Monday, May 2, 2011
Osama Bin Laden Headshots
Yesterday American Forces found and killed Osama Bin Laden. Of course, throughout the world there are always skeptics, those who doubt that he was really found and that it was really he who was shot and killed. Well, apparently there are photographs taken after he was shot in the head that show his face recognizably but also show the bullet wound through or close to his eye that reveals blood and brain oozing out of the wound. Officials now question whether it would be too disturbing to the public to see these images. Even after years of having seen individuals with open head injuries with brain exposed, I am always disturbed by the sight. However, in my opinion it is less disturbing than the videos of beheadings, than the sight of young soldiers with dismembered limbs and life-long disfigurements, than the sight of innocent people having to jump to their certain death out of burning, collapsing buildings. We were forced to witness horrific carnage on September 11, 2001 and beyond. Seeing the mortal wounds of the mastermind behind all this demonic terror is far less disturbing than that which was witnessed by many millions on September 11, 2001. Those who do not want to see the image of Osama Bin Laden's mortal wounds don't have to look at them but for those who doubt and those who need confirmation to be able to move on with their lives, seeing is believing.
Sunday, February 20, 2011
Serena Branson and complex migraines
It turns out that after two days of extensive testing, Serena Branson's aphasia was diagnoses as a complex migraine. What she has stated in an interview is that she had not been feeling well with a sense of tiredness and the onset of a headache before the speech disturbance began. That was a big clue. Never-the-less a full work-up needed to be done, including MRI of the brain, MRA (MR angiography, looking at the blood vessels) of the neck and the brain, EKG and echocardiogram as well as blood tests. When it was found that all of these tests were normal than the symptoms could be utilized to make the final diagnosis.
So how could a migraine cause the symptome of speech dysfunction? First, the phenomenon of migraines needs to be understood. Fundamentaly, the arteries in the brain constrict in the first phase (prodromal phase) and then dilated. Though the constriction may cause some headache, the dilation phase is generally what causes the severe headache. When the blood vessels dilate, there can be a reduction in blood flow to the area of the brain most affected. Depending on which area is affected, symptoms related to that area develop. This is referred to as an aura. If it occurs in the occipital area which has to do with vision, then the aura will included symptoms such as seeing spots, flashing lights, zigzags or moving lines, like blades of a fan. This usually lasts minutes but can last up to almost an hour. If it affects the prefrontal gyrus which controls movement then there may be problems with movement of a limb or with the face. When it effects Broca's area in the base of the posterior frontal lobe, then, though the individual may know what they want to say, they can not get it out coherently. This is exactly what happened with Serena Branson. Many other symptoms may also occur such as tingling, confusion, even hallucinations. Following this aura, the migraine headache usually ensues but it may not always occur so when it is only the aura which is the significant symptom, it may be difficult to diagnose until other causes of the neurologic dysfunction are excluded. Rarely, the vasospasm and reduction in bloodflow can be so severe that a stroke can occur. When auras occur regularly and can be temporarily disabling then medication can be used such as inderal to limit these troubling events.
Those who suffer from these symptoms should meet with a neurologist to find the right treatment including avoiding triggers such as certain foods or even odors or scents.
So how could a migraine cause the symptome of speech dysfunction? First, the phenomenon of migraines needs to be understood. Fundamentaly, the arteries in the brain constrict in the first phase (prodromal phase) and then dilated. Though the constriction may cause some headache, the dilation phase is generally what causes the severe headache. When the blood vessels dilate, there can be a reduction in blood flow to the area of the brain most affected. Depending on which area is affected, symptoms related to that area develop. This is referred to as an aura. If it occurs in the occipital area which has to do with vision, then the aura will included symptoms such as seeing spots, flashing lights, zigzags or moving lines, like blades of a fan. This usually lasts minutes but can last up to almost an hour. If it affects the prefrontal gyrus which controls movement then there may be problems with movement of a limb or with the face. When it effects Broca's area in the base of the posterior frontal lobe, then, though the individual may know what they want to say, they can not get it out coherently. This is exactly what happened with Serena Branson. Many other symptoms may also occur such as tingling, confusion, even hallucinations. Following this aura, the migraine headache usually ensues but it may not always occur so when it is only the aura which is the significant symptom, it may be difficult to diagnose until other causes of the neurologic dysfunction are excluded. Rarely, the vasospasm and reduction in bloodflow can be so severe that a stroke can occur. When auras occur regularly and can be temporarily disabling then medication can be used such as inderal to limit these troubling events.
Those who suffer from these symptoms should meet with a neurologist to find the right treatment including avoiding triggers such as certain foods or even odors or scents.
Wednesday, February 16, 2011
Serena Branson's Speech Arrest
America witnessed a dramatic ezample of speech arrest or expressive aphasia when Serena Branson began speaking incoherently when reporting on the Grammies while on- air. According to news reports, her symptoms resolved within a few minutes at the most and she refused further medical assistance after the paramedics found her vital signs to be stable. There is great interest in knowing what could have caused a dramatic and sudden but thankfully brief loss of speech.
There are numerous possible causes of sudden aphasia that fully resolves. These include transient ischemic attacks, seizures, brain hemorrhages, low blood pressure, low blood sugar, multiple sclerosis and inflammatory conditions of the brain and blood vessels.
What comes to mind first is a transient ischemic attack (TIA). This is due to a brief reduction of blood flow to a portion of the brain but with resumption of adequate blood flow before damage to that area occurs. The reduction in blood flow can be due to a piece of "debris" breaking off a plaque in a narrowed, diseased artery in the neck or when there is such a high degree of narrowing of an artery in the neck or brain that briefly the blood flow through that artery is profoundly reduced. These events usually occur in individuals over the age of sixty. Another cause of TIA can be due to an abnormality in the heart such as an infection in the heart or an abnormal heart rhythm. In these instances a small piece of "debris" can be released from the heart into the blood stream and then into the brain. A TIA can also be caused by birth control pills, blood disorders and drugs such a cocaine. Inflammation of arteries, refered to as arteritis is another cause of TIAs.
TIAs are highly significant because they are often precurors of major strokes leading to permanent neurologic dysfunction. Therefore, it is important to diagnose the cause of a TIA and treat it appropriately and rapidly.
A focal seizure can present as a brief loss of neurologic dysfunction including a brief episode of aphasia as Serena Branson experienced. Again, there are numerous possible causes for the new onset of a seizure. A brain tumor, drug reaction, brain hemorrhage or low blood sugar are all possible causes of a focal seizure.
Even when someone recovers fully and feels well after an brief episode of aphasia, as apparently was the case with Serena Branson, the individual needs a full and careful medical evaluation. Not only do they need an MRI of the brain, which may, in fact, be normal but the arteries in the neck and the heart need to be fully evaluated. Additionally blood tests need to be performed. Without appropriate diagnosis and treatment, a permanent stroke could ensue or a minor hemorrhage in the brain could lead to a major hemorrhage. If a seizure has occured, a subsequent seizure might be more profound. The early stage of an infection such as encephalitis could become a life-threatening infection of the brain.
Certainly Ms. Branson will have a thorough medical evaluation and hopefully the cause of her episode of aphasia will be found to be readily treatable and she will not suffer future neurologic dysfunction.
There are numerous possible causes of sudden aphasia that fully resolves. These include transient ischemic attacks, seizures, brain hemorrhages, low blood pressure, low blood sugar, multiple sclerosis and inflammatory conditions of the brain and blood vessels.
What comes to mind first is a transient ischemic attack (TIA). This is due to a brief reduction of blood flow to a portion of the brain but with resumption of adequate blood flow before damage to that area occurs. The reduction in blood flow can be due to a piece of "debris" breaking off a plaque in a narrowed, diseased artery in the neck or when there is such a high degree of narrowing of an artery in the neck or brain that briefly the blood flow through that artery is profoundly reduced. These events usually occur in individuals over the age of sixty. Another cause of TIA can be due to an abnormality in the heart such as an infection in the heart or an abnormal heart rhythm. In these instances a small piece of "debris" can be released from the heart into the blood stream and then into the brain. A TIA can also be caused by birth control pills, blood disorders and drugs such a cocaine. Inflammation of arteries, refered to as arteritis is another cause of TIAs.
TIAs are highly significant because they are often precurors of major strokes leading to permanent neurologic dysfunction. Therefore, it is important to diagnose the cause of a TIA and treat it appropriately and rapidly.
A focal seizure can present as a brief loss of neurologic dysfunction including a brief episode of aphasia as Serena Branson experienced. Again, there are numerous possible causes for the new onset of a seizure. A brain tumor, drug reaction, brain hemorrhage or low blood sugar are all possible causes of a focal seizure.
Even when someone recovers fully and feels well after an brief episode of aphasia, as apparently was the case with Serena Branson, the individual needs a full and careful medical evaluation. Not only do they need an MRI of the brain, which may, in fact, be normal but the arteries in the neck and the heart need to be fully evaluated. Additionally blood tests need to be performed. Without appropriate diagnosis and treatment, a permanent stroke could ensue or a minor hemorrhage in the brain could lead to a major hemorrhage. If a seizure has occured, a subsequent seizure might be more profound. The early stage of an infection such as encephalitis could become a life-threatening infection of the brain.
Certainly Ms. Branson will have a thorough medical evaluation and hopefully the cause of her episode of aphasia will be found to be readily treatable and she will not suffer future neurologic dysfunction.
Sunday, August 22, 2010
Whiplash and Brain Injury, Part 1
Whiplash can cause brain injuries
Part 1 of 2 Part blog
I am proud to be a co-author of an study published in the medical journal, Brain Injury that describes a change in the brain of a significant number of individuals who have suffered a whiplash injury.
Patients who have not suffered demonstrable injury to their spine often, over time, have been considered to have no clear cause of their symptoms. Many have been felt to have unsubstantiated injuries and that their symptoms were either psychological or for secondary/monetary gain.
In 95% of normal individuals, the cerebeller tonsils, a part of the brain that sits in the back of the skull and controls coordination, rests above the opening at the bottom of the skull (where the spinal cord passes from the brain into the spine). In 5% of individuals, these cerebeller tonsils can project through the opening (foramen magnum)--essentially meaning that part of the brain dips into the top part of the neck. This condition is know as cerebeller ectopia or Chiari malformation. This may cause multiple symptoms including headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.
20% who have whiplash have Chiari malformation, study says.
This study has demonstrated that over 20% of individuals who experienced a whiplash injury have cerebeller tonsils below the foramen magnum when an MRI is performed with the individuals in the sitting position. Individuals who do not have a whiplash injury do not show a drop of the cerebeller tonsils in the sitting position.
It is uncertain whether this finding is a causative factor for any of the symptoms of the whiplash syndrome or if the same trauma that caused this brain injury can caused other, yet to be defined injuries that lead to the painful symptoms.
Further study is needed before we can say whether surgical intervention is warranted in these cases of cerebeller ectopia.
Speak to your doctor if you've had whiplash, or suffer from persistent headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.
Part 1 of 2 Part blog
I am proud to be a co-author of an study published in the medical journal, Brain Injury that describes a change in the brain of a significant number of individuals who have suffered a whiplash injury.
Patients who have not suffered demonstrable injury to their spine often, over time, have been considered to have no clear cause of their symptoms. Many have been felt to have unsubstantiated injuries and that their symptoms were either psychological or for secondary/monetary gain.
In 95% of normal individuals, the cerebeller tonsils, a part of the brain that sits in the back of the skull and controls coordination, rests above the opening at the bottom of the skull (where the spinal cord passes from the brain into the spine). In 5% of individuals, these cerebeller tonsils can project through the opening (foramen magnum)--essentially meaning that part of the brain dips into the top part of the neck. This condition is know as cerebeller ectopia or Chiari malformation. This may cause multiple symptoms including headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.
20% who have whiplash have Chiari malformation, study says.
This study has demonstrated that over 20% of individuals who experienced a whiplash injury have cerebeller tonsils below the foramen magnum when an MRI is performed with the individuals in the sitting position. Individuals who do not have a whiplash injury do not show a drop of the cerebeller tonsils in the sitting position.
It is uncertain whether this finding is a causative factor for any of the symptoms of the whiplash syndrome or if the same trauma that caused this brain injury can caused other, yet to be defined injuries that lead to the painful symptoms.
Further study is needed before we can say whether surgical intervention is warranted in these cases of cerebeller ectopia.
Speak to your doctor if you've had whiplash, or suffer from persistent headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.
Sunday, August 8, 2010
Cross-word
Cross-word
After the craniotomy to remove the enormous
Blood clot in the brain of this octogenarian
The children remained in the waiting room,
Allowing their parents a moment of privacy.
As he remained unresponsive,
His wife approached his side and spoke to him,
“I have been doing the cross-word puzzle without you.
It’s a good thing it’s Monday.”
He awoke on Tuesday.
A blood-clot to his lungs killed him on Friday.
Sunday the cross-word puzzle was no doubt
Excruciatingly difficult
But she certainly completed it
For what else was she to do?
Ezriel Kornel
2/8/05
After the craniotomy to remove the enormous
Blood clot in the brain of this octogenarian
The children remained in the waiting room,
Allowing their parents a moment of privacy.
As he remained unresponsive,
His wife approached his side and spoke to him,
“I have been doing the cross-word puzzle without you.
It’s a good thing it’s Monday.”
He awoke on Tuesday.
A blood-clot to his lungs killed him on Friday.
Sunday the cross-word puzzle was no doubt
Excruciatingly difficult
But she certainly completed it
For what else was she to do?
Ezriel Kornel
2/8/05
Sunday, August 1, 2010
What it takes to be an excellent neurosurgeon
I proctor pre-med students during winter and summer breaks and one of the students asked me an interesting question the other day, what does it take to be a good neurosurgeon? Well, first of all, you want, not a good neurosurgeon but an excellent one. So, what does it take to be an excellent neurosurgeon?
The first thing that is crucial and without which the rest would not matter, is judgment. A neurosurgeon needs to be able to establish a diagnosis and then determine when surgery is necessary, when it is not and what other treatment options are available. Once that is established they need to decide what operation is best for each individual patient and their particular condition. It is also of great importance and a matter of judgment that a surgeon be confident in their decision and in their capability in performing a particular procedure. They should be willing to confer with colleagues to help with decision-making and should be able to turn to other colleagues to assist with surgery. Should another colleague have greater expertise in a particular operation, the excellent neurosurgeon should refer the patient to that physician.
Secondly, the neurosurgeon needs to have the surgical skills to be able to perform these operations. Generally, well-trained neurosurgeons who have completed an accredited training program and have become board-certified possess the requisite skills. But, in truth, just as some professional musicians are greater virtuosos then others, the same applies to surgeons. It is a strange gift that skilled surgeons possess, just as certain musicians, artists, mathematicians and writers are more gifted. In fact, I believe everyone has a gift, they just need to recognize where that gift lies, acknowledge it and express it.
Thirdly, an excellent neurosurgeon needs to have great confidence without manifesting a huge ego. They need to know that they can do the job. Anxiety in surgery can interfere with the best results. However, a big ego will prevent anyone from obtaining advice from others and will make them incapable of listening to constructive criticism. They are less likely to learn from their mistakes (and everyone makes mistakes at one time or other, being human after all and not divine.)
Being patient is another skill that neurosurgeons need to possess. If they make a decision too quickly they may perform unnecessary or even dangerous surgery. Sometimes patience allows a problem to manifest or resolve itself in a different manner. With prudent waiting surgery may not be necessary or a different procedure may be deemed appropriate.
Respect and compassion for their patients is another quality that an excellent neurosurgeon should possess. When this is present, a good bed-side manner is always manifest. This needs no further amplification.
Finally, an excellent neurosurgeon must have love and passion for their work. Nobody wants a neurosurgeon who is eager to get you out of the door, or rush to leave their side when lying in a hospital bed or to rush to get through the day. Though neurosurgeons have a life outside of the operating room with families, friends and other interests they should always feel a deep gratification when performing their work. When they are in the operating room all their attention and focus should be on the surgery they are performing.
When all these qualities are evident, you are most likely to experience the best results possible and the quickest and most complete resolution of your illness.
The first thing that is crucial and without which the rest would not matter, is judgment. A neurosurgeon needs to be able to establish a diagnosis and then determine when surgery is necessary, when it is not and what other treatment options are available. Once that is established they need to decide what operation is best for each individual patient and their particular condition. It is also of great importance and a matter of judgment that a surgeon be confident in their decision and in their capability in performing a particular procedure. They should be willing to confer with colleagues to help with decision-making and should be able to turn to other colleagues to assist with surgery. Should another colleague have greater expertise in a particular operation, the excellent neurosurgeon should refer the patient to that physician.
Secondly, the neurosurgeon needs to have the surgical skills to be able to perform these operations. Generally, well-trained neurosurgeons who have completed an accredited training program and have become board-certified possess the requisite skills. But, in truth, just as some professional musicians are greater virtuosos then others, the same applies to surgeons. It is a strange gift that skilled surgeons possess, just as certain musicians, artists, mathematicians and writers are more gifted. In fact, I believe everyone has a gift, they just need to recognize where that gift lies, acknowledge it and express it.
Thirdly, an excellent neurosurgeon needs to have great confidence without manifesting a huge ego. They need to know that they can do the job. Anxiety in surgery can interfere with the best results. However, a big ego will prevent anyone from obtaining advice from others and will make them incapable of listening to constructive criticism. They are less likely to learn from their mistakes (and everyone makes mistakes at one time or other, being human after all and not divine.)
Being patient is another skill that neurosurgeons need to possess. If they make a decision too quickly they may perform unnecessary or even dangerous surgery. Sometimes patience allows a problem to manifest or resolve itself in a different manner. With prudent waiting surgery may not be necessary or a different procedure may be deemed appropriate.
Respect and compassion for their patients is another quality that an excellent neurosurgeon should possess. When this is present, a good bed-side manner is always manifest. This needs no further amplification.
Finally, an excellent neurosurgeon must have love and passion for their work. Nobody wants a neurosurgeon who is eager to get you out of the door, or rush to leave their side when lying in a hospital bed or to rush to get through the day. Though neurosurgeons have a life outside of the operating room with families, friends and other interests they should always feel a deep gratification when performing their work. When they are in the operating room all their attention and focus should be on the surgery they are performing.
When all these qualities are evident, you are most likely to experience the best results possible and the quickest and most complete resolution of your illness.
Wednesday, July 28, 2010
Quiet Hero
Rita Cosby was my special guest on BackTalkLive this past Sunday. Though the show deviated a bit from its usual format, I found what Rita had to share with us about her Dad and his experiences in WWII to be profoundly significant. Of course, since my father, like hers, was from Poland and experienced the horrors of the Nazi invasion, we felt an immediate bond. However, her father and mine had very different experiences. While my father at sixteen fled his small town with his uncle towards Russia and survived in a labor camp there, Rita's father, living in Warsaw joined the underground as a resistance fighter. His story is fascinating and among other things, reveals how people can tolerate great pain when they have a higher, meaningful goal. However, the long-term effects of that pain can lead to psychological problems later in life. I found the book "Quiet Hero, Secrets of my Father's Past" hard to put down, enlightening about a very dark time in the world's history (not so long ago) and profoundly moving. It is beautifully written in a very engaging manner. I urge you to pick up a copy of this book right away. I have no doubt you will find it to be an important addition to your library.
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