Chapter 14 Brain Bee: Injury and Illness

When was first known brain surgery

The first known brain surgeries happened about 6000 years ago in Asia Minor.

trepanation

small pieces of skull carefully removed to treat head wounds

First brain surgery

Archaeologists found skulls of ancient Incas of Peru with small pieces of skull carefully removed (process called trepanation) to treat head wounds, maybe to cure epilepsy or infection. Earliest Incan skulls didn't show healing, so patients died soon after.

By 1400s, how many ancient skulls discovered showed bone regrowth

about 90% of ancient skulls discovered showed bone regrowth.

How did patients thousands of years ago tolerate pain and survive

Likely used herbs like tobacco and coca leaves. Corn beer may have been drank to give relief.

Neuroscience seeks to understand roots of issues like brain tumors, head traumas, pain management, etc.... Why

To hopefully advance medical field and give more effective treatments and therapies.

Each year, how many in US are diagnosed with primary brain tumor

Each year, more than 79,000 in US are likely to be diagnosed with a primary brain tumor

Primary brain tumor

tumor that originates in brain.

Of the primary brain tumors diagnosed each year, how many are malignant

About 26,000 of them are malignant

Malignant

cancerous

Cancerous tumors called

malignant

Of the primary brain tumors diagnosed each year, how many are benign

53,000 will be benign (non-cancerous).

benign

non-cancerous

non-cancerous

benign

How many are diagnosed each year in US with metastatic brain tumor

More than 200,000 people

Metastatic brain tumors

brain tumors that develop when cancer cells from other parts of body travel through bloodstream to brain. These are called metastatic tumors.

What is are places that metastatic tumor cells originate from

Original place of tumor is normally lung, breast, skin, colon, or kidney.

Regardless of origin, why are tumors dangerous

tumors or any space occupying lesions in the brain can be lethal, so surgical removal is needed.

Types of brain tumors named by what

by the kind of cell they arise from and brain area where they develop.

Many brain tumors are

gliomas

Gliomas

general term for tumors that arise from glial cells that support and protect neurons in the brain.

Most common form of brain cancer is

Glioblastoma

Glioblastoma

proliferation of immature glial cells.

Most common type of primary brain tumor

meningioma

Meningioma

a benign tumor arising in the meninges

Meninges

thin layers of tissue that cover the brain

Symptoms of brain tumors

vary with tumors size and location, and also differ among people.

General symptoms

headache. Tumor in a part of the brain controlling vision can cause difficulties with sight.

What are headaches in tumors caused by

mainly bc of pressure that a tumor buts on the brain

Sometimes, a tumor damages what

can damage healthy tissue as it grows.

Which tumors damage healthy brain tissue and how

Gliomas - as gliomas grow, they release toxic amounts of glutamate, which destroy nerve cells near the tumor and cause seizures.

What is released in gliomas

release toxic amounts of glutamate

What do toxic amounts of glutamate do

destroy nerve cells near the tumor and cause seizures.

Treatments of tumors

surgery, radiation, targeted treatments, chemotherapy. Can be used alone or in combo to treat tumors.

Goal of treatment is what

to remove or shrink brain tumors to relieve pressure on the brain, and eliminate or reduce symptoms like seizures and headaches.

Surgery for brain tumor

If tumor can be accessed without hurting nearby brain areas, surgery is normally first step. Tumors can be removed with conventional techniques like craniotomy

Craniotomy

skull is opened and as much tumor as possible is removed.

Radiation for tumors is called

Stereotactic radiosurgery.

What happens in radiation in surgery

A high dose of radiation is aimed precisely at the tumor. A few treatments can reduce the size or eliminate the tumor while sparing healthy tissue nearby.

More recent radiation techniques

More recently, they have been treated with multiple beams of ultrasound focused precisely to intersect exactly at the tumor. This can be done painlessly in awake patients in brain imaging machines that visualize the tumor.

After surgery, what do doctors prescribe

doctors prescribe steroid meds to reduce brain swelling.

Reduced swelling alleviates what symptoms

symptoms like seizures, memory problems, or confusion that can happen after brain surgery.

Without anti-swelling meds after surgery, what symptoms can occur

seizures, memory problems, or confusion that can happen after brain surgery

In patients with cancerous tumors, why is radiation used

radiation can be used on surrounding brain areas to eliminate cancer cells left after surgery.

Chemotherapy given for what

Patients with cancerous tumors can also be given chemotherapy to prevent growth or re-growth of tumors.

What do new chemo methods do

allow meds to be delivered directly to tumor instead of traveling through the body first.

Wafers for chemo

After surgery, small wafers with anticancer drugs can be put in space previously occupied by tumor. Overtime, wafers slowly dissolve and release chemotherapy drugs to nearby areas.

New treatments that target specific cell mechanisms

Researchers also studying promising treatments that target specific cell mechanisms considered to important in cancer cell growth. These zero in on genes and other cell mechanisms that fuel cancer cell growth and spare healthy tissues. Causes less severe side effects than in conventional radiation or chemo.

meds that block formation of blood vessels.

Currently being used to treat glioblastomas. Is key in treating them bc glioblastomas form strong networks of vessels that feed tumor growth.

What is currently being used to treat glioblastomas

meds that block blood vessels - Is key in treating them bc glioblastomas form strong networks of vessels that feed tumor growth.

Immunotherapy

Researchers testing ways to stimulate ability of body's immune system to stop tumor growth.

Checkpoint inhibitors

Promising research using substances called checkpoint inhibitors that interfere with signals some tumors send to inhibit the immune system's ability to block tumor growth.

Gene therapy for tumors

identifies genetic components that promotes tumor growth and interferes with their ability to work. Research underway on many gene therapies to kill tumor cells and suppress their growth-promoting growth.

Other approaches for tumors

targeted delivery of antibodies, toxins, and growth-inhibiting molecules that can attach directly to tumor cells and interfere with their growth.

Stem cells in tumors

Researchers looking at role of stem cells in both development and treatment of brain tumors.

How do cancer cells divide

Normally, regulatory processes prevent mature, specialized cells from dividing and spreading; cancer cells escape these processes.

Stem cells

undifferentiated, or unspecialized, cells with potential to develop into any of a number of specialized cells, such as neurons.

How might scientists understand what is wrong in cancer cells

Understanding normal processes that allow stem cells to mature will let researchers understand what may be wrong in cancer cells.

Neurological Trauma includes

traumatic brain and spinal cord injuries

Traumatic brain and spinal cord injuries can lead to what

significant disabilities and death.

In US, how many have TBIs each year

1.7 million have

How many are hospitalized for TBI each year in US

275,000 are hospitalized

How many die of TBI each year

52,000 die bc of it.

TBI stands for

traumatic brain injuries

Leading cause of TBI

falls.

Leading cause of TBI-related death

motor vehicle/traffic injury

Direct medical costs and indirect costs of TBI

(such as lost productivity) are more than $60 billion each year in US.

Each year, how many in US have spinal cord injury

17,000 people in US have spinal cord injury.

How many currently live with spinal cord injury

Around 282,000 people currently live with spinal cord injury.

Leading cause of spinal cord injury

vehicle crashes, then falls, then acts of violence (mainly gunshot wounds), and injuries due to participation in sports and recreational activities).

Death rates for those with spinal cord injuries are much higher when

in the 1st year after injury, especially in those whose injuries cause severe neurological impairments.

General treatment for TBIs and spinal cord injuries

Few effective remedies for either injuries. New methods to prevent damage that comes after initial injury. Also there are ongoing efforts to support better rehabilitation techniques and research into regeneration and repair of injured tissue.

What lets us see extent of tissue damage in TBI

Computerized tomography (CT) and magnetic resonance imaging (MRI) techniques let us see extent of tissue damage in TBI and determine its medical management.

CT stands for

computerized tomography

MRI stands for

magnetic resonance imaging

Causes of TBI

Caused by bumps, blows, or jolts to the head that cause multiple minuscule bleeds or by penetrating head injuries that directly destroy brain tissue.

Ranges of TBI

Can be "mild" like concussion (a temporary disruption in brain activity) or "severe."

Concussion

a temporary disruption in brain activity

Types of damages in TBI

TBI can cause bruises in the brain, massive bleeding in the brain, cuts in brain tissue, direct nerve damage, and death of nerve cells.

What can TBI trigger

Can trigger swelling, fever, seizures, and other neurological impairments. Even "mild" TBI can cause damage to neurons, which release proinflammatory factors that initiate and sustain an inflammatory response.

People like pro football players or boxers who have repeated concussions or other brain trauma may develop what

CTE

CTE stands for

chronic traumatic encephalopathy

What is CTE

a progressive degenerative brain disease that happens when repeated head trauma triggers degeneration of brain tissue.

What happens in CTE

buildup of abnormal proteins (this can begin months, years, or even decades after the last brain trauma

Symptoms in CTE

memory loss, confusion, impaired judgement, impulse control problems, aggression, depression, and eventually, progressive dementia.

Most with mild injuries like concussions recover fully in a show much time

short period of time, but not really - see other

Study shows what with brains after concussions

However, a study of college ice hockey players with concussions showed that heir brain volume decreased 2 weeks after concussion. Change lasted at least 2 months.

What is key to recovery after TBI

Rest and avoiding physically demanding activities give the brain enough time to heal.

What happens to people who come into ER with severe head injury

They are carefully monitored for bleeding or swelling that puts pressure on the brain.

Treatments for increased pressure in skull include

removing amount of water fluid from injured and inflamed brain tissue.

Severe TBIs can cause

bruising on surface or in the brain. Bruising may cause blood to leak from vessels and contact brain tissue directly. This can be toxic to brain cells.

Pressure increases where

in injured area. This compresses blood vessels and reduces key blood flow to injured area.

If fluid removal and meds can't decrease pressure on brain, what can you do

part of skull can be drilled open or removed to relieve pressure.

In extreme cases, bruising in brain can do what

contribute to development of a seizure disorder called post-traumatic epilepsy.

seizure disorder after TBI

post-traumatic epilepsy

Once patient is stable, road to recovery

there is long road to recovery. Physical and occupational therapy needed to help people regain lost function like speech or movement.

Meds for TBI

can be used to treat other symptoms of TBI like pain, seizures, muscle spasms, sleep disorders, depression, and anxiety.

SCI stands for

Spinal Cord Injury

What can SCI do

Can permanently damage nerve cells and cause disabilities (including paralysis to diff degrees)

Treatment of SCI

steroid drug called Methylprednisolone is only approved treatment right now by US FDA.