Foster-Kennedy syndrome is characterized by a combination of increased intracranial pressure and compressed optic nerve. The condition often results from neoplasms, particularly in the frontal lobe of the brain. Therefore, causative treatment is primarily aimed at removing the tumor.
What is Foster-Kennedy syndrome?
Foster-Kennedy syndrome is a disease characterized by two features: increased intracranial pressure and compression of an optic nerve. Intracranial pressure is the medical term for the pressure that prevails in the brain. It involves both the pressure of blood vessels and the pressure of fluid in tissues. In a healthy person, intracranial pressure is between 5 and 15 mmHg. Robert Foster Kennedy first described the condition in 1911, a neurologist who lived in both Ireland and the United States and was one of the first physicians to use electroconvulsive therapy with psychotic patients. He also endeavored to explain war neuroses and became president of the American Neurological Association in 1940.
Causes
A tumor in the brain is responsible for the development of Foster-Kennedy snydrome. In this case, the neoplasm is located at the base of the frontal lobe, which forms the frontal (frontal) area of the cerebrum. The frontal lobe controls movements and cognitive processes. It also influences higher mental abilities such as social behavior, creativity, self-control and action planning. The neoplasm itself indirectly damages the body in Foster-Kennedy syndrome; the symptoms arise because the tumor grows and consequently requires more space. It presses on the optic nerve, which is on the same side as the tumor. The space squeezes the optic nerve, which interrupts its nutrient supply. As a result, it atrophies, meaning it wastes away. Medicine calls this symptom ipsilateral (lying on the same side) optic atrophy. At the same time, a congestion papilla forms on the other side (contralateral). This is an edema that forms where the optic nerve contacts the retina. The growing tumor also causes intracranial pressure to increase: it changes the volume-to-mass ratio in the skull.
Symptoms, complaints, and signs
The signs of Foster-Kennedy syndrome are triggered primarily by increased intracranial pressure. If it rises, symptoms such as nausea and vomiting initially manifest, which affected individuals often initially mistake for acute gastrointestinal symptoms. This is potentially accompanied by vigilance disorders, headache, fatigue and quantitative disturbances of consciousness up to coma. There may be a slowing of the heartbeat. Medicine refers to bradycardia when the rate drops to less than 60 heartbeats per minute in an adult. At the same time, blood pressure may rise. Bradycardia and high blood pressure are due to the so-called Cushing’s reflex. The rising intracranial pressure impairs blood flow to the brain. This condition is critical for the human body because the nerve and ganglion cells no longer receive enough oxygen and other nutrients. If the cells are undersupplied for too long, they eventually die. They cannot regenerate. To prevent this, the Cushing reflex kicks in: it causes blood pressure to rise in order to balance the ratio of blood pressure to intracranial pressure. The blood pressure can reach peak values of 300 mmHg (systolic). It may manifest as headaches, dizziness, nausea, and sleep disturbances, but may also occur without symptoms. In addition, because Foster-Kennedy syndrome also affects the optic nerves, affected individuals often suffer from visual disturbances.
Diagnosis
Diagnosis is made by doctors determining the two cardinal symptoms of Foster-Kennedy syndrome. A probe in the tissue can measure intracranial pressure. However, this measurement is relatively prone to error because intracranial pressure can vary widely in different areas of the tissue. Relatively, examination of the optic nerve is easier. Optical methods are able to reveal its condition. A detailed medical history helps in the diagnosis of Foster-Kennedy syndrome, as does the diagnosis of individual symptoms. Imaging techniques such as CT or MRI can visualize the tumor. Depending on the type of neoplasm and the individual conditions, a cure is possible if the tumor can be completely removed.
Complications
Usually, Foster-Kennedy syndrome presents with complications such as vomiting, headache, or nausea as is common in quite a few medical conditions. For this reason, Foster-Kennedy syndrome is not directly identified. The affected person often suffers from stomach pain or symptoms of a gastrointestinal infection. Fatigue also occurs, which can rarely be compensated with sleep. If Foster-Kennedy syndrome progresses and is not treated, disorders of consciousness manifest. In the worst cases, these can slow the heartbeat and lead to a comatose state. The brain is no longer supplied with sufficient oxygen by the syndrome, which is why certain nerves can be damaged and, in the worst case, die. This can lead to disabilities or mental impairment of the patient. Often there are also visual disturbances and sleep disorders. In many cases, the tumor can be removed so that Foster-Kennedy syndrome can be completely treated. If coma has occurred, the patient is usually kept alive and given medication. Life expectancy decreases greatly due to Foster-Kennedy syndrome. If the tumor has already spread throughout the body, the syndrome cannot be treated and leads to death.
When should you see a doctor?
Since Foster-Kennedy syndrome is the appearance of a tumor, it always requires medical treatment and examination. This can prevent the premature death of the affected person. A doctor should be consulted if the affected person suffers from permanent vomiting and nausea without any particular reason. Severe headaches, persistent fatigue, and discomfort in the stomach and intestines may also indicate Foster-Kennedy syndrome and must always be investigated. Furthermore, affected individuals may also lose consciousness and often suffer from a slow heartbeat. At the same time, high blood pressure is also evident. If this remains high over a longer period of time, a visit to the doctor is also recommended. Likewise, visual disturbances, sleep disturbances or severe dizziness are among the symptoms of Foster-Kennedy syndrome. The syndrome is usually diagnosed and treated in a hospital. The earlier the tumor is discovered and can be removed, the higher the likelihood of a positive disease outcome. Since the syndrome can lead to psychological discomfort in the patient and his or her relatives, additional treatment with a psychologist is advisable.
Treatment and therapy
The therapy of Foster-Kennedy syndrome depends on various factors. Basically, physicians must weigh which form of treatment or which combination of therapies is most appropriate in each individual case. For example, the size of the tumor, its localization and its behavior play a major role. The benefits and risks of individual treatment options vary greatly between different individuals. Surgeons can remove the neoplasm if there is no contraindication and the tumor is easily accessible. Appropriate surgery separates out the diseased tissue as carefully as possible without removing healthy brain tissue as well. Another option is radiation. If the appropriate conditions are met, a combination of the two forms of therapy may also be useful. Furthermore, physicians treat the individual symptoms that occur in the context of Foster-Kennedy syndrome. Quantitative disorders of consciousness are a particular challenge; patients who are in a coma require intensive care. However, even less severe disorders of consciousness may require sufferers to rely on others for help – for example, to take medications on a regular basis.
Outlook and prognosis
Foster-Kennedy syndrome is a result of a tumor in the human brain. Because it is not a causative disease, the prognosis of the syndrome depends on the treatability of the underlying tumor. Without seeking medical care, further growth of the brain tumor will occur. In addition, the cancer cells may continue to spread throughout the organism via the person’s bloodstream, leading to the spread of the cancer. The premature death of the affected person is ultimately the result.If the brain tumor forms in an unfavorable position or if the stage of the cancer is already very advanced, it is often no longer possible to provide adequate medical care. The focus of therapy for these patients is pain relief. If the brain tumor is detected and treated at an early stage, there is a chance of a cure. The tumor is removed in a surgical procedure. This is followed by cancer therapy to prevent the cancer cells from forming again. If the treatment proceeds without complications, recovery can occur. However, secondary symptoms and a longer healing process are to be expected. For many patients, lifelong impairments remain. In addition, despite all efforts, the brain tumor may recur at any time, resulting in Foster-Kennedy syndrome.
Prevention
There is no direct prevention of Foster-Kennedy syndrome. Early detection of the disease can prevent more severe complications. If the tumor has already spread very far, this may make it difficult or even impossible to remove.
Follow-up care
Follow-up care for Foster-Kennedy syndrome depends on whether the causative tumor can be treated and successfully removed. If not, because of late detection timing or metastasis, blindness and death are imminent. In the aftercare, the only thing that can be done is to try to make the remaining days of life as painless and without suffering as possible. However, if the triggering tumor can be successfully irradiated, treated with chemotherapy and then operated on, the aftercare for Foster-Kennedy syndrome is different. Care must be taken during the follow-up period to allow the compressed optic nerve to recover and relieve intracranial pressure. In addition, surgery for the space-occupying tumor can leave severe after-effects. The extent to which these can be repaired depends on the individual case. Problematically, the precipitating tumor is often not discovered until a later stage because of the insidious onset of symptoms. The symptoms of Foster-Kennedy syndrome initially seem to indicate other diseases. These are often not considered dangerous. This usually delays the first visit to the doctor. Once the tumor is located as the cause of Foster-Kennedy syndrome, treatment is often successful. However, metastases may have already formed. The damage to the optic nerve and brain may be irreparable. In this case, follow-up success may not be as resounding as it would be with early detection.
Here’s what you can do yourself
In general, the options for self-help in Foster-Kennedy syndrome are relatively limited. The success of treatment and the further course of the disease depend greatly on the extent of the tumor. The earlier it is detected, the higher the probability of a positive course of the disease. In many cases, those affected are dependent on psychological treatment. Talking to close friends or relatives can have a very positive effect on the course of the disease. Also a conversation with other affected persons or with other cancer patients can alleviate psychological discomfort. Since Foster-Kennedy syndrome also leads to permanent fatigue and exhaustion of the patient, he should be supported in his everyday life by his family and friends. The patient should take it easy on his body and not engage in any strenuous activities. The regular intake of medication should also be checked by the family. Since the patient’s relatives often also suffer from psychological complaints or depression, psychological treatment is also advisable for these people. This can prevent severe moods.
