A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications. The good news is that strokes can be treated and prevented.

Symptoms

Watch for these signs and symptoms if you think you or someone else may be having a stroke. Pay attention to when the signs and symptoms begin. The length of time they have been present can affect your treatment options:

• Trouble with speaking and understanding. You may experience confusion. You may slur your words or have difficulty understanding speech.
• Paralysis or numbness of the face, arm or leg. You may develop sudden numbness, weakness or paralysis in your face, arm or leg. This often happens just on one side of your body. Try to raise both your arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Also, one side of your mouth may droop when you try to smile.
• Trouble with seeing in one or both eyes. You may suddenly have blurred or blackened vision in one or both eyes, or you may see double.
• Headache. A sudden, severe headache, which may be accompanied by vomiting, dizziness or altered consciousness, may indicate you’re having a stroke.
• Trouble with walking. You may stumble or experience sudden dizziness, loss of balance or loss of coordination.

When to see a doctor

Seek immediate medical attention if you notice any signs or symptoms of a stroke, even if they seem to fluctuate or disappear. Think “FAST” and do the following:

• Face. Ask the person to smile. Does one side of the face droop?
• Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise up?
• Speech. Ask the person to repeat a simple phrase. Is his or her speech slurred or strange?
• Time. If you observe any of these signs

Causes

A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn’t cause permanent damage.

Ischemic stroke

About 80 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). The most common ischemic strokes include:

• Thrombotic stroke. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to your brain. A clot may be caused by fatty deposits (plaque) that build up in arteries and cause reduced blood flow (atherosclerosis) or other artery conditions.
• Embolic stroke. An embolic stroke occurs when a blood clot or other debris forms away from your brain — commonly in your heart — and is swept through your bloodstream to lodge in narrower brain arteries. This type of blood clot is called an embolus.

Hemorrhagic stroke

Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. Brain hemorrhages can result from many conditions that affect your blood vessels. These include:

• Uncontrolled high blood pressure (hypertension)
• Overtreatment with anticoagulants (blood thinners)
• Weak spots in your blood vessel walls (aneurysms)

A less common cause of hemorrhage is the rupture of an abnormal tangle of thin-walled blood vessels (arteriovenous malformation). Types of hemorrhagic stroke include:

• Intracerebral hemorrhage. In an intracerebral hemorrhage, a blood vessel in the brain bursts and spills into the surrounding brain tissue, damaging brain cells. Brain cells beyond the leak are deprived of blood and are also damaged.High blood pressure, trauma, vascular malformations, use of blood-thinning medications and other conditions may cause an intracerebral hemorrhage.
• Subarachnoid hemorrhage. In a subarachnoid hemorrhage, an artery on or near the surface of your brain bursts and spills into the space between the surface of your brain and your skull. This bleeding is often signaled by a sudden, severe headache.A subarachnoid hemorrhage is commonly caused by the bursting of a small sack-shaped or berry-shaped aneurysm. After the hemorrhage, the blood vessels in your brain may widen and narrow erratically (vasospasm), causing brain cell damage by further limiting blood flow.

Transient ischemic attack (TIA)

A transient ischemic attack (TIA) — sometimes known as a ministroke — is a temporary period of symptoms similar to those you’d have in a stroke. A temporary decrease in blood supply to part of your brain causes TIAs, which may last as little as five minutes. Even when symptoms last for under an hour, there is still a risk of permanent tissue damage.

Treatment:

• Intravenous injection of tissue plasminogen activator (tPA).
• Emergency endovascular procedures.
• Carotid endarterectomy
• Angioplasty and stents
• Surgical blood vessel repair
• Neuro-Rehabilitation

Risk factors

Many factors can increase your stroke risk. Some factors can also increase your chances of having a heart attack. Potentially treatable stroke risk factors include:

Lifestyle risk factors

• Being overweight or obese
• Physical inactivity
• Heavy or binge drinking
• Use of illicit drugs such as cocaine and methamphetamines

Medical risk factors

• Blood pressure readings higher than 120/80 millimeters of mercury (mm Hg)
• Cigarette smoking or exposure to secondhand smoke
• High cholesterol
• Diabetes
• Obstructive sleep apnea
• Cardiovascular disease, including heart failure, heart defects, heart infection or abnormal heart rhythm
• Personal or family history of stroke, heart attack or transient ischemic attack.

Other factors associated with a higher risk of stroke include:

• Age —People age 55 or older have a higher risk of stroke than do younger people.
• Race — African-Asians have a higher risk of stroke than do people of other races.
• Sex — Men have a higher risk of stroke than women. Women are usually older when they have strokes, and they’re more likely to die of strokes than are men.
• Hormones — use of birth control pills or hormone therapies that include estrogen, as well as increased estrogen levels from pregnancy and childbirth.

Complications

A stroke can sometimes cause temporary or permanent disabilities, depending on how long the brain lacks blood flow and which part was affected. Complications may include:

• Paralysis or loss of muscle movement. You may become paralyzed on one side of your body, or lose control of certain muscles, such as those on one side of your face or one arm. Physical therapy may help you return to activities affected by paralysis, such as walking, eating and dressing.
• Difficulty talking or swallowing. A stroke might affect control of the muscles in your mouth and throat, making it difficult for you to talk clearly (dysarthria), swallow (dysphagia) or eat. You also may have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. Therapy with a speech-language pathologist might help.
• Memory loss or thinking difficulties. Many people who have had strokes experience some memory loss. Others may have difficulty thinking, making judgments, reasoning and understanding concepts.
• Emotional problems. People who have had strokes may have more difficulty controlling their emotions, or they may develop depression.
• Pain. Pain, numbness or other strange sensations may occur in the parts of the body affected by stroke. For example, if a stroke causes you to lose feeling in your left arm, you may develop an uncomfortable tingling sensation in that arm.People also may be sensitive to temperature changes, especially extreme cold, after a stroke. This complication is known as central stroke pain or central pain syndrome. This condition generally develops several weeks after a stroke, and it may improve over time. But because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments.
• Changes in behavior and self-care ability. People who have had strokes may become more withdrawn and less social or more impulsive. They may need help with grooming and daily chores.

As with any brain injury, the success of treating these complications varies from person to person.

Uterine myomatosis

Uterine myomatosis is a benign type of cancer, often affecting women over 30 years of age. It is the presence of tumors in the musculature of the uterus. If a single muscular tumor is found in the uterus, it is called a myoma, if there are more myomas present, they are referred to as myomatosis. In some women myomatosis can cause no issues and be left untreated, however, if any problems present themselves, a surgery is required.

Causes:

Uterine myomatosis is the most common pelvic tumor, present in up to 40% of women in the age of 30-50. The tumor may be solitary, referred to as a myoma, but often there are multiple, known as myomatosis. It is a hormone dependent tumor, meaning that it is influenced by natural female hormones present during childbearing age and in menopause, when regular menstrual bleeding stops due to a decrease of female hormones production it tends to disappear on its own. Its exact causes are not yet understood however, genetic influences play a role as well.

Symptoms:

Myomatosis is not dangerous on its own, but it can cause issues to the woman, especially if it reaches larger dimensions. The most common symptoms is a strong and prolonged menstrual bleeding, which can cause anemia and tiredness and weakness as a result. Further symptoms can be a painful sexual intercourse, pain or pressure in the abdominal area and frequent urination, if the enlarged uterus pushes on the urinary tract. Myomatosis can also cause infertility. If it is present during pregnancy, the growth of myomas accelerated due to the increased amount of hormones and can complicate the course of pregnancy or be the cause of complications during birth. If you suffer from strong or irregular menstrual bleeding, weakness and tiredness after exertion, abdominal pain and other symptoms listed above, you need to visit your gynecologist as soon as possible.

Treatments:

If the uterine myomatosis causes no issues, it is possible to go without treatment and only undergo regular gynecological exams. In older women, who have significant issues, are on the verge of menopause and don’t plan any pregnancy, the entire uterus may be removed. This procedure is known as a hysterectomy. It is a surgery performed in a full anesthesia with several days of hospitalization. The uterus may be removed through the abdomen through an open incision, it can be removed laparoscopically or through the vagina. Laparoscopy is a method where the doctor makes several small openings to the abdomen. Through these holes, using and optical device and other tools he removes the uterus, watching the entire procedure on a monitor. The ovaries and fallopian tubes are usually left, as their function, tied to the production of hormones, is important. If the woman has already underwent menopause, these organs are removed as well. Other procedure is used for young women planning a child. In this case it is important to save the uterus and only remove the tumors that would prevent pregnancy. These are removed laparoscopically or hysteroscopically. Using hysteroscopy it is possible to observe the uterus’s inside as well as remove individual myomas.

Benign Fibrous Histiocytoma or Dermatofibromas  is a rare tumor of mesenchymal origin. First described in 1958 by Dahlin. They are composed of two cell types, namely atypical fibroblasts and histiocytes, arranged in a storiform pattern. Lipid-filled cells may be conspicuous and occasionally are the major component. These types of benign fibrous histiocytomas are known as xanthomas or fibroxanthomas. Benign Fibrous Histiocytomas are microscopically very similar to non-ossifying fibroma. It is essentially a non ossifying fibroma that grows in and unusual location or in an unusual age group.

Causes

Is it a Dermatofibroma or a Mole?

The cerebral cortex of the brain has 4 lobes on each side: the frontal lobe, the temporal lobe, the parietal lobe and the occipital lobe. Each of these regions carries out specific functions, and damage to any of these areas results in corresponding impairment. The frontal lobes are relatively large compared to other regions of the brain, and the extensive functions controlled by the frontal lobe reflects that large size.

Occipital Lobe Strokes:

Fig: branching point of the right middle cerebral artery (MCA) trunk (red circle), suspicious for thrombus or embolus.

Of the 4 major lobes of the brain, the occipital lobe is the smallest—but in our daily lives, we perhaps lean on it the most. The lobe is located at the back of the skull, thus the name (“occipital” comes from the Latin for “back of the head”).

The occipital lobe’s purpose is to receive visual stimuli from the eyes, process the information, and forward the information to the frontal lobe (which will formulate a response). Put simply, the occipital lobe controls our ability to respond to things we see. However, that role is far more complex than we may understand at first.

While sight is probably our most valued senses, it’s also the one that’s most taken for granted. Because we use our sight so instinctively, we often forget about how incredible our sight truly is. Take a second and look at an object in the distance. A simple task, yes?

Except in that split second it took you to pick an object, your brain not only focused your center of vision on it, but it processed its contour, distinguished it from the objects around it, located its distance away from you, identified its size relative to the objects around it, and probably understood its relative size to you.

That’s a great deal of information to receive and process correctly in a split-second, but it’s what your occipital lobe does thousands of times every day. All told, your “ability to see” is actually a series of abilities that is made possible by the different parts of the occipital lobe.

CONSCIOUS & UNCONSCIOUS PROCESSING

Because our understanding of the world around us leans so heavily on sight, we associate our ability to see with our conscious decisions. For example, there are laws nationwide that address the problem of distracted driving. Lawmakers are facing a whole new generation of people behind the wheel who do not place their complete, conscious focus on the road.

Now, Plasticity Brain Centers is certainly not recommending texting while driving or anything similar, but sight depends on far more than conscious attention. In addition to the things you are focusing on, the occipital lobe is constantly processing visual stimuli that you may not be consciously aware of. This can result in something truly remarkable known as “blindsight.”

SEEING /WITHOUT SEEING: DAMAGE TO THE OCCIPITAL LOBE:

The condition we call “blindness” has two possible, general causes. The common one we know of is caused by damage to the eyes themselves. Because the receptors are damaged, the functioning occipital lobe receives no stimuli, so the brain cannot formulate a response to the outside world. In some of these cases, the occipital lobe becomes an additional site of processing for aural stimuli—which is why blind people seem to have incredible hearing or can respond to obstacles through sound.

However, the less common cause of blindness is a result of damage to the occipital lobe. For example, lesions on the occipital lobe can result in a “hole” in your vision known as a scotoma. Extensive damage can result in total blindness. Unlike other lobes of the brain, damage to one side of the occipital lobe can result in damage to both eyes’ fields of vision.

However, in these cases, the eyes are still completely functional. They continue to receive information, except the occipital lobe is not processing it correctly. While this results in a kind of blindness, some processing can still occur that isn’t consciously understood. For example, studies have been conducted on patients who are blind in one eye due to occipital lobe damage. Despite not being consciously aware of what they are seeing, these patients were able to navigate obstacles or detect movement without perceiving what they were seeing.

Treatments 

Plasticity Brain Centers leverages the complex relationship between receptors (eyes, skin, tongue, nose, ears), stimuli, and their corresponding lobes (occipital, parietal, temporal, frontal) through clinical neuroscience. In other words, we use receptors of different kinds to create tests and targeted therapies for the damaged parts of our patients’ brains.

For damaged or underperforming occipital lobes, we employ visual stimuli such as eye movement training, visual search exercises, hand-eye coordination exercises, or light therapy to rebuild or create pathways between neurons. These pathways can bypass damaged tissue or rebuild old pathways in order to restore visual processing power.

Our therapies can improve a patient’s ability to perceive depth, distinguish objects from their surroundings, identify objects or people more quickly, and track objects with their sight more accurately. By understanding the state of your occipital lobe, we can more precisely identify why your sight is suffering and how we can restore function to the visual processing part of your brain.

Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia.

The hiatus is an opening in the diaphragm — the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus(food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

Leprosy is an infectious disease that causes severe, disfiguring skin sores and nerve damage in the arms, legs, and skin areas around the body. You can catch it only if you come into close and repeated contact with nose and mouth droplets from someone with untreated leprosy. Children are more likely to get leprosy than adults.

Fig: Leprosy on hand and leg

Causes: Leprosy is caused by a slow-growing type of bacteria called Mycobacterium leprae .

Symptoms:

Leprosy primarily affects the skin and the nerves outside the brain and spinal cord, called the peripheral nerves. It may also strike the eyes and the thin tissue lining the inside of the nose. The main symptom of leprosy is disfiguring skin sores, lumps, or bumps that do not go away after several weeks or months. The skin sores are pale-colored.

Nerve damage can lead to:

• Loss of feeling in the arms and legs
• Muscle weakness

It usually takes about 3 to 5 years for symptoms to appear after coming into contact with the leprosy-causing bacteria. Some people do not develop symptoms until 20 years later. The time between contact with the bacteria and the appearance of symptoms is called the incubation period. Leprosy’s long incubation period makes it very difficult for doctors to determine when and where a person with leprosy got infected.

Types of Leprosy:

• A mild, less severe form of leprosy. People with this type have only one or a few patches of flat, pale-colored skin (paucibacillary leprosy). The affected area of skin may feel numb because of nerve damageunderneath. Tuberculoid leprosy is less contagious than other forms.
• Lepromatous. A more severe form of the disease. It has widespread skin bumps nd rashes(multibacillary leprosy), numbness, and muscle weakness. The nose, kidneys, and male reproductive organs may also be affected. It is more contagious than tuberculoid leprosy.
• People with this type of leprosy have symptoms of both the tuberculoid and lepromatous forms.

Diagnosis:

Affected skin send it to lab for biopsy. A skin smear test may also be done. With paucibacillary leprosy, no bacteria will be detected. In contrast, bacteria are expected to be found on a skin smear test from a person with multibacillary leprosy. 

Treatments: 

Treatment depends on the type of leprosy that you have. Antibiotics are used to treat the infection. Long-term treatment with two or more antibiotics is recommended, usually from six months to a year. People with severe leprosy may need to take antibiotics longer. Antibiotics cannot treat the nerve damage.

Anti-inflammatory drugs are used to control nerve pain and damage related to leprosy. This may include steroids, such as prednisone. Patients with leprosy may also be given thalidomide, a potent medication that suppresses the body’s immune system. It helps treat leprosy skin nodules. Thalidomide is known to cause severe, life-threatening birth defects and should never be taken by women who are pregnant or women who may become pregnant. 

Leprosy Complications

Without treatment, leprosy can permanently damage your skin, nerves, arms, legs, feet, and eyes. Complications of leprosy can include:

• Blindness or glaucoma.
• Disfiguration of the face (including permanent swelling, bumps, and lumps).
• Erectile dysfunctionand infertility in men.
• Kidney failure.
• Muscle weakness that leads to claw-like hands or an inability to flex the feet.
• Permanent damage to the inside of the nose, which can lead to nosebleedsand a chronic, stuffy nose.
• Permanent damage to the nerves outside the brainand spinal cord, including those in the arms, legs, and feet.

Nerve damage can lead to a dangerous loss of feeling. A person with leprosy-related nerve damage may not feel pain when the hands, legs, or feet are cut, burned, or otherwise injured.

Spinal muscular atrophy (SMA) most often affects babies and children and makes it hard for them to use their muscles. When your child has SMA, there’s a breakdown of the nerve cells in the brain and spinal cord. The brain stops sending messages that control muscle movement.

When that happens, your child’s muscles get weak and shrink, and he can have trouble controlling head movement, sitting without help, and even walking. In some cases, he can have trouble swallowing and breathing as the disease progresses.

Woman with muscular atrophy

Diagnosis

SMA can sometimes be hard to diagnose because the symptoms may be similar to other conditions. To help figure out what’s going on, your doctor may ask you:

• Has your baby missed any developmental milestones, such as holding his head up or rolling over?
• Does your child have trouble sitting or standing on his own?
• Have you seen your child have trouble breathing?
• When did you first notice the symptoms?
• Has anyone in your family had similar symptoms?

Treatment

The FDA has approved one medication to treat SMA: nusinersen (Spinraza). Studies show it helps about 40% of people who use it by slowing down the advance of the disease and making people stronger.

Doctors inject nusinersen into the fluid around your child’s spinal cord. The procedure for the shot-including preparation and recovery time — can take at least 2 hours. Your child will need multiple shots.

Nusinersen is a type of gene therapy. It belongs to a group of drugs called antisense oligonucleotides that have small bits of man-made genetic material. They work by “modulating,” or adjusting, the SMN2 gene.

Everyone who has spinal muscular atrophy has at least one copy of the SMN2 gene, and some people have more. The SMN2 gene isn’t doing a good job of making a key protein that allows the cells that control muscles to work. Adjusting this gene can let it make more protein or a better-quality protein.

Besides adjusting the SMN2 gene, researchers are studying another type of gene therapy that involves replacing or correcting the SMN1 gene. Since spinal muscular atrophy is caused by a mutation — or change — in the SMN1 gene, doctors are checking to see if replacing or fixing it will treat the disease.