CR4-DL

Life Lessons from a Brain Surgeon

By Rahul Jandial

Prologue

  • This book attempts to separate the BS from the brain science, the hype from the hope.

Chapter 1: An Anatomy Lesson Like No Other

  • The brain doesn’t actually sit inside the skull; it floats in a natural, shock absorbing fluid called cerebrospinal fluid (CSF).
  • CSF is produced at a rate of two cups per day from the brain’s ventricles.
  • CSF serves as the brain’s nourishing liquor and drains away the brain’s waste.
  • The texture of a living brain is like flan or bread pudding.
  • The cells on the outer lining of the brain, the cerebral cortex, are the most precious ones.
  • It’s where most of the magic happens.
  • Gyrus = Hill, Sulcus = Valley.
  • 60% of the brain is white matter.
  • Review of dendrites, axons, synapse.
  • Axons and dendrites never physically touch.
  • It’s a myth to assign one feeling or cognitive function to each neurotransmitter.
  • E.g. Excessive dopamine can result in the development of a gambling addiction and becoming hypersexual, and it isn’t just a “feel good” chemical.
  • Near the outside edge of your eyebrow is Broca’s area.
  • Penfield’s maps of the somatosensory cortex are so accurate that we still use them today as a general guide to where the motor and sensory functions are located.
  • One inch above each ear is just above the temporal lobe.
  • In the living brain, gray matter isn’t gray and white matter isn’t white. Those colors only appear in dead brain tissues filled with preservatives.
  • Inside a living brain, gray matter is actually beige-pink and white matter is actually pearl-white.
  • The hippocampus sits in the basement of the temporal lobe.
  • Usually, either your left or right hippocampus is dominant with the other acting as a spare.
  • The amygdala is where three imaginary lines intersect, two directly from the eyes and one across the ears.
  • While it’s true that the amygdalae play an important role in fear, it’s also important for positive emotions.
  • The amygdala isn’t the fear center, but it’s an intense emotion hub.
  • The thalamus sits near the bottom of the brain but above the brain stem. It sits at the center of the brain.
  • The thalamus smooths and refines outgoing muscle commands and modulates incoming sensory information.
  • The thalamus also directs a stream of incoming and outgoing calls to the right place.
  • The hypothalamus sits directly below the thalamus and regulates hormones. It’s also a no-fly zone during surgery due to it’s importance.
  • The brain stem is no thicker than your thumb and controls basic functions.
  • E.g. Breathing, sleeping, heart rate, consciousness, and pain sensitivity.
  • Damage to the brain stem doesn’t recover unlike the rest of the brain.
  • The cerebellum lies behind the brain stem and helps refine physical movements, particularly on coordination and timing.
  • Glia cells feed neurons with nutrients and oxygen, insulate neurons from each other, destroy invading pathogens, remove dead neurons, and enhance their communication.

Chapter 2: Beyond Memory and IQ

  • The Flynn effect, that IQ has been steadily increasing over the past 100 years, shows us that intelligence isn’t simply determined by DNA.
  • Memory works like an area-restricted search, it searches until it finds what it’s looking for, search around that area, and then leave when it’s done.
  • In other words, it’s similar to a small-world network.
  • Review of emotional intelligence, grit, and deliberate practice.
  • The only talent improved is the specific skill practiced.

Chapter 3: The Seat of Language

  • Review of Broca (speech production) and Wernicke (speech comprehension) areas.
  • Different areas of the brain handle different languages.
  • Busy neurons are thriving neurons, and those that aren’t busy tend to wither.
  • Neurosurgeons are like a cerebral cartographer in search of tiny islands of safe brain tissue.
  • The brain can’t feel touch; it doesn’t have the ability to know when it’s being touched, cut, or manipulated.
  • One patient had to go for brain surgery a second time but the first map couldn’t be trusted due to neuroplasticity.
  • Her language areas had reorganized in response to the surgeon’s previous dissection.

Chapter 4: Unleash Creativity

  • A slow growing frontal lobe tumor can be confused as major depression or dementia.
  • Review of the left/right brain myth.
  • Mind wandering is directly linked to enhanced creativity.
  • The more your mind wanders, the greater the connections seen between far brain areas.
  • Fear of failure keeps too many people from daring to express themselves.
  • To boost creativity, break your routine and spend more time goofing around.

Chapter 5: Smart Drugs, Stupid Drugs

  • Lost in the conversation about smart drugs is that dose, age, and genetic predisposition matter.
  • Alcohol isn’t a smart drug, but may helps cognitive functioning in low doses.
  • E.g. One can of beer every day.
  • Caffeine might be a smart drug, but the evidence is conflicting.
  • Cocaine isn’t a smart drug as its highly addictive and a nightmare.
  • While high on weed, people have reduced attention and reduced performance on psychomotor tasks.
  • The greatest concern is the growing body of evidence that regular weed use is linked to an increased risk of developing severe psychiatric illnesses.
  • E.g. Schizophrenia.
  • Marijuana isn’t a smart drug, but it isn’t a dumb one either.
  • Modafinil is consider one of the most effective and least dangerous smart drugs.
  • Tobacco is toxic, but nicotine without tobacco is an interesting drug.
  • Smokers were found to have a reduced risk of developing Parkinson’s disease.
  • Nicotine appears to mildly improve cognition, but there’s not enough evidence to say so.
  • A common side effect of prescription stimulants, such as Adderall and Ritalin, is paranoia.
  • No study has ever shown these drugs to be true cognitive enhancers.
  • They don’t make you smarter, they just keep you awake and alert for longer.

Chapter 6: Sleep On It

  • The brain never rests.
  • Sleep isn’t a time when the brain rests.
  • The only time the brain rests is in a medically-induced coma. These patients don’t dream and they’re not asleep.
  • One purpose of sleep is to transform short-term memories stacked up during the day into long-term memories.
  • Another function of sleep is to take out the garbage, to erase and forget information built up throughout the day.
  • Why we dream is still an unsolved mystery.
  • Sleeping less than 6 hours a night increases the risk of death by 12 percent, while sleeping more than 9 hours increases the risk of death by 30 percent.
  • Fragmented sleep often feels worse than no sleep at all.
  • Over-the-counter drugs only work to initiate sleep, but they don’t help you stay asleep through the night.
  • Recommendations for better sleep
    • Keep a consistent sleep schedule.
    • Avoid caffeine in the afternoon and evening.
    • If you don’t fall asleep after 20 minutes, get out of bed.
    • Use your bed only for sleep and sex.
    • Limit exposure to bright light in the evenings.
    • Turn off electronic devices at least 30 minutes before bedtime.

Chapter 7: Just Breathe

  • Other organs can go hours without blood flow before their cells die, but neurons survive only a few minutes without blood.
  • E.g. Getting disoriented if you stand up too quickly because blood hasn’t had time to go to your brain.

Chapter 8: How to Handle Head Injuries

  • Bullets shot into the sky return and can cause heavy brain and head trauma.
  • 42% of people shot in the head survive and do well enough to be discharged from the hospital within six months.
  • The vast majority of concussions leave no lasting effect on a person’s mental functioning.
  • However, getting a second concussion before recovering from the first one is very dangerous.

Chapter 9: Food for Thought

  • Nearly every millimeter of your body is penetrated by nerves sent out from the brain.
  • The gut is not a second brain.
  • Some people insist that breakfast is the most important meal of the day, but there’s no good evidence for that.
  • Only oxygen, glucose, ketones, some fats, vitamins, and minerals pass the blood brain barrier.
  • “Eat food. Not too much. Mostly plants.” - Michael Pollan

Chapter 10: How the Brain Heals Itself

  • Your brain isn’t hardwired.
  • Most researchers believed that the brain was hardwired up until the 1980s.
  • Brain tissue isn’t cut like other tissue; its delicately chiseled by the force of suction.
  • In a hemispherectomy (removing half of the brain), the lobes are removed first before suctioning out the white matter, hippocampus, amygdala, thalamus, and hypothalamus.

Chapter 11: The Bionic Brain

  • Review of direct brain stimulation (DBS) treatments.
  • The electrophysiologist can hear when the electrode reaches its target when the sound of spikes changes.

Chapter 12: Shock and Tingle

  • Review of electroconvulsive therapy (ECT) and transcranial direct-current stimulation (tDCS).
  • ECT, when properly administered, is the fastest, most effective treatment for depression and bipolar disorder when medications have failed.
  • Electricity as medicine.

Chapter 13: Stem Cells and Beyond

  • Review of injecting stem cells and CAR T cells into the brain to treat cancer.

Chapter 14: The Younger Brain

  • The prefrontal cortex doesn’t fully mature until our late twenties.
  • Neuronal maturity doesn’t happen at the same pace across the human brain.
  • Neurons are created at a rate of 250,000 per minute when the baby is in the womb.
  • Neither the destinations nor the timing is random, as each neuron is expected to arrive at an exact location at a predetermined time.
  • Brain development involves not just growth, but also death.
  • Review of synaptic pruning.
  • Use it or lose it.
  • Control of the pruning process is incredibly precise, and when it goes wrong, neurodevelopment suffers.
  • E.g. Autism be due to too many synapses in certain parts of the brain.
  • The simple fact is that babies and children require stimulation to grow normally.
  • Most children and adults don’t need to be given vitamin supplements except pregnant women.
  • Fruit juice is almost as bad as soda in terms of the amount of sugar in them.

Chapter 15: The Older Brain

  • On average, a person’s brain volume shrinks by about 5 percent per decade after the age of forty.
  • However, brain atrophy doesn’t equal mind atrophy.
  • Memory with age
    • Semantic memory continues to grow with age.
    • Procedural memory slowly declines with age.
    • Episodic memory peaks in your mid-twenties and slowly declines throughout life.
    • Working memory becomes more limited with age.
  • High blood pressure has been known to increase the risk of cognitive impairment.
  • The reason education pays off in helping you remain cognitively healthy is because of cognitive reserve: people with extra brain power can afford to lose more before showing signs of decline.
  • Those who put their brains to better use can withstand greater loss of brain matter.
  • Physical activity turns out to be one of the absolute best ways to maintain and even improve cognitive health.

Epilogue

  • Your brain’s health is within your control.
  • Your willingness to engage in lifelong learning, social engagement, and childlike openness to new experiences will define your brain’s fate.