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!)

Photo by Fox

Photo by Fox

Danger level: Medium

What is it

Syringomyelia is damage to the spinal cord caused by a fluid-filled area (a cyst, which is called a syrinx). The syrinx usually appears first in the neck, and later extends upwards or downwards – putting pressure on other areas of the spinal cord.

Who gets it

Syringomyelia is not common – the frequency in the US is 8.4 cases per 100,000 people. The disease usually appears around the ages of 20-40, and men get it more than women.

What causes it

The fluid inside the syrinx is called Cerebro-Spinal Fluid (CSF) – this fluid can be found normally around and inside the brain and spinal cord. A syrinx is formed when there is a problem with the circulation of this fluid so there’s too much of it in a specific area inside the spinal cord. This might happen for several reasons, including birth defects (which are the most common reason), trauma to the spinal cord (like in the House episode), a tumor in the spine or inflammation of the spine.

How does it feel

The symptoms usually develop slowly and appear gradually:

• Muscle problems, including muscle weakness in the arms and legs, loss of muscle mass and contractions or  muscle-spasm in the legs.
• Sensory problems – decreased sensations (of pain, temperature and touch), numbness or pain. These problems are more common in the neck, shoulders, arms and trunk (a “cape-like” pattern).
• Headaches.
• Problems with bowel and bladder function.

How is it discovered

If you have symptoms of syringomyelia, the doctors will start with a neurological exam (checking muscle strength and sensation) which will help them to estimate where the problem which causes the symptoms is located. In order to prove that there is a syrinx and show it, the doctor will perform an MRI of the spinal cord.

An MRI of syringomyelia. The syrinx is the white area inside the gray spinal cord. Photo by Cyborg Ninja

How is it treated

When there are symptoms, the treatment is surgery to drain the fluid from the syrinx. Sometimes a tube is inserted for continuous draining. After surgery, physiotherapy can help restoring function in the damaged muscles. If there are no symptoms, treatment is not necessary.

What happens after treatment

The surgery stops the progression of the syrinx so new symptoms will not appear. Also, about half of the patients report significant improvement in the symptoms they had.

Without treatment the disease gets worse and worse and eventually causes severe disabilities.

The bottom line – how do I avoid it

There is no way to prevent syringomyelia – the most important thing is to catch it on time before the symptoms cause disabilities.

Related posts:

1. As Seen on Grey’s Anatomy – Tethered Spinal Cord Syndrome
2. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)
3. Teratoma–When You Can Find Teeth and Hair Inside Your Body (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 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)

This is part of our House MD Project series.

On episode 6 of season 2, called “Spin”, a famous cyclist called Jeff collapses during a race and is brought to the hospital. He has shortness of breath and muscle weakness. The team also discover he has deficiency of red blood cells (a type of anemia, “pure red cell aplasia”). A scan of the neck also discovers a thymoma (a tumor of a gland called the thymus). Connecting the dots together, he has myesthenia gravis, and a line of illegal medications he has been taking for his cycling prevented the symptoms from appearing until now.

Photo by Fox.

Myasthenia gravis is a disease in which the body attacks certain areas in our muscles, causing muscle weakness and fatigue. We already covered that in the past, and you can read about it here:

Myasthenia Gravis – The Body Attacking Its Own Muscles

Related posts:

1. Myasthenia Gravis – The Body Attacking Its Own Muscles
2. Necrotizing Fasciitis Revisited, Osteosarcoma, and Aneurysms – (As Seen on House MD)
3. Acute Intermittent Porphyria Revisited (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 9, named DNR, John Henry Giles, a famous trumpet player, loses his breath in the middle of a musical session. Dr. House is more intrigued by the patient being paralyzed and doubts a previous diagnosis given to him of a disease called ALS. Turns out House was right, as always, as it’s discovered by the end of the episode that the patient had arteriovenous malformation compressing his spine, which caused his paralysis.

Danger level: High

What is it?

Arteriovenous malformation (or AVM for short) is a defect in the blood vessels causing an abnormal connection between veins and arteries.

Who gets it?

AVM isn’t very common, and not much data exists about who gets it. It is known, though, that in the United States about 300,000 people have it.

It usually occurs in young adults, even though the origin of the disease goes back to being a fetus.

What causes it?

To understand what AVM is, you first need to understand the basics of blood vessels in the body.

Our circulatory system (the system through which blood is delivered to organs in the body) is composed mainly of arteries and veins. Arteries (appearing red in the drawing below) carry oxygen-rich blood to our organs. Arteries divide into smaller and smaller arteries until the become the smallest blood vessels, called capillaries.

Capillaries join together and form veins (appearing blue in the drawing). The veins’ role is to take up waste products from the organs.

In AVM, defects in the circulatory system cause direct connections between arteries and veins, without the capillaries in between. When these happen in our nervous system (the brain or the spinal cord), 3 things can happen that lead to problems:

1. Hemorrhage – Due to the defect, blood can spill from the vessels to the surrounding area, including the brain (if the AVM is in the brain).

2. Seizures – Again, if the AVM is in the brain.

3. Neurological defect – A defect in the brain or spinal cord functions can happen and advance over months and years. This is what happened on the House episode.

Why does these happen? No one knows for sure. It may be because the area with the AVM “steals” blood from the normal blood vessels. Or because the AVM presses on the area outside of it.

(Remember that AVMs can occur anywhere in the body. In this article we deal with the nervous system simply because the House episode showed an example of this location).

How does it feel?

Most people don’t even know they have AVM, since no symptoms appear.

When they do appear, symptoms can include persistent headaches or seizures. If the AVM bleeds, it can cause a very severe headache and a stroke or even death.

When the AVM presses the surrounding area it can cause neurological problems depending on the area of the brain or spinal cord it’s located at. In the House episode, for example, it caused paralysis.

How is it discovered?

A CT scan or an MRI are used to discover AVMs. An angiography (a technique used to image the inside of blood vessels) of the area can also be used.

An angiography showing AVM in the brain. Photo by Dr Marina-Portia Anthony

How is it treated?

AVMs are treated by a surgery, by irradiation of the AVM, or by a process called embolization. In embolization, the doctor plugs the AVM by inserting a coil or glue that will block off the area.

What happens after treatment?

Without treatment, 2-4% of AVMs will bleed each year. Treatment should stop these complications from happening.

Since you are born with AVMs, there is no known way you can avoid it.

This video shows how dangerous AVMs can be through the story of Amit, who had headaches which were first thought to be flu-related:

httpv://www.youtube.com/watch?v=IZGxW9RQQzk

Related posts:

1. Wegener’s Granulomatosis–A Rare Inflammation in Blood Vessels that Can Lead to Death (As Seen on House MD)
2. Blood Clotting Tendency (Thrombosis) – Are You at Risk? (As Seen on House MD)
3. Peripheral Arterial Disease – A Narrowing of Blood Vessels that Will Shorten Your Life

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

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:

Related posts:

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

Yesterday Grey’s Anatomy came back for another season, and so does this column, where we teach you about a disease featured on each episode. This time – tethered spinal cord syndrome.

Danger level: High

Health forums category: Children’s Diseases

What is it?

Tethered cord syndrome (TCS)  is a condition which limits the movement of the spinal cord within the spinal column.

Who gets it?

TCS is a rare disease – it happens in about 0.05-0.25 of 1000 births.

There is, however, a more common condition called spina bifida, which happens to 1-2 people out of 1000. About 20-50% of children born with spina bifida have TCS. Spina bifida, in case you’re wondering, is a condition in which the bones of the spine (the vertebrae) do not form properly during pregnancy.

What causes it?

To understand TCS, you have to know how our spine is built.

In our back there is a row of bones (vertebrae), which together form our spine. Inside these bones travels a cord, called the spinal cord. The spinal cord is responsible for sending messages from our brain (where it starts) to the rest of our body, and by this it controls movement and sensation in the body.

The lower tip of the spinal cord is called the conus medullaris. During development in the womb, the spinal cord moves up in the spine. In TCS, it stops in the middle of the way, so that the conus medullaris is lower in the spinal cord than it should be. In this case, it is tethered, and doesn’t float freely.

When a child that has tethering of his lower spinal cord starts growing, the spinal cord, which is still tethered, starts stretching. This can cause damage to the spine and interfere with the blood supply to it.

How does it feel?

There are several things which TCS can cause:

1. Back pain – It’s usually worsened by activity and relieved by rest.
2. Leg pain – Especially in the back of the legs.
3. Leg numbness or tingling
4. Changes in the strength of the legs
5. Difficulty riding a bicycle, playing sports and falling while running.
6. Muscle contractions
7. Tenderness along the spine
8. Scoliosis – This is a condition in which the spine grows crooked.
9. Problems with urinating

And others…

How is it discovered?

MRI – This is a technique in which an x-ray image of the spine is taken. This is the best way to detect TCS.

How is it treated?

TCS is usually treated with surgery, in which the cord is released so that it is no longer tethered.

This video shows the part in the surgery where the cord is released:

What happens after treatment?

With treatment, the problems should disappear.

Without surgery, though, the condition can get worse. As the child keeps growing and the spine keeps stretching, the blood vessels supplying it get damaged, and less blood is transferred to the cord. This can lead to further damage to the cord and deterioration of the condition.

As mentioned above, TCS often coexist with a condition called spina bifida. There are certain things you can do to lower your baby’s risk for having spina bifida, and by this lowering its risks for TCS:

1. Take folic acid during pregnancy. Foods rich in folic acid contain avocados, black beans, and asparagus. The best way to obtain it, though, is by taking a pill supplement. Consult your doctor for the recommended dosage.
2. If you take drugs to treat seizures or acne, you should consult your doctor before getting pregnant, as those can cause birth defects.
3. Avoid getting too hot in the first weeks of pregnancy (such as in a sauna, a very hot bath, or when you have high fever) – The heat may raise the risk for spina bifida.

Related posts:

1. Syringomyelia – Fluid Inside Your Spinal Cord (As Seen On House MD)
2. Treacher-Collins Syndrome – Being Born Without Cheek Bones (As Seen on Grey’s Anatomy)
3. As Seen on Grey’s Anatomy – Normal Pressure Hydrocephalus (NPH)