Tumors of the central nervous system( brain, spine) - Causes, symptoms and treatment. MF.

Tumors of the brain - a group of intracranial formations, different in composition of the cells that form them, along the flow, location, growth, but with equally severe course and prognosis. Non-operated patients, all without exception, are doomed to perish.

Located in a limited cranial cavity, a growing tumor either shifts the structures of the brain, or sprouts in them, disrupting the vital organ. The causes of tumor development and triggering mechanisms of uncontrolled cell growth are unknown. Recently, there has been an increase in the number of diseases. The role is played by age, family history, radiation, exposure to chemicals in the workplace( for example, in the oil refining industry).

Classification of tumors by cellular composition:

1. Neuroectodermal - gliomas:
a) benign;
b) malignant:
- mature( medulloblastoma)
- immature( spongioblastoma)
2. mesodermal;
3. pituitary - adenomas of the pituitary gland;
4. - heterotopic;
5. - metastatic - more often with carcinoma of the lungs, breast, gastrointestinal tract, thyroid gland, melanoblastoma skin;

6. - infectious granulomas and parasitic processes.

Tumors can be extra-cerebral - meningiomas, neurinomas and intracerebral - gliomas.

Course:

- tumorous course - slow gradual appearance and growth of symptoms, focal, associated with compression of the brain tumor and symptoms of increased intracranial pressure;
- vascular - acute onset of a stroke, possibly with a hemorrhage into a tumor;
- epileptiform - an acute onset with the development of an epileptic fit;
- inflammatory course - slow development of symptoms by the type of meningoencephalitis - inflammation of the brain and its membranes;
is an isolated cerebrospinal fluid.

In the clinical course, there are:

1- The phase of clinical compensation - characterized by asthenic syndrome - weakness, fatigue, emotional disorders - nervousness, irritability. The doctor practically does not reveal either focal, or general cerebral symptoms.

2- The phase of clinical subcompensation is characterized by a partial disruption of labor and household adaptation with a general satisfactory condition. In this phase, the diagnosis is timely. The neurologist discovers the phenomena of irritation - various disorders of sensitivity - paresthesia, hyperpathy, epipriposition, hallucinatory phenomena. Syndromes of loss of functions are not pronounced, mainly a difference in tendon reflexes, asymmetric disorders of sensitivity - numbness, sometimes a decrease in muscle strength - paresis. Among cerebral symptoms - headaches, moderate, at night and poutram. At examination at the oculist the normal still an eye fundus or the initial phenomena of a stagnation of disks of an optic nerve is defined or determined.

3- The phase of mild clinical decompensation is characterized by a complete or almost total disruption of labor and significantly reduced household adaptation of the patient. General condition of moderate severity. In the clinical picture, the headache increases, accompanied by nausea and vomiting, inhibition appears. Symptoms of loss of functions prevail over symptoms of irritation. Pareses and paralysis are defined, speech, swallowing, orientation, and criticism are possible.

4- The phase of severe clinical decompensation - a serious condition of the patient, bed sick. Frequent and severe headaches with vomiting, impaired consciousness of varying severity. It is possible to develop a secondary dislocation syndrome-the defeat of the oculomotor nerves-upward paresis, different pupil sizes( anisocoria), violation of the visual fields, bilateral pathological signs, meningeal signs, dysfunction of the cardiovascular system and respiration, speech disorders, swallowing. In this stage, diagnosis is considered to be belated.

5- Terminal phase - gross disorders of basic vital functions, impaired consciousness to coma, severe cardiovascular system, pathological breathing, fever - hyperthermia, changes in muscle tone. Possible hemorrhage in the tumor, cerebral edema, dislocation of the brain. Lasts hours - days - the state is irreversible.

Symptoms of tumor growth:

1. Brain cerebral symptoms are symptoms of increased intracranial pressure as a result of compression of arteries and veins, cerebrospinal fluid, cerebral edema as a result of toxic effects of tumor products and symptoms of impairment of higher nervous activity as a result of disruption of connections between the cortex and subcortical structures. The patient feels a headache - a bursting, often appearing in the second half of the night and towards the morning and diminishing towards the evening. At the height of the headache, nausea and vomiting appear. The patient is disturbed by the psyche - a state of inhibition, deafness, distraction.
There are meningeal signs, epileptic seizures are possible.
2. Focal symptoms - nesting - due to the immediate location of the tumor;
3. Symptoms in the neighborhood - the tumor grows and squeezes surrounding tissues;
4. Symptoms are remote - as a result of compression of the brain and displacement of structures.

Meningiomas are usually benign tumors, develop from the endothelium of the meninges and are characterized by slow growth. More often this is one node, fused with the dura mater, well delimited from the brain substance, which they push aside, forming a place for themselves. Sometimes cysts are formed. Most often appear along the venous vessels.

Meningioma of the optic nerve, infiltrating the soft tissues of the orbit

Meningosarcoma are malignant tumors with germinating growth, necrosis and decay, without capsules.

Astrocytomas are relatively benign tumors from macroglial cells( astrocytes).Characterized by slow growing sprouts, without clear boundaries, are prone to the formation of cysts.

Glioblastomas - malignant tumors from macroglial cells, are characterized by rapid germinating growth with decay, epipripeds, massive disorders of the psyche.

Glioma of the brain

Depending on the location( location) of the tumor, various neurological symptoms are possible.

Tumors of the frontal lobe are manifested by mental disorders, epileptic seizures, impaired innervation of mimic muscles, speech. The patient is indifferent( apathetic), reduced criticism to his condition, can commit absurd actions, do not navigate in place and time.

The temporal lobe of the brain is the epileptogenic zone. For epipripeds of this localization, the aura( harbingers of attack) is characteristic - auditory, olfactory, gustatory. The aura is often negative - smells of putrefaction, intimidating visual visions, perhaps "shining" before the eyes. The field of vision is broken - areas of the review fall out - quadrants, halves( hemianopsia).

The defeat of the parietal lobe of the brain gives a violation of complex types of sensitivity - the joint-muscular sense( the patient can not determine which finger is taken into the arm where it is tilted), the feeling of discrimination( can not determine how many times the doctor touched the paralyzed limb and blunt object or acute)the sense of weight disappears, the opportunity to count, write, speak, read is lost.

The occipital lobe is a visual analyzer. With tumors, visual hallucinations are possible, sparks in front of the eyes, visual field disturbances, and blindness in case of bilateral damage.

When the cerebellum is affected, there are violations of statics, coordination - the patient falls, hyperkinesis( twitching), handwriting changes.

Pituitary tumors are neuroendocrine tumors characterized by visual and endocrine disorders. Adenomas can be hormonally inactive and hormonally active, that is, intensively produce hormones - prolactin, somatotropin, corticotropin. With increased production of prolactin, gynecomastia appears in men - the mammary glands grow, there are discharge from them, libido and potency decrease, women develop lactorrhea( milk is allocated), the menstrual cycle is disrupted. With an excess of growth hormone( growth hormone), acromegaly develops-facial features gradually change-the nose, the superciliary arches, the chin, the brushes and feet grow.

Increase of feet in acromegaly

With increased secretion of corticotropin, a serious disease develops - Itenko-Cushing's - high blood pressure, especially obesity of the face, neck, thighs.

Brainstem disease is characterized by the development of alternating symptoms when the craniocerebral nerves are affected on the side of the tumor, and motor and sensory disturbances appear on the opposite side. At the same time, speech, swallowing, cardiovascular and respiratory activities are disrupted.

Not all possible symptoms are enumerated, but most often there are their combinations. Everything happens individually, depending on the location of the tumor process and its development.

The main thing for timely diagnosis and treatment is to consult a neurologist. The emergence of systematic headaches of the same type, changes in mood, behavior, intellectual abilities, loss of consciousness, visual impairment, visual fields, double vision, sensitive disorders and muscle weakness should lead you to a survey.

Necessary examinations:

- general clinical and biochemical blood tests;
- for suspected adenoma of the pituitary - tests to determine the level of hormones;
- examination of the ophthalmologist - eye fundus, determination of visual fields;
- electroencephalography;
- radiography;
- lumbar puncture;
- computed tomography and magnetic resonance imaging;the most qualitative diagnostics with contrasting, the most sensitive are magnetic resonance tomographs with magnetic field induction of 1.5 Tesla;

This is how a magnetic resonance tomograph

- consultation of a neurosurgeon, angiography.

In addition, a comprehensive examination of the patient is conducted to exclude the possible metastasis of the tumor and the presence of foci in other organs. According to the appointment of a neurosurgeon, angiography can be performed.

Treatment of brain tumors

Treatment - prompt. The neurosurgeon determines the necessity, possibility and scope of the operation. The removed tumor undergoes a histological examination to confirm the diagnosis. Depending on the histological diagnosis, questions of the need for radiotherapy and chemotherapy after surgery are being addressed. For brain tumors, mainly remote gamma-therapy is used. Depending on the type of tumor, the oncologist and the radiologist compose different schemes and doses of radiation therapy and chemotherapy.

Modern "Gamma Knife" centers conduct effective non-invasive removal of deep-located brain tumors. In Russia, the "Gamma Knife" centers are located at the Scientific Research Institute of Neurosurgery named after N. Burdenko.in Moscow, in the center of radiosurgery in St. Petersburg. In Ukraine, in Kiev - Cyber ​​Clinic Spizhenko - the center of radiosurgery Cyber ​​Knife.

Cyberknife

Treatment of adenomas of the pituitary gland is minimally traumatic, it is performed transnally, but also requires the observation of an endocrinologist, gynecologist, sex therapist, andrologist to correct hormonal disorders.

Tumors of the spine and spinal cord:

1. Metastatic - more often from the lungs, mammary glands, prostate, ovaries, kidneys - the body and vertebrae are more often affected;
2. Extramedullary tumors - by location there are subdural( meningiomas, neurinomas, vascular tumors), tumors from the dura mater;extradural( fibromas, lipomas, sarcomas, neurinomas), primary tumors growing from the vertebrae - osteomas;intramedullary tumors( glial, epipdymoma);extramedullary.

The clinical picture depends on the nature of the tumor, its location, growth, influence on the surrounding tissues - vessels, nerve roots, spinal cord, brain membranes, venous collectors, pain syndromes often present with sensory and motor impairments. A neurologist can detect radicular syndromes and spinal cord involvement syndromes when examined. Perhaps the first acute appearance of the symptoms of a tumor by the type of spinal stroke. Depending on the symptomatology found and the alleged topical lesion, the doctor appoints the necessary studies and consultations of specialists.

It is impossible and unacceptable to engage in self-diagnosis and even more self-medication. If there are any violations of health, systematic pain, you need to come to the doctor and talk about your symptoms. With late treatment, large tumor size, its deep location, germination in vital structures, surgical treatment can already be impossible.

Doctor's consultation on brain tumors

Question: Are there any contraindications for conducting magnetic resonance therapy?
Answer: Yes - the presence of a pacemaker, ferromagnetic and electronic ear implants, large metal implants and fragments, an installed Ilizarov apparatus, hemostatic clamps on the vessels of the brain.

Question: which examination is better for making a computer or magnetic resonance imaging?
Answer: This is decided by the attending physician, sometimes both studies need to be done to clarify the diagnosis, as they complement each other.

Question: What is the effectiveness of the treatment?
Answer: only time evaluates the effectiveness of treatment - the longer the tumor does not grow - the more effective the treatment is.

Doctor neurologist Kobzeva S.V.