Singer Sheryl Crow’s Brain Tumor Diagnosis

Michael Schulder, MD

As reported in the news recently, singer Sheryl Crow has been diagnosed with a benign tumor called a meningioma, a tumor that occurs outside of the brain.  These tumors grow from the lining of the brain, inside the skull known as the dura mater, making them less severe of a problem than tumors that arise within the brain itself.  Moreover, most meningiomas are benign tumors, meaning they almost never spread outside of the head, and patients can be cured by surgery.  In the United States, about 10,000 people a year are diagnosed with a meningioma.

While most meningiomas can be treated with surgery, not all meningiomas can be removed safely.  If the tumor appears attached to critical structures such as the brainstem or optic nerves, in some cases it is much better for the surgeon to remove only as much of the tumor as can be done safely.  As meningiomas usually grow slowly, performing a “subtotal removal” may relieve a patient’s symptoms for many years.  An excellent alternative for many patients is to be treated with a non-invasive method called stereotactic radiosurgery (SRS).  This technique, invented 60 years ago, uses highly focused radiation beams to treat small tumors in one or several treatment sessions.  Nearly 95 percent of the time, patients with meningiomas who receive SRS will have their tumor controlled.

Additionally, not all meningiomas are benign.  A small percentage (1 to 2 percent) of these tumors are malignant; they tend to grow back even after surgery and radiation.  A larger fraction, maybe 30 percent, is deemed “atypical.”  These tumors have some tendency to re-grow despite surgical removal, although not in all cases.  For this reason, we still don’t know for sure if patients with “atypical” meningiomas need radiation therapy after the tumors are removed, although there is an increasing tendency to offer this treatment.

A final consideration is that many if not most meningiomas are diagnosed as “incidental findings” – in other words, they are found on an magnetic resonance imaging (MRI) or computed tomography (CT) scan done for unrelated symptoms.  In such cases, it is often best to do nothing beyond getting follow-up MRI scans, and to reserve surgery only if the tumor clearly enlarges over time.  That is why most people with meningiomas never actually get surgery.  So the bottom line is, if you or your loved one has a meningioma, you have some very favorable options to consider. Full Post - to Detail View

May is Stroke Awareness Month: Know the Signs!

David Langer, MD

A stroke is an injury to the brain caused by the obstruction of blood flow to a brain artery-usually by a blood clot or a direct bleed into the brain itself. It can be due to weakness in the vessel wall commonly caused by high blood pressure or cerebral aneurysm.

Stroke is the third leading cause of death and the number one cause of disability in the United States. Stroke or "brain attack" can occur in all ages and nearly one quarter of strokes occurs in people under age 65.

The warning signs of stroke include motor weakness, sensory change (i.e. numbness or tingling of the face, arm or leg), speech difficulty or visual disturbance. Pain is present only in patients with the hemorrhagic form of stroke (a bleed in the brain) which represents only 15 percent of all strokes.

For the most part, the treatment of hemorrhagic stroke remains conservative with therapeutic options to reverse brain injury being very limited. Treatment is surgical only when a blood clot in the brain becomes life threatening. Surgery or catheter-based neurointerventional procedures are often used in patients who suffer bleeds from cerebral aneurysms to prevent a second hemorrhage.

Neurointerventional treatments are becoming more common in treating patients with ischemic stroke-strokes caused by vessel blockage. Along with intravenous clot-busting drugs (called tPA), intra-arterial delivery of these same drugs, as well as new technologies such as intravascular suction catheters and sophisticated mechanical devices, are increasingly being used for patients who either fail medical therapy or who present outside the three-hour time window reserved for the administration of intravenous tPA. Full Post - to Detail View

Nicotine During Pregnancy Increases the Risk of Colic

Dan Jacobsen, NP

Babies are more likely to have colic when their mothers smoked or used nicotine replacement therapy during pregnancy, according to research just published in the journal Pediatrics. A significantly increased risk of infantile colic--ranging from 30 percent to 60 percent--was associated with prenatal nicotine exposure in the study of more than 63,000 mothers in the Danish National Birth Cohort.

As difficult as a bout of colic can be, tobacco’s effects on a fetus are worse. Smoking during pregnancy is associated with babies of low birth weight, which can affect lifetime growth and development. Smoking is also associated with spontaneous abortion, stillbirth and sudden infant death syndrome.
Obstetricians in the United States don't usually prescribe nicotine replacement therapy (like patches or gum) for pregnant women. The Center for Tobacco Control can help expectant mothers overcome nicotine addiction with counseling, behavioral therapy or hypnosis.
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Lead in Lipstick Should Worry the FDA--and You, Too

Ken Spaeth, MD

The Food and Drug Administration (FDA) has issued a report that it found lead in hundreds of shades of popular brands of lipstick found everywhere from drugstores to department stores. 

The agency said that the lead levels it found pose no health risk. However, this claim flies in the face of scientific consensus that there is no such thing as a safe level of lead.
In fact, two populations are at heightened risk of harm from lead poisoning--particularly from lipstick:
  • pregnant women, because lead exposure during fetal development can cause neurological and cognitive defects; and
  • young girls, because their smaller stature and lack of fully developed blood/brain barriers leave them vulnerable.  
This development is another example of the need for adequate health and safety testing of consumer products. From a public health policy perspective, there should be a zero tolerance policy for lead in consumer products--particularly those used by pregnant women and children.
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Nicotine Patch May Help Memory Impairment

Marc Gordon, MD

Nicotine patches may ease mild cognitive impairment, according to a new study in the journal Neurology. Study participants showed improved attention plus improvements in secondary measures of attention, memory and thought-processing speed. But the research did not demonstrate a significant difference between nicotine and placebo on overall improvement.

The study was conducted with 74 non-smokers with amnestic mild cognitive impairment, who were randomly assigned to receive either nicotine patches or placebo patches for six months. Amnestic mild cognitive impairment is characterized by measurable impairment in memory without obvious functional disability. It may represent an intermediate stage between normal aging and mild Alzheimer's dementia. Alzheimer’s is associated with a deficiency of a neurotransmitter called acetylcholine, which sends signals between nerve cells by binding to specific receptors. Nicotine has the ability to bind to and activate some of these receptors.

The nicotine-treated group experienced weight loss, more adverse events and more discontinuations due to adverse events, but there were no severe adverse events, and overall, the nicotine patch appeared to be safe and relatively well-tolerated by the participants.

While these results are encouraging and justify further research into the potential therapeutic use of nicotine in mild cognitive impairment, it is important to bear in mind that this is a small, preliminary study. Full Post - to Detail View