Brain Diseases

Neurological Diseases

Neurological diseases pose a significant burden on health and affect a large portion of the population. In Switzerland alone, about one in five residents suffers from migraines, and across Europe, more than half of the population is affected by a neurological condition.

Among the most common neurological diseases are migraines, strokes, and dementia. According to the Global Burden of Disease Study, 115,000 people in Switzerland are affected by dementia, and 100,000 by cerebrovascular diseases (strokes, aneurysms, transient ischemic attacks). Parkinson's disease, with 15,000 cases, and multiple sclerosis, with 14,000 cases, are somewhat less common.

Neurological Diseases in MRI

Neurological diseases can be diagnosed and monitored very precisely using MRI, as it provides excellent resolution and a detailed representation of the brain, spinal cord, and peripheral nerve structures. In particular, MRI delivers detailed images in the examination of multiple sclerosis, strokes, and brain tumors, making both structural changes and inflammatory processes visible. By using specific sequences, even the smallest lesions or pathological changes can be detected, enabling early and targeted therapy. Therefore, MRI is an indispensable tool for comprehensively evaluating and monitoring neurological diseases.

What Are Neurological Diseases?

Neurological diseases are a group of disorders that affect the nervous system, including the brain, cranial nerves, spinal cord, and peripheral nerves. They pose a significant burden on global health, as they are the second leading cause of death and the primary cause of severe long-term disabilities worldwide.

Common symptoms of neurological diseases include movement disorders such as muscle weakness, rigidity, spasms, gait and balance disturbances, and involuntary twitching. Sensory disturbances like numbness or tingling may also occur. Visual disturbances, hearing impairments, and difficulties in language comprehension are also typical. Additionally, patients may experience pain (tension headaches, back pain), dizziness, epileptic seizures (convulsions), and memory disorders.

Info Box: The exact number of neurological diseases is difficult to quantify due to varying classifications and definitions. The National Institutes of Health (NIH) estimate that there are more than 600 different neurological disorders.

Vascular Diseases of the Brain

• Aneurysms:
  • Extracranial Aneurysm: An abnormal bulging of an artery located outside the skull, commonly found in the carotid artery.
  • Cerebral Aneurysm: An abnormal bulging of an artery within the brain.
• Vascular Malformations:
  • Cerebral Arteriovenous Malformation (AVM): A congenital malformation where arteries and veins in the brain are directly connected without intervening capillaries.
  • Developmental Venous Anomaly (DVA): A congenital malformation of the veins in the brain that leads to altered blood drainage.
  • Dural Arteriovenous Fistula (DAVF): An abnormal connection between an artery and a vein in the dura mater (the outermost layer of the meninges).
• Small Vessel Diseases:
  • CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy): A genetic condition affecting the small arteries in the brain, which can lead to vascular disorders, strokes, and dementia.
  • Cerebral Microangiopathy: A group of conditions that damage the small blood vessels in the brain, potentially leading to various neurological symptoms.

Cerebral Hemorrhage

An intracranial hemorrhage, also known as a cerebral hemorrhage, is a life-threatening condition characterized by bleeding within the skull. This bleeding can occur in various locations, such as within the brain itself (intracerebral hemorrhage), between the meninges (subarachnoid hemorrhage), or in other areas of the skull.

Possible causes may include:

• Head trauma
• Hypertension
• Aneurysm
• Blood coagulation disorders
• Tumors

Stroke

A stroke (apoplexy) is a medical emergency that occurs when there is a sudden disruption of blood flow, interrupting the circulation to a part of the brain. This can happen either due to a blockage of a blood vessel (ischemic stroke) or the rupture of a blood vessel (hemorrhagic stroke). In both cases, the lack of oxygen and nutrients causes brain cells to die, which can result in nerve damage or permanent disabilities.

Cystic Changes in the Brain

Cystic changes in the brain are fluid-filled cavities that can form in various areas of the brain. They may be congenital or develop over the course of life. While some cysts remain asymptomatic and do not require treatment, others can cause symptoms or complications that necessitate medical intervention.

The most common cystic changes in the brain include:

• Arachnoid Cyst: Located between the meninges, often asymptomatic but can exert pressure on the brain.
• Choroid Plexus Cyst: Found in the area of cerebrospinal fluid production, usually benign and often resolve on their own.
• Rathke's Cleft Cyst: Near the pituitary gland, typically small and asymptomatic, but can cause hormonal or vision disturbances.
• Pineal Cyst: In the pineal gland, often asymptomatic but can lead to headaches or eye problems.
• Colloid Cyst: Located in the third ventricle, can block cerebrospinal fluid flow and lead to hydrocephalus.

Alzheimer’s Dementia

What is Alzheimer’s Dementia?

Alzheimer’s dementia is the most common form of dementia, a progressive brain disease that impairs memory, thinking, and behavior. It is characterized by the degeneration of nerve cells and the formation of plaques and tangles in the brain, leading to disrupted communication between nerve cells.

Symptoms of Alzheimer’s Dementia

• Memory loss
• Forgetfulness
• Speech difficulties
• Disorientation
• Changes in behavior and personality
• Problems with performing everyday tasks
• Global reduction in brain volume

Alzheimer's disease leads to a gradual shrinkage of the brain, particularly in areas important for memory, thinking, and planning. This reduction in brain volume can be visualized through imaging techniques such as MRI and is a characteristic feature of the disease.

Inflammatory Brain Diseases

What are Inflammatory Brain Diseases?

Inflammatory brain diseases are a group of conditions characterized by inflammation in the brain or spinal cord. This inflammation can be triggered by various causes, including infections (e.g., viruses, bacteria), autoimmune diseases, or unknown factors. The inflammation leads to damage to nerve tissue, which can result in a variety of neurological symptoms.

Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system that often occurs in young adults. In MS, inflammatory lesions appear in the central nervous system, which typically manifests in relapses. This means there are phases with acute episodes of illness during which new or previously known symptoms emerge or worsen. In this condition, the body’s immune system attacks the myelin sheaths that protect nerve fibers. This leads to disrupted signal transmission in the nervous system and a variety of symptoms, such as vision problems, numbness or tingling, muscle weakness, coordination difficulties, and cognitive impairments.

Other Neurological Inflammatory Brain Diseases:

• Encephalitis
• Meningitis
• Neuromyelitis optica spectrum disorders (NMOSD)
• Autoimmune encephalitis
• Central nervous system vasculitis
• Sarcoidosis
• Systemic lupus erythematosus

Tumors

What are Brain Tumors?

Brain tumors are abnormal cell growths in the brain or surrounding tissues. They can be benign (non-cancerous) or malignant (cancerous) and can lead to a variety of symptoms by pressing on surrounding tissues or disrupting normal brain activity.

Types of Brain Tumors

• Pituitary Tumor: Usually benign growths of the pituitary gland.
• Pituitary Microadenoma: A small benign brain tumor (adenoma) on the pituitary gland (less than 1 cm in diameter).
• Pituitary Macroadenoma: A large benign brain tumor (adenoma) on the pituitary gland (more than 1 cm in diameter).
• Pineal Gland Tumor: A rarer, typically benign tumor in the pineal gland.
• Neurofibroma: A benign tumor composed of various cell types from the nerve sheath (Schwann cells, fibroblasts, and others).
• Schwannoma: A benign tumor made up of Schwann cells.
• Acoustic Neuroma: A slowly growing benign tumor on the balance and hearing nerve.
• Meningeal Metastases: Cancer cells that have spread from another part of the body to the meninges.
• Glioma: A malignant tumor that arises from glial cells, which support and protect the brain.
• Meningioma: Usually a benign tumor that arises from the meninges.

Other Neurological Disorders

• Narcolepsy: Narcolepsy is a rare, chronic neurological disorder that disrupts the sleep-wake cycle. People with narcolepsy experience excessive daytime sleepiness and may fall asleep uncontrollably, often accompanied by cataplexy (sudden loss of muscle tone) or sleep paralysis.
• Polyneuropathy: Polyneuropathy is a condition of the peripheral nervous system in which multiple nerves are damaged simultaneously. Symptoms can vary depending on the type and severity of nerve damage, but they often occur symmetrically on both sides of the body and typically begin in the feet and hands. Common symptoms include tingling, numbness, muscle weakness, or cramps.
• Restless Legs Syndrome: Characterized by a strong urge to move the legs, Restless Legs Syndrome typically occurs at rest, especially in the evening and at night. Affected individuals often experience symptoms such as tingling, pulling, or pain, which can significantly disrupt sleep. Movement can temporarily alleviate the discomfort.

Info Box: According to the WHO, neurological disorders are the most common cause of illness and disability worldwide. The burden of these disorders has significantly increased over the past few decades.

Causes and Risk Factors of Neurological Diseases

Neurological diseases can have a variety of causes and risk factors that differ depending on the specific condition.

In general, the causes can be categorized as follows:

• Genetic Factors: Some neurological diseases, such as Huntington's chorea or certain forms of muscular dystrophy, are directly inherited through genetic mutations. Certain gene variants can also increase the risk of diseases like Alzheimer's or Parkinson's, even if they are not directly inherited.
• Environmental Factors: Viruses, bacteria, or other pathogens can directly attack the nervous system and cause inflammation or damage (e.g., meningitis, encephalitis). Environmental toxins (toxins) such as heavy metals or pesticides can also harm the nervous system and trigger neurological diseases.
• Lifestyle Factors: An unhealthy diet, lack of physical activity, alcohol consumption, and smoking can increase the risk of neurological diseases.
• Age: Aging increases the risk of neurological diseases due to neuronal degeneration, changes in the myelin sheath and blood vessels, a weaker immune system, and cumulative environmental influences.
• Sex: Certain diseases occur more frequently in men or women. For example, women are more often affected by MS, migraines, or Alzheimer's dementia, while men are more likely to develop Parkinson's disease.
• Pre-existing Conditions: Certain conditions such as diabetes, hypertension, or cardiovascular diseases can elevate the risk of neurological complications. For instance, diabetic neuropathy has emerged as a significant cause of neurological diseases in recent years. This increase is closely linked to the rising prevalence of diabetes mellitus, particularly type 2, which is preventable in many cases.

Diagnosis and Treatment of Neurological Diseases

The diagnosis and treatment of neurological diseases require a comprehensive approach tailored to the individual needs of the patient.

Diagnosis

The diagnostic process usually begins with a detailed medical history (patient history) and a thorough neurological examination. The following aspects are considered:

• Symptoms: Type, duration, severity, and progression of complaints Medical History: Previous illnesses, surgeries, medication use
• Family History: Occurrence of neurological diseases in the family
• Neurological Examination: Assessment of reflexes, muscle strength, sensation, coordination, balance, speech, and other functions

Depending on the suspected diagnosis, further examinations may be necessary and ordered by a neurologist or other specialists, such as:

• Imaging Procedures: MRI (Magnetic Resonance Imaging), CT (Computed Tomography), PET (Positron Emission Tomography) to visualize the brain and spinal cord
• Electrophysiological Examinations: EEG (Electroencephalography), EMG (Electromyography), nerve conduction studies to check the electrical activity of nerves and muscles
• Laboratory Tests: Blood tests, cerebrospinal fluid examinations to detect infections, inflammations, or other abnormalities
• Genetic Tests: If hereditary disease is suspected

Therapy

The treatment of neurological diseases depends on the specific diagnosis and can include various approaches:

• Medication Therapy: To alleviate symptoms, slow disease progression, or treat the underlying cause (e.g., antiepileptics for epilepsy, immunomodulators for multiple sclerosis)
• Surgical Therapy: In certain conditions such as brain tumors, aneurysms, or herniated discs, surgical intervention may be necessary.
• Physiotherapy: To improve mobility, strength, coordination, and balance
• Occupational Therapy: To assist with daily tasks and promote independence
• Speech Therapy: For speech and swallowing disorders
• Psychotherapy: To support coping with illness and treat psychological side effects

Additional Measures:

• Nutritional Counseling: A balanced diet can contribute to overall health and positively influence the course of the disease.
• Pain Management: Various methods can be used to alleviate chronic pain.

Prevention and Lifestyle Changes in Neurological Diseases

Although not all neurological diseases can be completely prevented, there are several lifestyle changes and preventive measures that can reduce the risk or positively influence the course of the disease.

Healthy Diet

A healthy diet plays a crucial role in the prevention of neurological diseases. Fruits and vegetables provide essential vitamins, minerals, and antioxidants that protect the brain. Whole grains supply long-lasting energy through fiber and complex carbohydrates. Healthy fats, particularly omega-3 fatty acids from fish, nuts, and seeds, support brain function and have anti-inflammatory effects. Limiting saturated and trans fats is important, as they can increase the risk of cardiovascular diseases and thus strokes. Finally, adequate hydration is essential for optimal brain function.

Regular Exercise

Regular physical activity increases blood circulation and metabolism in the brain. Additionally, exercise significantly reduces the risk of cardiovascular diseases and diabetes.

Mental Activity

Mental activity contributes to brain health. Regular challenges and learning new things stimulate the formation of new neural connections. This can help maintain cognitive abilities such as memory, attention, and problem-solving skills, while also reducing the risk of dementia. Ways to keep the brain active include reading, learning a new language, solving puzzles and crosswords, playing a musical instrument, or participating in social activities.

Avoidance of Risk Factors

Neurological diseases are influenced by certain risk factors. Smoking should be strictly avoided, as it increases the risk of strokes and other neurological problems. Alcohol consumption should be moderate, as excessive intake can harm the brain. Additionally, the head should be properly protected in traffic or during certain sports activities.

Summary and Conclusion

Neurological diseases encompass a wide range of disorders affecting the brain, spinal cord, and nerves—from common conditions like migraines and strokes to rare genetic disorders. Given that the prevalence of neurological diseases in Europe is around 60%, it is evident that theoretically anyone can be affected at some point in their lives.

Therefore, early detection of these diseases is crucial. Most neurological conditions have a progressive course and can lead to permanent damage and disabilities if left untreated. The earlier a diagnosis is made and treatment initiated, the better the chances of slowing disease progression, alleviating symptoms, and improving the quality of life for those affected.