A rare subependymoma brain tumour
John. S.
What to know about brain aneurysms
A brain aneurysm, sometimes called a cerebral aneurysm, is a weak spot in a brain artery. The weak spot creates a balloon that fills with blood.
The walls of the artery are weaker near an aneurysm, which means that the aneurysm can break open, or rupture. A ruptured aneurysm is a life threatening condition that can cause serious brain injuries or stroke. However, not all aneurysms rupture.
People with an aneurysm may need ongoing monitoring to ensure that it is not growing. A doctor may need to remove a larger aneurysm.
In this article, we provide an overview of brain aneurysms, including the types, symptoms, causes, complications, and treatments.
According to the National Institute of Neurological Disorders and Stroke, brain aneurysms affect an estimated 3–5% of people in the United States during their lifetime. They are more common in females than in males and tend to affect adults between the ages of 30 and 60 years.
The Brain Aneurysm Foundation state that ruptured brain aneurysms account for just 3–5% of all new stroke cases. If an aneurysm does rupture, it is fatal in about 40% of cases, with 15% of people dying before they reach the hospital.
Types of aneurysm
Doctors classify aneurysms according to the shape of the weak spot in the artery.
There are three main types of aneurysm:
- Saccular aneurysms form a pocket on the outside of an artery. They are the most common type of cerebral aneurysm. Some people refer to them as berry aneurysms due to their appearance.
- Fusiform aneurysms occur when the blood vessel expands on all sides. This type of aneurysm is more common after an injury to a blood vessel.
- Mycotic aneurysms are those that form a sac around an artery. They happen when an infection from another area of the body gets into the bloodstream and spreads to the brain. Myocarditis, a type of heart infection, is a common culprit, but mycotic aneurysms are very rare.
The size of an aneurysm is a significant predictor of whether or not it will rupture:
- Small aneurysms are less than 11 millimeters (mm) across — about the size of a large pencil eraser.
- Large aneurysms are 11–25 mm in diameter — roughly the size of a dime.
- Giant aneurysms are 25 mm or larger — more than the diameter of a quarter.
Some aneurysms grow over time, and a small number grow rapidly. Growth, especially rapid growth, increases the risk that the aneurysm will rupture.
Larger aneurysms are more likely than smaller ones to cause symptoms before they rupture, but most aneurysms do not cause any symptoms during this stage.
When people with an unruptured aneurysm do experience symptoms, they may include:
- pain above or behind the eye that gets worse or does not go away with time
- numbness
- weakness
- paralysis or twitching on one side of the face
- vision changes, such as blurred or double vision
- a dilated pupil in only one eye
Sometimes an aneurysm leaks before it ruptures. Doctors call this a sentinel rupture or sentinel bleed.
Sentinel ruptures sometimes cause sentinel headaches. A sudden, severe headache — especially one that does not fit a person’s usual headache pattern or that is worse than any other headache they have ever had — could be a sentinel headache.
Other symptoms of a sentinel rupture include:
- nausea or vomiting
- vision changes
- confusion or changes in consciousness
- a stiff neck
- light sensitivity
- fainting or seizures
- cardiac arrest
Anyone who has symptoms of an aneurysm should seek immediate medical care. If a person has previously received a diagnosis of an unruptured aneurysm, it is essential that they make the emergency care team aware of this.
Causes and risk factors
Brain aneurysms are more common in females than in males and more likely to affect adults between 30 and 60 years old. In addition, genetic and lifestyle factors that weaken the walls of blood vessels greatly increase the risk of aneurysm.
Risk factors for brain aneurysms include:
- genetic conditions that weaken blood vessels, including polycystic kidney disease, some connective tissue disorders, and arteriovenous malformations (AVM)
- a close family member, such as a parent, child, or sibling, having an aneurysm
- uncontrolled high blood pressure
- drug use disorder, particularly that involving drugs that raise blood pressure, such as amphetamines and cocaine
- using illicit drugs intravenously
- smoking
- a brain tumor
- head injuries
- infections in the arteries
Diagnosis
While brain imaging techniques, such as CT scans and MRI scans, can help doctors diagnose some aneurysms, an angiogram allows them to make a definitive diagnosis.
To perform a cerebral angiogram, a doctor will insert a small, thin tube called a catheter into a blood vessel in the groin and direct it into the blood vessels of the brain under X-ray guidance. There, they will inject a dye that makes it easier to see the blood vessels and any unusual structures.
An angiogram can help the doctor assess the size and severity of the aneurysm, as well as its type. This information helps them make appropriate treatment recommendations.
Treatment
Not all brain aneurysms require immediate treatment. If the aneurysm is small, a doctor may recommend monitoring it over time.
The best treatment option will depend on the following factors:
- the person’s age
- any neurological or medical conditions
- whether the aneurysm has ruptured
- the risk of the aneurysm rupturing
- any family history of subarachnoid hemorrhage
A person with a family or personal history of aneurysm rupture may need treatment even if the aneurysm is small.
A doctor may recommend an endovascular procedure or surgery to treat the aneurysm.
Endovascular procedure
During an endovascular procedure, a surgeon inserts a catheter through the groin, then navigates to the aneurysm. Next, they pack the aneurysm with metal coils or a stent to redirect the blood flow. Doing this stops blood from flowing into the aneurysm, which prevents rupture.
Surgery
Surgery for an aneurysm requires an operation on the brain, which will take place under general anesthesia. This procedure usually requires a person to spend several days in the hospital, and it may be necessary to shave the person’s head. During the operation, a surgeon clips the aneurysm to prevent blood from flowing into it.
Following this treatment, most aneurysms do not reoccur.
Risks of treatment
Both endovascular treatment and brain surgery come with risks, including:
- heart or lung damage
- stroke
- surgical complications, such as infection
- death
- surgery failure that makes further treatment necessary
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a vertebrate's body. In a human, the cerebral cortex contains approximately 14–16 billion neurons,[1] and the estimated number of neurons in the cerebellum is 55–70 billion.[2] Each neuron is connected by synapses to several thousand other neurons. These neurons typically communicate with one another by means of long fibers called axons, which carry trains of signal pulses called action potentials to distant parts of the brain or body targeting specific recipient cells.
| Brain | |
|---|---|
 A common chimpanzee brain | |
| Identifiers | |
| MeSH | D001921 |
| NeuroNames | 21 |
| TA98 | A14.1.03.001 |
| TA2 | 5415 |
| Anatomical terminology | |
Physiologically, brains exert centralized control over a body's other organs. They act on the rest of the body both by generating patterns of muscle activity and by driving the secretion of chemicals called hormones. This centralized control allows rapid and coordinated responses to changes in the environment. Some basic types of responsiveness such as reflexes can be mediated by the spinal cord or peripheral ganglia, but sophisticated purposeful control of behavior based on complex sensory input requires the information integrating capabilities of a centralized brain.
The operations of individual brain cells are now understood in considerable detail but the way they cooperate in ensembles of millions is yet to be solved.[3] Recent models in modern neuroscience treat the brain as a biological computer, very different in mechanism from an electronic computer, but similar in the sense that it acquires information from the surrounding world, stores it, and processes it in a variety of ways.
This article compares the properties of brains across the entire range of animal species, with the greatest attention to vertebrates. It deals with the human brain insofar as it shares the properties of other brains. The ways in which the human brain differs from other brains are covered in the human brain article. Several topics that might be covered here are instead covered there because much more can be said about them in a human context. The most important is brain disease and the effects of brain damage, that are covered in the human brain article.
A hemispherectomy.
.hemispherectomy. Strange but True: When Half a Brain Is Better than a Whole One
You might not want to do it, but removing half of your brain will not significantly impact who you are
https://www.scientificamerican.com/article/strange-but-true-when-half-brain-better-than-whole/
Matt S.
Matt was diagnosed with a rare subependymoma brain tumour seven years after first being diagnosed with vertigo. He underwent surgery to remove the tumour in 2018 but has been left with life-changing effects, including 50% blindness, fatigue and memory problems. Being the local postman has been his saving grace.
His wife Julie tells his story…
Matt and I met when we were both working shifts at our local pub. He was a fit, healthy guy who loved watching sport, especially wrestling and his beloved Tottenham Spurs playing. We have been together for 19 years and married for 15. He is now the postman who delivers the mail in our village of Cranfield in Bedfordshire and I work for Thames Valley Police as a civilian in the control room.
In 2011, Matt started suffering with what we were told was vertigo brought on by labyrinthitis. He went back and forth to the GP for seven years until in February 2018, the GP thought it might be something neurological and referred him. Matt wasn’t seen in neurology at Bedford Hospital until August of that year. They did tests including asking him to walk a straight line with his eyes shut and concluded he may have inner ear damage. However, he was referred for an MRI and to ENT. A couple of weeks later, the technologist doing his scan worried him when she told him he needed to come back at 9.30 am the following day. She said she had found something serious but couldn’t say what.
Matt then had an MRI with contrast and was going to be sent home to await results from a doctor. Obviously, he was really concerned and begged for someone to tell him what was going on. Eventually, a neurologist came and told us they had found a 6cm x 6cm tumour. They said it was slow-growing and that he would be referred to neurology and oncology at Addenbrooke’s.
“A day later, we were out to lunch with friends when Matt had a massive tonic-clonic seizure. It was absolutely terrifying. Matt stopped breathing for four minutes and I really thought he was dead.”
Matt was taken by ambulance to Bedford Hospital and spent two days there where they started him on a low dose of Keppra, a drug to treat epilepsy, as well as steroids. I was concerned that the MRI scans and the stress Matt had been under, realising they had obviously found something, had brought on the seizure out-of-the-blue, but we were told it was a coincidence.
Ahead of his impending surgery, I was often in tears, but Matt was very matter-of-fact, possibly numbed because of all the medication he was under. The only thing that helped me was getting everything organised ahead of him going into hospital.
“On 7th September, Matt was in Addenbrooke’s for surgery. I was expecting it to take around six hours, but he was gone for ten. It was an agonising wait, not knowing if I would ever see him again.”
Luckily, the surgeons were able to fully remove the tumour, which they thought was a meningioma, but turned out to be a subependymoma, a rare type of grade 1 ependymoma that develops from the glial cells that line the ventricles of the brain and the spinal cord. However, Matt has been left with lasting effects. The surgery has meant he is now registered as sight impaired, having had damage to his visual pathway because of the surgery. He has lost 50% of his sight on the left side of both eyes, which means he will never be able to drive again and struggles when he is unfamiliar places and has to rely on my help. He also has issues with his memory and I have to write lots of notes to remind him to do things.
He is so lucky to have his job as a postman in our home village. It means he can walk to and from work. And pushing his trolley is great because he has weakness down his left side and because his balance isn’t good either he uses the trolley as support.
Everyone seems to have a soft spot for Matt. When he was having surgery, people sent him lots of cards and were popping into the Coop which has a little post office for news. When he finally was back at work six months after his operation, his customers were constantly offering cups of tea and cake or a place to sit and rest for a while. Everyone seemed very concerned but glad he was back on his round.
In April 2019, we had arrived at Heathrow on our way to New York for a few days. I had bought tickets for WrestleMania and we were excited about visiting the Big Apple for the first time. We had just stepped out of the minibus which took us from the car park to the airport when Matt had another massive seizure. The lovely minibus driver quickly called for an ambulance and later even brought my car to Hillingdon Hospital where Matt was taken so I didn’t have to worry about collecting it.
Sadly, we didn’t get to New York.
Matt’s dosage of anti-seizure medicine was increased. He continued to have seizures every two to four months, with the dosage being increased each time until he was at the maximum dosage after another seizure in January 2020. Matt didn’t then have another seizure until August – a gap of seven or eight months. We decided not to add another anti-seizure medication to his regime at this stage because of the side-effects and hope he will go a good long stretch without another fit.
We were both shocked to discover the stats about brain tumours and how low funding into research actually is. It’s disgusting that they don’t warrant more investment. Even people with low-grade or slow-growing brain tumours can suffer life-changing side effects.
“People often say how well Matt looks, but they don’t know what he has to contend with, having lost his driving licence and therefore his independence when he became partially-sighted.”
Matt and I have two children, Harry, who is 17 and Elissa, 16, but he also has an older daughter and three grandchildren and has to wait for me to drive him to see them even though they live less than eight miles away.
We have registered to do a virtual Walk of Hope in Marston Vale and have set ourselves a challenge to complete 10 miles. We hope to be able to sponsor a day of research to help find better outcomes for brain tumour patients.
Julie Shanley
September 2020
Brain tumours are indiscriminate; they can affect anyone at any age. What’s more, they kill more children and adults under the age of 40 than any other cancer... yet just 1% of the national spend on cancer research has been allocated to this devastating disease.
Brain Tumour Research is determined to change this.
If you have been inspired by Matt’s story, you may like to make a donation via www.braintumourresearch.org/donation/donate-now or leave a gift in your will via www.braintumourresearch.org/legacy
Together we will find a cure.
If you have been inspired by Matt’s story, you may like to make a donation via www.braintumourresearch.org/donation/donate-now or leave a gift in your will via www.braintumourresearch.org/legacy
Together we will find a cure.
IMUNOTHERAPY
Imunotherapy for brain cancer wherein we harness the mechanisms of the immunization system. T-cells are trained to attack and kill cancerous tissue and leave healthy tissue alone.
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