Hi, thanks for asking from HCM. I can understand your concern. Your daughter is quite young for diffuse cerebral atrophy. Age related cerebral atrophy usually occurs after 60 years age. I suspect repeated head injuries as the cause of diffuse cerebral atrophy in her. Repeated head injuries can cause accumulation of blood and chronic ischemia of brain. It can result into progressive cerebral atrophy. If she had sustained diffuse axonal injury or/and acute subdural hematoma, the atrophy will be more. Now coming to its treatment, it can be treated symptomatically only. It is irreversible. With medication, we can delay its progression. You have mentioned about some psychiatric issues (details not provided). - You can consult a Psychiatrist for psychiatric illness. Counselling, medication and family support will help her in overcoming it. - Increase diet of green vegetables, almonds, fruits, fish to provide maximum nutrition and antioxidatives to brain. - You can also give her nerve specific vitamin like B12, folic acid, pyridoxine, Pantothenic acid, Benfotamine after proper prescription. It will take care of nutritional deficiency. - Some new cognition improving medications like Citicoline, cerebrohydrosylate can be tried after proper prescription. For memory, she can be given tablet Donepezil after proper prescription. - Music therapy, Yoga and meditation enhance the cognition and higher mental function. Hi, thanks for asking from HCM. I can understand your concern. Your uncle is suffering from multiple diseases like DM, pulmonary TB, Thalassemia minor and ependymoma. All these diseases can cause deterioration in patient s general condition. Thus worsen the prognosis of TB and ependymoma. Now coming to your questions, 1 Spine surgery can be deferred for few weeks till 1-2 months. It is because your uncle is having ependymoma at terminal spinal cord. it is usually Myxopapillary ependymoma . This ependymoma is grade I and carries a good prognosis. It is very slow growing tumor. Waiting for few weeks will not going to increase the size of tumor. 2 Both are priorities. Pulmonary TB can be completely treated by anti-tubercular treatment. During TB therapy, patient can undergo surgery of ependymoma. Also you have to wait for decision of neurosurgeon who is going to operate him. If he thinks, patient is not fit for surgery, then wait. 3 CT guided biopsy can be done after surgery. If his sputum was positive for TB, then there is no need of CT guided biopsy. 4 Prognosis of both diseases are good. Pulmonary TB is 100% curable if complete ATT is received. Ependymoma can be completely resected. Myxopapillary ependymoma carries best prognosis among ependymoma. Hope above answers will clear your doubts. Hope it will help you. If still in doubt, do let me know. Thanks. Take care. Dr Ishu Bishnoi