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Serving all people by providing personalized health and wellness through exemplary care, education and research.

 
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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 DiseaseEnfermedad de Alzheimer

Alzheimer Disease

What is Alzheimer disease?

Alzheimer disease is a disease that affects the brain and nervous system. It happens when nerve cells in the brain die. The disease gets worse over time. It is a type of dementia.

Alzheimer disease often causes:

  • Problems with memory, thinking, and behavior
  • Confusion
  • Restlessness
  • Personality changes
  • Problems with judgment
  • Problems with making sense when talking
  • Problems with following directions
  • Problems with eyesight
  • Problems with knowing how objects around you relate to you (spatial awareness)
  • Lack of interest or concern about other people

The disease does not affect a person’s movement. He or she can still get around normally.

What causes Alzheimer disease?

Doctors do not know what causes Alzheimer disease. They think it might be caused by one or more of these:

  • Age and family history
  • Certain genes
  • Abnormal protein deposits in the brain
  • Environmental factors
  • Immune system problems

What are the symptoms of Alzheimer disease?

The following are the most common symptoms of Alzheimer disease. But not everyone has all of these symptoms. Symptoms may include:

  • Memory loss that affects job skills, especially short-term memory loss
  • Difficulty doing familiar tasks
  • Problems with language
  • Confusion about time and place
  • Poor judgment
  • Problems with abstract thinking
  • Misplacing things
  • Changes in mood or behavior
  • Changes in personality
  • Loss of desire to do things
  • Loss of the ability to know who people are. This even includes people whom the person knows well such as a child or spouse.

The symptoms of Alzheimer disease may look like other health conditions or problems. Always see your healthcare provider for a diagnosis.

How is Alzheimer disease diagnosed?

No single test can diagnose Alzheimer disease. A healthcare provider will first rule out other conditions. At that point, a a diagnosis of Alzheimer disease is accurate in 9 out of 10 cases. But the only way to confirm a diagnosis of Alzheimer disease is after death. An autopsy can show changes in the brain that mark the disease.

It’s important to find out if the dementia is caused by an illness that can be treated. A healthcare provider will do thorough exams of the person’s nervous system. The provider may also do:

  • Complete health history. This may include questions about overall health and past health problems. The provider will see how well the person can do daily tasks. The provider may ask family members about any changes in behavior or personality.
  • Mental status test. This may include tests of memory, problem solving, attention, counting, and language.
  • Standard medical tests. These may include blood and urine tests to find possible causes of the problem.
  • Brain imaging tests. CT, MRI, or position emission tomography (PET) may be used to rule out other causes of the problem.

How is Alzheimer disease treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

At this time, Alzheimer disease has no cure. There is no way of slowing down the progression of this disease, and no treatment is available to reverse the changes that the disease brings on. But new research findings give reason for hope. Several medicines are being studied in clinical trials to see if they can slow the progress of the disease or improve memory for a period of time. No medicines can bring back memory that has been lost, but some medicines may help in the early stages of the disease.

Some medicines are available to help manage some of the most troubling symptoms of Alzheimer disease. These symptoms include:

  • Depression
  • Behavior problems
  • Sleep problems

Exercise and social activities are important to help manage the disease. So are good nutrition, a healthy lifestyle, and a calm and well-structured environment.

Can Alzheimer disease be prevented?

Because doctors don’t know what causes the disease, they can’t recommend any steps to prevent it.

What are the complications of Alzheimer disease?

Alzheimer disease is a progressive disease. This means that memory problems and problems with doing daily tasks gradually get worse. Each person is affected differently, but people with Alzheimer disease have mood and behavior problems that make it difficult for family members to care for them. As a person is less able to care for himself or herself, families or others must help with personal care, meals, and daily activities. People with advanced Alzheimer disease will most likely need to stay in a place that specializes in care of people with memory disorders.

Living with Alzheimer disease

Care programs for people with Alzheimer disease differ depending on the symptoms a person has and how far along the disease is. These programs can help a person and his or her family manage the disease.

Any skills lost will not be regained, but the following tips can help people and families living with Alzheimer disease:

  • Plan a balanced program of exercise, social activity, good nutrition, and other health lifestyle activities.
  • Plan daily activities that help to give structure, meaning, and goals for the person.
  • As the person is less able to function, change activities and routines to let the person take part as much as possible.
  • Keep activities familiar and satisfying.
  • Allow the person to do as many things by him or herself as possible. The caregiver may need to start an activity, but allow the person to complete it as much as he or she can.
  • Give "cues" to help the person. For example, label drawers, cabinets, and closets to let the person know what is in them.
  • Keep the person out of harm's way by removing all safety risks. These might include car keys and matches.
  • As a caregiver, understand your own physical and emotional limits. Take care of yourself and ask for help if you need it.

Key points about Alzheimer disease

  • Alzheimer disease is a disease that affects the brain and nervous system. It gets worse over time.
  • Alzheimer disease affects a person’s memory, thinking, personality, emotions, and ability to care for himself or herself.
  • Alzheimer disease has no cure.
  • Medicines may help with some of the symptoms.
  • Caregivers need to be aware of their own needs and ask for help as needed.
  • Over time a person with Alzheimer disease will most likely need to stay in a place that specializes in care for people with this disease.

Next steps

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

  • 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 names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • 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.

Alzheimer's Disease

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

Learn More

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. This results in several categories of headaches. While the actual brain tissue doesn’t have pain-sensitive nerve fibers and doesn’t feel pain, other parts of the head can be responsible for a headache including:

  • 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)

Different types of headaches include:

Migraine

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 with migraine. Migraines are also unique in that they have distinct phases. Not all people have 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 vision changes, 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 causes a headache?

Headaches are classified as primary or secondary.

  • A primary headache means the headache itself is the main medical problem, although other factors, such as muscle tension or exposure to certain foods, may be identified. Other contributing factors include medications, dehydration, or hormone changes.
  • A secondary headache is related to an underlying medical condition. An example of this would be a headache due to neck injury, eye problems, jaw, teeth or sinus infection.

What are the 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. Typical headache symptoms include:

  • 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).

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

How is a headache 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 lab 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 health care provider 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 health care provider
  • Stress management

Migraine headaches may require specific medication management including:

  • Abortive medications. Medications, prescribed by your health care provider, 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 health care provider, 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.

Can headaches be prevented?

When headache triggers are known, avoiding the triggers can prevent a headache. Reducing stress can minimize or prevent headaches caused by stress. Migraine headaches may be prevented by taking a daily preventive medication.

When should I call my health care provider?

Most headaches can be managed with over-the-counter pain relievers. However, you should call your health care provider right away if a severe headache is accompanied by:

  • Stiff neck
  • Fever
  • Nausea
  • Vomiting
  • Convulsion
  • Shortness of breath
  • Confusion
  • Muscular weakness
  • Double vision
  • Change in level of consciousness.

Symptoms that may suggest a more serious headache include any of the following:

  • Worst headache ever, or new type of headache
  • Recurring headaches in children
  • Headaches that start early in the morning
  • Headache that follows a head injury
  • 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
  • Seizures

Key points

  • A headache is pain or discomfort in the head or face area.
  • Types of headaches include migraine, tension, and cluster.
  • Headaches can be primary or secondary. If it is secondary, it is caused by another condition.
  • Avoiding headache triggers is the best prevention.
  • Mild to moderate headaches can be managed with over-the-counter medications but notify your health care provider if your headache is severe and accompanied by other symptoms.

Next steps

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

  • 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 names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • 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.

Headaches

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

Learn More

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 a stroke?

A stroke, or brain attack, happens when blood flow to your brain is stopped. It is an emergency situation.

The brain needs a constant supply of oxygen and nutrients in order to work well. If blood supply is stopped even for a short time, this can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen.

When brain cells die, brain function is lost. You may not be able to do things that are controlled by that part of the brain. For example, a stroke may affect your ability to:

  • Move
  • Speak
  • Eat
  • Think and remember
  • Control your bowel and bladder
  • Control your emotions
  • Control other vital body functions

A stroke can happen to anyone at any time.

What causes a stroke?

A stroke is caused when blood flow to your brain is stopped or disrupted.

There are 2 kinds of stroke: ischemic and hemorrhagic.

  • Ischemic stroke. This is the most common type of stroke. It happens when a major blood vessel in the brain is blocked. It may be blocked by a blood clot. Or it may be blocked by a buildup of fatty deposit and cholesterol. This buildup is called plaque.
  • Hemorrhagic stroke. This occurs when a blood vessel in your brain bursts, spilling blood into nearby tissues. With a hemorrhagic stroke, pressure builds up in the nearby brain tissue. This causes even more damage and irritation.

Who is at risk for a stroke?

Anyone can have a stroke at any age. But your chance of having a stroke increases if you have certain risk factors. Some risk factors for stroke can be changed or managed, while others can’t.

Risk factors for stroke that can be changed, treated, or medically managed:

  • High blood pressure. Blood pressure of 140/90 or higher can damage blood vessels (arteries) that supply blood to the brain.
  • Heart disease. Heart disease is the second most important risk factor for stroke, and the major cause of death among survivors of stroke. Heart disease and stroke have many of the same risk factors.
  • Diabetes. People with diabetes are at greater risk for a stroke than someone without diabetes.
  • Smoking. Smoking almost doubles your risk for an ischemic stroke.
  • Birth control pills (oral contraceptives)
  • History of TIAs (transient ischemic attacks). TIAs are often called mini-strokes. They have the same symptoms as stroke, but the symptoms don’t last. If you have had one or more TIAs, you are almost 10 times more likely to have a stroke than someone of the same age and sex who has not had a TIA.
  • High red blood cell count. A significant increase in the number of red blood cells thickens the blood and makes clots more likely. This raises the risk for stroke.
  • High blood cholesterol and lipids. High cholesterol levels can contribute to thickening or hardening of the arteries (atherosclerosis) caused by a buildup of plaque. Plaque is deposits of fatty substances, cholesterol, and calcium. Plaque buildup on the inside of the artery walls can decrease the amount of blood flow to the brain. A stroke occurs if the blood supply is cut off to the brain.
  • Lack of exercise
  • Obesity
  • Excessive alcohol use. More than 2 drinks per day raises your blood pressure. Binge drinking can lead to stroke.
  • Illegal drugs. IV (intravenous) drug abuse carries a high risk of stroke from blood clots (cerebral embolisms). Cocaine and other drugs have been closely linked to strokes, heart attacks, and many other cardiovascular problems.
  • Abnormal heart rhythm. Some types of heart disease can raise your risk for stroke. Having an irregular heartbeat (atrial fibrillation) is the most powerful and treatable heart risk factor of stroke.
  • Cardiac structural abnormalities. Damaged heart valves (valvular heart disease) can cause long-term (chronic) heart damage. Over time, this can raise your risk for stroke.

Risk factors for stroke that can’t be changed:

  • Older age. For each decade of life after age 55, your chance of having a stroke more than doubles.
  • Race. African Americans have a much higher risk for death and disability from a stroke than whites. This is partly because the African-American population has a greater incidence of high blood pressure.
  • Gender. Stroke occurs more often in men, but more women than men die from stroke.
  • History of prior stroke. You are at higher risk for having a second stroke after you have already had a stroke.
  • Heredity or genetics. The chance of stroke is greater in people with a family history of stroke.

Other risk factors include:

  • Where you live. Strokes are more common among people living in the southeastern U.S. than in other areas. This may be because of regional differences in lifestyle, race, smoking habits, and diet.
  • Temperature, season, and climate. Stroke deaths occur more often during extreme temperatures.
  • Social and economic factors. There is some evidence that strokes are more common among low-income people.

What are the symptoms of a stroke?

A stroke is an emergency situation. It’s important to know the signs of a stroke and get help quickly. Call 911 or your local emergency number right away. Treatment is most effective when started right away.

Stroke symptoms may happen suddenly. Each person’s symptoms may vary. Symptoms may include:

  • Weakness or numbness of the face, arm, or leg, usually on one side of the body
  • Having trouble 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
  • Fainting (loss of consciousness) or seizure
  • Severe headaches with no known cause, especially if they happen suddenly

Other less common symptoms of stroke may include:

  • Sudden nausea or vomiting not caused by a viral illness
  • Brief loss or change of consciousness, such as fainting, confusion, seizures, or coma
  • TIA, called a mini-stroke

A TIA can cause many of the same symptoms as a stroke. But TIA symptoms are passing. They can last for a few minutes or up to 24 hours. Call for medical help right away if you think someone is having a TIA. It may be a warning sign that a stroke is about to occur. But not all TIAs are followed by a stroke.

Get help FAST

FAST is an easy way to remember the signs of a stroke. When you see these signs, you will know that you need to call 911 fast. FAST stands for:

F - Face drooping. One side of the face is drooping or numb. When the person smiles, the smile is uneven.

A - Arm weakness.  One arm is weak or numb. When the person lifts both arms at the same time, one arm may drift downward.

S - Speech difficulty. You may see slurred speech or difficulty speaking. The person can't repeat a simple sentence correctly when asked.

T - Time to call 911. If someone shows any of these symptoms, call 911 right away. Call even if the symptom goes away. Make note of the time the symptoms first appeared.

How is a stroke diagnosed?

Your healthcare provider will take a complete health history and do a physical exam.  You will need tests for stroke such as brain imaging and measuring the blood flow in the brain. Tests may include:

  • CT scan of the brain. An imaging test that uses X-rays to take clear, detailed images of the brain. A brain CT scan can show bleeding in the brain or damage to brain cells caused by a stroke. It is used to find abnormalities and help find the location or type of stroke.
  • MRI. This test uses a combination of large magnets, radiofrequencies, and a computer to make detailed images of organs and structures in the body. An MRI uses magnetic fields to find small changes in brain tissue that help to find and diagnose stroke.
  • CTA (computed tomographic angiography). An X-ray image of the blood vessels. A CT angiogram uses CT technology to get images of blood vessels.
  • MRA (magnetic resonance angiography). This test uses MRI technology to check blood flow through the arteries.  
  • Doppler sonography (carotid ultrasound). A test that uses sound waves to create pictures of the inside of your carotid arteries. This test can show if plaque has narrowed or blocked your carotid arteries.

The following heart tests may also be used to help diagnose heart problems that may have led to a stroke:

  • Electrocardiogram (ECG). This test records your heart’s electrical activity. It shows any irregular heart rhythms that may have caused a stroke.
  • Echocardiography. This test uses sound waves to create a picture of your heart. This test shows the size and shape of your heart. It can check if the heart valves are working properly. It can also see if there are blood clots inside your heart.

How is a stroke treated?

Your healthcare provider will create a care plan for you based on:

  • Your age, overall health, and past health
  • The type of stroke you had
  • How severe your stroke was
  • Where in your brain the stroke happened
  • What caused your stroke
  • How well you handle certain medicines, treatments, or therapies
  • Your opinion or preference

There is no cure for stroke once it has occurred. But advanced medical and surgical treatments are available. These can help reduce your risk for another stroke.

Treatment is most effective when started right away. Emergency treatment after a stroke may include:

  • Clot-busting medicines (thrombolytics or fibrinolytics). These medicines dissolve the blood clots that cause an ischemic stroke. They can help reduce the damage to brain cells caused by the stroke. To be most effective, they must be given within 3 hours of a stroke occurring.
  • Medicines and therapy to reduce or control brain swelling. Special types of IV (intravenous) fluids are often used to help reduce or control brain swelling. They are used especially after a hemorrhagic stroke.
  • Neuroprotective medicines. These medicines help protect the brain from damage and lack of oxygen (ischemia).
  • Life support measures. These treatments include using a machine to help you breathe (a ventilator), having IV fluids, getting proper nutrition, and controlling your blood pressure.
  • Craniotomy. This is a type of brain surgery that is done to remove blood clots, relieve pressure, or repair bleeding in the brain.

What are the complications of having a stroke?

Recovery from stroke and the specific ability affected depends on the size and location of the stroke.

A small stroke may cause problems such as weakness in your arm or leg.

Larger strokes may cause parts of your body to not be able to move (be paralyzed). Larger strokes can also cause loss of speech or even death.

What can I do to prevent a stroke?

Know your risk for stroke. Many stroke risk factors can be changed, treated, or medically modified. Some things you can do to control your risk factors are listed below.

Lifestyle changes

A healthy lifestyle can help reduce your risk for stroke. That includes the following:

  • Stop smoking, if you smoke.
  • Make healthy food choices. Be sure to get the recommended amounts of fruits, vegetables, and whole grains. Choose foods that are low in saturated fat, trans fat, cholesterol, salt (sodium), and added sugars.
  • Stay at a healthy weight.
  • Be physically active.
  • Limit alcohol use.

Medicines

Take your medicines as instructed by your healthcare provider. The following medicines can help prevent stroke:

  • Blood-thinning medicines (anticoagulants) help prevent blood clots from forming. If you take a blood thinner, you may need regular blood tests.
  • Antiplatelets, such as aspirin, are prescribed for many stroke patients. They make blood clots less likely to form. Aspirin is available over the counter.
  • Blood-pressure medicines help lower high blood pressure. You may need to take more than one blood-pressure medicine.
  • Cholesterol-lowering drugs make plaque less likely to build up in your artery walls, which can reduce the risk for stroke.
  • Heart medicines can treat certain heart problems that increase your risk of stroke.
  • Diabetes medicines adjust blood sugar levels. This can prevent problems that lead to stroke.

Surgery

Several types of surgery may be done to help treat a stroke, or help to prevent one. These include:

  • Carotid endarterectomy. Carotid endarterectomy is surgery to remove plaque and clots from the carotid arteries, located in the neck. These arteries supply the brain with blood from the heart. Endarterectomy may help stop a stroke from occurring
  • Carotid stenting. A large metal coil (stent) is placed in the carotid artery much like a stent is placed in a coronary artery.
  • Surgery to repair aneurysms and AVMs (arteriovenous malformations). An aneurysm is a weakened, ballooned area on an artery wall. It is at risk for bursting (rupturing) and bleeding into the brain. An AVM is a tangle of arteries and veins. It interferes with blood circulation and puts you at risk for bleeding.
  • PFO (patent foramen ovale) closure. The foramen ovale is an opening that occurs in the wall between the 2 upper chambers of the heart. This opening usually closes right after birth. If the flap does not close, any clots or air bubbles can pass into the brain circulation. This can cause a stroke or TIA (transient ischemic attack). However, experts are still debating whether the PFO should be closed.

Living with a stroke

How a stroke affects you depends on where the stroke occurs in your brain. It also depends on how much your brain is damaged.

Many people who have a stroke are left with paralysis of one of their arms.

Other problems can include having trouble with:

  • Thinking
  • Speaking
  • Swallowing
  • Doing simple math such as adding, subtracting, or balancing a checkbook
  • Dressing
  • Showering
  • Going to the bathroom

Some people may need long-term physical rehabilitation. They may not be able to live in their home without help.

Support services are available to help with physical and emotional needs after a stroke.

When should I call my healthcare provider?

Strokes can happen again. Call your healthcare provider if you have symptoms that seem like a stroke, even if they don’t last long.

If you have repeated damage to your brain tissue, you may be at risk for life-long (permanent) disabilities.

Key points about stroke

  • A stroke happens when blood flow to your brain is stopped. It is an emergency situation.
  • It can be caused by a narrowed blood vessel, bleeding, or a clot that blocks blood flow.
  • Symptoms can happen suddenly. If someone is showing any sign of a stroke, call 911 immediately.
  • You have a better chance of recovering from a stroke if emergency treatment is started right away.
  • How a stroke affects you depends on where the stroke occurs in your brain, and on how much your brain is damaged.

Next steps

Tips to help you get the most from a visit to your health care 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.

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 grow 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 lung, breast, 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.

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.

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 is likely to be. 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 (ependymomas, astrocytomas, or gangliogliomas), which are cancers that form in cells called glial cells

  • 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)

  • Metastatic (secondary) tumors, which are cancers that have spread from the lung, breast, prostate, or other organs

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 medicine

  • Pain that feels worse as time passes

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

Diagnosis

A doctor will usually do 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 can 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

  • Biopsy (removal of a small pieces of the tumor to determine what type it is)

  • Exam 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 tell your doctor or seek emergency help 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.

Learn More

Brain Tumors: Treatment QuestionsTumores Cerebrales

Brain Tumors: Treatment Questions

Talking with healthcare providers about your tumor can be overwhelming. It can be hard to take in all of the information. It helps to be prepared. Make a list of questions and bring them to your appointments. Write the answers down in a notebook. Make sure you ask how the treatment will change your daily life, including your diet, and how you will look and feel after treatment. Ask how successful the treatment is expected to be, and what the risks and possible side effects are.

You may also want to ask a friend or family member to go with you. He or she can take notes and write down the answers, and also ask questions you may not think of. You can also ask your healthcare provider if you can record the conversation.

Below are some questions to ask during your appointments.

Deciding on a treatment

  • What type of brain tumor do I have?

  • How quickly is this type of tumor expected to grow?

  • Where exactly is the tumor? How big is it?

  • How often do you treat this type of tumor?

  • Do I need to be treated right away?

  • What are my treatment choices?

  • Can the tumor be removed with surgery?

  • What treatments do you think are best for me and why?

  • What treatments do you think are not for me and why?

  • What are the goals of the treatment you are recommending?

  • What is the success rate of this treatment for my type of tumor?

  • Are there any clinical trials I should apply for?

Getting ready for treatment

  • What is the length of the treatment period?

  • How long will each treatment take?

  • Where do I have to go for the treatment?

  • Who will give me the treatment?

  • Does someone need to go with me during treatments?

  • Can I take my other medicines during treatment?

Coping during treatment

  • What side effects should I expect?

  • How long will side effects last?

  • Are there side effects that I need to call you about?

  • How do I reach you after hours and on weekends?

  • What can I do to ease the side effects?

  • Should I change my diet? Are there foods I should not eat?

  • Will I be able to go to work and be around my family?

  • Are there support groups nearby that I can join?

After treatment

  • How will I feel after the treatment?

  • What type of follow-up will I need after treatment?

  • How will we know if treatment worked?

  • What are my options if the treatment doesn't work or the tumor comes back?

 

Tumors of the Brain & Spine

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

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