The environment and neuroplasticity

One would often think of neuroplasticity as being a natural capability of the brain that kicks in whenever the brain gets damaged from trauma or any other form of injury. This belief is only partially true. The brain can only become neoplastic with constant training and repetitive exercises to build up new neural connections and strengthen them with each practice done. However, it should be taken noted that repetitive exercises either physical or mental are not the only things that promote neuroplastic factors of the brain to initiate its ability to repair itself. Other factors such as the environment where we spend most of our time at also affect how much our brains can become neuroplastic. This is especially true when it comes o lighting as the light that we see around us also plays a role in stimulating our neurons both directly or indirectly.

Light affects our brains directly by way of direct radiation. This means that sunlight that we are exposed to everyday travels to us directly by means of radiation through a vacuum ( empty space) before hitting us on earth which allows us to see our environment. the light that is visible is captured by our eyes and transmit signals to the optic nerve that transfers it further to our brains to interpret the image of the environment that we see. This biological mechanism is how we are able to see and how our brains give us the gift of sight. However, not many people are aware that this same process has an impact on our neurons causing them to become excited and fire of signals. In other words, light excites the brain to become more active and to allow neurons to fire off more signals. When this happens damaged neurons will have an easier time of picking up some of the signals made by the healthy neurons and establish a new connection with it. therefore it should be recommended that all rain injury patients should at least spend a few minutes of their time getting exposed to sunlight. This is also crucial in changing the mood of patients as we all know that patients who spend most of their time inside hospital rooms would always end up with mild depression so going outside for some sunshine is not only good for the brain but also for the mind.

Another way that light is good for brain injury is that it helps start neurogenesis, the brains capability of generating new cells. the brain is one of the most photoactive organs of the human body. It needs light to be stimulated and grow new cells. A good example of this would be the victims of the Hiroshima bomb in 1945. They are exposed to dangerous radiation that grew cancer cells in their internal organs including their brain. Though this may not be the most pleasant or comforting examples of how light stimulates growth in the human body. it does tell you that if an excess exposure to light causes uncontrolled growth in the human body to the point of causing cancer, would moderate exposure help stimulate the safe growth of brain cells? the answer to that question is an astounding "yes" Research has shown that brain cell tends to grow better an faster in areas with high illumination. Hence it is for this reason that researchers have taken the next step further in using light repair brain tissue after a brain injury. Such examples would be laser therapy where low-intensity lasers are used to repair damaged organs by illuminating the damaged areas with the laser with a certain intensity so that the cells natural repair mechanism would be activated and the organ old be able to repair itself. If man-made light such as lasers could do this then so can natural sunlight. So I urge all brain injury patients to expose themselves to more sunlight while they can especially when they are still in the hospital.

Light isn't the only external factor affecting our neuroplasticity. Sound also has an effect on the brain. we keep forgetting that our brains are like computer processors that are always taking in information from our environment even as we sleep. So it's no surprise that the sounds we hear around us are also being recorded by our brain and contribute to the firing of signals by our neurons. To brain injury patients who would like to speed up their neoplastic recovery, it is recommended that they avoid a noisy environment to get a better sense of awareness of their body and brain especially when trying to remember certain limb movements or a certain mental task. This can even be applied in real life with the use of mindfulness meditation where the person would block all external information both sight and sound and focus on their breathing. Only when both auditory and visual stimulus is removed can patients really get intuned with their own body. The smallest of all changes and sensations will be easily identified and corrected, this would include muscular tremors and pulses, which are both are a sign that nervous stimulus towards the certain area or body is still active and that the brain is still sending signals towards that area.

Another external factor affecting our neuroplastic capability is the food that we consume. it should be remembered that our brain consists mostly of water. Therefore bein constantly hydrated is a good thing to allow our brains to replenish themselves and become well hydrated to allow neurons to talk to one another. If possible, Patients with any form of brain injuries should avoid consumption of excess sugar or caffeine as this two have a tendency to overexcite neurons which can cause too much neural noise in the brain that could slow down neuroplastic repair. it's best to consume a more protein based diet since it's mostly protein that our body uses for muscular and cerebral repair. When consuming such a diet, it would be best to do it with fewer carbohydrates as consuming too much of it will be converted by the body to glucose (sugar) that could overstimulate the neurons.                   
                    



                           

                                                     

MRI result

The very next day after my second scan. I was lazily in bed watching the Simpsons on the fox channel. i was delighted to be able to watch such shows as i had no cable TV back at my apartment and had to resort to reading books or watching shows on Netflix. luckily the hospital was kind enough to give me access to all the fox channels and thus be able to watch the Simpsons. I remember watching the show during a gloomy morning as the skies outside were dark and looked as if it was going to rain. if it was shining outside, i would have taken the option of getting on my wheelchair and stroll around the hospital to see if there's anything interesting going on. luckily i didn't take that option and just stayed at my room to enjoy some cartoons to cheer me up. during the middle of my show i heard somebody outside of my room, it sounded like a group of people were standing in front, i wondered who it was and suddenly the people outside opened the door to my room and entered. turns out it was Dr Evran church and his colleagues from the radiology department. They came in to talk about my results from the MRI, the revealed to me that the brain structure post craniotomy was looking fine with little surgical scarring on the surrounding healthy brain matter.

However, they are concerned about the residual AVM nidus that's still present after the surgery. The angiography from the MRI showed that the there was still a 2cm residual nidus left behind as the surgeons were conducting an emergency operation and were not able to throughly remove all of them. the told me and my parents on their findings and lay out the best possible treatment that would solve it. the first option that they offered was another craniotomy, which means i go back into the operating theater and have my head cut opened again like a coconut and remove the nidus. This option was definitely scary as there will be more complications for conducting brain surgery, especially after the first one, where i had lost 10 kg of my body weight and had to be given 8 bags of blood for blood transfusion. needless to say this option poses a lot of risks and complication which may jeopardize my chance of survival. The second option they offered was radio therapy where radiation is used to precisely fry the nidus on the spot in hopes of shrinking it and kill all the cells of the nidus so that it's not active. the upside of this option is that it's non invasive. it's a walk in and walk out procedure with very little side effects and risks. my mother and i weighed the option and decided that the radiation treatment was best and safer. we told the doctors on our agreed decision and asked if we could get further information on the treatment so that we could learn more about it and inform ourselves on how it's going to happen. Dr church told us that the radiation treatment will be delivered using the cyberknife stariotactic radio surgery. At first we didn't know anything about this cyberknife radio surgery, so we looked it up online and learned that it's the most advance form of equipment used in delivering radiation to treat tumors, cancers and even lesions such as AVM's. during our search, we also encountered the gamma knife radio surgery, not knowing what the differences between the two are. we decided to ask Dr. Church to give us further clarification.

Te good doctor informs us that the cyberknife is better than the gamma-knife in terms of accuracy and patient comfort. however my mother and I are still not sure and decided to research further online , it turns out that a gamma knife treatment requires a metallic frame to be bolted on the surface of the patients skull to keep it in place while treatment takes place, while the cyberknife system only uses a soft face mask to do this job. thus it was obviously clear that the cyberknife is the best option to get rid of my AVM. that being said, Dr. church informs us that if we ever have further enquiries to the treatment, we could contact him through one of the senior nurses on duty on the ward. he left us his contact details along with the number of his registrar at the radiology department. after having showed the images of my MRI and clarifying it to us, the doctor and his colleagues left my room and returned to the radiology department downstairs. i was left with my medical imaging of my brain. i was amazed that i still feel normal, though the surgeons had removed large chunks of my brain. Even to this day when i look at my MRI images, i'm still blown away by this fact. After gazing through the images i placed it back into the envelop and proceeded with watching the Simpsons. throughout the duration of watching the show i realized that my room was getting brighter. I looked outside and realized that the sun was already out again, it didn't rain as i thought it would. This was a perfect time to get on my wheelchair and stroll around the hospital's courtyard to have a change of atmosphere.

I asked my mum to bring my wheelchair a bit closer to the right side of my bed so i can slide over to it and stroll around. she placed it on my right and i slid over to the right side, landing safely on my chair. I then strap on my seatbelt on the chair to prevent me from falling forwards if i ever made a sudden stop. with that done, my mum pushed me around the ward. it was a good feeling to be able to get out of my room. Though i was still inside the hospital, i was at least happy to go outside and exposed myself to some sunshine. i spend most of my time outside of the hospital ward at the gardens  near the DD block cancer center. while i was bathing in sunlight. i came to realize that having a change of atmosphere is just as important as any kind of therapies for people with brain injuries.                

Medical imaging of cerebral lesions

AVM's are considered in the medical world as abnormal lesions forming in either the brain or any other parts of the human body along as there are endovascular networks that are present, primarily the  arteries and veins. Knowing this, it makes it absolutely essential that the right kind of medical imaging is applied to identify the location of such lesions and it's size to determine its possible treatment outcomes. A lot of you AVM patients out there are familiar with the kind of medical imaging that is available out there to achieve this but it's also important to be mindful of the capacities and limitations of each medical imaging types. The most common being digital subtraction angiography, magnetic resonance angiography and computerized tomogram angiography. Each type of imaging are all effective in identifying the presence of AVM's or any other form lesions but they all can only be applied during the right circumstances.

1. Digital subtraction angiography: This method has always been the gold standard for doctors in identifying AVM's mostly because this type of angiogram uses a catheter that's able to reach deep inside the cerebral interior via injection through the femoral artery, the largest artery in the human body. The advantage of this medical imaging is that it's capable of identifying lesions up to a size of 7mm or less. This form of medical imaging will come in handy for AVM patients after they have done treatment to remove their AVM's either through craniotomy, embolizations or radio therapy. The only downside of this method is that it uses a catheter with micro camera that would have to be injected through your arteries, the blood vessel that carries blood from the heart through all parts of the body. So it's no surprise that there will be a lot of bleeding, when the injection takes place. Though the thought of doing this kind of angiogram is scary, it is still relatively safe and with less complications. After doing the procedure, it is essential that pressure is applied on the area bleeding for about six hours to stop the blood circulation from flowing. When applying pressure, it also necessary to stay still as well to limit blood circulation to that area.
2. Magnetic resonance angiography: This form of angiogram is done with the help of an MRI machine, the fluid used for the imaging will be similar with the one used with the standard digital subtraction angiogram, the only difference is that it reacts with the magnets to give a contrast image of the endovascular formations. The plus side of this method is that it's less invasive and there is less complications when doing the procedure. However, this imaging may have complications for patients with metal implants in their body so it's advised that doctors are informed first of any potential foreign objects that may be present before conducting the scan so that an alternative scan can be given that doesn't involve the use of magnets that may endanger patients. the angiogram fluid that will be used for the scan could also pose a risk for patients especially if they have allergies to certain substances. it should be noted that though some allergies are not present in the substance used for the angiography such as seafood allergies, the basic element that's present in such allergies may still be present in the fluid used for the angiogram, in this case it would be iodine. If patients are aware that they have allergies for seafood then they should inform doctors not to use any angiography with iodine in it. 
3. Computerized Tomogram Angiography (CTA): Similar with an MRA, both are a form of angiography the only big difference is the imaging. A CTA uses X-rays to capture internal images of the human body. The benefits of an X-ray assisted angiogram is that it provides a clear 3D picture of the endovascular structure which may help in detecting aneurisms. This is also the gold standard of medical imaging that is often used for the preparation of radiation treatment; Gamma knife, cyberknife and proton therapy. All of these fall under the sub type of radiation treatment that require the use of a CTA to determine the exact location of the AVM so that it can be targeted with precision.

Though the description of each type of medical imaging mentioned above is straightforward, certain cases may require a combination of one or more medical imaging especially when it comes towards deciding a treatment option. for example in the case of preparations for radiation treatments, it is common that 2 CT scans will be conducted on separate occasions for different purposes. One scan will be conducted to identify the size and location of the AVM's including the number of arterial feeders that are present. The other scan will be done to plan out how the radiation will be implemented to treat the area with lesions. However if patients are worried of the thought of using ionizing radiation for medical imaging because of the risk of DNA damage from radiation, it can be changed upon request that patients get an MRI instead of a CT scan for the imaging, however it's most likely that it's non negotiable to have different type of imaging before the treatment takes place. That being said, you can be rest assured that ionizing radiation in medical imaging such as CT scans are still safe both before and after the treatment, as the ionizing radiation used is substantially low.