intracranial

A brain aneurysm is an abnormal bulge or "ballooning" in the wall of an artery in the brain. They are sometimes called berry aneurysms because they are often the size of a small berry. Most brain aneurysms produce no symptoms until they become large, begin to leak blood, or burst.

If a brain aneurysm presses on nerves in your brain, it can cause signs and symptoms. These can include:

• A droopy eyelid
• Double vision or other changes in vision
• Pain above or behind the eye
• A dilated pupil
• Numbness or weakness on one side of the face or body

Treatment depends on the size and location of the aneurysm, whether it is infected, and whether it has burst. If a brain aneurysm bursts, symptoms can include a sudden, severe headache, nausea and vomiting, stiff neck, loss of consciousness, and signs of a stroke. Any of these symptoms requires immediate medical attention.

NIH: National Heart, Lung, and Blood Institute

Your brain is the control center of your body. It controls your thoughts, memory, speech, and movement. It regulates the function of many organs. It's part of your nervous system, which also includes your spinal cord and peripheral nerves. The nervous system sends signals between your brain and the rest of the body. Your nerves take in information from your senses and send it to the brain to be processed. Your brain and nerves also communicate to help you move and to control your body's functions.

When the brain is healthy, it works quickly and automatically. But when you have a brain disease, it may affect how well you can function and do your daily activities. Some common brain diseases include:

• Brain tumors, which can press on nerves and affect brain function.
• Degenerative nerve diseases, which can affect many of your body's activities, such as balance, movement, talking, breathing, and heart function. Types include Alzheimer's disease and Parkinson's disease.
• Encephalitis (inflammation in the brain), which can lead to problems such as vision loss, weakness, and paralysis.
• Genetic brain disorders, which are caused by changes in genes (also called variants or mutations). These disorders can affect the development and function of the brain.
• Strokes, which can cause a loss of brain cells and can affect your ability to think clearly.
• Traumatic brain injuries (TBIs), which can affect brain function. They may range from mild to severe. The effects of a TBI may be temporary or permanent.

The symptoms of brain diseases vary widely, depending on the specific problem. In some cases, damage is permanent. In other cases, treatments such as surgery, medicines, or therapies such as physical, occupational, and speech therapies, may cure the disease or improve the symptoms.

The optic nerve is a bundle of more than 1 million nerve fibers that carry visual messages. You have one connecting the back of each eye (your retina) to your brain. Damage to an optic nerve can cause vision loss. The type of vision loss and how severe it is depends on where the damage occurs. It may affect one or both eyes.

There are many different types of optic nerve disorders, including:

• Glaucoma is a group of diseases that are the leading cause of blindness in the United States. Glaucoma usually happens when the fluid pressure inside the eyes slowly rises and damages the optic nerve.
• Optic neuritis is an inflammation of the optic nerve. Causes include infections and immune-related illnesses such as multiple sclerosis. Sometimes the cause is unknown.
• Optic nerve atrophy is damage to the optic nerve. Causes include poor blood flow to the eye, disease, trauma, or exposure to toxic substances.
• Optic nerve head drusen are pockets of protein and calcium salts that build up in the optic nerve over time

Contact your health care provider if you are having vision problems. Tests for optic nerve disorders may include eye exams, ophthalmoscopy (an examination of the back of your eye), and imaging tests. Treatment depends on which disorder that you have. With some optic nerve disorders, you may get your vision back. With others, there is no treatment, or treatment may only prevent further vision loss.

Traumatic brain injury (TBI) is a sudden injury that causes damage to the brain. It may happen when there is a blow, bump, or jolt to the head. This is a closed head injury. A TBI can also happen when an object penetrates the skull. This is a penetrating injury.

Symptoms of a TBI can be mild, moderate, or severe. Concussions are a type of mild TBI. The effects of a concussion can sometimes be serious, but most people completely recover in time. More severe TBI can lead to serious physical and psychological symptoms, coma, and even death.

The main causes of TBI depend on the type of head injury:

• Some of the common causes of a closed head injury include
  • Falls. This is the most common cause in adults age 65 and older.
  • Motor vehicle crashes. This is the most common cause in young adults.
  • Sports injuries
  • Being struck by an object
  • Child abuse. This is the most common cause in children under age 4.
  • Blast injuries due to explosions
• Some of the common causes of a penetrating injury include
  • Being hit by a bullet or shrapnel
  • Being hit by a weapon such as a hammer, knife, or baseball bat
  • A head injury that causes a bone fragment to penetrate the skull

Some accidents such as explosions, natural disasters, or other extreme events can cause both closed and penetrating TBI in the same person.

Certain groups are at higher risk of TBI:

• Men are more likely to get a TBI than women. They are also more likely to have serious TBI.
• Adults aged 65 and older are at the greatest risk for being hospitalized and dying from a TBI

The symptoms of TBI depend on the type of injury and how serious the brain damage is.

The symptoms of mild TBI can include:

• A brief loss of consciousness in some cases. However, many people with mild TBI remain conscious after the injury.
• Headache
• Confusion
• Lightheadedness
• Dizziness
• Blurred vision or tired eyes
• Ringing in the ears
• Bad taste in the mouth
• Fatigue or lethargy
• A change in sleep patterns
• Behavioral or mood changes
• Trouble with memory, concentration, attention, or thinking

If you have a moderate or severe TBI, you may have those same symptoms. You may also have other symptoms such as:

• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• Not being able to wake up from sleep
• Larger than normal pupil (dark center) of one or both eyes. This is called dilation of the pupil.
• Slurred speech
• Weakness or numbness in the arms and legs
• Loss of coordination
• Increased confusion, restlessness, or agitation

If you have a head injury or other trauma that may have caused a TBI, you need to get medical care as soon as possible. To make a diagnosis, your health care provider:

• Will ask about your symptoms and the details of your injury
• Will do a neurologic exam
• May do imaging tests, such as a CT scan or MRI
• May use a tool such as the Glasgow coma scale to determine how severe the TBI is. This scale measures your ability to open your eyes, speak, and move.
• May do neuropsychological tests to check how your brain is functioning

The treatments for TBI depend on many factors, including the size, severity, and location of the brain injury.

For mild TBI, the main treatment is rest. If you have a headache, you can try taking over-the-counter pain relievers. It is important to follow your health care provider's instructions for complete rest and a gradual return to your normal activities. If you start doing too much too soon, it may take longer to recover. Contact your provider if your symptoms are not getting better or if you have new symptoms.

For moderate to severe TBI, the first thing health care providers will do is stabilize you to prevent further injury. They will manage your blood pressure, check the pressure inside your skull, and make sure that there is enough blood and oxygen getting to your brain.

Once you are stable, the treatments may include:

• Surgery to reduce additional damage to your brain, for example to
  • Remove hematomas (clotted blood)
  • Get rid of damaged or dead brain tissue
  • Repair skull fractures
  • Relieve pressure in the skull
• Medicines to treat the symptoms of TBI and to lower some of the risks associated with it, such as
  • Anti-anxiety medication to lessen feelings of nervousness and fear
  • Anticoagulants to prevent blood clots
  • Anticonvulsants to prevent seizures
  • Antidepressants to treat symptoms of depression and mood instability
  • Muscle relaxants to reduce muscle spasms
  • Stimulants to increase alertness and attention
• Rehabilitation therapies, which can include therapies for physical, emotional, and cognitive difficulties:
  • Physical therapy, to build physical strength, coordination, and flexibility
  • Occupational therapy, to help you learn or relearn how to perform daily tasks, such as getting dressed, cooking, and bathing
  • Speech therapy, to help you to with speech and other communication skills and treat swallowing disorders
  • Psychological counseling, to help you learn coping skills, work on relationships, and improve your emotional well-being
  • Vocational counseling, which focuses on your ability to return to work and deal with workplace challenges
  • Cognitive therapy, to improve your memory, attention, perception, learning, planning, and judgment

Some people with TBI may have permanent disabilities. A TBI can also put you at risk for other health problems such as anxiety, depression, and post-traumatic stress disorder. Treating these problems can improve your quality of life.

There are steps you can take to prevent head injuries and TBIs:

• Always wear your seatbelt and use car seats and booster seats for children
• Never drive under the influence of drugs or alcohol
• Wear a properly fitting helmet when riding a bicycle, skateboarding, and playing sports like hockey and football
• Prevent falls by
  • Making your house safer. For example, you can install railings on the stairs and grab bars in the tub, get rid of tripping hazards, and use window guards and stair safety gates for young children.
  • Improving your balance and strength with regular physical activity

Arteriovenous malformations (AVMs) are defects in your vascular system. Your vascular system is your body's network of blood vessels. It includes your:

• Arteries, which carry oxygen-rich blood from your heart to your tissues and organs.
• Veins, which carry the blood and waste products back to your heart.
• Capillaries, which are tiny blood vessels that connect your small arteries to your small veins.

An AVM is an abnormal tangle of arteries and veins. They are connected to each other, with no capillaries between them. Without the capillaries, the blood flow from the arteries goes directly into the veins at a faster rate than normal. Because of this, the nearby tissue does not get all the oxygen it would normally get. This lack of oxygen can lead to tissue damage and the death of nerve cells and other cells. The fast rate of blood flow can also increase the blood pressure inside the arteries and veins. This can weaken the arteries and veins. A weakened artery or blood vessel could burst or leak blood.

AVMs are rare. The cause of AVMs is unknown. Most of the time, people are born with them. But sometimes they can appear shortly after birth or later in life.

The symptoms of AVM will depend on where the AVM is located. They can happen anywhere in the body, but they are more common in the brain or spinal cord. Most people with brain or spinal cord AVMs have few, if any, major symptoms. But if a weakened blood vessel bursts, it can spill blood into the brain (called a hemorrhage). Severe hemorrhages can cause a stroke and brain damage.

If an AVM is causing symptoms, they can include:

• Seizures
• Headache
• Pain in the area where the AVM is located
• Vision problems
• Muscle weakness
• Problems with movement and speech
• Confusion
• Dizziness
• Loss of consciousness

To find out if you have an AVM, your health care provider:

• Will ask about your symptoms and medical history.
• Will do a physical exam. This may include listening for a bruit. A bruit is whooshing sound caused by the rapid blood flow through the arteries and veins of an AVM.
• May order imaging tests, such as a CT scan, MRI, ultrasound, or cerebral angiography. For a cerebral angiography, you are injected with a special dye that helps the blood vessels in your brain show up on x-rays.

Treatments for AVMs will depend on factors such as:

• Where the AVM is located
• Its size
• Your symptoms
• Your overall health
• Your risk of bleeding

The treatment options may include:

• Monitoring for any signs that may mean you have an increased risk of hemorrhage.
• Medicines to help with the symptoms from AVMs.
• Surgery, which may be done if you have a higher-than-usual risk of bleeding. There are a few different types of surgery for AVMs. In some cases, you may have more than one type. Surgery can be risky, especially when it's done on the brain or spinal cord. So you and your provider will need to discuss the risks and benefits of doing the surgery before you make a decision.

NIH: National Institute of Neurological Disorders and Stroke

Bleeding is the loss of blood. It can be external, or outside the body, like when you get a cut or wound. It can also be internal, or inside the body, like when you have an injury to an internal organ. Some bleeding, such as gastrointestinal bleeding, coughing up blood, or vaginal bleeding, can be a symptom of a disease.

Normally, when you are injured and start bleeding, a blood clot forms to stop the bleeding quickly. Afterwards, the clot dissolves naturally. To be able to make a clot, your blood needs blood proteins called clotting factors and a type of blood cell called platelets. Some people have a problem with clotting, due to another medical condition or an inherited disease. There are two types of problems:

• Your blood may not form clots normally, known as a bleeding disorder. This happens when your body does not make enough platelets or clotting factors, or they don't work the way they should.
• Your blood may make too many clots, or the clots may not dissolve properly

Sometimes bleeding can cause other problems. A bruise is bleeding under the skin. Some strokes are caused by bleeding in the brain. Severe bleeding may require first aid or a trip to the emergency room.

A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. They can also develop between two blood vessels, such as between an artery and a vein or between two arteries.

Some people are born with a fistula. Other common causes of fistulas include:

• Complications from surgery
• Injury
• Infection
• Diseases, such as Crohn's disease or ulcerative colitis

Treatment depends on the cause of the fistula, where it is, and how bad it is. Some fistulas will close on their own. In some cases, you may need antibiotics and/or surgery.

Chances are you've bumped your head before. Often, the injury is minor because your skull is hard and it protects your brain. But other head injuries can be more severe, such as a skull fracture, concussion, or traumatic brain injury.

Head injuries can be open or closed. A closed injury does not break through the skull. With an open, or penetrating, injury, an object pierces the skull and enters the brain. Closed injuries are not always less severe than open injuries.

Some common causes of head injuries are falls, motor vehicle accidents, violence, and sports injuries.

It is important to know the warning signs of a moderate or severe head injury. Get help immediately if the injured person has:

• A headache that gets worse or does not go away
• Repeated vomiting or nausea
• Convulsions or seizures
• An inability to wake up
• Dilated (enlarged) pupil in one or both eyes
• Slurred speech
• Weakness or numbness in the arms or legs
• Loss of coordination
• Increased confusion, restlessness, or agitation

Doctors use a neurologic exam and imaging tests to make a diagnosis. Treatment depends on the type of injury and how severe it is.

NIH: National Institute of Neurological Disorders and Stroke

A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when a blood vessel breaks and bleeds into the brain. Within minutes, brain cells begin to die. Causes include a bleeding aneurysm, an arteriovenous malformation (AVM), or an artery wall that breaks open.

Symptoms of stroke are:

• Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

It is important to treat strokes as quickly as possible. With a hemorrhagic stroke, the first steps are to find the cause of bleeding in the brain and then control it. Surgery may be needed. Post-stroke rehabilitation can help people overcome disabilities caused by stroke damage.

National Institute of Neurological Disorders and Stroke