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Subarachnoid haemorrhage (SAH) affects a person suddenly and spontaneously
without any warning. The haemorrhage is a leakage of blood over the
surface of the brain from a major blood vessel. SAH causes the sufferer
to develop a very sudden and severe headache, which is often accompanied
by nausea, vomiting, neck stiffness and perhaps collapse, seizure and
loss of consciousness. For 15% of those who suffer SAH, the cause of
the haemorrhage is unclear and cannot be identified.
In approximately 70-75% of cases, however, the leakage occurs at a weakness
in the wall of the blood vessel. When the weak vessel wall begins to
bulge outwards, it forms an aneurysm. Currently we do not know what
causes aneurysms to develop or to rupture but we do know that 1% of
the population have them and are not troubled by them.
Approximately 30% of patients have more than one aneurysm. Ruptured
aneurysms pose a much greater risk than those that have not ruptured
so there is no urgency to treat an aneurysm that has not bled. It is
not always wise to treat this kind of aneurysm at all. The issue will
be discussed with you at your follow up appointment.
There is no evidence that stress of any kind plays any part in this
condition. There is also evidence to suggest that this condition is
hereditary.
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An AVM is an abnormal tangle of blood vessels that
alters the regular flow of oxygenated blood to the affected area of
the brain, this results in a lack of nutrition in that specific area.
The two most common problems caused by AVMs are :
- A rupture of one of the blood vessels, resulting in haemorrhage.
- Pressure against the surrounding brain, resulting in seizures.
The cause of most AVMs is still unknown, they may be caused by the
abnormal development of blood vessels before birth, but AVMs are not
thought to be hereditary and family members are at no increased risk.
Surgery - the aim being to totally remove the AVM.
Stereotactic Radiosurgery - this involves the very accurate localisation
of X-rays and gamma rays to treat the AVM. It does not involve open
surgery.
Endovascular Treatment (also know as "Coiling") - this involves
the embolisation (plugging) of the blood vessels of the AVM under X-ray
guidance. This is done with special coils known as GDC (Guglielmi Detachable
Coils). This procedure again does not involve open surgery.
If you need more information or are just hoping to talk to someone about
AVM, ring the BASIC HELPLINE 0870 7500 000
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The brain is made up of two sorts of cells:
1. Neurones or nerve cells - these send electrical impulses to and from
various parts of the body. They may make muscles contract and produce
movement (motor neurones) or convey sensation from all over the body
(sensory neurones). These cells also control the higher mental functions
such as memory, concentration, personality, ideas etc.
2. Glial cells are the supporting cells; these provide a skeleton or
framework for the neurones.
The brain itself is covered by three membranes (the meninges).
Primary Tumours are those that arise from the brain cells (neurones),
the skeletal or supporting cells (glial cells ) , the nerve coverings
or the membranes covering the brain.
Secondary Tumours are those that arise in other parts of the body and
spread (metastasise) in the blood stream to the brain.
There is, as yet, no explanation for the occurrence of a primary brain
tumour. The reason why some tumours are benign and others malignant
also remains elusive. Unlike lung cancer, where smoking has been heavily
implicated, there are no identifiable risk factors that contribute to
the development of a brain tumour and therefore there is nothing that
can be done by adjusting one's life-style to reduce the risk.
The vast majority of tumours are not inherited, nor can they be passed
on to future generations.
A tiny minority of brain tumours are related to an abnormal gene which
may be passed onto children. This is exceptionally rare and your doctor
will have certainly informed you.
The spread of cells from a primary tumour elsewhere in the body may
produce "secondary deposits" in the brain.
The symptoms depend largely on which part of the brain the tumour
affects. They can also vary greatly from person to person. Some of the
more common symptoms are:
HEADACHE - This occurs irrespective of the location
of the brain tumour. The headache will frequently be worse in the mornings
and may be associated with vomiting.
PROBLEMS AFFECTING ONE SIDE OF THE BODY - Lack of coordination,
unsteadiness, numbness, tingling or weakness.
VISION
Loss of part of the visual field, difficulty focusing or double vision.
SPEECH - Often speech may be slurred or more commonly
jumbled. This word-jumbling is known as dysphasia and can be very frustrating
and upsetting for the sufferer.
EPILEPSY - A brain tumour may interfere with the electrical
transmission of messages from the brain to other parts of the body.
This interference may result in the shaking of one part or the whole
of the body when the person may lose consciousness.
MEMORY - depending on where the brain tumour is situated,
a person may generally become more forgetful. In some cases this forgetfulness
can be so severe that it is not possible to remember the previous day's
events or future plans.
BEHAVIOUR- A brain tumour may cause changes in a person's
behaviour. He may become unable to carry out even simple domestic tasks.
A person may also behave inappropriately at home or in social settings
and not be aware that their behaviour is in any way abnormal.
Please understand that we have mentioned common symptoms, any or all
of which can occur without any underlying tumour. Some patients with
tumours suffer all, some or even none of these symptoms. Even after
successful treatment, some symptoms may persist.
If you experience a combination of the above symptoms, the first step
is to seek medical advice. If after all other medical explanations have
been explored your doctor thinks there is a need for a further opinion
you may be sent to see a neurologist or a neurosurgeon. The first indication
that some sort of tumour is present is nearly always on a CT or, less
commonly a MR scan.
CT (Computerised Topography) scan: This is a special type of X-ray which
can identify the site and extent of the tumour. The injection of colourless
dye into a vein may enhance the images produced.
MR (Magnetic Resonance) scan: This is another means of providing images
of the brain and any tumour that may be present. An MR scan uses magnetic
fields rather than X-rays. An injection of a colourless dye may enhance
the images.
For many tumours there are three different forms of therapy:
SURGERY: The aim of surgery is to remove as much of
the tumour as possible without damaging the surrounding healthy brain
tissue. The success of this depends upon the location and type of tumour.
In cases where the tumour cannot be fully removed without causing serious
disability, as much tumour as is judged safe is removed. Although a
provisional diagnosis of the type of tumour can be made by the neurosurgeons,
a small piece of tumour (biopsy) is sent away to provide a more accurate
diagnosis and to guide further treatment.
RADIOTHERAPY: This is the use of high energy X-rays
or gamma rays to destroy the tumour cells left behind by the neurosurgeon.
This treatment will not harm the surrounding healthy brain cells, but
a great deal of care is taken to ensure the normal brain cells absorb
as little of the radiation as possible. The side effects of radiotherapy
treatment include hair loss particular to the irradiated area, tiredness
and nausea. This treatment is painless. Radiotherapy is given in a different
department or hospital from the surgical treatment, and any further
questions you have will be answered by the consultant radiotherapist
in charge of your treatment.
CHEMOTHERAPY: This is the use of drugs to kill tumour
cells. There are many different types of chemotherapy. Nearly all are
administered into veins via a drip, though some of these drugs may be
taken by mouth or by injection. The side effects of chemotherapy vary
considerably depending on the type of drug used and as with radiotherapy
you should ask the consultant in charge of your particular case. Even
so there will be side effects, such as nausea, lethargy, thinning of
the blood, hair loss and increased susceptibility to infection.
Any brain operation will affect your eligibility to drive. You are
legally obliged to notify the DVLC in Swansea of your condition and
must not drive until you have DVLC approval. Your right to drive will
only be legally approved by DVLC after they have contacted your G.P.
and your consultant neurosurgeon and received assurances that the tumour
is unlikely to cause further adverse symptoms. More detailed information
can be obtained by contacting the DVLC directly
Most sports can be safely resumed once you have fully recovered. Any
sport which may involve blows to the head, such as boxing or rugby,
should be permanently avoided. If you have any worries please ask a
member of your medical team.
The time when you can resume work depends upon the job you do. The best
advice is to follow your own instincts. Many people return on a part
time basis and then gradually increase their hours. Resuming work makes
many people feel better as this is a major step to resuming a normal
life.
After the wound has healed, feel free to wash your hair as normal. However,
after radiotherapy you should only use a very mild baby shampoo for
the first six months after treatment.
Obviously any disruption to the functioning of the brain can cause physical
problems. Often overlooked is the effect that this disruption has on
the emotional functions of the brain. Having any brain surgery is a
life experience and often it is difficult to cope with this change of
lifestyle. It is likely that there is a neuropsychologist attached to
the ward where you had your treatment and she will be more than happy
to help with any emotional or psychological problems you may experience.
If you are having or think you may have financial problems you may become
eligible for several different benefits. There is very likely to be
a social worker attached to the unit where you are receiving treatment
and you should certainly seek her advice as soon as possible. If this
is not possible your local Citizens Advice Bureau will be happy to help.
Some of the benefits you may be able to claim are:
- Incapacity Benefit (formerly Invalidity Benefit)
- Disability Living Allowance
- Income Support
The diagnosis of a brain tumour naturally causes a great deal of anxiety
and worry for both the sufferer and relatives. If you have any worries,
however small, contact your Neurosurgical Unit or your G.P. Often just
having the correct information will put your mind at rest. If your tumour
is malignant, there are people who are specially trained to offer help
and support. These are called the MacMillan Nurses and can be either
contacted through the hospital or referral from your G.P. If you are
experiencing practical problems, your local district nurse, occupational
therapist or physiotherapist may be able to help. Contact your G.P.
if you feel that they could be of assistance. When you leave hospital
and return home, you may feel quite isolated and frightened by not having
doctors and nurses at hand. REMEMBER there are people to help and support
you during this difficult time.
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