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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Severe Cognitive ProblemsForum: Neurology Forum
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| I want to thank you for this forum. I do not have anyone I can turn to for help as I'm not even sure if I'm asking the proper questions. Antecedent Action: My older brother who is now 48 years old originally had a cyst on the pituitary gland in 1960. Steve came walking down the stairs sideways and when my Mother asked why, he replied---because I see two of you. My folks immediately took him to Chanute Air Force Base where he was put on a plane to Walter Reed Army Hospital in D.C. He was operated on the next day--successfully. This was at a time when they lifted the scalp completely off the head and left terrible scars starting at the right eye and continued back behind the right ear. Then there were the two 2" scars down the back of his head. He has been taking all kinds of medicine since then. I do know that Cortef is one of them. A diagnosis of diabetes insipidus (sp?) was presented. Present Time: Unfortunately, About 3 years ago Steve did not tell anyone that he started having the same type headaches he had when he was 10. He evidently had them for over a year. So, of course, one day his roommate found him on the floor of his bedroom. He was then taken by ambulance to the Kaiser facility in Redwood City where they do that type surgery. Unfortunately, he did not come out of the surgery 100% this time. The surgeon told me he had had a stroke. Oops! I don't know, I cannot prove it. I suspect it is true. But Steve has no cognitive memory skills; no short term memory but certainly can remember things that happened in 1950-1970 time period. They then had to go back in a second time and they put a shunt in to take care of a "small problem" . He then had six weeks of radiation with four days being 15-20 minutes and the fifth day 45 minutes. He can not have any type of radiation ever again per the doctor's orders. The doctors also told me if it comes back again, they will "make him Now that you've read the novel above, my questions are: The other thing is that he suffers from sleep apnea. He had to have I realize this ended up being very long and narrative but what Thank you again. Common childhood tumors of the pituitary gland region include craniopharyngeomas and pitutary adenomas. Craniopaharyngiomas are notoriuous for being locally invasive and tough to completely excise and grow slowly enough that it can be many years between recurrences. Above and in front of the pituitary gland region are some areas of the brain that are critically important for memory formation and cognition, called the gyrus rectus, septal area, and basal forebrain. Damage to these areas can produce a permanent amnestic state (permanent inability to form new memories). Diabetes insipidus is a condition where the body dumps out water due to lack of antidiuretic hormone, which is produces in the hypothalamus (the part of the brain right next to the pituitary gland) and the back part of the pituitary gland, which extends directly from the hypothalamus. This can be a very serious and even fatal problem if not controlled. The replacement of antidiuretic hormone, cortisone, and thyroid hormone, and sex hormones like testosterone in men is a very important part of the treatment of the syndrome of panhypopituitarism, which is the complete absence or deficiency of all functions of the pituitary gland due to its being destroyed or severely damaged by a tumor, hemorrhage, or other means. Strokes are not usually a complication of pituitary tumors, although there are arteries nearby the gland. Usually people go blind and have lots of other major problems that lead to the tumors treatment before there is ever any chance of an artery getting compressed by the tumor and causing stroke. Unfortunately, if your brother has had memory problems for 20+ years, the likelihood of this improving is very small to none. Radiation itself may cause delayed damage to the parts of the brain that were radiated, even 15 or 20 years later. We wish you well in dealing with the challenges of caring for a loved one with such a disabling and chronic problem. Please remember that information we provide on this forum is intended for general informational purposes only and that the actual diagnosis and treatment of your brother's specific medical condition should be strictly in conjunction with his treating physician(s). If he would be interested in a formal evaluation at the Cleveland Clinic regarding his condition and long term prognosis, our number is 1-800-223-2273 extension 4559. I would suggest Dr. Bruce Cohen, one of our neurooncologists for such a complex case. We hope you find the information helpful.
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