Collection of pus inside a closed capsule is known as an abscess. Brain abscess occurs in the brain.

Introduction

 

Collection of pus inside a closed capsule is known as abscess. It can be found in any part of the body. It usually results from an infection present in the same organ. But on occasions, the infection can spread from another part of the body.

Compared to abscess in other parts of the body, abscess in the brain is considered very serious. Despite the improved treatments available today, 5% to 10% patients affected by a brain abscess may die.

Unfortunately, this disease is very common in India.

Causes of Brain Abscess

Infection from surrounding areas may spread via blood, lymph (a fluid that cleanses the body from infection), or by direct extension and settle down in the brain, to form an abscess. They include:

  • Ear Infection

    Untreated ear infection can gradually seep into the brain, forming a brain abscess. In India, this is the cause of more than 50% of the brain abscess.

  • Sinusitis

    Sinuses are empty air spaces in the skull that make the skull feel light. Sinuses also secrete mucous, which helps in keeping the nose moisturized. Any infection in th enose or sinus can enter the brain and result in abscess formation.

  • Tooth Infection

    Infection in the teeth can quickly spread to the brain. Hence, teeth infections must be attended to immediately.

  • Meningitis

    This is a common bacterial infection of the brain, usually seen in children. Very rarely, this can also be a source of brain abscess.

Here are few other assorted causes of a brain abscess:

  • Open Head Injuries

    When an open head injury happens, pieces of bone, hair and dirt particles can get inside the head. If these particles are not properly washed away through a surgery, they act as a focus of injection. In the course of many years, they form a brain abscess.

  • Metastatic Abscess

    Microorganisms from other parts fo the body (chest, skin, bone, abdomen, etc.) can travel through the blood, get lodged in the brain and form an abscess. This is more common in people with an odd heart condition wherein their blood bypasses the filteration by lungs.

  • Cryptogenic Abscess

    Crypto = Uknown. Genic = Of origin. In some cases, the source of a brain abscess may not be identifyable. These cases are called Cryptogenic Abscess.

  • Post-Operative Abscess

    Improper healing of surgical wounds after a brain surgery can result in a brain abscess formation.

Complication due to Brain Abscess

Epilepsy is a common complication of brain abscess. So, all patients with a brain abscess are given anti-seizure drugs for at least 1 to 2 years after the treatment for the abscess has ended.

Symptoms of a Brain Abscess

Symptoms of a brain access depend on the size, location and number of abscesses, on the virulence of the micro organism forming the abscess and the immune power of the affected individual.

Here is the long list of common symptoms seen in individuals with Brain Abscess. The exact symptom seen in an individual depends on the part of the brain affected by the abscess:

  • Headache
  • Seizures
  • Inability to move one or more parts of the body
  • Improper co ordination or gait
  • Speech problems
  • Visual problems
  • Nausea
  • Vomiting
  • Mild confusion to coma, depending on severity of infection
  • Bulged out eyes, which is often a late sign. It indicates increased pressure inside the brain.

In infants, the usual presenting signs are as follows:

  • Enlarging head
  • Bulging fontanelle
  • Separation of sutures
  • Vomiting
  • Seizures
  • Irritability
  • Poor feeding

Diagnosis of a Brain Abscess

The only useful blood test to ascertain the presence of a Brain Abscess is an elevated CRP (C-Reactive Protein). But elevated CRP only says that there is an infection somewhere in the body. Additional imaging studies are required to pin point the infection to a brain abscess.

Here are usual imaging studies carried out to study a brain abscess:

  • Skull X-Ray

    Infection of the sinuses and ear infection, which often result in a brain abscess, can be easily seen in a skull X-Ray. Also, presence of air inside the skull, if seen, indicates brain abscess that has resulted in prior traumatic event.

  • Skull CT Scan

    A CT scan can provide information like the stage of the abscess, number of abscesses, incresed intracranial pressure, surrounding infection, etc.

  • MRI of the Brain

    MRI is more sensitive than a CT scan in identifying an abscess in its earliest stage.

  • Magnetic Resonance Spectroscopy (MRS)

    MRS is a newly emerging diagnostic tool. It can tell between a brain abscess and other type of brain tissue damages.

Treatment for the Brain Abscess

Depending on age, neurological condition, location, number, size and severity of the abscess, the doctor decides whether to go for a medical or surgical treatment option.

Medical Treatment

Small abscesses in its early stages can be treated with antibiotics. After a treatment round, a follow up CT scan is usually advised to check for recurrence.

Surgical Treatment

When the brain abscess is estimated to be in an advanced stage or if it is through of life threatening, a surgery is performed to remove the abscess. Depending on the nature of the abscess, many surgical procedures have been described for the treatment of abscess.

Go here for more information on surgical treatment for the Brain Abscess

Treatment Window

Early diagnosis, appropriate treatment and proper control of the primary and secondary infection, helps achieve a good outcome and complete cure.

Till properly treated, bacteria causing the brain abscess literally eat into the brain.

Based on their location in the spine, an injury to the spine has different effects. In order to minimize the damages, spinal injuries must be attended to quickly.

Introduction

 

A set of 33 stacked-up bones make up the human vertebra or the human backbone. These 33 bones can be divided into 4 sets:

  • Cervical Vertebrae

    These are 5 vertebrae, named C1 to C5. Among these, C1 and C2 are the most critical as they support the skull and help in head movemenet. Unfortunately, this region is prone to injury and fracture.

  • Thoracic Vertebrae

    There are 12 thoraciv vertebrae, named from T1 to T12. The thoracic vertebrae join with the ribs and help protet the heart, lungs and other vital structures.

  • Lumbar Vertebrae

    These are a set of 5 veertebrae, named from L1 to L5. These bones help sustain the body’s weight and help with movement. This region is also prone to fracture and degeneration with age.

  • Sacral Vertebrae

    These are located at the level of the hip. They are a set of 5 bones, fused together as one. The sacral vertebra helps connect the spine to the hipbones.

Spinal Cord injuries can strike any region of the spine. Patient’s symptoms vary based on the location of the spinal cord injury. The symptoms can range from minor loss of sensation to total paralysis.

Depending on the location and mode of injury, following are types of spinal injuries commonly seen:

  • Craniovertebral Junction Injury

    Starting from the base of the skull, ending at C2 vertebrae, is called the Craniovertebral Junction.

  • Upper Cervical Spine Injury

    C1 and C2 vertebrae come under the Upper Cervical Vertebrae group.

  • Sub-Cervical Spine Injury

    Injury to the middle and lower cervical spine, that is C3 to C7 vertebral level, is known as sub-cervical spine injury.

  • Thoracic and Thoracolumbar Injuries

    Injuries to the thoracic vertebrae or T12-L1 junction vertebrae fall under this category.

  • Lumbar and Lumbosacral Injuries

    Injury to the Lumbar vertebrae is called a Lumbar Injury. Injur to the L5-S1 junction vertebrae is known as Lumbosacral Injury.

  • Penetrating Injuries

    These are very common in areas of violent crimes. These injuries are sustained after a gunshot or a stab wound in the spinal cord.

Causes of Acute Spinal Injuries

Many things can lead to a spinal trauma. Some of the most common causes are:

  • Road Traffic Accidents: Worldwide, they remain the leading cause of spine trauma.
  • Rural Accidents: In an agricultural economy like India, falling from trees, falling into uncovered wells, coconuts falling on the head of a passerby are the common causes of spinal injuries.
  • Sports Injuries
  • Gunshot Injuries

Complication due to Spinal Injuries

If Spinal Injuries are not identify early and treated, they can lead to Neurogenic Shock and Aspiration.

Neurogenic Shock

In more than half the people who undergo a spinal injury above the level of 6th thoracic vertebra, severe nervous system damage can result in dilation of the blood vessels. This can lead to severe drop in blood pressure, slowing of heart rate and breathing. If it is detected early and treated adequately, a patient may come out of this condition in one to three weeks.

However, if it is not attended to adequately, neurogenic shock can lead to organ failure and even death.

Aspiration

In severe injuries involving the cervical spine, movement and sensation of the patient below the neck region is affected. This includes the function of swallowing. If this complication is not recognized early on, food enters the airway, which leads to chocking and difficulty with breathing.

Spinal Shock

This condition arises out of nerves partly or fully losing their ability to communicate below the level of the spinal injury. Timely treatment of Spinal Injury can, at the very least, arrest the condition from getting any worse.

Symptoms of an Acute Spinal Injury

Symptoms of a spine injury are closely related to the location of such injury. However, few common symptoms of spine injury include:

  • Neck pain
  • Back pain
  • Weakness in one or more parts of the body
  • Paralysis of arms and/or legs or gait changes
  • Loss of reflexes
  • Uncontrolled urination
  • Uncontrolled passage of stools
  • Breathing difficulty
  • Swallowing difficulty

Diagnosis of Acute Spinal Injuies

These are the standard tools used to diagnose an acute spine injury

  • X-Ray of the Spine

    Plain X-Ray is the initial investigation tool of choice to identify a spine injury.

  • CT Imaging

    A CT produces better images than an X-Ray. From a CT image, additional information like bone, blood, bruises, cervica-thoracin juntion, etc., can be better visualized. As a matter of fact, X-Ray can even fail to pickup certain types of spine fractures.

  • CT Angiogram

    This tool is useful to study blood vessel injuries in the spine.

  • MRI Imaging

    MRI is currently the investigation of choice for spinal trauma. Disc injuries, nerve compression, fluid accumulation in the spine, bleeds, bruises and injury to other important structures in the spinal cord can be clearly spotted using an MRI.

Treatment of the

Injury of the spinal cord involves mechanical forces like compression, penetration, cuts and dislocation. So, medical management is not the main stay in management of spinal trauma.

Medical Treatment

If the patient is seen within 8 hours of injury, the patient can be put on steroid medications. This can help in recovery and in reducing the fluid accumulation that follows a spine injury. In case an infection is seen or suspected, the patient is also put on antibiotics and pain medication.

Traction

Controlled pulling of a dislocated bone back to its original position, with the help of special pins, is known as traction. Closed fractures of cervical spine can be easily corrected with the help of traction.

Surgical Treatment

Spinal Cord Decompression and Fixation

Fractures and spinal injuries that compress on nerves require early surgery. In the surgery, fractures are fixed with screws and compressed nerves are released.

 

Treatment Window

With early identification of spinal injuries, irreversible complications of spinal injury can be prevented. Early surgical intervention also helps in speedy recovery and prevents deformities.

Weak blood vessels in the brain tend to balloon at the points of their weakness. This is called an aneurysm.

Introduction

Sometimes, weak blood vessels in the brain can bulge out like a balloon, causing a condition called aneurysm. When an aneurysm ruptures, it spills the blood it carries in to the brain, causing a life threatening condition.

About 1 in 50 people are thought to have an unruptured aneurysm. When an aneurysm ruptures, it can kill 40% of the people in whom the rupture occurs.

Causes of Aneurysm

Here are some common causes that lead to aneurysm:

  • High Blood Pressure

    The presence of high blood pressure weakens the blood vessel walls and make it vulnerable to bulging under any kind of stress or uncontrollable increase in blood pressure.

  • Smoking

    Smokers, particularly the ones who have been smoking for years, end up with their blood vessels weakening, making them susceptible for formation of aneurysm.

  • Blood Vessel Abnormalities

    When malformed blood vessels face any kind of internal stress, they can lead to formation of aneurysms.

  • Hereditary

    In some cases, aneurysm runs in the family. These patients are usually affected by aneurysm at a much younger age.

  • Congenital Disorders

    Some disorders that are present since birth are known to be associated with multiple brain aneurysms.

  • Gender

    When women hit menopause, the level of estrogen in their blood drops. This drop in estrogen makes them vulnerable for aneurysm.

Complication due to Aneurysm

The single most critical complication of aneurysm is rupture. Rupture of an aneurysm is dangerous to life. It can lead to irreversible brain damage and death.

Symptoms of Aneurysm

Small aneurysms rarely produce any symptoms. However, a large aneurysm may press upon important structures in the brain, causing symptoms like

  • Headache
  • Vision problems
  • Nausea
  • Weakness
  • Speech disturbance

If the aneurysm bursts, the patient may immediately fall unconscious and/or present with the following:

  • Sudden and severe headache
  • Sudden loss of vision
  • Sudden paralysis
  • Vomiting
  • Nausea
  • Stiffness of the neck
  • Seizures

Diagnosis of Aneurysm

These are the common tools used for diagnosing the presence of aneurysm

  • Angiography

    This is the best imaging modality for visualizing abnormally dialated blood vessels.

  • CT Imaging

    A CT Image plays an important role in localizing the site of rupture of an aneurysm.

  • MRI Imaging

    An MIR also helps to locate the exact site of aneurysm and to identify any bleed in the brain that occurs due to a ruptured aneurysm. Fluid accumulation in the brain can also be appreciated with the help of an MRI.

Treatment of the Aneurysm

Following are the treatment options available for aneurysm

Medical Treatment

There are no medical management options available for aneurysm. The best that can be done is to put the patient on pain relievers till they are surgically managed.

Surgical Treatment

There are two treatment choices available for aneurysm: Clipping and Coiling

Aneurysm Clipping

In this procedure, the skull is opened and the bulging blood vessel is identified. After identifying the vessel, the surgeon clips it just below the aneurysm, thereby preventing the aneurysm from rupturing.

Coiling of an Aneurysm

This is a minimally invasive procedure in which a catheter (tube) is into an artery at the groin. The tube is gently pushed forward till such time it reaches the blood vessel with the ballooning. At the site of the ballooning, a coil is inserted and the catheter is removed. Blood clot forms around the coil, which in turn heals the aneurysm.

Treatment Window

If an aneurysm is identified and the patient is symptomatic, immediate intervention is warranted so as to fix it before the aneurysm ruptures.

 

 

Tumor of the Glial Cells in Brain and Spinal Cord:

In our brain and spinal cord, there are housekeeping cells called the glial cells. There are 3 types of glial cells. One of them is called astrocytes. Cancer of the astrocytes is called astrocytoma.

Introduction

Astrocytes are star-like cells in the brain and spinal cords. It is one of the three type of glial cells. While neurons do all the thinking/feeling work, glial cells are the housekeepers.

Cancer of the astrocytes is called astrocytoma.

Astrocytomas come in different flavors. Based on how aggressive they are, World Health Organization (WHO) has classified astrocytomas into the following four grades (1 being the least aggressive and 4 being the most).

 

  • Grade 1

These are slow growing tumors and they do not penetrate into surrounding cells. So, it is safe to surgically remove cancerous cells and start chemotherapy. Since there remaining cells grow very slowly, they usually do not pose a life threat. Cancers like Pilocytic astrocytoma, Pleomorphic Xanthoastrocytoma, Subependymal Giant Cell Astrocytoma and Subependymoma fall into this category.

 

  • Grade 2

These are slow growing cancers. Unlike Grade-1 cancers, Grade-2 penetrate into surrounding cells. So, surgery ends up leaving some tumor cells. Even through surgery is always followed by chemo and radio therapies, chances of these cancers recurring is very high. Cacers like Low-grade (fibrillary) Astrocytoma and Mixed Oligoastrocytoma fall into this category.

 

  • Grade 3

Grade-3 astrocytomas grow faster than Grades 1 and 2. Grade-3 also diffuse into surrounding cells. So, surgery must always be following up by radiotherapy. The only type of cancer that falls in to this category, namely Anaplastic Astracytoma, doesn’t respond much to chemotherapy.

 

  • Grade 4

These cancers grow rapidly and they infiltrate the surrounding tissue. Surgery is the main tool against this cancer. However, since it infiltrates into surrounding cells, surgery cannot remove this cancer in entirity. Radiotherapy is taken up after the surgery. Unfortunately, about 75% of astrocytomas fall in this category.

Complication due to Astrocytoma

Based on the WHO grading given above, some astrocytomas can be easily defeated if they are diagnosed and treated early. Whereas, fighting against a Grade-3 or Grade-4 astrocytomas is usually a futile.

Symptoms of an Astrocytoma

Symptoms of an astrocytoma varies depending on the location of the tumor. Here are some of the symptoms that are seen often:

  • Clumsiness
  • Headache
  • Nausea
  • Vomiting
  • Gait problems
  • Vision problems
  • Seizures
  • Movement problems
  • Speech problems
  • Difficulty understanding new things

Diagnosing an Astrocytoma

Here are the standard tools for diagnosing an astrocytoma:

  • CT Imaging

    In order to locate the tumor and determine its exact size, a CT imaging is taken up. This is only the initial line of investivation.

  • MRI Imaging

    In case of a tumor that infiltrate the surrounding tissue, then an MRI imaging may be required to get nerve and soft tissue involvement in the suspected tumor.

  • Tissue Biopsy

    CT and MRI are useful only to tell that there is a tumor and where it is situated. To identify the exact nature of a tumor cell, we must obtain a tiny bit of the tumor tissue using a needle and look at it using a microscope. This procedure, called a tissue biopsy, can tell everything about the tumor cell.

Treatment of an Astrocytoma

Surgery is usually the first line of treatment for an astrocytoma, always followed by radiotherapy. Based on the the nature of the astrocytoma, a chemotherapy may or may not be recommended.

Surgical Treatment

Surgical removal of the tumor tissue is the preferred first action against astrocytoma. In case of Grade-1 tumors, timely surgery followed up by radiation therapy will most certainly guarantee a complete remission or a long term relief. Whereas with Grade-4 tumors, surgery greatly delays the progress of the disease.

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Radiation Therapy

In order to destroy residual cancer cells left behind after a surgery (if the tumor is an invasive/diffusive type, which are Grade-2, 3 & 4 tumors, it becomes impossible to remove the cancer without any residue), a radiation therapy is always taken up after the surgery.

Medical Treatment

Patients with astrocytoma are usually given medicines to prevent them from getting brain seizures.

The tumor in the brain can press on other structures and cause excess fluid retention. These patients may be prescribed steroids.

Other than these, if the tumor cells are expected to respond to chemotherapy (special kind of medication that are used for treating cancers), then the patient will be prescribed these medication too.

Treatment Window

When a cancerous tumor is diagnosed, the recommended thing to do is to have it have it remove surgically as quickly as possible. This reduces the chances of it spreading to other parts of the body.

Once a cancerous cells starts to move into other parts of the body, it become impossible to locate all the sites and remove the cancerous cells.

 
 
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