Normal Pressure Hydrocephalus

A Simple Guide to Normal Pressure Hydrocephalus
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What is Normal Pressure Hydrocephalus?
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Normal Pressure Hydrocephalus(NPH) is an abnormal accumulation of cerebrospinal fluid in the cavities of the brain.

Who is at risk of getting Normal Pressure Hydrocephalus?
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Normal Pressure Hydrocephalus occurs in adults of 55 years old and above.

The accumulation of cerebrospinal fluid is gradual leading to enlargement of the cavities in the brain called ventricles.

This in turn stretches the nerve tissues of the brain giving rise to 3 main neurological disturbances in the brain which is characteristic of NPH.

What are the causes of Normal Pressure Hydrocephalus?
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In most cases the cause is unknown.

In the remaining cases, the secondary causes can be found:

1. Brain infection can cause damage to brain tissues and the resulting cell damage can increase fluid in the brain

2. Stroke may damage brain cells resulting in damaged brain tissues and increase fluid in the brain

3. Trauma and head injury may damage brain cells similar to above

4. Brain tumors are another cause of increased fluid in the brain


What are the Symptoms of Normal Pressure Hydrocephalus?
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Onset is slow and gradual but typically the following symptoms are present:

Gait disturbance
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Difficulty in walking or balancing

Cognitive impairment
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mild dementia

Urinary Incontinence
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Problems with bladder control and hence incontinence

How is the diagnosis of Normal Pressure Hydrocephalus confirmed?
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1.History of the above 3 symptoms

2.Physical examination shows the neurological deficits:
difficulty in walking

mild dementia

urinary incontinence

3.MRI of brain shows the presence of enlarged ventricles in the brain

What is the Treatment of Normal Pressure Hydrocephalus?
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NPH cannot be cured but its symptoms can be controlled.

Treatment is by surgery using a shunt to divert the excessive fluid in the brain to the peritoneal cavity.

What are the complications of Normal Pressure Hydrocephalus?
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1. Dementia

2. Disabilty

3. Disturbed urinary and bowel function.

What is the prognosis of Normal Pressure Hydrocephalus?
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With early diagnosis and treatment, symptoms can be partially or fully reversed leading to resumption of a normal life.

With the use of the shunt, symptoms may disappear within days or at most a few months.

There is dramatic improvement in the first week in mild cases.

Some adjustments of the valve are often needed before the correct setting is obtained for the individual.

A Simple Guide to Mastitis

A Simple Guide to Mastitis
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What is Mastitis?
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Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.

What causes Mastitis?
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The causes of Mastitis are mostly due:

A.Hormonal:
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1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.

2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.

3.Premenstrual pain and swelling of breasts may occur

B.Infections:
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Infections of the breasts may occur due to
1.poor skin hygiene

2.Injuries or wounds allowing microganism to enter the wound

3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.

4.Mastitis may occur as a rare complication of mumps.

5.Most common bacteria infection is staphyloccus aures.

6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis

What are the symptoms of Mastitis?
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The Symptoms of Mastitis are:

1.Pain usually present in all cases except in babies

2.swelling of the breasts or the nipple area

3.Pus discharge from the nipple

Signs:

1.redness of the nipple or areola

2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.

3.Local tenderness of inflammed area

4.Fever and genral malaise

5.Axillary lymph nodes may be swollen and painful

What are the complications of Mastitis?
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1.Abscess formation

2.Cystic formation

3.Chronic mastitis or fibroadenosis

How is diagnosis of Mastitis confirmed?
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1. clinical features

2. Mammograms to exclude malignant tumors

3. Ultrasound scan of the breasts

What is the treatment of Mastitis?
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1. antibiotics are given to cure the infections.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.

2. Painkillers may be given if there is pain

3.Rest and support of the breasts with soft bras

4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.

5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary

6.Reassurance in hormonal cases of mastitis

What is the Prognosis of Mastitis?
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Most cases of mastitis usually will recover with proper treatment.

What are the Preventive measures for Mastitis?
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Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently

A Simple Guide to Appendicitis

A Simple Guide to Appendicitis
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What is Appendicitis?
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Appendicitis is an infection of the vermiform appendix, a small elongated appendage at the base of the caecum.

What are the causes of Appendicitis?
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Appendicitis may occur after:

1.obstruction of the lumen of the appendix by fecalith(small hard faeces), foreign body(eg. seeds), kinking

2.inflammatory oedema of the mucosa

3.infection of the intestine(eg. E. coli) spreading to the appendix

What are the symptoms and signs of Appendicitis?
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Symptoms:

1.Pain occurs in the navel region, then moves down to right lower quadrant(McBurney's point-one third from right pelvic protrusion and two thirds from the navel)

2.nausea and vomiting

3.mild fever

4.often a history of constipation, rarely diarrhea

5. loss of appetite

Signs:

1.tenderness,guarding and rebound pain at McBurney's point

2.Positive Psoas and obturator sign in some cases

3.leucocytosis - mainly polymorphs

4.Palpable mass felt at McBurney's point may indicate presence of appendicular
abscess

5.rectal examination may show a palpable tender swelling at the right iliac fossa

What are the complications of Appendicitis?
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1.Perforation of the untreated inflammed appendix causes pus to spill into the abdominal cavity

2.Peritonitis(inflammation of the the whole of the internal abdomen) may occur as a result of a ruptured inflammed appendix

3.Septicemia may result from the bacteria entering the blood.

Death may occur in untreated peritonitis and septicemia.

What is the treatment of Appendicitis?
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All confirmed appenicitis should be treated by surgical removal of the inflammed appendix.

Following surgery, antibiotics are given either intravenously or orally.

What is the prognosis of Appendicitis?
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1.Excellent with appropriate surgical intervention

2.Abscesses which developed and are surgical drained and treated with antibiotics recovered rapidly.

3.Peritonitis and septicemia treated early by surgery and antibiotics usually recovered.

Finally there is no such condition such as chronic Appendicitis.
All Appendicitis cases are acute.

A Simple Guide to Folliculitis

A Simple Guide to Folliculitis
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What is Folliculitis?
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Folliculitis is an infection of the hair follicles.

What are the causes of Folliculitis?
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Folliculitis may occur after:
1. abrasions or wounds on the skin

2.friction due to tight clothing

3.eczema or dermatitis

4.diabetes or leukemia patients are more susceptible to infection

The bacteria causing the folliculitis is usually staphylococcus aureus.

What are the symptoms and signs of Folliculitis?
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There is usually a superficial pustule or inflammatory nodule surrounding the base of a hair.

They may occur all around the same area or scattered on the body.

Chronic Folliculitis may occur around the beard area.(sycosis barbae)

What are the complications of Folliculitis?
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The inflammatory nodule of Folliculitis may develop into a pustule with cental necrosis and discharge of pus and sometimes blood stained material.
This is a furuncle or boil.

A group of furuncles can merge and become a larger entity called a carbuncle which is deep and wide .

What is the treatment of Folliculitis?
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Most mild Folliculitis may disappear by itself without treatment after a few days.

The severe cases requires topical antibiotic creams like bactroban or systemic antibiotics to clear the infections.

Carbuncles may need surgical treatment.