When a 24 year old Chinese woman approached doctors complaining of nausea and dizziness, none of them could have expected what an extraordinary case they were dealing with. A brain scan revealed something shocking– part of the woman’s brain was missing.
The young woman had lived normally for two decades, but had experienced dizziness and speech troubles as a child. Finally seeking medical attention after a month-long bout of inexplicable vomiting and nausea, doctors were shocked by the results of her MRI scan. The images revealed the woman was missing a crucial part of her brain, the cerebellum. Where her cerebellum should have been was instead a dark, fluid-filled hole.
Doctors realized she had been born without one, making her one of only eight such cases in the world.
The cerebellum, Latin for ‘little brain’, is the lower grooved region of the brain, tucked in behind and under the upper hemispheres. It plays a vital role in motor control and cognitive functions: walking, movement, speech, and more. Those born without a cerebellum suffer debilitating difficulties, and rarely survive the condition, dying very young. Many aspects of this woman’s case were remarkable, including the fact that she had survived where others had died from the condition, experiencing relatively mild motor and speech problems. It was evident that her brain had compensated for the missing cerebellum by reassigning the tasks to other regions. Her doctors noted this demonstrates remarkable plasticity of the brain.
Dr. Raj Narayan, chair of neurosurgery at North Shore University Hospital, told Live Science, “It shows that the young brain tends to be much more flexible or adaptable to abnormalities. When a person is either born with an abnormality or at a very young age loses a particular part of the brain, the rest of the brain tries to reconnect and to compensate for that loss or absence.” The human brain is not always so plastic or acclimating. “As we get older, the ability of the brain to tolerate damage is much more limited. So, for example, in a 60-year-old person, if I took the cerebellum out, they would be severely impaired,” Narayan said.
Other cases of living with less than a full brain are not uncommon.
Hemispherectomy is a neurosurgery where up to half the brain is removed. Once thought radical and beyond dangerous, it is a surgery which has been performed hundreds of times, usually on patients in childhood. The younger a patient is the more successful the treatment. Scientific American writes of hemispherectomy, “Neurosurgeons have performed the operation on children as young as three months old. Astonishingly, memory and personality develop normally. A recent study found that 86 percent of the 111 children who underwent hemispherectomy at Hopkins between 1975 and 2001 are either seizure-free or have nondisabling seizures that do not require medication.”
Some patients require brain altering surgery to treat ailments like epilepsy, stroke, or to remove tumors. It was not long ago, from about 1930 to 1955, that lobotomy - the cutting away of part of the frontal lobes of the brain - was controversially used to treat perceived psychiatric conditions, or cases of post-traumatic stress disorder. The procedure often resulted in debilitation, and is rarely performed today.
The earliest known ‘brain surgery’ was called trepanning. Evidence of trephination dates back to Neolithic era, and still has some proponents in modern times. Trepanning employs a drilling device to bore a hole in a patient’s head to expose the brain matter. This was thought to relieve pressure, and treat seizures, migraines or mental illness. It was even a means of allowing demons to escape the body, according to belief.
Thankfully, neurosurgery has advanced to a point today where it is less dangerous, and more routine and successful on the whole. Doctors continue to treat brain issues without surgery as well, relying on chemical and electroconvulsive therapies.
Though our modern science and technology is advanced, experts will attest that we still know relatively little about our most complex organ, the human brain. This need for knowledge is what drives high profile neurology research programs, like the BRAIN Initiative, and the Human Brain Project. The more we understand surprising cases like the woman without a cerebellum, the better position we'll be in to treat or cure diseases, disorders, and disabilities.
