Endometriosis is a disease in which tissue resembling the inner lining of the uterus (the endometrium) starts to grow outside the uterus. This tissue also breaks down in a woman’s monthly reproductive cycle, but causes inflammation and pain because it is unable to leave the body through menstruation.
Endometriosis is typically found in the pelvic region but can occur elsewhere if the endometrial cells manage to enter the blood or lymphatic fluid. In extremely unusual instances, endometrial tissue is found in the brain, a condition called cerebral endometriosis.
What is cerebral endometriosis?
Cerebral endometriosis is the growth of endometrial tissue in the brain. Cerebral endometriosis is extremely rare, with only three cases reported to date in scientific literature.
One involved a reported case of cerebellar endometriosis, or endometrial cells found in the back part of the brain known as the cerebellum. Specifically, they were in a region called the cerebellar vermis — the part that separates the two halves of the cerebellum.
What causes cerebral endometriosis?
It is not clear what exactly causes cerebral endometriosis. Retrograde menstruation (backflow of menstrual blood into the fallopian tubes and pelvic cavity) is thought to be one possibility, but this cannot explain the migration of endometrial cells to places such as the brain.
Studies in mouse models suggest that the extra-uterine endometrial tissue might spread in the body through stem cells that form endometrial lesions.
Symptoms of cerebral endometriosis
Symptoms of cerebral endometriosis may overlap with known symptoms of endometriosis, and can be characterized by headaches and seizures. Problems with gait (the manner of walking) are also possible.
In one of three three known studies (published in 1987), researchers reported that the patient complaining of seizures preceded by headache in the right occipital lobe (the visual processing center of the brain). These symptoms were said to have occurred once or twice a month, and were unrelated to her menstrual cycle.
In the case study published in 1993, the patient experienced partial seizures on the first day of her menstrual cycle.
In the case study on cerebellar endometriosis, published in 2004, the patient also began to experience headaches and gait disturbances shortly before seeing her doctor. But she had no history of seizures, and no complaints of pelvic pain or problems with fertility that might indicate endometriosis.
Diagnosis and treatment
These three cases of cerebral endometriosis were diagnosed with the help of computerized tomography (CT) and magnetic resonance imaging (MRI) scans. Histological examination of the affected brain areas also helped to confirm the presence of endometrial tissue.
Endometrial lesions in the brain can be surgically removed. The three patients studied to date reported symptom improvement post-surgery, including no further seizures and no problems with fertility.
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