on one side of the body
• Darkening, double vision or blurring
• Sudden severe headache

How to recognize a stroke?

If you think you are seeing symptoms of a stroke, do a simple three-part test.If it is difficult to complete of all three tasks , immediately call the ambulance team, immediately clarifying that we are talking about a suspected stroke.

1. Ask person to smile broadly showing teeth. With a stroke, the smile loses its naturalness, becomes very tense and looks like a grin, or one-sided and crooked.

2. Then ask to close your eyes, raise your hands and hold them in this position for 10 seconds. With a stroke, muscles weaken and it is difficult to keep them lifted for a long time.If one arm does not rise at all, this is also a sure sign of a stroke.

3. Next ask to repeat any sentence, for example: “The weather is good this morning.” Stroke is characterized by speech disorders, and the patient does not cope well with this task.

What causes a stroke?

Blood clots that cause ischemic strokes usually form in arteries that are narrowed by atherosclerotic plaques . These are deposits of proteins that transport cholesterol.

Blood clots can form from poor heart function or from trauma that ruptures blood vessels in the limbs, abdomen, or chest.

Hemorrhages are also caused by an increase in blood pressure – it leads to rupture of small vessels in the brain.

Another cause of stroke is rupture of aneurysms, abnormally dilated sections of blood vessels. But this problem is often caused and aggravated by high blood pressure.

Main factors of development

Stroke can affect any person. Some risk factors, such as developing an aneurysm or developing a blood clot from an injury, are difficult to control. However, a significant number of factors are mainly due to lifestyle.

These factors include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity and overweight
• Cardiovascular disease
• Smoking
• Drug use
• Alcohol use

In addition, stroke develops more often in people over 55 and those whose close relatives have already suffered from a stroke.In the age range from 45 to 55 years, stroke in men occurs twice as often as in women,

How to prevent it?

Stroke prevention is based on the Healthy Living Principles .

Know and control your blood pressure.

Do not start smoking or quit smoking as early as possible.

Add as little salt as possible to food and refuse canned food and convenience foods that contain excessive amounts of it.

Monitor blood cholesterol levels.

Follow the basic principles of a healthy diet – eat more vegetables and fruits, and cut out added sugar and saturated animal fat.

Do not drink alcohol. The risk of developing a stroke is highest in the first hours after drinking.

Exercise regularly. Even moderate physical activity – walking or cycling – reduces the risk of developing cardiovascular diseases, including stroke.

Source – portal Zdorovaya Rossiya

Occlusive peripheral arterial disease –

Occlusive peripheral arterial disease or diseases provoked by vasoconstriction and blockage can be defined as anomalies in the functions of the nervous system resulting from any pathology of cerebral circulation or stroke … Occlusive cerebrovascular diseases are a group of diseases that cause the longest period of disability and occupy 3rd place, and according to other sources, even 2nd place among diseases leading to death.Peripheral arterial occlusive disease is generally described as a disorder that causes acute and focal neurological disorders due to stroke or generalized disorders of cerebral circulation. This type of disorder is divided into two main types: ischemic and hemorrhagic stroke. Ischemic strokes account for 80% of cases of this type of disease. Ischemic stroke, which is an acute disturbance of cerebral circulation in a specific arterial basin, which leads to a focus of necrosis of the brain tissue and is accompanied by persistent neurological deficits that persist for a long time.Hemorrhagic stroke is a hypertensive hemorrhage in the parenchyma of the brain, accompanied by an acute disturbance of cerebral circulation, loss of functions of the affected area, the development of pathogenesis in the nucleus and perifocal zone, and other similar disorders. The occurrence of this type of disease is associated with many reasons, listed below:

Atherothrombotic blockage of large arteries: is a blockage of large and medium vessels of the circulatory system that feeds the brain tissue.This type of blockage consists of stages such as enlargement and hardening of deposits that form atheromatous plaques in the lumen of an artery leading to the brain called the carotid artery. Then, there is a narrowing of the walls of the vessels that are closest to the brain or vessels of the brain tissue. Atherothrombotic blockage of the arteries occurs in approximately 20% of patients.

Lacunar occlusion of small vessels: 40% of patients belong to this group. It occurs as a result of blockage of small blood vessels located inside the brain.In the process of such a blockage in such deep structures of the brain as the basal ganglia, internal capsules and the trunk, a small rounded cavity filled with cerebrospinal fluid is formed. Having no walls, cavities or gaps between the elements of brain tissue after a heart attack are called “lacuna”.

Cardioembolic occlusion: is a pathology that occurs in 20% of cases of vascular occlusion caused by cerebrovascular disease.Cardioembolic occlusion most often manifests itself as a blockage of the middle vessels, called the vessels of the vertebrobasilar system, that feed the blood vessels and the back of the brain. More than half of this disorder occurs after a heart condition called atrial fibrillation.

Blockage of blood vessels due to other causes: accounts for 20% of cases. Diseases that cause such vascular occlusion include: vascular dissection, fibromuscular dysplasia, and Moyamoya’s disease.

After a decrease in blood flow below the critical level required for nerve cells occurs, a chain of biochemical processes is triggered, as a result of which cell death occurs in a certain area of ​​the body. In this connection, there are clinical signs of ischemia, which can vary depending on the degree of intensity of its manifestation, as well as on the volume of the affected area, the functional characteristics of these areas and the duration of its manifestation. Meanwhile, headache occurs in 25% of patients and is the most common symptom.If ischemia occurs in a small area of ​​the brain, it is defined as focal, if ischemia occurs in a very large (anoxic zone), it is defined as extensive ischemia. Against the background of occlusive peripheral arterial disease, the following 4 main clinical manifestations are most often observed:

Transient (transient) ischemic attack (TIA): represents an acute, lasting less than 24 hours, impaired blood circulation in the brain. In most cases, the duration of such an ischemic attack is 10-15 minutes, and therefore, when making a diagnosis, you can rely on this fact.Transient ischemic attack is manifested primarily by focal neurological symptoms, such as dizziness, impaired coordination of movement, slurred speech, unilateral manifestation of binocular visual impairment, and sometimes unilateral weakening of muscle tone. Multiple repetitions of TIA (according to the available data, in 20-80% of cases) may portend the development of a stroke in the future.

Reversible ischemic neurological deficit: characterized by complete regression of neurological symptoms lasting more than 24 hours within 3 weeks.Reversible ischemic neurological deficits are mainly caused by cardiac embolism. In the future, there is a possibility of developing a massive cerebral stroke.

Progressive stroke: The term progressive stroke or “in progress” stroke refers to a stroke in which, after the first neurologic examination, a further deterioration is observed within a few minutes or hours. Originally formed by the expansion of the affected area.This usually resolves within 48 hours. Meanwhile, a progressive stroke can last much longer in the area where the blood vessels supplying the back of the brain are located.

Asymptomatic stroke: caused by stenosis and occlusion of cerebral arteries in the absence of a corresponding neurological deficit on examination or history. An embolic stroke begins suddenly, while neurological disorders are manifested to the maximum extent, after which complete recovery occurs, the recovery process of which can take several hours, days or months.After recovery, patients usually wake up with no signs of stroke or neurological deficits.

Stroke at a young age: The likelihood of stroke in one in six people under the age of 40 who do not have hypertension and do not have diabetes is very low. The most common cause of heart stroke is embolism. However, drug use, in particular cocaine, as well as arterial dissection, fibromuscular dysplasia and blood clotting disorders, can also cause stroke at a young age.

Early diagnosis is of great importance, which will exclude other diseases or the following disorders, such as various types of brain tumors, brain infections such as abscess – encephalitis, (postictal condition) after stroke attacks, trauma, subdural hematoma, hysteria, contusion, increased or lowering blood sugar levels, dysfunctions of the heart. When diagnosing a stroke, various blood tests are carried out, as well as computed tomography and magnetic resonance imaging of the brain, Doppler ultrasonography, MRI angiography and all kinds of other studies and tests.

In acute stroke, first of all, urgent treatment is required, and in the long term, in the treatment process, it is recommended to eliminate such factors provoking the development of stroke as diabetes mellitus, arterial hypertension, atrial fibrillation, high cholesterol levels, excessive alcohol consumption and physical inactivity. In addition, prophylactic treatment, surgery and endovascular surgery can be used to eliminate any other causes of stroke.In the case of neurological disorders such as paralysis of one of the limbs, arms or legs, physical therapy or rehabilitation treatment is possible.

90,000 ultrasound of the vessels of the brain (head and neck) done in St. Petersburg

Ultrasound examination of the vessels or duplex scanning of the vessels of the brain (head and neck) is performed for a more complete and effective assessment of the structure and function of the vessels. It is an affordable and safe method used to screen the blood vessels of the brain.
This study allows not only to study the patency of blood vessels, but also to get an idea of ​​their anatomy and to study the blood flow velocity.

Why are the vessels of the head and neck examined

• With the help of ultrasound scan (duplex scanning) of vessels, early vascular changes and disorders that can be caused by blood clots or atherosclerotic processes in the body are determined.
• Also, the doctor of functional or ultrasound diagnostics will assess the speed of blood flow passing through the main arteries of the neck and head.
• USDG determines the presence of narrowing of the arteries (stenoses), their degree and significance, the state of the vertebral arteries, the presence of cerebral aneurysms is diagnosed, the state of venous blood flow in the neck vessels is assessed.
• This type of research can clarify the diagnosis of the cause of headaches and migraines.

Cost of ultrasound of the vessels of the head and neck

Screening of cerebral vessels. Ultrasound scan , prescribed for adults, is a study of the vessels of the brain and neck.When diagnosing the circulatory network based on the effect of Doppler , one of three methods can be used: Doppler ultrasound – the sensor is installed in the projection sites of the arteries and veins under study without prior visualization of the vessels.

Duplex scanning or Doppler ultrasonography is combined with two-dimensional ultrasound. An image of the vessels in the tissues is displayed on the screen and the specialist sees where the sensor should be placed.

Triplex scanning or duplex examination is combined with color differentiation of blood flow velocities in the vessels.

An ultrasound of the vessels of the brain (duplex scanning of the vessels of the neck and head) refers to a transcranial study, which consists in examining the arteries and veins in the cranial cavity, and an extracranial study of the vessels from which these arteries and veins depart into the cranial cavity.

Ultrasound diagnostics of head vessels is indicated for the following symptoms and is mainly prescribed by a neurologist, cardiologist:

• for dizziness;
• for ringing / noise in the ears;
• for headache;
• with temporary loss of sensitivity or loss of motor activity of the limbs, trunk, face;
• in case of loss of visual fields;
• in the presence of abnormalities in the brain substance visible on CT or MRI images;
• for persistent arrhythmias;
• for recurrent stroke;
• after myocardial infarction.

What can be diagnosed with a transcranial duplex of cerebral vessels

• stenosis and blockages of blood vessels;
• disorders caused by systemic vascular disease;
• preclinical manifestations of systemic vascular pathology;
• Violation of venous circulation, aneurysm, anastomosis, spasms, vascular malformations.
• Complex ultrasound diagnostics of the vessels of the brain and neck is prescribed when planning heart operations, in particular, with coronary artery disease before coronary artery bypass grafting.

For preventive purposes, the study is recommended in case of an increased risk of vascular lesions: smokers, suffering from arterial hypertension, patients with diabetes mellitus, obesity.

REFERENCE: The brachiocephalic arteries are the vessels that supply blood to the brain, head tissue, shoulder girdle and arms. They are detached from the aorta at shoulder level. The research method is based on the use of the Doppler effect, which is named after the Austrian scientist Christian Doppler, who discovered it.The method allows you to determine the state of the vascular walls; vascular lesions even in the early stages; the presence and severity of atherosclerosis; the presence and severity of stenosis; the speed and nature of blood flow.

Preparing and conducting research

Ultrasound screening of cerebral vessels does not require preliminary preparation of the patient. A few hours before the study, it is recommended to exclude the use of tonic drinks (tea, coffee, energy drinks), since they affect the tone of the cerebral vessels.

In a transcranial study, the sensor is installed in the temporal bone, in the occiput, above the orbit. A small amount of gel is applied to the probe and the surface to be examined, including the scalp, to provide better signal transmission. When examining large vessels before they enter the cranial cavity, the sensor is placed on the neck. During the procedure, at the request of the doctor, the patient performs functional tests consisting of holding his breath, rapid and deep breathing, and taking an upright position.The study is carried out in a supine or sitting position. It is necessary to remove accessories from the examined areas (neck and head)

Ultrasound decoding

In the decoding of the study of the arteries indicate:

• Arterial wall thickness, pulsation index, resistive index, linear blood flow velocity, systolic-diastolic ratio, vessel diameter, degree of artery stenosis, blood flow pattern.
• For veins, measure the diameter, study the state of the lumen of the vessel, examine the indicators of the phasicity of the blood flow depending on respiration and functional tests.
• The method allows you to detect formations in the lumen of a vessel (plaques, blood clots), assess their nature (floating or immobile formation) and how much the vessel is blocked by it.
• As a rule, due to the information content and low price, ultrasound of the brain is the first stage of the examination in case of suspicion of a violation or pathology. The method allows for effective screening of the state of blood vessels, to assess the risks associated with the identified deviations.

Clinic address

Ultrasound diagnostics can be done in all branches of the ONA network of clinics in St. Petersburg: Bogoslovskaya 4/1 (Art.Lesnaya metro station), 110 Fontanka River embankment (Sennaya / Spasskaya / Sadovaya metro station or Technological Institute metro station), Rizhskaya 12 (Novocherkasskaya metro station).

Prices are given as a reference and are not an offer.
90,000 Scientists: COVID-19 Leads to Brain Problems

Coronavirus causes encephalopathy, strokes and other neurological complications, according to scientists from the United States. Young patients are more susceptible to such symptoms, but, perhaps, doctors simply do not pay enough attention to the complaints of the elderly.

Coronavirus can lead to encephalopathy, strokes and other neurological complications, experts at Northwestern University in the United States warn. Neurological symptoms in one form or another occur in more than 80% of patients. For more information, see Annals of Clinical and Translational Neurology .

Researchers examined the medical data of 509 COVID-19 patients admitted to Chicago hospitals. In 215 of them, neurological symptoms appeared at the onset of the disease, in 319 – by the time of hospitalization.By the end of the disease, 419 people had encountered them – 82% of patients.

These symptoms included a wide range of problems associated with the nervous system. Most were fairly mild and included muscle pain (present in 45% of patients throughout the illness), headaches (38%), and dizziness (30%).

Another relatively common complication in this group was encephalopathy, a brain damage fraught with confusion, memory and concentration problems.About 32% of hospitalized patients had this symptom.

Cases of encephalopathy were associated with a higher risk of severe illness and death, regardless of the severity of other symptoms.

The cause of encephalopathy in patients could not be determined, but scientists believe that systemic inflammation caused by COVID-19, as well as the direct penetration of the virus into the nervous system, can lead to it.

More severe neurological complications such as strokes, movement disorders and seizures were rare – they were observed in only 0.2-1.4% of patients.

The majority of patients with neurological symptoms (71%) recovered by the time of discharge.

Researchers also note that neurological symptoms are generally more common in younger patients than older patients.

In the elderly, encephalopathy was observed more often, and there was less time between the first symptoms of infection and hospitalization. Most of these patients were men with a history of neurological or cancer, chronic kidney disease, cardiovascular disease and diabetes, and smokers.

“The fact that any neurological manifestations in general were more likely in young people is surprising,” the authors write. “It is possible that when working with elderly patients, doctors pay more attention to respiratory symptoms than any other.”

These results come from a relatively small sample, so it is unclear how common these symptoms are in all people with coronavirus infection, the authors note. But new evidence suggests COVID-19 may cause neurological symptoms – especially in those who are seriously ill and need hospitalization.

“This study highlights the high incidence and range of neurological manifestations that occurred in more than 4/5 of patients hospitalized with COVID-19,” the researchers write.

Headaches and other neurological symptoms are common with viral illnesses, but any headache or dizziness should not be mistaken for a COVID-19 symptom. They should be considered in the context of other symptoms such as fever, cough, shortness of breath. If you suspect COVID-19, you should see a doctor.

Earlier, British experts have already reported about the danger of coronavirus for the brain. According to them, in 62% of patients with COVID-19 who received neurological and psychiatric complications, the blood supply to the brain was damaged. At the same time, 31% had confusion and prolonged unconsciousness.

Other observations showed that many patients with COVID-19 have temporary brain dysfunction or inflammation, including acute disseminated encephalomyelitis.

90,000 Double vision

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11 September

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests.For a diagnosis and correct prescription of treatment, you should contact your doctor.

Doubling in the eyes – the causes of the appearance, with what diseases it occurs, the diagnosis and methods of treatment.

Bifurcation of the image in a vertical or horizontal plane is called diplopia. This condition is not an independent disease, but a symptom of damage to other organs. In addition to visual impairment, dizziness and sometimes nausea may occur.

Varieties

Diplopia can occur due to weakening or paresis of the oculomotor muscles, damage to the oculomotor nerves (or one nerve) or structures of the brain stem – the sections in which the nuclei of the cranial nerves responsible for eye movements are located.

Depending on the plane of double vision, horizontal, vertical and cross diplopia are distinguished.

Vertical diplopia is caused by unsynchronized work of the oblique ocular muscles or paresis of the blocky nerve, horizontal diplopia – by dysfunction of the rectus muscles or paresis of the abducens nerve.

In cross-diplopia (the most severe form), the image taken by the left eye is displayed on the right side, and vice versa. If the cause of double vision is due to the mismatch of the horizontal axes of the two eyes, the diplopia is called binocular. It disappears when the patient closes one eye. If double vision occurs when looking with one eye, diplopia is called monocular.

Possible causes and diseases in which diplopia occurs

Damage to the muscles of the eye or mechanical damage to the orbit.Diplopia can occur due to genetically determined dystrophy or inflammatory disease of the oculomotor muscles. The ocular form of muscular dystrophy develops for a very long time and is accompanied by ptosis, or drooping of the upper eyelid. Inflammation can be autoimmune in nature or develop as a result of trauma, infectious disease (flu, rheumatism), intoxication (drug or alcohol poisoning, pesticides). In addition, the inflammatory process can occur after eye surgery.Ocular myositis, or inflammation of the muscles of the eye, is characterized by rapid onset of swelling around the eyes, exophthalmos (bulging of the eye), and pain.

Pathological processes in the orbital cavity lead to double vision, if they are accompanied by a displacement of the eyeball. This situation occurs with traumatic damage to the orbit (for example, with a fracture of the lower wall of the orbit with infringement of the eye muscle), with the formation of a hematoma or tumor growth.

Any neoplasm in the cavity of the orbit or adjacent parts of the brain can cause limitation of the mobility of the eyeball.

The cause of double vision in case of thyroid dysfunction is exophthalmos – bulging of the eyeball (the so-called endocrine ophthalmopathy).

Some forms of strabismus are also accompanied by double vision. So, with Brown’s syndrome, diplopia occurs due to difficulty in moving the eye up and towards the bridge of the nose due to shortening of the tendons of the superior oblique muscle.

Damage to the oculomotor nerve.Compression or rupture of a nerve fiber in the event of a head injury leads to impairment of binocular vision. The nerve can be affected by tumors or protrusion of the wall (aneurysm) of the internal carotid artery, which leads to a gradually progressive paresis of the oculomotor muscles and is accompanied by the involvement of the optic nerve and the first branch of the trigeminal nerve in the process. Compression of the nerve can also occur with a persistent increase in intracranial pressure. In this case, the earliest symptom, which often occurs before the paralysis of the eye muscles, is the dilation of the pupils or one pupil.An increase in intracranial pressure may occur after a lumbar puncture; in these cases, the double vision symptom disappears a few hours after the manipulation.

Common causes of damage to the oculomotor nerves include infectious processes that involve the central nervous system (mumps, rubella, tetanus, diphtheria, meningitis), as well as alcohol and drug intoxication.

Diplopia is a characteristic symptom of botulism.

Violation of metabolic processes, for example, in diabetes mellitus, is sometimes accompanied by damage to the oculomotor and abducens nerves, which does not cause pupillary disorders.

This condition is based on vascular ischemia of the nerve.

With multiple nerve damage as a result of systemic diseases (Guillain-Barré syndrome, Fisher syndrome) and multiple sclerosis, diplopia is often the first symptom.In these diseases, the destruction of the myelin sheaths of the nerves occurs, which leads to muscle weakness, paresis, ataxia (violation of the coordination of movements).

Tolosa-Hunt syndrome, which is accompanied by double vision, is characterized by damage to the oculomotor, abducens and lateral nerves, the first branch of the trigeminal nerve, orbital vein and artery. The disease is of an autoimmune nature and can occur after previous infections, nervous stress, hypothermia.

Ophthalmoplegic migraine is one of the rare causes of double vision. Such a diagnosis helps to establish the presence of migraine, identified in the process of interviewing the patient.

Lesion at the level of the oculomotor nuclei. In addition to diplopia, other manifestations of the disease develop that allow a diagnosis to be made.

The cause of damage to the optic nuclei can be strokes, tumors (especially gliomas), metastases in the brain stem.

Trauma with the formation of a hematoma in the brain stem has the same effect on the nuclei.

Diplopia is one of the symptoms of a very serious disease of the medulla oblongata – syringobulbia. The first symptoms in this case arise from the oculomotor muscles (ptosis, diplopia and limitation of the mobility of the eyeballs) and facial muscles.

Monocular double vision (double vision when looking with one eye) can be psychogenic in nature or occur as a result of impaired refraction of the eye due to astigmatism (changes in the shape of the lens or cornea, which leads to incorrect image formation), reduced transparency and dystrophy of the cornea or lens.Do not confuse motion blur in astigmatism and double vision, which can occur due to muscle fatigue.

In addition, diplopia can be caused by a foreign body in the eye or defective contact lenses.

Which doctors should I contact?

If double vision occurs in the eyes, it is necessary to urgently consult an ophthalmologist. If diplopia is caused by syndromic diseases and polyneuropathies of various origins, the ophthalmologist will give a referral to specialized specialists: a neurologist, rheumatologist, endocrinologist,
oncologist, neuropsychiatrist or psychiatrist.

Diagnostics and examinations

When communicating with the patient, the ophthalmologist determines the type of diplopia, the presence of other symptoms and events preceding the onset of the disease. Visual inspection of the eye with a slit lamp

various defects can be found. The neoserine test reveals myasthenia gravis, which is accompanied by diplopia. If metabolic polyneuropathy is suspected, the doctor prescribes a glucose test to detect diabetes mellitus.

Atherosclerosis of the brachiocephalic arteries

Atherosclerosis is by far the most common disease in Russia among people over 50 years of age. This disease affects any arteries in the body, from the brain to the legs. It should be noted that not atherosclerosis itself is terrible, but its formidable complications. For example, a heart attack and stroke annually claim about half a million lives of Russians.

It must be remembered that “recognizing the disease in time means saving life”

Atherosclerosis of the brachiocephalic arteries is a lesion of the arteries supplying the head and neck (carotid and vertebral arteries), causing narrowing and blockage of these vessels.As a result of the accumulation of low-density cholesterol fractions in the walls, the arteries thicken, plaques are formed in them, which partially or completely block the lumen of the vessel.

If the brachiocephalic vessel becomes completely blocked or narrows severely, blood flow to a part of the brain is impaired and a stroke may occur.

Atherosclerosis of cerebral arteries and arteries of other localizations (for example, heart vessels) have the same risk factors. These include:

• diabetes
• high blood pressure,
• high cholesterol
• smoking

One of the outcomes of carotid atherosclerosis is transient ischemic attacks (TIA or microstroke).The fact is that fragments of atherosclerotic plaque and blood clots, which are formed in the event of a tear of the plaque, are carried by the blood stream to the head, where they can block the vessels supplying the brain.

Typical (focal cerebral) symptoms include numbness or weakness on one side of the body, weakness in the upper or lower extremities, inability to speak or understand speech, and decreased vision.

If there is a small fragment blockage of the vessel and it quickly disintegrates, then TIA occurs.If a vessel of a larger diameter closes or a fragment of a plaque (embolus) does not dissolve in the near future, a stroke occurs.

A true stroke is associated with a great risk to the patient’s life. According to statistics, the survival rate after a stroke is about 60% during the first year and no more than 50% in patients who have lived for 5 years.

The first symptoms of a stroke may be: impaired consciousness; state of stunnedness; drowsiness or restlessness; intolerable headache; loss of consciousness; nausea and vomiting.Later, focal brain symptoms join, but unlike TIA, they may not be completely cured.

When the vertebral arteries are affected, the posterior parts of the brain are usually affected. Symptoms of damage to these vessels can be of different intensity or suddenly appear with a stroke.

These symptoms include: dizziness, nausea, difficulty maintaining balance or coordination, blurred or double vision, and hearing loss.

Treatment of atherosclerosis of the brachiocephalic arteries

Drug treatment is possible if the artery does not have significant narrowing.

However, in cases of significant vasoconstriction (70% or more), surgery is recommended – carotid endarterectomy. During the operation, the plaque narrowing the lumen of the vessel is completely removed, and the blood flow in the vessel is restored.

In recent years, carotid endarterectomy has become not just an effective operation, but even is called the “gold standard” in the treatment of carotid atherosclerosis.

Since 2004, a new minimally invasive procedure for the treatment of atherosclerosis of the carotid arteries has appeared – stenting of the carotid arteries.

This procedure is performed by opening the artery with a small catheter, at the end of which a balloon is inflated, which presses the plaque into the vessel wall.

Next, a special device (stent) is installed into the lumen of the vessel, which lines the lumen of the vessel from the inside, keeps it open and holds the crushed plaque. By the way, this procedure can be performed in the case of damage to the vertebral arteries.

When choosing between endarterectomy and carotid artery stenting, doctors evaluate a variety of factors, including a person’s general health.

Surgeons opt for stenting in cases where the patient has symptoms of brachiocephalic atherosclerosis, but there is a high risk for surgical treatment (for example, concomitant heart disease or the consequences of a stroke), as well as if there are technical difficulties for the operation.

Studies show that the risk of stroke and death with carotid stenting is slightly higher than with open surgery.

Thus, carotid endarterectomy is the operation of choice in case of significant vasoconstriction and in patients with symptoms of cerebrovascular accident.

Timely performance of this operation will help the patient to avoid the most dangerous outcomes of atherosclerosis of the brachiocephalic arteries – TIA and stroke!

Carotid endarterectomy is included in the list of operations performed in the department of vascular surgery of the NUZ Road hospital at the Sverdlovsk-passenger station of JSC Russian Railways.