the brain is the major control center of a person’s body and mind. it is where ideas, senses,...

The brain is the major control center of a persons body and mind. It is where ideas, senses, reflexes and movements originate. The human brain is extremely complex, but can be roughly organized into different structures that are responsible for different tasks.

Cerebral Cortex - The largest, most familiar part of the brain -Divided into left and right cerebral hemispheres that control the opposite sides of the body -responsible for reading, speech, thinking, learning, emotions, and reactions to senses. - Can be divided into more specific areas

Divisions of the Cerebral Cortex Frontal Lobe- gives you the ability to choose right from wrong, use correct social responses, and retain long term memories Temporal Lobe involved with speech, memory and hearing Occipital Lobe processes visual stimuli Parietal Lobe processes information to help with spatial orientation, manipulation of objects and understanding numbers

Inner Brain The inner brain lies beneath the cerebral cortex and works as a connection between the cerebral cortex and the brainstem. Its structures determine our emotional state, consciousness, perceptions and reflexes.

Inner Brain Structures Thalamus processes information from the cortex and plays an important role in consciousness Hypothalamus Links the nervous system to the endocrine system, which makes it a major control center for emotions Hippocampus Responsible for memory formation and storage Pituitary Gland Controls hormone secretion

Inner Brain Structures Basal Ganglia A collection of nuclei that provide connections between the cortex, thalamus, and brainstem. These connections are involved with movement coordination, executing voluntary movements, perception, learning and memory. Olfactory Bulb Involved with smell. Amygdala Controls emotions, especially by forming emotional memories, and is also responsible for long-term memory.

Brain Stem Responsible for essential life functions and relays information between the brain and the rest of the body Midbrain Controls reflexes and movement. Pons - Responsible for breathing and arousal, and also coordinates movement information between the cortex and cerebellum. Medulla Maintains autonomic functions like breathing, blood pressure, and heart rate.

Cerebellum Detects surroundings and coordinates movements to respond to specific situations

Important Links Brain Anatomy (for fun) 3-D Brain Anatomy http://anatomyarcade.com/games/wordsearch/nervou sWS/nervousWordsearch.html

Question What are the 4 main lobes of the Cerebral Cortex? What actions is the Cerebral Cortex responsible for?

Answer: The Cerebral cortex is responsible for: Frontal lobe Long term memories, social interaction Parietal lobe Spatial orientation, object manipulation Occipital lobe Processing visual stimuli Temporal lobe Involved in speech, memory, and hearing

Meninges The brain is a floating network of cells suspended in Cerebrospinal fluid (CSF). The CSF is produced by ependymal cells and circulates through the ventricles and meninges. The meninges cover the brain and attach it to the skull.

Meninges We have 3 Meninges Dura Mater The tough layer next to the skull Arachnoid Mater The middle layer that is made up of web-like projections that connect the two other layers and allows CSF to flow through Pia Mater The thinnest layer that lies closely against the brain

Ventricles There are four ventricles The paired lateral ventricles Third Ventricle Fourth Ventricle They are cavities in the brain that carry and promote the flow of cerebrospinal fluid

Question: What are the three Meninges? What flows through the Meninges What are the big cavities in the brain that hold this fluid?

Answer Dura Mater, Arachnoid Mater, Pia Mater Cerebrospinal Fluid Ventricles

Brain Matter The brain is made up of neurons and glial cells. The neurons carry signals throughout the brain, while the glial cells mainly provide support for the neurons.

Neurons 100 billion neurons in the brain Have 3 basic parts Dendrites Detect signals from the surrounding cells and transmits them to the cell body Cell body Contains the nucleus, which is the control center for the cell Axon Carries signals from the cell body to the end of the axon The axon is covered with myelin, which is an insulating sheath that helps to speed up signal movement

Glial Cells Estimated 10x more glial cells than neurons Do NOT chemo-electric carry signals Main job is to hold neurons in place Capable of secreting nutrients and other chemicals that can change signals sent throughout the brain

Types of Glial Cells Oligodendrocytes Schwann Cells These cells produce myelin (insulating cover) for the nerves in the brain and spinal cord These cells produce myelin for the nerves outside of the brain and spinal cord

Astrocytes Microglia Anchor to neurons and provide support Act as a buffer to absorb chemicals and promote homeostasis in the brain Eat foreign entities in the brain part of the brains immune system

Ependymal Cells Line the ventricles in the brain Make CSF and helps it flow throughout the ventricles

Questions: Are there more neurons or glial cells in the brain? What is the main role of glial cells? Specifically, what do Oligodendrocytes do? Specifically, what do Astrocytes do?

Answers: Glial cells There is up to ten times more glial cells than neurons Glial cells provide support Oligodendrocytes make the insulating cover for neurons (myelin) Astrocytes anchor neurons and absorb chemicals in the brain

Brain Tumors arise when cell division occurs irregularly and uncontrolled. When more tissue is produced than needed, tumors are formed. They can grow in many different parts of the brain and involve different types of tissues and cells. If tumors are benign, they grow locally and do not spread. If a tumor is malignant, it is invasive and can spread throughout the body.

Malignant Brain Tumors -When determining how malignant a brain tumor is, the cells are examined by a pathologist and given a grade. Brain tumors can be graded using the WHO classification system. WHO Grade 1 Well differentiated (Low Grade) WHO Grade 2 Moderately differentiated (Intermediate Grade) WHO Grade 3 Poorly Differentiated (High Grade) WHO Grade 4 Undifferentiated (High Grade)

Cell Differentiation Examples A Grade 2 B Grade 3 C Grade 4

Symptoms of a Brain Tumor By Location: Frontal lobe Weakness, personality changes, speech disturbances Parietal lobe Loss or changes in sensation, changes in vision Temporal lobe Seizures, difficulty understanding, difficulties with language Occipital lobe Changes in vision Cerebellum Abnormal eye movements, loss of coordination, changes in gait, hearing loss, vertigo, headaches, nausea, vomiting

Diagnosis The process of detecting and treating a brain tumor can be extremely stressful and complicated. Once a patient goes to see the doctor, they do a basic neurological exam. This exam tests many functions, such as eye movements, pupil reactions, reflexes, hearing, mental abilities, facial movements, and balance and coordination. If these are abnormal, the doctor may schedule an MRI or a CT Scan

MRI Magnetic Resonance Imaging The patient lies on a table that slides into a tunnel with a magnetic field During the scan, radio waves are sent to the head. The different cell types in the brain cause the waves to bend, which are recognized by a computer that forms a picture.

CT Scan Computed Tomography For a CT Scan, a person is injected with a dye and then lies on a table. A big donut shaped machine circles the head and sends x-ray waves through the brain to measure the amount of rays that are emitted back in the machine vs. the amount that are absorbed. By putting together all of the signals, a computer forms a picture of the brain.

Biopsy Once it is determined that there is a growth in the brain, a biopsy is done in order to make an accurate diagnosis. If the tumor is in an accessible location, a patient may choose to have the whole tumor removed and then send a sample away for the biopsy. If the tumor is inaccessible, a tiny needle can be inserted into the brain to capture a small sample of tissue. Once the samples are attained, they are sent to a neuropatholigst.

Pathology The tissue samples are either frozen or dried, then sliced into very thin sections. The slices are mounted on to slides and examined with a microscope First, the cell type that the tumor originated from is determined Next, the growth rate of the tumor is assessed Finally, the type and grade of the tumor is diagnosed

Pathology Report When a patient is diagnosed, the details are put into a document called a pathology report. Physicians write them with the intent that other physicians will read them, so they are often complex and difficult to decipher. Get picture

Pathology Report Contents Main Sections Personal Information Name, date of birth, etc. Clinical History A brief description of a persons medical situation Gross Description Describes how the tissue looks to the naked eye Microscopic Description Describes how the tissue looks under the microscope Diagnosis States the final Diagnosis This is the biggest section of the report that specifically describes the type of tumor, what tissues are involved and patterns of growth. This section provides important information that is used to determine how to treat the patients specific tumor type. Comments

Questions What are some symptoms of brain tumors? How is the level of malignancy graded? What types of scans are done to see if a person has a brain tumor? What document gives the results of a tumor analysis?

Answers: Seizure, Nausea, Headaches, Weakness, Fatigue, Mood or Personality changes WHO grade I-IV MRI and CT Scan Pathology report

Types of Brain Tumors Some are from a single cell type Ex.- Astrocytoma, Oligodendroglioma Some are from a mixed cell type Ex. Oligoastrocytoma, mixed glioma Some are mixed with neurons Ex. Ganglioma Some are from neurons Gangliocytoma Some are from other tumors that have metastasized About 40% of brain tumors are metastatic The most common cancers that spread to the brain are lung, breast, melanoma, renal and colon cancers

Astrocytomas Arise from Astrocyte cells - Astrocytoma VideoAstrocytoma Video 4 types Pilocytic Astrocytoma (grade I) Occurs mostly in children, benign Low-Grade Astrocytoma (Grade II) Can be removed by surgery, but radiation is also recommended Anaplastic Astrocytoma (Grade III) Radiation and Chemotherapy recommended Glioblastoma Multiforme (Grade IV) Very aggressive and spreads throughout the CNS Patients usually have neurological symptoms Radiation and chemotherapy recommended Account for about 25% of all brain tumors Life expectancy is about a year GBM Video

Oligodendroglioma Arise from oligodendrocytes Average age of diagnosis = 35 years 9.4% of all primary brain and CNS tumors Occur most frequently in the frontal lobe Primary symptom is usually a seizure Usually grade II or III Median survival 11.6 years for grade II 3.5 years for grade III Usually grows slower than an Astrocytoma

Mixed Glioma Most often a mix between an astrocytoma and an oligodendroglioma = oligoastrocytoma Primarily occurs people aged 20 50 Account for 1% of all brain tumors Symptoms Headache Nausea and vomiting Behavioral changes Treatment based on most malignant cell type

Intraventricular Tumor Make up about 10% of CNS tumors May be composed of surrounding cells Astrocytoma, Meningioma etc. May arise from cells lining the ventricle Ependymoma 5% of CNS tumors Survival rate of 5-10 years 85% are benign Tumor can block flow of Cerebrospinal fluid through the ventricles and cause obstructive hydrocephalus May cause nausea, vomiting, deteriorating mental status, headache, neurological defects Standard treatment includes surgery, and then radiation and/or chemotherapy if needed

Primary CNS Lymphoma 90% are diffuse large B-cell lymphomas Can also be poorly characterized low-grade lymphomas, Burkitt lymphomas, and T-cell lymphomas Incidence increasing especially among immunocompromised patients Most commonly occurs around age 55 Survival with radiation and chemotherapy is around 44 months

Metastatic Brain Tumors Not a primary brain tumor Composed of cancer cells that have spread from their original location Most common: Breast, Melanoma, Lung, Kidney Treatment is composed of radiation and surgery if possible Chemotherapy has not been found to be helpful Surgery is not done when there are multiple tumors

Question What is the name of a Grade IV astrocytoma? What is the average life expectancy for a Grade IV astrocytoma? Oligodendrogliomas are usually what Grades? What is a type of Intraventricular Tumor?

Answer: Glioblastoma Multiforme 1 year Grade II and III Ependymoma

Benign Tumors Caused by a group of cells that grow irregularly Non-invasive and grow slowly May cause pressure on important brain structures Can be removed by surgery Usually dont grow back

Meningioma Arise from the meninges surrounding the brain Accounts for about 20% of brain tumors 2 nd most common brain tumor Usually occurs during 40s-60s May cause weakness, seizures Small, slow growing tumors may not need to be treated be treated with surgery, radiosurgery or radiation therapy

Pituitary Tumor Abnormal growth in the pituitary gland Causes irregular hormone levels Treatment Surgery Expanded Endonasal approach Radiation Drugs To shrink tumor To treat irregular hormone levels

Other Benign Tumors Central Neurocytoma Typically in young adults in lateral ventricles Chondroma Arises from cartilage, usually at the base of the skull Gangliocytoma Occur in children/young adults and arises from ganglion Schwannoma Arise in the nerve sheath and can compress nerves Cause pain, weakness and numbness

Questions What brain structure do Meningiomas arise from? What can a Pituitary Tumor Cause?

Answers Meninges Irregular Hormone Levels

Surgery Stereotactic Biopsy 3-D Mapping of the brain and removal of a small amount of specific tissue Usually done when the tumor can not be removed Explanation Craniotomy Done if the tumor is accessible and can be removed safely A piece of skull is removed to reach the brain Surgeons carefully separate tumor from brain tissue and remove as much as possible Craniotomy video Craniotomy Video - Dr. Mintz

Surgery Expanded Endonasal Approach Surgeons reach structures in the brain by going through the nasal passages and sinus cavities Animated Video

Chemotherapy Given mainly to high-grade tumors, but may also be prescribed for low-grade or benign tumors Designed to prevent cells from dividing or promote cell death Certain tumors may become resistant to chemotherapy or may simply not react at all May also kill healthy cells, especially in the gastrointestinal tract

Common Chemotherapy Drugs Temozolomide (Temodar) Most often prescribed for astrocytomas and other high-grade gliomas Taken in 28 day cycles Take pill from days 1-5 No pills from days 6-28 Cycle may be different for some individuals May cause nausea, fatigue and constipation

Other Chemotherapy Drugs The PCV Regimen 6 cycles, each lasting 42 Days Take CCNU pill on day 1 Taken at bedtime, may cause nausea Vincristine injection on day 8 and 29 Usually given at hospital, may cause temporary nerve damage Procarbazine pills on days 8-21 Taken at bedtime, may cause nausea, loss of appetite, fatigue, decrease in blood counts

Radiation Therapy Stereotactic Radiosurgery Not surgery Precise radiation therapy given in concentrated beams Gamma-ray or x-ray beams Gamma Knife Surgery when gamma rays are used Beams damage tumor cell DNA, causing it to shrink Referred to as fractionated stereotactic radiosurgery when multiple treatments are done

Other Avastin (Bevacizumab) Vascular endothelial growth factor-specific angiogenesis inhibitor Stops the formation of blood vessels, which carry nutrients, into tumors Often used in conjunction with chemotherapy First drug that inhibits angiogenisis (blood vessel formation) Approved in May 2009 for treatment of recurrent glioblastoma. In IIIrd phase clinical trial for treatment of initial tumor growth

Biotherapy (Investigational) Gene Therapy Adenoviruses are viruses that can change the DNA composition in the cells that they infect Made to target tumor cells in order to change their DNA composition to include the specific adenovirus DNA component Once the tumor cell DNA includes the adenovirus DNA, it can be targeted by a specific anti-viral agent Adenovirus

Immunotherapy (Investigational) Take tumor specific T-cells and helper t-cells (cells in the immune system that fight off disease) from the patient Use Interleukin-2 to help them grow and duplicate Transfer the T-cells back into the body Tumors inhibit immune system activity, so this allows the immune system to gain strength and fight specific tumor cells T-Cell killing a cancer cell

Common Medications Steroids Decadron (Dexamethasone), Prednisone Used to control swelling in the brain Also can be prescribed to increase appetite Side Effects Insomnia Weight gain with fat deposition in cheeks High blood pressure High blood sugar Stomach ulcers

Common Medications Anti-Seizure Dilantin (Phenytion) May cause rash Tegretol (Carbamazepine) May cause rash Depakote (Valproic acid) May cause tremor

Common Medications Anti-Nausea Zofran Usually given along with chemotherapy Anti-Constipation Senekot Colace

Questions What chemotherapy drug is most commonly prescribed for Astrocytomas and Other High Grade Gliomas? What do radiation beams do to cells? What are common Anti-Seizure medications?

Answers Temozolomide (Temodar) It kills cell DNA, which causes the cells to shrink and die Dilantin (Phenytion), Tegretol (Carbamazepine), Depakot (Valproic Acid)

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