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Symptoms, Conditions and Diagnosis

As a Primary Stroke Center, we can diagnose and treat neurological disorders quickly

IS IT A STROKE?
THINK F-A-S-T

FACE   Ask the person to smile. Does one side of the face droop?
ARM   Ask the person to raise both arms. Does one arm drift downward?
SPEECH   Ask the person to repeat a simple phrase. Does the speech sound slurred or strange?
TIME   If you observe any of these signs, it's time to call 911!

Neurology is the study and treatment of diseases of the nervous system, which includes:

  • The brain and spinal cord
  • Cranial nerves connected to the eyes, face, ears, nose and throat
  • Peripheral nerves, which supply the arms and legs
  • Muscles of the body
  • The autonomic nervous system, which manages the internal organs including the blood vessels and sweat glands

Know the symptoms of a stroke

A stroke or “brain attack” occurs when there is a sudden loss of circulation to an area of the brain. When it comes to stroke, “Time is brain.” The longer treatment is delayed after the onset of stroke symptoms, the greater the potential for brain damage. For the sake of you and your family, it is important to know the signs of stroke and to seek medical help immediately when you notice any of the warning signs of a stroke. Visit our Stroke section>>

Additional neurological conditions diagnosed and treated by our neurosciences physicians

The Northwest Community Healthcare Neurosciences Program specializes in treatment of vascular disorders of the brain and spinal cord utilizing minimally invasive techniques that rely on image-guided navigation within the blood vessels.

Northwest Community physicians and specialists from the Northwestern Medical Faculty Foundation constantly update and create new scan sequences to better diagnose and treat conditions of the brain and spine on state-of-art equipment.

Neurological conditions we treat include:

Arteriovenous fistulae

Arteriovenous fistulae (AVF) form when the usual connection between arteries and veins becomes “short-circuited.” This condition circumvents the normal capillary mesh that exists between high-pressure arteries in the head and the large veins that are found in the top layers of the brain and spine (dural sinuses). Without this intermediary step, blood flows directly from the arteries to the veins with more pressure than the “draining” veins can handle. If the vein ruptures, bleeding in or around the brain can result.

Symptoms of a dural arteriovenous fistula may include headache, pulsating or humming sounds heard in one ear, seizure, stroke-like episodes and other neurological problems.

AVFs can occur outside of the head, in the scalp or soft tissues of the neck. While not as dangerous as ones in the head, they can grow over time and present with problems such as bleeding and shunting of flow from normal organs.

The neurosciences team at NCH employs highly advanced diagnostic tools such as MR (magnetic resonance) imaging and MR angiography to detect and locate AVFs in the brain.

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Arteriovenous malformations (AVMs)

Arteriovenous malformations (AVMs) are congenital blood vessel abnormalities found in the brain as well as elsewhere in the body. Composed of a complex tangle of arteries and veins, AVMs wreak havoc on the normally smooth operation of the human circulatory system. Bleeding in the brain is one of the major causes for concern. AVMs account for two percent of all strokes and require prompt medical attention.

In healthy individuals, the heart pumps oxygenated and nutrient-rich blood to vital organs such as the brain. Moving at relatively high speed and pressure, blood leaving the heart travels throughout the body through a series of arteries from large to small. As the blood flow reaches smaller and smaller arteries, it slows its pace until eventually it has transported its precious life-sustaining cargo to the capillaries. Among the tiniest vessels in the body, capillaries nourish brain tissue with oxygenated blood. At the same time, a carbon dioxide exchange takes place. From the capillaries, the veins carry non-oxygenated blood and other waste materials back to the heart and lungs. Blood flowing through veins, rather than via arterial routes, makes the return trip to the heart at a slower pace and with decreased pressure. It is at this point that AVMs become a problem.

AVMs “short circuit” the system by interfering with the capillary mesh that usually exists between arteries and veins. This condition allows blood to return to the veins faster and with more pressure then they are designed to handle. Without this intermediary zone of give and take, the thin walls of the veins may expand and adversely affect adjacent areas of normal brain tissue causing weakness, numbness, loss of vision or seizures. Rupture of the supplying arteries, AVM or the enlarged veins result in bleeding. Patients with AVMs, primarily considered to be congenital and not inherited, are often unaware of this condition until a diagnosis is made at the time of a seizure or an intracranial hemorrhage.

NCH’s neurosciences team relies on state-of-the-art computed tomography (CT) and magnetic resonance (MR) imaging to assess patients complaining of AVM symptoms such as seizures, headaches or stroke-like episodes.

A cerebral angiogram or arteriogram will normally follow the confirmation of an AVM to identify the vessels creating the malformation. A number of factors from patient history to AVM size and location within the brain determine the best course of action. Treatment of AVMs includes embolization, open surgical removal and/or radiation. In many cases, a combination of the treatments is necessary for cure.

Treatment option

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Carotid and vertebral artery disease

Oxygen-rich blood flows from the heart and throughout the body courtesy of the arteries, which move the blood along to where it is needed. Two carotid arteries reside in the lower neck and the vertebral arteries are near the spine. Both sets of arteries work to supply the brain with an adequate flow of blood, crucial to normal neurological functions from thinking to motor skills.

Narrowing of these arteries, due in large part to atherosclerosis, can lead to serious consequences such as ischemic stroke. Plaque build-up over time can decrease blood flow and/or lead to stroke through the formation of blood clots or pieces of plaque that have broken off and clogged a smaller artery upstream to the brain.

Many patients are unaware that they have developed carotid and vertebral artery disease until they begin exhibiting symptoms of a stroke. Transient ischemic attacks (TIAs) or “miniokes” are temporary vessel blockages that produce stroke symptoms that may disappear after a few minutes or hours. TIAs could signal a major stroke and warrant prompt medical attention. TIA symptoms include impaired vision, weakness or numbness in the arms or legs, slurred speech, and trouble swallowing.

Treatment options

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Carotid-cavernous fistulae

Among the abnormal connections of arteries to veins, carotid-cavernous fistulae specifically affect the eye and the area around it. This condition can lead to glaucoma, double vision, and/or loss of vision without immediate and appropriate treatment.

Short circuiting the normal capillary mesh that helps regulate the blood flow from the carotid artery to the venous system, this condition results in undue pressure on the large vein (cavernous sinus) that sits behind the eye. This vein receives blood from the eye, the pituitary gland and the brain.

There are two forms of this condition: direct and indirect fistulae. Trauma generally triggers the development of direct carotid-cavernous fistulae. Injury to the internal carotid artery causes blood to flow directly to the cavernous sinus at a higher rate than normal, resulting in redness, swelling and pain around the affected eye. Indirect fistulae often occur spontaneously and may be caused by the rupture of an aneurysm or are associated with atherosclerosis, high blood pressure, and/or pregnancy and childbirth. Direct fistulae are often seen in young men, while indirect fistulae commonly appear in middle-aged to elderly women.

Treatment options

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Dissections—vascular

Arteries can sometimes tear or split into layers with bleeding in between each layer because of trauma, simple manipulation of the neck or spontaneous occurrence. Known as “dissection,” this process can block blood flow to the brain, lead to the formation of blood clots and eventually result in a stroke. Dissections are often the main cause of stroke in individuals under 40 years of age.

Common symptoms for this condition may include head, neck or facial pain, and/or transient ischemic attacks (TIAs). These “miniokes” are temporary vessel blockages that produce stroke symptoms that may disappear after a few minutes or hours. TIAs could signal a much larger stroke and should be taken seriously.

The neurosciences team at NCH uses highly sophisticated imaging tools such as ultrasound, as well as MR (magnetic resonance) imaging and CT angiography, to diagnose and assess artery dissections.

Treatment option

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Dural arteriovenous fistulae

Arteriovenous fistulae (AVF) form when the usual connection between arteries and veins becomes short-circuited. This condition circumvents the normal capillary mesh that exists between high-pressure arteries in the head and the large veins that are found in the top layers of the brain and spine (dural sinuses). Without this intermediary step, blood flows directly from the arteries to the veins with more pressure than the “draining” veins can handle. If the vein ruptures, bleeding in or around the brain can result.

Symptoms of a dural arteriovenous fistula may include headache, pulsating or humming sounds heard in one ear, seizure, stroke-like episodes, and other neurological problems.

AVFs can occur outside of the head, in the scalp or soft tissues of the neck. While not as dangerous as ones in the head, they can grow over time and present with problems such as bleeding and shunting of flow from normal organs.

The Neurosciences Team at NCH employs highly advanced diagnostic tools such as MR imaging and MR angiography to detect and locate AVFs in the brain.

Treatment option

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Epistaxis (nosebleeds)

Children and adults alike have a 50 percent chance of experiencing at least one episode of epistaxis, or bleeding from the nose, in their lifetimes. A common condition, these episodes generally resolve themselves with treatment ranging from local pressure and nasal packing to cauterization.

Persistent and severe bleeding, however, can become life-threatening, especially in elderly patients and those with high blood pressure and other medical problems.

Those patients who do not respond to conventional treatment will usually be referred to NCH’s neurosciences team.

Treatment option

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Head, neck and spinal tumors

Cancerous and non-cancerous tumors—like all living tissue in the human body—rely on a vascular supply to survive and thrive. The abnormal growth of tumors in the head and neck, however, can result in bleeding into the throat or severe and persistent nosebleeds, also known as epistaxis.

Patients awaiting surgical removal of these tumors may benefit a great deal from minimally invasive medical treatment to reduce and eliminate any throat or nose bleeding before surgery. Tumors in the spine can cause severe pain, or can press on the spinal cord and nerve roots causing partial weakness or paralysis. Preoperative embolization of tumors of the head, neck and spine can help control further blood loss during and after surgery, improve the chances of complete tumor removal, relieve intractable pain, and decrease the risk of damage to adjacent healthy tissue. Individuals undergoing radiation treatment or experiencing a recurrence of head and neck cancers may also seek methods to reduce the bleeding caused by tumors affecting the mouth, throat, sinuses, nasal cavity, larynx or salivary glands.

Treatment option

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Intracranial aneurysms

Intracranial aneurysms, also called cerebral or brain aneurysms, occur when an artery in the brain develops an abnormal bulge due to the weakening of the arterial wall. Like a balloon that is over-inflated to the point of bursting, this defect can gradually enlarge and result in a life-threatening rupture as blood flows through the artery to the brain. Bleeding in and/or around the area closely surrounding the brain—the subarachnoid space—can lead to a subarachnoid hemorrhage. This condition could, in turn, cause hemorrhagic stroke, brain damage and death.

Brain aneurysms can strike at any age but most commonly appear in individuals ranging from 40 to 60 years old. Women are more likely to develop a brain aneurysm than men, with a ratio of 3:2. Some 20 percent of patients may have multiple aneurysms. Cigarette smoking and family history play a significant role in the occurrence of aneurysms. Overall, your risk of an aneurysm rupture is one to two percent per year, according to the American Society of Interventional and Therapeutic Neuroradiology (ASITN), and a rupture demands immediate medical attention to stop the bleeding and reduce permanent damage to the brain.

A severe headache often signals a rupture in progress. Other symptoms may include nausea and vomiting, neck pain, blurred or double vision, pain above and behind the eye, sensitivity to light (photophobia), and loss of sensation. Some 40 percent of patients with unruptured aneurysms will experience “warning” signs such as problems with peripheral vision, speech, balance and coordination, and short-term memory. Suspected aneurysms should be diagnosed and treated by qualified medical specialists—interventional neuroradiologists and neurosurgeons—as soon as possible before a rupture occurs.

NCH’s neurosciences team assesses patients with top-of-the-line CT and MR imaging, which can detect many aneurysms. More definitive testing via a cerebral angiogram follows for most patients and provides the best roadmap for treatment options.

Treatment option

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Intracranial atherosclerosis

Plaque build-up and the hardening of arteries (atherosclerosis) compromise the ability of vital blood vessels to circulate blood away from the heart and to vital organs. When atherosclerosis develops in the arteries supplying the brain, patients face an increased risk of stroke due to reduced blood flow.

Intracranial atherosclerosis can result from the same risk factors—smoking, diabetes, hypertension, elevated cholesterol levels—that prompt vessels to narrow in other parts of the body such as the heart and legs. Often not recognized until a patient has experienced a major stroke, intracranial atherosclerosis provides few warning signs and should be evaluated for treatment as soon as it is discovered.

Treatment option

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Spinal fractures

A healthy spine is central to many of the activities of daily living. When the bones (vertebrae) within the spine weaken as result of osteoporosis, trauma or tumors, they may fracture. Causing pain and limiting normal function, spinal compression fractures affect a significant number of patients each year.

The loss of normal bone due to osteoporosis contributes to the majority of spinal fractures. Some 25 million Americans—80 percent of them women—have experienced the pain and diminished mobility caused by vertebral compression fractures. In patients suffering from osteoporosis, spinal fractures may occur from the simplest of actions, such as twisting the back or lifting a heavy object. In individuals with normal bone strength, trauma from a serious car accident or fall may fracture the bones in the spine.

Tumors that involve the spinal column can also weaken the bones and cause a spinal fracture.

Treatment options

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Spine vascular malformations

Malformations of the blood vessels to the spine and spinal cord are less common than those formed in the brain, but can cause significant damage to the spinal cord and nerves. In general, they are divided into those malformations that primarily involve/affect the spinal column (bones, muscles, epidural space) and those that affect the spinal cord.

There are four major subtypes of vascular malformations affecting the cord:

TYPE I—Spinal Dural Arteriovenous Fistulae
These are the most commonly encountered malformations in adults. They usually affects people between 40 and 60 and disproportionally affect men. In this disease, there is a “short-circuit” that develops between a small artery supplying a nerve root (radicular artery) and a vein that drains the blood away from the spinal cord. Because of the “short circuit,” the high-pressure flow in the artery is directed into the normally low pressure vein, reversing the direction of flow in the vein towards the spinal cord. This causes high pressure in all the veins normally draining blood away from the cord and causes low blood flow (ischemia) of the spinal cord. Patients usually present with pain in the back and legs, as well as a slow but progressive weakness in the legs. Untreated, this can progress to paraplegia and loss of bowel and bladder function.

Diagnosis: Diagnosis is usually made with a combination of the patients’ symptoms and an MRI. A spinal angiogram is necessary to find the exact level and anatomy of the fistulae.

Treatment: Treatment can be either with conventional surgery or with embolization. Embolization can often be performed at the same time as the diagnostic spinal arteriogram. Embolization is minimally invasive and, if successful, obviates the need for surgery.

TYPE II—Spinal Cord AVM
These lesions are very similar to AVMs in the brain, consisting of a network of abnormal connections (“short circuits”) between arteries and veins. The lesions are located inside the substance of the spinal cord. These lesions often present much earlier in the childhood or teenage years. The way they present is often by causing bleeding in or around the spinal cord.

Diagnosis: An MRI and a spinal angiogram are necessary.

Treatment: These lesions are difficult to treat. Treatment often consists of a combination of embolization and radiosurgery or conventional surgery.

TYPE III
These are very rare and consist of AVMs involving several different compartments of the spinal column.

TYPE IV—Pial Arteriovenous Fistulae
These malformations are also more likely to present prior to middle age in the first of the four decades. They consist of an abnormal connection (“short circuit”) between the main artery of the spinal cord (anterior spinal artery) and the normal veins of the cord. They usually occur toward the bottom end of the spinal cord. They can present with bleeding in or around the cord or mass effect/pressure on the spinal cord or nerve roots.

Diagnosis: Diagnosis is based on an MRI and a spinal angiogram.

Treatment: Treatment is usually endovascular with embolization. A very small catheter (microcatheter) is carefully placed in the anterior spinal artery and navigated to the level of the abnormal “short circuit.” The connection is then closed with a liquid “glue” or a combination of “glue” and small coils made of platinum.

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Stroke (brain attack)

Strokes, or “brain attacks,” occur when there is a sudden loss of circulation to an area of the brain. Decreased blood flow to the brain results in serious long-term disabilities including trouble speaking or difficulty with comprehension, impaired vision, problems with balance and coordination, confusion, and memory loss. Some 700,000 Americans suffer a new stroke each year; another 200,000 experience a recurrent stroke. In the United States, stroke follows heart disease and cancer as the third leading cause of death. A medical emergency, strokes (brain attacks) require immediate attention and treatment to reduce their debilitating effects and improve the odds of close-to-complete or complete recovery.

Strokes fall into two categories: ischemic and hemorrhagic. Acute ischemic stroke describes blood clots that block the artery. Ischemic strokes account for about 80 percent of all strokes. Transient ischemic attacks (TIAs) or “miniokes” are temporary vessel blockages that produce stroke symptoms that may disappear after a few minutes or hours. TIAs could signal a much larger stroke and should be taken seriously. Bleeding or hemorrhagic strokes often result from a ruptured blood vessel or aneurysm.

Hardening of the arteries or atherosclerosis in the carotid arteries ranks high as a leading cause of ischemic stroke. Carotid arteries supply blood to the head and brain and are located on both sides of the neck. Atherosclerosis causes plaque—composed of fat and cholesterol deposits—build-up in the carotid artery, which can either narrow the artery itself or cause a clot to form over the plaque, which can then flake away and plug smaller vessels supplying the brain to cause a stroke. In either case, restricted blood flow results in acute stroke and potential damage to the brain.

The neurosciences team at NCH employs highly advanced diagnostic tools such as MR (magnetic resonance) imaging, MR angiography and MR perfusion to detect and locate strokes in the brain.

Learn more about our award-winning stroke program.

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Traumatic vascular lesions

Injuries to the head and neck shouldn’t be taken lightly. In many cases, trauma to these areas from such incidents as motor vehicle accident, gunshot or stab wound, or assault can seriously damage arteries and veins in the brain and spine and threaten survival. A whole host of problems may occur, including abnormal blood flow and the development of arteriovenous fistulae, severe bleeding from an artery, or an expanding clot in a torn vessel.

Traumatic vascular lesions require immediate medical attention to reduce the consequences of bleeding or pressure build-up in the brain. These conditions could lead to strokes or compromise normal neurological function from breathing to swallowing.

Treatment option

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Vascular and lymphatic malformations—head and neck

Vascular and lymphatic malformations are benign tumors of blood vessels or lymphatics that often appear in children at birth or during the first several years of life. These vascular lesions can be found in various parts of the body, but are commonly seen in the head and neck. In children, a majority of these lesions, particularly smaller ones, will shrink and fade on their own over time. In the case of adult lesions, they may persist and require treatment. For both children and adults, these lesions can compromise functioning if they develop near the eye, ear, lip or larynx, as well as cause social and psychological distress due to their unsightliness.

These lesions fall into several categories:

Lymphatic malformations

Lymphatic malformations (LMs) are sponge-like collections of abnormal channels and spaces that contain clear fluid that accumulates and dilates the vessels, causing them to swell up. LMs can be superficial or deep, localized or diffused. In general, over time they all increase in size, some more rapidly then others, often due to infections or trauma. Enlargement is sudden but temporary. The exact cause is unknown. They are usually observed to form due to errors in the formation of lymphatics during fetal development. No drug or medication has been found to be the cause, nor any environmental exposure that may have occurred during pregnancy. The external appearance of LMs can be divided into two types:

  1. Macrocystic malformations are large, soft, clear masses under normal or bluish skin
  2. Microcystic malformations are small, raised lesions that contain clear fluid

If superficial, these lesions may present as tiny clear bubbles that can become dark red due to bleeding. They may also cause enlargement of any structure.

Diagnosis: LMs are diagnosed based on medical history and physical examination. MRIs and CTs are used to confirm the diagnosis and determine the extent of the lesion. Before birth, LMs can be detected by an ultrasound exam.

Venous malformations

Venous vascular malformations appear as a bluish discoloration on the skin, lips or inside the mouth. When pressure on the venous system increases (crying, pushing, other maneuvers), these malformations tend to increase in size. They are not life-threatening. Treatment involves sclerotherapy—direct injection of a substance that will produce scarring within the vascular lesion. Different sclerosis agents are being used to achieve this goal. Treatment has markedly advanced with the use of fluoroscopis-guided (viewed by X-ray) sclerotherapy.

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Get the best in neurological care. For a physician referral, call HealthConnection at 847.618.4YOU (4968), or find a physician here.

Healthcare providers: For emergency or urgent intra-hospital transfers, please call our 24-hour Stroke Hotline at 847.618.8888.

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Last Updated 05/05/2009