On last Thursday’s episode of Grey’s Anatomy (titled “Poker Face”), new mom Mary has a brain tumor called “butterfly tumor” (or Astrocytoma) and only 6 months left to live. Meredith thinks differently and tries to change the course of Mary’s disease.

Danger Level: High

What is it?

Astrocytoma is a type of brain tumor which tends to spread inside the brain ignoring anatomical borders. That causes it to be present on both sides of the brain (and sometimes look life a butterfly – hence the name).

Who gets it?

Astrocytomas are rare – in the United States, every year there are 5.4 new cases per 100,000 people. They are a little more common in men, and most cases appear around ages 20-45.

What causes it?

Astrocytes are star-shaped brain cells located between nerve cells (astro=star, cyte=cell). They are actually part of a larger group of cells in the brain called glia cells – which support the nerve cells and glue them together.

Photo by Neurorocker

When astrocytes start dividing without control, they create a tumor called astrocytoma. These tumors come in different grades (1 to 4) – low grade tumors are slow-growing while high-grade tumors can be very aggressive (on the Grey’s Anatomy episode, Mary had a grade-4 tumor which is the most aggressive type).

The reason for astrocytoma is unknown, but scientists have found that it can be related to radiation to the head at young age, and there are several genes that are also related to this tumor.

How does it feel?

The symptoms of astrocytoma are related to its location – almost any neurological symptom is possible, including changes in mental status, seizures, and movement or sensory problems. These symptoms appear because the tumor puts pressure on brain tissue or ruins it while growing. Symptoms like these are called focal neurological symptoms.

Besides that, astrocytoma (and any other brain tumor) can increase the pressure inside the skull (called intra-cranial pressure) – this causes symptoms like headaches, nausea and vomiting as well as decreased alertness.

How is it discovered?

When someone comes to the doctor with the symptoms described above, the doctor will order a scan – a CT or an MRI (MRI is the best option). Sometimes doctors can guess the type of the tumor according to the way it looks on MRI – but final diagnosis can be made only when checking the tumor under a microscope after it’s removed in surgery.

This is a part of a brain with a grade 4 astrocytoma which spread to both sides of the brain.

How is it treated?

Aggressive astyrocytomas are treated with surgery to remove the tumor, radiation and chemotherapy. Steroids sometimes help with the symptoms, and so do anti-epileptic drugs (for patients with seizures).

What happens after treatment?

Even with treatment, astrocytoma can be deadly. Patients with low-grade tumors can survive for an average of 6-8 years, but with high-grade aggressive disease, average survival is less that 1 year.

The story of Jodi Fenton who recovered from grade-3 astrocytoma

The bottom line – how do I avoid it

Unfortunately, there is no known way to avoid astrocytoma.

Related posts:

1. As Seen on Grey’s Anatomy – Tay-Sachs Disease – Fat Accumulating in The Brain
2. Nesidioblastoma – A Tumor of the Pancreas That Can Secrete Hormones (As Seen on House MD)
3. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!) On episode 1 of season 7 (named “Now What”), the hospital’s only neurosurgeon, Dr. Richardson, has a severe nausea which doesn’t respond to strong anti-nausea drugs. The team treats him with stronger medications for his nausea – it passes but he starts to hallucinate and behave oddly. At first, the team thinks his behavior is a side effect of the drugs they gave him and test for a bunch of diseases like hepatitis and peptic ulcer. Only when they start to think of his behavior as a new symptom, and after they find out he was at a sea-food festival several days before, they diagnose him with toad egg poisoning

[Photo from episode]

Photo by Fox

Danger Level: High

What is it?

The poison in toad eggs is the venom of the Cane Toad. The venom is usually located in the salivary glands of the frog and on the skin, and rarely it can also pass to the eggs. The toad venom is also used in Chinese medications, so consuming these medications might also cause poisoning: it is the main ingredient in a medicine called Chan-Su which is used mostly as a topical aphrodisiac (and was banned from the Uniter States after four men died after trying to swallow it), and is also an ingredient of Kyushin, which is used in Chinese medicine to treat heart problems.

What causes it?

The toad poison contains a substance called Bufotenin, which is very similar to a cardiac medication called Digoxin (used to treat heart failure and certain abnormal heart rhythms). Digoxin can be toxic in high doses, and the toad venom causes symptoms similar to an overdose.

How does it feel?

The venom of the toad causes several symptoms:

• Nausea with vomiting and possible abdominal pain.
• Cardiac symptoms – mostly problems with the heart rate (which are called arrhythmias), which can be deadly. You might feel heart palpitations.
• Mental symptoms, such as hallucinations. The cane toad is also known as the “hallucinogenic toad” – licking its skin can cause hallucinations which last for about an hour. However, mental symptoms are less described in toad venom poisoning.

Photo by Doug Greenberg

How is it discovered?

The doctors will suspect this if there is a story of eating certain foods such as toad soup, toad cake or toad eggs, or if the patient uses one of the Chinese medications mentioned above. They will test your blood for potassium levels (if it’s high – this is usually a bad sign, since it may cause the heart rhythm problems mentioned above) and for the level of Digoxin (this test can also identify the poison). They will also do an ECG to look for problems with the heart rate.

How is it treated?

There is an antibody for Digoxin which can be used to treat toad venom poisoning as well and has been proved to save lives. Besides that, the treatment focuses on stopping the symptoms.

The bottom line – how do I avoid it?

It’s important to be aware of the possibility of poisoning, and seek medical help if you start feeling nausea or have heart palpitations after eating foods which contain toad. Also, avoid topical aphrodisiacs containing Chan-Su, which are marketed as “Rockhard”, “Love Stone”, or “chan su” – and are forbidden to import to the United States.

Related posts:

1. Radiation Poisoning– What it Can Do To You (As Seen on House MD)
2. Organophosphate Poisoning – Getting Poisoned by Pesticides (As Seen on House MD)
3. Naphthalene Poisoning – When Mothballs Kill More Than Just Moths (As Seen on House MD)

Several days ago the World Health Organization (WHO) cancer research agency (IRAC) announced that the radiation produced by cell phones can possibly cause brain cancer. This was concluded after a group of more than 30 experts met together and went through all the research done in this subject on the last decades.

(Photo by Jose Oller)

What exactly is this radiation?

Cellular phones produce a type of radiation called radiofrequency electromagnetic radiation. Radiation is practically a group of waves which travels through the air, but which you can’t see. Radiation comes in two flavors: ionizing (like UV, X-rays) and non-ionizing (like infra-red, microwave, radio, and yes – cell phone radiation).

Ionizing radiation is proved to be dangerous and cause cancer (which is why, for example, you shouldn’t do too many CT scans, which are just a whole lot of x-rays done together). On the other side, non-ionizing radiation shouldn’t cause any damage to your body. Or at least that was the belief until now.

(Photo by FDA.gov)

How dangerous is it?

The WHO divides all the things that were thought to cause cancer to 5 groups by the “level of evidence” – how much they are sure that something is carcinogenic (causes cancer). The most dangerous stuff belongs to group 1, which includes, for example, asbestos (small particles that cause lung cancer) and some viruses (like Hepatitis B and C, which can cause liver cancer) and ionizing radiation (which we spoke about above). Group 4 is supposed to include agents which are probably not carcinogenic. Naturally there are also groups 2 and 3 in between.

The group of experts classified cellular phones radiation in group 2b. This means that there could be some risk, and more research should be done to understand the risks better. One of the most important studies that the experts based their assumption on was The Interphone Study, which found an increased risk for brain cancer only in the group of heavy users (around 30 minutes per day, every day, for 10 years). People in this group were 40% more likely to get a brain cancer called glioma. There were several problems with this study – and some claimed that the way is was conducted caused results that aren’t reliable.

What types of cancer can I get from cell phones?

The experts found that two diseases were possibly related to cellular phone use:

Glioma: This is the most common type of brain cancer. The tumor is composed of glial cells, which are cells placed between the main cells in the brain (neurons) and support them. Gliomas cause symptoms by growing into healthy areas of the brain and hurting the neurons – either by destroying them or compressing them. This can cause headaches, seizures, problems with language or vision, and even personality changes – depending on the function of the neurons damaged. The treatment can include brain surgery, radiation and chemotherapy.

An MRI of a brain with a glioma – which is the darker round spot on the right of both pictures (photo by Mikhail Kalinin)

Acoustic neuroma: This is a slowly-growing tumor on the acoustic nerve – which is the nerve responsible for hearing. The special location of the tumor causes symptoms like hearing loss or ringing in the ears, and sometimes it can also hurt your balance (which is also a function of the ear and its nerves). Rarely, it grows fast into structures of the brainstem -which is responsible for vital functions like breathing. The treatment depends on the symptoms – in some cases no treatment is needed, but sometimes surgery or radiation treatments will be used.

What the world has to say

On the last couple of days, the internet and the news are full of responses to the WHO announcement. For example, the LA Times health blog “booster shots” claims there is not enough data and refers to former studies dealing with the relation between non-ionizing radiation and cancer; the health blog of Time wonders ‘what took them so long’; the Wall Street Journal reviews the studies conducted on the subject and criticizes the WHO for an immature announcement ; and CNN published an opinion article by physicist Bernard Leikind who claims that cell phones cannot cause cancer from the physics point-of-view. The main conclusion is that there is no reason to panic just yet.

(Photo by Kevin Micalizzi)

What can I do to prevent it?

• Use an earphone: According to earlier data released by the WHO on this subject, cellular phones emit radiation only when turned on, and the radiation exposure of the used depends on the distance from the phone – when the phone is placed 30-40 cm away from the body (like when text-messaging or using an “hands free” device – like an earphone), the exposure is much lower then when its close to the head.
• Limit use as much as possible: Like explained before, one of the largest studies that proved damage from cellular phone use showed an increased risk for glioma only in heavy users.
• Avoid using cell phones when reception is low: In cases of low reception, the phone has to transmit at increased power – which increases the exposure to radiation.
• The International Business Times published yesterday a list of the lowest radiation emitting cell phones.
• According to the WHO, the use of commercial devices for reducing exposure wasn’t proved to be effective.

Related posts:

1. Pancreatic Cancer–6 Facts You Should Know [News]
2. In The News – Pancreatic Cancer – The 4th Leading Cause of Death
3. Lung Cancer – Why You May Be at Risk (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 18 of season 7, called “The Dig”, a science teacher has symptoms matching Q fever (we’ll cover this disease in the future). The team finds out, while visiting his house, he has been hoarding – keeping almost everything he encountered. Later they also find his wife among those things, and it is found that she’s the hoarder, and also that she and him both have Q fever caused by raccoon scat in the house. After his wife has a heart attack and it’s found out she’d had miscarriages, the team reaches the conclusion that she has Ehler-Danlos Syndrome, which caused miscarriages (and the heart attack), and the hoarding came as a compensation for lost babies. Complicated? We think so too. Out of the 3 diseases mentioned here, we’ll go this time with the most interesting one – Hoarding.

Photo by NBCUniversal

Danger level: Low

What is it?

Hoarding is the excessive collection of possessions, with an inability to get rid of them when they are no longer useful or needed. Some view it as a condition by itself, while others say it’s part of obsessive compulsive disorder (OCD).

Who gets it?

Hoarding usually starts in early adolescence (around age 13) and tends to worsen with age (although cases of people as young as 3 years old (!) have been reported). It tends to affect women more than men.

Since, as you’ll read ahead, hoarders don’t see it as a problem and don’t usually seek help, it’s hard to tell how common the condition is. Still, some suggest the numbers are around 1 in 20 people.

There are some risk factors connected with hoarding, which may raise the risk of developing the condition. They include:

1. Family history – If a close family member is a hoarder.
2. Stress – Some people develop hoarding after a stressful event in their life (as was the case in the House episode, where the woman started hoarding after going through miscarriages).
3. Perfectionism – These people tend to worry about making the right decision about what to do with each possession. They avoid the distress involved in making the decision by just keeping it.
4. Emotional instability – Such as depression or anxiety.
5. Problems processing information – This is something similar to ADHD, when the person has a problem with attention. They find it difficult to concentrate on a task without being distracted by other things. One such task is categorizing their possessions and organizing them.

What causes it?

Studies have found that hoarding may be related to abnormalities in specific brain regions. Describing those is beyond the scope of this article, though.

How does it feel?

Living room of a hoarder. Photo by Shadwwulf

First thing about the problem is collecting too many things. The most common way they do that is by shopping, but they also collect free things. They may also collect things that don’t require acquiring specifically – such as packing material that comes with new purchases.

The second thing is difficulty getting rid of these items. It’s very difficult for them to throw away, sell, give away, or even recycle their items. To most people, most of the things saved may seem worthless or worn-out.

They also find it hard to organize their possessions – they just spend hours moving them from one place to another without any effective result.

The main problem with hoarding is that hoarders usually don’t see it as a problem.

This video is from a reality show on TLC called “Hoarding: Buried Alive”, which depicts the lives of real people as they try to overcome hoarding:

How is it discovered?

Along with experiencing the above mentioned problems, which a psychiatrist can recognize as hoarding, there are also tests (sort of questionnaires) that can help with the diagnosis.

How is it treated?

There are several ways to treat hoarding. Unfortunately medications aren’t usually part of them (although they may help reduce the symptoms). Treatment includes challenging the hoarder’s thoughts and beliefs about the need to keep items, practicing removal of clutter with the help of a clinician or a coach, and other behavioral techniques.

Do you hoard or know of a person that hoards? Let us know in the comments below.

No related posts.

The following guest post was contributed by Wendy Graham who writes for CRNA Schools

A study conducted at the University of Minnesota, roughly 20 years ago, disclosed that there might be early signs in our writing that indicate a connection to Alzheimer’s disease. The “nun study” was conducted to examine aging women over time, and the focus of the study was at first on four women, not actual nuns, but sisters with similar history and background.

Photo by churl

David Snowden, the conductor of the study, signed on eventually close to seven hundred sisters, age 75 and older, and all of them agreed to donate small portions of their brains to the experimental study after they died. Each year, a researcher would visit in order to set-up memory tests for the elderly women, and upon one of these visits, Snowden made an unlikely discovery. A collection of biographies that many of the women had to write upon entering the school fifty years ago displayed some very pertinent information. Snowden and his research team looked at the following two criteria: grammatical complexity and the amount of distinct ideas within every ten words. An idea-laden sentence appears as follows:

“It was about a half hour before midnight between February 28 and 29 of the leap year 1912 when I began to live, and to die, as the third child of my mother, whose maiden name is Hilda Hoffman, and my father, Otto Schmidt…”

And here’s an example of a sentence with less ideas in it: “I was born in Eau Claire, Wisconsin on May 24, 1913, and was baptized in St. James Church…”

The discovery for Snowden and his research team was that the sisters who did poorly regarding these two measures were much more likely to develop dementia. And those sisters at the bottom third of the sample were close to sixty times as likely to develop Alzheimer’s disease than those at the top third of the study. According to this test, ninety-two percent of the time, researchers were able to predict that the brain in question had some of the lesions and plaque associated with the disease. Opposing beliefs claim that the study is merely an association, which does not mean simple writing points to Alzheimer’s disease and dementia later on in life. Further analysis concludes that Alzheimer’s can be detected early, following a number of methods, but it is uncertain whether writing can be justified as a discernable method for doing so.

Related posts:

1. Tragedy of Rebecca Doig – A 31 Years Old New Mother with Alzheimer Disease
2. Women Have Inbuilt Fear of Getting Fat

Yesterday we covered Alzheimer disease, a disease which usually occurs after the age of 65. Rebecca Doig’s case, however, is different.

What should have been the happiest moment of Rebecca’s life – the birth of her first baby girl, has become a moment of indifference for her. 31 years old Rebecca has a rare form of Alzheimer disease. Her symptoms started about two years ago, but deteriorated rapidly.

This case is thought to be the first case of an Alzheimer patient giving birth.

This video is from a TV show that aired a month before the birth:

The couple’s healthy daughter Emily was delivered by caesarean section last week. Rebecca hasn’t been able to hold her yet and she can’t recognize her own baby.

Related posts:

1. Alzheimer Disease – Are You at Risk?
2. Predicting Alzheimer’s Through One’s Writing
3. As Seen On 24 – Creutzfeldt-Jakob Disease – A Disease Caused by Prions

Danger level: High

What is it?

Alzheimer disease (AD)  is a disorder which causes a deterioration in mental functioning, especially memory loss.

Who gets it?

In the US, more than 14% of people over age 65 have AD, and after age 80 the number reaches 40%. All in all there are about 4 million Americans with the disease.

Around the world, the percentages are similar.

There are some risk factors – having those puts a person at a higher risk of developing AD:

1. Age – The disease usually affects people after the age of 65. It can, rarely, affect people younger than 40 (we will talk about this on tomorrow’s post).

   
   Old age – the older you are, the more at risk you are to develop AD. Photo by jamelah

2. Family history – If you have first-degree relatives (parents, siblings) with the disease, your risk of developing it yourself are higher.
3. Sex – Women tend to have the disease more than men.
4. Education level – People who had less education during their lifetime are more likely to get AD than other, more educated, people.
5. Down syndrome – People with Down syndrome tend to develop AD in their 30s and 40s.
6. High cholesterol levels and high blood pressure

What causes it?

No one knows for sure what causes AD. What is known, though, is that AD causes damage to the brain.

Our brain is composed of cells called neurons. They help the brain serve as the control center for the body, controlling everything from movement to memory and understanding.

In AD there are two things found in brain cells which scientists believe are related to the damage that’s caused to them:

1. Senile plaques
2. Neurofibrillary tangles

These are both materials that accumulate in small numbers during our normal aging of the brain. In AD, for reasons unknown, they occur in excess.

The brain of an Alzheimer patient under a microscope. The groups of plaques shown around the picture are senile plaques. Photo by KGH

How does it feel?

AD is a type of dementia, which is a group of diseases in which people have a decline in their mental functions, especially memory loss.

When someone has AD, its signs usually start gradually and are often subtle. They include:

• Memory problems –
  - AD patients tend to forget recent events (including conversations they had)
  - They have trouble finding the right words – Including names, often of family members and everyday objects
  - They repeat things they had already said
  - They forget appointments
  - They misplace things
• Trouble performing complex tasks – Like paying the bills
• Disorientation – They may get lost in familiar places
• Loss of judgment – They forget what to do in situations such as fire starting in the house.

How is it discovered?

Besides taking a history and discovering the problems described above, the doctor can perform a special test called the Mini-Mental State Exam, which tests a person’s problem solving skills, attention span, counting skills and memory.

Other than that, lab tests and imaging of the body may be done to rule out other causes of the memory decline.

How is it treated?

Unfortunately, there’s no cure for AD.

There are certain drugs which can be given to patients, which include names such as Aricept, Exelon, Razadyne and Namenda.

None of these cure the disease, but studies have shown that they may improve mental function.

What happens after treatment?

AD tends to get worse over time. The rate at which the person worsens is different for each person.

People with AD tend to die earlier than normal (although they may live anywhere from 3-20 years after the diagnosis). They usually become immobile and disabled with the advancement of the disease. Usually death isn’t a direct result of the disease, but of an infection or failure of body systems.

There’s no proven way to prevent AD. You may be able to reduce your risk of developing it by controlling your blood pressure and cholesterol levels in the blood.

Studies have also shown that participating in leisure activities such as reading, playing board games, playing musical instruments, and dancing may lower your risk of developing AD.

This excellent video shows the progression of the disease inside the brain:

Related posts:

1. Tragedy of Rebecca Doig – A 31 Years Old New Mother with Alzheimer Disease
2. Are Obese Kids at Risk for Heart Disease?
3. Predicting Alzheimer’s Through One’s Writing

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 2 of season 1, also known as Paternity, Dan, a 16 year old gets hit in the head during a lacrosse game. He also has night terrors and double vision. After a few mis-diagnoses (including sexual abuse and multiple sclerosis) the team (or, rather, Dr. House) arrive at the correct diagnosis of subacute sclerosing panencephalitis.

Dr. House asking his team to run unethical DNA tests on episode 2 of season 1. Photo by Fox Broadcasting Company. Credit: Danny Feld/FOX.

Danger level: High

What is it?

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurological disorder characterized by inflammation of the brain (encephalitis = brain inflammation). It’s associated with infection of the brain with the measles virus.

Who gets it?

SSPE is rare. Before the measles vaccine was used, in the 1960’s, it was more common (and even then pretty rare – 0.61 cases per million people). In the early 1990’s only 2-3 cases per year were discovered in the US.

SSPE usually happens when people are infected by the measles virus at an early age, before the age of 4, and mostly before age 2. It then affects the infected person 7-13 years after the infection.

SSPE is twice as common in males as it is in females. It also tends to happen less in people living in cities, and more in rural areas. It’s also more common in children of Hispanic origin.

What causes it?

Usually, an infection by the measles virus tends to subside and the virus goes away. In SSPE, there appears to be a persistent infection with a virus that had somehow changed. That virus stays inside the cells in the brain for several years. After 7-10 years it starts attacking the cells in the brain that previously protected it.

This causes an inflammation in the cells which eventually leads to their death.

The measles virus. In SSPE it destroys brain cells.

How does it feel?

The disease can appear anywhere between age 1 and 30, but is more common in children and adolescents, as it usually begins 7-13 years after the infection with the measles virus occurred.

The disease has 4 stages:

In stage 1 subtle changes in behavior or school performance appear – including irritability, reduced attention span, or temper outbursts. This stage may be missed since the symptoms are mild.

In stage 2, a phenomenon called myoclonus is observed (which was also seen in the House episode). This is a brief, involuntary twitch of a muscle or a group of muscles.

In stage 3 there are no more involuntary movements. Instead, other, more severe types of movement problems appear, including something called choreathetosis (dancing movements), immobility, rigidity of muscles. These result from the destruction of areas in the brain responsible for movement.

In this stage, the infected person’s consciousness also deteriorates and can lead to a coma.

In Stage 4 brain areas that control our breathing, heart rate and blood pressure are destroyed, leading to death.

How is it discovered?

If the clinical stages above are seen by a doctor this might give a clue to SSPE. Also, at least one of these findings has to exist in order to diagnose SSPE -

1. Detection of antibodies – Antibodies are molecules the body produces to fight infections. Once we are infected, they may be found in the blood. Here, we actually look for antibodies not in the blood but in the spinal fluid, which runs throughout our brain and spinal cord. This is done by taking a sample from the spine, usually by inserting a needle to the lower back.
2. Findings on EEG – EEG is a tracing of our brain’s electrical activity, much like an ECG can show the electrical activity in our heart. In SSPE, the EEG has a certain pattern that can be seen in stage 2 of the disease.
3. Brain biopsy – This used to be more common. A part of the brain was taken to examine it under the microscope and see if the virus is there. Today it’s no longer done routinely.

Example of an EEG. Photo by Der Lange.

How is it treated?

Usually no specific treatment can be offered to people with SSPE, in contrast to what was seen on the House episode. On that episode, treatment with a drug called interferon was given to the kid, which cured him. Studies made on such treatment showed that only about 30% of people treated with it improved.

What happens after treatment?

Most people, unless rarely cured by the treatment, die within 1-3 years.

SSPE can be prevented if the initial infection by the measles virus is prevented. This is done by taking the measles vaccine.

Related posts:

1. Measles Vaccine Not Linked To Autism, According To Britain
2. Echoviruses (As Seen on House MD)
3. Rabies – All You Need To Know (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On season 1, episode 1. A.K.A “Pilot”, an elementary school teacher named Rebecca Adler suddenly collapses during class and starts babbling. After a deterioration and some misdiagnoses, a final diagnosis of neurocysticercosis is made.

The team rescues Rebecca after a collapse at the MRI machine. Photo by Fox broadcasting company. Credit: Alan Zenuk/FOX.

Danger level: High

What is it?

Neurocysticercosis is the most common disease caused by a parasite that infects the brain and spinal cord. It is caused by eating a type of worm.

Who gets it?

In the US, neurocysticercosis is mainly an immigrant disease. It’s more common among the Hispanic population and in the states of California, Texas and New Mexico. Other cases are caused by traveling to other parts of the world, or by eating infected foods (more on that later).

Throughout the world, the disease is most common in Central and South America, sub-Saharan Africa, and in some regions of the Far East.

What causes it?

Neurocysticercosis is caused by the ingestion of eggs of a certain type of worm, the pork tapeworm (which, in its scientific name is called Taenia solium).

How does this happen?

The tapeworm has a lifecycle, as can be seen in the drawing below:

People infected with the worm shed its eggs in their feces. In places of questionable hygiene,  the infected feces can reach food or water sources (1). Once other people eat or drink infected food or drinks (7), the worm’s embryos hatch from the eggs in the small intestine, where they invade the intestines’ wall (8). From there they travel through the blood stream to the brain, muscles, under the skin, the eye, or almost any other place in the body (9). That leads to a dead-end, as you can see in the drawing.

If, on the other hand, a pig were to eat the contaminated food or water, and that pig is not cooked appropriately, a human eating that pig can be infected by the worm (4) (this is what happened on the House episode). The worm then attaches to the human’s small intestines (5), where they mature over a period of 2-4 months (6). They can live in the small intestines for years. Then the worm is spread in that human’s feces, and the cycle continues.

It’s important to understand that usually the worms we get from eating pork don’t reach our brains. Only when we eat eggs which can hatch as discussed above do we get neurocysticercosis. (However, if you do carry the worm and transmit it through your feces, and don’t wash your hands appropriately after visiting the toilet, you can transmit the eggs to yourself).

How does it feel?

As mentioned above, the worms can reach different organs in our body. What we feel depends on where they reach. Neurocysticercosis is the name of the disease that occurs when the worms reach the brain.

Once they reach the brain, any number of things can happen. The infected person can develop seizures. The pressure inside the brain can also rise, causing headache, nausea, vomiting, changes in vision, dizziness, problems walking, or confusion. The worms may also cause a stroke.

How is it discovered?

To find out if someone has neurocysticercosis, the eggs or worms have to be found. How can this be done? In one of 3 ways:

1. Showing the worm in a sample taken from the body (muscle, for example).
2. Showing the worm inside the eye, through equipment used by eye doctors.
3. Showing the worm in images of the body (MRI or CT images), for example the brain – you can see an example of such an image below.

A brain infected with neurocysticercosis as seen in an MRI image.

There are other ways to discover the worm, such as blood tests or simply trying to treat the patient and seeing if the disease has improved.

How is it treated?

Once someone has a worm-infected brain, two things can be done to help them: Treating them with drugs that control seizures, and treating them with drugs that kill the worms (One such drug was used in House, called albendazole).

Steroids can also help in the treatment, since they can help reduce the brain swelling that may be caused by the disease. This actually happened in the show, when the patient was given steroids, which helped her, but only temporarily.

What happens after treatment?

Usually, the seizures associated with neurocysticercosis improve after treatment and can be stopped. In people with more severe complications, treatment may be less helpful.

The CDC (Center for Disease Control) recommends you take the following measures to avoid having neurocysticercosis:

1. Avoid eating raw or undercooked pork and other meats.
2. Don’t eat meat of pigs that are likely to be infected with the tapeworm.
3. Wash hands with soap and water after using the toilet and before handling food, especially when traveling in developing countries.
4. Wash and peel all raw vegetables and fruits before eating. Avoid food that may be contaminated with feces.
5. Drink only bottled or boiled (1 minute) water or carbonated (bubbly) drinks in cans or bottles. Do not drink fountain drinks or any drinks with ice cubes. Another way to make water safe is by filtering it through an “absolute 1 micron or less” filter AND dissolving iodine tablets in the filtered water. “Absolute 1 micron” filters can be found in camping/outdoor supply stores.

Related posts:

1. Echinococcosis – How Even Your Cat or Dog Can Infect You With Worms (As Seen on House MD)
2. Meningitis – The Brain Infection That Could Kill You, and How To Recognize It
3. Stroke – A Heart Attack In The Brain

On last night’s episode, Izzie Stevens brings her former biology teacher to Seattle Grace (+Mercy West) hospital as he has been having memory problems. Turns out her teacher has a condition called NPH, which we will cover today.

Danger Level: High

What is it?

Normal Pressure Hydrocephalus (NPH) is a condition in which there is excess “brain fluid” inside the brain.

Who gets it?

NPH usually occurs in elderly people (usually over 60). It can happen to men and women alike.

What causes it?

Our brain and our spinal cord are connected to each other. They are both a part of our central nervous system. It doesn’t take a doctor to know that damage to them can lead to severe consequences.

To prevent damage to them, they are protected by fluid which floats around them, cushioning them. This fluid also provides them with nutrients and gets rid of waste products they produce. This fluid is called CSF – or cerebrospinal fluid.

This fluid is produced within our brain and circulates inside the brain and along our spinal cord.

 

The CSF is produced inside the brain and protects the brain and spine.

Our brain isn’t a solid structure. It has “holes” in it, called ventricles. Inside them there is an area called choroid plexus, in which the CSF is produced.

Normally, CSF circulates in the ventricles and on to the spinal cord and when an excess is produced it is absorbed. In NPH the system which drains and absorbs extra CSF doesn’t work like it should and there is too much CSF inside the ventricles. This causes the ventricles to enlarge and press on different parts of the brain, causing the pressure inside our skull.

NPH can be caused because of a head injury, bleeding around the brain, stroke, meningitis, or a brain tumor.

How does it feel?

NPH normally causes three major things:

1. Dementia: This is a decline in our mental abilities, meaning our ability to remember things, solve problems, concentrate and so on. It is the same thing that’s seen in people with Alzheimer’s disease.

2. Urinary incontinence: This is an inability to hold urine.

3. Abnormal gait: This means difficulty walking.

Other things which can be seen in NPH are headaches, nausea and difficulty focusing the eyes.

How is it discovered?

NPH can sometimes, but not always, be seen on CT scans or MRI scans. In them the brain’s ventricles might look bigger than normal.

A better way to diagnose NPH is to perform a spinal tap (or lumbar puncture) – in it a syringe is inserted to an area around the spinal cord and CSF is removed. This fluid is than analyzed for possible abnormalities. The interesting thing about this procedure is that when fluid is removed, the pressure on the brain subsides, making the symptoms go away.

How is it treated?

If the cause (such as a brain tumor) for NPH is known, a surgery to correct the problem is performed.

If it isn’t (which happens in many cases) a shunt operation is performed. In it, a tube is implanted in the brain’s ventricles, and travels under the skin to the belly, to where the fluid is drained.

What happens after treatment?

The shunt operation should relieve future pressure from the brain and prevent recurrence of the symptoms. Without treatment, symptoms often get worse and could lead to death.

It’s important to note that surgical treatment improves symptoms in about 50% of cases.

The bottom line – How do I avoid it?

Treating disorders that may lead to NPH (such as a brain tumor or a stroke) may prevent it from developing.

This video sums it all up:

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1. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome
2. Astrocytoma (Butterfly Tumor)–A Brain Tumor That Spreads To Both Sides (As Seen On Grey’s Anatomy)
3. Want Your Newborn To Have a Normal Weight? Exercise