Dr. John J. J. Entwistle, DO

Hydrocephalus is most often treated with an implanted device called a shunt. A shunt is a long, thin tube that is used to drain excess fluid. One end is placed within the brain. The tube runs under the skin, along the neck behind the ear, and to another part of the body where the fluid can be reabsorbed. Most often this is the abdomen, but the chest or other areas can also be used. Shunts have a valve that allows doctors to monitor and control the pressure within the brain. Insertion of a shunt is a surgical procedure that takes one to two hours. Incisions are made in the head and the abdomen, and the shunt is threaded into place before the openings are stitched closed.

In cases where hydrocephalus is caused by a blockage, a procedure called endoscopic third ventriculostomy, or ETV, may be performed. During this procedure, a surgeon makes a dime-sized hole in the skull and uses a thin tube with a camera on the end (called an endoscope) to see inside the brain. The surgeon punctures a hole in the floor of the third ventricle, a fluid-filled space within the brain. The hole provides an opening for cerebrospinal fluid to flow around the blockage, normalizing pressure. The entire procedure usually takes less than an hour and patients can often go home the following day. ETV can provide a permanent and safe alternative to a shunt, but it is only useful for patients whose hydrocephalus is caused by a blockage.

There are several different types of spinal fusion surgery available, mostly depending on where a patient's pain is located and whether his or her surgeon will perform the procedure through the back, front, or side. In general, a fusion is performed by packing the vertebrae to be fused with grafted bone. This bone may be taken from the patient's hip, may be donated from a cadaver, or it may be a manufactured synthetic material. The bone is placed along the vertebrae, and sometimes, the disc that lies in between the vertebrae is removed and replaced with grafted bone. The bone material will grow and cement the two vertebrae together. After the bone graft is placed, the vertebrae are sometimes held in place with rods, screws, plates, or cages, depending on the weakness of the spine and needs of the graft.

Spinal fusion is a significant surgery and can take three to four hours or more. Recovery is typically two to four days in the hospital. After surgery, it is important to remember that the fusion takes time to grow from the bone graft. So, the actual fusion is not complete for several months. Patients will probably feel somewhat better right away, but it may take a while to feel the full effects of the fusion as the bone grows into place. In the meantime, doctors might have patients wear a brace to protect their spine and keep it properly aligned.

Spinal fusion is not used for all kinds of back pain. Changing the way the spine moves can lead to strain on the other joints in the back, and fusion is only performed when the benefits outweigh the risks. Some spine disorders that are treated with fusion include:

• Curvature disorders, such as scoliosis and kyphosis
• Degenerative disc disease
• Spondylolisthesis, a disorder that causes vertebrae to slip over each other
• Significant spinal fractures that cause instability
• Weakened spine due to infection or tumor
• Some cases of spinal stenosis, a narrowing of the spinal column
• Chronic lower back pain (although the use of fusion to treat this is controversial)

Regardless of the diagnosis, there is always a possibility of 'failure' with spinal fusion, or of the surgery not fully solving the pain. This is more likely when fusion is used primarily to treat pain instead of structural problems. Patients can improve their chances of a successful outcome by stopping smoking, maintaining a healthy weight, moving their body every day, and following their doctor's instructions for any physical therapy that they are prescribed.

There are two main types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs more commonly and is when a blood vessel in the brain becomes blocked. Blockages are caused by blood clots and built-up plaque (deposits of fat and cholesterol), which leads to atherosclerosis, a condition where the blood vessels narrow and harden. The resultant restricted blood flow may lead to an ischemic stroke by blocking essential oxygen to the brain, causing the heart to exert more effort to pump blood.

Hemorrhagic stroke occurs when a blood vessel in or around the brain ruptures. The burst vessel leaks blood into surrounding brain tissue, causing irreparable brain damage.

Hemorrhagic strokes are less common and may occur from head injuries, brain aneurysms, brain tumors, and bleeding disorders, amongst other conditions.

Both ischemic and hemorrhagic strokes require immediate medical treatment. Medical intervention can prevent severe and life-threatening brain damage. Signs of stroke include:

-Disorientation or confusion

-Difficulty speaking

-Difficulty walking

-Impaired vision

-Weakness in the face, legs, or arms

-Severe headaches

When someone suspected of having a stroke reaches the hospital, the patient will usually receive a CT or other scan that provides an image of the brain. The scan results can reveal clotted or leaking blood in the brain. Physical exams, neurological exams, and blood tests may also be used to check for blood clotting and sugar. Treatment begins generally immediately if a stroke is detected.

Medical treatment for ischemic strokes includes a thrombolytic medicine which breaks up and disperses blood clots. This medicine can greatly improve stroke recovery and long-term health. However, the thrombolytic medicine must be administered as soon as possible to achieve these results. Other treatments for ischemic strokes are blood thinners and thrombectomy, a surgical procedure to remove a blood clot in the brain. Thrombectomy is performed by inserting a catheter (thin needle) into the artery to reach the blood clot and mechanically remove it. With the clot removed, normal blood flow to the brain resumes. Thrombectomy is typically performed at most six hours after a patient shows signs of a stroke.

Hemorrhagic strokes are treated with blood-saving medication and surgery. For a hemorrhagic stroke caused by the rupture of an aneurysm (blood vessel bulges), surgery to stem the bleeding aneurysm and vessel may be used. One surgical technique is stent-assisted coiling, which adds a stent (small wire-meshed tube) into the blood vessel to block the leaking opening of the aneurysm. A non-surgical procedure is endovascular coiling, where a catheter (thin, hollow needle) places a platinum wire coil at the spot of the aneurysm. The coil blocks bleeding and prevents the aneurysm from continuing to leak blood. These procedures are usually combined with blood-thickening medications. Blood transfusions may be administered if substantial blood loss has occurred.

Since stroke patients may have lost some essential functions while the blood flow to their brains was obstructed, both ischemic stroke and hemorrhage stroke patients may receive post-stroke rehabilitation to rebuild their physical and mental abilities. Some restorative treatments include occupational, physical, and speech therapy. Patients may also receive care from neurologists, who can assist patients in recovering certain brain functions and cognitive abilities, and rehabilitation psychologists, who may help patients with their emotional, behavioral, and cognitive recovery. Some stroke patients require lengthy rehabilitation and may never fully regain function, while others may recover more quickly. While the fastest recovery improvements are usually seen in the first three or four months, stroke rehabilitation can last for years.

If someone begins to show signs of stroke, contact emergency services and call 9-1-1 immediately since blood flow must be restored as soon as possible to help avoid significant brain damage. If an ambulance takes the person to the hospital, paramedics can initiate stroke treatment as soon as the patient enters the ambulance, allowing for more prompt medical intervention and care.