Friday, November 7, 2008

Our Brain

Your brain and spinal cord make up your central nervous system. Together, they control your body -- but it's the brain which is Commander-in-chief.

What is a brain?
Okay, so your brain is wrinkled, soft and a little wet. It doesn't look like much. But it's made of more than 10 billion nerve cells and over 50 billion other cells and weighs less than 3 pounds! And it's the most extraordinary thing that you could possibly imagine! It monitors and regulates unconscious bodily processes like breathing and heart rate, and coordinates most voluntary movement. It's the site of consciousness, thought and creativity!

How does my brain communicate with my body?
Different parts of your brain do different things. Some areas receive messages from sense organs, others control balance and muscle coordination, still others handle speech, or emotion, memories, or basic motor skills, or complex calculations. You may think your heart is where you feel emotion, but it's really your brain. You may think your legs take you down the street, but it's your brain instructing the muscles in your legs to move. Your eyes may take in light and an image may be projected onto the pupil, but it's your brain that interprets what you see...you get the picture.

Are human brains different than other animal's brains?
Be glad you're a human. Because human brains are more complex than the brains of any animal on Earth! Why? It's not that they're the biggest. But human brains are larger and heavier in comparison to the human body, than any other animal. Underneath your scalp, sits a brain that, as it has grown, has continued to fold in on itself and develop deeper and deeper folds and crags. Spread out it would be the size of a pillowcase. Folded in on itself it becomes the place to think, dream, and create beautiful poetry!

Factoids:
  • A newborn baby's brain grows almost 3 times in course of first year!
  • Humans have the most complex brain of any critter on earth!
  • Your brain is divided into two sides. The left side of your brain controls the right side of your body; and, surprise, the right side of your brain controls the left side of your body.

Source: http://yucky.discovery.com/flash/body/pg000135.html

Sunday, October 26, 2008

Brain & Nerve Facts

The adult human brain weighs about 3 pounds (1,300-1,400 g).

The adult human brain is about 2% of the total body weight.

The elephant brain weighs about 6,000 g.

The cat brain weighs about 30 g.

The average human brain is 140 mm wide.

The average human brain is 167 mm long.

The average human brain is 93 mm high.

The human brain has about 100,000,000,000 (100 billion) neurons.

The octopus brain has about 300 million neurons.

The total surface area of the cerebral cortex is about 2500 sq. cm (~2.5 ft2)

The world record for time without sleep is 264 hours (11 days) by Randy Gardner in 1965. Note: In Biopsychology (by J.P.J. Pinel, Boston: Allyn and Bacon, 2000, p. 322), the record for time awake is attributed to Mrs. Maureen Weston. She apparently spent 449 hours (18 days, 17 hours) awake in a rocking chair. The Guinness Book of World Records [1990] has the record belonging to Robert McDonald who spent 453 hours, 40 min in a rocking chair.

Unconsciousness will occur after 8-10 seconds after loss of blood supply to the brain.

Neurons multiply at a rate 250,000 neurons/minute during early pregnancy.

The weight of an adult human cerebellum is 150 g.

The total volume of cerebrospinal fluid (CSF) is 125-150 ml.

A total of 400-500 ml of cerebrospinal fluid (CSF) is produced every day.

Cerebrospinal fluid is normally clear and colorless.

There are 12 pairs of cranial nerves.

There are 31 pairs of spinal nerves.

There are about 13,500,00 neurons in the human spinal cord.

The human spinal cord is 45 cm long in men and 43 cm long in women.

Humans can hear in the range of 20 Hz to 20,000 Hz.

Rats can hear in the range of 1,000 to 50,000 Hz.

The most sensitive range of human hearing is between 1,000-4,000 Hz.

Pain occurs when sounds are above 130 db.

Hearing damage can occur if people are exposed to sounds above 90 db for an extended period of time.

The total number of human taste buds (tongue, palate, cheeks) is about 10,000.

The total number of human olfactory receptor cells is about 40 million.

The human eyeball is about 24.5 mm long.

The octopus does not have a blind spot.

The total weight of skin in an average adult human is 6 lb.(2.7 kg).

There are 1,000 to 10,000 synapses for a "typical" neuron.

The cell bodies of neurons vary in diameter from 4 microns (granule cell) to 100 microns (motor neuron in cord).

The resting potential in a squid giant axon is -70 mV.

Friday, October 10, 2008

Meningioma Surgery in Medan (May 16, 2007)

I had been in Medan since May 15, 2007.
Prof. A had another tumor surgery, so I brought Selector with me.
The flight was alright, I used Sriwijaya Air.
This time I went alone. Boss wouldn’t permit Arie to come along, well…it’s OK, I can manage. I’m always the strong girl :)

MAY 15, 2007

The work:

Delivered Selector to hospital and explained to O.R. nurses how to assemble and disassemble the handpiece. It’s important because I won’t have a colleague to help me. I needed them to be my help.


MAY 16, 2007

The work:

Arrived in the hospital at 10 am because the nurse informed me surgery will be at 11 am. Then I found out, schedule has changed, it would be at 1 pm. Waited for 3 hours. Surgery started at 2 pm, finished 5.30 pm.

Meningioma was so big, it was 1/4 of the brain. It was very big, Prof. A used his finger to separate it from the brain. No need to use Selector!

Meningioma

The tumor!

Wow, that was my first experience seeing that kind of procedure.

Hmmm, a request from him: I to stay with Selector because he’d have another tumor surgery on Friday. Oh God! How should I tell Ms. S from MK Hospital? Damn!

Asked my boss’ approval for this. I needed his help to contact Dr.J!

This also meant I had to re-schedule my flight.


For the rest of my trip, read here.

Saturday, September 20, 2008

Four Health Tips to Enhancing Your Brain

By Leon Edward

Long thought to be the soul of the human psyche, the human brain weighs in at about 3 pounds or 1300-1400g. What we know about the brain expands almost daily as new science finds more and more nuances that control our perception of life around us. We know that it controls what keeps us alive: respiration, digestion, heartbeat and a number of other involuntary or automatic functions of the body. Without our brain constantly working in the background, we would not be able to live.

It also controls what we call -Our Higher Functions- or things we are consciously doing day-to-day - abstract thinking, reasoning, dreaming and thought. Considered superior to any other species, our brain is responsible for our culture, advancements and higher level thinking including reading, speech and extrapolation. Things like creativity and personality are associated with the brain. We make decisions, define colors and smells and that is just the tip of the iceberg. This very special organ perceives the world around us and our activity in it.

The human brain is strong and some may consider it invincible; however, many times as we age, we realize isn not going to stay that way forever. Like any other part of our body, the brain is subject to the ravages of time, and our lifestyles affect it to a greater or lesser degree. As we age, the brain becomes slower in its functioning and its ability to rejuvenate itself. But, through science, we have also discovered that this doesn not have to be the end of things. There are many ways to enhance and improve our brain power and forestall the slowing down that comes with aging. This article gives you four excellent tips to get your started in reversing the damages that time causes.

Tip #1: Healthy lifestyles are the key

Integral to our overall anatomy, the brain is probably the most important organ in our bodies because without it, we could not function. So, we need to treat it like the special organ that it is. For the person who drinks heavily, they are damaging their brain more than the person who is a modest drinker. We have long known that alcohol and other substances like drug use destroy brain cells. Most alcoholics will argue that since we only use 10% of our overall brainpower, we have plenty of spare brain cells to call on. This is more myth than reality. Drinking does nothing to activate the other 90% of our brain's capacity, and this fallacy will cause alcoholism to destroy our organ faster than believed. As a result, if you think of that 10% we're using as a lifetime organ, we should go to great lengths to preserve and protect it.

Tip #2: Eat well and your brain will thank you.

You know the saying: Garbage in; Garbage Out. This applies to healthy eating to keep the brain operating at peak efficiency. Consuming the correct sets of food definitely benefits the brain. Consider this: the brain is the most active part of the body. In order to keep the brain vibrant and alive, we must give it the best fuel available. The brain is always on even when we are sleeping, so having an abundance of good fuel will keep the brain fit and thriving. Good foods will be greatly appreciated by your brain, and in return it will deliver excellent computing and reasoning powers. Never underestimate the power of a balanced diet, exercise and adequate sleep when it comes to staying focused and alert.

Tip #3: Exercise Makes the Brain Grow Stronger

Taking the time to get proper exercise is an excellent way for the body and brain to operate at maximum effectiveness. Leading a well-balanced lifestyle goes a long way towards having a brain that is alive, fit and ready to tackle any problem that the world throws at it.

Tip #4: Relieving Stress is Essential

Exercise also releases stress which can cloud and slow the brains functioning and create a good mood and a sense of well being.

The brain is an organ that should be respected, cared for and cherished. We only have one, and it allows us to make choices, and live our lives to the fullest. A well-cared for brain will deliver healthy perceptions, and result in a more active and fulfilled existence.

Friday, September 19, 2008

Classification of Brain Tumor

By Peter Sams

A brain tumor — primary or secondary — can cause a variety of signs and symptoms because it can directly press on or invade brain tissue. This can damage or destroy areas responsible for sight, movement, balance, speech, hearing, memory or behavior. Brain tumor symptoms vary from patient to patient, and most of these symptoms can also be found in people who do NOT have brain tumors.

Therefore, the only sure way to tell if you have a brain tumor or not is to see your doctor and get a brain scan. The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (non-cancerous) or malignant. A primary brain tumor is a group (mass) of abnormal cells that start in the brain. This article focuses on primary brain tumors in adults. Brain tumors encompass neoplasms that originate in the brain itself (primary brain tumors) or involve the brain as a metastatic site. Brain tumors (metastatic brain tumors), which are malignant, are more common. These tumors result from cancer that started elsewhere in the body and spread (metastasized) to the brain.

Classification

HISTOPATHOLOGIC CLASSIFICATION — Primary brain tumors are classified by light microscopy according to their predominant cell type and graded based upon the presence or absence of standard pathologic features. Historical attempts at developing a classification system for brain tumors date back to the 1830s. The German pathologist Rudolf Virchow first introduced the term "glioma" in 1860. Virchow was also the first to attempt a correlation of microscopic to macroscopic features of CNS tumors.

Cellular Classification-He classification of brain tumors is based on both histopathological characteristics and location in the brain. Undifferentiated neuroectodermal tumors of the cerebellum have historically been referred to as medulloblastomas, while tumors of identical histology in the pineal region would be diagnosed as pineoblastomas. The nomenclature of pediatric brain tumors is controversial and potentially confusing. Some pathologists advocate abandoning the traditional morphologically-based classifications such as medulloblastoma in favor of a terminology that relies more extensively on the phenotypic characteristics of the tumor.

Primary Brain Tumor

Astrocytomas — these tumors arise from small, star-shaped cells called astrocytes. They may grow anywhere in the brain or spinal cord. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum and the cerebellum. A grade III astrocytoma is sometimes called anaplastic astrocytoma. A grade IV astrocytoma is usually called glioblastoma multiforme.

Brain stem gliomas — These tumors occur in the lowest, stem-like part of the brain. The brain stem controls many vital functions. Most brain stem gliomas are high-grade astrocytomas.

Secondary Brain Tumor

Metastatic brain tumors originate from malignant tumors located primarily in other organs. Their incidence is higher than that of primary brain tumors. The most frequent types of metastatic brain tumors originate in the lung skin (malignant melanoma, kidney (hypernephroma, breast (breast carcinoma), and colon (colon carcinoma). These tumor cells reach the brain via the blood-stream.
Some non-tumoral masses and lesions can mimic tumors of the central nervous system. These include tuberculosis of the brain, cerebral abscess (commonly in toxoplasmosis), and hamartomas

Thursday, September 18, 2008

Different Types of Brain Injury

By Dave J. Davies

Brain injury can be as individual as people, because every case of brain injury can happen for different reasons and have different effects on people. Classifying the different types of brain injury can require a lot of research. Generally the classification starts with the two more common types of brain injury: traumatic brain injury and acquired brain injury. The levels are ranted as mild, moderate or severe. Brain injuries can also be classified as an open or closed brain injury. In this article, we'll talk about the more common types of brain injuries.

Traumatic Brain Injury

Traumatic brain injury can happen whenever something strikes the head with force. The force would be strong enough to cause the brain to move in the skull causing internal damage to the brain. It can also occur if the skull breaks and the break itself injures the brain.

There are various reasons for this type of force. It could due to a violent experience, sports injury or a variety of other causes. Any event that causes the head to be struck hard enough an cause this type of traumatic brain injury.

This type of brain injury can also occur from rapid movement back and forth, shaking the brain hard enough in the skull that it becomes damaged. This more commonly happens in auto accidents or in cases such as Shaken Baby Syndrome. The rapid movement back and forth can do severe damage to the brain.

How To Tell If You've Suffered Traumatic Brain Injury

If you have suffered a severe blow to the head, or have been in an accident where your head was violently shaken, or suspect someone else has had this type of injury, go to the emergency room immediately or call 911 for further assistance. It is recommended that you do not wait. Severe brain injuries can become worse and could become fatal if not treated immediately.

Common symptoms of traumatic brain injury are as follows:

Spinal fluid coming out of the ears or nose, looking like thin, watery liquid
Loss of consciousness
Suspected concussion - not all concussions cause loss of consciousness
Severe dizziness or loss of balance
Dilated eyes
Loss of vision, or change in vision, either improved or reduced
Slow pulse
Slow breathing
Vomiting
Lethargic
Headache
Confusion
Numbness or tingling sensations in any parts of the body

Different Types of Traumatic Brain Injury

Depending on how severe the injury is, the brain can suffer many types of injuries. Some of the more common classifications of such injuries include:

Diffuse Axonal Injury - This type of injury seems to be more common with the rapid movement of the head as occurs with Shaken Baby Syndrome. It usually happens because the skull is moving faster than the brain, causing certain structures in the brain to tear. This injury can be temporary or permanent, causing a coma or even possibly producing fatal effects.

Concussion - A concussion can be caused by violent action toward the head, by severe blows, or a whiplash effect. This type of injury causes blood vessels to stretch. It's one of the more common types of brain injuries, and a concussion can take months or even years to fully heal.

Contusion - Again, this type of traumatic brain injury will happen with a violent action at the head. The injury is caused by bruising or bleeding on the brain. If the injury is severe and there is much bruising and bleeding, it can require surgery to correct.

Acquired Brain Injury

An acquired brain injury occurs any time after birth and is not induced by birth trauma or hereditary. This type of injury occurs on a cellular level. Such an injury can affect the entire brain, rather than a limited area like a traumatic brain injury.

Such injuries can occur for any of the following reasons: air obstruction, chocking, throat swelling, near drowning, electrical shock, trauma to the head, severe blood loss from open wounds, heart attack, stroke, infectious diseases, Meningitis, AIDS, brain tumors, toxic exposure, illegal drug use, overdose of drugs, alcohol abuse.

Symptoms of Acquired Brain Injury

Because this type of brain injury is internal, you might have a harder time trying to identify the symptoms. Some of the more common symptoms for acquired brain injury are:

Impairment of function, motor skills or memory
Long lengths of time spent in a still, 'vegetative' state
Sudden or severe behavior changes or problems - depression, restlessness, anxiety, psychosis, etc

As with traumatic brain injury, if you suspect someone may have acquired brain injury, call 911 or get the person to the emergency room right away.

Different Types of Acquired Brain Injury

Anoxic Brain Injury - This type of injury occurs when the brain is deprived of oxygen. There are three types of anoxia: Anoxic which is no oxygen is getting through, anemic which means severely limited amounts of oxygen is getting through, and toxic which means something is blocking the oxygen in the blood from being used in the brain.

Hypoxic Brain Injury - This sort of brain injury occurs when the brain does get oxygen, but doesn't seem to get enough oxygen. It could happen because of lack of blood flow or blood pressure is weak.

If you should suffer from any symptoms listed, have suffered a blow to the head or you suspect that you or someone you know may have any form of brain injury, seek medical treatment right away. Call 911 if you see someone who has had an injury to the head, even if that person says they are fine. When caught early enough, many types of brain injuries are treatable.

Thursday, September 11, 2008

The needs of medical assistant during brain surgery

I‘ve attended several brain surgeries in my previous employment. During that, I learned a lot. Usually there will be one senior neurosurgeon who’s in charge of the surgery, then he’ll be accompanied by junior neurosurgeon as his assistant. Then comes several medical assistants. They are there to support the surgeons and make sure everything comes to place. In the sterile area there will be around 4 people, including senior and junior neurosurgeons.


Some medical assistant will take care of anesthesia, some will take care of big equipments, some handles and cleans the surgical instruments. It’s complicated and need special skills.


I asked them how they got the skill. They said, after finished medical assistant schools and got hired, there are specialization, which surgery field that they will work on. Then the hospital will send them for training and attend workshops.


In medium size hospitals in remote area in Indonesia, usually there is only one neurosurgeon, there is no other surgeon to help him. The medical assistants play important role. They prepare the patient before surgery, and they stitch the wounds after neurosurgeon finishes his part. The neurosurgeon relies on them.



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Wednesday, September 10, 2008

More information on Hydrocephalus

Reference: "Hydrocephalus" by Eugenia-Daniela Hord, MD, Instructor, Departments of Anesthesia and Neurology, Massachusetts General Hospital Pain Center, Harvard Medical School

Pathophysiology

Normal CSF production is 0.20-0.35 mL/min; a majority is produced by the choroid plexus, which is located within the ventricular system, mainly the lateral and fourth ventricles. The capacity of the lateral and third ventricles in a healthy person is 20 mL. Total volume of CSF in an adult is 120 mL.

Normal route of CSF from production to clearance is the following: From the choroid plexus, the CSF flows to the lateral ventricle, then to the interventricular foramen of Monro, the third ventricle, the cerebral aqueduct of Sylvius, the fourth ventricle, the 2 lateral foramina of Luschka and 1 medial foramen of Magendie, the subarachnoid space, the arachnoid granulations, the dural sinus, and finally into the venous drainage.

ICP rises if production of CSF exceeds absorption. This occurs if CSF is overproduced, resistance to CSF flow is increased, or venous sinus pressure is increased. CSF production falls as ICP rises. Compensation may occur through transventricular absorption of CSF and also by absorption along nerve root sleeves. Temporal and frontal horns dilate first, often asymmetrically. This may result in elevation of the corpus callosum, stretching or perforation of the septum pellucidum, thinning of the cerebral mantle, or enlargement of the third ventricle downward into the pituitary fossa (which may cause pituitary dysfunction).

The mechanism of NPH has not been elucidated completely. Current theories include increased resistance to flow of CSF within the ventricular system or subarachnoid villi; intermittently elevated CSF pressure, usually at night; and ventricular enlargement caused by an initial rise in CSF pressure; the enlargement is maintained despite normal pressure because of the Laplace law. Although pressure is normal, the enlarged ventricular area reflects increased force on the ventricular wall.

Frequency

United States

Incidence of congenital hydrocephalus is 3 per 1,000 live births, while the incidence of acquired hydrocephalus is not known exactly.

International

Incidence of acquired hydrocephalus is unknown. About 100,000 shunts are implanted each year in the developed countries, but little information is available for other countries.

Mortality/Morbidity

In untreated hydrocephalus, death may occur by tonsillar herniation secondary to raised ICP with compression of the brain stem and subsequent respiratory arrest.

  • Shunt dependence occurs in 75% of all cases of treated hydrocephalus and in 50% of children with communicating hydrocephalus.
  • Patients are hospitalized for scheduled shunt revisions or for treatment of shunt complications or shunt failure.
  • Poor development of cognitive function in infants and children, or loss of cognitive function in adults, can complicate untreated hydrocephalus. It may persist after treatment.
  • Visual loss can complicate untreated hydrocephalus and may persist after treatment.

Sex

Generally, incidence is equal in males and females. The exception is Bickers-Adams syndrome, an X-linked hydrocephalus transmitted by females and manifested in males. NPH has a slight male preponderance.

Age

Incidence of human hydrocephalus presents a bimodal age curve. One peak occurs in infancy and is related to the various forms of congenital malformations. Another peak occurs in adulthood, mostly resulting from NPH. Adult hydrocephalus represents approximately 40% of total cases of hydrocephalus.

Tuesday, September 9, 2008

More on Hydrocephalus

Common Causes of Hydrocephalus

Although rare, hydrocephalus can be inherited genetically or may be associated with developmental disorders, including spina bifida (congenital defect of the spine) and encephalocele (hernia of the brain). Other causes can include bleeding within the brain, brain tumors, head injuries, complications of premature birth such as hemorrhage, or diseases such as meningitis or other infections. In some cases, normal flow of CSF within the brain is blocked, resulting in fluid build-up.

Symptoms of hydrocephalus vary greatly from person to person. According to the Hydrocephalus Association, some of the most common symptoms are listed below as a reference.

Symptoms of Hydrocephalus in infants Abnormal enlargement of the head; soft spot (fontanel) is tense and bulging; scalp can appear thin; bones separated in baby's head; prominent scalp veins; vomiting; drowsiness; irritability; downward deviation of baby's eyes; seizures; or poor appetite.

Symptoms of Hydrocephalus in toddlers/children
Abnormal enlargement of baby's head; headache; nausea; vomiting; fever; blurred or double vision; unstable balance; irritability; sleepiness; delayed progress in walking or talking; poor coordination; change in personality; inability to concentrate; loss of sensory motor functions; seizures; or poor appetite. Older children may experience difficulty in remaining awake or waking up.

Symptoms of Hydrocephalus in young and middle-aged adults
Headache; difficulty in remaining awake or waking up; loss of coordination or balance; bladder control problems; impaired vision and cognitive skills that may affect job performance and personal skills.

Symptoms of Hydrocephalus in older adults
Loss of coordination or balance; shuffling gait, memory loss; headache; or bladder control problems. Hydrocephalus is often categorized for age groups as either congenital or normal pressure hydrocephalus. Congenital hydrocephalus refers to conditions that are caused by conditions existing at birth. Primary symptoms include headache, nausea, vomiting and drowsiness. Normal pressure hydrocephalus (NPH) is the accumulation of cerebrospinal fluid that causes the ventricles in the brain to become enlarged, with little or no increase in pressure. Adult-onset NPH mainly occurs in adults age 60 and older. Patients with NPH often get misdiagnosed with Alzheimer's disease or dementia, as some of the symptoms mimic these two conditions.

Diagnosing Hydrocephalus

Before your doctor can recommend a course of treatment, he or she will:

  • Review your medical history, and perform a physical examination
  • Perform a complete neurological examination including diagnostic testing if needed
  • Ask specific questions to determine if symptoms are caused by hydrocephalus

The neurological examination will also help to determine the severity of your condition. Further tests such as an ultrasound (if the patient is an infant), computed tomography (CT or CAT scan), or magnetic resonance imaging (MRI) may be ordered. The tests may reveal useful information about the severity of the condition and its likely cause.

When Surgery is Necessary

Diverting FluidHydrocephalus can be treated in a variety of ways. The problem area may be treated directly (by removing the cause of CSF obstruction), or indirectly (by diverting the fluid to somewhere else; typically to another body cavity). Indirect treatment is performed by implanting a device known as a shunt to divert the excess CSF away from the brain. The body cavity in which the CSF is diverted is usually the peritoneal cavity (the area surrounding the abdominal organs).

In some cases, two procedures are performed, one to divert the CSF, and another at a later stage to remove the cause of obstruction (e.g., a brain tumor). Once inserted, the shunt system usually remains in place for the duration of a patient's life (although additional operations to revise the shunt system are sometimes needed). The shunt system continuously performs its function of diverting the CSF away from the brain, thereby keeping the intracranial pressure within normal limits.

An alternative operation called endoscopic third ventriculostomy utilizes a tiny camera to look inside the ventricles, allowing the surgeon to create a new pathway through which CSF can flow.

Recovery

Your neurological function will be evaluated post surgery. If any neurological problems persist, rehabilitation may be required to further your improvement. However, recovery may be limited by the extent of the damage already caused by the hydrocephalus and by your brain's ability to heal.

Because hydrocephalus is an ongoing condition, long-term follow-up by a doctor is required. Follow-up diagnostic tests including CT scans, MRIs and x-rays, are helpful in determining if the shunt is working properly. Do not hesitate to contact your physician if you experience any of the following postoperative symptoms:

  • Redness, tenderness, pain or swelling of the skin along the length of the tube or incision
  • Irritability or drowsiness
  • Nausea, vomiting, headache or double vision
  • Fever
  • Abdominal pain
  • Return of preoperative neurological symptoms

Prognosis

The prognosis for hydrocephalus depends on the cause, the extent of symptoms, and the timeliness of diagnosis and treatment. Some patients show a dramatic improvement with treatment while others do not. In some instances of NPH, dementia can be reversed by shunt placement. Other symptoms such as headaches may disappear almost immediately if the symptoms are related to elevated pressure.

In general, the earlier hydrocephalus is diagnosed, the better the chance for successful treatment. The longer the symptoms have been present, the less likely it is that treatment will be successful. Unfortunately, there is no way to accurately predict how successful surgery will be for each individual. Some patients will improve dramatically while others will reach a plateau or decline after a few months.

Shunt malfunction or failure may occur. The valve can become clogged or the pressure in the shunt may not match the needs of the patient, requiring additional surgery. In the event of an infection, antibiotic therapy may be needed. A shunt malfunction may be indicated by headaches, vision problems, irritability, fatigue, personality change, loss of coordination, difficulty in waking up or staying awake, a return of walking difficulties, mild dementia or incontinence. Fortunately, most complications can be dealt with successfully.


Source: NeurosurgeryToday.Org

Thursday, September 4, 2008

WHAT CAN I DO TO IMPROVE MY MEMORY?

Source: Traumatic Brain Injuries

Work with a Specialist in Memory--One of the most important things is to get help from people who specialize in head injury. Every head injury program has a specialist who teaches memory strategies. In most cases, this is a Speech Therapist (they don't just help people who have slurred speech). In the Neuro-Recovery program, our Speech Therapist teaches 15 different memory strategies and helps you to pick the 2 or 3 that work best for you. There is often a fair amount of testing in order to figure out the best memory strategy for each head-injured person. For some people, one type of memory may be impaired (verbal recall) but another type be intact (remembering visual information). If I know that my verbal memory is not very good, I write things down and encourage visual memory systems to work. Specialists can help you pick out the best memory strategies to help you. Once you find an effective strategy, keep working on it. Think of memory like a muscle. The more you use it, the stronger it gets.

Get Organized--We learn better if we are organized. Many people have told me that, prior to their head injury, they had incredibly messy desks with papers all over. But if someone came in and said, "I need this particular paper", they could pull it out of a big pile and say "here it is." After a head injury, though, the ability to organize gets really messed up. One symptom of not being organized is when someone says, "I've started 50 projects and haven't finished one of them." If you organize information, it tends to help you recall it. For example, if you are constantly losing your car keys or constantly forgetting where you put your wallet, there's one simple technique to use. Put things in the same place. Always put your car keys in one spot on the dresser. Always put your purse in one spot in the house and nowhere else. Being organized helps your memory and you will be less likely to lose things.

Break It Down--Another thing that we can do to help memory is to break it into small bits. If you have something really tough to learn, try to break it down into small bits and then learn each one little bit at a time. Some people call this "chunking;" you are memorizing little "chunks" of information. For example, your brand new VCR has a remote control with 50 buttons on it. Reading the entire manual in one sitting to learn what all of the 50 buttons do is very hard. So, learn one function and then play with that feature for awhile. Once you've learned that, go on to the next button. We've been using this technique for years to learn simple information like a phone number. The wonderful folks at Bell Labs (they invented the phone) figured out that people will learn a 7 digit phone number if you group 3 digits together and then group 4 digits together (a "chunk" of 3 numbers and a "chunk" of 4 numbers).

Using Association-- Association is really important for retrieving important information. For example, you are taking a literature course and you need to remember a famous essayist--Francis Bacon. You might associate the image of a piece of bacon with the name of this person. So if you're trying to think of this explorer, an image of a piece of bacon will come to you. This approach is particularly helpful with learning names. Remembering names is a difficult task for most people in the world; it is especially hard for most people with a head injury.

Get a Daily Planner--Probably one of the best things you can do to help your memory is to use a daily planner. This brings up two important points:

  • The First Rule of Memory--write everything down in one spot (your daily planner).
  • The Second Rule of Memory--write it down when it's fresh in your mind.

For example, you go to your doctor's office and you are asked to return for another appointment. Many people have a calendar stuck on their refrigerator or on a wall at home. By the time you get back home, you've forgotten the date or lost the appointment card. Next time, bring a planner to the doctor's office and write your appointment in it just after the doctor tells you the date. Get a medium size planner or something called an organizer. Don't get something that's too small--you're going to be doing a lot of writing. Write complete notes! Some people make notes so short that they later can't figure out what the note means.

Make A "To Do" List--In addition to a planner, make a "to do" list. For example, you may have a number of chores to do around the house but none of them in any particular order. What you can do is get a small pad of paper and write down the things that they have to do. Once you have this list, decide which task to do first, second, third, and so on. This will work if your list doesn't get too long. If the list gets too long, you're going to run into problems.

Make a "Modified To Do" List--I commonly hear the same problem, "I've got 50 projects going but I haven't finished any of them." This is a combined problem of memory deficits and organizational deficits. One solution is to buy a small dry-erase board and put it up in the home (or office). On the board, you are only allowed to list five items on the "To Do" list. You cannot add another item to the board until you have completed one of the items already on the board. Make a "Modified To Do List" and put it somewhere in your house where the whole family can see it. Family can also offer suggestions to help you to get projects organized. This will in turn help family members get a better understanding of what the head-injured person has to deal with. When you get organized and use the Planner/To Do List, you'll feel better about yourself because you will be getting things accomplished.

Wednesday, September 3, 2008

The effects of hydrocephalus on intelligence quotient in children with localized infratentorial ependymoma before and after focal radiation therapy

By: THOMAS E. MERCHANT, D.O., PH.D., HEATHER LEE, M.D., JUNHONG ZHU, M.S.,
XIAOPING XIONG, PH.D., GREGORY WHEELER, M.B.B.S., SEAN PHIPPS, PH.D.,
FREDERICK A. BOOP, M.D., AND ROBERT A. SANFORD, M.D.

Departments of Radiation Oncology and Biostatistics, St. Jude Children’s Research Hospital,
Memphis, Tennessee


Object. The goal of this study was to determine the influence of hydrocephalus on intelligence quotient (IQ) in children with infratentorial ependymoma before and after the administration of focal radiation.

Methods. Measurements of ventricular size, including Evans index (EI), cella media index (CMI), frontal horn diameter (FHD), and ventricular angle, were performed using magnetic resonance imaging at the time of diagnosis and again at 3, 6, 9, and 12 months after the initiation of radiation therapy. Of the 59 patients (median age at time of radiation treatment, 4.1 years), the clinical diagnosis established in 50 (85%) was hydrocephalus and 23 (39%) required placement of a cerebrospinal fluid (CSF) shunt. Extent of resection was gross or near total in 50 (85%). Before and after radiation treatment, IQ was measured using age-appropriate testing. The correlation between multiple ventricular measurements and IQ was investigated using standard regression techniques and a generalized linear model.
Patients with a higher EI (p = 0.04), CMI (p = 0.001), and FHD (p = 0.0002) at the time of diagnosis were more likely to have lower IQ scores before radiation treatment. Patients with higher CMI (p = 0.04) and FHD (p = 0.01) at the time of diagnosis were more likely to exhibit an increase in IQ score after radiotherapy. The rate of change in IQ after radiation treatment was positively correlated with the CMI intercept (p = 0.015) and negatively correlated with the rate
of FHD change (p = 0.006).

Conclusions. Changes in IQ score before and after radiation treatment are significantly influenced by the extent and treatment of hydrocephalus at the time of diagnosis. Hydrocephalus is an important factor to include when analyzing the effects of treatment. Patients who undergo a second surgery for ependymoma are more likely to require the placement of a CSF shunt (p = 0.0001).


KEY WORDS • ependymoma • hydrocephalus • cognition • radiation treatment • pediatric neurosurgery

Saturday, August 23, 2008

Pharmacokinetics Study Confirms Therapeutic-Enabling Quantities of Allon's Drugs AL-108 and AL-208 in Human Cerebrospinal Fluid

Aug 12, 2008 09:15 ET

VANCOUVER, BRITISH COLUMBIA and BOSTON, MASSACHUSETTS--(Marketwire - Aug. 12, 2008) - Allon Therapeutics Inc. (TSX:NPC) announced today that a pharmacokinetics study has confirmed that the Company's clinical stage drugs AL-108 and AL-208 penetrate the blood brain barrier of healthy adults and Alzheimer's disease patients in sufficient quantities to enable a therapeutic effect on Alzheimer's and other neurodegenerative diseases.

Gordon McCauley, President and CEO of Allon, said the results support the Company's ongoing clinical development programs for AL-108 and AL-208 and will help determine appropriate dosages for future clinical trials.

"Our results confirmed that therapeutic-enabling quantities of AL-108 or AL-208 were found in the cerebrospinal fluid (CSF) of the healthy adults and the Alzheimer's patients," said McCauley. "The amounts of AL-108 and Al-208 in the CSF were dose proportional and both drugs were safe and well-tolerated by the test subjects."

McCauley announced the pharmacokinetic results during his presentation to the Canaccord Adams Inc. 28th Annual Global Growth Conference in Boston, MA. The conference brings together institutional investors, venture capital investors and small to mid-cap growth-oriented companies.

Allon is developing AL-108 as a treatment for Alzheimer's disease and for schizophrenia-related cognitive impairment. Allon is developing AL-208 as a treatment for the ischemic damage resulting from a variety of acute brain injuries.

- Earlier this year, Allon announced that a Phase IIa clinical trial evaluating AL-108 in 144 patients with amnestic mild cognitive impairment (aMCI), a precursor to Alzheimer's disease, demonstrated that specific memory function improved in patients who were given twice daily dosages of 15 milligrams (mgs) of AL-108 intranasally over 12 weeks. Later this year, the Company will begin enrolment in a Phase IIb clinical trial evaluating AL-108 in Alzheimer's patients.

- The Company expects to complete patient enrolment during the Third Quarter and report top-line results during the Fourth Quarter from a Phase II clinical trial evaluating AL-108 as a treatment for schizophrenia-related cognitive impairment.

- The Company expects to release top-line results during the Third Quarter from the randomized portion of a Phase II clinical trial evaluating the safety, tolerability and effect of AL-208 as a prevention for the mild cognitive impairment resulting from ischemic damage during coronary artery bypass graft surgery.

Pharmacokinetic study results

Test subjects were given a single 15 mg intranasal dose of AL-108 or a single intravenous dose of 50 mg or 300 mg of AL-208. These doses were found to be safe and well-tolerated by the healthy volunteers and mild-to-moderate AD patients.

The pharmacokinetic profile of AL-108 and AL-208 in healthy volunteers confirm results obtained in Allon's previous Phase 1 trials. These conclusions are based on measures of peak concentrations, overall exposure to drug and rate of clearance. The concentration of AL-108 and AL-208 in CSF indicate that the drug crosses the blood-brain barrier in quantities that have conferred protection in prior experimental models.

McCauley said the pharmacokinetic profile of 15 mg AL-108 in mild-to-moderate Alzheimer's patients provides sufficient information to design dose-range components of the Company's proposed Phase IIb Alzheimer's trial. "The modest intra-individual variability observed in the Alzheimer's patients validates the intranasal route of administration for this therapeutic indication and provides us with added confidence in moving this program forward," said McCauley.

About Allon's neuroprotective platforms

Allon's two neuroprotective technology platforms are based on two naturally occurring proteins secreted by the brain in response to a range of insults. The platforms are activity-dependent neuroprotective protein (ADNP) and activity-dependent neurotrophic factor (ADNF). Because the two platforms are based on different proteins, the drugs from each are different molecules with different therapeutic mechanisms and distinct commercial opportunities. Clinical-stage drugs AL-108 and AL-208 are derived from ADNP, while preclinical stage drug AL-309 is derived from ADNF.

About Allon

Allon Therapeutics Inc. is a clinical-stage biotechnology company developing treatments for major neurodegenerative conditions. In Q1 2008, Allon's drug AL-108 demonstrated human efficacy in amnestic mild cognitive impairment, a precursor to Alzheimer's disease. Allon has Phase II human efficacy programs pursuing three large underserved markets: Alzheimer's disease, stroke and schizophrenia-related cognitive impairment. The Company is listed on the Toronto Stock Exchange under the trading symbol "NPC" (Neuro Protection CompanyTM) and based in Vancouver. For additional information please visit the Company's website: www.allontherapeutics.com.

Friday, August 22, 2008

The Prince Synergy Beats Harvard in Full Recovery of Traumatic Brain Injury

August 19, 2008 10:30 AM Eastern Daylight Time


LOS ANGELES--(BUSINESS WIRE)--The Prince Synergy (www.ThePrinceSynergy.com), a leading resource in human capital, announces its full recovery record in Traumatic Brain Injury, including poor impulse control secondary to the injury. A full recovery from Traumatic Brain Injury has been a tough issue even to Harvard University, which The Prince Synergy has unexpectedly discovered recently.

When asked the significance of the recovery, Dr. Bin Yang, CEO and Founder of The Prince Synergy, said, “Victims can regain more freedom. Businesses can reduce more costs in disability and worker’s compensation. A full recovery is possible even two years after the injury. The poor impulse control can be cured.”

Traumatic Brain Injury takes away victims’ freedom and opportunities internally, which makes this injury extremely painful. The victims’ cognitive difficulties also make the recovery harder. Other obstacles include lack of deep knowledge and efficient treatment options, bias against brain injury victims and a slow and stressful recovery process. Some professionals and family members abuse victims and systems, which is the worst drawback toward a full recovery.

Some parts of the recovery take special skills. The Prince Synergy offers 2 days hands-on recovery training. The program enables victims to sharpen their insights into experts and themselves, utilize full resources, strike to recover from inside out, and get back to work and life fast. This program is also very beneficial to victims’ families. The Prince Synergy welcomes partners and investors in research and expand the horizon of human potential.

About The Prince Synergy:

The Prince Synergy is a leading resource in human capital, founded by Bin Yang who has a background in medicine, business, law and eastern medicine. The Prince Synergy not only maximizes innovation and productivity, but also sustains creativity and health efficiently from unexpected change, stress and illness. Most of its hands-on training and management consulting have been featured in Forbes and Euroinvestor. The Prince Synergy helps individuals stay at their optimal level, and helps businesses reduce workplace stress, keep talents, and save health care costs efficiently. In addition to bringing injured people back to work fast, The Prince Synergy also makes CEOs, executives and others more sustainable to life challenges.

Thursday, August 21, 2008

SharpBrains' Top 10 Brain Training Predictions 2007-2015

Ten emerging trends of applied cognitive science that will impact the future of healthcare and wellness to be discussed at World Economic Forum's Global Agenda Council.
In an emerging market like cognitive training, it is difficult to make precise projections

San Francisco, CA (PRWEB) August 5, 2008 -- SharpBrains, the brain fitness market authority, announces the public release of its Top 10 Brain Training Predictions for the period 2007-2015.

"In an emerging market like cognitive training, it is difficult to make precise projections", says Alvaro Fernandez, CEO and co-founder of SharpBrains. "But, we can observe a number of trends that executives, consumers, public policy makers, and the media should watch closely in the coming years, as research-based cognitive fitness and training becomes mainstream, new tools appear, and an ecosystem grows around it."

Mr. Fernandez has been invited to become a member of the World Economic Forum's Global Agenda Council on the Challenges of Gerontology. He has accepted this invitation and confirmed his attendance of the Inaugural Summit on the Global Agenda to be held in Dubai from 7 to 9 November 2008.

Mr. Fernandez is a co-author of the acclaimed State of the Brain Fitness Software Market 2008 report, which estimates a revenue growth for the brain fitness software category (applications to measure and/ or train cognitive functions) from $100m in 2005 to $225m in 2007, and forecasts its future growth to over $2 billion by 2015.

SharpBrains' Top 10 Brain Training Predictions 2007-2015 are:

1. We predict an increased emphasis on brain maintenance in locations ranging from retirement communities to gyms. As a computer-savvy baby boomer population looks for ways to stay mentally fit, brain fitness, or brain training, is becoming part of their vocabulary and concern.

2. Physical and mental exercise will be better integrated. Physical exercise has been shown to increase the rate of neurogenesis, whereas mental exercise helps ensure the survival of any newly created neurons. Today both activities usually take place in very different settings: the former, in health clubs, the later, in universities. We predict that the borders between them will become more diffuse. Expect new programs such as brain fitness podcasts that allow us to train working memory as we jog or exercise bikes with built-in brain games.

3. Watch for a broad government initiative, similar to the one JFK led, to increase the public awareness of the need for brain fitness. It is becoming more widely understood by the medical and policy community that a combination of physical exercise, nutrition, mental exercise and stress management can help us maintain our brain health as we age. As politicians and policy makers look for ways to delay the onset of Alzheimer-related symptoms of our aging population, new initiatives may be launched.

4. Better and more widely available assessments of cognitive function will serve as objective baselines to measure the impact of cognitive training interventions. There will also likely be better diagnostic tests to identify early Alzheimer's symptoms, for example. Reliable diagnostic assessments of cognitive abilities will help move this field forward just as jumping on a scale tells you if your physical fitness and diet program is working.

5. Improved computer-based tools will come to market. The growing pipeline of research studies will enable the market leaders and new entrants to refine existing tools and devise new ones. More clinical studies will show the benefits of brain fitness programs to address specific clinical conditions and learning disabilities.

6. Low tech options will play an increasing role in the brain fitness field. Already, increasing research is showing the cognitive value and brain plasticity impact of interventions such as meditation and cognitive therapy. More research and wider applications will help refine our understanding of when and how they can be most helpful.

7. Doctors and pharmacists will help patients navigate through the overwhelming range of available products and interpret the results of cognitive assessments. This will require significant professional development efforts, given that most doctors today were trained under a very different understanding of the brain than the one we have today.

8. Insurance companies will introduce incentives for members to encourage healthy aging. Many insurance plans today include rewards for members who, for example, voluntarily take health-related questionnaires that enable them to identify steps to take to improve health. Increasingly, brain-related lifestyle factors will become part of these incentivized interventions.

9. Investments in new cognitive interventions for the U.S. military will be commercialized. As the military increasingly funds research to improve the diagnostic and treatment of problems such as PTSD and TBI, the resulting products will ultimately find commercial uses.

10. Brain training will be added to corporate wellness and leadership initiatives. Large employers with existing corporate wellness and leadership programs will introduce brain fitness specific programs aimed not only at improved health outcomes but also at increased productivity and cognitive performance in the workplace.

About The State of the Brain Fitness Software Market 2008 Report:
These predictions come from SharpBrains' market report "The State of the Brain Fitness Software Market 2008", the first comprehensive report to cover the emerging category of applications that help assess and/ or train brain functions, both computer-based and via mobile brain training.

Monday, August 18, 2008

Top 10 Brain Foods for Children

Give your child’s brain a nutritional boost.
By Jeanie Lerche Davis
WebMD Feature

Want your child to do better in school? Take a close look at diet. Certain "brain foods" may help boost a child's brain growth -- plus improve brain function, memory, and concentration.

In fact, the brain is a very hungry organ -- the first of the body's organs to absorb nutrients from the food we eat, explains Bethany Thayer, MS, RD, a Detroit nutritionist and spokeswoman for the American Dietetic Association (ADA).

"Give the body junk food, and the brain is certainly going to suffer," she tells WebMD.

Growing bodies need many types of nutrients -- but these 10 superfoods will help kids get the most from school.

1. Brain Food: Salmon

Fatty fish like salmon are an excellent source of the omega-3 fatty acids DHA and EPA -- both essential for brain growth and function, says Andrea Giancoli, MPH, RD, a Los Angeles nutritionist and ADA spokeswoman.

In fact, recent research has also shown that people who get more of these fatty acids in their diet have sharper minds and do better at mental skills tests.

While tuna is also a source of omega-3s, it's not a rich source like salmon, Giancoli tells WebMD.
"Tuna is definitely a good source of lean protein, but because it's so lean it's not very high in omega-3s like canned salmon is," Giancoli tells WebMD. Also, albacore "white" tuna has more mercury than canned light tuna, so the EPA advises eating no more than 6 ounces of albacore tuna weekly.

Eat more salmon: Instead of tuna sandwiches, make salmon salad for sandwiches -- canned salmon mixed with reduced-fat mayo or non-fat plain yogurt, raisins, chopped celery, and carrots (plus a little Dijon mustard if your child likes the taste). Serve on whole-grain bread -- which is also a brain food.

Soup idea: Add canned salmon to creamy broccoli soup -- plus frozen chopped broccoli for extra nutrition and soft texture. Boxed soups make this an easy meal, and are generally low in fat and calories, Giancoli says. Look for organic boxed soups in the health food section.

Make salmon patties -- using 14 oz. canned salmon, 1 lb. frozen chopped spinach (thawed and drained), 1/2 onion (finely chopped), 2 garlic cloves (pressed), 1/2 teaspoon salt, pepper to taste. Combine ingredients. Mix well. Form into small balls. Heat olive oil in pan, flatten spinach balls with spatula. Cook over medium heat. Serve over brown rice (instant or frozen).

2. Brain Food: Eggs

Eggs are well-known as a great protein source -- but the egg yolks are also packed with choline, which helps memory development.

Eat more eggs: Send your child off to school with a grab-and-go breakfast egg burrito. Try breakfast for dinner one night a week -- scrambled eggs and toast. Make your own egg McMuffin at home: just put a fried egg on top of a toasted English muffin, topped with a slice of low-fat cheese.


3. Brain Food: Peanut Butter

"Peanuts and peanut butter are a good source of vitamin E, a potent antioxidant that protects nervous membranes -- plus thiamin to help the brain and nervous system use glucose for energy," says Giancoli.

Eat more peanut butter: For a twist on an old favorite, make a peanut butter and banana sandwich. Dip apple slices in peanut butter. Or, top off your favorite salad with a handful of peanuts.

4. Brain Food: Whole Grains

The brain needs a constant supply of glucose -- and whole grains provide that in spades. The fiber helps regulate the release of glucose into the body, Giancoli explains. "Whole grains also have B-vitamins, which nourish a healthy nervous system."

Eat more whole grains: It's easy to find more whole grain cereals these days (make sure a whole grain is the first ingredient listed). But also think outside the box -- and try whole wheat couscous for dinner with cranberries, or low-fat popcorn for a fun snack, she suggests.

Whole-grain bread is a must for sandwiches. Switch to whole-grain tortillas and chips for quesadillas, wraps, and snacks.

5. Brain Food: Oats/Oatmeal

Oats are one of the most familiar hot cereals for kids and a very nutritious “grain for the brain,” says Sarah Krieger, MPH, RD, LD/N, a St. Petersburg, Fla. consultant and ADA spokeswoman. "Oats provide excellent energy or fuel for the brain that kids need first thing in the morning."

Loaded with fiber, oats keep a child’s brain fed all morning at school. Oats also are good sources of vitamin E, B-vitamins, potassium and zinc -- which make our bodies and brains function at full capacity.

Eat more oats: Top hot oatmeal with pretty much anything -- applesauce and cinnamon, dried fruit and soy milk, sliced almonds and a drizzle of honey, fresh banana and a dash of nutmeg with skim milk, Krieger suggests.

Cooking? Throw a handful of dry oats into a smoothie to make it thick -- or into pancake, muffin, waffle or a granola bar recipe.

Here’s a simple snack kids can make: 1 cup peanut butter, ½ cup honey, 1 cup dry oats, ½ cup dry milk powder. Mix it up with your hands -- then put a tablespoon between 2 apple or pear slices for a fun and different sandwich!

6. Brain Food: Berries

Strawberries, cherries, blueberries, blackberries. "In general, the more intense the color, the more nutrition in the berries," Krieger says. Berries boast high levels of antioxidants, especially vitamin C, which may help prevent cancer.

Studies have shown improved memory with the extracts of blueberries and strawberries. "But eat the real thing to get a more nutritious package," Krieger says. "The seeds from berries are also a good source of omega-3 fats.."

Eat more berries: Add berries to veggies that may need a flavor boost -- like sliced sweet cherries with broccoli or strawberries with green beans. Toss berries into a green salad. Add chopped berries to a jar of salsa for an excellent flavor surprise.

More berry ideas: Add berries to yogurt, hot or cold cereal, or dips. For a light dessert, top a mound of berries with nonfat whipped topping, Krieger suggests.


7. Brain Food: Beans

Beans are special because they have energy from protein and complex carbs -- and fiber -- plus lots of vitamins and minerals, Krieger says. "These are an excellent brain food since they keep a child's energy and thinking level at peak all afternoon if they enjoy them with lunch."

Kidney and pinto beans contain more omega 3 fatty acids than other beans -- specifically ALA, another of the omega-3’s important for brain growth and function, says Krieger.

Eat more beans: Sprinkle beans over salad and top with salsa. Mash vegetarian beans and spread on a tortilla. Mash or fill a pita pocket with beans -- and add shredded lettuce and low-fat cheese. Add beans to spaghetti sauce and salsa. Infants love mashed beans with applesauce!

8. Brain Food: Colorful Veggies

Tomatoes, sweet potatoes, pumpkin, carrots, spinach -- vegetables with rich, deep color are the best sources of antioxidants that keep brain cells strong and healthy, Thayer says.

Eat more veggies: Try sweet potato fries: Cut up in wedges or sticks. Spray them with vegetable oil cooking spray and then bake them in the oven (400 degrees, 20 minutes or until they start to brown).

Make pumpkin muffins: Mix 1 15-ounce can of pumpkin with a box of your favorite cake or muffin mix. Stir the two ingredients together and follow the directions.

Baby carrots and tiny tomatoes fit nicely into lunch bags. Kids love spinach salads with lots of stuff in them -- like strawberries, mandarin oranges, sliced almonds. Another trick: Sneak all sorts of chopped veggies into spaghetti sauce, soups, and stews.

9. Brain Food: Milk & Yogurt

Dairy foods are packed with protein and B-vitamins -- essential for growth of brain tissue, neurotransmitters, and enzymes. "Milk and yogurt also provide a bigger punch with both protein and carbohydrates – the preferred source of energy for the brain," Thayer says.

Recent research suggests that children and teens need 10 times more the recommended dose of vitamin D -- a vitamin that benefits the neuromuscular system and the overall life cycle of human cells.

Eat more dairy: Low-fat milk over cereal -- and calcium- and vitamin D-fortified juices -- are easy ways to get these essential nutrients. Cheese sticks are great snacks.

Low-fat yogurt parfaits are also fun. In a tall glass, layer yogurt with berries (fresh, frozen, or dried) and chopped nuts (almonds or walnuts), Thayer suggests.

10. Brain Food: Lean Beef (or Meat Alternative)

Iron is an essential mineral that helps kids stay energized and concentrate at school. Lean beef is one of the best absorbed sources of iron. In fact, just 1 ounce per day has been shown to help the body absorb iron from other sources. Beef also contains zinc, which helps with memory.

For vegetarians, black bean and soy burgers are great iron-rich meatless options. Beans are an important source of nonheme iron -- a type of iron that needs vitamin C to be absorbed. Eat tomatoes, red bell pepper, orange juice, strawberries, and other "Cs" with beans to get the most iron.

For a burger-less source of iron -- try spinach. It's packed with nonheme iron, too.

Eat more iron: For dinner, grill kebobs with beef chunks and veggies. Or stir-fry a bit of beef with kids' favorite veggies. Grill black bean or soy burgers, then top with salsa or a tomato slice. Or, chow down on a spinach salad (with mandarin oranges and strawberries for vitamin C).





Sunday, August 17, 2008

Congenital Hydrocephalus: Treatment

Early treatment-within a baby's first 3 to 4 months-is important to help limit or prevent brain damage. The long-term effects of congenital hydrocephalus depend largely on the cause of the condition, its severity, and the response to treatment.

Treatment generally consists of surgically inserting a flexible tube (shunt) in the brain to drain the cerebrospinal fluid. The shunt will remain in the brain permanently but may need to be repaired or replaced if a problem develops.

Endoscopic third ventriculostomy (ETV) is sometimes performed instead of surgical shunt placement. ETV is a surgical procedure in which a small hole is made in a ventricle in the brain, allowing CSF to flow freely. It is often done when hydrocephalus seems to be a result of a blockage between ventricles. If used as treatment for congenital hydrocephalus, it is more likely to be tried after a shunt malfunction or infection. ETV was once thought to be a permanent solution for redirecting CSF flow, but it has been shown to fail over time. Babies younger than 6 months of age usually are not good candidates for this procedure.

Children with congenital hydrocephalus are at increased risk for developmental disabilities and may require treatment such as speech therapy or physical therapy.

Saturday, August 16, 2008

Congenital Hydrocephalus: Diagnosis

Most cases of congenital hydrocephalus are diagnosed during a physical exam soon after birth based on the larger-than-normal size of the baby's head. In rare cases, a diagnosis is made later in childhood. There may be reasons other than congenital hydrocephalus for why a baby has a larger-than-normal head.
With sophisticated imaging technologies, congenital hydrocephalus can be detected in a fetus as early as the third or fourth month of pregnancy. By the fifth or sixth month, abnormal dilation of brain cavities is more clearly detectable. Tests to identify the condition include:

  • Ultrasound -- Performed by a radiologist or perinatologist, this test will establish if there is an abnormal collection of fluid but may not show the obstruction. Imaging tests are usually done to see whether congenital hydrocephalus is a possibility.

  • Amniocentesis -- This, or a needle aspiration of intrauterine fluid, may be performed to detect the presence of other birth defects associated with hydrocephalus.

Congenital hydrocephalus, however, is frequently diagnosed at birth or shortly after. Sometimes it's not diagnosed until after birth.

A computed tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound may be done to help confirm the diagnosis or to provide a more detailed picture of the brain and its structures.

Friday, August 15, 2008

Congenital Hydrocephalus: Signs and Symptoms

Signs and Symptoms

The most common cause of congenital hydrocephalus is obstruction of the cerebral aqueduct -- the long, narrow passageway between the third and fourth ventricle or cavity of the brain. This condition may result from a blockage, infection, hemorrhage, tumor or arachnoid cyst. Other medical problems associated with this form of hydrocephalus are:

* Chiari malformations, an abnormality at the base of brain where the spinal column joins the skull
* Craniosynostosis, when the bones in the skull fuse together before the brain has stopped growing
* Dandy-Walker syndrome, when the fourth ventricle is enlarged because of partial or complete closure of its outlets
* Hydranencephaly, a rare condition in which the brain's cerebral hemispheres are absent and replaced by sacs filled with cerebrospinal fluid
* Neural tube defects or spina bifida, when the spinal cord is exposed at birth and is often lacking cerebrospinal fluid
* Schizencephaly, an extremely rare disorder characterized by abnormal slits, or clefts, in the brain's cerebral hemispheres
* Vein of Galen malformations, abnormal connections between arteries and the deep draining veins of the brain that develop before birth

Symptoms in infants may include:

* A very large head or a head that's growing very quickly in relation to the rest of the body
* Vomiting
* Sleepiness
* Irritability
* Downward deviation of the eyes, called "sunsetting"
* Seizures

Source: UCSF

Thursday, August 14, 2008

Types of hydrocephalus and their etiologies

Hydrocephalus can be caused by impaired cerebrospinal fluid (CSF) flow, reabsorption, or excessive CSF production.

Based on its underlying mechanisms, hydrocephalus can be classified into communicating, and non-communicating (obstructive). Both forms can be either congenital, or acquired.

Communicating hydrocephalus

Communicating hydrocephalus, also known as non-obstructive hydrocephalus, is caused by impaired cerebrospinal fluid resorption in the absence of any CSF-flow obstruction. It has been theorized that this is due to functional impairment of the arachnoid granulations, which are located along the superior sagittal sinus and is the site of cerebrospinal fluid resorption back into the venous system. Various neurologic conditions may result in communicating hydrocephalus, including subarachnoid/intraventricular hemorrhage, meningitis, Chiari malformation, and congenital absence of arachnoidal granulations (Pacchioni's granulations).

  • Normal pressure hydrocephalus (NPH) is a particular form of communicating hydrocephalus, characterized by enlarged cerebral ventricles, with only intermittently elevated cerebrospinal fluid pressure. The diagnosis of NPH can be established only with the help of continuous intraventricular pressure recordings (over 24 hours or even longer), since more often than not, instant measurements yield normal pressure values. Dynamic compliance studies may be also helpful. Altered compliance (elasticity) of the ventricular walls, as well as increased viscosity of the cerebrospinal fluid, may play a role in the pathogenesis of normal pressure hydrocephalus.
  • Hydrocephalus ex vacuo also refers to an enlargement of cerebral ventricles and subarachnoid spaces, and is usually due to brain atrophy (as it occurs in dementias), post-traumatic brain injuries and even in some psychiatric disorders, such as schizophrenia. As opposed to hydrocephalus, this is a compensatory enlargement of the CSF-spaces in response to brain parenchyma loss - it is not the result of increased CSF pressure.

Non-communicating hydrocephalus

Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a CSF-flow obstruction (either due to external compression or intraventricular mass lesions).

  • Foramen of Monro obstruction may lead to dilation of one or, if large enough (e.g., in colloid cyst), both lateral ventricles.
  • The aqueduct of Sylvius, normally narrow to begin with, may be obstructed by a number of genetically or acquired lesions (e.g., atresia, ependymitis, hemorrhage, tumor) and lead to dilatation of both lateral ventricles as well as the third ventricle.
  • Fourth ventricle obstruction will lead to dilatation of the aqueduct as well as the lateral and third ventricles.
  • The foramina of Luschka and foramen of Magendie may be obstructed due to congenital failure of opening (e.g., Dandy-Walker malformation).
  • The subarachnoid space surrounding the brainstem may also be obstructed due to inflammatory or hemorrhagic fibrosing meningitis, leading to widespread dilatation, including the fourth ventricle.

Congenital hydrocephalus

The cranial bones fuse by the end of the third year of life. For head enlargement to occur, hydrocephalus must occur before then. The causes are usually genetic but can also be acquired and usually occur within the first few months of life, which include 1) intraventricular matrix hemorrhages in premature infants, 2) infections, 3) type II Arnold-Chiari malformation, 4) aqueduct atresia and stenosis, and 5) Dandy-Walker malformation.

In newborns and toddlers with hydrocephalus, the head circumference is enlarged rapidly and soon surpasses the 97th%. Since the skull bones have not yet firmly joined together, bulging, firm anterior and posterior fontanelles may be present even when the patient is in an upright position.

The infant exhibits fretfulness, poor feeding, and frequent vomiting. As the hydrocephalus progresses, torpor sets in, and the infant shows lack of interest in his surroundings. Later on, the upper eyelids become retracted and the eyes are turned downwards (due to hydrocephalic pressure on the mesencephalic tegmentum and paralysis of upward gaze). Movements become weak and the arms may become tremulous. Papilledema is absent but there may be reduction of vision. The head becomes so enlarged that the child may eventually be bedridden.

About 80-90% of fetuses or newborn infants with spina bifida - often associated with meningocele or myelomeningocele - develop hydrocephalus.[6]

Acquired hydrocephalus

This condition is acquired as a consequence of CNS-infections, meningitis, brain tumors, head trauma, intracranial hemorrhage (subarachnoid or intraparenchymal) and is usually extremely painful for the patient.



Source: Wikipedia

Wednesday, August 13, 2008

Top 10 Brain Training Predictions 2007-2015 Unveiled by Brain Fitness Authority SharpBrains

Ten emerging trends of applied cognitive science that will impact the future of healthcare and wellness to be discussed at World Economic Forum's Global Agenda Council.
In an emerging market like cognitive training, it is difficult to make precise projections

San Francisco, CA (PRWEB) August 5, 2008 -- SharpBrains, the brain fitness market authority, announces the public release of its Top 10 Brain Training Predictions for the period 2007-2015.


"In an emerging market like cognitive training, it is difficult to make precise projections", says Alvaro Fernandez, CEO and co-founder of SharpBrains. "But, we can observe a number of trends that executives, consumers, public policy makers, and the media should watch closely in the coming years, as research-based cognitive fitness and training becomes mainstream, new tools appear, and an ecosystem grows around it."

Mr. Fernandez has been invited to become a member of the World Economic Forum's Global Agenda Council on the Challenges of Gerontology. He has accepted this invitation and confirmed his attendance of the Inaugural Summit on the Global Agenda to be held in Dubai from 7 to 9 November 2008.

Mr. Fernandez is a co-author of the acclaimed State of the Brain Fitness Software Market 2008 report, which estimates a revenue growth for the brain fitness software category (applications to measure and/ or train cognitive functions) from $100m in 2005 to $225m in 2007, and forecasts its future growth to over $2 billion by 2015.

SharpBrains' Top 10 Brain Training Predictions 2007-2015 are:

1. We predict an increased emphasis on brain maintenance in locations ranging from retirement communities to gyms. As a computer-savvy baby boomer population looks for ways to stay mentally fit, brain fitness, or brain training, is becoming part of their vocabulary and concern.

2. Physical and mental exercise will be better integrated. Physical exercise has been shown to increase the rate of neurogenesis, whereas mental exercise helps ensure the survival of any newly created neurons. Today both activities usually take place in very different settings: the former, in health clubs, the later, in universities. We predict that the borders between them will become more diffuse. Expect new programs such as brain fitness podcasts that allow us to train working memory as we jog or exercise bikes with built-in brain games.

3. Watch for a broad government initiative, similar to the one JFK led, to increase the public awareness of the need for brain fitness. It is becoming more widely understood by the medical and policy community that a combination of physical exercise, nutrition, mental exercise and stress management can help us maintain our brain health as we age. As politicians and policy makers look for ways to delay the onset of Alzheimer-related symptoms of our aging population, new initiatives may be launched.

4. Better and more widely available assessments of cognitive function will serve as objective baselines to measure the impact of cognitive training interventions. There will also likely be better diagnostic tests to identify early Alzheimer's symptoms, for example. Reliable diagnostic assessments of cognitive abilities will help move this field forward just as jumping on a scale tells you if your physical fitness and diet program is working.

5. Improved computer-based tools will come to market. The growing pipeline of research studies will enable the market leaders and new entrants to refine existing tools and devise new ones. More clinical studies will show the benefits of brain fitness programs to address specific clinical conditions and learning disabilities.

6. Low tech options will play an increasing role in the brain fitness field. Already, increasing research is showing the cognitive value and brain plasticity impact of interventions such as meditation and cognitive therapy. More research and wider applications will help refine our understanding of when and how they can be most helpful.

7. Doctors and pharmacists will help patients navigate through the overwhelming range of available products and interpret the results of cognitive assessments. This will require significant professional development efforts, given that most doctors today were trained under a very different understanding of the brain than the one we have today.

8. Insurance companies will introduce incentives for members to encourage healthy aging. Many insurance plans today include rewards for members who, for example, voluntarily take health-related questionnaires that enable them to identify steps to take to improve health. Increasingly, brain-related lifestyle factors will become part of these incentivized interventions.

9. Investments in new cognitive interventions for the U.S. military will be commercialized. As the military increasingly funds research to improve the diagnostic and treatment of problems such as PTSD and TBI, the resulting products will ultimately find commercial uses.

10. Brain training will be added to corporate wellness and leadership initiatives. Large employers with existing corporate wellness and leadership programs will introduce brain fitness specific programs aimed not only at improved health outcomes but also at increased productivity and cognitive performance in the workplace.

About The State of the Brain Fitness Software Market 2008 Report:
These predictions come from SharpBrains' market report "The State of the Brain Fitness Software Market 2008", the first comprehensive report to cover the emerging category of applications that help assess and/ or train brain functions, both computer-based and via mobile brain training.

Brain Aerobics Could be Key to Famous Heart Doctor’s Longevity, Says Alzheimer’s Expert

The late pioneer heart surgeon Michael DeBakey attributed his longevity to genetics and not smoking. However, Alzheimer’s disease and brain longevity expert Dharma Singh Khalsa, M.D. believes that mental exercise and brain aerobics played a big role.

Tucson, AZ, August 06, 2008 --(PR.com)-- Dr. Michael E. DeBakey, one of the United States’ most eminent heart doctors, died recently at the ripe old age of 99 years.

Being the first to develop and perform surgical heart bypass surgery, as well as many other medical innovations, Dr. DeBakey worked and performed surgeries well into his 80’s.

Before his death, he was asked about the secret to his longevity. He gave credit to good family genes and having never smoked.

Dharma Singh Khalsa, M.D., president and medical director of the Alzheimer’s Research and Prevention Foundation (http://www.AlzheimersPrevention.org) — and America’s #1 brain longevity specialist — believes other factors may have also contributed to Dr. DeBakey’s long and active life.

“Just as your body needs strength building activities to keep fit, so does your brain.” Dr. Khalsa explains, “You need to carefully nurture your brain with vigorous mental exercise, what I call ‘brain aerobics’.”

According to Dr. Khalsa, Dr. DeBakey’s ritual of starting his day early in the morning, writing for two hours before leaving his house, working at the hospital until early evening, reading or writing again before bed was key in keeping his brain fit and active.


A diligent course of brain exercises, such as reading and writing everyday, is paramount to staving off age-related memory loss and Alzheimer’s disease.

Numerous studies have shown that memory loss and mental decline do not have to be an inevitable part of the aging process. In fact, Dr. Khalsa says, brain degeneration can be prevented or even reversed through an integrated health program consisting of what he calls the Four Pillars to Building a Better Memory: proper diet and vitamins, stress management, exercise, and medication.

Brain aerobics is an important element of the Four Pillars because it is the key to maintaining a sharp memory. Just like physical exercise increases blood flow and oxygen to the muscles, mental exercise increases blood and oxygen to the brain, thereby improving neural cell growth.

As reported by the non-profit organization Alzheimer’s Research and Prevention Foundation (http://www.AlzheimersPrevention.org) (ARPF), regular participation in brain aerobics has shown to reduce the chances of developing Alzheimer’s disease by up to 70%.

The ARPF, founded by Dr. Khalsa, believes an integrative medical approach utilizing the best of conventional, as well as alternative medical practices such as diet, brain specific nutrients, stress management, physical, and mental exercise, offers the best chance of preventing Alzheimer’s disease.

The Alzheimer’s Research and Prevention Foundation is the leading non-profit organization in the country dedicated to the prevention of memory loss and Alzheimer’s disease. Its mission is to reduce the overall incidence of Alzheimer’s disease through clinical research and to provide public information in the form of educational outreach.

Monday, August 4, 2008

Bradmer reports progression free survival data from previous Phase II glioblastoma multiforme trials




- PFS data from Neuradiab(TM) compares favorably to data from other technologies -

TSX: BMR

TORONTO, July 17 /PRNewswire-FirstCall/ - Bradmer Pharmaceuticals Inc. (TSX: BMR), a biopharmaceutical company dedicated to the development and commercialization of cancer therapies, today released progression free survival (PFS) data from two previously conducted Phase II trials of
Neuradiab(TM) in glioblastoma multiforme (GBM) patients. As an exploratory endpoint of the single arm Phase II trials, the data showed a mean overall PFS of 17.2 months in 19 GBM patients treated with Neuradiab. Bradmer is currently conducting a Phase III clinical trial, termed the GLASS-ART Trial, evaluating Neuradiab as an adjunct therapy to the current standard of care for GBM patients. The primary endpoint of the GLASS-ART Trial is the increase in median overall survival in the treated arm compared to the standard of care control arm.

"These PFS data from the Phase II Neuradiab trials exceed the results achieved in any other clinical trial in newly-diagnosed GBM to our knowledge. This is compelling because of recent inquiries from the U.S. Food and Drug Administration (FDA) which suggested that Bradmer may opt to evaluate sensitivities around the merits and use of PFS as an additional interim marker of prognostic benefit," said Dr. Alan M. Ezrin, President and Chief Executive Officer of Bradmer. "While the GLASS-ART Trial is being conducted with a clear primary endpoint of median overall survival, the opportunity for Neuradiab to demonstrate a patient benefit via the parameter of PFS could provide an augmented regulatory approval path. We have examined the PFS outcomes from the previous studies of Neuradiab and intend to discuss with the FDA the most appropriate method in which to use PFS data from the GLASS-ART Trial."

Recent communications from the FDA have led Bradmer to consider using PFS data not only as a secondary endpoint in the GLASS-ART Trial but to evaluate such data in a blinded and centrally reviewed manner in order to be able to use the PFS data for additional labeling consideration. As the trial is currently designed, PFS data is being collected as an exploratory secondary endpoint. New regulatory submissions can include secondary endpoint data to support labeling claims for registration purposes if the data are collected in an acceptable manner. In some cases, secondary
endpoint data can also provide early insight into patient benefit from an ongoing Phase III trial.

A recent article published in Neuro-Oncology (Lamborn et al, 2008) examined six-month progression free survival as a predictor of overall survival in glioma patients. The article included data from 597 adult patients with recurrent high-grade gliomas that enrolled in Phase II trial
protocols collected by the North American Brain Tumor Consortium between 1998 and 2002. The study concluded that progression status at 9, 18, and 26 weeks were strong predictors of survival and that progression free survival is a valid endpoint for trials of therapies for recurrent malignant glioma.

Bradmer's PFS analysis is based on 19 GBM patients in two recent single-arm Phase II trials of Neuradiab with a targeted dose of 44 Gy delivered as an adjunct to the current standard of care consisting of surgery, temozolomide and external radiation therapy (study 01128; n = 21
(Reardon et al., J Neuro-Oncology, Doc. D06-00199, February 20, 2008) (http://neuro-oncology.dukejournals.org) (DOI:10.1215/15228517-2007-053) and study 05018; n = 5).

In addition, Bradmer has reviewed the existing external GBM literature, and in nine of the eleven studies published between 2003 and 2008 by outside parties that the Company analyzed, progression free survival ranged from 4 to 10 months, with two other studies achieving 13 month and 17 month PFS results. The results from the external studies covered 16 different newly diagnosed GBM patient populations receiving various combinations of approved and investigational therapies. Bradmer has submitted its PFS data (Reardon et al.) as an abstract for inclusion at the 13th Annual Scientific Meeting of the Society of Neuro-Oncology to be held in November, 2008.

About the GLASS-ART Trial (http://www.glassarttrial.com)

The Phase III GLASS-ART trial derives its name from its description: GBM Locoregional Agent Survival Study - Antitenascin Radiolabeled antibody Therapy Trial. The study is designed to determine the survival benefit derived from, and safety of, adding Neuradiab(TM) to the current standard of care therapy, consisting of surgery, radiation and adjuvant chemotherapy
(temozolomide), for patients diagnosed with primary glioblastoma mulitforme. The randomized trial will enroll up to 760 patients at leading treatment centers across the United States. The goal of the GLASS-ART trial is to replicate the increase survival benefit recently reported by investigators from Duke University in patients treated with Neuradiab(TM) (Reardon et al., in J Neuro-Oncology, Doc. D06-00199, February 20, 2008) (http://neuro-oncology.dukejournals.org) (DOI:10.1215/15228517-2007-053).
Additional information on the trial can be found at http://www.glassarttrial.com or at http://www.clinicaltrials.gov and then by searching the term "Bradmer" or the study identifier NCT00615186.

About Neuradiab

Neuradiab is a monoclonal antibody, conjugated to radioactive iodine, used to treat glioblastoma multiforme (GBM), the most common and most advanced form of brain cancer. Neuradiab(TM) delivers tumor-killing radiation specifically to residual brain tumor cells after surgery, with minimal impact on normal brain tissue. During the course of development at Duke University, over US$60 million in research grants and related support has produced a series of Phase I and Phase II clinical trials on Neuradiab(TM) and other closely related technologies. Approximately 200 brain cancer patients, including over 160 with GBM, have been treated with the Neuradiab therapy regimen, and survival benefits have significantly exceeded historical controls in each completed trial. Neuradiab(TM) has been formerly referred to in literature as 131I anti-tenascin monoclonal antibody 81c6.

Each year up to 30,000 new cases of GBM are diagnosed in the world's seven largest healthcare markets. The current standard of care for GBM patients is surgical resection followed by radiation and temozolomide. GBM tumors typically have infiltrating edges that are very difficult to completely remove with surgery. The Neuradiab(TM) therapy is delivered directly into the surgical resection cavity in a separate procedure after the initial surgery. Neuradiab(TM) delivers a concentrated level of radiation specifically to the remaining cancer cells by targeting tenascin. Tenascin is a protein over-expressed in 99% of GBM cells but absent from normal brain cells.