Transcript of The brain is the major control center of a person’s body and mind. It is where ideas, senses,...
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- The brain is the major control center of a persons body and
mind. It is where ideas, senses, reflexes and movements originate.
The human brain is extremely complex, but can be roughly organized
into different structures that are responsible for different
tasks.
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- Cerebral Cortex - The largest, most familiar part of the brain
-Divided into left and right cerebral hemispheres that control the
opposite sides of the body -responsible for reading, speech,
thinking, learning, emotions, and reactions to senses. - Can be
divided into more specific areas
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- Divisions of the Cerebral Cortex Frontal Lobe- gives you the
ability to choose right from wrong, use correct social responses,
and retain long term memories Temporal Lobe involved with speech,
memory and hearing Occipital Lobe processes visual stimuli Parietal
Lobe processes information to help with spatial orientation,
manipulation of objects and understanding numbers
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- Inner Brain The inner brain lies beneath the cerebral cortex
and works as a connection between the cerebral cortex and the
brainstem. Its structures determine our emotional state,
consciousness, perceptions and reflexes.
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- Inner Brain Structures Thalamus processes information from the
cortex and plays an important role in consciousness Hypothalamus
Links the nervous system to the endocrine system, which makes it a
major control center for emotions Hippocampus Responsible for
memory formation and storage Pituitary Gland Controls hormone
secretion
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- Inner Brain Structures Basal Ganglia A collection of nuclei
that provide connections between the cortex, thalamus, and
brainstem. These connections are involved with movement
coordination, executing voluntary movements, perception, learning
and memory. Olfactory Bulb Involved with smell. Amygdala Controls
emotions, especially by forming emotional memories, and is also
responsible for long-term memory.
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- Brain Stem Responsible for essential life functions and relays
information between the brain and the rest of the body Midbrain
Controls reflexes and movement. Pons - Responsible for breathing
and arousal, and also coordinates movement information between the
cortex and cerebellum. Medulla Maintains autonomic functions like
breathing, blood pressure, and heart rate.
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- Cerebellum Detects surroundings and coordinates movements to
respond to specific situations
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- Important Links Brain Anatomy (for fun) 3-D Brain Anatomy
http://anatomyarcade.com/games/wordsearch/nervou
sWS/nervousWordsearch.html
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- Question What are the 4 main lobes of the Cerebral Cortex? What
actions is the Cerebral Cortex responsible for?
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- Answer: The Cerebral cortex is responsible for: Frontal lobe
Long term memories, social interaction Parietal lobe Spatial
orientation, object manipulation Occipital lobe Processing visual
stimuli Temporal lobe Involved in speech, memory, and hearing
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- Meninges The brain is a floating network of cells suspended in
Cerebrospinal fluid (CSF). The CSF is produced by ependymal cells
and circulates through the ventricles and meninges. The meninges
cover the brain and attach it to the skull.
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- Meninges We have 3 Meninges Dura Mater The tough layer next to
the skull Arachnoid Mater The middle layer that is made up of
web-like projections that connect the two other layers and allows
CSF to flow through Pia Mater The thinnest layer that lies closely
against the brain
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- Ventricles There are four ventricles The paired lateral
ventricles Third Ventricle Fourth Ventricle They are cavities in
the brain that carry and promote the flow of cerebrospinal
fluid
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- Question: What are the three Meninges? What flows through the
Meninges What are the big cavities in the brain that hold this
fluid?
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- Answer Dura Mater, Arachnoid Mater, Pia Mater Cerebrospinal
Fluid Ventricles
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- Brain Matter The brain is made up of neurons and glial cells.
The neurons carry signals throughout the brain, while the glial
cells mainly provide support for the neurons.
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- Neurons 100 billion neurons in the brain Have 3 basic parts
Dendrites Detect signals from the surrounding cells and transmits
them to the cell body Cell body Contains the nucleus, which is the
control center for the cell Axon Carries signals from the cell body
to the end of the axon The axon is covered with myelin, which is an
insulating sheath that helps to speed up signal movement
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- Glial Cells Estimated 10x more glial cells than neurons Do NOT
chemo-electric carry signals Main job is to hold neurons in place
Capable of secreting nutrients and other chemicals that can change
signals sent throughout the brain
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- Types of Glial Cells Oligodendrocytes Schwann Cells These cells
produce myelin (insulating cover) for the nerves in the brain and
spinal cord These cells produce myelin for the nerves outside of
the brain and spinal cord
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- Astrocytes Microglia Anchor to neurons and provide support Act
as a buffer to absorb chemicals and promote homeostasis in the
brain Eat foreign entities in the brain part of the brains immune
system
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- Ependymal Cells Line the ventricles in the brain Make CSF and
helps it flow throughout the ventricles
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- Questions: Are there more neurons or glial cells in the brain?
What is the main role of glial cells? Specifically, what do
Oligodendrocytes do? Specifically, what do Astrocytes do?
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- Answers: Glial cells There is up to ten times more glial cells
than neurons Glial cells provide support Oligodendrocytes make the
insulating cover for neurons (myelin) Astrocytes anchor neurons and
absorb chemicals in the brain
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- Brain Tumors arise when cell division occurs irregularly and
uncontrolled. When more tissue is produced than needed, tumors are
formed. They can grow in many different parts of the brain and
involve different types of tissues and cells. If tumors are benign,
they grow locally and do not spread. If a tumor is malignant, it is
invasive and can spread throughout the body.
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- Malignant Brain Tumors -When determining how malignant a brain
tumor is, the cells are examined by a pathologist and given a
grade. Brain tumors can be graded using the WHO classification
system. WHO Grade 1 Well differentiated (Low Grade) WHO Grade 2
Moderately differentiated (Intermediate Grade) WHO Grade 3 Poorly
Differentiated (High Grade) WHO Grade 4 Undifferentiated (High
Grade)
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- Cell Differentiation Examples A Grade 2 B Grade 3 C Grade
4
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- Symptoms of a Brain Tumor By Location: Frontal lobe Weakness,
personality changes, speech disturbances Parietal lobe Loss or
changes in sensation, changes in vision Temporal lobe Seizures,
difficulty understanding, difficulties with language Occipital lobe
Changes in vision Cerebellum Abnormal eye movements, loss of
coordination, changes in gait, hearing loss, vertigo, headaches,
nausea, vomiting
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- Diagnosis The process of detecting and treating a brain tumor
can be extremely stressful and complicated. Once a patient goes to
see the doctor, they do a basic neurological exam. This exam tests
many functions, such as eye movements, pupil reactions, reflexes,
hearing, mental abilities, facial movements, and balance and
coordination. If these are abnormal, the doctor may schedule an MRI
or a CT Scan
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- MRI Magnetic Resonance Imaging The patient lies on a table that
slides into a tunnel with a magnetic field During the scan, radio
waves are sent to the head. The different cell types in the brain
cause the waves to bend, which are recognized by a computer that
forms a picture.
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- CT Scan Computed Tomography For a CT Scan, a person is injected
with a dye and then lies on a table. A big donut shaped machine
circles the head and sends x-ray waves through the brain to measure
the amount of rays that are emitted back in the machine vs. the
amount that are absorbed. By putting together all of the signals, a
computer forms a picture of the brain.
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- Biopsy Once it is determined that there is a growth in the
brain, a biopsy is done in order to make an accurate diagnosis. If
the tumor is in an accessible location, a patient may choose to
have the whole tumor removed and then send a sample away for the
biopsy. If the tumor is inaccessible, a tiny needle can be inserted
into the brain to capture a small sample of tissue. Once the
samples are attained, they are sent to a neuropatholigst.
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- Pathology The tissue samples are either frozen or dried, then
sliced into very thin sections. The slices are mounted on to slides
and examined with a microscope First, the cell type that the tumor
originated from is determined Next, the growth rate of the tumor is
assessed Finally, the type and grade of the tumor is diagnosed
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- Pathology Report When a patient is diagnosed, the details are
put into a document called a pathology report. Physicians write
them with the intent that other physicians will read them, so they
are often complex and difficult to decipher. Get picture
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- Pathology Report Contents Main Sections Personal Information
Name, date of birth, etc. Clinical History A brief description of a
persons medical situation Gross Description Describes how the
tissue looks to the naked eye Microscopic Description Describes how
the tissue looks under the microscope Diagnosis States the final
Diagnosis This is the biggest section of the report that
specifically describes the type of tumor, what tissues are involved
and patterns of growth. This section provides important information
that is used to determine how to treat the patients specific tumor
type. Comments
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- Questions What are some symptoms of brain tumors? How is the
level of malignancy graded? What types of scans are done to see if
a person has a brain tumor? What document gives the results of a
tumor analysis?
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- Answers: Seizure, Nausea, Headaches, Weakness, Fatigue, Mood or
Personality changes WHO grade I-IV MRI and CT Scan Pathology
report
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- Types of Brain Tumors Some are from a single cell type Ex.-
Astrocytoma, Oligodendroglioma Some are from a mixed cell type Ex.
Oligoastrocytoma, mixed glioma Some are mixed with neurons Ex.
Ganglioma Some are from neurons Gangliocytoma Some are from other
tumors that have metastasized About 40% of brain tumors are
metastatic The most common cancers that spread to the brain are
lung, breast, melanoma, renal and colon cancers
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- Astrocytomas Arise from Astrocyte cells - Astrocytoma
VideoAstrocytoma Video 4 types Pilocytic Astrocytoma (grade I)
Occurs mostly in children, benign Low-Grade Astrocytoma (Grade II)
Can be removed by surgery, but radiation is also recommended
Anaplastic Astrocytoma (Grade III) Radiation and Chemotherapy
recommended Glioblastoma Multiforme (Grade IV) Very aggressive and
spreads throughout the CNS Patients usually have neurological
symptoms Radiation and chemotherapy recommended Account for about
25% of all brain tumors Life expectancy is about a year GBM
Video
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- Oligodendroglioma Arise from oligodendrocytes Average age of
diagnosis = 35 years 9.4% of all primary brain and CNS tumors Occur
most frequently in the frontal lobe Primary symptom is usually a
seizure Usually grade II or III Median survival 11.6 years for
grade II 3.5 years for grade III Usually grows slower than an
Astrocytoma
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- Mixed Glioma Most often a mix between an astrocytoma and an
oligodendroglioma = oligoastrocytoma Primarily occurs people aged
20 50 Account for 1% of all brain tumors Symptoms Headache Nausea
and vomiting Behavioral changes Treatment based on most malignant
cell type
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- Intraventricular Tumor Make up about 10% of CNS tumors May be
composed of surrounding cells Astrocytoma, Meningioma etc. May
arise from cells lining the ventricle Ependymoma 5% of CNS tumors
Survival rate of 5-10 years 85% are benign Tumor can block flow of
Cerebrospinal fluid through the ventricles and cause obstructive
hydrocephalus May cause nausea, vomiting, deteriorating mental
status, headache, neurological defects Standard treatment includes
surgery, and then radiation and/or chemotherapy if needed
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- Primary CNS Lymphoma 90% are diffuse large B-cell lymphomas Can
also be poorly characterized low-grade lymphomas, Burkitt
lymphomas, and T-cell lymphomas Incidence increasing especially
among immunocompromised patients Most commonly occurs around age 55
Survival with radiation and chemotherapy is around 44 months
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- Metastatic Brain Tumors Not a primary brain tumor Composed of
cancer cells that have spread from their original location Most
common: Breast, Melanoma, Lung, Kidney Treatment is composed of
radiation and surgery if possible Chemotherapy has not been found
to be helpful Surgery is not done when there are multiple
tumors
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- Question What is the name of a Grade IV astrocytoma? What is
the average life expectancy for a Grade IV astrocytoma?
Oligodendrogliomas are usually what Grades? What is a type of
Intraventricular Tumor?
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- Answer: Glioblastoma Multiforme 1 year Grade II and III
Ependymoma
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- Benign Tumors Caused by a group of cells that grow irregularly
Non-invasive and grow slowly May cause pressure on important brain
structures Can be removed by surgery Usually dont grow back
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- Meningioma Arise from the meninges surrounding the brain
Accounts for about 20% of brain tumors 2 nd most common brain tumor
Usually occurs during 40s-60s May cause weakness, seizures Small,
slow growing tumors may not need to be treated be treated with
surgery, radiosurgery or radiation therapy
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- Pituitary Tumor Abnormal growth in the pituitary gland Causes
irregular hormone levels Treatment Surgery Expanded Endonasal
approach Radiation Drugs To shrink tumor To treat irregular hormone
levels
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- Other Benign Tumors Central Neurocytoma Typically in young
adults in lateral ventricles Chondroma Arises from cartilage,
usually at the base of the skull Gangliocytoma Occur in
children/young adults and arises from ganglion Schwannoma Arise in
the nerve sheath and can compress nerves Cause pain, weakness and
numbness
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- Questions What brain structure do Meningiomas arise from? What
can a Pituitary Tumor Cause?
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- Answers Meninges Irregular Hormone Levels
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- Surgery Stereotactic Biopsy 3-D Mapping of the brain and
removal of a small amount of specific tissue Usually done when the
tumor can not be removed Explanation Craniotomy Done if the tumor
is accessible and can be removed safely A piece of skull is removed
to reach the brain Surgeons carefully separate tumor from brain
tissue and remove as much as possible Craniotomy video Craniotomy
Video - Dr. Mintz
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- Surgery Expanded Endonasal Approach Surgeons reach structures
in the brain by going through the nasal passages and sinus cavities
Animated Video
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- Chemotherapy Given mainly to high-grade tumors, but may also be
prescribed for low-grade or benign tumors Designed to prevent cells
from dividing or promote cell death Certain tumors may become
resistant to chemotherapy or may simply not react at all May also
kill healthy cells, especially in the gastrointestinal tract
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- Common Chemotherapy Drugs Temozolomide (Temodar) Most often
prescribed for astrocytomas and other high-grade gliomas Taken in
28 day cycles Take pill from days 1-5 No pills from days 6-28 Cycle
may be different for some individuals May cause nausea, fatigue and
constipation
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- Other Chemotherapy Drugs The PCV Regimen 6 cycles, each lasting
42 Days Take CCNU pill on day 1 Taken at bedtime, may cause nausea
Vincristine injection on day 8 and 29 Usually given at hospital,
may cause temporary nerve damage Procarbazine pills on days 8-21
Taken at bedtime, may cause nausea, loss of appetite, fatigue,
decrease in blood counts
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- Radiation Therapy Stereotactic Radiosurgery Not surgery Precise
radiation therapy given in concentrated beams Gamma-ray or x-ray
beams Gamma Knife Surgery when gamma rays are used Beams damage
tumor cell DNA, causing it to shrink Referred to as fractionated
stereotactic radiosurgery when multiple treatments are done
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- Other Avastin (Bevacizumab) Vascular endothelial growth
factor-specific angiogenesis inhibitor Stops the formation of blood
vessels, which carry nutrients, into tumors Often used in
conjunction with chemotherapy First drug that inhibits angiogenisis
(blood vessel formation) Approved in May 2009 for treatment of
recurrent glioblastoma. In IIIrd phase clinical trial for treatment
of initial tumor growth
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- Biotherapy (Investigational) Gene Therapy Adenoviruses are
viruses that can change the DNA composition in the cells that they
infect Made to target tumor cells in order to change their DNA
composition to include the specific adenovirus DNA component Once
the tumor cell DNA includes the adenovirus DNA, it can be targeted
by a specific anti-viral agent Adenovirus
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- Immunotherapy (Investigational) Take tumor specific T-cells and
helper t-cells (cells in the immune system that fight off disease)
from the patient Use Interleukin-2 to help them grow and duplicate
Transfer the T-cells back into the body Tumors inhibit immune
system activity, so this allows the immune system to gain strength
and fight specific tumor cells T-Cell killing a cancer cell
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- Common Medications Steroids Decadron (Dexamethasone),
Prednisone Used to control swelling in the brain Also can be
prescribed to increase appetite Side Effects Insomnia Weight gain
with fat deposition in cheeks High blood pressure High blood sugar
Stomach ulcers
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- Common Medications Anti-Seizure Dilantin (Phenytion) May cause
rash Tegretol (Carbamazepine) May cause rash Depakote (Valproic
acid) May cause tremor
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- Common Medications Anti-Nausea Zofran Usually given along with
chemotherapy Anti-Constipation Senekot Colace
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- Questions What chemotherapy drug is most commonly prescribed
for Astrocytomas and Other High Grade Gliomas? What do radiation
beams do to cells? What are common Anti-Seizure medications?
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- Answers Temozolomide (Temodar) It kills cell DNA, which causes
the cells to shrink and die Dilantin (Phenytion), Tegretol
(Carbamazepine), Depakot (Valproic Acid)
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