Cerebrovascular Disease And Stroke Program
The Cerebrovascular Disease and Stroke Program at the Marcus Neuroscience Institute includes the Divisions of Stroke Neurology, Cerebrovascular Surgery and Endovascular Surgery. Within these divisions, we treat the following conditions:
Ischemic and Hemorrhagic Strokes
Ischemic strokes account for more than 80 percent of stroke cases. They are caused by blood clots, the result of fatty deposits that build up on vessel walls and block the flow of blood to the brain. The deposits can lead to two kinds of obstructions, cerebral thrombosis and cerebral embolism. Cerebral thrombosis develops on the clogged part of a vessel. Cerebral embolism forms elsewhere in the circulatory system, such as the heart or large arteries within the upper chest and neck. In this case, part of the clot breaks free and travels through the bloodstream until blocked by vessels. Atrial fibrillation, or an irregular heartbeat, can also cause a clot to form in the heart, eventually break off and reach the brain.
Hemorrhagic strokes are the result of bleeding in the brain, caused by either intracerebral or subarachnoid hemorrhages. A cerebral hemorrhage occurs when a weak vessel ruptures, releasing blood that accumulates and compresses brain tissue. A head injury or aneurysm (see below) may cause a cerebral hemorrhage. A subarachnoid hemorrhage refers to when there is bleeding between the brain and skull, though the blood does not reach the brain. Both types of hemorrhages cause an unnatural flow of blood to the brain, thus hindering its function.
Transient Ischemic Attacks (TIAs)
Also known as "mini-strokes," Transient Ischemic Attacks (TIAs) carry stroke-like symptoms, but are usually fleeting and typically do not cause permanent damage. However, a TIA should be considered a serious warning, since about one in three people who have a TIA will later suffer a stroke - sometimes within a year of the initial TIA.
Carotid Artery Disease
Carotid artery disease refers to a disease caused by plaque buildup in the carotid arteries, located on the sides of the neck. The carotid arteries divide into internal and external carotid arteries, with the internal supplying oxygen-rich blood to the brain and the external to the face, scalp and neck. Too much plaque buildup prevents blood flow to the brain, which can cause a stroke.
Also known as an intracranial or intracerebral aneurysm, a cerebral aneurysm refers to a weakened spot on a blood vessel within the brain that balloons and fills with blood. The aneurysm can create pressure on a nearby nerve or tissue or possibly rupture (a hemorrhage). Not all cerebral aneurysms bleed, and they can occur anywhere within the brain, though most occur on arteries between the brain and the skull. They are more common to occur in people with specific genetic diseases, such as connective tissue disorders and polycystic kidney disease, or circulatory disorders such as arteriovenous malformations (see below).
Abnormal blood vessels, cavernous malformations resemble small mulberries in the spinal cord or brain. They can be hereditary, but that is not always the case. If the malformations bleed, it can cause a hemorrhage and lead to neurological symptoms. These include numbness or weakness in the face, arms or legs, double vision or loss of vision, unsteadiness and trouble with speaking or swallowing. Cavernous malformations can also cause seizures or additional hemorrhages.
Arteriovenous Malformations (AVMs)
Arteriovenous malformations (AVMs) refer to abnormal blood flow between arteries and veins. AVMs often occur in the central nervous system, but can occur in any location. They can lead to acute pain, bleeding or additional medical issues. AVMs are rare and their cause is unknown. Although AVMs usually are not hereditary, patients with AVMs are often born with them.
What is Moyamoya Disease?
A rare, progressive disorder, Moyamoya disease is caused by blocked arteries at the brain’s base. Its name is Japanese for “puff of smoke” and refers to the look of tiny vessels that form as a result of the blockage. The disease is primarily found in children, but it can affect adults. Initial symptoms include a stroke or multiple “mini-strokes” (transient ischemic attacks), often with seizures, paralysis on half of the body or weakness in muscles. Moyamoya is thought to be an inherited disease and symptoms include speech deficits, involuntary movements, and vision, sensory or cognitive impairments.
The Neuro-oncology Program at the Marcus Neuroscience Institute includes the Divisions of Medical Neuro-oncology, Surgical Neuro-oncology, Skull-Base Surgery and Radiation Neuro-oncology and Radiosurgery. Within these divisions, we treat the following conditions:
A meningioma refers to a tumor arising from the membranes surrounding the brain and spinal cord, the meninges. Though most meningiomas are benign, they may be malignant in rare cases. Meningiomas are more common in older women, but can occur in men of any age, including childhood.
Also known as vestibular schwannoma, an acoustic neuroma is a benign tumor that slowly grows on the main nerve between the inner ear and the brain. Pressure from an acoustic neuroma can cause hearing loss, ringing in the ears or unsteadiness, since it affects the nerve directly tied to balance and hearing. While the tumor is typically slow-growing, it can sometimes grow large enough to impact the brain and affect vital functions.
Pituitary tumors are abnormal growths found in the pituitary gland. While most pituitary tumors are noncancerous, some can cause excessive hormone production or reduce hormone levels, affecting the regulation of bodily functions. These tumors are confined to the pituitary gland or nearby areas and do not spread.
Malignant Brain Tumors
Malignant brain tumors are fast-growing, fast-spreading and life-threatening. They are often “secondary cancers” in that they begin in one part of the body and then spread to the brain. Brain tumors are usually graded on a scale of one to four - with four being the most severe - based on growth rate and likelihood of spreading. A malignant brain tumor is a grade three or four.
Spinal Cord Tumors
Spinal cord tumors are abnormal growths found on spinal cord nerves. Tumors that start on the spinal cord are primary and less common, while those that spread to the spinal cord are classified as secondary. Spinal cord tumors can cause muscles to weaken, a loss of sensation in certain parts of the body or a lack of bowel control and bladder function.
Spinal Surgery And Disease Program
Within the Spinal Surgery and Disease Program at the Marcus Neuroscience Institute, we treat the following conditions:
Spine Deformity and Scoliosis
Scoliosis is an abnormal curve of the spine that measures greater than 10 degrees. Due to the curvature, a person with scoliosis may appear to be leaning to one side. While the curvature may be functional or structural, scoliosis can cause pain and stiffness in the lower back, as well as numbness or cramping in the legs if the curvature pinches nerves.
Degenerative Disc Disease
Degenerative disc disease is a condition that causes pain due to a damaged spinal disc. Some common symptoms of degenerative disc disease include pain while seated, increased pain when lifting, bending or twisting, periods of intense pain in the lower back, the neck, buttocks or thighs, and numbness or tingling in the extremities.
Spinal Fractures and Traumatic Injuries
Spinal fractures occur when too much pressure causes a vertebra to break. Symptoms vary and are dependent upon the location and severity of the fracture. Common signs include pain in the back or neck, numbness, weakness, muscle spasms, tingling and changes in the bowel or bladder. Losing movement in the arms or legs, known as paralysis, may also indicate a spinal fracture.
Spine oncology refers to cancer of the spine. All types of tumors can form on the spine. If the tumor continues to grow, it can affect spinal nerves, which could lead to pain, neurological issues and permanent paralysis.
Spondylosis and Spondylolisthesis
Spondylosis and spondylolisthesis affect the spine joints responsible for aligning vertebrae. Spondylosis refers to a weakness or fracture in the bridges that connect upper and lower joints. When the weakness causes vertebrae to fall out of their usual position, the condition is called spondylolisthesis. Spondylosis and spondylolisthesis have been known to cause muscle spasms, stiffness or lower back pain, and sometimes pain in the legs.
Myelopathy is a condition affecting the spinal cord, often caused by compression of the cord. Spinal cord compression may be caused by several factors, such as cysts, tumors or blunt trauma to the spine. Less common causes of myelopathy are herniated disks and bone spurs.
Neuromodulation And Functional Neurosurgery (Neurorestorative Surgery)
Using neuromodulation and functional neurosurgery (neurorestorative surgery) at the Marcus Neuroscience Institute, we treat the following conditions:
A progressive disorder of the nervous system, Parkinson's disease affects the body’s movement. It may begin as a slight tremor, although Parkinson’s can also lead to stiffness in the body and slowing of movement. During the disease’s early stages, a person with Parkinson’s may not be able to generate facial expressions or control arm movements while walking. The disease may also cause slurred or softened speech.
A tremor is an involuntary muscle movement. Although tremors are most common to occur in hands, they can affect various parts of the body, including the head and legs. Tremors can occur as a result of various neurological conditions, such as a stroke, brain injury or Parkinson’s disease. A person with tremors may have difficulty holding or using items. While tremors can occur at any age, they are more common in the middle-aged and elderly populations.
Dystonia is a disorder that affects the body’s muscles and can cause involuntary movements, such as tremors. A person with dystonia may exhibit symptoms such as spams, abnormal posture, difficulty speaking and uncontrollable or rapid blinking. Dystonia may progress over time and affect more parts of the body in some cases, while showing no signs of progression in other cases.
Epilepsy is a neurological disorder that causes seizures, moments of uncontrollable physical behavior that may include symptoms ranging from twitching to a loss of consciousness. A person who does not have epilepsy may still have a seizure. Likewise, just because a person suffers a single seizure, it doesn’t mean that person has epilepsy
Pain that lasts more than six months is considered chronic pain. The pain can range in severity, from nagging to debilitating. People with chronic pain may suffer from headaches, aches in their joints and muscles, fatigue, emotional stress, depression and anger. Everyday tasks may become too painful to complete. Chronic pain is considered prevalent and is said to affect about 100 million Americans.