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Conditions Treated 

We provide personalized, comprehensive and compassionate care for patients with all types of neurological diseases. We offer advanced screening, prevention, diagnostic and treatment services, as well as comprehensive education and support programs. We offer you and your family the physical, emotional and spiritual support you need during your journey. Click on the "Learn More" links below for in-depth information on each type of neurological disorder or disease.

Alzheimer's DiseaseEnfermedad de Alzheimer

Alzheimer's Disease

What is Alzheimer's disease?

According to the National Institute of Neurological Disorders and Stroke, Alzheimer's disease is a progressive, neurodegenerative disease that occurs when nerve cells in the brain die. The disease often results in the following behaviors:

  • Impaired memory, thinking, and behavior

  • Confusion

  • Restlessness

  • Personality and behavior changes

  • Impaired judgment

  • Impaired communication

  • Inability to follow directions

  • Language deterioration

  • Impaired thought processes that involve visual and spatial awareness

  • Emotional apathy

With Alzheimer's disease, motor function is often preserved.

When Alzheimer's was first identified by German doctor Alois Alzheimer in 1906, it was considered a rare disorder. Today Alzheimer's disease is recognized as the most common cause of dementia (a disorder in which mental functions deteriorate and break down). An estimated 5.3 million Americans have Alzheimer's disease. According to the Alzheimer's Association, this number includes 5.1 million people over the age of 65, as well as 200,000 to 500,000 people younger than 65 who have early-onset Alzheimer's and other types of dementias.

Illustration showing how alzheimer affects the brain
Click Image to Enlarge

How is Alzheimer's different from other forms of dementia?

Alzheimer's disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination during autopsy. Brains affected by Alzheimer's disease often show presence of the following:

  • Fiber tangles within nerve cells (neurofibrillary tangles)

  • Clusters of degenerating nerve endings (neuritic plaques)

Another characteristic of Alzheimer's disease is the reduced production of certain brain chemicals necessary for communication between nerve cells, especially acetylcholine, as well as norepinephrine, serotonin, and somatostatin.

What causes Alzheimer's disease?

Although intense investigation has been underway for many years, the causes of Alzheimer's disease are not entirely known. The National Institute on Aging says that suspected causes often include the following:

  • Age and family history

  • Certain genes

  • Abnormal protein deposits in the brain

  • Other risk and environmental factors

  • Immune system problems

What are the warning signs or symptoms of Alzheimer's disease?

According to the Alzheimer's Association, the following are the most common symptoms of Alzheimer's disease. However, each individual may experience symptoms differently. Symptoms may include:

  • Memory loss that affects job skills, especially short-term memory loss

  • Difficulty performing familiar tasks

  • Problems with language

  • Disorientation to time and place

  • Poor or decreased judgment

  • Problems with abstract thinking

  • Misplacing things

  • Changes in mood or behavior

  • Changes in personality

  • Loss of initiative

  • Loss of ability to recognize who people are, even people well known to the individual, such as his or her child or spouse, when the disease progresses to a severe stage

The symptoms of Alzheimer's disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is Alzheimer's diagnosed?

There is not a single, comprehensive test for diagnosing Alzheimer's disease. By ruling out other conditions through a process of elimination, doctors, or other specialists, can obtain a diagnosis of probable Alzheimer's disease with approximately 90 percent accuracy. However, the only way to confirm a diagnosis of Alzheimer's disease is through autopsy.

Examination and evaluation are essential in determining whether the dementia is the result of a treatable illness. In addition to a complete medical history and extensive neurological motor and sensory exam, diagnostic procedures for Alzheimer's disease may include the following:

  • Mental status test. This is a brief and simple test of memory and some other common cognitive or thinking skills; it is usually part of a complete neurological exam

  • Neuropsychological testing

  • Blood tests

  • Lumbar puncture (spinal tap). A procedure performed by inserting a hollow needle into the lower back (lumbar spine)

  • Urinalysis. Laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein

  • Chest X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film

  • Electroencephalogram (EEG). A procedure that records the brain's continuous electrical activity by means of electrodes attached to the scalp

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body

  • Genetic testing. Some genetic testing is available, especially in some research settings. Because there is no cure or effective treatment for Alzheimer's, the decision to undergo genetic testing is one that requires careful consideration and counseling with a specialist in genetics.

Can Alzheimer's disease be prevented?

Because the cause of the disease is unknown, there are no prevention protocols to follow at this time. And, because the controllable risk factors for Alzheimer's disease are unknown, it is not yet possible to reduce the chances of developing the disease.

What is the treatment for Alzheimer's?

Specific treatment for Alzheimer's disease will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the disease

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the disease

  • Your opinion or preference

At this time, there is no cure for Alzheimer's, no way of slowing down the progression of this disease, and no treatment available to reverse the deterioration of Alzheimer's disease. New research findings give reason for hope, and several drugs are being studied in clinical trials to determine if they can slow the progress of the disease or improve memory for a period of time.

There are some medications available to assist in managing some of the most troubling symptoms of Alzheimer's disease, including the following:

  • Depression

  • Behavioral disturbance

  • Sleeplessness

In managing the disease, physical exercise and social activity are important, as are proper nutrition, health maintenance, and a calm and well-structured environment.

What are Alzheimer's rehabilitation programs?

The rehabilitation program for people with Alzheimer's differs depending on the symptoms, expression, and progression of the disease, and the fact that making a diagnosis of Alzheimer's is so difficult. These variables determine the amount and type of assistance needed for the Alzheimer's individual and family.

With Alzheimer's rehabilitation, it is important to remember that, although any skills lost will not be regained, the caregiving team must keep in mind the following considerations:

  • To manage the disease, plan a balanced program of physical exercise, social activity, proper nutrition, and health maintenance activities.

  • Plan daily activities that help to provide structure, meaning, and accomplishment for the individual.

  • As functions are lost, adapt activities and routines to allow the individual to participate as much as possible.

  • Keep activities familiar and satisfying.

  • Allow the individual to complete as many things by himself or herself as possible. The caregiver may need to initiate an activity, but allow the individual to complete it as much as he or she can.

  • Provide "cues" for desired behavior (for example, label drawers, cabinets, and closets according to their contents).

  • Keep the individual out of harm's way by removing all safety risks (for example, car keys and matches).

  • As a caregiver (full-time or part-time), understand your own physical and emotional limitations.

Alzheimer's Disease

Alzheimer's disease is a degenerative disease which destroys brain cells, causing problems with memory, thinking and behavior.

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HeadacheDolores de Cabeza

Headache

What is a headache?

A headache is pain or discomfort in the head or face area. Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur. As a result of this variation, several categories of headache have been created by the International Headache Society to more precisely define specific types of headaches.

What aches when you have a headache?

There are several areas in the head that can hurt when you have a headache, including the following:

  • A network of nerves that extends over the scalp

  • Certain nerves in the face, mouth, and throat

  • Muscles of the head, neck, and shoulders

  • Blood vessels found along the surface and at the base of the brain (these contain delicate nerve fibers)

The tissues of the brain itself do not hurt because they do not have pain-sensitive nerve fibers.

What causes a headache?

Headaches may be caused by a number of conditions, such as disorders of the neck, eyes, brain, jaw, or teeth. Headaches with an underlying medical condition are classified as secondary headaches because they are related to the condition. An example of this would be a headache due to neck injury or sinus infection.

Other headaches are classified as primary because the headache itself is the main medical problem, although associated factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors may include medications, dehydration, or changing levels of hormones. These factors that influence headaches are sometimes called headache triggers.

What are some of the different types of primary headaches?

  • Migraines. This type of headache is distinguished by the fact that symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur.

    Migraines are also unique in that they have distinct phases. Not all individuals experience each phase, however. The phases of a migraine headache may include:

    • Premonition phase. A  change in mood or behavior that may occur hours or days before the headache.

    • Aura phase. A group of visual, sensory, or motor symptoms that immediately precede the headache. Examples include hallucinations, numbness, changes in speech, and muscle weakness.

    • Headache phase. Period during the actual headache with throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.

    • Headache resolution phase. Pain lessens during this phase, but may be replaced with fatigue, irritability, and difficulty concentrating. Some individuals feel refreshed after an attack, while others do not.

  • Tension headaches. Tension headaches are the most common type of headache. Stress and muscle tension are often factors in tension-type headaches. While symptoms may differ, the following are common symptoms of a tension-type headache:

    • Slow onset of the headache

    • Head usually hurts on both sides

    • Pain is dull or feels like a band or vice around the head

    • Pain may involve the back (posterior) part of the head or neck

    • Pain is mild to moderate, but not severe

    Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).

  • Cluster headaches. Cluster headaches usually occur in a series that may last weeks or months, and the headache series may return every year or two. While people often experience symptoms differently, the following are the most common symptoms of a cluster headache:

    • Severe pain on one side of the head, usually behind one eye

    • The eye that is affected may be red and watery with a droopy lid and small pupil

    • Swelling of the eyelid

    • Runny nose or congestion

    • Swelling of the forehead

What are the most serious symptoms of a headache?

Headache symptoms depend on the type of headache. The frequency of headaches and the intensity of the symptoms may vary as well. Symptoms that may suggest a more serious headache include any of the following:

  • Headaches that start early in the morning

  • Pain that is worsened by strain, such as a cough or a sneeze

  • Vomiting without nausea

  • Sudden onset of pain and the "worst headache" ever

  • Headache that is becoming more severe or continuous

  • Personality changes

  • Changes in vision

  • Weakness in the arms or legs

  • Seizures

The symptoms of a headache may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How are headaches diagnosed?

The full extent of the problem may not be understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history, physical examination and diagnostic tests.

Questions commonly asked during the exam may include, but are not limited to, the following:

  • When do headaches occur?

  • What is the location of the headache?

  • What do the headaches feel like?

  • How long do the headaches last?

  • Have there been changes in behavior or personality?

  • Do changes in position or sitting up cause the headache?

  • Do you have trouble sleeping?

  • Do you have a history of stress?

  • Is there a history of head injury?

If the history is consistent with migraine or tension-type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if it is not a primary type headache, then other tests may be needed to determine the cause.

Tests used to determine the cause of a headache may include:

  • Blood tests. Various blood chemistry and other laboratory tests may be run to check for underlying conditions.

  • Sinus X-rays. A diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

How are headaches treated?

Specific treatment for headaches will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Type of headaches

  • Severity and frequency of the headaches

  • Your tolerance for specific medications, procedures, or therapies

  • Your opinion or preference

The ultimate goal of treatment is to stop headaches from occurring. Adequate headache management depends on the accurate identification of the type of headache and may include:

  • Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting

  • Changing eating habits

  • Exercise

  • Resting in a quiet, dark environment

  • Medications, as recommended by your doctor

  • Stress management

Migraine headaches may require specific medication management including:

  • Abortive medications. Medications, prescribed by your doctor, that act on specific receptors in nerves and blood vessels in the head to stop a headache in progress.

  • Rescue medications. Medications purchased over-the-counter, such as analgesics (pain relievers), to stop the headache.

  • Preventive medications. Medications, prescribed by your doctor, that are taken daily to reduce the onset of severe migraine headaches.

Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the underlying condition causing the headache. Full recovery depends on the type of headache and other medical problems that may be present.

Headaches

A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are very rare.

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Parkinson's Disease (PD)Enfermedad de Parkinson

Parkinson's Disease (PD)

What is PD?

Illustration of Parkinson's disease effect on the brain
Click Image to Enlarge

Parkinson's disease (or, simply, Parkinson's) is the most common form of parkinsonism, a group of motor system disorders. It is a slowly progressing, degenerative disease that is usually associated with the following symptoms, all of which result from the loss of dopamine-producing brain cells:

  • Tremor or trembling of the arms, jaw, legs, and face

  • Stiffness or rigidity of the limbs and trunk

  • Bradykinesia (slowness of movement)

  • Postural instability, or impaired balance and coordination

Dopamine is a substance produced in the body that has many effects, including smooth and coordinated muscle movement.

What are the facts about PD?

It is a myth that Parkinson's disease was cured after the introduction of levodopa (L-dopa) in the 1960s. In fact, about 60,000 Americans are newly diagnosed with Parkinson's disease each year, and more than 1 million Americans affected at any one time. in addition, more people suffer from Parkinson's disease than multiple sclerosis, muscular dystrophy, and amyotrophic lateral sclerosis combined.

What causes PD?

The specific cause of PD is unknown; however, medical experts believe the symptoms are related to a chemical imbalance in the brain caused by brain-cell death. Parkinson's disease is chronic (persists over a long period of time), and progressive (symptoms grow worse over time).

Although the disease may appear in younger patients (even teenagers), it usually affects people in late middle age. It is not contagious.

The biggest risk factor for developing PD is advancing age. The average age for the onset of PD is 60 years. In addition, 50 percent more men are affected than women, according to the National Institute of Neurological Disorders and Stroke. However, the reason for this is unclear.

Family history is another important risk factor. Individuals with a parent or sibling who are affected have approximately two times the chance of developing PD. This increased risk is most likely because of a combination of environmental and genetic factors.

Environmental causes are being researched and the strong consistent findings are that rural living, exposure to well water, and exposure to agricultural pesticides and herbicides are related to PD. It is important to remember, however, that these factors do not guarantee the development of PD, nor does their absence prevent it. Having one or more close relatives with PD increases one's risk of developing the disease; however, unless there is a known genetic mutation for PD present, the increased risk is only 2 to 5 percent.

Currently researchers believe that in most individuals the cause of PD is a combination of genetics and environmental exposure.

Parkinson's syndrome, atypical Parkinson's, or parkinsonism

Parkinson's disease is also called primary parkinsonism or idiopathic Parkinson's disease. (Idiopathic is the term for a disorder for which no cause has yet been identified.)

In the other forms of parkinsonism, either the cause is known or suspected, or the disorder occurs as a secondary effect of another primary neurological disorder that may have both primary and secondary symptoms of Parkinson's disease. These disorders, described as Parkinson's syndrome, atypical Parkinson's, or, simply, parkinsonism, may include the following:

  • Tumors in the brain

  • Repeated head trauma

  • Drug-induced parkinsonism. This occurs due to the prolonged use of tranquilizing drugs, such as the phenothiazines, butyrophenones, reserpine, and the commonly used drug, metoclopramide for stomach upset.

  • Toxin-induced parkinsonism. This occurs due to manganese and carbon monoxide poisoning.

  • Postencephalitic parkinsonism. A viral disease that causes "sleeping sickness."

  • Striatonigral degeneration. The substantia nigra of the brain is only mildly affected, while other areas of the brain show more severe damage.

  • Parkinsonism that accompanies other neurological conditions. Examples of this are Shy-Drager syndrome, (multiple system atrophy, once thought to be a distinct disease, is now commonly thought to be simply an extensive progression of idiopathic PD), progressive supranuclear palsy, Wilson disease, Huntington's disease, Hallervorden-Spatz syndrome, Alzheimer's disease, Creutzfeldt-Jakob disease, olivopontocerebellar atrophy, post-traumatic encephalopathy, and dementia with Lewy bodies.

What are the four primary symptoms of PD?

The following are the most common symptoms of Parkinson's disease. However, each individual may experience symptoms differently. Symptoms may include:

  • Muscle rigidity. Stiffness when the arm, leg, or neck is moved back and forth.

  • Resting tremor. Tremor (involuntary movement from contracting muscles) that is most prominent at rest.

  • Bradykinesia. Slowness in initiating movement.

  • Postural instability. Poor posture and balance that may cause falls; gait or balance problems.

Are there other symptoms of PD?

Symptoms of Parkinson's disease vary from patient to patient. The symptoms may appear slowly and in no particular order. Early symptoms may be subtle and may progress over many years before reaching a point where they interfere with normal daily activities.

The four cardinal symptoms of PD are listed above. Other symptoms are divided into motor (movement-related) and nonmotor symptoms.

  • Motor symptoms:

    • Tremor

    • Bradykinesia (slow movement)

    • Rigidity and freezing in place

    • Stooped posture

    • Shuffling gait

    • Decreased arm swing when walking

    • Difficulty rising from a chair

    • Micrographia (small, cramped handwriting)

    • Lack of facial expression

    • Slowed activities of daily living (for example, eating, dressing, and bathing)

    • Difficulty turning in bed

    • Remaining in a certain position for a long period of time

  • Nonmotor symptoms

    • Diminished sense of smell

    • Low voice volume (hypophonia)

    • Difficulty speaking (dysarthria)

    • Painful foot cramps

    • Sleep disturbance

    • Depression

    • Emotional changes (fearful and insecure)

    • Skin problems

    • Constipation

    • Drooling

    • Increased sweating

    • Urinary frequency/urgency

    • Male erectile dysfunction

As the disease progresses, walking may become affected, causing the patient to stop in mid-stride or "freeze" in place, and maybe even fall over. Patients also may begin walking with a series of quick, small steps as if hurrying forward to keep balance, a practice known as festination.

The symptoms of Parkinson's disease may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

How is PD diagnosed?

Making an accurate diagnosis in the early stages of Parkinson's disease can be difficult, as the beginning signs and symptoms may be considered to be indications of other conditions or the effects of normal aging. For this reason, observation of the patient may be required for some time until the symptoms are consistently present.

Currently, there are no blood or laboratory tests that are useful in the diagnosis of PD. Diagnosis of PD is based primarily on a medical history and thorough neurological examination. Brain scans and/or lab tests may be performed to help rule out other diseases or conditions, but brain scan generally will turn out to be normal with PD.

Methods to assist with the diagnosis of PD include:

  • Neurological examination (including evaluation of symptoms and their severity)

  • Trial test of drugs. When symptoms are significant, a trial test of drugs (primarily levodopa [L-dopa]) may be used to further diagnose the presence of PD. If a patient fails to benefit from levodopa, a diagnosis of Parkinson's disease may be questionable.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

What is the treatment for PD?

Specific treatment for a Parkinson's disease will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Type of condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

With today's medicine, we have yet to find a cure for Parkinson's disease. However, based on the severity of the symptoms and medical profile, the doctor will establish an appropriate treatment protocol. Treatment for Parkinson's disease may include the following:

  • Medications

  • Surgery

  • Complementary and supportive therapies, such as diet, exercise, physical therapy, occupational therapy, and speech therapy

Medication for PD

Once the diagnosis of PD has been made, the next decision is whether a patient should receive medication, which depends on the following:

  • The degree of functional impairment

  • The degree of cognitive impairment

  • Ability to tolerate antiparkinsonian medication

  • The advice of the attending doctor

No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms.

Surgery for PD

Based on the severity of the condition and the medical profile, the doctor may recommend surgery as one treatment option for Parkinson's disease.

There are several types of surgery that may be performed that can help patients with Parkinson's disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms of Parkinson's disease.

There are three types of surgeries that may be performed for Parkinson's disease, including the following:

  • Lesion surgery (burning of tissue). In this procedure, deep parts of the brain are targeted and small lesions are made in critical parts of the brain that help control movement. The surgery may be done while the patient is awake to help determine the exact placement of the lesion. The lesion is placed to help control, or stop, the area of the brain that is causing the tremor.

  • Deep brain stimulation (DBS). With this type of surgery, a small electrode is placed in the critical parts of the brain that help to control movement. The electrode is attached to a small battery in the chest wall and is connected by wires that are placed under the skin. The stimulator is then turned on and interrupts the normal flow of information in the brain and can help to decrease symptoms of Parkinson's disease.

  • Neural grafting or tissue transplants. Experimental research is being done to find a replacement for the part of the brain that functions improperly in Parkinson's disease.

It is important to remember that surgery may help with symptoms of Parkinson's disease, but does not cure the disease or stop the progression of the disease.

Parkinson's Disease

Parkinson's is a motor system disorder, resulting from the loss of dopamine-producing brain cells.

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Common Disorders of the Spine, Shoulder, and PelvisTrastornos Comunes de la Columna Vertebral, el Hombro y la Pelvis

Common Disorders of the Spine, Shoulder, and Pelvis

There are many conditions that affect the spine, shoulder, and pelvis, which require clinical care by a physician or other healthcare professional. Listed in the directory below are some, for which we have provided a brief overview.

Arthritis

Ankylosing Spondylitis

Treatment for Arthritis

Avascular Necrosis

Bursitis

Hip Problems

Hip Replacement Surgery

Kyphosis

Low Back Pain

Neck Problems

Neck Pain and Problems

Torticollis (Wryneck)

Whiplash Injury

Osteoporosis

Pelvis Problems

Sciatica

Scoliosis

Shoulder Problems

Overview of Shoulder Problems

Shoulder Dislocation

Shoulder Tendonitis

Rotator Cuff Injury

Soft-Tissue Injuries

Spine Disorders

Spine disorders and injuries affect the main support system of the body.

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StrokeAtaque Cerebral

Stroke

What is stroke?

Stroke, also called brain attack, occurs when blood flow to the brain is disrupted. Disruption in blood flow is caused when either a blood clot blocks one of the vital blood vessels in the brain (ischemic stroke), or when a blood vessel in the brain bursts, spilling blood into surrounding tissues (hemorrhagic stroke).

The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen. The area of dead cells in tissues is called an infarct. Due to both the physical and chemical changes that occur in the brain with stroke, damage can continue to occur for several days. This is called a stroke-in-evolution.

A loss of brain function occurs with brain cell death. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder, eating, emotional control, and other vital body functions. Recovery from stroke and the specific ability affected depends on the size and location of the stroke. A small stroke may result in problems such as weakness in an arm or leg. Larger strokes may cause paralysis (inability to move part of the body), loss of speech, or even death.

According to the National Stroke Association (NSA), it is important to learn the three R's of stroke:

  • Reduce the risk.

  • Recognize the symptoms.

  • Respond by calling 911 (or your local ambulance service).

Stroke is an emergency and should be treated as such. The greatest chance for recovery from stroke occurs when emergency treatment is started immediately.

Stroke is the fourth leading cause of death, ranking behind diseases of the heart, lungs, and all forms of cancer. According to the NSA, strokes kill more than 137,000 Americans each year.

What are the different types of stroke?

Strokes can be classified into two main categories:

  • 87 percent are ischemic strokes. These strokes are caused by blockage of an artery.

  • 13 percent are hemorrhagic strokes. These strokes caused by bleeding.

What is an ischemic stroke?

Illustration of Ischemic Stroke
Click Image to Enlarge

An ischemic stroke occurs when a blood vessel that supplies the brain becomes blocked or "clogged" and impairs blood flow to part of the brain. The brain cells and tissues begin to die within minutes from lack of oxygen and nutrients. The area of tissue death is called an infarct. About 87 percent of strokes fall into this category. Ischemic strokes are further divided into two groups, including the following:

  • Thrombotic strokes. These strokes are caused by a blood clot that develops in the blood vessels inside the brain.

  • Embolic strokes. These strokes are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to one of the blood vessels in the brain via the bloodstream.

What is a thrombotic stroke?

Thrombotic strokes are strokes caused by a thrombus (blood clot) that develops in the arteries supplying blood to the brain. This type of stroke is usually seen in older persons, especially those with high-cholesterol levels and atherosclerosis (a buildup of fat and lipids inside the walls of blood vessels).

Sometimes, symptoms of a thrombotic stroke can occur suddenly and often during sleep or in the early morning. At other times, it may occur gradually over a period of hours or even days. This is called a stroke-in-evolution.

Thrombotic strokes may be preceded by one or more "mini-strokes," called transient ischemic attacks, or TIAs. TIAs may last from a few minutes to a few days and are often a warning sign that a stroke may occur. Although usually mild and transient, the symptoms caused by a TIA are similar to those caused by a stroke.

Another type of stroke that occurs in the small blood vessels in the brain is called a lacunar infarct. The word lacunar comes from the Latin word meaning "hole" or "cavity." Lacunar infarctions are often found in people who have diabetes or hypertension (high blood pressure).

What is an embolic stroke?

Embolic strokes are usually caused by an embolus (a blood clot that forms elsewhere in the body and travels through the bloodstream to the brain). Embolic strokes often result from heart disease or heart surgery and occur rapidly and without any warning signs. About 15 percent of embolic strokes occur in people with atrial fibrillation, a type of abnormal heart rhythm in which the upper chambers of the heart do not beat effectively.

What is a hemorrhagic stroke?

Illustration of hemorrhagic stroke
Click Image to Enlarge

Hemorrhagic strokes occur when a blood vessel that supplies the brain ruptures and bleeds. When an artery bleeds into the brain, brain cells and tissues do not receive oxygen and nutrients. In addition, pressure builds up in surrounding tissues and irritation and swelling occur. About 13 percent of strokes are caused by hemorrhage. Hemorrhagic strokes are divided into two main categories, including the following:

  • Intracerebral hemorrhage. This is bleeding from the blood vessels within the brain.

  • Subarachnoid hemorrhage. This is bleeding in the subarachnoid space (the space between the brain and the membranes that cover the brain).

What is an intracerebral hemorrhage?

Intracerebral hemorrhage is usually caused by hypertension (high blood pressure), and bleeding occurs suddenly and rapidly. There are usually no warning signs and bleeding can be severe enough to cause coma or death.

What is a subarachnoid hemorrhage?

Subarachnoid hemorrhage results when bleeding occurs between the brain and the meninges (the membrane that covers the brain) in the subarachnoid space. This type of hemorrhage is often due to an aneurysm or an arteriovenous malformation (AVM).

  • An aneurysm is a weakened, ballooned area on an artery wall and has a risk for rupturing. Aneurysms may be congenital (present at birth), or may develop later in life due to such factors as hypertension or atherosclerosis.

  • An AVM is a congenital disorder that consists of a disorderly tangled web of arteries and veins. The cause of AVM is unknown.

What are the most common symptoms of stroke?

The following are the most common symptoms of stroke. However, each individual may experience symptoms differently. If any of these symptoms are present, call 911 (or your local ambulance service) immediately. Treatment is most effective when started immediately.

Symptoms may be sudden and include:

  • Weakness or numbness of the face, arm, or leg, especially on one side of the body

  • Confusion or difficulty speaking or understanding

  • Problems with vision such as dimness or loss of vision in one or both eyes

  • Dizziness or problems with balance or coordination

  • Problems with movement or walking

  • Severe headaches with no other known cause

All of the above warning signs may not occur with each stroke. Do not ignore any of the warning signs, even if they go away--take action immediately. The symptoms of stroke may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

What are some other symptoms of stroke?

Other, less common, symptoms of stroke may include the following:

  • Sudden nausea, vomiting, or fever not caused by a viral illness

  • Brief loss or change of consciousness such as fainting, confusion, seizures, or coma

  • Transient ischemic attack (TIA), or "mini-stroke"

    A TIA can cause many of the same symptoms as a stroke, but TIA symptoms are transient and last for a few minutes or up to 24 hours. Call for medical help immediately if you suspect a person is having a TIA, as it may be a warning sign that a stroke is about to occur. Not all strokes, however, are preceded by TIAs.

The stroke rehabilitation program

Rehabilitation of the patient with a stroke begins during the acute treatment phase. As the patient's condition improves, a more extensive rehabilitation program is often begun.

The outlook for stroke patients today is more hopeful than ever due to advances in both stroke treatment and rehabilitation. Stroke rehabilitation works best when the patient, family, and rehabilitation staff works together as a team. Family members must learn about impairments and disabilities caused by the stroke and how to help the patient achieve optimal function again.

The goal of stroke rehabilitation is to help the patient return to the highest level of function and independence possible, while improving the overall quality of life--physically, emotionally, and socially. Rehabilitation is designed to meet each person's specific needs; therefore, each program is different. Some general treatment components for stroke rehabilitation programs include the following:

  • Treating the basic disease and preventing complications

  • Treating the disability and improving function

  • Providing adaptive tools and altering the environment

  • Teaching the patient and family and helping them adapt to lifestyle changes

According to the National Institute of Neurological Disorders and Stroke, in general, there are several types of disabilities that stroke can cause: paralysis or problems controlling movement such as walking or balance and/or swallowing; sensory (ability to feel touch, pain, temperature, or position) disturbances; difficulty using or understanding language; thinking and memory problems, and emotional disturbances. Stroke rehabilitation can help you recover from the effects of stroke, relearn skills, and new ways to perform tasks and depends on many variables, including the following:

  • Cause, location, and severity of stroke

  • Type and degree of any impairments and disabilities from the stroke

  • Overall health of the patient

  • Family support

Areas covered in stroke rehabilitation programs may include:

Patient need

Example

Self-care skills, including activities of daily living (ADLs)

Feeding, grooming, bathing, dressing, toileting, and sexual functioning

Mobility skills

Walking, transfers, and self-propelling a wheelchair

Communication skills

Speech, writing, and alternative methods of communication

Cognitive skills

Memory, concentration, judgment, problem solving, and organizational skills

Socialization skills

Interacting with others at home and within the community

Vocational training

Work-related skills

Pain management

Medications and alternative methods of managing pain

Psychological testing

Identifying problems and solutions with thinking, behavioral, and emotional issues

Family support

Assistance with adapting to lifestyle changes, financial concerns, and discharge planning

Education

Patient and family education and training about stroke, medical care, and adaptive techniques

The stroke rehabilitation team

The stroke rehabilitation team revolves around the patient and family and helps set short- and long-term treatment goals for recovery. Many skilled professionals are part of the neurology rehabilitation team, including any or all of the following:

  • Neurologist/neurosurgeon

  • Physiatrist

  • Critical care nurse

  • Internist

  • Other specialty doctors

  • Rehabilitation specialists

  • Physical therapist

  • Occupational therapist

  • Speech/language pathologist

  • Audiologist

  • Registered dietitian

  • Social worker

  • Psychologist/neuropsychologist/psychiatrist

  • Case manager

  • Orthotist

  • Recreation therapist

  • Vocational counselor

  • Chaplain

Types of stroke rehabilitation programs

There are a variety of stroke treatment programs, including the following:

  • Acute rehabilitation programs

  • Subacute rehabilitation programs

  • Long-term care rehabilitation programs

  • Home health rehabilitation programs

Cerebrovascular Disorders

Cerebrovascular disorders affect the blood flow in the arteries and veins which supply the brain - such as aneurysms and strokes.

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Seizure Disorder

Seizures cause involuntary changes in body movement or function, sensation, awareness or behavior.

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Spinal Cord Tumor Overview

Spinal Cord Tumor Overview

A tumor forms when an abnormal cell proliferates to form a mass of abnormal cells. Spinal cord tumors are tumors that form on the spinal cord or in the area around it.

A spinal cord tumor may be cancerous (malignant) or noncancerous (benign). Even if benign, a tumor often causes pain and discomfort because it pushes on the spinal cord or nerves.

A spinal cord tumor may be called “primary,” which means the cancer started in the spinal cord, or “secondary,” which means the cancer started somewhere else in body and spread to the spinal cord. Most of the time, spinal cord tumors are secondary tumors. A spinal cord tumor is often a cancer of the breast, thyroid, lung, prostate, or another cancer that has extended throughout the body to reach the spine.

Spinal cord tumors are sometimes caused by a genetic disorder, like neurofibromatosis. Some people get spinal cord tumors because they were exposed to toxic chemicals that can cause cancer or have been exposed to radiation.

Facts about spinal cord tumors

Spinal cord tumors are relatively uncommon. It's much more common to develop a brain tumor than a tumor on the spinal cord. A spinal cord tumor may form inside the spinal cord itself or around the bones that make up the spine. Spinal cord tumors cause problems with the nerves, blood vessels, and bones, and can prevent sufficient blood flow throughout the body as it grows.

Some spinal cord tumors can be successfully treated. The earlier you tell your doctor about your symptoms, get a diagnosis, and start treatment, the better your outcome. But spinal cord tumors often cause permanent damage to the nerves and result in disability.

Types of spinal cord tumors

Spinal cord tumors affect many different areas and come in many different types, including:

  • Leukemia or lymphoma, cancers of the blood

  • Myeloma, cancer of the bone marrow

  • Medulloblastomas, which start in the brain and metastasize to the spine, and are most common in children

  • Gliomas or gangliogliomas, cancers that form in cells called glial cells (glial cells also include neurons)

  • Chordomas, which form in the spine and can push against it

  • Schwannomas, which start inside the peripheral nerves

  • Meningiomas, which start in the tissues around the spinal cord (meninges)

Symptoms

Spinal cord tumors can cause many different symptoms:

  • Inability to control the bowels and/or bladder

  • Weak muscles that you can't seem to control, so that you fall or have trouble walking

  • Muscle spasms

  • An unusual feeling or sensation in the legs

  • Feeling cold in the hands, fingers, or legs

Spinal cord tumors often cause back pain, including:

  • Feeling worse when you strain in any way, sneeze, or cough

  • Increased pain when you lie down

  • Pain that’s specific to the spine

  • Extreme pain that isn't improved by taking medication

  • Pain that feels worse as time passes

  • Pain that spreads into the arms, feet, legs, or hips

Diagnosis

A doctor will usually perform a neurologic exam to diagnose a spinal cord tumor. The exam will look for these signs:

  • Soreness in the area of the spine

  • Inability to feel pain, heat, or cold

  • An abnormal reflex response

These tests help your doctor see a spinal cord tumor and find out more information about it:

  • Imaging tests of the spine, such as a CT scan, MRI, or myelogram, which uses an X-ray in combination with an injection of contrast dye into the spine to better see the tumor

  • Hormone tests

  • Examination of the cerebrospinal fluid and the cells in the fluid

Treatment

Treatment for a spinal cord tumor is different for everyone and depends on the type of tumor, its location, and your overall health. These are treatment options:

  • Surgery to remove all or part of the tumor

  • Radiation therapy, which is sometimes used in addition to surgery

  • Chemotherapy

  • Corticosteroid medications to lessen swelling

Some types of spinal tumors require radiation of the whole spine. This procedure, called craniospinal radiation, can lead to anemia and other side effects. When there is radiation to the lumbar spine, fertility needs to be considered. 

Prevention

Since it's not understood why most primary spinal cord tumors develop, experts don't know how to prevent them.

Managing spinal cord tumors

Working with your doctor can help you to ease your symptoms so that you feel more comfortable before and during treatment.

After your treatment, you may need physical therapy to strengthen muscles and help them work properly again.

During the course of your treatment, always notify your doctor or seek emergency medical assistance if your symptoms suddenly become more severe or change in some way.

Finding additional resources

Joining a support group for people with cancer or spinal cord problems can be helpful when you're battling a spinal cord tumor.

To find out more information about spinal cord tumors, you may want to contact:

Key points to remember

If you are currently undergoing treatment for any type of cancer and develop back pain, you should let your doctor know right away. It's also a good idea to contact your doctor about any back pain that worsens or doesn't go away with time.

Spinal Cord Tumors

Spinal cord tumors are tumors that form on the spinal cord or in the area around it.

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Brain TumorsTumores Cerebrales

Brain Tumors

What is a brain tumor?

A brain tumor is an abnormal growth of tissue in the brain. The tumor can either originate in the brain itself (primary brain tumor), or come from another part of the body and travel to the brain (metastatic or secondary tumor). Brain tumors may be classified as either benign (noncancerous) or malignant (cancerous), depending on their behavior.

A benign tumor does not contain cancer cells and usually, once removed, does not recur. Most benign brain tumors have clear borders, meaning they do not invade surrounding tissue. These tumors can, however, cause symptoms similar to cancerous tumors because of their size and location in the brain.

Malignant brain tumors contain cancer cells. Malignant brain tumors are usually fast growing and invade surrounding tissue. Malignant brain tumors very rarely spread to other areas of the body, but may recur after treatment. Sometimes, brain tumors that are not cancer are called malignant because of their size and location, and the damage they can do to vital functions of the brain.

Metastatic brain tumors are tumors that begin to grow in another part of the body, then spread to the brain through the lymph system and bloodstream. Common types of cancer that can travel to the brain include lung cancer, breast cancer, nasopharyngeal cancer, melanoma (a type of skin cancer), and colon cancer. These cancers are described and treated based on the specific type of cancer. For example, breast cancer that has spread to the brain is still called breast cancer.

Facts about brain tumors

According to the National Cancer Institute:

  • Over 23,000 people in the U.S. will be diagnosed with malignant tumors of the brain or spinal cord during 2013.

  • Approximately 14,000 people in the U.S. will die from brain tumors in 2013.

Illustration of lateral view of brain and divisions into cerebrum, cerebellum and brainstem
Click Image to Enlarge

What causes brain tumors?

The majority of brain tumors have abnormalities of genes involved in cell cycle control, causing uncontrolled cell growth. These abnormalities are caused by alterations directly in the genes or by chromosome rearrangements which change the function of a gene.

Patients with certain genetic conditions (for example, neurofibromatosis, von Hippel-Lindau disease, Li-Fraumeni syndrome, and retinoblastoma) also have an increased risk of developing tumors of the central nervous system. There have also been some reports of people in the same family developing brain tumors who do not have any of these genetic syndromes.

Workers in oil refining, rubber manufacturing, and chemists may have a higher incidence of certain types of tumors, although not all studies have found such links. Which, if any, chemical toxin is related to an increase in tumors is unknown at this time.

Patients who have received radiation therapy to the head as part of prior treatment for other malignancies are also at an increased risk for new brain tumors.

What are the symptoms of a brain tumor?

The following are the most common symptoms of a brain tumor. However, each person may experience symptoms differently. Symptoms vary depending on the size and location of tumor. Many symptoms are related to an increase in pressure in or around the brain. There is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue, or fluid can cause pressure on the brain and result in increased intracranial pressure (ICP), which may result from one or more of the ventricles that drain cerebral spinal fluid (CSF, the fluid that surrounds the brain and spinal cord) becoming blocked and causing the fluid to be trapped in the brain. This increased ICP may cause the following:

  • Headache

  • Vomiting (usually in the morning)

  • Nausea

  • Personality changes

  • Irritability

  • Drowsiness

  • Depression

  • Decreased cardiac and respiratory function and, eventually, coma if not treated

Symptoms of brain tumors in the cerebrum (outer part of the brain) may include:

  • Symptoms caused by increased intracranial pressure (ICP)

  • Seizures

  • Visual changes

  • Slurred speech

  • Paralysis or weakness on half of the body or face

  • Drowsiness and/or confusion

  • Personality changes/impaired judgment

  • Short-term memory loss

  • Gait disturbances

  • Communication problems

Symptoms of brain tumors in the brainstem (base of brain) may include:

  • Symptoms caused by increased intracranial pressure (ICP)

  • Endocrine problems (diabetes and/or hormone regulation)

  • Visual changes or double vision

  • Headaches

  • Paralysis of nerves/muscles of the face, or half of the body

  • Respiratory changes

  • Clumsy, uncoordinated walk

  • Hearing loss

  • Personality changes

Symptoms of brain tumors in the cerebellum (back of brain) may include:

  • Symptoms caused by increased intracranial pressure (ICP)

  • Vomiting (usually occurs in the morning without nausea)

  • Headache

  • Uncoordinated muscle movements

  • Problems walking

The symptoms of a brain tumor may resemble other conditions or medical problems. Always consult your doctor for a diagnosis. 

How is a brain tumor diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for brain tumors may include the following:

  • Blood and urine tests. These include tumor markers and gene testing. 

  • Neurological examination. Doctor tests reflexes, muscle strength, eye and mouth movement, coordination, and alertness.

  • Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs, such as the brain. CT scans are more detailed than general X-rays.

  • Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. MRI is very helpful for looking at the brain and spinal cord. Functional MRI (fMRI) is a special kind of MRI used to determine which areas of the brain are active with specific functions. This may be done before surgery if the tumor is in a vital area of the brain. 

  • X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

  • Arteriogram (also called an angiogram). An X-ray of the arteries and veins to detect blockage or narrowing of the vessels. (This test is used less often than in the past, as special CT or MRI angiogram techniques can now be used to look at blood vessels in the brain.)

  • Magnetic resonance arteriogram (MRA) or computed tomography arteriogram (CTA). Combinations of the above noted scans. 

  • Myelogram. A procedure that uses dye injected into the spinal canal to make the structure clearly visible on X-rays.

  • Spinal tap (also called a lumbar puncture). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

  • Positron emission tomography (PET). A type of nuclear medicine procedure. This means that a tiny amount of a radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is injected into a vein during the procedure to assist in the examination of the tissue under study. Specifically, PET studies evaluate the metabolism of a particular organ or tissue, so that information about the physiology (functionality) and anatomy (structure) of the organ or tissue is evaluated, as well as its biochemical properties. Thus, PET may detect biochemical changes in an organ or tissue that can identify the onset of a disease process before anatomical changes related to the disease can be seen with other imaging processes, such as CT or MRI.

  • Single photon emission CT scan (SPECT). Also uses an injected radionuclide to show areas of greater metabolism and blood flow. 

  • Magnetic resonance spectroscopy (MRS). A procedure that produces images depicting function rather than shape. The equipment requires a special, highly complex facility.

  • Biopsy of tumor. A procedure in which a sample of tissue is removed (with a needle or during surgery) to be looked at under a microscope.

Diagnosis of a brain tumor depends mostly on the types of cells involved and the tumor location. Tumors are graded from I to IV based on the type of cells seen on microscopic exam, as well as the growth rate of the cells. Brain tumors are not described by stages like other body tumors, because they almost never move beyond the brain and spinal cord. 

What are the different types of brain tumors?

Illustration of  the brain detailing common tumor sites, adult
Click Image to Enlarge

There are many different types of brain tumors. They are usually categorized by the type of cell where the tumor begins, or they are also categorized by the area of the brain where they occur. The most common types of brain tumors include the following:

  • Gliomas. The most common type of primary brain tumor is a glioma. Gliomas begin from glial cells, which are the supportive tissue of the brain. There are several types of gliomas, categorized by where they are found, and the type of cells that originated the tumor. The following are the different types of gliomas:

    • Astrocytomas. Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor, and the most common type of primary brain tumor in adults. Astrocytomas are generally subdivided into high-grade, medium-grade, or low-grade tumors. High-grade astrocytomas (glioblastomas) are the most malignant of all brain tumors. Astrocytomas are further classified for presenting signs, symptoms, treatment, and prognosis, based on the location of the tumor. The most common location of these tumors in children is in the cerebellum, where they are called cerebellar astrocytomas. These people usually have symptoms of increased intracranial pressure, headache, and vomiting. There can also be problems with walking and coordination, as well as double vision. In adults, astrocytomas are more common in the cerebral hemispheres (cerebrum), where they commonly cause increased intracranial pressure (ICP), seizures, or changes in behavior.

    • Brain stem gliomas. Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure (ICP), but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination.

    • Ependymomas. Ependymomas are also glial cell tumors. They usually develop in the lining of the ventricles or in the spinal cord. The most common place they are found in children is near the cerebellum. The tumor often blocks the flow of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing increased intracranial pressure. This type of tumor mostly occurs in children younger than 10 years of age. Ependymomas can be slow growing, compared to other brain tumors, but may recur after treatment is completed. Recurrence of ependymomas results in a more invasive tumor with more resistance to treatment. Two percent of brain tumors are ependymomas.

    • Optic nerve gliomas. Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in children who have neurofibromatosis, a condition a child is born with that makes him or her more likely to develop tumors in the brain. People usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures.

    • Oligodendrogliomas. This type of tumor also arises from the supporting cells of the brain. They are found commonly in the cerebral hemispheres (cerebrum). Seizures are a very common symptom of these tumors, as well as headache, weakness, or changes in behavior or sleepiness. These tumors have a better prognosis than most other gliomas, but they can become more malignant with time. About two percent of brain tumors are oligodendrogliomas.

  • Metastatic tumors. In adults, metastatic brain tumors are the most common type of brain tumors. These are tumors that begin to grow in another part of the body, then spread to the brain through the bloodstream. When the tumors spread to the brain, they commonly go to the part of the brain called the cerebral hemispheres, or to the cerebellum. Often, a patient may have multiple metastatic tumors in several different areas of the brain. Lung, breast, and colon cancers frequently travel to the brain, as do certain skin cancers. Metastatic brain tumors may be quite aggressive and may return even after surgery, radiation therapy, and chemotherapy.

  • Meningiomas. Meningiomas are usually benign tumors that come from the meninges, the outer coverings of the brain just under the skull. This type of tumor accounts for about one third of brain tumors in adults. They are slow growing and may exist for years before being detected. Meningiomas are most common in older patients, with the highest rate in people in their 70s and 80s. They are commonly found in the cerebral hemispheres just under the skull. They usually are separate from the brain and can sometimes be removed entirely during surgery. They can, however, recur after surgery and certain types can be malignant.

  • Schwannomas. Schwannomas are usually benign tumors, similar to meningiomas. They arise from the supporting cells of the nerves leaving the brain, and are most common on the nerves that control hearing and balance. When schwannomas involve these nerves, they are called vestibular schwannomas or acoustic neuromas. Commonly, they present with loss of hearing, and occasionally loss of balance, or problems with weakness on one side of the face. Surgery can be difficult because of the area of the brain in which they occur, and the vital structures around the tumor. Occasionally, radiation (or a combination of surgery and radiation) is used to treat these tumors.

  • Pituitary tumors. The pituitary gland is a gland located at the base of the brain. It produces hormones that control many other glands in the body. These glands include the thyroid gland, the adrenal glands, the ovaries and testes, as well as milk production by pregnant women, and fluid balance by the kidney. Tumors that occur in or around the area of the pituitary gland can affect the functioning of the gland, or overproduce hormones that are sent to the other glands. This can lead to problems with thyroid functioning, impotence, milk production from the breasts, irregular menstrual periods, or problems regulating the fluid balance in the body. In addition, due to the closeness of the pituitary to the nerves to the eyes, patients may have decreased vision.

    Tumors in the pituitary are frequently benign, and total removal makes the tumors less likely to recur. Since the pituitary is at the base of the skull, approaches for removal of a pituitary tumor may involve entry through the nose or the upper gum. Certain types of tumors may be treated with medication, which, in some cases, can shrink the tumor or stop the growth of the tumor.

  • Primitive neuroectodermal tumors (PNETs). PNETs are much more common in children than in adults. They can occur anywhere in the brain, although the most common place is in the back of the brain near the cerebellum. When they occur here, they are called medulloblastomas. The symptoms depend on their location in the brain, but typically the patient experiences increased intracranial pressure. These tumors are fast growing and often malignant, with occasional spreading throughout the brain or spinal cord.

  • Primary CNS lymphoma. Lymphocytes are carried in lymph fluid in and out of the brain. A CNS tumor occurs when these cells turn malignant. A weakened immune system may increase the risk of this tumor.  

  • Medulloblastomas. Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually necessary to control these tumors.

  • Craniopharyngiomas. Craniopharyngiomas are benign tumors that occur at the base of the brain near the nerves from the eyes to the brain, and the pituitary gland. These tumors are more common in children and comprise only about 1% of all brain tumors diagnosed in the U.S. Symptoms include headaches, as well as problems with vision. Hormonal imbalances are common, which may lead to poor growth in children. Symptoms of increased intracranial pressure may also be seen. Although these tumors are benign, they are hard to remove due to the sensitive brain structures that surround them.

  • Pineal region tumors. Many different tumors can arise near the pineal gland, a gland that helps control sleep and wake cycles. Gliomas are common in this region, as are pineal blastomas (a type of PNET). In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. People with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size.

What is the treatment for brain tumors?

Specific treatment for brain tumors will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Type, location, and size of the tumor

  • Extent of the condition

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Treatment may include (alone or in combination):

  • Surgery. Surgery is usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible while maintaining neurological function. A biopsy may be done first to examine the types of cells the tumor is made of for a diagnosis. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured if the whole tumor is surgically removed.

  • Chemotherapy (there are many types) 

  • Radiation therapy (there are many types)

  • Steroids (to treat and prevent swelling especially in the brain)

  • Antiseizure medication (to treat and prevent seizures associated with intracranial pressure)

  • Placement of a ventriculoperitoneal shunt (also called a VP shunt). This is a tube that is placed into the fluid filled spaces of the brain called ventricles. The other end of the tube is placed into the abdomen to help drain excess fluid that can build up in the brain and cause an increase in pressure in the brain.

  • Supportive care (to minimize the side effects of the tumor or treatment), such as pain relief and stress reduction techniques 

  • Rehabilitation (to regain lost motor skills and muscle strength; speech, physical, and occupational therapists may be involved in the health care team)

  • Antibiotics (to treat and prevent infections)

  • Continuous follow-up care (to manage disease, detect recurrence of the tumor, and to manage late effects of treatment)

  • Hospice care for those who determine that continued aggressive treatment will not provide a benefit 

Newer therapies that may be used to treat brain tumors include the following:

  • Stereotactic radiosurgery. A new technique that focuses high doses of radiation at the tumor site from many different angles, while sparing the surrounding normal tissue, with the use of photon beams from a linear accelerator or cobalt X-rays.

  • Gene therapy. A special gene is added to a virus that is injected into the brain tumor. An antivirus drug is then given which kills the cancer cells that have been infected with the altered virus. This is still considered an experimental treatment.

  • Chemotherapy wafers. Wafers containing a cancer-killing drug, BCNU, are inserted directly into the area of the brain tumor during surgery.

  • Targeted therapy. Newer drugs that are aimed at specific parts of tumor cells, or at other cells that help them grow.  For example, a drug called bevacizumab affects a tumor's ability to make new blood vessels. It may be helpful for glioblastomas in adults. Other drugs can now target growth factors. 

  • Electric field treatments. Electrodes are placed along the scalp to provide a mild electric current that may affect tumor cells more than normal brain cells.

  • Brain tumor vaccines. Cancer vaccines channel the body's own immunity against the tumor as a way of treatment. This is still considered an experimental treatment. 

What is the long-term outlook for a person with a brain tumor?

Prognosis greatly depends on all of the following:

  • Type of tumor

  • Extent of the disease

  • Size and location of the tumor

  • Presence or absence of metastasis

  • The tumor's response to therapy

  • Your age, overall health, and medical history

  • Your tolerance of specific medications, procedures, or therapies

  • New developments in treatment

As with any cancer, prognosis and long-term survival can vary greatly from individual to individual. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a person diagnosed with a brain tumor. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of brain tumors.

Rehabilitation for lost motor skill and muscle strength may be required for an extended amount of time. Speech therapists and physical and occupational therapists may be involved in some form of rehabilitation. More research is needed to improve treatment, decrease side effects of the treatment for this disease, and develop a cure. New methods are continually being discovered to improve treatment and to decrease side effects.

Please consult your doctor with any questions or concerns you may have regarding this condition.

Tumors of the Brain & Spine

Tumors of the Brain are abnormal growths of tissue found inside the skull or brain.

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