SYMPTOMS & SIGNS:

Sudden onset of most severe headache

Sudden neurological impairment: vision, speech, limbs

Unexplained headaches (especially morning)

Unexplained nausea, vomiting, drowsiness

Unexplained headaches with fever and neck stiffness

Progressive deafness or ringing in one ear, vertigo, gait imbalance

Progressive neurological changes (any of the above)

Miscellaneous; Seizure, personality and memory changes

INVESTIGATIONS:

CT head scan – low resolution study; good start to screen for lesions

MRI head scan – high resolution study; good for most brain lesions

MRA/V head and/or neck – to look at brain and neck arteries and veins

CTA/V head and/or neck – to look at brain and neck arteries and veins

Cerebral angiogram – high detail study of brain artery and vein roadmap

PET scan – for brain blood flow and metabolism

SPECT – for brain blood flow and brain blood volume

TCD – for blood flow in brain arteries threatened by spasm

Carotid ultrasound – for blood flow across the neck’s carotid arteries

Lumbar puncture – to obtain CSF for lab studies, spinal fluid pressure

Blood tests – for markers of inflammation, infection; sodium; genetics

Brain biopsy – brain tissue samples for pathology, microbiology (bugs)

TREATMENT OPTIONS:

Observation – periodic scans and Office visits but no active treatment

Medical management – steroids, anti-seizure and pain meds, blood thinners

Open surgery – major procedure: Craniotomy

Open surgery – minor procedure: EVD, shunt, reservoir, needle biopsy

Endovascular surgery – coils, stents, glues or resins

Radiation therapy – whole-brain versus stereotactic

Chemotherapy

INFORMED CONSENT:

Benefits of procedure

Risks of procedure

Overview of procedure

Alternatives to the procedure

Team approach

Discussion of advance directives

HEALING:

Takes time, maybe several months

May affect thinking clarity, personality, strength, agility, sexual function

May involve formal rehabilitation therapy, speech therapist, psychologist

Personal motivation, patience and psyche very important

Social supports: family, friends, community resources; spiritual person or group

Awareness that patients, family members are under new, extraordinary stresses

Accept help

FOLLOW-UP:

Wound-check date

Periodic Office visits

Periodic scans

Physician/Office contact numbers – write names, numbers down before leaving