Gliosis of the brain: life prognosis. What are supratentorial foci of gliosis?

Brain glioma is the most common type of tumor that grows from glial tissue, which makes up the supporting cells of the nervous system. Gliomas account for about 60% of all tumors localized in the brain. The name of the types of gliomas - astrocytomas, ependymomas and others - comes from the name of the cells that form the tumor.

Services for the diagnosis and treatment of brain glioma are offered by the leading multidisciplinary medical center in Moscow - Yusupov Hospital. Positive treatment results are achieved thanks to the high professionalism of the oncology center’s doctors and advanced technologies used to combat brain tumors.

General information

Gliosis of the brain is a pathological process manifested by the replacement of neurons with glial elements.
Gliosis is not an independent disease; rather, it is a protective reaction to the death of neurons, that is, a secondary process. At the same time, the process of destruction of neurons stimulates the filling of the resulting voids with glial cells, which leads to a change in the quantitative ratio of elements of the nervous tissue. Brain tissue consists of a collection of neurons, ependymal membrane and glial cells. Normally, glial tissue is responsible for trophic/secretory functions and metabolism in brain cells, and also performs the function of protecting neurons. It accounts for about 40% of the total brain mass. The proliferation of glial cells forms foci of gliosis in the white matter of the brain, which, depending on the etiology of the primary disease, can be focal/diffuse in nature. Foci of gliosis can be located in any area (structures) of the brain. And the more glia are formed, the less efficiently the central nervous system functions. With a large proliferation of glia, a cystic-gliotic atrophied area of brain tissue can form. The more glia are formed in the white matter, the worse the functioning of the entire nervous system. A cystic-glial-atrophic area is formed.

There are no statistical data on the incidence of various types of gliosis. It can only be noted that supratentorial foci of gliosis are most common.

Supratentorial lesions - what are they? Supratentorial are foci of gliosis of vascular origin. Various pathological processes in the vessels of the brain ( thrombosis , fibrosis , necrosis ) that cause circulatory disorders contribute to the formation of small hyper/hypertensive areas, which are accompanied by such disorders as poor coordination, dizziness , and changes in handwriting.

Single foci of gliosis

Focal gliosis is characterized by single, clearly defined islands in the white matter, the size and location of which is determined by the causes of neuronal death. They occur in people of any age and, perhaps, as a manifestation of natural age-related degenerative processes in brain tissue, ischemia of cerebral structures, local inflammatory process, chronic hypertension demyelination process , and as a consequence of injuries during childbirth in infants. Typically, single (limited foci) of gliosis of the brain are an accidental finding on CT/MRI, since in most cases they are not clinically manifested and do not cause discomfort, with the exception of their localization in the frontal lobe, where the centers associated with feelings and sensations are located, which can manifested by the appearance of hallucinations. A single gliosis of the brain is not prone to proliferation.

Multiple foci of gliosis

The appearance of multiple foci of gliosis is caused by injuries and acute/chronic circulatory disorders of the brain, that is, of vascular origin. As the pathology/disease that causes neuronal death develops, both the number and size of the altered areas increase. They occur predominantly against the background of severe atherosclerosis , stroke , cerebral infarction , with compression of cerebral vessels and as a result of age-related changes. Multiple foci of gliosis for the most part enhance the clinical symptoms of the underlying disease and cause dysfunction of the central nervous system.

Life prognosis for patients with gliosis

To talk about life prognosis, you need to remember what causes gliosis. Usually the disease is provoked by severe diseases of the cardiovascular and nervous systems. Therefore, mortality statistics from gliosis are imperfect: some patients die from primary diseases. But the average number of years that an adult with a similar diagnosis can live is two or three years.

With timely and high-quality treatment, this period can increase by almost one and a half times.

You can increase this period if you consult a doctor in time.

The fact is that only a doctor can determine how life-threatening glial tumors are. And only in a specialized clinic will it be possible to conduct a correct diagnosis and develop further therapy.

People living with gliosis experience paralysis, hearing and vision problems, and memory and attention disorders.

Unfortunately, even with proper treatment, the patient’s life is complicated by the side effects of the disease. For example, if a person develops supratentorial gliosis, it will be followed by hallucinations, the shapes and scales of objects will be distorted, and cognitive connections between the image of an object and its name will be disrupted. There is no guarantee that treatment will stop the development of gliosis completely, but this does not eliminate its need.

Classification

The classification is based on the nature of the proliferation of glial cells and their localization.

Based on morphological characteristics, the following are distinguished:

The isomorphic form is characterized by an ordered proliferation of neuroglia.
Anisomorphic form - has a pronounced cellular structure and is characterized by chaotic growth; most often localized subcortically/paraventricularly. Periventricular gliosis - formed in the ventricles of the brain. Often periventricular gliosis is accompanied by the development of cysts. Fibrous form—the predominance of the fibrous type structure is noted.

According to the localization of the pathological process, the following are distinguished:

Periventricular gliosis - glial cells are formed in the ventricles of the brain. Periventricular gliosis is often accompanied by the development of cysts.
Perivascular (vascular) gliosis is the growth of glia along atherosclerotic vessels. It is often diagnosed on MRI as microangiopathy with the presence of foci of gliosis.
Subependymal gliosis is predominantly localized on the inner lining of the ventricles of the brain.
Marginal gliosis - located on the surface of the brain.
Marginal gliosis - foci of degeneration are localized in the intrathecal region.

Based on quantitative criteria, single and multiple foci of gliosis are distinguished. Histologically, hypodense (without a definite structure, cannot be stained) and hyperintense (clearly structured, well stained) areas of gliosis are distinguished.

Based on the nature of the process/prevalence, the following are distinguished:

A focal type of flow, involving a limited area of the brain (usually in the temporal/parietal regions).
Diffuse type of course - characterized by multiple lesions of various sizes/localizations. Most often of vascular origin and may have the appearance of a cystic-gliotic formation.

Development mechanism

The central nervous system is made up of three types of cells.

neurons are functional cells that transmit signals;
ependyma - cells lining the ventricles of the brain, also forming the central canal of the spinal cord;
Neuroglia are helper cells that perform metabolic processes: trophic, supportive, secretory and other functions. Neuroglia are 10-15 times smaller than neurons, 10-50 times larger than nerve cells and make up about 40% of their mass.

When functional nerve tissue is damaged, neuroglia replace dead neurons—foci that are engulfed by neuroglia. This replacement ensures that metabolic processes continue even with the death of nerve cells. The bumps form a type of scar tissue.

Their appearance is clearly secondary, since cell death has already occurred, and the focus of gliosis only indicates the location of the lesion. There is no treatment option.

The process of glia filling itself cannot be called destructive for any reason. Neuronal lesions in the white matter cannot be left unfilled, because then the metabolic process in the brain is disrupted.

Glia fill this space, allowing normal metabolic processes to occur, but these cells cannot perform neuroregulatory functions.

Types of gliosis

Foci of neuronal damage lead to deterioration in the functionality of the central nervous system. It is not possible to treat them as mentioned above because dead neuronal tissue cannot be regenerated. It is also unacceptable to remove the core of the glia cluster, since it serves as a substitute.

As a rule, the change occurs in a specific location - the hearth, although not always.

Based on the location of concentration and the form of the lesion, gliosis of the brain can be divided into the following groups:

Anisomorphic form - the cellular structure of the glyca predominates over the fibrous one. Fouling is chaotic.
Fibrous form - the fibrous structure predominates, the signs of dominance are clear.
Diffuse - there are no lesions, tissue changes are observed not only in the brain, but also in the spinal cord. This picture is typical for diffuse pathological diseases, for example, cerebral ischemia. Treatment, of course, must begin with eliminating the underlying disease.
Focal length - has a clearly defined area - focus. This is usually the result of an inflammatory process that has led to the death of neurons. In this case, treatment is in vain.
marginal - lesions are mainly located on the surface of the brain, under the membrane
Perivascular - Glia surround hardened blood vessels. These changes are often observed in systemic vasculitis. First of all, it is necessary to treat multiple sclerosis so that the disease does not progress.
Subependyma - the lesion is localized in the subependyma, that is, the ventricle of the brain.

The size of gliosis is physical and can be calculated. This is equal to an increase in the number of ganglion cells relative to the number of normally functioning neurons per unit volume. The larger the lesion and the less localized it is, the more difficult the functioning of the central nervous system.

Foci of gliosis

Gliosis flares are abnormal proliferations of glial cells that replace damaged neurons. The occurrence of gliosis is a consequence of the following pathological processes and diseases:

Multiple sclerosis;
Tuberous sclerosis;
Inflammation - encephalitis of various origins;
Epilepsy;
Hypoxia;
Birth injuries;
Long-term arterial hypertension;
Chronic hypertensive encephalopathy.

To detect gliosis, it is necessary to perform magnetic resonance imaging, which not only determines the location and size of the gliosis, but in some cases even provides information about the age of the lesion. This allows the neurologist, in combination with other studies and clinical examination, to determine whether the gliosis is the result of active or earlier CNS changes.

Gliosis may not be clinically apparent, but may be discovered incidentally during examination for other indications. Remember that an MRI showing “signs of gliosis” is not a diagnosis, but a reason to undergo a comprehensive medical examination by a neurologist. The result of any such test is the treatment not of gliosis, but of the disease that caused it.

Causes

The pathological process of replacing neurons with neuroglial cells may be based on a variety of reasons:

Age-related changes caused by the natural process of neuron death.
Diseases of hereditary origin - lysosomal storage disease ( Tay-Sachs disease ), inherited in an autosomal recessive manner, characterized by massive death of neurons in children, which is the cause of their death); genetically determined pathology - tuberous sclerosis .
Birth injuries at birth.
Traumatic brain injuries.
Multiple sclerosis (destruction of myelin and the formation of foci of demyelination in various brain structures).
Cerebral infarction (ischemic stroke).
Hemorrhagic stroke is a hemorrhage into the structures of the brain, which forms foci of gliosis of vascular origin.
Brain swelling.
Epilepsy.
Arterial hypertension/encephalopathy caused by a persistent increase in blood pressure.
Neuroinfections ( encephalitis , meningitis ). oxygen starvation of brain tissue ( hypoxia ).
Hypoglycemia (low blood sugar).
Surgical interventions on brain structures.
Atherosclerosis of cerebral arteries.
Abuse of products containing animal fat.

Symptoms

Clinical symptoms vary widely and are determined mainly by the symptoms of the underlying disease that caused gliosis. As a rule, single small foci of gliosis do not produce specific neurosymptoms and are discovered by chance during an MRI examination of the brain. At the same time, multiple (extensive) foci of gliosis almost always manifest neurosymptoms in the form of:

Unreasonable long-term intense headaches that are not controlled by taking antispasmodics.
Blood pressure instability (sudden changes in a short period of time).
Periodically occurring dizziness .
Decreased performance/increased fatigue.
Changes in visual/auditory perception.
Disorders of coordination, attention and memory.
Motor disorders (with large lesions, up to convulsive conditions).

Clinical symptoms are largely determined by the localization of the focus of gliosis:

Localization of foci of gliosis in the temporal lobes is characterized by frequent, intense, long-term headaches. With the vascular genesis of the process, the pain syndrome is combined with sudden changes in blood pressure.
Supratentorial gliosis manifests itself mainly with visual disturbances – hallucinations; distortion of the outlines, sizes, shapes of objects; loss of visual fields, difficulty recognizing an object by appearance.
Gliotic foci in the white matter of the brain can cause dizziness , an episyndrome characterized by increased convulsive activity with the possible development of epileptic seizures. Such symptoms develop as a complication of traumatic brain injury/surgery.

The localization of gliosis foci in the frontal lobes is often due to age-related changes. It is generally accepted that if diseases that can cause the death of neurons and the proliferation of glial cells have not been identified, then such a process should be considered a primary pathology that develops as the body ages and manifests itself as impaired concentration, attention, memory, fine motor disorders, and slowed reactions.

Features of treatment

There is no specific therapy for gliosis. Treatment methods depend on the underlying disease that caused the death of neurons. The main goals of therapy are:

slow down the process;
Ensuring normal tissue trophism in the central nervous system;
Elimination of oxygen starvation;
normalize metabolic processes.

Conservative treatment

To eliminate the symptoms of brain damage, the following groups of drugs are prescribed:

Vasoactive - drugs that activate cell metabolism and improve tissue trophism (Cavinton, Vinpocetine).
Antiplatelet agents are drugs that slow down platelet sedimentation (all derivatives of acetylsalicylic acid).
Drugs that improve the walls of small and large arteries (Ascorutin, vitamins).
Nootropics are drugs that increase the resistance of the central nervous system to negative factors (Piracetam, Nootropil).
Statins have a lipid-lowering effect and prevent the development of atherosclerosis (Fenofibrate, Atorvastatin).
Painkillers and antispasmodics for headaches.

Surgery

Surgery for gliosis is prescribed very rarely. Only for single large fires.

After surgery, treatment of the underlying disease that caused the death of neurons should be continued in order to avoid the development of relapses.

Indications for surgery for large single lesions are:
violation of the outflow of fluid (cerebrospinal fluid);
seizures caused by a large area of gliosis;
diagnosed cancer;
changes in the functioning of internal organs.

In the case of multifocal gliosis, only constant conservative treatment can bring a positive effect.

Nutrition

Traditional medicine methods can be used only after consulting a neurologist. Decoctions and infusions of medicinal plants and fruits improve the functioning of the circulatory system and stimulate metabolism.

The Gliosis Diet aims to:

Improves brain function and relieves vascular spasms. To achieve this effect, you need to eat foods rich in magnesium: buckwheat, barley, corn grits, nuts, pumpkin seeds, lentils, cabbage of all varieties, figs.
Treats swelling, improves heart function - the diet includes foods high in potassium: citrus fruits and vegetables, dried fruits, mushroom and potato dishes.
Weight loss - To control weight, eliminate bread, canned food, sugary carbonated drinks, meat, fatty meats, fast food and processed foods from your daily diet.

The daily diet consists of fish, lean meat, cereals, dairy products, cheese, vegetables, nuts and fruits. It is better to steam, cook or bake dishes.

Tests and diagnostics

Diagnostics is based on imaging methods (MRI/CT) of the brain. These methods allow you to determine:

location and size of pathological foci;
the presence of marginal (perifocal) infiltration;
structure (homogeneity) of the white matter of the brain;
perivascular spaces of various areas;
areas of the basal ganglia;
the presence of other pathological formations;
condition of the ventricles of the brain/pituitary gland, functionality/condition of the blood vessels of the brain.

The image below shows multiple foci of gliosis.

MRI makes it possible to establish not only the presence of areas of gliotic changes, but also to identify the cause. MRI images provide a clear picture of the presence of areas in the brain that do not receive sufficient nutrition due to vascular obstruction by atherosclerotic plaques; allow you to identify inflammatory processes, areas of hematoma, and identify neoplasms. This, to a certain extent, makes it possible to eliminate the provoking factor and develop tactics to minimize the risks of further spread of the process.

Complications and consequences

The presence of extensive areas of neuronal replacement by gliomas has serious consequences:

persistent headaches that are not relieved by medications;
mental disorders;
permanent loss of speech, vision or hearing;
convulsions and epileptic seizures;
paralysis (partial or complete);
mental disorders;
impaired coordination of movements.

In extremely rare cases, gliosis of nongenetic origin is fatal.

Diet

There is no special diet, but it is recommended to adhere to the diet recommended for the underlying disease that initiates the process of formation of glial lesions ( Diet for stroke , Diet for hypertension , atherosclerosis , diabetes mellitus , Diet for obesity , etc.). In general, it is recommended to adhere to a low-calorie diet with sufficient vitamin content (vegetables, fruits) and a minimum content of animal fats in the diet.

Prevention

No drugs or methods of specific prevention of neuronal death have been developed. To maintain the activity of neuro-processes and brain vessels, we can only recommend:

Lead a healthy lifestyle.
Monitor your body weight.
Maintain age-appropriate physical activity.
Constantly monitor blood pressure, cholesterol , and blood sugar levels.
Minimize bad habits.
Practice a healthy balanced diet by minimizing foods containing animal fats.
Train brain functions: solve puzzles/crosswords, learn poetry, foreign languages.

Forecast

The prognosis of life with cerebral gliosis is largely determined by the underlying disease and can vary significantly depending on the volume of gliosis foci and the intensity of neuronal replacement. As a rule, the prognosis for life with single foci outside important brain structures is relatively favorable, while extensive foci of gliosis in areas of the brain responsible for important functions of the central nervous system can be unfavorable, for example, in the temporal lobe, initiating frequent epileptic seizures.

Treatment of glioma at Yusupov Hospital

Oncologists at the Yusupov Hospital have enormous experience and effective methods of treating cancer. An individual treatment program is drawn up for each patient, based on the results of a thorough diagnostic examination. The Oncology Center of the Yusupov Hospital is equipped with innovative equipment for high-quality diagnosis and treatment of gliomas and other brain tumors.

An appointment with an oncologist can be made by calling the Yusupov Hospital or online on the website using the feedback form. The coordinating doctor will answer all your questions and tell you about the cost of medical services and the conditions for hospitalization of the patient.

Make an appointment

List of sources

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Vasiliev V.N., Kindyashova V.V., Kozhevnikova V.V., Tikhomirova O.V., Lomova I.P., Serebryakova S.V. Clinical and diagnostic significance of microfocal brain lesions of vascular origin among management specialists // Medical, biological and socio-psychological problems of safety in emergency situations. 2014. No. 3. pp. 27-32.
Gladky P. A., Sergeeva I. G., Tulupov A. A. Infectious lesions of the brain. Tutorial. Novosibirsk 2015. – 24 p.
Putilina M.V. Chronic cerebral ischemia//Attending physician. 2005. No. 5.
Yanishevsky S.N. Brain damage in patients with type 2 diabetes // International Journal of Endocrinology. No. 8(64). 2014 pp. 89-97.