Every year the 8th of June is celebrated as World Brain Tumor Day. This initiative was initially taken by the German Brain Tumor Association and is now celebrated worldwide to raise awareness and educate people about brain tumors.
Well, if you ask me, does Covid impact brain tumor treatment? I'd say yes because I got Covid myself.
Mansi Aggarwal and hubby are crazy. I deciphered that they thought Mum although started with CT level 21.05 because at 68 she developed moderate Covid perhaps because of collecting the deliveries of medicines or food kept in the bag hanging on the door. Perhaps some delivery men might be Covid positive and she collected stuff after an hour but aSARS-CoV-2 remained viable in aerosols throughout the duration of 3 hours, with a reduction in infectious titer from 103.5 to 102.7 TCID50 per litre of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per millilitre.
As from 18/3/2020, we are under voluntary isolation to avoid the pandemic and just Mum collects the deliveries hanging on the bag outside the door after the person has gone for over an hour.
Also since Mansi Aggarwal had Covid below 20 and tested negative once they thought Mum had a high viral load and because she came out of her room to give my medicines and breakfast which happens to be a mere gruel.
Mansi Aggarwal thought her hubby will contract Covid and if I die everyone will be saved because Mum will not have to care for anyone.
That's why she hit me twice and said I have to die right now.
Good logic. But I got Covid from Mansi Aggarwal after 3 days. Mum had symptoms on the 28th. She might have contacted it before as the incubation period is 2-14 days but I didn't get it from her because she wears a double N95 mask while coming out of her room.
A woman unaware of the viral world and how it works, out of apathy said I should die right now, else who will account for it if my brother gets ill?
She was a patient with few symptoms for 26 days under isolation with high viral RNA load in the nasopharynx early in the course of disease.
CT count or cyclic threshold is inversely proportional to the viral load..more than 30 considered very low infectivity..less than 20 high infectivity..20 - 30 moderate infection- hence Mum had moderate infection which rose to CT count 28 and now vamoosed, gone!
Biology, and evolution in particular, are based on reproduction or multiplication and on variation. Reproduction; pure has the property of self-enhancement and leads to exponential growth. Self-enhancement in chemical reactions under isothermal conditions is tantamount to auto catalysis.Nevertheless, based on the assumption that viral RNA load correlates with high levels of viral replication, there are important insights to be gained from this time-course analysis. Currently, our understanding of the relationship between viral RNA load kinetics and disease severity in patients with COVID-19 remains fragmented.
Unaware of the viral RNA kinetics of patients despite the disappearance of nasopharyngeal viral RNA she was shedding without a mask creating an aerosol without wearing a mask.
Experts have also strongly suggested that solely relying on testing as a safeguard can make people ‘lax’ and take other safety measures, such as mask-wearing and social distancing lightly, which could be the two biggest factors which can spike up infections. Remember, the tests are a preventive measure and only effective, as long as you put in place other security measures. But she put my life at a risk by subtly killing me.
The most peculiar and constant query has been about those who have COVID-19 symptoms but continue to test negative in RT-PCR tests. Sometimes, even though CT scan reports display patches in lungs due to coronavirus, the RT-PCR test report remains negative. According to experts, RT-PCR is the gold standard for COVID detection, however, as per reports from across the country, at least 1 in 5 patients may end up getting a false negative report. Why is that happening?
- Even though RT-PCR is the gold standard, it's known that there’s a 30 percent chance of it being inaccurate. Moreover, when the testing kits are developed, the scientists pick up those parts of virus which are least prone to mutate, therefore this could be a reason behind the false-negatives.
- The second reason for this could be that the viral load in your body is so low that it's not getting detected in the RT-PCR test, as per experts.
- The sample collection, transportation as well as the overburden of the cases, wherein the labs are not able to complete the analysis of the sample, plays a major role in the quality of tests, Dr Mahajan explained.
Next, repeat your RT-PCR test in 2-3 days, and take advice from your doctor to get a CT scan, says Dr Ray.
Blood tests at times are a good marker of inflammation and they can also give you and your doctor an idea of what is going on in your body, in particular, the C-reactive protein and the D dimer. Both of them are said to be a good testing ground for understanding what is happening in your body.
The RT-PCR test was not done in my case because I have trouble swallowing food and medicines, Here I'd like to state The cranial nerves associated with the swallowing process are the trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), accessory (XI) - usually not considered - and hypoglossal (XII).
It should be emphasized that the structures involved in the swallowing process are pairs, both anatomically and/or functionally, due to the dual-side innervation.
Anatomically unique, the tongue, palate, pharynx, and larynx are functional pairs, each side having independent innervation.
Hence it might be extremely hurtful as I get pain in the pharynx and larynx and often my tongue gets paralyzed. Voice becomes hoarse after speaking a bit.
Both Naso and Oropharyngeal samples are collected. If there's problem in nasopharyngeal then it can be done in Oropharyngeal sample only hence I got my CRP, D-Dimer and antibody tested.
Ur antibody level is low..which can occur
1.early in disease
2.low viraemia
3.immunocompromised state"
Said Dr. Ishita B Sen
Nuclear Medicine
Director & Head
Dr. Ishita B Sen is a Nuclear Medicine Physician She also treats Covid.
The transplanted liver has been affected and the enzymes were high which during my MDR TB was never so high.
There was an attempt to kill me mentally as well by reporting my blog and blocking my reading and writing penchant which is the only force which keeps me alive
Meanwhile, the oxygen level suddenly dropped and and NGO Jeevan Stambh loaned me an oxygen concentrator
I experienced horrors that would give most people nightmares for life but the thing is if you face serious issues from a younger age you don't cringe inside or give up on life. The older you get without ever having a real problem you don't know how to handle it. Starting early gives you a perspective if you don't die first. but still I was provoked because I have lost weight due to my diseases and she's healthy and stout. I couldn't take the full impact twice.
That made me put up a status on Facebook,
"If I die today within some time, nobody is responsible for that because my brother has to live and take care of my wonder mum. I have chest pain and I am not feeling well.
I ought to die because I am a bad soul burden to all and I am going to take off adieu.
15 surgeries and now the nerves blasted my existence. Pancreas. A rare genetic cancer patient has no right to live.
Long live Arindam Bhattacharjee Mansi Aggarwal
Thanks for your tip that I ought to die now"
Dolly Sharma from Mahajan Imaging called immediately and calmed me down. She said I am God's child and it was very kind of her.
The woman told me to embrace winter
Not knowing I am December born
I carry winter in my right pocket
Fifteen times have taken it out and kissed the cold lips
Enjoying the twilight.
I had so many life threatening surgeries and my realisation of Memento Mori started very long ago.
We desperately need in our own lives—a thought or an idea that we’d rather do everything to avoid and pretend is not true. Most often, our ego runs away from anything that reminds us of reality or, we are simply petrified to look at life’s facts as they are. And there is one simple fact that most of us are utterly scared to meditate, reflect on and face head on: We are going to die. Everyone around us is going to die.Such reminders take part of Memento Mori—the ancient practice of reflection on mortality that goes back to Socrates...Memento Mori translated in English, “Remember you must die.” The point of this reminder isn’t to be morbid or promote fear, but to inspire, motivate and clarify. The idea has been central to art, philosophy, literature, architecture, and more throughout history.
Memento mori is an artistic or symbolic reminder of the inevitability of death by keeping an object such as a skull.
I wrote in a poem ' Seasons of life"
Ineffably beautiful butterfly
flitting by the grassy land
Riding the horns of winged horse
Highlights indomitable life force
If nothing ever changed, there'd be no butterfly
Our winged friend
Emerged from the dark end
Sometimes, you need, rainbow, struggle, butterfly and unicorn
Today I want to soar.
Like a lion roar
My troops have lift me up to my feet
when my wings were getting trouble remembering to fly
Drums of war have begun.
Yesterday after a month of the first symptoms I formed antibodies under immunocompromised conditions.
Meanwhile the oxygen level dropped below 90 and Jevan Stambh Foundation loaned me an oxygen concentrator.
Dr. Randeep Guleria said "okay" on Whatsapp
But Dr Harsh Mahajan worried about CRP getting raised.
Higher than 16.4 in my previous report
And I have formed antibodies
Treating doctor Neeraj Saraf said to Repeat CRP and D Dimer after 10 days.
Now coming to my brain tumors.
The major ailment, the king of all diseases entered and my reading habit interpreted it differently.
I started getting strange feelings or thoughts, like tingling or deja vu, while returning from school crossing the traffic lights I spotted a white ambassador car that looked familiar and drew me towards it. More commonly, I had an auditory hallucination and I imagined a specter going along with me. It still persists. I stood on the roof and saw bubbles of lights floating past. Then I laughed or cried for no reason. I dreamt of aliens contacting me.
Dismissing the symptoms as untrue or psychological. It was insulting and demeaning to have a physician invalidate what I was experiencing and I had to go for a psychologist's treatment and put under dissociative drugs.
Under their treatment, I became repellently fat like Mr Pyecraft with a serious obesity problem.
Mother noticed continual jerkings or spasms of the left a leg and called my father, and both tried the application of pressure on the limb to calm it down but it started again. Then it was found that because of my migraines an MRI was done where a tiny spot was found which has grown over 5 times in a few years.
Supratentorial HB is a rare and benign neoplasm. Very scarce literature is available regarding supratentorial HB. Supratentorial HB, which is quite rare, was first described by Bielschowsky in 1902.
They are most commonly found in the frontal lobe of the cerebrum followed by the parietal and temporal lobe. Mine was in the parietal lobe.
But the surgery was done by a doctor not aware of several facts and within 60 months I ended up with tumours scattered all over my brain.
I recall I came to the OT during my craniotomy in 2006 and blood was flowing out from under the head and the anaesthesiologist yelling I needed more blood because my haemoglobin was dropping. The doctor didn't take enough care and put me on the verge of uncertainty.
While I was pushed out of the OT in a trolley I was telling Mum there's no sense in the left side. My leg and hand were numb. I couldn't even make a fist.
My recovery is always fast and with physiotherapy, I could squeeze a softball and slowly climb the stairs.
But even now being half-blind I type with only one finger and have published 4 books and written about 125 blog posts starting from May 2020 and Sahitya akademi. I was wondering about why Times of India digital blocked me from writing with them without honorarium to motivate and spread awareness about rare disease and came to the conclusion it happened after the event when I got Covid 19 and there was a diatribe on Facebook and my Facebook account was reported," The truth. It is a beautiful and terrible thing, and must therefore be treated with great caution. " I told the truth and many didn't accept but most did.
As a parting message I was even thrown a challenge " let's see who dies first" and "nobody understands Masnsi Agarwal" Facebook didn't have the eyes to see who bullied whom with full knowledge of the liver transplant and immunosuppression?
After my father passed away Poonam Gupta, student of Dr AC Ammini got in touch with me for research purposes.
I got an email from AIIMS
I was diagnosed with leptomeningeal hemangioblastomas after the cyber knife in 2013.
Detecting and treating the condition of leptomeningeal hemangioblastoma without delay seems to help survival, though the number of patients analysed is small. The most common cause of death is respiratory failure due to pontomedullary or cervical cord compression.
After 2017 I also have a chronic ischemic brain. Cerebral ischemia or brain ischemia, and when there isn’t enough blood flow to the brain leading to limited oxygen supply it may lead to the death of brain tissue, or ischemic stroke.
The electrons can be made to strike a tungsten target within the head of the accelerator to create a beam of photons (or “X-rays”). These X-ray beams are then directed at the site of cancer. Photons have no charge or mass and can be regarded as small packets of energy. Photons deposit their energy along the entire path that they travel through the body. Therefore, a beam of X-rays irradiates not only the area of the tumour but also the healthy tissue that the beam encounters on its way towards the tumour and beyond the tumour. X-rays used for treating cancer usually do not stop within the body. X-rays travel right through you. On the other hand, proton beam therapy is delivered by larger, much more expensive accelerators called cyclotrons and synchrotrons.
A proton beam directed at a tumour travels in a straight trajectory towards its target, gives off most of its energy at a defined depth called the Bragg peak, and then stops. While X-rays often deposit more energy within the healthy tissues of the body than within the tumour.
Not to worsen the condition further, I sought the help of Dr Jalali
The small tumors floating around in the fluid used for cushioning the brain and spine tend to compress all the nerves that come their way. Hence the first nerve to be compressed was the optico-hypothalamic nerve which made me blind with right eye even after killer sessions of radiation therapy it didn't shrink.
Then I got bilateral trigeminal neuralgia which was treated at HCG cancer centre Colaba Mumbai by a cyberknife of the right side which was most painful side.
There were multiple cysts in the pancreas already. They blocked the exocrine functions ( enzymes) and for a couple of months I had to run to the bathroom after every meal. After Creon SD microgranules were prescribed my diarrhea feels better but you can confirm it is around Rs 3000 and lasts for only 3 days.
I am constantly losing weight because I can't swallow food and even choke on drinks and pancreatic cysts make me run to the bathroom after every meal. If I miss a dose of Creon granules it becomes worse.
Pancreatic cysts can cause issues if they are causing some kind of blockage or obstruction. Typically pancreatic cysts are monitored, but left alone, unless they are causing issues, in which case they are drained and removed.
A Ga-DOTANOC PET-CT based SSTR imaging because VHL syndrome associated hemangioblastomas frequently express SSTR ( Somatostatin receptors) confirmed that the tumours in my brain are hemangioblastomas. With this, the true nature could be seen and the diagnosis was confirmed.
Brain tumours grow within a rigid, firm bony skull. Benign, slowly growing or malignant brain tumours may produce serious neurological symptoms and signs prior to treatment or cure but rarely metastasize outside the central nervous system (CNS), disability and death occur when the intracranial contents exceed the intracranial space, causing herniation and compression of respiratory centres.
Fewer than 5% of patients with brain tumours have a predisposing genetic syndrome. The most common of these are von Recklinghausen's types I and II neurofibromatosis, tuberous sclerosis, von Hippel-Lindau disease, and the epidermal nevus syndrome. These dominantly inherited neurocutaneous syndromes are associated with an increased incidence of specific tumours.
von Hippel-Lindau or vHL which is a genetic defect that causes capillary growth to go out of control. While the tiniest blood vessels or capillaries usually branch out gracefully like trees, in vHL patients a little knot of extra capillaries forms a growth or tumour and in certain cases, it turns cancerous. It is a genetic form of cancer VHL patients battle a series of tumours throughout their life.
vHL may occur in up to 10 organs of the body like liver, kidney, brain, spinal cord or retina, inner ear, pancreas. There is also a possibility of neuroendocrine tumours.
Meninges are the three membranous envelopes—pia mater, arachnoid, and dura mater, that surround the brain and spinal cord.
Cerebrospinal fluid fills the ventricles of the brain and the space between the pia mater and the arachnoid. The primary function of the meninges and of the cerebrospinal fluid is to protect the central nervous system.
The two innermost layers of tissue, arachnoid mater and pia mater that cover the brain and spinal cord are together called the leptomeninges.
Leptomeningeal dissemination of hemangioblastomas (HB) of the central nervous system (CNS) is extremely rare. Between 1902 and 2013, approximately 132 cases were reported.
Because no case of de novo development of disseminated HB without previous surgery has been reported, it is strongly suggested that the spillage and spread of tumour cells through the CSF space may be an origin of hemangioblastomatosis in patients with a genetic predisposition to the condition, Care should be taken to avoid tumour cell spillage during surgery.
I was diagnosed with supranational leptomeningeal hemangioblastomas in 2013. I have been seeking anyone experiencing the same condition but didn't find anyone till now. So I consider myself a myth, a unicorn, butterfly.
Struggle is needed in our lives
Unless obstacles cripple us
We will never be strong enough to fly
Upto the rainbows high up in the sky,
It's not death
But dying of who you were
By giving up the emotion called fear
As Caterpillar enters the cocoon
Where there's incredible struggle
Befallen in deep trouble
It's a part of the puzzle
When every cell is calling for
Down to the very core
Transformation, resuscitation of the crisis,surprise celebration
Spirit doesn't surrender or breakdown
Because of the potential morbidity associated with resection of multiple craniospinal hemangioblastomas in von Hippel-Lindau disease, stereotactic radiation therapy has been used instead. Small hemangioblastomas (<3 cm diameter), and those not associated with cysts might respond safely to radiation therapy.
~ Russell Lonser
Bakshi et al3 described a 55-year-old patient with disseminated intradural masses involving almost the entire spinal cord on magnetic resonance imaging. They reported both extramedullary intradural tumours with numerous leptomeningeal nodules and microscopic infiltration of the spinal cord and coined the term leptomeningeal hemangioblastomatosis to define this condition.
Because no case of de novo development of disseminated HB without previous surgery has been reported, it is strongly suggested that the spillage and spread of tumour cells through the CSF space may be an origin of hemangioblastomatosis in patients with a genetic predisposition to the condition, Care should be taken to avoid tumour cell spillage during surgery.
Here the opinion of Dr Russell Lonser is very important as he has treated such cases and I am perhaps the only one in India.
https://wexnermedical.osu.edu/find-a-doctor/russell-lonser-md-47618
The electrons can be made to strike a tungsten target within the head of the accelerator to create a beam of photons (or “X-rays”). These X-ray beams are then directed at the site of cancer. Photons have no charge or mass and can be regarded as small packets of energy. Photons deposit their energy along the entire path that they travel through the body. Therefore, a beam of X-rays irraditumorot only the area of the tumour but also the healthy tissue that the beam encounters on its way towards the tumour and beyond the tumour. X-rays used for treating cancer usually do not stop within the body. X-rays travel right through you. On the other hand, proton beam therapy is delivered by larger, much more expensive accelerators called cyclotrons and synchrotrons.
A proton beam directed at a tumour travels in a straight trajectory towards its target, gives off most of its energy at a defined depth called the Bragg peak, and then stops. While X-rays often deposit more energy within the healthy tissues of the body than within the tumour.
L2, L3, and L4 spinal nerves provide sensation to the front part of the thigh and inner side of the lower leg. These nerves also control movements of the hip and knee muscles. ... The L5 spinal nerve controls hip, knee, foot, and toe movements. I have been facing the similar jabbing pain as if a live electric cable was held against her eyes, cheeks, jaw and teeth as I feel for the trigeminal nerve and while electricity flows through the knee a soft touch with the right thigh makes me fall and toes of the right leg curl inwards.
Lower back pain
Loss of normal bladder and bowel function
Can cauda equina nerves are compressed as they supply muscle sensation to the bladder, bowel and legs.
Once Dr. Jalali told me that the nature of the leptomeningeal hemangioblastomas is compression.
Our nervous system - a complex machine
Our nervous system is divided into two parts. The central nervous system includes the brain and the spinal cord. The peripheral nervous system consists of a network of neurons, which spans the organs, the muscles and the body. The neurons in both systems work together to help us think, survive and act on the world around us.
How does this system work?
The nervous system works on the principle of input and output, perception and (re) action. Living beings are able to sense what is going on in their surroundings and do something in reaction to that. For example: if the flame of a candle burns your finger, you draw back your hand immediately. You sensed and then acted.
Simple components for a complex assembly
Our nervous system has different types of neurons that are constantly at work. Neurons that receive information from our sensory organs (e.g. eye, skin) and transmit this input to the central nervous system are called afferent neurons. Neurons that send impulses from the central nervous system to your limbs and organs are called efferent neurons.
The organs of digestion are served primarily by the Vagus nerve, one of the larger nerve networks in the body.
It’s divided into nerves in the submucosal layer that stimulate secretions and nerves deeper within the muscles of the gut which stimulate peristalsis. These nerves of course communicate with the brain through the central nervous system, but they are also rich in interneurons, or cross-links that enable the GI system to make most of its own decisions.
The cranial nerves associated with the swallowing process are the trigeminal (V), facial (VII), glossopharyngeal (IX), vagus (X), accessory (XI) - usually not considered - and hypoglossal (XII). It should be emphasized that the structures involved in the swallowing process are pairs, both anatomically and/or functionally, due to the dual-side innervation. Anatomically unique, the tongue, palate, pharynx, and larynx are functional pairs, each side having independent innervation.
From receptors on each side of the oral cavity, the trigeminal (V), facial (VII), and glossopharyngeal (IX) nerves conduct information to the brainstem. These mixed nerves lead sensitivity (afferent pathway) and motor command (efferent pathway). The afferent pathways of the anterior two-thirds of the tongue are supplied by the lingual nerve, which associates the trigeminal (general sensibility) with the facial nerve (taste). In the posterior third of the tongue, both the general sensibility and taste are conducted by the glossopharyngeal nerve.
The trigeminal nerve (V) has three branches; upper (ophthalmic), middle (maxillary), and lower (mandibular). The upper and medium are exclusively sensitive, and the inferior, mixed. The sensitive fibers of the three branches innervate the face in transverse bands of representation. Regarding the oral cavity, the middle branch (maxillary) has sensitive responsibility for the upper arcade teeth, upper lip, cheeks, hard palate (mouth mucosa), and mucosa of the rhinopharynx. The sensitive portion of the lower branch (mandibular) is responsible for the sensitivity of the lower arcade teeth and lower mucosa of the mouth, as well as by the general sensitivity of the anterior 2/3 of the tongue.
From the trigeminal ganglion to the brainstem, all the sensory pathways will end in the posterior portion of the brainstem, over the trigeminal sensitive nucleus that occupies the medulla oblongata (spinal tract nucleus of the cranial nerve V), the pons (main sensory nucleus of the cranial nerve V) and the midbrain (midbrain nucleus of the cranial nerve V). Centrally the sensitive fibers divide into short, ascending branches that end in the main sensorial nucleus, to attend to tactile sensibility, and into long, descending branches that serve to tact, temperature, and pain, also providing collateral pathways to the spinal nucleus of the cranial nerve V.
It is believed that proprioceptive fibers from the midbrain nucleus of the trigeminal nerve in synapse with its motor nucleus located in the upper portion of the pons, would be able to integrate important chewing reflex arcs. Unless expressly desired, these arcs allow reflex modulation of chewing intensity based on bolus consistency variations, even during the voluntary bolus chewing preparation.
The motor root of the trigeminal nerve emerges from the ventral portion of the pons and runs through the mandibular root to innervate the chewing muscles, the mylohyoid, the anterior belly of the diagastric, and the tensor muscle of the palate.
The facial nerve (VII) is a mixed one, considering its motor root in association with the sensitive root given by the intermediate (Wrisberg) nerve1. The taste of the anterior two-thirds of the tongue on each side are its responsibility. From the tongue, this afferent, pre-ganglionic route follows through the lingual nerve (association of nerves V and VII), and afterward through the tympanic cord nerve (facial branch), to make synapses on the geniculate ganglion. Through the intermediate nerve, the postganglionic fibers (afferent visceral special - gustative route) synapse in the solitary tract nucleus of the medulla oblongata, associated with the general afferent visceral fibers, providing sensitive innervation to the mucosa of the nasal cavities and soft palate.
The parasympathetic efferent fibers of the facial nerve, originating from the upper salivary nucleus located on each side of the upper portion of the medulla oblongata, run through the intermediate nerve and afterward through the tympanic cord nerve to make synapses in the submandibular ganglion. Thence, through postganglionic fibers, they stimulate salivary secretion of the submandibular and sublingual glands.
The motor portion of the facial nerve has its nucleus on the ventral portion of the pons. Its fibers stimulate the skin-inserted muscles in the face, neck, and scalp, as well as the posterior belly of digastric and stylohyoid muscles.
The glossopharyngeal (IX) nerve comes out of the skull together with the vagus (X) and accessory (XI) nerves. The visceral general afferent and the visceral special afferent fibers of the glossopharyngeal nerve are associated. The visceral general afferent fibers are responsible for the general sensitivity of the oropharynx mucosa and the posterior third of the tongue, and the special visceral afferent fibers, for the taste of the posterior third of the tongue. These preganglionic fibers make synapses with the upper ganglion. The postganglionic fibers will end at the solitary tract nucleus.
The glossopharyngeal nerve’s efferent pathways come from two distinct nuclei of the medulla oblongata, the salivary inferior (parasympathetic) nucleus and ambiguous motor (special visceral efferent) nucleus. The parasympathetic fibers stimulate the salivary secretion after synapses with the optic ganglion, from which postganglionic fibers emerge to innervate the parotid gland.
The glossopharyngeal nerve’s only motor role is with the stylopharyngeus muscle. Nevertheless, it has already been considered as motor to the superior pharyngeal constrictor muscle, whose activity had been previously attributed to the vagus nerve, responsible for the motor innervation of all pharyngeal constrictor muscles.
Traditionally the vagus nerve has been considered a parasympathetic efferent nerve ( carries nerve impulses away from the central nervous system toward the peripheral effector organs (mainly muscles and glands).
A bundle of these fibers is called an efferent nerve (if it connects to muscles, then it is a motor nerve) controlling and regulating autonomic functions such as heart rate and gastric tone); however, the vagus (cranial nerve X) is actually a mixed nerve composed of about 80% afferent sensory fibers carrying information to the brain from the head, neck, thorax, and abdomen.
The sensory afferent cell bodies of the vagus reside in the nodose ganglion (The nerve fibers originating in the nodose ganglion supply the respiratory organs, the gastrointestinal organs, and the heart. They are involved in visceral perception in these organs. The locations of the innervating neurons within the ganglion have been reported for each of the organs) and relay information to the NTS(Numerous studies have identified extensive projections of the vagus nerve via its sensory afferent connections in the nucleus tractus solitarius (NTS) to many brain areas)
These fibers are different from those that go to the other motor nuclei of the vagus.
The NTS relays this incoming sensory information to the rest of the brain through three main pathways:
1) an autonomic feedback loop,
2) direct projections to the
Elucidating that the sensory nerves distributed in the larynx chiefly travel via the superior laryngeal nerve branch, and their initiator cells are located in the rostrolateral side of the nodose ganglion. In addition, investigation of the distribution had coexistence of cells that contain neuropeptides such as CGRP, gasotransmitters, and catecholamines in the nodose ganglion and proved that several of them are involved in the laryngeal sensory nervous system. Elucidating that capsaicin receptors and ATP receptors are present in the nodose ganglion, contributing to the transmission of noxious stimuli information in the larynx.
The vagus (X) nerve has relationships extending from the cervical region to the abdomen (transverse colon). Its sensory afference (sensory pathway) connects with the solitary tract nucleus located in the medulla oblongata. The visceral special efference (motor pathway) comes from the ambiguous nucleus in the ventral region of the medulla oblongata, and the parasympathetic fibers (visceral general efference), from the dorsal motor nucleus of the vagus.
Motor neurons that direct digestive gland activities (secretion) and smooth muscle contraction (peristalsis) Some of the neurotransmitters at work in the ENS include acetylcholine, norepinephrine, GABA, serotonin, substance P, and vasoactive intestinal peptide. We recognize some of these also as hormones, and communication chemicals important also in mood, stress, and immune response. Hormones orchestrate much of homeostasis, or the maintenance of balance in the human being. This is quite a complex feat, and it’s the balance, or relationship of hormones to one another that facilitates equilibrium. Hormones from many different glands, including the kidney, heart and organs not usually associated with the endocrine system, all function in relationship to one another, for example high levels of some feedback to reduce levels of others. That’s how something like stress can impact other hormonal functions, like a late menstrual period or even changes to one’s cycle.
There are two ways that the condition of the gut tissue impacts, and can be impacted by the condition of the rest of the body. One is reflexive action – because the GI tract arises from the same cells in the embryo as respiratory and urinary tissue, they are all linked.
Where there is tension, stagnation, weakness or hypersensitivity become generalized throughout the body. In this case, normalizing the overall tissue state will address both nervous and digestive systems, along with the rest of the body. For example stimulating sluggish digestive, liver and circulatory function will also stimulate better, quicker nerve and hormonal communication.
Because digestion is controlled by both nervous and endocrine sytems, both can impact how well our GI tract functions. It’s well known that stress is positively correlated with several GI conditions, including ulcers, irritable bowel syndrome/spastic colon and inflammatory bowel diseases including ulcerative colitis. Especially chronic stress promotes the body’s secretion of inflammatory mediators – communication chemicals that the ENS recognizes that can initiate or exacerbate inflammation. The state of the digestive organs and their function can also, conversely, affect one’s mood. For example, stagnation in the gut—gas, bloating, constipation – can lead to feelings of gloom and depression. Irritation to the intestines, from food allergens, junk foods or poorly digested food, can result in irritability of the emotions as well.
The visceral special afferent (taste) and visceral general afferent (sensibility) pathways of the vagus nerve, after synapses in a peripheral ganglion (lower or caudal), have their postganglionic fibers end at the solitary tract nucleus, similar to that observed in the intermediate portion of the facial nerve and in the glossopharyngeal one. The visceral general afferent fibers conduct impulses related to the sensitivity of the pharynx, larynx, trachea and esophagus, and the visceral special afferent route lead taste stimuli from receptors on the vallecula and from a small posterior area of the tongue next to the vallecula.
The visceral general efferent (parasympathetic) fibers of the vagus nerve originate in the vagus dorsal motor nucleus, and from it, on each side, they gather in a single-trunk, descending pathway, emitting branches in the cervical, thoracic and abdominal region, where they end. These preganglionic fibers will establish synapses in peripheral ganglia of the parasympathetic vegetative or autonomous nervous system, close to, or even inside, the viscera walls.
The visceral special efferent (motor) fibers of the vagus originate in the ambiguous nucleus, and are responsible for innervation of the striated muscles of the pharynx, larynx and esophagus.
The Hypoglossal (XII) nerve, a motor one, has an individualized nucleus on the ventral-medial portion on each side of the medulla oblongata. It is responsible for the tongue extrinsic and intrinsic muscles. In addition, fibers from the cervical plexus in association with the hypoglossal nerve form the ansa cervicalis, from which a branch from the cervical plexus, usually C1, will innervate the geniohyoid muscle, one of the responsible for the hyoid-laryngeal displacement.
The pharyngeal plexus (glossopharyngeal, vagus and accessory though vagus) is considered responsible for the pharyngeal reflex phase, where afferent information from the pharynx reach the brainstem, generating efferent stimuli to the pharyngeal structures involved in this phase of the swallowing process.
The pressure transfer from the oral cavity to the pharynx by distention would produce afferent stimuli that would reach the brainstem, in special the sensitive (solitary tract) nucleus. From the sensitive nucleus, through interneurons of the reticular formation, the ventral motor (ambiguous) nucleus of the brainstem generates efferent motor stimuli to the pharyngeal structures. Several structural movements initiated during the voluntary oral phase, remain in progress until the end of the pharyngeal phase, such as hyoid-laryngeal elevation, swallowing apnea and tongue posterior projection, to pharynx, started during the oral ejection, without considering the palate tension produced by the trigeminal nerve. In this way, several elements of the oral phase incorporated by the pharyngeal reflex phase allow us to consider the pharyngeal phase as dependent on the cranial nerves V, VII, IX, X, XI and XII of both sides.
World Brain Tumour Day is observed annually on 8 June. The day is marked to raise awareness and educate people about brain tumours. Among the many deadly health issues and diseases, brain tumour is the tenth leading cause of morbidity in India.
In the past few years, the cases of this deadly disease are rising and different kinds of tumours have been identified at different age groups. As per recent research and reports, there are more than 500 new cases where people have been diagnosed with brain tumour every day worldwide. I have answered if Covid is affecting my treatment and a handful of fatal symptoms of my ultra rare brain tumours.
*Help Payel Bhattacharya Survive - VHL - Genetic Multi System Disorder*
Those who wishes can donate directly to the hospital account as well
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