MD XICOTENCATL PEREZ
NEUROSURGEON AND SPINE SURGEON
MIGRAINE
It's a type of headache that can occur with symptoms such as nausea, vomiting, or sensitivity to light and sound.
In many people, an intense throbbing pain is felt on only one side of the head. It is different from a headache. Migraine is disabling and can make a person unable to perform daily activities.
It is caused by abnormal brain activity that affects the blood vessels and can be triggered by many factors. However, the exact chain of events remains unclear. Most medical experts believe that the seizure begins in the brain and involves nerve and chemical pathways. The changes affect blood flow in the brain and surrounding tissues.
Migraines tend to first appear between the ages of 10 and 45. Sometimes they start earlier. Migraines have an hereditary relationship, more frequent in women than in men. Some women may have a decrease in migraine attacks when they are pregnant.
CEREBRAL STROKE
It is an event in which the brain is affected due to lack of blood supply. The blood supply from the arteries to certain territories or areas of the brain that depend on that blood flow to oxygenate it and carry various nutrients, is suspended. With this event, the affected area dies and infarcts. This is usually caused by a clot or thrombus (can be blood or a cholesterol plaque) that clogs the artery and doesn't allow blood to reach it.
What factors could trigger a stroke?
One of the main associated factors is high blood pressure or poor control of it, are: being older, suffering from atherosclerosis, drug addiction, having high cholesterol or diabetes, smoking and coagulation disorders.
What symptoms can I present due to a cerebral infarction?
They can range from confusion, lightheadedness, or drowsiness, to coma, seizures, slurred speech, or loss of understanding. In some cases, even death.
What tests should be done when a stroke is suspected?
When it is suspected that someone is suffering from a cerebral infarction, they should go to the Hospital. You must enter the Emergency Department directly and be evaluated by a neurosurgeon who will perform a simple skull tomography, followed by a skull magnetic resonance imaging and a cerebral angioresonance that will allow visualizing the area of ischemia, as well as the extension and location of the infarction.
What treatment should I receive if I had a stroke?
The treatment must be indicated by the neurosurgeon or neurologist, and they are generally anticoagulant or antithrombotic medications, you cannot self-medicate or give yourself a treatment, because that could cost you your life. Leave it in the hands of the expert.
What happens after a stroke is diagnosed?
After the heart attack has passed, you should continue with the anticoagulant therapy indicated by your treating physician. He will explain how long you should continue it, and will also inform you of a physical rehabilitation program that will be indicated based on the neurological deficit or injury. Evaluate for loss of muscle strength in one arm or loss of mobility in half of the body, loss of speech or expression or comprehension, swallowing problems, depression, irritability, impaired memory and reasoning, and mental disorders. for sphincter control. In the latter case, a specific neurological rehabilitation therapy will be indicated, which will be determined depending on the severity of the injury.
Are there rehabilitation programs for patients with stroke or heart attack?
There are programs that adapt to each clinical condition of each patient, in which family members are involved so that they learn about certain activities to be carried out with the patient. There are various activities such as occupational, physical, neurological, language, leisure and various therapy, as well as support with accessories that are of great support during rehabilitation at home.
BRAIN TUMORS
A brain tumor is a mass or abnormal cell growth in the brain. There are benign or malignant tumors; the malignant are those that due to their cellular behavior and invasion of the body and the brain, are deadly, in addition to causing severe damage to the brain. Benign tumors could have a behavior that affects the brain or nerves of the skull without being malignant, and due to their accelerated growth rate they may damage said structures or produce hydrocephalus, but it is rare.
Brain tumors are classified as primary when their origin is from brain cells, and secondary when they arise from another cell type (lung, prostate, breast or skin), known as metastases, and are usually malignant tumors with high mortality.
Symptoms
The most common symptom is headache. For that reason, in order to rule out a brain tumor, it is vitally important to perform a brain tomography or magnetic resonance imaging.
Likewise, the location of the tumors is closely related to the symptoms. For example, if a person begins to be irritable or aggressive, they could have a tumor in the frontal lobe, or if there is a decrease in half of the body (left or right arm or leg), it could be related to a lesion in the cerebral cortex of the parietal lobe. For this reason, it is very important to detail the signs and symptoms that you present to the doctor.
Another way in which tumors manifest, is with convulsive crises, without having previously experienced one in life, as well as balance disorder (known as ataxia), which is a condition of the cerebellum. In some cases, there may be no symptoms and diagnoses are made incidentally, that is, a person who suffers an accident or hits his head and undergoes a tomography that leads to the diagnosis of the tumor.
Symptoms include new or worsening headaches, blurred vision, loss of balance, confusion, and seizures.
Treatment
Treatment will depend on the type or cellularity of the lesion or tumor. But initially it will be determined based on an imaging study (magnetic resonance imaging of the skull), volume, location, surrounding tissues involved, inflammation or edema related to the injury. All this in order to determine the most appropriate surgery for the patient.
Consequently, it will be decided if it is considered necessary to only perform a biopsy, which is to take a small sample of the tumor, using a special needle that is inserted into the brain guided by a computer system. It is also necessary to determine if a craniotomy approach will be performed to be able to resect the tumor lesion. In this procedure, the skin, skull (craniotomy) and the dura mater have to be opened to dry out and remove the involved tumor.
Once the cell lineage or the type of tumor has been determined, it will be decided whether its behavior should only be monitored, completely resected or sent for chemotherapy or radiotherapy management. Neuro-oncologists are the experts in such management.
HEAD INJURIES
Cranioencephalic trauma is a traumatic injury to the skull and its bony structures, or brain; that could cause temporary or permanent damage to brain functions, leading to disability or death.
Head trauma is one of the leading causes of death in young people, secondary to exposure due to accidents on public roads, sports, accidents at home or falls.
Symptoms
The most common is decreased alertness or wakefulness, popularly known as loss of consciousness. Nausea, excessive projectile vomiting (sudden vomiting), seizures, confusional state, and increased headache are also common. Symptoms depend on the type of location or injury and may be accompanied by weakness of a leg, arm, or half of the body, as well as loss of understanding or expression. In children, one symptom may be uncontrollable crying.
HYDROCEPHALUS
Hydrocephalus is when an excessive amount of cerebrospinal fluid accumulates in the ventricles (cavities in the center of the brain through which cerebral fluid circulates that carries nutrients to the brain and bathes and protects it), but being in a greater quantity than usual, causes pressure and damage to the brain.
Hydrocephalus can be congenital, that is, presented since birth. Its causes include genetic and developmental problems during pregnancy. The main sign of congenital hydrocephalus is an abnormally sized head.
Hydrocephalus can also be caused by various medical problems (known as acquired hydrocephalus). It occurs at any age. Causes can include head trauma, stroke, infection, tumor, and bleeding from the brain or from a brain aneurysm.
Frequent symptoms
Headache.
Vomiting and nausea (very common with headache).
Blurry vision.
Balance or gait problems.
Loss of urine control (usually older adults).
Confusional state, seizures, or loss of memory.
It is very important to be able to diagnose hydrocephalus and its cause in time, since otherwise it could compromise life. Brain functionality such as reasoning, memory, calculation, and speech, among others, may also be at risk. Which, if neurological damage to the brain is established, are unrecoverable, leaving permanent brain damage.
Treatment
Once the diagnosis is made and discussed with the patient, a surgical intervention is proposed: it consists of the placement of a ventriculoperitoneal shunt system that is formed of three essential steps:
1.- A silicone tube is placed in the cerebral centricles, ideally the right frontal horn, which will permanently drain the liquid to a reservoir.
2.- Said reservoir will have the capacity to modulate the speed at which said fluid is drained or emptied from the brain to the abdomen.
3.- Placement of a long silicone tube that travels under the skin, from the head, neck, thorax and enters the abdomen, remaining in the free space between the abdominal viscera.
Procedural Risks
Like any procedure, the placement of a ventriculoperitoneal shunt (PVD) or shunt has risks. The most frequent being infection or meningitis, neurological injury, bleeding or the catheter becoming clogged, causing hydrocephalus again.
It is also important to follow up on clinical assessment and perform imaging studies periodically, since there could be various problems.
It is important to know that these procedures have to be performed by a neurosurgeon.
HEADACHE
Represents one of the most common manifestations of pain in people. It can occur intermittently and correspond to a migraine (if it worsens) or the famous tension or stress headache.
Both chronic and recurring headaches can cause pain and distress, even if they are the result of a serious illness. The ideal is to study it with a headache expert to rule out brain disorders or diseases that are dangerous to health and life.
Types of headache:
Broadly speaking, headaches can be divided into primary and secondary. Primary headaches represent approximately 90 percent of cases and are those in which headache is the only symptom. While secondary headaches are those that arise due to a specific disease.
SCOLIOSIS
It is a condition in which people have a deviation of the spine, with the thoracic region being mostly affected. This curvature tends to present a deformity that can be from mild to very exaggerated and the spine could look like a C or an S.
How can we classify scoliosis?
Idiopathic scoliosis is classified according to age:
Infantile scoliosis: Children 3 years of age or younger.
Juvenile scoliosis: Children from 4 to 10 years old.
Adolescent scoliosis: Children from 11 years to 18 years old.
It is worth mentioning that scoliosis is more frequent in girls. Timely treatment is essential because this situation could rapidly worsen during the growth period.
There is also congenital scoliosis, it is the one you have at birth and is secondary to a malformation of the baby's ribs.
Another type of scoliosis is neuromuscular, which is caused by a condition of the neuromuscular system. It mainly manifests muscle involvement and occurs in patients with muscular dystrophy, cerebral palsy, polio, and spina bifida (birth defect).
When and how should scoliosis be treated?
This specialty must be treated by an expert in spinal surgery. He is the one who must carry out a detailed analysis of the manifestations that occur and will decide if it will be something that will be kept under clinical and radiological surveillance with serial studies every 6 months, or what procedure should be followed. It is worth mentioning that not all scoliosis are surgical.
Another way to treat certain types of scoliosis is by wearing a brace. It can be useful in people older than 10 years old and has no efficacy in congenital scoliosis or neuromuscular scoliosis.
Surgery may be indicated if the curvature of the spine is rapidly worsening and needs to be corrected as best as possible in a short period of time.
What do I have to monitor or observe in my children or in someone suspected of having scoliosis?
It is important to note that the shoulders and hips are not uneven. Likewise, it is essential to check the alignment of the spine or the shape of the spine, which, during growth, could have rapid changes.
What symptoms might you see when someone has scoliosis?
Generally we observe the deformity of the curvature of the spine, the deviation of the hip or an unevenness. Symptoms may include lower back pain, or upper (thoracic) back pain, weakness or a tired feeling in the spine when standing or sitting for a long time, and shoulder pain.
What studies should I perform if I suspect that I have scoliosis?
The first thing is to visit a spine expert and observe the details mentioned above. First, a neurological study should be performed to rule out a neurological deficit.
Within the radiographic studies, a panoramic study of the entire spine should be made and the alignment or deviation of the pelvis observed.
X-rays of the spine in flexion and extension are required, as well as tomography of the spine and simple magnetic resonance imaging of the spine.
What other treatments might be required?
It should be considered that, due to age, illness and the degree of limitation that it may cause, psychological treatment intervention may be necessary to provide emotional support. In addition, support from physical therapists may be required to aid postoperative or preoperative recovery and to maintain a state of muscle strength.
ACUTE-ON-CHRONIC SUBDURAL HEMATOMA
It is a bleeding that generally occurs after a head trauma. It is a consequence of the disruption of the bridging veins, that is, small veins or vessels that go from the brain to the covering of the brain (known as the dura mater) and that, when they begin to increase in volume, produce pressure on the brain. It is much more common in adults over 60 years old.
