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Stroke
What Is It?
Stroke is a general term for a sudden neurological event which results in the new onset of
neurological symptoms. The term is derived from the same definition as a "stroke of
lightning", referring to something that occurs suddenly and without warning.
This commonly used term can refer to more than one nervous system disease. For
example, it can refer to either sudden hemorrhage or cerebral infarction. However, the
most common meaning of the term is to refer to cerebral infarction, due to cerebral
ischemia.
Common types:
Epilepsy
What Is It?
Epilepsy is a condition characterized by
recurring seizures in an individual.
Seizures are an abnormal overactivity of the cells of the brain which can affect variable
regions of the central nervous system, primarily in the forebrain. The effects of seizures
depend on their location in the brain and their extent. The classic appearance of seizure
with physical convulsions in a patient is a common manifestation of seizures but not all
types of seizures include convulsions.
There are many causes of seizures. In general, any injury to the brain can lead to seizures,
including trauma, tumors, vascular lesions, hemorrhage and developmental anomalies.
Below are many links to pages describing many of the various types of seizures and
causes of this disease.
Learn more about the symptoms.
Learn more about its treatment, including antiepileptic drugs and surgery.
Types of Seizures
Generalized Seizures: These are seizures that involve both sides of the brain
simultaneously, affecting the whole brain.
o Grand Mal or Tonic-Clonic
o Petit Mal or Absence
o Infantile Spasms
o Primary Generalized
Partial Seizures: These are seizures that only affect a part of the brain at one time.
o Simple Partial
o Complex Partial
o Secondary Generalization
Temporal Lobe Epilepsies: One of the most common types of epilepsy, these
seizures originate in the temporal lobe of the brain.
Cortical Dysplasia: Cortical dysplasia is an abnormal development of part of the
cortex of the brain, which often leads to a seizure condition in children.
Hemimegalencephaly: A severe form of cortical dysplasia which involves an
entire hemisphere (half) of the brain.
Hereditary Forms: These are genetic diseases which are inherited and tend to run
in families.
o Sturge-Weber Syndrome
o Tuberous Sclerosis
Pediatric and Infant Seizures
Febrile Seizures: Seizures that occur with fever in children are not uncommon.
What do they mean?
Rasmussen's Encephalitis: A rare inflammation of the brain that typically only
affects one side of the brain and causes seizures.
Post-Traumatic Seizures: Any trauma and injury to the brain can cause seizures.
Abdominal Seizures
Other Diseases Which can Cause Seizures:
o Brain Tumors
o Nervous System Infections (such as meningitis or abscess)
o Traumatic Brain Injury
o Cerebrovascular Disease (such as brain hemorrhage, Moyamoya disease,
arteriovenous malformation, etc.)
Status Epilepticus
Todd's Paralysis
A brain tumor is an abnormal growth that involves the brain itself or its surrounding
structures. This distinction helps us to divide nervous system tumors into two general
classes:
1. Intra-axial tumors: These are tumors which grow within the substance of the
brain itself
2. Extra-axial tumors: These are tumors that originate outside of the actual tissues
of the brain, but can involve the brain because of their close proximity to it.
In addition, pineal region tumors, originating from the area of the pineal gland, while
technically part of the brain are often considered separately. Tumors vary in location as
well as other characteristics such as their typical presenting symptoms, their speed of
growth and aggressiveness (whether they are benign or malignant) and their typical
locations.
Follow the links below to obtain more information about each type of tumor:
Intra-Axial Tumors:
o Gliomas: One of the most common types of primary brain tumors arising
from the brain tissue itself, gliomas arise from the supporting cells of the
brain, the glial cells.
Astrocytoma: The most common form of glioma, arising from
astrocytes.
Ependymoma: From the cells lining the ventricles in the brain.
Glioblastoma Multiforme (AKA grade IV glioma, malignant
glioma): The most aggressive form of glioma.
Oligodendroglioma
o Hemangioblastoma
o Medulloblastoma and other Primitive Neuroectodermal Tumors (PNETs)
o Metastatic Brain Tumor: Cancers that spread from distant organs can also
affect the brain.
o Colloid Cyst
Extra-Axial Tumors:
o Arachnoid Cyst
o Chordoma
o Craniopharyngioma
o Dermoid Cyst
o Epidermoid Cyst
o Meningioma
o Pituitary Adenoma
Acromegaly (Growth Hormone Secreting Adenoma in adults)
Cushing's Disease (ACTH Secreting Adenoma)
Endocrine Inactive Adenoma (NonSecreting Adenoma)
Gigantism (Growth Hormone Secreting Adenoma in children)
Prolactinoma
Pituitary Tumor Surgery (Transsphenoidal Surgery)
o Rathke's Cleft Cyst
o Schwannoma
Acoustic Neuroma (Vestibular Schwannoma)
o Teratoma
Pineal Region Tumors: The pineal gland is a small portion of the brain which can
develop several types of tumors.
o Pineal Cysts
o Pineal Germinoma/Seminoma
o Pineoblastoma
o Pineocytoma
Tumors In Children: There are a few specific types of tumors which affect
children.
Multiple Sclerosis
What Is It?
Multiple Sclerosis (MS) is a disease of the
central nervous system which leads to recurring attacks of neurological symptoms. The
deterioration in function is related to something termed "demyelination".
Nerve cells connect to other nerve cells at a distance by way of a long wire-like extension
of the cell called an axon. The axon carries an electrical signal along its length to transmit
messages from one cell to the next. These can be quite long, carrying nervous system
impulses up to feet at a time through the spinal cord and brain. Most of these long axons
are myelinated, wrapped in an insulating substance called myelin. The myelin helps the
electrical impulses conduct quickly and efficiently down the length of the axon.
In MS, the myelin sheath around some axons in the central nervous system becomes
damaged. This damage makes conduction along these axons faulty, slowing or stopping
completely, leading to symptoms. These areas of demyelination, called MS plaques, are
patchy and can occur almost anywhere in the brain or spinal cord at various times. The
specific symptoms that occur depend on the specific location of the demyelination within
the nervous system. The pattern and time course of these occurrences varies depending
on the type of multiple sclerosis. Most commonly, the demyelination occurs in attacks
which then resolve, the symptoms improving partially or completely. Further attacks then
occur at a later date.
Follow the links below for more information about types, symptoms, diagnosis, and
treatment of MS.
MS Topics:
Cerebrovascular Disease
Disorders of the Blood Vessels of the Brain
Cerebrovascular disease refers to disorders
of the blood vessels that supply blood flow to the brain. While many of these disorders
can cause what is generally referred to as "stroke", they vary quite a bit in their
presentation and specific disease characteristics. For this reason, "stroke" can be a
confusing term and is often misused. The term "stroke" originally meant a neurological
condition which occurs suddenly, like a stroke of lightning. However, this can refer to
many different underlying causes. The most common cause of "stroke" is what is called
cerebral infarction which is damage to a part of the brain because of a blockage of the
normal blood flow. The brain needs blood and therefore it will fail to function normally
when an infarction occurs. However, other forms of "stroke" include hemorrhage, or
bleeding, into or around the brain. These forms of "stroke" can be quite different in their
symptoms and underlying pathology that caused the bleeding.
Traumatic brain injury (TBI) is one of the most common causes of death and disability in
the world. Brain trauma can lead to a number of different consequences. It can result
from both blunt trauma, as in the case of a motor vehicle accident, and penetrating
trauma, such as in the case of gun-shot or stab wounds.
Severity of TBI
The severity of TBI is often classified as mild, moderate or severe, depending on the level
of consciousness of the patient. Severity scale of head injury and outcome from head
injury are often used by medical professionals:
Glasgow Coma Scale: This is a scale which rates the level of consciousness of a
TBI victim from 3 (worst) to 15 (normal).
Glasgow Outcome Scale: This scale ranks the long-term outcome of a TBI victim
from 1 (dead) to 5 (good recovery).
Types of Injury
There is a great deal of confusion amongst layman about the description of various
traumatic head injuries. For example, the term "concussion" gets used very frequently,
often without knowing the true meaning of the diagnosis. Here we have several traumarelated diagnoses with links to more information about each so that you can understand
what each means and implies:
Concussion: A very misunderstood and misused term, learn more about what
concussion really means here.
Traumatic Coma
Cerebral Contusion
Diffuse Axonal Injury
Epidural Hematoma
Intraparenchymal Hemorrhage
Traumatic Subarachnoid Hemorrhage
Subdural Hematoma
central nervous system: The central nervous system, or cns, refers to the brain, brain
stem and spinal cord. It is distinct from the peripheral nervous system which includes all
the peripheral nerves which go in and out of the central nervous system.
cerebellum: The cerebellum (or "little brain") is a part of the brain which lies just behind
the brain stem. It is important for motor coordination. Damage to the cerebellum can lead
to imbalance, clumsiness and problems with gait, among other neurological symptoms.
cerebrospinal fluid: Cerebrospinal fluid, or CSF, is the water-like fluid that is within the
brain, in chambers called the ventricles, as well as surrounding the brain and spinal cord
in an area called the subarachnoid space. All of the functions of this fluid are not well
known but it is clearly important for the support and protection of the brain and spinal
cord.
cerebrum: The cerebrum literally means the brain. However, it refers to the forebrain,
the most advanced part of the brain which primarily includes the two cerebral
hemispheres.
congenital: A congenital condition is one which a patient is born with. It does not
necessarily imply a genetic or hereditary cause, simply one that began before birth and
the individual has had since the time of birth.
craniectomy: A craniectomy is a medical term referring to a surgical opening of the
skull. However, whereas in a craniotomy the bone is re-attached at the end of the
procedure, in a craniectomy the bone is left out, leaving an opening in the skull. A
craniectomy is performed for various reasons, usually to decompress the structures
contained within the bone. For example, in severe traumatic brain injury a large
craniectomy may be performed to allow the brain room to expand while it swells.
craniotomy: A craniotomy is a medical term referring to a surgical opening of the skull.
This is performed frequently in neurosurgical operations to achieve access to the brain
and other structures within the head. Typically, at the end of the procedure, the piece of
bone that was removed is secured back into place, usually with titanium plates and
screws but sometimes with wire or suture.
CSF: CSF is an abbreviation for cerebrospinal fluid (see above).
decompression: Decompression is a general medical term that is often used in surgical
procedures which aim to decrease the pressure on a certain area of the nervous system.
For example, a decompressive craniectomy is the removal of a piece of skull to allow the
brain to expand after an injury. Another example is a laminectomy of the spine which
may aim to decompress the spinal canal so that the spinal cord or nerves are no longer
compressed.
epilepsy: This is the medical term for a condition of recurrent seizures. There are many
causes which can lead to epilepsy in an individual, including brain tumors,
traumatic injury or infarction, and hydrocephalus. Generally, as the pressure increases the
brain does not function as well, leading to neurological symptoms. Very high intracranial
pressures can cause coma or death. Patients with disorders that lead to high pressure are
often monitored with some form of intracranial pressure monitor, such as a
ventriculostomy, to record the pressure. Several treatments can be then used to help lower
the pressure to protect the brain.
ischemia: Ischemia is the lack of adequate blood flow to support the normal functioning
of a tissue such as the brain. As the tissue becomes ischemic, it does not function
normally and can lead to neurological symptoms. If the ischemia is severe enough or
prolonged enough it can lead to permanent damage to the brain tissue which is termed
infarction (see above).
lesion: Lesion is one of the general medical terms for an abnormality in the body. Several
pathologies can be called a lesion, such as a hematoma, a brain tumor or a cerebral
infarction.
mass: A mass is any lesion which takes up space in the head. For example, a hematoma
(a collection of clotted blood) can be called a mass since it takes up space. Also, a tumor
of any type could be termed a mass. Generally, a mass can cause symptoms by
compressing the normal structures to which it is adjacent. Mass does not imply that a
lesion is cancer, a tumor or anything else specific, it just refers to a mass that takes up
space in the head.
nerve: A nerve is a collection of nerve fibers. Each of the nerve fibers within a nerve are
tiny extensions of neurons (the nerve cells in the brain and spinal cord) which carry
electrical impulses down them at very fast speeds. Therefore, a nerve is generally
carrying information to or from the central nervous system. The nerves going from the
central nervous system include nerves that control some function of the body, such as
increasing or decreasing heart rate or telling a muscle to contract. Nerves coming back
into the central nervous system are typically carrying some sensory information from the
environment, including touch sensation, hearing, taste, etc.
neurologist: A neurologist is a medical specialist who specializes in diseases of the
nervous system. The neurologist focuses on the medical treatment of these diseases since
they are not trained in surgery. Diseases that require some surgical treatment will usually
be referred to a neurosurgeon.
neurosurgeon: Also known as a brain surgeon or neurological surgeon, a neurosurgeon is
a surgeon trained specifically to treat disorders of the nervous system. This can include
everything from intracranial diseases to diseases of the spine. However, many
neurosurgeons sub-specialize in one or more area of neurosurgery such as epilepsy,
traumatic brain injury, spinal disease, brain tumors, pediatric neurosurgery, movement
disorders (such as Parkinson's Disease) or cerebrovascular diseases (diseases of the blood
vessels).
peripheral nervous system: The peripheral nervous system includes all parts of the
nervous system that is external to the central nervous system (see above). In general this
includes all the nerves going to and coming from the central nervous system, including
the autonomic nerves and ganglia which control autonomic functions in the body.
seizure: A seizure is a sudden occurrence of abnormal, uncontrolled electrical activity in
the brain. There are many causes of seizures and they can cause various sensory
disturbances, loss or alteration of consciousness, convulsions and other symptoms
depending on the type and location in the brain. A condition of recurring seizures is called
epilepsy. Learn more about seizures and epilepsy in our Epilepsy section.
spasm: Spasm is a general medical term for a sudden involuntary muscle movement.
Like some other medical terms, it can be used to refer to a variety of disorders, from
benign muscle spasm which can occur with muscle injury or excessive activity to seizure
activity due to epilepsy. Therefore it is not a specific term that implies any one particular
disease or pathology.
spinal cord: The spinal cord is the long extension of the central nervous system which
occupies the spinal canal in the spine. The bony spine and the ligaments, muscles and
other soft tissues that surround it all help protect the spinal cord. The cord carries
information up to the brain and down from the brain to the periphery. It also contains the
motor neurons (nerve cells) which send out fibers to all muscles to control their
movement.
stroke: Stroke is a general term for the sudden onset of neurological symptoms. While
stroke can be used in this general way to refer to various diseases including spontaneous
hemorrhage such as subarachnoid hemorrhage due to the rupture of an intracranial
aneurysm, most commonly it is used to refer to an ischemic stroke or cerebral infarction.
This type of stroke is most commonly caused by a blood clot which obstructs the normal
flow of blood in one of the arteries that supplies blood to the brain. This interruption in
blood flow can lead to injury and death of the brain tissue which is supplied by that
artery.
tumor: Tumor is one of the general medical terms which refers to any mass. However,
for the most part the term is used to describe a group of abnormal cells which grows due
to the uncontrolled growth of the cells. The type of tumor is generally defined by the
origin of the tumor, which cell types from which it arose. Tumors also vary in their
behavior, grown rate and invasiveness. Slower growing, less aggressive tumors are
generally defined as "benign" whereas faster growing, more aggressive tumors are termed
"malignant". Malignant tumors are also known as cancer. Tumors can occur almost
anywhere in the body but there are several types of brain tumors which either grow
within the brain tissue itself or arise from tissues in the head near the brain and can
therefore involve the brain or nerves coming from the brain. There are also spinal tumors
which grown within or involve the spine.