PROBLEM BASED LEARNING REPORTNEUROPSYCHITRY SYSTEMHEMIPHARESIS

Scenario 4

Seorang lelaki berusia 38 tahun dibawa ke Puskesmas karena mengalami kejang yang diawali pada lengan kanan kemudian berlanjut pada tungkai kanan lalu ke seluruh tubuh. Keadaan ini sudah dialami selama 3 bulan dan timbul lebih 3 kali dalam sebulan. Penderita juga mengeluh sering sakit kepala dan merasa canggung jika berjalan atau memegang sesuatu karena tangan dan kaki kanannya terasa lemah.

Difficult Terms1. Kejang (seizure) - excessive nerve cell discharge in the brain.- focal involuntary movement (convulsion).2. Canggung-tidak enak/susah-awkward movementKeywords1. Lelaki , 38 tahun2. Kejang yang diawali pada lengan kanan kemudian berlanjut pada tungkai kanan lalu ke seluruh tubuh.3. Sudah dialami selama 3 bulan dan timbul lebih 3 kali dalam sebulan4. Mengeluh sering sakit kepala5. Merasa canggung jika berjalan atau memegang sesuatu karena tangan dan kaki kanannya terasa lemah.

Questions and Answers1. Apakah patomekasnisme kejang?

Pathophysiology of epilepsy

An epileptic seizure (epileptic attack, epileptic fit) is triggered by a spontaneous, synchronized, massive excitation of a large number of neurons, resulting in localized or generalized activation of motor (fits or seizures), sensory (sensory impressions), autonomic (e.g., salivation), or complex (cognitive, emotional) functions. The epileptic seizures can occur locally, for example, in the left precentral gyrus in the area of those neurons that control the right foot (partial seizure). They can spread from there to the entire precentral gyrus (Jacksonian epilepsy). Clonic cramps may spread, as in this example, from the right foot to the entire right half of the body (Jacksonian motor march), the patient not necessarily losing consciousness. However, should the seizures spread to the other side of the body, the patient will lose consciousness (partial seizure with secondary generalization). Primary generalized seizures are always associated with loss of consciousness. Certain seizures (absences) can also lead to isolated loss of consciousness. The triggering phenomenon is paroxysmal depolarization of individual neurons (paroxysmal depolarization shift [PDS]). This is caused by activation of Ca2+ channels. The entering Ca2+ first of all opens nonspecific cation channels and thus causes massive depolarization, which is terminated by opening of the Ca2+-activated K+ and Cl channels. An epileptic seizure occurs when a sufficient number of neurons have been excited. Causes or factors which favor epilepsy are, for example, genetic defects (of K+ channels and others), malformation of the brain, trauma to the brain (glial scars), tumor, bleeding, or abscesses. Seizures may also be provoked or promoted by poisoning (e.g., alcohol), inflammation, fever, cell swelling or (less likely) shrinkage, hypoglycemia, hypomagnesemia, hypocalcemia, lack of sleep, ischemia or hypoxia, and repetitive stimuli (e.g., a flickering light). Hyperventilation can lead to cerebral hypoxia, via hypocapnia and cerebral vasoconstriction, and may thus promote the onset of a seizure. Epileptic seizures have a higher incidence among pregnant women. Neuronal excitation or the spread of excitation to neighboring neurons is promoted by a number of cellular mechanisms: The dendrites of the pyramidal cells contain voltage-gated Ca2+ channels that open on depolarization and thus increase depolarization. In lesions of neurons more of these Ca2+ channels are expressed. They are inhibited by Mg2+, while hypomagnesemia promotes the activity of these channels. An increased extracellular concentration of K+ reduces K+ efflux through the K+ channels, i.e., it has a depolarizing effect and thus at the same time promotes the activation of Ca2+ channels. The dendrites of pyramidal cells are also depolarized by glutamate from excitatory synapses. Glutamate acts on a cation channel that is impermeable to Ca2+ (AMPA channel) and one that is permeable to Ca2+ (NMDA channel). The NMDA channel is normally blocked by Mg2+. However, the depolarization that is triggered by activation of the AMPA channel abolishes the Mg2+ block (co-operation of the two channels). Mg2+ and depolarization thus favor activation of the NMDA channel. The membrane potential of the neurons is normally maintained by the K+ channels. A precondition for this is an adequate K+ gradient across the cell membrane. This gradient is created by Na+/K+-ATPase. A lack of available energy (e.g., due to O2 deficiency or hypoglycemia) impairs Na+/K+-ATPase and thus promotes depolarization of the cell. Normally depolarizations are reduced by inhibitory neurons that activate K+ and/or Cl channels via GABA, among others. GABA is formed by glutamate decarboxylase (GD), an enzyme that needs pyridoxine (vitamin B6) as co-factor. Vitamin B6 deficiency or a reduced affinity of the enzyme for vitamin B6 (genetic defect) favors the occurrence of epilepsy. Hyperpolarization of thalamic neurons can increase the readiness of T-type Ca2+ channels to be activated, thereby promoting the onset of absences.

2. Kenapa kejang pada lengan kanan yang berlanjutan ke tungkai kanan ke seluruh badan?This seizure we called second generilize seizure, that happend because of abnormalities electrical discharge in a small area of one side of the brain resulting in a complex partial seizure. The discharge then quickly spreads to both sides of the brain, causing the entire brain to malfunction3. Kenapa kejangnya intermittent?Intermittent seizureEpilepsy is a brain disorder involving repeated, spontaneous seizures of any type. Seizures (sometimes called "fits" or convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain. Seizure types vary from a momentary disruption of the senses, to short periods of unconsciousness or staring spells, to convulsions. Some people have just one type of seizure, others have more than one type. There are two basic types of seizures: Epileptic:These seizures have no apparent cause (or trigger) and occur repeatedly. These seizures are called a seizure disorder or epilepsy. Non-epileptic:These seizures are triggered (provoked) by a disorder or another condition that irritates the brain. In children, a fever can trigger a non-epileptic seizure.

(http://www.merckmanuals.com/home/brain_spinal_cord_and_nerve_disorders/seizure_disorders/seizure_disorders.html)

4. Hubungan sakit kepala dengan keluhan utama?The brain lesion such as trauma, tumor, or infection, can cause increase intracranial pressure. The increases intracranial pressure will cause brain oedema. The brain edema will cause vascular ischemic in brain and stimulates vasomotor center then continued to fifth nerve. After that, headache occur.Resources: Patofisiologi Konsep Klinis Proses-proses penyakit Ed.6. Price, Sylvia and Wilson, Lorraine. Page 11125. Kenapa merasa lemah cuma di sebelah kanan?Hemiparesis

Hemiparesis is a weakness affecting one side of the body, less severe than a hemiplegia. Characteristically this affects the extensor muscles of the upper limb more than flexors, and the flexors of the leg more than extensors (pyramidal distribution of weakness), producing the classic hemiparetic/hemiplegic posture with flexed arm and extended leg, the latter permitting standing and a circumducting gait.

Hemiparesis results from damage (most usually vascular) to the corticospinal pathways anywhere from motor cortex to the cervical spine. Accompanying signs may give clues as to localization, the main possibilities being hemisphere, brainstem, or cervical cord.Hemisphere lesions may also cause hemisensory impairment, hemi-anopia, aphasia, agnosia or apraxia; headache, and incomplete unilateral ptosis, may sometimes feature. Spatial neglect, with or without anosognosia, may also occur, particularly with right-sided lesions producing a left hemiparesis. Pure motor hemiparesis may be seen withlesions of the internal capsule, corona radiata, and basal pons (lacunar/ small deep infarct), in which case the face and arm are affected more than the leg; such facio-brachial predominance may also be seen with cortico-subcortical lesions laterally placed on the contralateral hemisphere. Crural predominance suggests a contralateral paracentral cortical lesion or one of the lacunar syndromes.

Brainstem lesions may produce diplopia, ophthalmoplegia, nystagmus, ataxia, and crossed facial sensory loss or weakness in addition to hemiparesis (alternating hemiplegia).

Spinal lesions are more likely to show bilateral long tract signs(e.g., bilateral Babinksis sign) and may have accompanying spinal orroot pain, sphincter disturbance, and a sensory or motor level.

Hemiparesis is most usually a consequence of a vascular event(cerebral infarction). Tumor may cause a progressive hemiparesis (although meningiomas may produce transient stroke-like events). Hemiparetic multiple sclerosis is rare but well described. Transient hemiparesis may be observed as an ictal phenomenon (Todds paresis), or in familial hemiplegic migraine which is associated with mutations in a voltage-gated Ca2+ ion channel gene.

Right Sided Hemipharesis

6. Jenis hemiparesis/kejang.Type of hemiparesis and seizures For these case, the patient suffured right sided hemiparesis as he right part of the body weaken. It may be generalized seizure as its spread to the whole limbs Right-sided Hemiparesis problems talking and/or understanding what people say. Problem in left brain hemisphere Left-sided Hemiparesis - talk excessively, and have memory problems. Ataxia- weakness or clumsiness on one side of the body. Hemiparesis with origin in the lower section of the brain creates a condition known as ataxia, a loss of both gross and fine motor skills, often manifesting as staggering and stumbling Ataxic hemiparesis syndrome - weakness or clumsiness. The leg is usually more affected than the arm. Pure Motor Hemiparesis - weakness in their leg, arm, and face. A form of hemiparesis characterized by sided weakness in the leg, arm, and face, is the most commonly diagnosed form of hemiparesis. It can affect these body parts equally, but in some cases it may affect one body part more than the other.

For types seizures Partial: not loss consciousness,only one side,divided into three there are simple,complex,secondary Generalized:fully unconscious, whole body seizure

Differntial Diagnosis

SYMPTOMS TUMOR INTRACRANIAL BRAIN ABSCESS

LAKI-LAKI, 32 TAHUN ++Middle age +++

SEIZURE +++ ++

SEIZURE MULAI TUNGKAI KANAN LALU KAKI KANAN DAN SELURUH BADAN + +

INTERMITTENT SEIZURE + +

FREQUENT HEADACHE + +

RIGHT SIDED HEMIPARESIS + +

The Diagnose we choose is Tumor intrakranial because in Brain Abscess there was a sign and symptom of inflamation such as fever.

Definition

Brain tumors may originate from neural elements within the brain, or they may represent spread of distant cancers. Primary brain tumors arise from CNS tissue and account for roughly half of all cases of intracranial neoplasms. The remainder of brain neoplasms are caused by metastatic lesions. In adults, two thirds of primary brain tumors arise from structures above the tentorium (supratentorial), whereas in children, two thirds of brain tumors arise from structures below the tentorium (infratentorial). Gliomas, metastases, meningiomas, pituitary adenomas, and acoustic neuromas account for 95% of all brain tumors. Classification by tumor cell type is irrelevant to the emergency physician because emergent treatment is the same regardless of the tumor type.(http://emedicine.medscape.com/article/779664-overview#showall)

EtiologyAlthough few factors are unequivocally associated with an increased risk of brain cancer, some are consequential. Most CNS neoplasms are thought to arise from individual cell mutations. A prior history of irradiation to the head for reasons other than treatment of the present tumor may increase the chance of primary brain tumor. A few inherited diseases, such as neurofibromatosis, tuberous sclerosis, multiple endocrine neoplasia (type 1), and retinoblastoma, increase the predilection to develop CNS tumors. The most common tumors originating from the cerebellopontine angle are acoustic neuroma and meningioma. Primary CNS lymphoma is a relatively frequent occurrence in HIV patients. Metastatic tumors reach the brain via hematogenous dissemination through the arterial system. Lung cancer is by far the most common solid tumor disseminating to the brain, followed by breast, melanoma, and colon cancer. Less common sources of metastasis are malignant melanoma, testicular cancer, and renal cell cancer. Prostate, uterine, and ovarian cancers are unlikely sources of brain metastasis.(http://emedicine.medscape.com/article/779664-clinical#a0218)

Anatomy

The brain is one of the largest and most complex organs in the human body.It is made up of more than 100 billion nerves that communicate in trillions of connections called synapses.

The brain is made up of many specialized areas that work together: The cortex is the outermost layer of brain cells. Thinking and voluntary movements begin in the cortex. The brain stem is between the spinal cord and the rest of the brain. Basic functions like breathing and sleep are controlled here. The basal ganglia are a cluster of structures in the center of the brain. The basal ganglia coordinate messages between multiple other brain areas. The cerebellum is at the base and the back of the brain. The cerebellum is responsible for coordination and balance.

The brain is also divided into several lobes: The frontal lobes are responsible for problem solving and judgment and motor function. The parietal lobes manage sensation, handwriting, and body position. The temporal lobes are involved with memory and hearing. The occipital lobes contain the brain's visual processing system.The brain is surrounded by a layer of tissue called the meninges. The skull (cranium) helps protect the brain from injury.

(http://www.webmd.com/brain/picture-of-the-brain)

There are important asymmetrical differences in the frontal lobes. The left frontal lobe is involved in controlling language related movement, whereas the right frontal lobe plays a role in non-verbal abilities.

A brain lesion describes damage or destruction to any part of the brain. It may be due to trauma or any other disease that can cause inflammation, malfunction, or destruction of a brain cells or brain tissue. A lesion may be localized to one part of the brain or they may be widespread. The initial damage may be so small as to not produce any initial symptoms, but progresses over time to cause obvious physical and mental changes. There are many causes of brain lesion such as trauma, inflammation within brain,iInflammatory and autoimmune diseases,certain diseases,stroke,bleeding, tumors, pituitary adenomas, glioblastoma multiforme, cerebral palsy.(http://www.medicinenet.com/brain_lesions_lesions_on_the_brain/page2.htm#what_causes_brain_lesions) Pathophysiology of Tumor Intrakranial

Brain tumor is an abnormal cells growth in the brain, which can be cancerous or non-cancerous (benign). It is defined as an intracranial tumor created by abnormal cell division and uncontrolled in the brain (neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells), in the brain envelopes (meninges), lymphatic blood vessels) , in the cranial nerves (myelin-producing Schwann cells), the pituitary gland, skull, and pineal, or spread from cancers primarily located in other organs (metastatic tumors). Tumors can invade, infiltrate, or supplant normal parenchymal tissue, disrupting normal function. Because the brain dwells in the limited volume of the cranial vault, growth of intracranial tumors with accompanying edema may cause increased intracranial pressure.Tumors adjacent to the third and fourth ventricles may impede the flow of cerebrospinal fluid, leading to obstructive hydrocephalus. In addition, tumors generate new blood vessels (ie, angiogenesis), disrupting the normal blood-brain barrier and promoting edema.

Tumors can form anywhere in the brain. Depending on its type,a growing tumor can killhealthy cells or disrupt their function. It can move or press on sensitive tissue and block the flow of blood and other fluid, causing pain and inflammation. A tumor can also block the normal flow of electricity in the brain or nerve signaling to and from the brain.

Reference: http://www.ninds.nih.gov/disorders/brainandspinaltumors/detail_brainandspinaltumors.htmSymptoms & Diagnosis A brain tumor takes up space within the skull and can interfere with normal brain activity. It can increase pressure in the brain, shift the brain or push it against the skull, and/or invade and damage nerves and healthy brain tissue. The location of a brain tumor influences the type of symptoms that occur. Identifying the presence of a brain tumor is the first step in determining a course of treatment.1. What are the symptoms of a brain tumor? Brain tumors may have a variety of symptoms ranging from headache to stroke. Different parts of the brain control different functions, so symptoms will vary depending on the tumor's location. Brain tumors are great mimics of other neurological disorders, and many of the common symptoms could indicate other medical conditions. The best way to determine if you or someone you know has a brain tumor is to have a doctor perform a type of brain scan called an MRI or a scan called a CT scan It is sometimes hard to know whether a CT scan or MRI should be done if someone you know has some of the symptoms and signs noted below, but it is important to know that these studies will usually establish whether a brain tumor is behind them. If you are truly concerned, be sure to discuss your concerns with a physician.Possible symptoms of a brain tumor include:0. A new seizure in an adult0. Gradual loss of movement or sensation in an arm or leg0. Unsteadiness or imbalance, especially if it is associated with headache0. Loss of vision in one or both eyes, especially if the vision loss is more peripheral 0. Double vision, especially if it is associated with headache0. Hearing loss with or without dizziness0. Speech difficulty of gradual onsetOther symptoms may also include nausea or vomiting that is most severe in the morning, confusion and disorientation, and memory loss.The following symptoms are usually not caused by a brain tumor, but may sometimes be:0. Headache: Although headaches are probably the most common symptom of a brain tumor, most people with headaches even persistent or severe headaches do not have a tumor. However, some kinds of headaches are particularly worrisome. A steady headache that is worse in the morning than the afternoon, a persistent headache that is associated with nausea or vomiting, or a headache accompanied by double vision, weakness, or numbness all suggest a possible tumor.0. A change in behavior: The development of an "I don't care" attitude, memory loss, loss of concentration, and general confusion may all be subtle signs. In this case, an evaluation by a neurologist may be an important step, but a CT or MRI will also help.0. Infertility or abnormal cessation of menstruation (also known as amenorrhea)0. Troubles that seem to be caused by other diseases or concerns: A seizure that results from a fall or the discovery of what appears to be a subarachnoid hemorrhage (a type of stroke) may actually be caused by tumors.

1. How is a brain tumor diagnosed? Identifying a brain tumor usually involves a neurological examination, brain scans, and/or an analysis of the brain tissue. Doctors use the diagnostic information to classify the tumor from the least aggressive (benign) to the most aggressive (malignant). In most cases, a brain tumor is named for the cell type of origin or its location in the brain. Identifying the type of tumor helps doctors determine the most appropriate course of treatment.A neurological examination is a series of tests to measure the function of the patient s nervous system and physical and mental alertness. If responses to the exam are not normal, the doctor may order a brain scan or refer the patient to a neurologist or neurosurgeon, who will then order a brain scan. A brain scan is a picture of the internal structures in the brain. A specialized machine takes a scan in much the same way a digital camera takes a photograph. Using computer technology, a scan compiles an image of the brain by photographing it from various angles. Some types of scans use a contrast agent (or contrast dye), which helps the doctor see the difference between normal and abnormal brain tissue. The contrast agent is injected into a vein and flows into brain tissue. Abnormal or diseased brain tissue absorbs more dye than normal healthy tissue. The most common scans used for diagnosis are as follows:MRI (Magnetic Resonance Imaging) is a scanning device that uses magnetic fields and computers to capture images of the brain on film. It does not use x-rays. It provides pictures from various planes, which permit doctors to create a three-dimensional image of the tumor. The MRI detects signals emitted from normal and abnormal tissue, providing clear images of most tumors.CT or CAT Scan (Computed Tomography) combines sophisticated x-ray and computer technology. CT can show a combination of soft tissue, bone, and blood vessels. CT images can determine some types of tumors, as well as help detect swelling, bleeding, and bone and tissue calcification. Usually, iodine is the contrast agent used during a CT scan. PET Scan (Positron Emission Tomography) provides a picture of the brain s activity, rather than its structure, by measuring the rate at which a tumor absorbs glucose (a sugar). The patient is injected with deoxyglucose that has been labeled with radioactive markers. The PET scan measures the brain s activity and sends this information to a computer, which creates a live image. Doctors use PET scans to see the difference between scar tissue, recurring tumor cells, and necrosis (cells destroyed by radiation treatment).A biopsy is a surgical procedure in which a sample of tissue is taken from the tumor site and examined under a microscope. The biopsy will provide information on types of abnormal cells present in the tumor. The purpose of a biopsy is to discover the type and grade of a tumor. A biopsy is the most accurate method of obtaining a diagnosis.An open biopsy is done during a craniotomy. A craniotomy involves removing a piece of the skull in order to get access to the brain. After the tumor is resected (completely removed) or debulked (partially removed), the bone is usually put back into place. A closed biopsy (also called a stereotactic or needle biopsy) may be performed when the tumor is in an area of the brain that is difficult to reach. In a closed biopsy, the neurosurgeon drills a small hole into the skull and passes a narrow hollow needle into the tumor to remove a sample of tissue. Once a sample is obtained, a pathologist examines the tissue under a microscope and writes a pathology report containing an analysis of the brain tissue. Sometimes the pathologist may not be able to make an exact diagnosis. This may be because more than one grade of tumor cells exists within the same tumor. In some cases, the tissue may be sent to another institution for additional analysis.1. What else should I know about diagnostic tests? Because an MRI uses magnetic fields, people who have metal implanted in their body in any form should let the doctor know about it before scheduling the procedure. An MRI may not be an option for these patients because the intense magnetic fields can damage some types of implanted medical devices. Patients should advise the doctor if they have a pacemaker, cardiac monitor, surgical clip, or facial tattoos.In a standard MRI scan, the patient lies on a narrow table, which slides through a long, cylindrical tube with a narrow opening. Although there is enough room for the patient s body inside the cylinder, the patient will not be able to move around. The scan takes approximately 15-45 minutes. During the scan, the patient will hear loud banging sounds, caused by the electronics within the machine. Patients may request earplugs to reduce noise. Some people find the MRI claustrophobic and ask for a sedative beforehand to relax. Other people request an open MRI. An open MRI machine does not have a cylinder, so the patient is not enclosed. The procedure lasts approximately 45 minutes. There is some discussion among doctors concerning the quality of the images of an open MRI compared to the standard or closed MRI.Contrast agents may cause reactions in some patients. Gadolinium, the contrast agent used with an MRI, may cause temporary headaches. Patients with chronic renal disease may develop a condition called nephrogenic system fibronolysis (NSF). The FDA recommends using gadolinium only when clearly necessary in patients with stage 4 and 5 renal disease, which it defined as a glomerular filtration rate lower than 30 mL per minute per 1.73 m2. If patients with renal insufficiency receive gadolinium, then specific steps are taken to limit the possibility of NSF occurring, Patients undergoing MRI with gadolinium are screened for risk factors prior to receiving the scan.

Iodine is the contrast agent most commonly used for CT scanning. If you know you are allergic to iodine, tell your doctor. Allergic reactions can include rashes, a warm. sensation, or, in rare cases, difficulty breathing. CT scans involve exposure to ionizing radiation, which is known to cause cancer. This is a concern for people who may need multiple CT scans and for children, because they are more sensitive to radiation than adults. It is wise for people who have had frequent x-ray exams and parents of children who have brain tumors to keep a record of their x-ray history. This information can help doctors make informed decisions and minimize radiation over-exposure.1. How is a pathology report used to diagnose brain tumors? A pathology report contains the analysis of brain tissue taken at the time of a craniotomy or needle biopsy. A pathologist examines the tissue under a microscope. Further tests or analysis may be performed on the tumor tissue. Then the pathologist will write a pathology report, which provides the information needed to make a diagnosis of the tumor type.Sometimes the pathologist may not be able to make an exact diagnosis. This may be because more than one grade of tumor cells exists within the same tumor. [If cells of only one grade are removed and classified during a biopsy, it is possible that the tumor grade will be misdiagnosed. This is called a sampling error.] In some cases, the tissue may be sent to another institution for additional input.1. How can I find out more about the location and type of tumor in my brain? The NBTS Interactive Tour of the Brain illustrates parts of the brain and their functions.

Treatment

Three Types of Standard Treatment for Brain Tumor1. Surgery Surgery is the usual treatment for most brain tumors. To remove a brain tumor, a neurosurgeon makes an opening in the skull. This operation is called a craniotomy. Whenever possible, the surgeon attempts to remove the entire tumor. If the tumor cannot be completely removed without damaging vital brain tissue, your doctor may remove as much of the tumor as possible. Partial removal helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy.Some tumors cannot be removed. In such cases, your doctor may do only a biopsy. A small piece of the tumor is removed so that a pathologist can examine it under a microscope to determine the type of cells it contains. This helps your doctor decide which treatment to use.Sometimes, a biopsy is done with a needle. Doctors use a special head frame (like a halo) and CT scans or MRI to pinpoint the exact location of the tumor. The surgeon makes a small hole in the skull and then guides a needle to the tumor. Using this technique to do a biopsy or for treatment is called stereotaxis.Other advanced techniques during surgery includebrain mappingto find functional pathways near tumors, endoscopy to perform biopsies and open spinal fluid pathways through a small scope and advanced frameless stereotaxic computer assisted tumor resections. Intraoperative MRI also is available to help maximize tumor removal.2. Radiation Therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. It is often used to destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery. Radiation therapy also is used when surgery is not possible.There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.The way the radiation therapy is given depends on the type and stage of the cancer being treated. TheGamma Knife, or stereotactic radiosurgery, is another way to treat brain tumors. The Gamma Knife isn't actually a knife, but a radiation therapy technique that delivers a single, finely focused, high dose of radiation precisely to its target. Treatment is given in just one session. High-energy rays are aimed at the tumor from many angles. In this way, a high dose of radiation reaches the tumor without damaging other brain tissue.3. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regionalchemotherapy).A dissolving wafer may be used to deliver an anticancer drug directly into the brain tumor site after the tumor has been removed by surgery. The way the chemotherapy is given depends on the type and stage of the cancer being treated. Source:L. Manoj, M.Kalyani, K.Jyothi, G.Ganga Bhavani and V.Govardhani. Review of Brain and Brain Cancer Treatment. International Journal of Pharma and Bio Sciences. 2011.

Prognosis

Depending on the brain cancer type and overall health status of the patient, brain cancer frequently has only a fair to poor prognosis; children have a somewhat better prognosis. The survival rates in people with brain tumors depend on many different variables: Type of tumor (such as astrocytoma, oligodendroglioma, or ependymoma) Location and size of tumor (these factors affect whether or not the tumor can be surgically removed) Tumor grade Patient's age Patient's ability to function How far the tumor has spread end-of-life issues: if brain tumor are expected to soon be fatal