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Tumours inside the skull can arise from the meninges (the coverings around the brain), the blood vessels, the pituitary gland, or the brain substance itself. By far the most common malignant tumour is a secondary tumour; these are most common as complications of lung cancer, but they may come from any organ in the body. After secondary cancer, the most common primary cancer group are called the gliomas, which are tumours of the nerve cells themselves. After this, tumours arising from the meninges are the next most common.
The exact symptoms produced by a tumour depend entirely upon where it is, what it’s pressing on, and what structures it may be invading and destroying. Tumours at the front of the brain can produce a progressive change in personality, or alterations in the emotions, giving either euphoria or irritability. Further back, tumours can produce epilepsy and/or weakness of the limbs on the opposite side of the body.
Tumours in the side part of the brain called the temporal lobe can produce progressive inability to speak, and sometimes hallucinations; and tumours low down at the base of the brain cause a rise in pressure within the brain. This can lead to a condition called hydrocephalus (water on the brain), which causes severe headaches and vomiting, and which, in small children, can cause progressive enlargement of the head. Coordination is often a problem for people who have tumours in this position.
Benign tumours are relatively easy to treat and some malignant tumours respond to treatment, but others are relatively resistant. Surgery is usually the best treatment for benign tumours; malignant primary tumours can be successfully cut out, but the surgeon won’t want to remove too much of the brain tissue, and it may be difficult to remove a malignant tumour completely. Often surgery is used to begin with, then chemotherapy or radiotherapy afterwards. Surgery is seldom used in secondary tumours; these are often multiple, and impossible to remove completely.
The response to treatment depends very much on the exact type of tumour; tumours arising from the same type of tissue in two different patients may have quite different sensitivities to treatment. The response to treatment is very much an individual matter and doctors in the cancer clinics will often try a particular course of treatment, and then adjust the treatment according to the individual response.
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On the other hand, sometimes a blow is sufficient to dish in the skull, in which case the broken bones are now pressing on the brain and preventing its proper functioning. When this happens, many of the same symptoms occur as with bleeding underneath a fracture. Briefly, pressure on the brain causes a stroke-like effect, the patient becomes drowsy or loses consciousness, has a dreadful headache, may lose control of his vision so that he sees double, and the automatically controlled irises in the eye may go awry, so that one pupil becomes large and won’t react to light.
If these things occur, then the patient urgently needs an operation to lift the depressed pieces of bone. Once the pressure on the brain is relieved, it starts to work normally again. And provided the head injury has not irreparably damaged the brain tissue underlying the fracture, full recovery should follow.
How do you know if you have a fractured skull? A useful rule of thumb is that if you’ve been knocked out, or if you’ve had a blow from a blunt object which was hard enough to rupture the skin, you need to be seen in Casualty straightaway.
If you’ve been knocked out, or if the X-ray shows that you have fractured your skull, you’ll need to be admitted to hospital for observation for twenty-four hours, to make sure that internal bleeding isn’t developing.
One small event causes a lot of confusion and is worth mentioning. A relatively minor blow to a child’s forehead often brings up the most mountainous bruise, which usually frightens the life out of his parents! The child falls, bashing his head on the edge of a table and within minutes, there’s the bruise – rising a quarter of an inch above the normal level of the skin.
I call this the ‘Korky the cat’ phenomenon! If you remember back to the days when you read the ‘Dandy’, you’ll remember that every time one of the characters received a bang on the head, immediately he was pictured as having a mountainous bruise. This is really only a reflection of what happens to so many small children in the same circumstances. Although the bruise often looks awful, it seldom means anything important. So long as there is no cut in the skin, a cold compress will help to reduce the swelling, as will a hanky dipped in witchhazel, pressed to the bruise. And it usually goes down quite quickly, too. However, if the blow caused a cut in the skin; if the child was knocked out or can’t remember the incident; if he seems drowsy, is seeing double, or is vomiting, or in any way seems to be behaving unusually, then it is time to take him to Casualty.
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The key to self-help is avoidance. Make sure that you have your blood pressure measured from time to time. This is especially important if you have a family history of high blood pressure, or if your own blood pressure is known to be a little higher than normal. (In this case, more regular checks are likely to be needed.)
If your doctor is giving you tablets for blood pressure make sure you take them regularly, even if you get some side-effects. Do, by the way, tell your doctor about any side-effects. There are many different ways of treating high blood pressure and it may be that the drug you’re using at the moment doesn’t suit you as well as some of the others might.
If you’ve already had a stroke, then do attend to what your doctor and physiotherapist are telling you. In particular, if your physiotherapist is suggesting some exercises, take time to do them. It will help considerably to keep your remaining muscles trim and get the very best out of muscles that have been partially paralysed. By exercising properly you will be minimising the after-effects of your stroke to a degree you might not think possible at the moment.
Finally, if you are getting pains in your head, neck, or back following a stroke, don’t suffer in silence – tell your doctor.
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Meningitis is an infection of the coverings of the brain, whereas encephalitis is an infection of the brain tissue itself usually as a result of a viral infection. Often a small amount of encephalitis occurs as part of a viral illness, such as mumps or measles. Mostly the inflammation is minimal and spontaneously disappears without trace once the infection is over. In the moderately severe viral infections such as influenza it is probably a mild degree of encephalitis which is responsible for the transient disordered dreams, drowsiness, and slight irritability that sometimes accompanies these conditions.
More rarely, a more severe form of encephalitis from mumps, measles, etc., can cause permanent brain damage such as deafness or mental handicap. Sometimes infection is primarily in the brain itself, and in the really bad cases, encephalitis can be life-threatening. In cases like this there may be fits, gross alterations in the level of consciousness with extreme drowsiness or even coma. Severe cases of encephalitis look more or less exactly like meningitis, with vomiting, a stiff neck, and a severe headache.
The approach to treatment is the same, too. Clinically it is often impossible to tell meningitis and encephalitis apart without doing a lumbar puncture and other special tests. Urgent hospital admission is necessary, exactly as in the case of meningitis.
Patients with severe encephalitis are obviously ill; but because most cases are due to viral infections, often little can be done; unlike bacteria, viruses don’t respond to antibiotics. However, the herpes virus group does respond to the antiviral agent acyclovir and in severe cases acyclovir given by injection may help to limit (not remove) an encephalitis thought to be caused by this type of virus.
Fortunately, severe encephalitis is rare; treatment is entirely in the hands of orthodox medicine and no self-help nor alternative therapies are appropriate. Mild cases of encephalitis (where the encephalitis is really just part of an overall infection, such as flu or mumps) usually resolve spontaneously; the headache and other symptoms they produce are best treated symptomatically.
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Half those questioned about their migraines say that their migraine has interfered with their career and job prospects. Migraine has a considerable effect on our ability to work. With minor attacks it’s possible to work through a migraine, but in full-blown attacks it’s impossible. Not only is the headache so severe that you can hardly think, but it is worsened by excess noise, motion, flickering lights, stress and computer VDUs, to say nothing of strong smells.
Despite the fact that millions of working days are lost each year due to migraine, only about a third of employees have ever told their doctor that they suffer from migraine, even though they may find that it is triggered at work. It is interesting in that the group who are least likely to tell their employers about their migraine are those in middle management, for whom advancement and job prospects are so important.
Migraine attacks at work present two different problem^ firstly, work is more likely to trigger off migraines, simply because so many trigger factors may be present. Furthermore, stress may trigger off migraines in certain people, and work often stresses tis more than anything else. Finally allergic triggers, such as chemicals and strong smells may also be present in your workplace.
It’s not just stress and over-work that can cause damage, either. Underwork can do it, too. Therefore, if your job consists of mere machine minding, with little to do from hour to hour except to wait for the occasional problem, then you may get more migraines as a result.
Migraines can be quite dangerous at work, for several reasons. Firstly, your attention and concentration is likely to be reduced because of the pain, so you may make mistakes and errors of judgement. Secondly, if you’re working near machinery you may not be aware of danger, particularly if you’ve got distorted vision or a blind spot in your field of view. It also means you shouldn’t be driving if you have visual impairment of this sort. Thirdly, if you get paralysis or weakness you may not be able to control your car or your machine properly. Lastly, your mental functioning declines in migraine, and you may not be able to form sentences properly during the aura phase – and this is potentially dangerous if you need to give clear instructions or make complex decisions.
Once the attack has started, work is not a helpful place to be. In a bad attack a migraineur needs quiet and rest, and most factories and offices are anything but restful, quiet places.
If at the beginning of an attack you can get rest and quiet for a time, and take whatever medication you usually need, then you may abort the attack and be able to return to work; but, if there is no rest room or sick room where you can go and lie down, then the attack is likely to continue and you’ll be off work for the next day or so.
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