Introduction to Schwannoma

A special type of cells called Schwann cells (named after physiologist Theodor Schwann who discovered it) wrap around peripheral nervous system, acting like insulation around wires. This insulation is also called myelin sheath.

Overgrowth of the Schwann cells form into a tumor called Schwannoma. When the early surgeons realized that Schwannomas contained many nerve fibers within them. So, Schwannoma is also called neurofibroma (nerve fiber + (oma = tumor)).

Schwannomas grow very slowly and they are almost always benign. Less than 1% of Schwannomas become malignant. When they do, they are called neurofibrosacroma (nerve fiber + (sacroma = a type of cancer)).

Cells in a Schwannomas are smooth and spindle shaped, tapering on both ends and bulging in the center.

Complication due to Schwannoma

Schwannomas grow slowly. They are mostly benign. So, life-threat from Schwannomas is rather low.

However, when the tumors grow, they compress on the nerves touching the tumor, causing various complication from headache to loss of sensation.

There is also a tiny risk of a Schwannoma turning into a neurofibrosarcoma.

Symptoms of Schwannoma

The symptoms of a Schwannoma depends on the location and size of the tumor.

Following symptoms are seen if the Schwannoma occurs in the brain:

• Headache
• Nausea
• Vomiting
• Seizures
• Tremors
• Gait problems
• Speech disturbances

If the tumor occurs in the spinal cord, depending on the spot, symptoms vary. Common symptoms are:

• Back pain, increasing while lying down
• Muscle weakness
• Lack of sensation in one or more parts of the body
• Difficulty moving arms and/or legs
• Thinning of the muscles of the hand
• Hip pain
• Pain radiating to the legs
• Tingling or pricking sensation of legs
• Gait problems
• Loss of control over stools
• Loss of bladder control
• Impaired sexual functions
• If the tumor is located in the nape region, then nausea, vomiting and headache

Diagnosis of Schwannoma

When Schwannoma is suspected through clinical evaluation, one or more of the following imaging studies are ordered to ascertain the initial diagnosis:

Treatment for Schwannoma

Here are the options available for treating Schwannomas.

Medical Treatment

Steroid medication help to an extent to remove any fluid accumulation in the location of the tumor. Pain relievers are used to reduce the pain felt by the patient when the tumor starts compressing the nerves.

Surgical Treatment

Total Microsurgical Resection: This is the treatment of choice for Schwannomas. This procedure involves careful and meticulous removal of tumor using tiny surgical instruments and microscopes. Go here for more information on Total Microsurgical Resection.

Following the surgery, a radiotherapy is usually ordered in order to prevent recurrence of the tumor in the future.

Treatment Window

Since Schwannomas are generally not life threatening, a surgeon might decide to wait out till the time the symptoms of Schwannomas become debilitating.

There is growing scientific evidence that long term usage of steroids and pain medication result in future complications. So, there is a tendency to remove the tumor sooner than later.

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:

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:

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

Treatment of the Ailment

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.

Introduction

Types of Spinal TB

Depending on the location of the spine infected by the TB, there are four lesion (a lesion is a damaged tissue).

Complications due to Spinal TB

Abscess (bag of pus) of the infection, inflamed (swollen) parts of the spinal cord, affected bone or vertebra can press on the nerves passing through the spine. When this happens, the part of the body served by these nerves (like arms, legs, etc.) become weak or paralyzed.

Symptoms

When the tuberculosis bacteria leave the lungs and enter the blood, infection starts. This has various responses in the body:

• Fever
• Weight loss
• Muscle pain
• Sweating at night
• Lack of interest in eating

As the bacteria in the blood settle down on the backbone and start eating it up, the patient can experience the following:

• Back pain
• Spine stiffness
• Sudden cramping pain in the back muscle
• Mass felt in lower back
• Angulation of the spine

If the infection is left untreated, the backbone is destroyed and pieces of the bone start pressing on the nerves of the spinal cord. This leads to symptoms like:

• Weakness or paralysis of legs
• Calf pain
• Tingling sensation of the feet

Investigations

Here are the standard investigations the doctors conduct in order to assess the existence and nature of the disease:

Treatment of the Spine TB

We are fortunate indeed to be living in the era of effective antibiotics. Before antibiotics, TB killed large number of people it injected. Mathematician Ramanujan was a famous victim of tuberculosis. Even with antibiotics, eradication of TB from the body takes a long time.

Medical Treatment

If the spread of the TB is not severe, anti-tuberculosis medication is used to stop and growth of tuberculosis bacteria and then to kill them. The treatment usually stretches for 6 to 9 months to obtain a complete cure.

Surgical Treatment

• When patients with TB of the Spine do not respond to medical treatment satisfactorily, a surgeon physically removes tissue affected by TB. After this, the drug therapy is usually more effective.
• In advanced stages of Spinal TB, where nerves are compressed, resulting in weakness of the limb or paralysis, a spinal decompression surgery is preformed to release the compressed nerves.

Go here for more information on surgical treatment for the TB of the Spine

Treatment Window

Early treatment can save ones spine, arms and legs. If left untreated, the bacteria eats up the back bone, causing compression of spinal nerves, leading to paralysis.

Introduction

Hemorrhage is an ongoing bleeding. When the bleeding has already happened, it is called a hematoma.

Hemorrhage in the brain causes the blood to seep into the brain tissue, causing many inflammatory reactions to take place. This ultimately interrupts the blood flow to some parts of the brain. This leads to a condition called stroke, where brain tissue starving blood supply starts to die out and corresponding brain function is suddenly lost. Such loss of function an be permanent or temporary.

This condition, called a Spontaneous Intracerebral Hemorrhage, accounts for 10-30% of all stroke cases. However, the leading cause of stroke is blockage of blood vessels by blood clot, fat, etc.

Causes of Spontaneous Intracerebral Hemorrhage

Here are the common causes of Spontaneous Intracerebral Hemorrhages

Complication due to Spontaneous Intracerebral Hemorrhage

If left untreated, an intracerebral hemorrhage can grow in size, leading to injury and swelling (inflammation) of the brain. It leads to extensive damage and death to the brain tissue.

If the treatment is delayed, damage to the brain tissue becomes irreversible. Based on the part of the brain tissue affected, the patient can lose speech, movement control, weakness of limbs, paralysis, etc.

Symptoms of Spontaneous Intracerebral Hematomas

Common symptoms of intracerebral bleed are:

• Severe Headache
• Vomiting
• Increased blood pressure
• Altered level of consciousness
• Sudden loss of function in one part of the body
• Seizure
• Confusion
• Trouble with vision

Tools to Diagnose an Intracerebral Hemorrhage

These are the standard tools to diagnose and further investigate an intracerebral hemorrhage:

Treatment for Intracerebral Hemorrhage

Here are the standard treatments for a intracerebral hemorrhage.

Medical Treatment

All intracerebral patients with high blood pressure are treated to bring it down. Additional medication is also given to reduce the pressure within the brain and to divert fluid out of the brain.

Additionally, these patients may also be given supplements containing Vitamin K, which helps to stop bleeding.

Lastly, as an additional precaution, seizure control medication is given to these patients at least for a month following a hemorrhaging event.

Surgical Treatment

There are two common surgical treatments to manage an intracerebral hematoma

Decompressive Craniotomy

This technique is most helpful to treat an intracerebral bleed. In this technique, the skull is opened with special equipment and the leaking blood is drained out. Bleeding points are also identified and the bleeding is arrested using controlled heat. Go to this page to learn more about decompressive craniotomy.

Endoscopic Aspiration

Specilized flexible tubes are inserted into the brain. A camera is attached at the end of this tube, which helps the surgeon to identify the exact bleeding point and suck the bleed out.

With the help of specialized fine flexible tubes inserted into the brain, small bleeds are effectively sucked out. A camera

Treatment Window

If surgical intervention happens within 4 hours of the bleed, there are high chances of re-bleeding.

However, if an attempt is made to remove the bleed within 12 hours, particularly when it is performed using less invasive techniques like endoscopy, there are high chances of an improvement of the condition.

Introduction

Three thin tissue layers, namely the dura mater, arachnoid mater and pia mater, protect and nourish the brain and spinal cord. “Dura mater” in Latin means “hard mother”. It is the outermost layer and protects the brain. Below the dura is the arachnoid (spiderweb like) mater. It contains blood vessels and supplies nutrition to the brain. The pia mater attaches itself to the brain and spinal cord, covering it.

Infection from other organs like the ear, nose or throat, may disintegrate from their location, travel through the blood vessels to the arachnoid space and from there seeps into the dura mater, forming a collection of pus. This collection is called subdural empyema. Children are more commonly affected than adults.

Complication due to Subdural Empyema

Subdural empyema is a rare, but serious illness. This is because bacteria entering the brain lead to the following complications:

• Release toxins that directly damage the brain tissue.
• Forms pus collection that obstructs blood vessels, leading to loss of blood supply to the brain, and formation of blood clots, hence damaging the brain.
• The brain tissue starts fighting the bacteria by releasing various inflammatory substances, which ultimately cause the brain to retain fluid, leading to brain swelling and increased pressure within the brain.
• Superficial abscess over the skull.

Because the disease affects the brain in more than one way, the patients may quickly progress to coma and death, if left untreated. This calls for early diagnosis and treatment.

Symptoms

Symptoms of the Subdural Empyema depend on the part of brain affected by the infection. They include:

• Inability to think clearly or concentrate
• Headache
• Nausea
• Vomiting
• Speech problems
• Weakness
• Seizures

Investigations

These are the standard investigations, of escalation clarity, carried out to assess the existence and status of Subdural Empyema:

Treatment for Subdural Empyema

Antibiotics is the first line of treatment for a subdural empyema. However, in more severe cases, or when the empyema refuses to respond to antibiotics sufficiently, a surgery may be preferred in order to physically remove the cavity of pus.

Medical Treatment

Bacteria causing infection is identified using blood tests, and appropriate antibiotic therapy is given to kill the offending organism. Medications either heal the lesion completely or help prevent spread to surrounding areas.

Surgical Treatment

There are two main surgical solutions available to treat a Subrual Empyema:

• Surgeon may perform a Craniotomy (cutting through the skull bone), reach underneath the dura mater, and then remove the empyema.
• Alternatively, the surgeon can also suck out (aspirate) the pus using a suitable equipment.

Go here for more information on surgical treatment for the ailment

Treatment Window

If the diagnosis or treatment of subdural empyema is delayed, it can lead to serious neurological complications like paralysis, coma or death.

Introduction

When the head lands against a hard object, small vessels below the dura mater are injured, causing a bleed, leading to a hematoma.

A hematoma often occurs along with a brain contusion. Men are two to four times more likely affected than women.

Complication due to Subdural Hematoma

A subdural hematoma can expand or compress important structures in the brain, sometimes causing death of certain brain tissues.

Another complication is its tendency to cause fluid accumulation in the brain. This leads to brain swelling and increased pressure within the brain. This is a serious complication as it can lead to coma or death when it is not treated early.

Symptoms of Subdural Hematoma

Symptoms depend on the severity of the bleed. Here are the typical symptoms of a subdural hemotam, listed in the order of escalating severity:

• Headache
• Nausea
• Vomiting
• Stiffness of neck
• Changes in gait
• Loss of balance
• Seizures
• Weakness in one half of the body
• Unconsciousness
• Coma

Diagnosis of Subdural Hematoma

Here is the list of typical tools used for diagnosing an incident of Subdural Hematoma:

Treatment of Subdural Hematoma

Small hematomas can be left untouched. They heal on their own in time. Hematomas that cause swelling of the brain can first be treated with medications. But, hematomas that keep growing in size, and that do not respond to medications, need surgical intervention.

Medical Treatment

Drugs that take away fluids from the brain and drugs that maintain the blood pressure are the main stay of treatment for hematoma. Other than that, nerve protective medications are also given.

Surgical Treatment

Surgical treatments for subdural hematoma fall into two categories:

1. Decompressive Hemicraniectomy: With this surgery, a small portion of skull above the area of bleed is remove. This relieves the pressure inside the brain. The damaged tissue in the brain is allowed to heal without getting squeezed inside the skull. Often, when the skull is opened, the surgeon also sucks out the bleed.
2. Craniotomy with or without Duraplasty: Under this procedure, a large opening is made in the skull and the hematoma is evacuated. Any point of bleed is burnt using controlled heat. Once the bleed is removed, the dura mater is repaired using a muscle path and the skull is closed.

Treatment Window

Large, expanding hematomas can compress on vital blood vessels in the brain, leading to death of the brain tissue in the affection part of the brain. So, a subdural hematoma must be identified and treated early before complications arise.