Chapter 14 Injury & Illness Trepanation

Trepanation

Ancient surgical procedure where pieces of the skull are removed to treat head wounds, epilepsy, or infection

Earliest known brain surgeries

Occurred about 6000 years ago in Asia Minor

Ancient Incan trepanation survival rate

By the 1400s about 90% of skulls showed bone regrowth indicating patients survived

Ancient pain relief methods

Tobacco coca leaves and corn beer

Primary brain tumor

Tumor that originates in the brain

Metastatic brain tumor

Tumor formed when cancer spreads from another part of the body to the brain through the bloodstream

Common sources of metastatic brain tumors

Lung breast skin colon and kidney cancers

Glioma

General term for tumors arising from glial cells

Glioblastoma

Most common malignant brain tumor arising from immature glial cells

Meningioma

Most common primary brain tumor benign tumor arising from the meninges

Common brain tumor symptoms

Headache seizures vision problems memory problems depending on tumor location

How gliomas damage neurons

They release toxic glutamate that destroys nearby nerve cells and can cause seizures

Craniotomy

Surgical procedure where part of the skull is opened to remove a brain tumor

Stereotactic radiosurgery

High dose radiation beams precisely targeted at a tumor

Focused ultrasound therapy

Treatment where multiple ultrasound beams intersect at the tumor to destroy it

Purpose of steroids after brain surgery

Reduce brain swelling and inflammation

Chemotherapy wafers

Small wafers containing anticancer drugs implanted after tumor removal that slowly release medication

Targeted cancer therapy

Treatments that attack specific genes or mechanisms promoting tumor growth

Anti angiogenesis therapy

Treatment that blocks formation of blood vessels feeding tumors

Immunotherapy

Cancer treatment that stimulates the immune system to attack tumor cells

Checkpoint inhibitors

Drugs that block signals tumors use to suppress immune responses

Gene therapy for tumors

Treatment targeting genes responsible for tumor growth

Stem cells

Undifferentiated cells capable of becoming specialized cells such as neurons

Traumatic brain injury (TBI)

Brain damage caused by blows bumps jolts or penetrating injuries to the head

Annual TBI cases in the United States

About 1.7 million

TBI hospitalizations per year in the United States

About 275000

Annual deaths from TBI in the United States

About 52000

Leading cause of TBI

Falls

Leading cause of TBI related death

Motor vehicle accidents

Annual cost of TBI in the United States

More than 60 billion dollars

Concussion

Mild traumatic brain injury causing temporary disruption of brain activity

Severe TBI complications

Bleeding swelling seizures neuron death

Post traumatic epilepsy

Seizure disorder that can develop after traumatic brain injury

Chronic traumatic encephalopathy (CTE)

Degenerative brain disease caused by repeated head trauma

Symptoms of CTE

Memory loss confusion aggression depression progressive dementia

CT scan imaging technique

Computed tomography imaging used to observe brain damage

MRI imaging technique

Magnetic resonance imaging used to observe brain damage

Spinal cord injury (SCI)

Damage to the spinal cord causing loss of movement or sensation

SCI cases per year in the United States

About 17000

People living with SCI in the United States

About 282000

Leading cause of spinal cord injury

Vehicle crashes

Methylprednisolone

Steroid drug used to reduce inflammation after spinal cord injury

Time window for methylprednisolone treatment

Within 8 hours of spinal cord injury

SCI rehabilitation approaches

Physical therapy occupational therapy and electrical stimulation

Human immunodeficiency virus (HIV)

Virus that causes acquired immune deficiency syndrome

Global new HIV infections in 2015

About 2.1 million

Total people living with HIV worldwide

About 37 million

HIV associated neurocognitive disorder (HAND)

Neurological disorder caused by HIV affecting cognition and memory

HAND symptoms

Memory problems poor concentration coordination issues and dementia

Peripheral neuropathy in HIV

Damage to peripheral nerves causing tingling burning or pain

Antiretroviral therapy (ARV)

Combination drugs that slow HIV replication

Multiple sclerosis (MS)

Autoimmune disease where the immune system attacks the myelin sheath in the central nervous system

Typical age of MS diagnosis

20 to 40 years old

Myelin sheath

Fatty insulating layer around axons that speeds nerve signal transmission

MS lesions

Patches of scar tissue formed after myelin destruction

Common areas affected by MS

Spinal cord cerebellum optic nerve

MS symptoms

Vision problems numbness tremors weakness fatigue bladder problems

Types of MS

Relapsing remitting primary progressive and secondary progressive

Relapsing remitting MS

Flare ups of symptoms followed by partial or complete recovery

Primary progressive MS

Gradual worsening of symptoms from the start of the disease

Glucocorticoids

Steroid drugs used to reduce inflammation in MS attacks

Chronic pain

Pain that persists for weeks months or years

Americans affected by chronic pain

About 100 million

Annual economic cost of chronic pain in the United States

560 to 635 billion dollars

Local anesthetics

Drugs that temporarily block pain receptors

Examples of local anesthetics

Procaine and lidocaine

NSAIDs

Nonsteroidal anti inflammatory drugs that reduce inflammation and pain

Examples of NSAIDs

Ibuprofen naproxen and aspirin

Mechanism of NSAIDs

They block synthesis of prostaglandins which increase pain sensitivity

Opioids

Powerful painkillers that bind opioid receptors in the nervous system

Examples of opioids

Morphine and codeine

Endorphins

Naturally occurring opioid peptides produced by the body

Stroke

Interruption of blood flow to the brain caused by a clot or ruptured blood vessel

Strokes per year in the United States

About 800000

First strokes per year in the United States

About 600000

Annual stroke deaths in the United States

More than 130000

Major stroke risk factors

Obesity physical inactivity heart disease high blood pressure

Tissue plasminogen activator (tPA)

Clot dissolving drug used to treat stroke

Time window for tPA treatment

Within 3 hours of stroke onset

Function of tPA

Breaks down blood clots and restores blood flow to the brain

Future stroke treatments

Stem cell therapy and neuroprotective drugs