Categories
Ailmemts & Remedies

Meniere’s Disease

Definition:
Ménière’s disease is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo — a sensation of a spinning motion — along with fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear. In most cases, Meniere’s disease affects only one ear.
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People in their 40s and 50s are more likely than people in other age groups to develop Meniere’s disease, but it can occur in anyone, even children.
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Although Meniere’s disease is considered a chronic condition, there are various treatment strategies that can help relieve symptoms and minimize the disease’s long-term impact on your life.

It is named after the French physician Prosper Ménière, who, in an article published in 1861, first reported that vertigo was caused by inner ear disorders. The condition affects people differently; it can range in intensity from being a mild annoyance to a chronic, lifelong disability

Symptoms:
The symptoms of Ménière’s are variable; not all sufferers experience the same symptoms. However, so-called “classic Ménière’s” is considered to have the following four symptoms:
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*Periodic episodes of rotary vertigo or dizziness.

*Fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, usually in lower frequencies.

*Unilateral or bilateral tinnitus.

*A sensation of fullness or pressure in one or both ears.

Ménière’s often begins with one symptom, and gradually progresses. However, not all symptoms must be present for a doctor to make a diagnosis of the disease.  Several symptoms at once is more conclusive than different symptoms at separate times.

Attacks of rotational vertigo can be severe, incapacitating, and unpredictable and can last anywhere from minutes to hours,  but generally no longer than 24 hours. For some sufferers however, prolonged attacks can occur, lasting from several days to several weeks, often causing the sufferer to be severely incapacitated. This combines with an increase in volume of tinnitus and temporary, albeit significant, hearing loss. Hearing may improve after an attack, but often becomes progressively worse. Nausea, vomiting, and sweating sometimes accompany vertigo, but are symptoms of vertigo, and not of Ménière’s.

Some sufferers experience what are informally known as “drop attacks”—a sudden, severe attack of dizziness or vertigo that causes the sufferer, if not seated, to fall without warning. Drop attacks are likely to occur later in the disease, but can occur at any time.[10] Patients may also experience the feeling of being pushed or pulled. Some patients may find it impossible to get up for some time, until the attack passes or medication takes effect.

In addition to hearing loss, sounds can appear tinny or distorted, and patients can experience unusual sensitivity to noises.

Some sufferers also experience nystagmus, or uncontrollable rhythmical and jerky eye movements, usually in the horizontal plane, reflecting the essential role of non-visual balance in coordinating eye movements

Migraine:
There is an increased prevalence of migraine in patients with Ménière’s disease.  As well, migraine leads to a greater susceptibility of developing Ménière’s disease. The distinction between migraine-associated vertigo and Ménière’s is that migraine-associated vertigo may last for more than 24 hours

Causes:
Ménière’s disease is idiopathic, but it is believed to be linked to endolymphatic hydrops, an excess of fluid in the inner ear.

he inner ear is a cluster of connected passages and cavities called a labyrinth. The outside of the inner ear is made of bone (bony labyrinth). Inside is a soft structure of membrane (membranous labyrinth) that’s a slightly smaller, similarly shaped version of the bony labyrinth. The membranous labyrinth contains a fluid (endolymph) and is lined with hair-like sensors that respond to movement of the fluid.

In order for all of the sensors in the inner ear to function properly, the fluid needs to retain a certain volume, pressure and chemical composition. Factors that alter the properties of inner ear fluid may help cause Meniere’s disease. Scientists have proposed a number of potential causes or triggers, including:

*Improper fluid drainage, perhaps because of a blockage or anatomic abnormality

*Abnormal immune response

*Allergies

*Viral infection

*Genetic predisposition

*Head trauma

Because no single cause has been identified, it’s likely that Meniere’s disease is caused by a combination of factors.

Complications:
The unpredictable episodes of vertigo are usually the most debilitating problem of Meniere’s disease. The episodes often force a person to lie down for several hours and lose time from work or leisure activities, and they can cause emotional stress.

Vertigo can also increase your risk of:

*Falls

*Accidents while driving a car or operating heavy machinery

*Depression or anxiety in dealing with the disease

*Permanent hearing loss

Diagnosis:
Doctors establish a diagnosis with complaints and medical history. However, a detailed otolaryngological examination, audiometry and head MRI scan should be performed to exclude a vestibular schwannoma or superior canal dehiscence which would cause similar symptoms. There is no definitive test for Ménière’s, it is only diagnosed when all other causes have been ruled out. If any cause had been discovered, this would eliminate Ménière’s disease, as by its very definition,  as an exclusively idiopathic disease, it has no known causes.

Treatment:
Because Ménière’s cannot be cured, treatments focus more on addressing symptoms. In extreme cases, it is necessary to destroy vestibular hair cells with the antibiotic streptomycin or to remove the affected labyrinth surgically in order to relieve severe vertigo. Patients are sometimes treated by the insertion of a shunt that diverts excess endolymph directly to the cerebrospinal fluid, a procedure that is not always effective. Typical remedies to improve symptoms may include:

*Antihistamines considered antiemetics such as meclozine and dimenhydrinate

*Antiemetic drugs such as trimethobenzamide.

*Antivertigo/antianxiety drugs such as betahistine and diazepam.

*Herbal remedies such as ginger root

Coping:
Sufferers tend to have high stress and anxiety due to the unpredictable nature of the disease. Healthy ways to combat this stress can include aromatherapy, yoga, T’ai chi., and meditation.

Surgery:
If symptoms do not improve with typical treatment, more permanent surgery is considered.  Unfortunately, because the inner ear deals with both balance and hearing, few surgeries guarantee no hearing loss.

Nondestructive:
Nondestructive surgeries include those which do not actively remove any functionality, but rather aim to improve the way the ear works.

Intratympanic steroid treatments involve injecting steroids (commonly dexamethasone) into the middle ear in order to reduce inflammation and alter inner ear circulation.

Surgery to decompress the endolymphatic sac has shown to be effective for temporary relief from symptoms. Most patients see a decrease in vertigo occurrence, while their hearing may be unaffected. This treatment, however, does not address the long-term course of vertigo in Ménière’s disease.  Danish studies even link this surgery to a very strong placebo effect, and that very little difference occurred in a 9-year followup, but could not deny the efficacy of the treatment

Destructive
Destructive surgeries are irreversible, and involve removing entire functionality of most, if not all, of the affected ear.

The inner ear itself can be surgically removed via labyrinthectomy. Hearing is always completely lost in the affected ear with this operation. Alternatively, a chemical labyrinthectomy, in which a drug (such as gentamicin) that “kills” the vestibular apparatus is injected into the middle ear can accomplish the same results while retaining hearing.

Alternatively, surgeons can cut the nerve to the balance portion of the inner ear in a vestibular neurectomy. Hearing is often mostly preserved, however the surgery involves cutting open into the lining of the brain, and a hospital stay of a few days for monitoring would be required.

Vertigo (and the associated nausea and vomiting) typically accompany the recovery from destructive surgeries as the brain learns to compensate

Physiotherapy:
Physiotherapists also have a role in the management of Meniere’s disease. In vestibular rehabilitation, physiotherapists use interventions aimed at stabilizing gaze, reducing dizziness and increasing postural balance within the context of activities of daily living. After a vestibular assessment is conducted, the physiotherapist tailors the treatment plan to the needs of that specific patient.

The central nervous system (CNS) can be re-trained because of its plasticity, or alterability, as well as its repetitious pathways. During vestibular rehabilitation, physiotherapists take advantage of this characteristic of the CNS by provoking symptoms of dizziness or unsteadiness with head movements while allowing the visual, somatosensory and vestibular systems to interpret the information. This leads to a continuous decrease in symptoms.

Although a significant amount of research has been done regarding vestibular rehabilitation in other disorders, substantially less has been done specifically on Meniere’s disease. However, vestibular physiotherapy is currently accepted as part of best practices in the management of this condition

Prognosis:
Ménière’s disease usually starts confined to one ear, but it often extends to involve both ears over time. The number of patients who end up with bilaterial Ménière’s is debated, with ranges spanning from 17% to 75%.

Some Ménière’s disease sufferers, in severe cases, may end up losing their jobs, and will be on disability until the disease burns out.  However, a majority (60-80%) of sufferers will not need permanent disability and will recover with or without medical help.

Hearing loss usually fluctuates in the beginning stages and becomes more permanent in later stages, although hearing aids and cochlear implants can help remedy damage.  Tinnitus can be unpredictable, but patients usually get used to it over time.

Ménière’s disease, being unpredictable, has a variable prognosis. Attacks could come more frequently and more severely, less frequently and less severely, and anywhere in between.  However, Ménière’s is known to “burn out” when vestibular function has been destroyed to a stage where vertigo attacks cease.

Studies done on both right and left ear sufferers show that patients with their right ear affected tend to do significantly worse in cognitive performance.   General intelligence was not hindered, and it was concluded that declining performance was related to how long the patient had been suffering from the disease

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:
http://en.wikipedia.org/wiki/M%C3%A9ni%C3%A8re’s_disease
http://www.mayoclinic.com/health/menieres-disease/DS00535

http://www.dizziness-and-balance.com/disorders/menieres/menieres.html

http://www.360balance.com/hydrops.html

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Ailmemts & Remedies Pediatric

Concussion

Alternative Names :Mild brain injury, Mild traumatic brain injury (MTBI), mild head injury (MHI), minor head trauma

Definition:
A concussion is a traumatic brain injury that is caused by a sudden blow to the head or to the body. The blow shakes the brain inside the skull, which temporarily prevents the brain from working normally.Effects are usually temporary, but can include problems with headache, concentration, memory, judgment, balance and coordination.

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Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don’t realize it.

Concussions are common, particularly if you play a contact sport, such as football, boxing etc. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Luckily, most concussive traumatic brain injuries are mild, and with rest, most people fully recover from concussions within a few hours to a few weeks.

On rare occasions, concussions cause more serious problems. Repeated concussions or a severe concussion may require surgery or lead to long-lasting problems with movement, learning, or speaking. Because of the small chance of permanent brain problems, it is important to contact a doctor if you or someone you know has symptoms of a concussion.

Symptoms:
It is not always easy to know if someone has a concussion. Not everyone who has a concussion passes out. A person who might have a concussion should immediately stop any kind of activity or sport. Becoming active again before the brain returns to normal functioning increases the person’s risk of having a more serious brain injury.

Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months. If you notice any symptoms of a concussion, contact your doctor.

Symptoms of a concussion include:
*Passing out.
*Not being able to remember what happened after the injury.
*Acting confused, asking the same question over and over, slurring words, or not being able to concentrate.
*Feeling lightheaded, seeing “stars,” having blurry vision, or experiencing ringing in the ears.
*Not being able to stand or walk; or having coordination and balance problems.
*Feeling nauseous or throwing up.

Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they can’t readily communicate how they feel. Nonverbal clues of a concussion may include:
*Listlessness, tiring easily
*Irritability, crankiness
*Change in eating or sleeping patterns
*Lack of interest in favorite toys
*Loss of balance, unsteady walking

Occasionally a person who has a more serious concussion develops new symptoms over time and feels worse than he or she did before the injury. This is called post-concussive syndrome. If you have symptoms of post-concussive syndrome, call your doctor. Symptoms of post-concussive syndrome include:

*Changes in your ability to think, concentrate, or remember.
*Headaches or blurry vision.
*Changes in your sleep patterns, such as not being able to sleep or sleeping all the time.
*Changes in your personality such as becoming angry or anxious for no clear reason.
*Lack of interest in your usual activities.
*Changes in your sex drive.
*Dizziness, lightheadedness, or unsteadiness that makes standing or walking difficult.

Causes:
Your brain is a soft organ that is surrounded by spinal fluid and protected by your hard skull. Normally, the fluid around your brain acts like a cushion that keeps your brain from banging into your skull. But if your head or your body is hit unexpectedly hard, your brain can suddenly crash into your skull and temporarily stop working normally.

There are many ways to get a concussion. Some common ways include fights, falls, playground injuries, car crashes, and bike accidents. Concussions can also happen while participating in rough or high-speed sports such as football, boxing, hockey, soccer, skiing, or snowboarding.

Risk Factors:
Factors that may increase your risk of a concussion include:

*Participating in a high risk sport, such as football, hockey, soccer or other contact sport; the risk is further increased if there’s a lack of proper safety equipment and supervision
*Being involved in a motor vehicle collision
*Being a soldier involved in combat
*Being a victim of physical abuse
*Falling, especially in young children and older adults
*Having had a previous concussion

Complications:
Potential complications of concussion include:

*Epilepsy. People who have had a concussion double their risk of developing epilepsy within the first five years after the injury.

*Cumulative effects of multiple brain injuries. Evidence exists indicating that people who have had multiple concussive brain injuries over the course of their lives may acquire lasting, and even progressive, cognitive impairment that limits functional ability.

*Second impact syndrome. Sometimes, experiencing a second concussion before signs and symptoms of a first concussion have resolved may result in rapid and typically fatal brain swelling. After a concussion, the levels of brain chemicals are altered. It usually takes about a week for these levels to stabilize again. However, the time it takes to recover from a concussion is variable, and it is important for athletes never to return to sports while they’re still experiencing signs and symptoms of concussion.
Diagnosis:
Diagnosis of Concussion is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia (PTA; usually less than 24 hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15). Neuropsychological tests exist to measure cognitive function. The tests may be administered hours, days, or weeks after the injury, or at different times to determine whether there is a trend in the patient’s condition. Athletes may be tested before a sports season begins to provide a baseline comparison in the event of an injury.

Health care providers examine head trauma survivors to ensure that the injury is not a more severe medical emergency such as an intracranial hemorrhage. Indications that screening for more serious injury is needed include worsening of symptoms such as headache, persistent vomiting, increasing disorientation or a deteriorating level of consciousness,   seizures, and unequal pupil size. People with such symptoms, or who are at higher risk for a more serious brain injury, are CT scanned to detect brain lesions and are frequently observed for 24 – 48 hours.

If the Glasgow Coma Scale is less than 15 at two hours or less than 14 at any time a CT recommended.[8] In addition, they may be more likely to perform a CT scan on people who would be difficult to observe after discharge or those who are intoxicated, at risk for bleeding, older than 60, or younger than 16. Most concussions cannot be detected with MRI or CT scans.   However, changes have been reported to show up on MRI and SPECT imaging in concussed people with normal CT scans, and post-concussion syndrome may be associated with abnormalities visible on SPECT and PET scans. Mild head injury may or may not produce abnormal EEG readings.

Concussion may be under-diagnosed. The lack of the highly noticeable signs and symptoms that are frequently present in other forms of head injury could lead clinicians to miss the injury, and athletes may cover up their injuries to remain in the competition. A retrospective survey in 2005 found that more than 88% of concussions go unrecognized;.

Diagnosis of concussion can be complicated because it shares symptoms with other conditions. For example, post-concussion symptoms such as cognitive problems may be misattributed to brain injury when they are in fact due to post-traumatic stress disorder (PTSD).

Treatment:
Usually concussion symptoms go away without treatment, and no specific treatment exists. About one percent of people who receive treatment for MTBI need surgery for a brain injury. Traditionally, concussion sufferers are prescribed rest, including plenty of sleep at night plus rest during the day. Health care providers recommend a gradual return to normal activities at a pace that does not cause symptoms to worsen. Education about symptoms, how to manage them, and their normal time course can lead to an improved outcome.

Medications may be prescribed to treat symptoms such as sleep problems and depression. Analgesics such as ibuprofen can be taken for the headaches that frequently occur after concussion, but paracetamol (acetaminophen) is preferred to minimize the risk for complications such as intracranial hemorrhage. Concussed individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor, as they could impede healing.

Observation to monitor for worsening condition is an important part of treatment. Health care providers recommend that those suffering from concussion return for further medical care and evaluation 24 to 72 hours after the concussive event if the symptoms worsen. Athletes, especially intercollegiate or professional athletes, are typically followed closely by team trainers during this period. But others may not have access to this level of health care and may be sent home with no medical person monitoring them unless the situation gets worse. Patients may be released from the hospital to the care of a trusted person with orders to return if they display worsening symptoms or those that might indicate an emergent condition, like unconsciousness or altered mental status; convulsions; severe, persistent headache; extremity weakness; vomiting; or new bleeding or deafness in either or both ears. Repeated observation for the first 24 hours after concussion is recommended; however it is not known whether it is necessary to wake the patient up every few hours.

Prognosis:
Concussion has a mortality rate of almost zero. The symptoms of most concussions resolve within weeks, but problems may persist. Problems are seldom permanent, and outcome is usually excellent. People over age 55 may take longer to heal from MTBI or may heal incompletely. Similarly, factors such as a previous head injury or a coexisting medical condition have been found to predict longer-lasting post-concussion symptoms. Other factors that may lengthen recovery time after MTBI include psychological problems such as substance abuse or clinical depression, poor health before the injury or additional injuries sustained during it, and life stress.  Longer periods of amnesia or loss of consciousness immediately after the injury may indicate longer recovery times from residual symptoms. For unknown reasons, having had one concussion significantly increases a person’s risk of having another. Having previously sustained a sports concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. Other strong factors include participation in a contact sport and body mass size. The prognosis may differ between concussed adults and children; little research has been done on concussion in the pediatric population, but concern exists that severe concussions could interfere with brain development in children.

A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years. Compared to their peers with no history of brain trauma, sufferers of concussion exhibited effects including loss of episodic memory and reduced muscle speed.

Prevention:
The following tips may help you to prevent or minimize your risk of head injury:

*Wear appropriate protective gear during sports and other recreational activities. Always use the appropriate protective gear for any sport you or your child undertakes. Make sure the equipment fits properly, is well maintained and worn correctly. Follow the rules of the game and practice good sportsmanship. When bicycling, motorcycling, snowboarding or engaging in any recreational activity that may result in head injury, wear protective headgear.

*Buckle your seat belt. Wearing a seat belt may prevent serious injury, including an injury to your head, during a traffic accident.

*Make your home safe. Keep your home well lit and your floors free of clutter — meaning anything that might cause you to trip and fall. Falls around the home are the leading cause of head injury for infants, toddlers and older adults.

*Protect your children. To help lessen the risk of head injuries to your children, pad countertops and edges of tables, block off stairways and install window guards. Don’t let your children play sports that aren’t suitable for their ages.

*Use caution in and around swimming areas. Don’t dive into water less than 9 feet (3 meters) deep. Read and follow posted safety rules at water parks and swimming pools.

*Wear sensible shoes. If you’re older, wear shoes that are easy to walk and maneuver in. Avoid wearing high heels, sandals with thin straps, or shoes that are either too slippery or too sticky.

Prevention of  Concussion  involves taking general measures to prevent traumatic brain injury, such as wearing seat belts and using airbags in cars. Older people are encouraged to try to prevent falls, for example by keeping floors free of clutter and wearing thin, flat, shoes with hard soles that do not interfere with balance.

Use of protective equipment such as headgear has been found to reduce the number of concussions in athletes. Improvements in the design of protective athletic gear such as helmets may decrease the number and severity of such injuries. New “Head Impact Telemetry System” technology is being placed in helmets to study injury mechanisms and potentially help reduce the risk of concussions among American Football players. Changes to the rules or the practices of enforcing existing rules in sports, such as those against “head-down tackling”, or “spearing,” which is associated with a high injury rate, may also prevent concussions.

Post-concussion syndrome:
In post-concussion syndrome, symptoms do not resolve for weeks, months, or years after a concussion, and may occasionally be permanent. Symptoms may include headaches, dizziness, fatigue, anxiety, memory and attention problems, sleep problems, and irritability. There is no scientifically established treatment, and rest, a recommended recovery technique, has limited effectiveness. Symptoms usually go away on their own within months. The question of whether the syndrome is due to structural damage or other factors such as psychological ones, or a combination of these, has long been the subject of debate.

Cumulative effects:
Cumulative effects of concussions are poorly understood. The severity of concussions and their symptoms may worsen with successive injuries, even if a subsequent injury occurs months or years after an initial one. Symptoms may be more severe and changes in neurophysiology can occur with the third and subsequent concussions. Studies have had conflicting findings on whether athletes have longer recovery times after repeat concussions and whether cumulative effects such as impairment in cognition and memory occur.

Cumulative effects may include psychiatric disorders and loss of long-term memory. For example, the risk of developing clinical depression has been found to be significantly greater for retired American football players with a history of three or more concussions than for those with no concussion history.[74] Three or more concussions is also associated with a fivefold greater chance of developing Alzheimer’s disease earlier and a threefold greater chance of developing memory deficits.

Dementia pugilistica:
Chronic encephalopathy is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition called dementia pugilistica, or “punch drunk” syndrome, which is associated with boxers, can result in cognitive and physical deficits such as parkinsonism, speech and memory problems, slowed mental processing, tremor, and inappropriate behavior. It shares features with Alzheimer’s disease.

Second-impact syndrome:
Second-impact syndrome, in which the brain swells dangerously after a minor blow, may occur in very rare cases. The condition may develop in people who receive a second blow days or weeks after an initial concussion, before its symptoms have gone away. No one is certain of the cause of this often fatal complication, but it is commonly thought that the swelling occurs because the brain’s arterioles lose the ability to regulate their diameter, causing a loss of control over cerebral blood flow.  As the brain swells, intracranial pressure rapidly rises. The brain can herniate, and the brain stem can fail within five minutes. Except in boxing, all cases have occurred in athletes under age 20. Due to the very small number of documented cases, the diagnosis is controversial, and doubt exists about its validity.

Epidemiology:
Most cases of traumatic brain injury are concussions. A World Health Organization (WHO) study estimated that between 70 and 90% of head injuries that receive treatment are mild. However, due to underreporting and to the widely varying definitions of concussion and MTBI, it is difficult to estimate how common the condition is. Estimates of the incidence of concussion may be artificially low, for example due to underreporting. At least 25% of MTBI sufferers fail to get assessed by a medical professional. The WHO group reviewed studies on the epidemiology of MTBI and found a hospital treatment rate of 1–3 per 1000 people, but since not all concussions are treated in hospitals, they estimated that the rate per year in the general population is over 6 per 1000 people.

Young children have the highest concussion rate among all age groups. However, most people who suffer concussion are young adults. A Canadian study found that the yearly incidence of MTBI is lower in older age groups (graph at right). Studies suggest males suffer MTBI at about twice the rate of their female counterparts. However, female athletes may be at a higher risk for suffering concussion than their male counterparts.

Up to five percent of sports injuries are concussions. The U.S. Centers for Disease Control and Prevention estimates that 300,000 sports-related concussions occur yearly in the U.S., but that number includes only athletes who lost consciousness.  Since loss of consciousness is thought to occur in less than 10% of concussions, the CDC estimate is likely lower than the real number. Sports in which concussion is particularly common include football and boxing (a boxer aims to “knock out”, i.e. give a mild traumatic brain injury to, the opponent). The injury is so common in the latter that several medical groups have called for a ban on the sport, including the American Academy of Neurology, the World Medical Association, and the medical associations of the UK, the U.S., Australia, and Canada.

Due to the lack of a consistent definition, the economic costs of MTBI are not known, but they are estimated to be very high. These high costs are due in part to the large percentage of hospital admissions for head injury that are due to mild head trauma, but indirect costs such as lost work time and early retirement account for the bulk of the costs. These direct and indirect costs cause the expense of mild brain trauma to rival that of moderate and severe head injuries.

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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:
http://www.bbc.co.uk/health/physical_health/conditions/concussion1.shtml
http://en.wikipedia.org/wiki/Concussion
http://www.mayoclinic.com/health/concussion/DS00320
http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview?page=2

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Protein Intake Increases Hip Fracture Prevention

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Higher levels of protein intake may lower the risk of hip fractures in seniors, according to a study published in Osteoporosis International.
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A team of researchers from the Institute for Aging Research of Hebrew SeniorLife in Boston enrolled 946 elderly participants in the Framingham Osteoporosis Study, which examined the effects of consuming higher amounts of protein.

The results of the study showed that individuals who had the lowest protein intake were 50 percent more likely to suffer from hip fractures.

While other studies have found that protein intake is associated with an increase in bone mineral density, the researchers from this study stated that a higher intake of protein also builds strong muscles in the legs, which lowers the possibility of falling and suffering a hip fracture.

Marian T. Hannan, lead author and co-director at the Musculoskeletal Research Program at the Institute for Aging Research, stated that “[the] study participants who consumed higher amounts of protein in their diet were significantly less likely to suffer a hip fracture.”

People who wish to add more protein to their daily diet can benefit from consuming fish, leaner meats, dairy products, as well as different types of beans, which are all high sources of protein, according to the University of Pittsburgh Medical Center.


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Diagnonistic Test

Abdominal CT Scan

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Introduction:
An abdominal CT scan is an imaging method that uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomography.
CT scans are pictures taken by a specialized x-ray machine. The machine circles your body and scans an area from every angle within that circle. The machine measures how much the x-ray beams change as they pass through your body. It then relays that information to a computer, which generates a collection of black-and-white pictures, each showing a slightly different “slice” or cross-section of your internal organs. Because these “slices” are spaced only about a quarter-inch apart, they give a very good representation of your internal organs and other structures. Doctors use CT scans to evaluate all major parts of the body, including the abdomen, back, chest, and head.

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CT stands for computerized tomography. In this procedure, a thin X-ray beam is rotated around the area of the body to be visualized. Using very complicated mathematical processes called algorithms, the computer is able to generate a 3-D image of a section through the body. CT scans are very detailed and provide excellent information for the physician.

A CT scan is an excellent way to view the organs inside your abdomen. It is especially useful for looking at solid organs, such as the liver, pancreas, spleen, kidneys, and adrenal glands. It is also excellent for viewing the large blood vessels that pass through the abdomen (the aorta and vena cava) and for finding lymph nodes in the abdomen. Organs that can change their shape when they are empty or full, such as stomach and intestines, are harder for a CT scan to evaluate well, because it is sometimes difficult for a doctor to tell for sure if they are abnormal. Often the CT can give some information about these organs, though. Abdominal CT scans are often used to look for signs of inflammation or infection inside the abdomen in different organs, to look for cancer, or to look for injury to one or another internal organ.

A CT scan provides a better picture of internal organs than traditional x-rays. The benefits of an abdominal CT scan usually far outweigh the risks of radiation exposure.

How the Test is Performed
You will be asked to lie on a narrow table that slides into the center of the CT scanner. Usually, you will lie on your back with your arms raised above the head.

The health care provider may inject a dye into one of your veins. This helps certain diseases and organs show up better on the images.

Once inside the scanner, the machine’s x-ray beam rotates around you. Small detectors inside the scanner measure the amount of x-rays that make it through the abdomen. A computer takes this information and creates several individual images, called slices.

You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.

The actual scan time only takes a few minutes, although the entire procedure usually takes much longer.
A CT scan is an excellent way to view the organs inside your abdomen. It is especially useful for looking at solid organs, such as the liver, pancreas, spleen, kidneys, and adrenal glands. It is also excellent for viewing the large blood vessels that pass through the abdomen (the aorta and vena cava) and for finding lymph nodes in the abdomen. Organs that can change their shape when they are empty or full, such as stomach and intestines, are harder for a CT scan to evaluate well, because it is sometimes difficult for a doctor to tell for sure if they are abnormal. Often the CT can give some information about these organs, though. Abdominal CT scans are often used to look for signs of inflammation or infection inside the abdomen in different organs, to look for cancer, or to look for injury to one or another internal organ.

Why the Test is Performed
An abdominal CT rapidly creates detailed pictures of the belly area. The test may be used to:

*Study blood vessels
*Identify masses and tumors, including cancer
*Look for infections, kidney stones, or appendicitis
.How to Prepare for the Test
If you are having an abdominal CT scan, you might have to fast 2–4 hours before your test. You also may have to drink a large quantity of oral contrast, a fluid that will show up on the CT scan and help define the lining of some internal organs.

Tell your doctor if you’re allergic to x-ray contrast dyes, may be pregnant, or have diabetes and take insulin. Insulin can cause hypoglycemia after missing a meal. or have had difficulty with previous CT scans.

If contrast or sedation is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.

Since x-rays have difficulty passing through metal, you will be asked to remove jewelry and wear a hospital gown during the study.

What happens when the test is performed?
The test is done in the radiology department of a hospital or in a diagnostic clinic. You wear a hospital gown and lie on your back on a table that can slide back and forth through the donut-shaped CT machine. A technician or other health care professional inserts an IV and injects more contrast dye through it. This dye outlines blood vessels and soft tissue to help them show up clearly on the pictures.

The technologist moves the table with a remote control to enable the CT machine to scan your body from all of the desired angles. You will be asked to hold your breath for a few seconds each time a new level is scanned. The technologist usually works the controls from an adjoining room, watching through a window and sometimes speaking to you through a microphone. A CT scan takes about 30–45 minutes. Although it’s not painful, you might find it uncomfortable if you don’t like to lie still for extended periods.

How the Test Will Feel
The x-rays are painless. Some people may have discomfort from lying on the hard table.

Contrast give through an IV may cause a slight burning sensation, a metallic taste in the mouth, and a warm flushing of the body. These sensations are normal and usually go away within a few seconds.

Risk Factors:-
There are a few small risks. The contrast dye used in the test can damage your kidneys, especially if they are already impaired by disease.However, some newer dyes are less likely to cause kidney injuries. If kidney damage does occur, this is usually temporary, although in some rare cases it becomes permanent. If you are allergic to the dye used in the procedure, you may get a rash or your blood pressure may drop enough to make you feel faint until you get treatment. As with x-rays, there is a small exposure to radiation. The amount of radiation from a CT scan is greater than that from regular x-rays, but it’s still too small to be likely to cause harm unless you’re pregnant.

An abdominal CT scan is usually not recommended for pregnant women, because it may harm the unborn child. Women who are or may be pregnant should speak with their health care provider to determine if ultrasound can be used instead.

CT scans and other x-rays are strictly monitored and controlled to make sure they use the least amount of radiation. CT scans do create low levels of ionizing radiation, which has the potential to cause cancer and other defects. However, the risk associated with any individual scan is small. The risk increases as numerous additional studies are performed.

In some cases, a CT scan may still be done if the benefits greatly out weigh the risks. For example, it can be more risky not to have the exam, especially if your health care provider thinks you might have cancer.

The most common dye used is iodine based. A person who is allergic to iodine may have nausea, sneezing, vomiting, itching, or hives. Rarely, the dye may cause anaphylaxis (a life-threatening allergic response).

Results:-
What Abnormal Results Mean

The CT scan may show the following:

*Abdominal aortic aneurysm
*Abscesses
*Acute bilateral obstructive uropathy
*Acute cholecystitis
*Acute unilateral obstructive uropathy
*Addison’s disease
*Amebic liver abscess
*Appendicitis
*Bilateral hydronephrosis
*Bowel wall thickening
*Carcinoma of the renal pelvis or ureter
*Cholangiocarcinoma
*Choledocholithiasis
*Cholelithiasis
*Chronic bilateral obstructive uropathy
*Chronic cholecystitis
*Chronic pancreatitis
*Chronic unilateral obstructive uropathy
*Complicated UTI (pyelonephritis)
*Cystinuria
*Cysts
*Echinococcus
*Enlarged lymph nodes
*Enlarged organs
*Gastrointestinal or bowel obstruction
*Glucagonoma
*Hairy cell leukemia
*Hepatocellular carcinoma
*Histoplasmosis; disseminated
*Hodgkin’s lymphoma
*Islet of Langerhans’ tumor
*Multiple endocrine neoplasia (MEN) II
*Nephrocalcinosis
*Nephrolithiasis
*Non-Hodgkin’s lymphoma
*Ovarian cancer
*Pancreatic abscess
*Pancreatic carcinoma
*Pancreatic pseudocyst
*Pancreatitis
*Pheochromocytoma
*Primary hyperaldosteronism
*Pyelonephritis – acute
*Pyogenic liver abscess
*Renal cell carcinoma
*Retroperitoneal fibrosis
*Sclerosing cholangitis
*Stones (bladder, kidney, liver, gall bladder)
*Testicular cancer
*Tumors
*Unilateral hydronephrosis
*Ureterocele
*Wilms’ tumor
*Wilson’s disease
*Zollinger-Ellison syndrome

Additional conditions under which the test may be performed include the following:-
*Acute renal failure
*Alcoholic liver disease (hepatitis/cirrhosis)
*Atheroembolic renal disease
*Chronic glomerulonephritis
*Chronic renal failure
*Cushing syndrome
*Cushing syndrome caused by adrenal tumor
*Injury of the kidney and ureter
*Medullary cystic kidney disease
*Multiple endocrine neoplasia (MEN) I
*Polycystic kidney disease
*Reflux nephropathy
*Renal artery stenosis
*Renal vein thrombosis
*Skin lesion of histoplasmosis

How long is it before the result of the test is known?
The radiologist can probably give you preliminary results within a day. The formal reading of your CT scan might take another day.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/abdominal-ct-scan.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003789.htm

Categories
Ailmemts & Remedies

Head Injury

Alternative Names: Brain injury; Head trauma; Contusion

Definition: Head injury is a trauma to the head, that may or may not include injury to the brain (you may click to see also:-> Brain Injury). However, ‘brain injury’ and ‘head injury’ are often used interchangeably in the medical literature.

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A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.

Head injury is classified as either closed or open (penetrating).

A closed head injury means you received a hard blow to the head from striking an object.
An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.
There are several types of brain injuries. Two common types of head injuries are:

Concussion, the most common type of traumatic brain injury
Contusion, which is a bruise on the brain

You may click to see also:->

Subarachnoid hemorrhage
Subdural hematoma

Considerations:Every year, millions of people sustain a head injury. Most of these injuries are minor because the skull provides the brain with considerable protection. The symptoms of minor head injuries usually go away on their own. More than half a million head injuries a year, however, are severe enough to require hospitalization.

Learning to recognize a serious head injury, and implementing basic first aid, can make the difference in saving someone’s life.

In patients who have suffered a severe head injury, there is often one or more other organ systems injured. For example, a head injury is sometimes accompanied by a spinal injury.

Causes: The most Common causes of head injury are traffic accidents, home and occupational accidents, falls, and assaults. Bicycle accidents are also a common cause of head injury-related death and disability, especially among children.

Some head injuries result in prolonged or non-reversible brain damage. This can occur as a result of bleeding inside the brain or forces that damage the brain directly. These more serious head injuries may cause:

*Changes in personality, emotions, or mental abilities

*Speech and language problems

*Loss of sensation, hearing, vision, taste, or smell

*Seizures

*Paralysis

*Coma

Types of head injury:
Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull.

Head injuries may be closed or open. A closed (non-missile) head injury is one in which the skull is not broken. A penetrating head injury occurs when an object pierces the skull and breaches the dura mater. Brain injuries may be diffuse, occurring over a wide area, or focal, located in a small, specific area.

A head injury may cause a skull fracture, which may or may not be associated with injury to the brain. Some patients may have linear or depressed skull fractures.

If intracranial hemorrhage occurs, a hematoma within the skull can put pressure on the brain. Types of intracranial hemorrage include subdural, subarachnoid, extradural, and intraparenchymal hematoma. Craniotomy surgeries are used in these cases to lessen the pressure by draining off blood.

Brain injury can be at the site of impact, but can also be at the opposite side of the skull due to a contrecoup effect (the impact to the head can cause the brain to move within the skull, causing the brain to impact the interior of the skull opposite the head-impact).

If the impact causes the head to move, the injury may be worsened, because the brain may ricochet inside the skull causing additional impacts, or the brain may stay relatively still (due to inertia) but be hit by the moving skull (both are contrecoup injuries).

Specific problems after head injury can include:

*Skull fracture

*Lacerations to the scalp and resulting hemorrhage of the skin

*Traumatic subdural hematoma, a bleeding below the dura mater which may develop slowly

*Traumatic extradural, or epidural hematoma, bleeding between the dura mater and the skull

*Traumatic subarachnoid hemorrhage

*Cerebral contusion, a bruise of the brain

*Concussion, a temporary loss of function due to trauma

*Dementia pugilistica, or “punch-drunk syndrome”, caused by repetitive head injuries, for example in boxing or other contact sports

*A severe injury may lead to a coma or death

*Shaken Baby Syndrome – a form of child abuse

Concussion:
Mild concussions are not associated with any sequelae. However, a slightly greater injury can be associated with both anterograde and retrograde amnesia (inability to remember events before or after the injury). The amount of time that the amnesia is present correlates with the severity of the injury. In some cases the patients may develop postconcussion syndrome, which can include memory problems, dizziness, and depression. Cerebral concussion is the most common head injury seen in children.

Epidural hematoma:
Epidural hematoma (EDH) is a rapidly accumulating hematoma between the dura mater and the cranium. These patients have a history of head trauma with loss of consciousness, then a lucid period, followed by loss of consciousness. Clinical onset occurs over minutes to hours. Many of these injuries are associated with lacerations of the middle meningeal artery. A “lenticular”, or convex, lens-shaped extracerebral hemorrhage will likely be visible on a CT scan of the head. Although death is a potential complication, the prognosis is good when this injury is recognized and treated.

Subdural hematoma:
Subdural hematoma occurs when there is tearing of the bridging vein between the cerebral cortex and a draining venous sinus. At times they may be caused by arterial lacerations on the brain surface. Patients may have a history of loss of consciousness but they recover and do not relapse. Clinical onset occurs over hours. A crescent shaped hemorrhage compressing the brain will be noted on CT of the head. Surgical evacuation is the treatment. Complications include uncal herniation, focal neurologic deficits, and death. The prognosis is guarded.

Cerebral contusion:
Cerebral contusion is bruising of the brain tissue. The majority of contusions occur in the frontal and temporal lobes. Complications may include cerebral edema and transtentorial herniation. The goal of treatment should be to treat the increased intracranial pressure. The prognosis is guarded.

Diffuse axonal injury:
Diffuse axonal injury, or DAI, usually occurs as the result of an acceleration or deceleration motion, not necessarily an impact. Axons are stretched and damaged when parts of the brain of differing density slide over one another. Prognoses vary widely depending on the extent of damage.

Symptoms:
The signs of a head injury can occur immediately or develop slowly over several hours. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. (This is called a concussion.) The head may look fine, but complications could result from bleeding inside the skull.

When encountering a person who just had a head injury, try to find out what happened. If he or she cannot tell you, look for clues and ask witnesses. In any serious head trauma, always assume the spinal cord is also injured.

The following symptoms suggest a more serious head injury — other than a concussion or contusion — and require emergency medical treatment:

*Loss of consciousness, confusion, or drowsiness

*Low breathing rate or drop in blood pressure

*Convulsions

*Fracture in the skull or face, facial bruising, swelling at the site of the injury, or scalp wound

*Fluid drainage from nose, mouth, or ears (may be clear or bloody)

*Severe headache

*Initial improvement followed by worsening symptoms

*Irritability (especially in children), personality changes, or unusual behavior

*Restlessness, clumsiness, lack of coordination

*Slurred speech or blurred vision

*Inability to move one or more limbs

*Stiff neck or vomiting

*Pupil changes

*Inability to hear, see, taste, or smell

Diagnosis and prognosis:
Head injury may be associated with a neck injury. Bruises on the back or neck, back pain, pain radiating to the arms is a sign of cervical spine injury meriting spinal immobilization and application of a cervical collar. It is common for head trauma patients to have drowsiness but to be easily aroused, headaches, and vomiting after injury. If exam and consciousness are preserved, this is of no concern. But if these symptoms persist > 1 or 2 days, a CT of the head is needed. In some cases transient neurologic disturbance may occur, lasting minutes to hours and causing occipital blindness and a state of confusion. Malignant post traumatic cerebral swelling can develop unexpectedly in stable patients after an injury, as can post traumatic seizures. Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover, while those who are vegetative for months are less likely to improve. Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer’s disease later in life.

Management:
Unfortunately, once the brain has been damaged by trauma, there is no quick fix. However, there are some steps that can be taken to prevent secondary damage. If left untreated many patients with head injury will rapidly develop complications which may lead to death or permanent disability. Prompt medical treatment may prevent the worsening of symptoms and lead to a better outcome. Medical treatment should begin at the scene of the trauma. Paramedics will generally immobilize the patient to ensure no further damage to the spine or nervous system, insert an airway to ensure uninterrupted breathing, and perform endotracheal intubation if indicated. One or more IVs will be inserted to maintain perfusion status. In some cases medications may be administered to sedate or paralyze the patient to prevent additional movement which may worsen the brain injury. The patient should be delivered promptly to a hospital with neurosurgical capabilities. The management of brain injury requires the involvement of subspecialists who are generally available only at larger hospitals. Primary treatment involves controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion.

Second line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia. Although all of these methods have potential benefits, there has been no randomized study that has shown unequivocal benefit.

First Aid :

Get medical help immediately if the person:

*Becomes unusually drowsy

*Develops a severe headache or stiff neck

*Vomits more than once

*Loses consciousness (even if brief)

*Behaves abnormally

For a moderate to severe head injury, take the following steps:

1. Call 911.

2.Check the person’s airway, breathing, and circulation. If necessary, begin rescue breathing and CPR.

3.If the person’s breathing and heart rate are normal but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person’s head, keeping the head in line with the spine. and preventing movement. Wait for medical help.

4.Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the

person’s head. If blood soaks through the cloth, DO NOT remove it. Place another cloth over the first one.

5.If you suspect a skull fracture, DO NOT apply direct pressure to the bleeding site, and DO NOT remove any debris from the

wound. Cover the wound with sterile gauze dressing.

6.If the person is vomiting, roll the head, neck, and body as one unit to prevent choking. This still protects the spine, which you must always assume is injured in the case of a head injury. (Children often vomit ONCE after a head injury. This may not be a problem, but call a doctor for further guidance.)

7.Apply ice packs to swollen areas.

For a mild head injury, no specific treatment may be needed. However, closely watch the person for any concerning symptoms over the next 24 hours. The symptoms of a serious head injury can be delayed. While the person is sleeping, wake him or her every 2 to 3 hours and ask simple questions to check alertness, such as “What is your name?”

If a child begins to play or run immediately after getting a bump on the head, serious injury is unlikely. However, as with anyone with a head injury, closely watch the child for 24 hours after the incident.

Over-the-counter pain medicine (like acetaminophen or ibuprofen) may be used for a mild headache. DO NOT take aspirin, because it can increase the risk of bleeding.

DO NOT :-
*DO NOT wash a head wound that is deep or bleeding a lot.
*DO NOT remove any object sticking out of a wound.
*DO NOT move the person unless absolutely necessary.
*DO NOT shake the person if he or she seems dazed.
*DO NOT remove a helmet if you suspect a serious head injury.
*DO NOT pick up a fallen child with any sign of head injury.
*DO NOT drink alcohol within 48 hours of a serious head injury.

Prevention :-

*Always use safety equipment during activities that could result in head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.

*Obey traffic signals when riding a bicycle. Be predictable so that other drivers will be able to determine your course.

*Be visible. DO NOT ride a bicycle at night.

*Use age-appropriate car seats or boosters for babies and young children.

Make sure that children have a safe area in which to play.

*Supervise children of any age.

*DO NOT drink and drive, and DO NOT allow yourself to be driven by someone who you know or suspect has been drinking alcohol.

You may click to See also:->
Extra-axial hemorrhage
Intra-axial hematoma
Intraparenchymal hemorrhage
Brain Trauma Foundation

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:
http://www.nlm.nih.gov/medlineplus/ency/article/000028.htm
http://en.wikipedia.org/wiki/Head_injury

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