Mantle edge syndrome is damage to the mantle edge. This is accompanied by brain damage. This primarily causes a movement and sensitivity disorder of the legs.
What is mantle edge syndrome?
Mantle edge syndrome is a very rare disorder. Mantle edge is the name given to the longitudinal fissure of the cerebrum. The fissura longitudinalis cerebri is the cleft that divides the cerebrum in half. The cerebrum is named telencephalon and the two cerebral hemispheres are the right hemisphere and the left hemisphere. The mantle edge runs centrally above the brain from front to back. It forms the transition from the outer to the inner surface of the brain. The mantle edge contains the hard meninges or dura mater encephali. Its function is to provide mechanical support to the brain. In mantle edge syndrome, there is damage to the mantle edge of the cerebral hemisphere. This means that the functionality of the margo superior cerebralis, the blunt edge at the transition from the convex part of the cortex to the medial surface on the hemisphere, is impaired. The primary result is impaired movement and sensation in both legs. This may result in paraparesis and consequently paralysis of the extremities. In addition, there is a micturition disorder in the sufferer. This involves problems with emptying the bladder.
Causes
The most common cause of mantle edge syndrome is a parasagittal meningioma. Associated with this is spastic paraparesis of the legs and uncontrollable bladder emptying. Meningioma is a brain tumor that patients often develop in adulthood. It is diagnosed between the ages of 40 and 60 in most cases. Women are affected significantly more often than men. Characteristic of a meningioma is a slow growth of the brain tumor and its displacing appearance. For this reason, the cause of symptoms is not infrequently found only after several months or years. In mantle edge syndrome, both hemispheres of the brain are affected. This results in a dysfunction of cortical representational fields. Compression of the meningioma on the cortex results in contralateral or bilateral leg paratesis. However, brain contusion and consequent tissue damage may have other causes. In extremely rare cases, the lesion of both hemispheres may result from external causes. Grazing shots in the middle of the vertex, for example, are among them. Likewise, falling objects on the head can be triggers for damage to the mantle edge. The application of force, for example, by a severe blow to the vertex can also cause lesions of the cortex as well as the mantle edge.
Symptoms, complaints, and signs
Symptoms of mantle edge syndrome mainly include sensorimotor paralysis of the legs and bladder dysfunction. There is uncontrolled bladder emptying in the patient. In addition, initial foot-lifting weakness has been documented. The foot-lifting musculature in the swing phase is disturbed. This allows the leg to swing through freely. As in paratesis of the legs, one or both feet may be affected. Jackson seizures occur in some patients. These are focal epileptic seizures. Individual body regions or the extremities are affected. In extreme cases, an entire half of the body may be affected. In mantle edge syndrome, additional disturbances of the rectum may occur. Analogous to bladder dysfunction, only voluntary control of the external sphincter is lost. Gross neurological deficits also occur in mantle edge syndrome. These can all be attributed to dysfunction of the affected brain regions.
Diagnosis and course of the disease
Diagnosis of mantle edge syndrome is considered very difficult. It is often overlooked in examinations or not recognized or properly evaluated over a long period of time. The disease usually progresses over several years. The slow growth of the brain tumor is one of the reasons. In addition, the lesions are often underestimated by external influences and not sufficiently examined. In the course of the disease, mantle edge syndrome must be differentiated from spinal cord syndrome. The diagnosis is usually made by an imaging procedure such as magnetic resonance imaging (MRI).Over this, the structure and functional activity of the cortex are determined and the damage to the mantle edge is visible.
Complications
Due to the mantle edge syndrome, there are usually various damages and limitations that occur mainly in the patient’s brain. Due to this damage, there are further disturbances in sensibility and also paralysis. These paralyses then lead to movement restrictions and other limitations in the patient’s daily life. Epileptic seizures also occur, which in the worst case can lead to injury or death of the patient. Due to the mantle edge syndrome, the quality of life of the affected person is considerably restricted and reduced. Likewise, discomfort during emptying of the bladder or during defecation can occur and thus likewise lead to mental discomfort. However, mental discomfort does not occur as a result of mantle edge syndrome. The treatment of mantle edge syndrome is performed by a surgical intervention on the patient’s brain. Since this is a very serious surgery, it can also lead to various complications. Not in every case can the tumor be completely removed. In some cases, the affected person may then be dependent on diapers. The patient’s life expectancy is not affected by mantle edge syndrome. The movement restrictions can be treated with the help of various therapies as well.
When should you see a doctor?
Disturbances in motor function are signs of existing irregularities. A visit to the doctor is necessary as soon as there is an impairment of locomotion or signs of paralysis appear. A doctor is needed in case of pain, perceptual disturbances or a feeling of malaise. Further examination should be performed to determine the cause. If the foot-lifting muscles can no longer be moved as usual, consultation with a physician is recommended. In these situations, the affected person experiences a swing-through of the leg and has no control over the extremities. A doctor should be consulted to improve health so that treatment can be initiated immediately. If, in addition to the leg discomfort, inconsistencies in going to the toilet also set in, these are further symptoms that should be clarified by a doctor. If the sphincter cannot be subjected to voluntary control or if discomfort sets in when emptying the bladder, a doctor should be consulted. If wetting or defecation occurs during the day or night, a visit to the doctor is advisable. This also applies to children who are still in the growth phase. In the event of a seizure disorder, cramps or a feeling of illness, a doctor should be consulted. If there are impairments in the performance of everyday duties or if well-being drops significantly, the affected person should consult a doctor and seek help.
Treatment and therapy
Treatment of mantle edge syndrome is individualized, depending on the type of hemispheric damage. If a brain tumor is diagnosed, the patient undergoes surgery. In this procedure, the meningioma is surgically removed from him completely. The mantle edge is supplied by the anterior cerebral artery. If this supply is damaged, an attempt is made to restore it. In the case of bladder and fecal incontinence, medication is administered in an attempt to regulate it. Alternatively, the wearing of diapers is recommended. The weakness of the foot lifter is accompanied orthopedically. This reduces the risk of tripping or falling. Orthoses, for example, can be an individual support. These are functional electrical stimulators that provide stimulation of the foot surface and muscles. Alternatively, a neuroimplant can be used.
Outlook and prognosis
The prognosis for mania is unfavorable in most patients. If left untreated, a life-threatening condition often develops. Reckless behavior, an increased risk of accidents, and severe overconfidence place the affected person in unfavorable situations. Conflicts often arise that lead the patient into legal as well as health threats. The performed actions in a manic period lead to the fact that the affected person is incapacitated. This means that compulsory treatment is necessary and can be initiated in the worst case. In a therapeutic as well as medical care the complaints improve considerably. Frequently, periods of very depressed energy occur in addition to the strong euphoric mood.Many patients are suicidal and therefore are highly likely to bring about a self-chosen premature end to their lives. Long-term therapy is necessary to establish stability of health. If it is accepted and the patient cooperates in this therapy, the prospects of alleviating health irregularities increase. Under optimal conditions, there are periods of freedom from symptoms as well as a significant improvement in the overall situation. Independent living can be achieved, so that the affected person is not dependent on further daily care. Nevertheless, regression of existing symptoms can be expected at any time in the course of life.
Prevention
Basic preventive measures cannot be taken for mantle edge syndrome. If the cause is a brain tumor, there is no prior therapy or evidence such as contaminated genetic material that could be considered in this rare disorder. Since external influences can affect the lesions of the hemispheres, protective measures can be taken. In particular, preventive protective measures should be taken during activities or in places where there are falling objects. The top of the skull can be protected in these cases by wearing a helmet.
Aftercare
As with all tumorous diseases, close follow-up is initially required for mantle edge syndrome after treatment. This has the goal of establishing and permanently ensuring a quality of life despite the disease. Therefore, in the case of a brain tumor, aftercare checks take place several times a year at intervals of a few months. If no abnormalities are found, the intervals between the next check-ups are increased. Since the mantle edge syndrome is accompanied by such severe interruptions in the patient’s usual life, conditions suitable for everyday life should be developed in the course of aftercare to improve the patient’s ability to cope with the situation. Drug treatment will continue to be indispensable to alleviate any pain that may occur. However, if unusual physical symptoms occur outside the follow-up checks, this should be reported promptly to the attending physician. He will thus arrange for intensification of the follow-up treatment as quickly as possible.
What you can do yourself
People suffering from mantle edge syndrome have few options for self-help. If the condition is due to a brain tumor, surgery is necessary. During the treatment period, doctors’ guidelines should be followed for the prospect of a good recovery. Since the syndrome is a severe disease, the patient needs not only physical reserves but also sufficient mental strength to deal with the discomfort. To support the immune system, a balanced diet rich in vitamins is valuable. The consumption of harmful substances and toxins should be completely avoided. In particular, the consumption of alcohol or nicotine should be refrained from. Emotional stability can be promoted through various relaxation techniques. Qi Gong, autogenic training, yoga or meditation have often proved successful. The patient can use these methods on his own responsibility and in a self-determined manner. The regular exchange with confidants or in self-help groups is beneficial for many patients. Experiences are discussed and advice is given on how to live with the disease. Despite the limited possibilities, the patient should pursue leisure activities to strengthen his or her well-being. Daily life should be restructured to best suit the patient’s needs. Studies have shown that positive thinking and an optimistic basic attitude are helpful in coping with the disease.
