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Infections & Tumors

 

Infections

Encephalitis, Myelitis

Encephalitis and myelitis are neurological inflammatory conditions that occur mostly due to viral infections. Encephalitis affects one or several areas of the brain, and myelitis affects the spinal cord.

Encephalitis is a rare condition that may also occur due to immune system defects where the brain is attacked by the body’s own defense system. In the initial stages, you may experience flu-like symptoms such as headache and fever. As the condition worsens there may be confusion, problems with vision, hearing, smelling and speech, loss of sensation or paralysis, seizures, or loss of consciousness.

Myelitis affects the myelin, which is the protective outer layer of nerve cell fibers, disrupting the transmission of nerve impulses and preventing the communication between the spinal cord and the rest of the body. The inflammation may be caused by abnormal immune reactions, reaction to certain vaccines or may be associated with certain autoimmune conditions such as Sjogren’s’ syndrome, multiple sclerosis, or neuromyelitis optica. Myelitis causes an onset of sudden pain in the neck or back, which may radiate to the arms, legs or around the abdomen, numbness, tingling, burning or cold sensations, weakness of the arms or legs, paralysis, and loss of bowel and bladder control. The symptoms may develop over a few hours and progressively worsen in a few days. Symptoms may recover or cause permanent impairment.

In order to diagnose encephalitis or myelitis, your doctor will review your symptoms, medical history and risk factors. Diagnostic imaging tests such as CT or MRI of the brain and spinal cord may be ordered to look for swelling or the presence of a tumor. An EEG which records the electrical activity of the brain may be required. Fluid that surrounds the brain and spinal cord may be collected through a procedure called a spinal tap. Changes in this fluid may indicate inflammation or infection. Blood and urine tests may also be ordered to look for infections.

In case of mild encephalitis, bed rest and adequate fluid intake are recommended. Your doctor may prescribe anti-inflammatories, antiviral and painkillers. Anticonvulsant therapy may be ordered in case of seizures. To treat myelitis, plasma exchange therapy may be performed, where blood plasma is replaced with special fluids. Apart from these, rehabilitative processes such as physical therapy, occupational therapy, and psychotherapy are recommended for long-term recovery and functioning.

Meningitis

Meninges are the membranes covering the brain and spinal cord. Meningitis is an inflammation of these membranes, usually as a result of an infection, and is characterized by headache, high fever and neck stiffness. Some cases of meningitis can be life threatening, requiring urgent care while other forms of meningitis resolve on their own. Meningitis is often seen in children under the age of 5 but may develop later in life. Early diagnosis and treatment of meningitis is necessary to prevent seizures or permanent neurological damage.

Meningitis occurs mostly as a result of viral or bacterial infections, and rarely from a fungal infection. Bacterial meningitis is a serious condition that can be life-threatening, reaching the meninges through the blood stream from an ear or sinus infection, or trauma to the head. Viral meningitis is more common than bacterial meningitis and is usually self-limiting with milder symptoms. Meningitis may also have non-infectious causes such as chemical or drug reactions and certain types of autoimmune diseases and cancer.

The symptoms of meningitis may develop quickly from a few hours to days, including sudden fever, headache, nausea, vomiting, sensitivity to light, skin rash, confusion, drowsiness and seizures. Children may have a high fever, irritability, sluggishness, have a bulge on the soft spot of their head and do not feed well.

When you or your child present with symptoms of meningitis, your doctor will review the medical history and perform a thorough physical examination looking for signs of infection. Blood cultures are ordered to identify the infectious agent.  Swelling or inflammation of the meninges may be detected on an X-ray or CT scan and a sample of cerebrospinal fluid, which surrounds your brain and spinal cord may be analyzed for a definitive diagnosis.

The primary course of treatment involves antibiotics, antifungal or antiviral medication depending on the causative agent. Ample bed rest and adequate fluid intake are recommended. Non-infectious meningitis is treated with cortisone medication or appropriate treatment based on the cause.

Tumors

Pineal Tumors

Pineal tumors are tumors that occur in the pineal gland, which is located deep within the brain. The pineal gland is a tiny gland that helps regulate sleep patterns (circadian rhythms), hunger, thirst, sex drive and the biological clock along with the hypothalamus gland.

The exact cause of pineal tumors is unknown. These tumors block the normal flow of cerebrospinal fluid (CSF) found in the brain causing hydrocephalus (build-up of pressure). Common symptoms include change in vision, headache, vomiting, nausea, memory disturbances and seizures. Complications may include a life-threatening increase in intracranial pressure, requiring emergency medical attention.

Pineal tumors are diagnosed by performing a thorough neurological examination, checking your vision, balance, coordination, hearing and reflexes. Your doctor may order tests such as MRI and CT scans, angiogram (X-ray sensitive dye is injected into the blood vessels), head and skull X-rays and other brain scans to determine the diagnosis. To confirm on the diagnosis, a biopsy is performed, where a small hole is drilled into your skull, a needle is inserted and tissue is removed for examination in the lab.

Treatment involves surgical removal for benign pineal tumors. Malignant tumor treatment depends on the type of tumor and can include surgery, radiation therapy (uses high beam of radiations to destroy the cancer cells), chemotherapy (uses drugs to kill the cancer cells), or a combination of both chemo and radiotherapy. Stereotactic radiosurgery, a non-invasive treatment, may sometimes be indicated, where high-energy gamma radiation is directed at the tumor site to destroy the tumor cells.

Meningioma

Meningiomas are tumors that originate in the meninges, the outer layers of tissue that cover and protect the brain and spinal cord. They can be benign (noncancerous), malignant (cancerous and spreading to other parts of the body) or atypical (in between benign and malignant, but can turn cancerous).

The exact cause of a meningioma is unknown. Some of the risk factors can include previous radiation therapy to the head, female hormones and an inherited disorder known as neurofibromatosis type 2.

Meningiomas may lead to symptoms such as blurred or double vision, loss of smell, memory and hearing, headaches that get worse with time, seizures and weakness in your legs or arms. When you present to the clinic with these symptoms, your doctor reviews your medical history and diagnoses meningioma with imaging tests such as CT and MRI scans.

Treatment depends on the size, location and type of the tumor, and your overall health. Slow-growing, small and asymptomatic meningiomas do not require immediate treatment, but need to be monitored constantly for signs of growth. Tumors that require treatment may be indicated for the following:

  • Surgery is performed to remove the tumor completely. For situations in which complete removal can damage surrounding tissues, your doctor excises as much of the tumor as possible and then destroys the remaining tumor with other treatments.
  • Stereotactic radiosurgery is a type of radiation treatment that precisely targets high-energy radiation on small benign leftover tumors.
  • Radiation therapy is indicated for atypical or malignant cancers, and after surgery to destroy remnant cancer cells. It uses high-energy beams of radiations to destroy the cancer cells and ensure non-recurrence.
  • Fractionated radiation involves directing small doses of radiation onto the cancer, across many days. This is indicated for tumors too large for radiosurgery or those located in sensitive regions, such as the optic nerve region, which cannot withstand high-intensity radiations.

Brain Lymphoma

Brain lymphoma is a type of brain tumor that affects the white blood cells originating in the brain, and is more common in the age group 45 to 70 years old. The exact cause of this brain tumor is unknown. However, certain factors, such as a weakened immune system due to HIV or organ transplantation, may increase the risk of developing lymphoma.

Symptoms include speech and vision changes, seizures, fever, headache, confusion, loss of coordination, changes in personality, insensitivity to hot, cold and pain, weakness in hands and unexplained weight loss.

Lymphoma can be diagnosed with imaging tests such as CT or MRI scans of the head, biopsy of the brain and lumbar puncture (removal a sample of cerebrospinal fluid or fluid surrounding the brain and spinal cord for examination). Treatment involves administration of medications such as corticosteroids to improve symptoms and control swelling, and chemotherapy, followed by stem cell transplant or radiation therapy.

Choroid Plexus Tumors

Choroid plexus tumors are rare tumors found in the brain tissue called choroid plexus, which produces cerebrospinal fluid (CSF), a liquid that cushions and protects the brain and spinal cord from damage. These tumors block the flow of CSF and lead to its build-up, causing a condition called hydrocephalus. Choroid plexus tumors are of two types: papilloma (non-cancerous) and carcinomas (cancerous). The exact cause of choroid plexus tumors is not clear, but carcinomas are usually associated with the inherited disease Li-Fraumani Tumors predisposition syndrome. It develops primarily in infants or toddlers.

Common symptoms of choroid plexus tumors include headache, sporadic weakness of the arms or legs and vomiting. Papilloma tumors are diagnosed by their location and characteristic appearance on an MRI scan of the brain. Carcinomas are confirmed after removing the tissue and examining it.

Treatment involves surgical removal, chemotherapy and radiation therapy and depends on the type of tumor. Surgery is considered to be the most effective treatment for papilloma type of choroid plexus tumor. For choroid plexus carcinomas, surgery is found to improve outcome if complete removal of the tumor is possible. However, when surgery cannot remove the whole tumor, chemotherapy is administered. Radiation therapy is reserved for patients who do not respond well to chemotherapy or when there is recurrence of the tumor after initial treatment.

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