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Friday, December 20, 2013

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Cerebral Palsy - NHS Choices Introduction Cerebral palsy About one in 400 children born alive has cerebral palsy. An expert explains the causes, symptoms and treatment Media last reviewed: 30/04/2013 Next review due: 30/04/2015 Types of cerebral palsy There are several different types of cerebral palsy: spastic hemiplegia, where there is muscle stiffness on one side of the body and sometimes curvature of the spine spastic diplegia, where there is muscle stiffness in the legs ataxic cerebral palsy, where balance and depth perception are affected athetoid (dyskinetic) cerebral palsy, where there is increased and decreased muscle tone and speech problems spastic quadriplegia, the most severe type, where the child may be unable to walk and support their neck and may have moderate to severe learning difficulties. Learn about the symptoms of the different types of cerebral palsy. Cerebral palsy is a general term covering a number of neurological conditions that affect a child's movement and coordination. Neurological conditions affect the brain and nervous system. Cerebral palsy is caused by damage to the brain, which normally occurs before, during or soon after birth. Known possible causes of cerebral palsy include: infection in early pregnancy a difficult or premature birth bleeding in the baby’s brain abnormal brain development in the baby Read more about the causes of cerebral palsy. Symptoms of cerebral palsy The symptoms of cerebral palsy vary greatly from child to child and depend on the type of cerebral palsy your child has (see box, left). Some children have problems walking, while others are profoundly disabled and require lifelong care. Read more about the symptoms of cerebral palsy. Children with cerebral palsy often have other related conditions or problems, including: epilepsy learning difficulties incontinence visual impairment hearing impairment difficulties speaking or understanding other people speak delayed growth curved spine (scoliosis) drooling How common is cerebral palsy? It is estimated that 1 in every 400 children in the UK is affected by cerebral palsy. Approximately 1,800 babies are diagnosed with the condition each year. Outlook Cerebral palsy is not a progressive condition. This means it will not get worse as your child gets older. However, it can put a great deal of strain on the body, which can cause problems in later life. There is no cure for cerebral palsy, but a range of treatments can help relieve symptoms and increase a child's sense of independence and self-esteem. These include physiotherapy, occupational therapy and medication to relieve muscle stiffness and spasms. Find out more about treatments for cerebral palsy. Page last reviewed: 21/04/2012 Next review due: 21/04/2014 Meningitis - tuberculous - MedlinePlus Meningitis - tuberculous Tuberculous meningitis is an infection of the tissues covering the brain and spinal cord (meninges). Causes Tuberculous meningitis is caused by Mycobacterium tuberculosis, the bacteria that cause tuberculosis. The bacteria spread to the brain and spine from another site in the body. Risk factors include a history of: AIDS Excessive alcohol use Pulmonary tuberculosis Weakened immune system Tuberculous meningitis is a very rare disorder in the U.S. Symptoms The symptoms usually begin gradually, and may include: Fever and chills Mental status changes Nausea and vomiting Sensitivity to light (photophobia) Severe headache Stiff neck (meningismus) Other symptoms that can occur with this disease: Agitation Bulging fontanelles in babies Decreased consciousness Poor feeding or irritability in children Unusual posture, with the head and neck arched backwards (opisthotonos) Exams and Tests The doctor or nurse will examine you. This will usually show: Fast heart rate Fever Mental status changes Stiff neck A lumbar puncture ("spinal tap") is an important test in diagnosing meningitis. This test is done to collect a sample of spinal fluid for examination. More than one sample may be needed to make the diagnosis. Other tests that may be done include: Biopsy of the brain or meninges Blood culture Chest x-ray CSF examination for cell count, glucose, and protein CT scan of the head Gram stain, other special stains, and culture of CSF Polymerase chain reaction (PCR) of CSF Skin test for tuberculosis (PPD) Other tests to look for tuberculosis Treatment You will be given several medicines to fight the tuberculosis bacteria. Sometimes, treatment is started even if your doctor thinks you have the disease, but testing hasn't confirmed it yet. Treatment usually lasts for at least 12 months. Systemic steroids may also be used. Outlook (Prognosis) Tuberculous meningitis is life threatening if untreated. Long-term follow-up is needed to detect repeated infections (recurrences). Possible Complications Brain damage Build-up of fluid between the skull and brain (subdural effusion) Hearing loss Hydrocephalus Seizures When to Contact a Medical Professional Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms: Feeding problems High-pitched cry Irritability Persistent unexplained fever Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness. Prevention The BCG vaccine may help prevent severe forms of tuberculosis, such as meningitis, in very young children who live in areas where the disease is common. Treating people who have signs of a non-active (dormant) tuberculosis infection can prevent the spread of tuberculosis. A PPD test and other tuberculosis tests can be done to tell if you have this type of infection. Alternative Names Tubercular meningitis; TB meningitis References Ellner JJ. Tuberculosis. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 332. Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 250. Swartz MN. Meningitis: bacterial, viral, and other. In:Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 360. Tunkel AR, Van de Beek D, Scheld WM. Acute meningitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 84. CTEV Congenital Talipes Equino Varus (Club Foot) What is Congenital Talipes Equino Varus (CTEV)? Congenital Talipes Equino Varus (CTEV) for short is commonly known as clubfoot. This is a condition where a child presents with either one or both feet pointing downwards and turns inwards. There are two types of CTEV: postural and structural. Postural CTEV involves muscle imbalance and / or tightness. There is usually no bone or joint involvement. Structural CTEV involves the bone and joints of the foot, where the child's foot cannot be passively put through a full range of motion. Congenital Talipes Equino Varus (Club Foot) Signs and Symptoms Feet turning inwards Tightness in calf muscles For structural: the foot has decreased joint range of movement. Causes Postural: packing disorder (first born baby; big baby >4kg at birth; decrease fluid surrounding the baby) Structural: The cause is unknown and in some, it can be genetics. Complications Abnormal walking pattern. Foot pain due to abnormal foot positions. Treatment Options Postural: Self resolving. In some cases, physiotherapy intervention for stretching and stimulation to the feet is required. Structural: Serial casting and manipulation with minimal surgery if neccessary. In severe cases, surgery may be required. This is followed by maintenance with special boots and bar till 4 years of age. Tests and Diagnosis Orthopaedic assessments

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