Dementia

Dementia

A chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.

Dementia, also known as senility, is a broad category of brain diseases that cause a long term and often gradual decrease in the ability to think and remember that is great enough to affect a person's daily functioning. Other common symptoms include emotional problems, problems with language, and a decrease in motivation. A person's consciousness is not affected. A dementia diagnosis requires a change from a person's usual mental functioning and a greater decline than one would expect due to aging. These diseases also have a significant effect on a person's caregivers.

The most common type of dementia is Alzheimer's disease, which makes up 50% to 70% of cases. Other common types include vascular dementia (25%), Lewy body dementia (15%), and frontotemporal dementia. Less common causes include normal pressure hydrocephalus, Parkinson's disease, syphilis, and Creutzfeldt–Jakob disease among others. More than one type of dementia may exist in the same person. A small proportion of cases run in families. Diagnosis is usually based on history of the illness and cognitive testing with medical imaging and blood work used to rule out other possible causes. There is no cure for dementia.

What is dysautonomia?

 Dysautonomia

Dysautonomia presents in a number of forms, but all of them involve a certain level of failure in the autonomic nervous system (ANS). They can strike at any age but often first occur during puberty. Dysautonomias more commonly appear in females.

The ANS is the division of the nervous system that orchestrates many operations that our body carries out automatically without input from higher brain centers.

In particular, the ANS is responsible for maintaining a constant internal temperature, regular breathing patterns, a steady blood pressure, appropriate pupil dilation, sexual arousal and excretion. Symptoms of dysautonomia, therefore, generally manifest themselves as errors in those particular areas of physiology.

Symptoms

As mentioned, there are a number of dysautonomia subtypes, and so symptoms vary. Some of the more common symptoms are light headedness, fainting, unstable blood pressure and an abnormal heart rate.

In the most serious cases, death can occur from pneumonia, acute respiratory failure or sudden cardiopulmonary arrest.

Treatment

There are currently no cures for dysautonomia, but various medications can either ease some of the symptoms or treat the underlying causes of the illness.

headache

HEADACHES

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. Headaches can result from a wide range of causes both benign and more serious. Brain tissue itself is not sensitive to pain as it lacks pain receptors.

Primary headaches

Primary headaches are stand-alone illnesses caused directly by the overactivity of, or problems with, structures in the head that are pain-sensitive. This includes the blood vessels, muscles and nerves of the head and neck. They may also result from changes in chemical activity in the brain.

Common primary headaches include migraines, cluster headaches and tension headaches.

Some types of headache can be both primary and secondary as they may be an isolated issue or a result of another condition or illness. Such headaches can involve:

§  Direct physical stimuli, such as temperature and external pressure

§  Pain over the scalp (epicranial)

§  Physical exertion

§  Other miscellaneous headaches.

Secondary headaches

Secondary headaches are headaches that are symptoms of another condition that stimulates the pain-sensitive nerves of the head. There are a vast number of different conditions that can cause secondary headaches, ranging in severity from an alcohol-induced hangover to a brain tumor.

In addition to those two examples, the following list should serve to illustrate the variety of different conditions that can cause secondary headaches:

§  Blood clots

§  Brain freeze (ice cream headaches)

§  Carbon monoxide poisoning

§  Concussion

§  Dehydration

§  Glaucoma

§  Influenza

§  Overuse of pain medication (rebound headaches)

§  Panic attacks

§  Stroke.

Treatment of headaches

The most common methods recommended for treating headaches are rest and pain relief medication.

• Self-care
• Acupuncture
• Chiropractic treatment
• Cognitive behaviour therapy
• Herbal and nutritional health products
• Hypnosis
• Meditation.

As headaches can be a symptom of a serious condition, it is important to seek medical advice if headaches become more severe, regular or persistent.

Nasal polyps

Nasal polyps ??

Nasal polyps are the most common tumour of the nasal cavity. They are small sacs that grow from the mucosal lining of the nose and sinuses, and are most commonly found in the ethmoid sinus. Sometimes a number of polyps can grow at the same time (nasal polyposis).

Risks factors

The following risk factors may increase a person's chance of developing nasal polyps:

·         chronic inflammation of the nasal cavity and respiratory tract

·         asthma

·         hay fever

·         chronic sinus infections

·         cystic fibrosis – a genetic condition that causes severe lung and digestive problems.

Signs and symptoms

The signs and symptoms of nasal polyps may include:

·   nasal blockage

·         breathing through the mouth

·         nasal discharge

·         changes to or loss of sense of smell

·         taste changes

·         headache

·         sinus or facial pain

·         sleep apnea – breathing that stops or becomes very shallow during sleep

Diagnosis

If the signs and symptoms of nasal polyps are present, or if the doctor suspects a nasal polyp, tests will be done to make a diagnosis. Tests may include:

nasal endoscopy – examination of the nose with a light and mirror

computerized tomography (CT) scan of the sinuses

biopsy – may be done if the polyps have an unusual appearance or do not respond to treatment

Treatment

Treatment for nasal polyps is aimed at reducing allergic reactions and inflammation

Throat Cancer

What is Throat Cancer?

Cancer is a class of diseases in which abnormal cells multiply and divide uncontrollably in the body. These abnormal cells form malignant growths called tumors. Throat cancer refers to cancer of the voice box, the vocal cords, and other parts of the throat, such as the tonsils and the oropharynx.

Throat cancer is often grouped into two categories: pharyngeal cancer, which forms in the pharynx (the hollow tube that runs from behind your nose to the top of your windpipe) and laryngeal cancer, which forms in the larynx (your voice box).

Causes

Men are more likely to develop throat cancer than women, and the disease is more common in people over the age of 50. Certain lifestyle habits increase the risk of developing cancer of the throat. These include:

·         smoking

·         excessive alcohol consumption

·         vitamin A deficiency

·         exposure to asbestos

·         poor dental hygiene

There is also a connection between throat cancer and certain types of human papillomavirus infections (HPV). This is a sexually transmitted virus.

At your appointment, your doctor will ask about your symptoms and medical history. If you’ve been experiencing symptoms such as a sore throat, hoarseness, and persistent cough with no improvement and no other explanation, he or she may suspect throat cancer.

To check for throat cancer, your doctor will perform a laryngoscopy. This procedure gives your doctor a closer view of your throat. After you’re given a local anesthetic, your doctor inserts a long flexible tube down your throat, and uses a light and a mirror to examine your throat. If this test reveals abnormalities, your doctor may take a tissue sample from your throat (biopsy) and test the sample for cancer.

Your doctor can use a variety of tests to stage your throat cancer. Imaging tests like a CT scan or an MRI will allow your doctor to take a closer look at the chest, neck and head, giving him or her a better picture of the disease’s progression.

Treatment Options for Throat Cancer

There are different treatment options for throat cancer.

·         Surgery

·         Radiation Therapy

·         Chemotherapy

Meningitis

                                                                                            Meningitis

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord.

The swelling associated with meningitis often triggers the "hallmark" signs and symptoms of this condition, including headache, fever and a stiff neck.

Symptoms

The signs and symptoms that may occur in anyone older than age of 2 include:

·         Sudden high fever

·         Severe headache that isn't easily confused with other types of headache

·         Stiff neck

·         Vomiting or nausea with headache

·         Confusion or difficulty concentrating

·         Seizures

·         Sleepiness or difficulty waking up

·         Sensitivity to light

·         Lack of interest in drinking and eating

·         Skin rash in some cases, such as in meningococcal meningitis

Seek medical care right away if you or someone in your family has signs or symptoms of meningitis, such as:

·         Fever

·         Severe, unrelenting headache

·         Confusion

·         Vomiting

·         Stiff neck

Viral meningitis may improve without treatment, but bacterial meningitis is serious, can come on very quickly and requires prompt antibiotic treatment to improve the chances of a recovery. Delaying treatment for bacterial meningitis increases the risk of permanent brain damage or death. In addition, bacterial meningitis can prove fatal in a matter of days.

There's no way to know what kind of meningitis you or your child has without seeing your doctor and undergoing spinal fluid testing.

It's also important to talk to your doctor if a family member or someone you work with has meningitis. You may need to take medications to prevent an infection.

Causes

Meningitis usually results from a viral infection, but the cause may also be a bacterial infection. Less commonly, a fungal infection may cause meningitis. Because bacterial infections are the most serious and can be life-threatening, identifying the source of the infection is an important part of developing a treatment plan.

Other meningitis causes

Meningitis can also result from non-infectious causes, such as chemical reactions, drug allergies, some types of cancer and inflammatory diseases such as sarcoidosis.

Complications

The complications of meningitis can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including:

·         Hearing loss

·         Memory difficulty

·         Learning disabilities

·         Brain damage

·         Gait problems

·         Seizures

·         Kidney failure

·         Shock

·         Death

Tests and diagnosis

You or your child may undergo the following diagnostic tests:

Blood cultures, Imaging , Spinal tap (lumbar puncture)

Treatments and drugs

The treatment depends on the type of meningitis you or your child has.

Prevention

Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone who has the disease.

These steps can help prevent meningitis:

Wash your hands, Practice good hygiene, Stay healthy, Cover your mouth, Immunizations

Some forms of bacterial meningitis are preventable with the following vaccinations

Haemophilus influenzae type b (Hib) vaccine , Pneumococcal conjugate vaccine (PCV7) , Neisseria meningitidis serogroup B meningococcal vaccine (MenB) , Haemophilus influenzae type b and Neisseria meningitidis serogroups C and Y vaccine (Hib-MenCY). , Pneumococcal polysaccharide vaccine (PPSV) , Meningococcal conjugate vaccine (MCV4).

Article -3

Positive straight leg raising test secondary to conjoined lumbosacral nerve roots 

Figure  Axial and sagittal T2-weighted MRIs of lumbosacral spine

(A.a–D.a) Serial sagittal T2-weighted images of lumbar spine frommidline to periphery showing single nerve root splitting into left L4 and L5 nerve roots (arrows). (E.a)Right paramedian sagittal section showing normal location of nerve roots (arrows). (A.b–E.b) Axial T2-weighted images at L4-5 disk level showing “parallel sign” (arrowhead).

A 53-year-old man presented with low backache and left lower limb pain of 3 months’ duration, without radicular pain or lower limb weakness. Straight leg raising test was positive but the remainder of the neurologic examination was normal. His lumbosacral spine MRI revealed left L4 and L5 conjoined nerve roots (figure, A.a–D.a). The imaging was positive for sagittal“shoulder sign”(figure, A.a) and axial image“parallel sign”(figure, A.b), both favoring conjoined nerve roots.1 The absence of other neurologic signs with no imaging evidence of nerve root compression on the left suggests that the positive straight leg raising test was attributable to conjoined lumbosacral nerve roots.2

Kamble J. Harsha, MD, DM, Jain G. Panattil, MS, Mch

From the Departments of Neuroimageology and Interventional Neuroradiology (K.J.H.) and Neurosurgery (J.G.P.), Indo-American Hospital: Brain & Spine Centre, Chemmankary, Vaikom, India.

Author contributions: Dr. Harsha: MRI evaluation, drafting and revising the manuscript. Dr. Panattil: examination of the patient, reviewing the manuscript.

Study funding: No targeted funding reported.

Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Correspondence to Dr. Harsha: kjharsha@gmail.com

 1. Song SJ, Lee JW, Choi JY, et al. Imaging features suggestive of conjoined nerve root on routine  axial MRI. Skeletal Radiol 2008; 37:133–138.

 2. Lotan R, Al-Rashdi A, Yee A, Finkelstein J. Clinical features of conjoined lumbosacral nerve roots versus lumbar intervertebral disc herniations. Eur Spine J 2010;19:1094–1098.