Head & Brain | German Medical Clinics

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Head-Brain

Head and brain diseases:
  1. headache / migraine
  2. neuralgia / trigeminal neuralgia
  3. dizziness
  4. Parkinson´s disease

Headache / Migraine

Headache is common, but its causes can be very different. Often it requires an thorough interdisciplinary examination by, for example, internists, neurologists, ENT specialists, orthopedics and ophtalmologists.

The acute headache has to be differentiated from the chronic and persistent, and the intermittend, recurring types of headache.

The subarachnoidal hemorrhage (SAH) is an important cause of the acute, newly occuring headache. SAH is an intracranial (inside the skull) bleeding, which is caused by a vessel malformation, a so-called aneurysm. The bleeding (or the aneurysm, respectively) has to be treated very quickly since it is a life-threatening disease.

Other causes of a newly occuring headache can be paranasal inflammations, or eye diseases accompanied by changes of the visual system.

-Cerebral hemorrhage caused by a hypertensive crisis (increase of blood pressure above preexisting values) also lead to severe headache. But it is accompanied by neurological deficits (paralyzations, speech disorders, vision deficiency).

-Even a cerebral infarction resulting from ischemia (restriction in blood supply) can make its presence felt simply by severe acute headache.

-Causes of intermittent headache are migraine, different forms of face ache (prosopalgia), or neuralgia (for instance, trigeminal neuralgia), or mechanical blockade of cervical spine (e.g., first cervical vertebra).

-Chronic persistent headache is a diagnostic challenge and can have many causes, which has to be analyzed in each individual case. Causes are arterial hypertension (blood pressure change above normal levels), chronic paranasal inflammation and many more. Even psychological issues matter in case of chronic headache.

All types of headache can also be engendered by a tumor or intracranial space-occupying lesions. A space-occupying lesion can emerge if a tissue expands. Therefore, an exhaustive examination including detailed anamnesis is very important ensued by indicated corresponding examinations (blood sample analysis, EEG, CT, MRI, cerebrospinal puncture / spinal tap, etc.).

Treatment trigeminal neuralgia

Depending on the afflicted area and cause of nerve damage, there are different therapy options. Generally, one will try a drug therapy with special drugs like antiepileptic drugs (anticonvulsants) or antidepressants. The classic trigeminal neuralgia (idiopathic) is cured with drugs. Beforehand, a neuroradiological MRI is conducted to rule out symptomatic trigeminal neuralgia. Applied drugs derive from epileptology where they are used to treat epileptic fits. They reduce the electrical irritability of the brain. Because neuralgia is based on hyperexcitability of nerves, these drugs are successfully used in case of trigeminal neuralgia. Alternatively, trigeminal neuralgia is also treated by acupuncture or TCM (traditional Chinese medicine).

If trigeminal neuralgia is not curable, in case of being severe or medically resistant, or in case of a mechanically compressed (clamped) nerve, surgery is an option. Earlier methods like obliteration of ganglia of skull base are no longer state-of-the-art because of a very successful microsurgical technique, the so-called decompression of the trigeminal nerve after Jannetta.

Dizziness

Many patients talk about ‘dizziness’, but actually mean imbalance (disequilibrium / balance disorder) or other conditions. Some types of epilepsy can be misinterpreted as dizziness. Due to this dizziness is discussed more detailed below.

Acute, intermittent (occuring at intervals, episode-like) and chronic dizziness are differentiated.

Dizziness is caused by diseases of balance system (also called vestibular system), brain, spine as well as vascular and circulatory system.


Following types of dizziness are distinguished:
  1. rotatory vertigo – comparable to the impacts of a fierce ride on the merry-go-round
  2. vestibular vertigo – e.g., in case of seasickness or after excessive alcohol consumption
  3. up and down dizziness – the sensation that you are dragged upwards by an elevator (mostly centrally)
  4. imbalance (ataxia) – during drunkenness, but also in case of many neurological diseases

Parkinson´s disease
  1. Symptoms Parkinson’s disease / PD
  2. Causes Parkinson’s disease / PD
  3. Diagnostics Parkinson’s disease / PD
  4. Therapy Parkinson’s disease / PD

Parkinson’s disease / PD

Parkinson’s disease is one of the most frequent neurological movement disorders. About 400.000 people in Germany are suffering from Parkinson’s disease. This chronic disease mainly afflicts elderly people but can also emerge from the 40th year or even earlier. The idiopathic Parkinson’s disease is the most frequent kind of PD. Idiopathic means that there is no direct, identified cause of the disease. Besides idiopathic Parkinson’s disease, there are also rarer forms having genetic or other causes. PD can cause different symptoms.


Symptoms of Parkinson’s disease in short:
  1. initial symptoms often in only one side of the body
  2. shaking (tremor)
  3. muscle rigidity
  4. slowness of movements (Bradykinesia)
  5. instability related to hold a posture or balance (postural instability)
  6. further symptoms like paresthesia, bladder or gastrointestinal disorder, sexual dysfunction, mood swing, depression or sleep disorders

Causes Parkinson’s disease / PD

The typical movement-related symptoms of Parkinson’s disease do mainly express the loss of brain cells regulating and coordinating motion sequences by transmitting the messenger dopamine. But the cause behind the loss of these brain cells is uncertain for the neurodegenerative forms of PD to which the most frequent idiopathic Parkinson’s disease belongs. However, certain factors have been identified that may trigger or start the disease processes. But these factors are still subject of research. In very rare cases accompanied by an early outbreak of PD, the disease is caused by genetic mutations (PARK2, PARK6 and others) to be identified with a blood test. Other forms of Parkinson’s disease are caused by an apoplectic stroke, drugs or the impact of toxic substances in some cases.


Diagnostics Parkinson’s disease / PD

The diagnosis Parkinson’s disease necessitates a comprehensive neurological-orthopedic examination. Often imaging procedures like MRI are used to differentiate different diseases that may cause similar or the same symptoms like PD.


Therapy Parkinson’s disease / PD

Today we have a big amount of efficient drugs to control the symptoms of PD. Accompanying treatments like physiotherapy, speech-language pathologists or occupational therapy play a crucial role. Movement-related symptoms, and speaking does also belong to them, are treated this way.

The individual treatment strategy depends on one hand on the PD type (idiopathic, genetic, drug-related, caused by toxic substances, etc.) and on the other hand on the emerging symptoms, the state of PD and also side effects of the drugs. These side effects may cause movement-related on-off fluctuations (on = improved condition and mobility, off = worsened condition with lack of mobility). They may also result in drug-related writhing of movements (dyskinesia) but also affect vegetative functions, sleep and the psychic condition.

Especially patients suffering from progressive Parkinson’s disease, severe gait disorder, shaking and dyskinesia (writhing of movements) benefit from deep brain stimulation (DBS). DBS treats pathologically changed brain structures by transmitting electrical impulses that stimulate or deactivate the corresponding area of the brain. The necessary electrodes are implanted during the minimally invasive, stereotactic brain surgery.

Read more about deep brain stimulation (DBS) as a treatment option of Parkinson’s disease