Conditions we treat

Brain and spinal cord tumors

Brain and spinal cord tumors are abnormal growths of tissue found inside the skull or the bony spinal column. The word tumor is used to describe both abnormal growths that are new (neoplasms) and those present at birth (congenital tumors). No matter where they are located in the body, tumors are usually classed as benign (or non-cancerous) if the cells that make up the growth are similar to other normal cells, grow relatively slowly, and are confined to one location. Tumors are called malignant (or cancerous) when the cells are very different from normal cells, grow relatively quickly, and can spread easily to other locations.

In most parts of the body, benign tumors are not particularly harmful. This is not necessarily true in the brain and spinal cord, which are the primary components of the central nervous system (CNS). Because the CNS is housed within rigid, bony quarters (that is, the skull and spinal column), any abnormal growth can place pressure on sensitive tissues and impair function. Also, any tumor located near vital brain structures or sensitive spinal cord nerves can seriously threaten health. A benign tumor growing next to an important blood vessel in the brain does not have to grow very large before it can block blood flow. Or, if a benign tumor is found deep inside the brain, surgery to remove it may be very risky because of the chances of damaging vital brain centers. On the other hand, a tumor located near the brain’s surface can often be removed surgically.

An important difference between malignant tumors in the CNS and those elsewhere in the body lies with their potential to spread. While malignant cells elsewhere in the body can easily seed tumors inside the brain and spinal cord, malignant CNS tumors rarely spread out to other body parts. Brain and spinal cord tumors cause many diverse symptoms, which can make detection tricky. Whatever specific symptoms a patient has, the symptoms generally develop slowly and worsen over time.

Lower back Pain LBP

It is the most expensive benign condition in industrialized countries and the most common cause of disability in persons younger than 45 years. It is defined as pain that persists longer than 12 weeks and often is attributed to degenerative or traumatic conditions of the spine. Fibrositis, inflammatory spondyloarthropathy, and metabolic bone conditions also are cited as causes. Patients with mechanical LBP often prefer to lie still in bed, while those with a vascular or visceral cause are often found writhing in pain, unable to find a comfortable position. Unrelenting pain at rest should generate suspicion for a serious cause such as cancer or infection. 

Alzheimer Disease

It is the most common cause of dementia, which is an acquired cognitive and behavioral impairment of sufficient severity to interfere significantly with social and occupational functioning. At present, the disorder afflicts approximately 5 million people in the United States and more than 30 million people worldwide. A larger number of individuals have lesser levels of cognitive impairment, which frequently evolve into a full-blown dementia, thereby increasing the number of affected persons. Prevalence of this disorder is expected to increase substantially in this century, since the disorder preferentially affects the elderly, who constitute the fastest growing age bracket in many countries, especially in industrialized nations. For example, statistical projections indicate that the number of persons affected by the disorder in the United States will nearly triple by the year 2050.

AD most commonly presents with insidiously progressive memory loss, to which other spheres of cognitive impairment are added over the course of several years. Functions commonly affected after the development of memory loss include language disorders (e.g., anomia, progressive aphasia) and impaired visuospatial skills and executive functions. Substantially rarer presentations include right parietal lobe syndrome, progressive aphasia, spastic paraparesis, and impaired visuospatial skills, subsumed under the so-called visual variant of AD. These latter, unusual presentations often present a diagnostic challenge, since they are not covered under the guidelines for the clinical diagnosis of the disease. Therefore, their diagnosis necessitates histopathologic confirmation or is made at the time of autopsy, disconfirming previous diagnoses (e.g., primary progressive aphasia, cerebrovascular conditions, prion disorders) made on purely clinical grounds.

Autism

Autism is classified as one of the pervasive developmental disorders of the brain. It is not a disease. People with classical autism show three types of symptoms: impaired social interaction, problems with verbal and nonverbal communication, and unusual or severely limited activities and interests. These symptoms can vary in severity. In addition, people with autism often have abnormal responses to sounds, touch, or other sensory stimulation. Symptoms usually appear during the first three years of childhood and continue through life. Studies of people with autism have found abnormalities in several regions of the brain, which suggest that autism results from a disruption of early fetal brain development. Autism affects an estimated 10 to 20 of every 10,000 people, depending on diagnostic criteria used, and strikes males about four times more often than females.

Brain Trauma

Most traumatic brain injuries are the result of motor vehicle accidents. During the accident, the head strikes something firm and resistant or the head rocks quickly backward and forward. Both events may occur together and this results in significant injury of the brain. As the brain moves forward and backward, white matter pathways are strained and tear. Certain parts of the brain also strike resistant parts of the skull and brain structures, such as the falx and anterior parts of the skull. The rotational injury produces mechanical trauma of the white matter and blood vessels within the white matter. Damaged blood vessels hemorrhage and this compresses the surrounding brain tissue. When the brain strikes the interior surface of the skull, this may also produce contusion and hemorrhage.

Dementia Related Illnesses

Dementia is a term used to describe a general decline of more than one cognitive function. Dementia-related illnesses are a class of diseases that have such a generalized, deleterious effect on the brain that they usually result in dementia. Most of these diseases also have an incidious onset of symptoms and a progressive loss of intellectual skills. The most common dementia related illnesses are Alzheimer’s disease and Multiple-infarction dementia. Some CNS infections also cause dementia, such as Jakob-Creutzfelt disease and viral encephalitis.

Meningitis and Septicaemia

Meningitis is inflammation of the meninges, the lining surrounding the brain. It can be caused by many different organisms including bacteria, viruses and fungi. Septicaemia is blood poisoning caused by bacteria entering the bloodstream and multiplying uncontrollably.

Meningitis and meningococcal septicaemia may not always be easy to spot at first, because the symptoms can be similar to those of flu. They may develop over one or two days, but sometimes develop in a matter of hours. The incubation period for bacterial meningitis is between 2 and 10 days and for viral meningitis it can be up to 3 weeks. Symptoms do not appear in any particular order and some may not appear at all. It is important to remember that other symptoms may occur.

Headaches

Sleep Disorder

Sleep disturbances occur in about 12% to 25% of the general population and are often associated with situational stress, illness, aging, and drug treatment. Poor sleep adversely affects daytime mood and performance. In the general population, persistent insomnia has been associated with a higher risk of developing clinical anxiety or depression. Sleep disturbances and, ultimately, sleep-wake cycle reversals, can be early signs of a developing delirium.

Narcolepsy

It is characterized by the classic tetrad of excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. Note that this tetrad is seen only rarely in children. The term “narcolepsy” is derived from Greek, “seized by somnolence.” Gelineau was the first to delineate the syndrome in 1880. Narcolepsy frequently is unrecognized, with a typical delay of 10 years between onset and diagnosis. Approximately 50% of adults with the disorder retrospectively report symptoms beginning in their teenage years. This disorder may lead to impairment of social and academic performance in otherwise intellectually normal children. The implications of the disease are often misunderstood by patients, parents, teachers, and health care professionals.

In patients with narcolepsy, severe EDS leads to involuntary somnolence during more active conditions such as eating and talking. Sleepiness in narcolepsy may be severe and constant, with paroxysms during which patients may fall asleep without warning (i.e., sleep attacks). Patients with narcolepsy tend to take short and refreshing naps (i.e., REM type naps) during the day. Cataplexy (Latin, “to strike down with fear”) is an abrupt attack of muscle weakness. If severe and generalized, it may cause a fall. More subtle forms exist with only partial loss of tone (e.g., head nod). The most characteristic feature of cataplexy is that it usually is triggered by emotions (usually laughter and danger). Sleep paralysis is the inability to move upon falling asleep or awakening with consciousness intact. It often is accompanied by hallucinations. Sleep paralysis occurs during REM sleep in healthy subjects. Sleep-related hallucinations may occur at sleep onset (i.e., hypnagogic) or awakening (i.e., hypnopompic) and are usually vivid (dreamlike) visual, auditory, or tactile in nature.

The classic picture of narcolepsy may be somewhat different in young children. Children may deny EDS because of embarrassment. Sometimes restlessness and motor over activity may predominate. Academic deterioration, inattentiveness, and emotional liability are common. Children younger than 5 years presented with unexplained falls and “drop attacks,” aggressive behavior, abrupt irritability, sleep terrors, and abrupt dropping of objects. In children aged 5-10 years, the most common initial complaint was repetitive sleepiness, followed by difficulty with morning arousal associated with aggressive behavior and abrupt falls in school. These children often were misdiagnosed as having attention deficit hyperactivity disorder (ADHD), learning disability, or another neurological disorder.

In children aged 10-12 years, poor academic performance was a common complaint. Other presenting symptoms included inappropriate low level of alertness, falling asleep in class, and inability to wake up in the morning.

Multiple Sclerosis

It is a disease of the myelin, the white covering of the nerve cell axons. Myelin is composed of specialized glial support cells. In the central nervous system, these are the oligodendrocytes. In the peripheral nervous system myelin is composed of Schwann cells. Consequently, the disease is most apparent in the white matter pathways of the brain. There are usually multiple areas of degenerated myelin and inflammation called plaques. These result in neuronal dysfunction and impairment. The initial neurological symptoms may reflect the patient’s greatest functional impairment rather than all the areas containing plaques. The cause of this inflammation and degeneration of the myelin is unknown. One commonly accepted theory is that the inflammation episodes and plaques represent a response of the patient’s immune system. Loss of myelin reduces the efficiency of nerve conduction. The most common symptoms are slight or incomplete paralysis (paresis), abnormal sensations (paresthesias), and visual impairment. The onset and progression of symptoms vary considerably from case to case. The great majority of cases will have exacerbations and remissions of symptoms.