Ask a Neurosurgeon & Spine Surgeon: Dr Gerard Arvind Martin from Sunway Medical Centre Velocity Malaysia

dr. Gerard Arvind Martin replied 2 years ago

First of all cysts in the brainstem area may be due to causes that may be harmless or harmful to the patient and the first thing to identify is where in this area does the cyst lie, i.e. is it within the brainstem or outside the brainstem and what symptoms did the patient experience that made them see a doctor in the first place.

For this a detailed history and examination with a neurosurgeon or neurologist is important, followed by a good brainscan, typically an MRI. Cysts around a brainstem are harmless (e.g. arachnoid cyst) but may irritate the nerves around the brainstem causing symptoms. Often they can be left alone or operated to release pressure and therefore lessen the irritation to the nerves. If a cyst is found within the brainstem, an MRI will tell us what that cyst is caused by i.e. tumor being most common. Whether it is benign ( not harmful) or malignant depends on the tissue result obtained from surgery. The majority of tumors affecting the brainstem are benign ( more likely to be harmless) but because it is the brainstem that is involved, it makes surgery very risky, often outweighing the benefit.

Therefore the answer to the question "what should I do to treat cysts in the brainstem" the answer depends on the findings of the brain MRI. Brainstem function is extremely important
for human beings and surgery can be very risky in this part of the brain.

dr. Gerard Arvind Martin replied 2 years ago

I am assuming you are at least of middle age as you have stated that you had a cardiac assessment carried out for these symptoms you mentioned. However in view of these "shakes" and problems on standing it is best for you to be seen by a neurologist and an endocrinologist. A neurologist is a doctor who specialises in nerve disorders. An endocrinologist is a doctor who specialises in hormone problems.

dr. Gerard Arvind Martin replied 2 years ago

Longstanding giddiness (since 1984) may be due to a number of causes, and oral (tablets, taken by mouth) medications can be helpful once the cause has been determined properly.
Along with brain MRI scans, this may require an ENT / ophthalmological assessment also if the neurological assessment turns out to be normal.

dr. Gerard Arvind Martin replied 2 years ago

How old are you and what sort of work do you do? Apart from age ( the older a person gets, the less sleep they tend to require and this is normal) and actual long standing pain conditions already existing different parts of the body that can disrupt sleep themselves, sleep issues are not uncommon and the cause can be attributed to breathing problems that occur during sleep, resulting in poor sleep patterns that make the person feel lethargic and restless and unable to concentrate the next day. A respiratory physician ( a doctor who specialises in lung and breathing disorders) will be able to diagnose these conditions using sleep studies. Very rarely, a stroke in the brainstem also cause breathing related issues which can disrupt sleep patterns. Finally psychological stress can additionally burden a person and this may manifest with poor sleep quality at night.

dr. Gerard Arvind Martin replied 2 years ago

For humans, a specialised region in the inner ear is responsible for providing balance and it communicates with the cerebellum through the brainstem to achieve this. When you have vertigo spells, a problem may be occuring in these regions and this is common in older age group patients. Vertigo itself can be benign however it can be disruptive in everyday life and can be treated using oral medications. However you should see an ENT specialist ( a doctor who sees patients with ear/hearing/nose/throat problems) before starting them. Sometimes however, patients report imbalance when they close their eyes or additionally they develop shaking symptoms in their arms and seem to lack coordination. It is important to differentiate between these symptoms as the problem may instead involve the spinal cord or cerebellum rather than
just the inner ear only.

dr. Gerard Arvind Martin replied 2 years ago

If a headache causes you much pain, affecting your walk and blurring your vision, you should get it checked immediately as it may be related to a brain problem. A visit to a neurosurgeon or neurologist is required.

dr. Gerard Arvind Martin replied 2 years ago

Please get yourself checked once again by a neurosurgeon and an opthalmologist, and this time please also do a brain scan. High eye pressure is not good and may be revealing or lead to something else more distressing if not checked properly. A brain problem cannot be ruled out based on your history and you should be examined thoroughly along with an MRI brain scan if required.

dr. Gerard Arvind Martin replied 2 years ago

Problems with facial nerves, called hemifacial spasm, need to be assessed using an MRI brain scan to see if there is anything irritating the nerve in the brain. Once an MRI is done and there is no condition within the brain that is causing the twitches, injections can be used to control the twitches, but complete cure is less likely. If something is found in the brain that is causing the twitches, surgery can help to address the problem.

dr. Gerard Arvind Martin replied 2 years ago

Your daughter may need an MRI brain to discover what is causing her seizures. Once a problem has been found in her brain, we use medications first to fully control her seizures and when that is no longer helpful, surgery to address the brain problem may be considered. Her medications will still be continued after the surgery. Permanent cure without anymore future medications can be difficult but not impossible.

dr. Gerard Arvind Martin replied 2 years ago

From what you have mentioned about your husband, yes it is quite likely that he has Parkinsons disease and the medications given are to help his symptoms and restless legs syndrome. It is advised that he continues his medicaions and follow-up with his neurologist. As I am a neurosurgeon I would not be of much help to a patient who has Parkinsons disease.

dr. Gerard Arvind Martin replied 2 years ago

Although migraines can be very debilitating to a person, they are themselves not dangerous. However they are said to carry a higher risk of stroke and so it would be best to have them treated and controlled. Before a person is diagnosed with migraine however, an MRI brain would be recommended to make sure there is nothing else sinister in the brain that is causing these headaches, conditions such as brain tumors and vessel problems cannot be treated by medicines alone and may need surgery.

dr. Gerard Arvind Martin replied 2 years ago

It is worthwhile for you to visit a neurologist or neurosurgeon who will examine you thoroughly and have a brain MRI scan done for you to determine the cause of your problems and advise you accordingly

dr. Gerard Arvind Martin replied 2 years ago

Since the results of his MRI is good, the combination of his medication to help his epilepsy is rightly determined by his treating neurologist. If his epilepsy is not being controlled satisfactorily, perhaps you could visit another neurologist to seek his opinion

dr. Gerard Arvind Martin replied 2 years ago

1 meningioma has very low recurrence rate, which means it does not return back easily, if it is completely removed in the first surgery itself. Sometimes removing it completely may not be possible if the tumour is stuck to important structures like nerves or blood vessels which is risky to the patient if harmed. In these cases, some tumor may be left behind and watched over time. Regular MRI scans may be required to follow these tumours and operated again to safely remove more tumor if required. Can you describe more what you mean by strain?

dr. Gerard Arvind Martin replied 2 years ago

Pain on the right side of head radiating to the back can be due to many things and it is most important to determine where the pain is coming from. An MRI scan will tell you if the pain is coming from within the head, skull, the area surrounding the eye and ear or even the neck spine. Pain arising from different structures may need different approaches in terms of treatment.

dr. Gerard Arvind Martin replied 2 years ago

Do you have any other symptoms such as seizures, blurring of vision or weakness or numbness in your limbs along with this headache you describe? If so you will need to see a neurologist or neurosurgeon for a complete evaluation and brain scan. Problems arising from the sinuses, such as sinusitis can also cause one sided headache that can be brought about by changes in head position, and if this is present, you may need to see an ENT specialist to help you with this.

dr. Gerard Arvind Martin replied 2 years ago

How old are you and how long have you had this experience? Were you involved in any accident before and did you injure your head or neck? Complex regional pain syndromes may involve one side of the head and body. In the absence of any history of injury, problems in the thalamus ( a structure deep in the brain) may also give these sort of problems, involving the same half of the head and body. Please see a neurologist or neurosurgeon as it may require a thorough examination and an MRI brain scan to evaluate your condition.