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Ailmemts & Remedies Pediatric

Hydrocephalus

Definition:
Hydrocephalus (pronounced hi-dro-SEF-a-lus) is a potentially harmful build up of cerebrospinal fluid (CSF) in parts of the brain.
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Images from a patient with normal pressure hyd...
Images from a patient with normal pressure hydrocephalus (NPH) showing pulsations of CSF with heartbeat. (Photo credit: Wikipedia)

Cerebrospinal fluid (CSF)A clear fluid produced in the brain’s ventricular system – the four cavities in the brain. It travels throughout the brain and in the area outside the brain and spinal cord. It bathes and protects or cushions the brain and spinal cord.

Hydrocephalus literally means water (hydro) in the head (cephalus). It is sometimes called water on the brain. The “water” is actually cerebrospinal fluid. Cerebrospinal fluid is normally present in areas both inside and outside the brain.

Children with hydrocephalus have too much cerebrospinal fluid in the areas of the brain called ventricles.

Ventricles are four small cavities in the brain that produce cerebrospinal fluid (CSF). This fluid flows through the ventricles to the area around the brain and spinal cord.
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The ventricles store and circulate cerebrospinal fluid. Children with hydrocephalus may also have extra fluid in spaces between the brain and the skull called the  subarachnoid spaces

Subarachnoid spaces  are the spaces lie between the three membranes protecting the brain. Cerebrospinal fluid moves through these spaces. Delicate connective tissue extends across them.

When a child’s cerebrospinal fluid cannot flow or be reabsorbed properly, it builds up. This makes the ventricles bigger and puts pressure on the tissues of the brain

Hydrocephalus is sometimes present at birth, although it may develop later. About 1 out of 500 children is born with the disorder. The outlook if  some one has hydrocephalus depends on how quickly the condition is diagnosed and whether any underlying disorders are present.

Symptoms:
The signs and symptoms of hydrocephalus vary by age group and disease progression.

In infants, common signs and symptoms of hydrocephalus include:

*An unusually large head
*A rapid increase in the size of the head
*A bulging “soft spot” on the top of the head
*Vomiting
*Sleepiness
*Irritability
*Seizures
*Eyes fixed downward (sunsetting of the eyes)
*Developmental delay

In older children and adults, common signs and symptoms of hydrocephalus include:

*Headache followed by vomiting
*Nausea
*Blurred or double vision
*Eyes fixed downward (sunsetting of the eyes)
*Problems with balance, coordination or gait
*Sluggishness or lack of energy
*Slowing or regression of development
*Memory loss
*Confusion
*Urinary incontinence
*Irritability
*Changes in personality
*Impaired performance in school or work

Hydrocephalus produces different combinations of these signs and symptoms, depending on its cause, which also varies by age. For example, a condition known as normal pressure hydrocephalus, which mainly affects older people, typically starts with difficulty walking. Urinary incontinence often develops, along with a type of dementia marked by slowness of thinking and information processing.
Causes:
The cause of hydrocephalus is excess fluid buildup in the brain.

Our brain is the consistency of gelatin, and it floats in a bath of cerebrospinal fluid. This fluid also fills large open structures, called ventricles, which lie deep inside the brain. The fluid-filled ventricles help keep the brain buoyant and cushioned.

Cerebrospinal fluid flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain, where it’s absorbed into your bloodstream.

Keeping the production, flow and absorption of cerebrospinal fluid in balance is important to maintaining normal pressure inside your skull. Hydrocephalus results when the flow of cerebrospinal fluid is disrupted — for example, when a channel between ventricles becomes narrowed — or when your body doesn’t properly absorb this fluid.

Defective absorption of cerebrospinal fluid causes normal pressure hydrocephalus, seen most often in older people. In normal pressure hydrocephalus, excess fluid enlarges the ventricles but does not increase pressure on the brain. Normal pressure hydrocephalus may be the result of injury or illness, but in many cases the cause is unknown.

Risk Factors:
Premature infants have an increased risk of severe bleeding within the ventricles of the brain (intraventricular hemorrhage), which can lead to hydrocephalus.

Certain problems during pregnancy may increase an infant’s risk of developing hydrocephalus, including:

*An infection within the uterus
*Problems in fetal development, such as incomplete closure of the spinal column

Congenital or developmental defects not apparent at birth also can increase older children’s risk of hydrocephalus.

Other factors that increase your risk of hydrocephalus include:

*Lesions or tumors of the brain or spinal cord
*Central nervous system infections
*Bleeding in the brain
*Severe head injury

Complications:
The severity of hydrocephalus depends on the age at which the condition develops and the course it follows. If the condition is well advanced at birth, major brain damage and physical disabilities are likely. In less severe cases, with proper treatment, it’s possible to have a nearly normal life span and intelligence

Diagnosis:
Doctors will examine the child, looking for signs of hydrocephalus. They may also use techniques to monitor pressure inside your baby’s head. Doctors also use imaging tests to see signs of hydrocephalus. These tests include:

*CT scan (computerized tomography) of the head
*MRI (magnetic resonance imaging)

If the child has hydrocephalus, doctors may use ultrasound images of the brain to monitor the condition.
Treatment:
To treat hydrocephalus, doctors try to improve the flow of cerebrospinal fluid. Most often, they use surgery to do this.
Surgery:
Neurosurgeons most often perform three types of operations for hydrocephalus.

1.Shunts
The most common surgery for hydrocephalus is putting in a shunt.

A shunt is a small tube (catheter) that drains extra cerebrospinal fluid from a ventricle in your child’s brain to another area in the body. There, the fluid is either reabsorbed by your child’s body or passed out through the kidneys.

Neurosurgeons place one end of the small tube in the ventricle where extra fluid is causing problems. A valve in the tube controls the amount of fluid that runs through it. This controls the pressure in your child’s head. It also makes sure that the fluid flows in only one direction, away from the brain.
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The three areas a VP shunt can be placed in the head
The tube is placed under the skin and drains the fluid to another area of the body. The end of the tube most often is placed in the belly (abdomen). This is called a ventricular to peritoneal shunt. If the abdomen is not suitable for the tube, it may be placed in the heart (ventricular to atrial shunt), chest, or other areas. No matter where the tube ends, the fluid from the brain is reabsorbed by the body.

Placement of a VP shunt from the head to the belly.
Our neurosurgeons choose from many different types of shunts and valves, depending on your child’s needs. In some cases, they use a valve that can be adjusted from the outside by a small magnet. If your child has an MRI, these types of valves must always be reset immediately by one of our neurosurgery nurse practitioners.

2.Endoscopy:
An endoscope is a thin, flexible tube that carries a light and a camera. Surgeons can use it to see inside the body and perform some operations. Endoscopy requires smaller cuts (incisions) than other types of surgery (open surgery). It is a minimally invasive technique. Neurosurgeons use it to treat some types of hydrocephalus.

The approach made by an endoscope to make a hole in the ventricle so that the patient can avoid needing a shunt.
Some children have a complex type of the condition called multiloculated hydrocephalus. This happens when bleeding or infection causes scars within the ventricles of the brain. The scaring causes many small compartments of spinal fluid that do not connect with each other to develop.

In the past, doctors treated this condition by placing a separate shunt in each area with fluid and draining it. But by using an endoscope, they can make small holes in each of the areas. This connects them so they need only one shunt to drain the entire system.

3.Endoscopic third ventriculostomy (ETV)
Depending on your child’s brain structures and age, the neurosurgeon may talk with you about using an ETV instead of putting in a shunt.

During an ETV, the neurosurgeon makes a small hole in your child’s skull. Then the neurosurgeon uses an endoscope to reach the third ventricle in brain. Using the endoscope, the neurosurgeon makes a hole in the ventricle. This lets the extra fluid drain out and be reabsorbed.

An ETV lets neurosurgeons avoid putting in any permanent hardware, such as a shunt. Such a treatment may avoid the complications of using shunt hardware. But the treatment may fail and a shunt may be needed.

This video, developed by Anthony M. Avellino, MD, shows an example of an endoscopic third ventriculostomy procedure for treatment of obstructed hydrocephalus.

Prevention:

To reduce the risk of hydrocephalus:

*If you’re pregnant, get regular prenatal care. Following your doctor’s recommended schedule for checkups during pregnancy can reduce your risk of premature labor, which places your baby at risk of hydrocephalus and other complications.

*Protect against infectious illness. Follow the recommended vaccination and screening schedules for your age and sex. Preventing and promptly treating the infections and other illnesses associated with hydrocephalus may reduce your risk.

To prevent head injury:

*Use appropriate safety equipment. For babies and children, use a properly installed, age- and size-appropriate child safety seat on all car trips. Make sure all your baby equipment — crib, stroller, swing, highchair — meets all safety standards and is properly adjusted for your baby’s size and development. Older children and adults should wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle.

*Always wear a seat belt in a motor vehicle. Small children should be secured in child safety seats or booster seats. Depending on their size, older children may be adequately restrained with seat belts.

Should you be vaccinated against meningitis?

Ask your doctor if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. A meningitis vaccine is now recommended for people ages 2 and older who are at increased risk of this disease due to:

*Traveling to countries where meningitis is common

*Having an immune system disorder called terminal complement deficiency

*Having a damaged spleen or having had your spleen removed

*Living in a dormitory as a college freshman

*Joining the military

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

Click to access What-is-ETV.pdf

http://en.wikipedia.org/wiki/Hydrocephalus
http://trialx.com/curebyte/2011/06/01/hydrocephalus-photos/
http://www.mayoclinic.com/health/hydrocephalus/DS00393

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Memory Foggy? 5 Signs It’s Not Serious

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It’s natural to feel nervous when you forget something, knowing that Alzheimer’s disease now affects 5.3 million Americans.  But a memory slip doesn’t always mean the worst. According to KPHO, the following five situations point toward normal, age-related memory loss.

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1.Lapses Don’t Interfere With Everyday Life
Slowed recall of information from time to time is normal — erverybody forgets stuff.  What’s not normal is when memory impairment interferes with your ability to get through the day.

2.You See an Improvement After ‘Brain Training’
Dementia is not a problem of retrieving old memories so much as it is is an inability to form new ones. If you can still learn new things, you’re still forming new memories.

3.You’ve Just Started A New Medication
Drug side effects are one of the more common causes of memory trouble.

4.Nobody Else Seems To Notice Anything’s Amiss
Usually, there’s a lot of family friction around the kind of memory loss that predates a diagnosis — arguments over who neglected to do something, missed appointments, or forgotten messages.

5.You’re Forgetful When Stressed, Sleep Deprived or Multitasking
A stressed brain is not the same thing as a demented brain.

Source: KPHO December 9, 2010

Posted By:  Dr. Mercola | December 30 2010

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Vitamin B Found to Halve brain Shrinkage in Old Age

 

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High doses of vitamine B can halve the rate of brain shrinkage in elderly people with memory problems. It may slow their progression toward dementia.

A two-year clinical trial was the largest to date into the effect of B vitamins on “mild cognitive impairment,” a condition which is a major risk factor for Alzheimer’s disease and other forms of dementia.

Reuters reports:
“[Researchers] conducted a two-year trial with 168 volunteers with MCI who were given either a vitamin pill containing very high doses of folic acid, vitamin B6 and vitamin B12, or a placebo dummy pill …

[O]n average the brains of those taking the vitamin treatment shrank at a rate of 0.76 percent a year, while those taking the dummy pill had an average brain shrinkage of 1.08 percent.”

Resources:
Reuters September 8, 2010
Los Angeles Times September 9, 2010

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Alzheimer’s Disease Drug

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Introduction:-
This public information leaflet provides information about drugs used to treat Alzheimer’s disease. It discusses how the drugs work, why they are prescribed, their side effects and alternative treatments. Alzheimer’s disease is only one of many possible causes for memory problems in people. The other causes are described in detail in our Help is at Hand leaflet, ‘Memory and Dementia’.

Cholinesterase Inhibitors
What are Cholinesterase inhibitors?
These are the main drugs used for Alzheimer’s disease in the United Kingdom. Three drugs are currently licensed:

Drug name….Donepezil.       Other name ….Aricept

Drug Name….Galantamine   Other Name.… Reminyl

Drug Name.…Rivastigmine  Other Name.... Exelon

There are no major differences between these drugs. They are all designed to alleviate certain symptoms of Alzheimer’s disease – for example, memory loss, apathy and anxiety. They are not a cure, though there is some evidence that they may slow the course of the illness.

What effect can these drugs have?
They can improve memory, particularly remembering new information and recall of old information. They can also have general benefits including improving alertness and motivation. It may take some months of treatment for there to be a noticeable improvement or slowing down of memory loss. Some people report improved mood and will be able to perform tasks which they had forgotten how to do such as going shopping.

What side effects are there?
The most common side effects of these drugs are nausea, loss of appetite, tiredness, diarrhoea, muscle cramps and sometimes poor sleep. These may be reduced or avoided by increasing the dose slowly, or taking the medicine after food. The side effects usually fade after a few weeks and will go away if the medicine is stopped. More information about side effects can be obtained from the doctor prescribing the treatment or by reading the leaflet that comes with the prescription.

How do they work?
Acetylcholine is a chemical that is involved in the transmission of information between certain brain cells involved in memory. In Alzheimer’s disease, these brain cells start to die and the amount of acetylcholine available to pass messages between cells is very much reduced. Memory starts to suffer. Cholinesterase Inhibitors reduce the destruction of acetylcholine and increases its levels in the brain. The increase in the amount and effectiveness of acetylcholine reduces some of the effects of Alzheimer’s disease.

How well do they work?
Research has shown that about 50-60% of people who have taken these drugs show a slight improvement or a stabilisation of their condition over a period of six months. However, in the longer term, it is not known whether the effect of these drugs will be temporary or whether they will slow the rate of decline over a longer period of time. Unfortunately not everyone benefits from these medicines, and if no improvement or stabilisation is seen in the first few months, it is recommended that they are stopped. In Britain the National Institute for Health and Clinical Excellence (NICE) has decided that these drugs are not cost effective in the early stages of Alzheimer’s Dementia and should only be given to people in moderate stages of the illness. Many people are unhappy about this decision.

How should these drugs be taken?
It is usual to start on a low dose which is gradually increased. Don’t be put off by any side effects early on in the treatment as these usually wear off after a few weeks. It is important to take the drugs every day for them to be effective.

How long should these drugs be taken?
These drugs are usually prescribed for a trial period of three to four months. If the doctor decides they are not working, he or she will recommend stopping them. If these drugs do work, there is currently no clear consensus as to how long they should continue to be prescribed. People with Alzheimer’s disease are often given a memory test called the ‘Mini Mental State Examination‘ (MMSE). Current guidelines suggest that these drugs should only be used for moderate dementia which equates to an MMSE score of between 10 and 20 out of 30. However, there is some evidence that these drugs work in earlier and later stages of the illness.

Who can prescribe these drugs?
A specialist, rather than your GP, will prescribe the medicine during the trial period. You will usually see the specialist in a hospital clinic. You may need blood tests and a brain scan to exclude any other causes for the memory loss. In some areas the specialist will continue to prescribe the drug if they conclude that it is working. In other areas the specialist may continue assessing its effectiveness but ask that the family doctor prescribes it.

Memantine
This drug, which is also known as Ebixa, has been used to treat dementia in Germany since 1989. It is thought to work by affecting glutamate, a brain chemical which is involved in learning and memory 3. In Alzheimer’s disease too much glutamate leaks out of damaged brain cells and this interferes with learning and memory. In the studies completed so far just over half the people taking Memantine show some slowing down in the progression of the dementia but this effect has only been demonstrated so far in people with more severe dementia. The main side effects of Memantine, which are usually mild, are nausea, restlessness, stomach-ache and headache.

More studies are being undertaken to see how effective it is and how the drug can best be used. NICE has issued guidance that Memantine should not be routinely prescribed in Britain due to doubts about its cost effectiveness.
Other Treatments:-

Ginkgo biloba
This is a naturally occurring substance extracted from the Maidenhair tree. It has long been thought to enhance memory.

A recent study looked at the effects of Ginkgo in over 3000 people taking it for an average of 6 years. Unfortunately Ginkgo did not stop dementia developing and in a small number of people with heart problems it actually seemed to make their dementia worse.

Vitamin E
This is a natural substance found in oils from soya beans, sunflower seeds, corn and cotton seed, as well as whole-grain foods, fish-liver oils and nuts. Vitamin E has various functions in the body and acts as a natural anti-oxidant. Vitamin E deficiencies are very rare.

Some studies suggest that taking Vitamin E can slow the progression of Alzheimer’s disease. However, further research needs to be done to establish its place in the treatment of Alzheimer’s disease. It can interfere with blood clotting and should be used with caution in people with a clotting disorder and on oral anticoagulants, although it can be used with aspirin.

In 2004 a review of studies involving a total of over 136,000 patients suggested that people taking over 400 units a day may be at a small increased risk of harm. Some experts are therefore suggesting that not more than 200 units a day should be taken.

There is some evidence that a diet rich in natural Vitamin E may reduce the risk of developing Alzheimer’s disease.

Selegeline
This is a drug that is normally used in Parkinson’s disease. It is also thought to work as an anti-oxidant but has more possible side effects than the use of Vitamin E, including lowering of blood pressure, nausea, dizziness or vivid dreams. Some studies suggest it may slow the progression of Alzheimer’s but further research is needed.

Other therapies:-
Other drugs and therapies are being investigated for Alzheimer’s disease. Developments in this field are rapid and encouraging. It is important to be wary of claims for any new drugs or therapies you read about in the media. Advice should always be sought from your family doctor, specialist or a national organisation such the Alzheimer’s Society.

Dementia can be a great burden for carers and loved ones. Their health and well-being is also vital. Further information about ways in which they can help and be supported can be found in our Memory and Dementia leaflet.

Sources: http://www.rcpsych.ac.uk/mentalhealthinfoforall/olderpeople/drugtreatmentofalzheimers.aspx

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Amnesia

Amnesia is a term used to cover the partial or complete loss of memory. It is most often a temporary condition and covers only a part of a person’s experience, such as immediate memory. The causes of amnesia range from psychological trauma to brain damage caused by a blow to the head or conditions such as a brain tumour, a stroke or swelling of the brain. There are many definitions covering the different types of amnesia.

click & see the pictures

There are several types of Amnesia, some of the main types are:
Anterograde amnesia: People who find it hard to remember ongoing events after suffering damage to the head. They do not tend to forget their childhood or who they are, but have trouble remembering day-to-day events.

Retrograde amnesia: People who find it hard to retrieve memories prior to an incident in which they suffer damage to the head. Sometimes people never remember the seconds leading up to the incident.

Korsakoff’s psychosis: Memory loss caused by alcohol abuse. The person’s short-term memory may be normal, but they will have severe problems recalling a simple story, lists of unrelated words, faces and complex patterns.

This tends to be a progressive disorder and is usually accompanied by neurological problems, such as uncoordinated movements and loss of feeling in the fingers and toes. If these symptoms occur, it may be too late to stop drinking.

Traumatic amnesia: This follows brain damage caused by a severe non-penetrative blow to the head, such as in a road accident. It can lead to anything from a loss of consciousness for a few seconds to coma.

Infantile/childhood amnesia: This refers to a person’s inability to recall events from early childhood. There are many theories on this, for example, Freud put it down to sexual repression. Others say it could be linked to language development or the fact that some areas of the brain linked to memory are not fully mature.

Hysterical amnesia (also known as fugue amnesia): This covers episodes of amnesia linked to psychological trauma. It is usually temporary and can be triggered by a traumatic event with which the mind finds it difficult to deal. Usually, the memory slowly or suddenly comes back a few days later, although memory of the trauma may remain incomplete.
The Most Comon Causes:
Amnesia is most commonly associated with either brain damage through injury or degeneration of brain cells in dementia. In both cases, brain cells are lost, and due to the complex network connecting cells within the human brain, they cannot be replaced. Most significant brain damage occurs when the brain is injured, such as in a car accident or as the result of a fall or blow. These traumas tend to cause a state of confusion, and some memory is often lost.

Infections that affect the brain, such as herpes or encephalitis may also cause memory loss. Severe alcohol or drug abuse, and malnutrition, act to deprive the brain of nutrients causing the death of brain cells. This can also cause significant loss of memories. Memory loss may sometimes result from stroke, if it affects the area of the brain concerned with memory functions.

Diagonises and Treatment:
The process of diagnosing the cause of amnesia involves conducting a series of tests. Anyone experiencing unexplained memory loss should consult their GP. If you suffer an accident that involves a blow to the brain, you should go to hospital immediately.

A mental health professional will want to take a careful personal history.

Causes of amnesia can include:
External trauma, such as a blow to the head
Internal trauma, such as stroke
Exposure to a toxic substances such as carbon monoxide
Inadequate diet
Brain tumors
Seizures
There are no laboratory tests that are necessary to confirm amnesia nor are there any physical conditions that must be met. However, it is very important not to overlook a physical illness that might mimic or contribute to amnesia. If there is any doubt about a medical problem, the mental health professional should refer to a physician, who will perform a complete physical examination and request any necessary laboratory tests.

Very sophisticated psychological testing, called neuropsychological testing, can be very helpful in determining the presence of amnesia. Sometimes the diagnosis of amnesia can be aided by the use of brain scans such as the magnetic resonance imaging (MRI).
Treatment varies according to the type of amnesia and the suspected cause.

Once brain cells die, they cannot be replaced. Depending on the cause of the amnesia, the brain may be able to recover many of its previous faculties, or may simply get worse. Those who have suffered brain loss as a result of an injury may see some improvement over time, as the brain attempts to heal itself. However, those whose amnesia is a symptom of a degenerative illness, such as Alzheimer’s disease, are unlikely to see an improvement.

Some forms of therapy have proven useful to amnesiacs in helping them to cope with their loss. Cognitive therapies in particular can help people regain skills that they have lost through amnesia.

Psychotherapy can be helpful for people whose amnesia is caused by emotional trauma. For instance, hypnosis may help some patients/clients recall forgotten memories.

Sometimes it is appropriate to administer a drug called Amytal (sodium amobarbital) to people suffering from amnesia. The medicine helps some people recall their lost memories. The use of hypnosis or Amytal has become controversial when it is used to help a patient recall repressed memories, especially repressed memories associated with sexual abuse. After recalling memories of abuse, some patients have filed suit against the alleged perpetrator of the sexual abuse. The validity of memories recalled under these treatment situations is being questioned and tested in the courts.

Hospitalization is usually not necessary to treat amnesia unless the person is at risk for harming himself/herself.

Ayurvedic & Herbal Remedy for Amnisia

Prognosis :
The course of the amnesia is variable depending upon the cause of the memory problem. By removing the toxic substance, for instance alcohol, the person’s memory will recover within hours. However, if the brain has been severely injured, it may take weeks, months, or years for recovery to occur. In some instances, the amnesia never goes away.

Therefore, the prognosis depends upon the extent of the brain trauma. If an ingested substance caused the memory loss and the body can rid itself of the offending substance without causing permanent brain injury, the prognosis is quite good. However, once the brain is damaged it may be very slow to heal, and therefore, the prognosis can be quite poor.

Anyone suffering from or having any symptoms of amnesia should seek immediate medical attention.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

References:

http://www.athealth.com/Consumer/disorders/Amnesia.html
http://www.medicalnewstoday.com/medicalnews.php?newsid=9673
http://news.bbc.co.uk/2/hi/health/medical_notes/167771.stm

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