Diseases Treatment

What is this condition?

In this disorder, the brain and the spinal cord meninges become inflamed, usually as a result of bacterial infection. Such inflammation may involve all three meningeal membranes: the dura mater, the arachnoid, and the pia mater. The prognosis is good and complications are rare, especially if the disease is recognized early and the infecting organism responds to antibiotics. However, the death rate in untreated disease is 70% to 100%. The prognosis is poorer for infants and elderly people.
What causes it?

Meningitis is almost always a complication of another bacterial infection: bacteremia (especially from pneumonia, pus in a body cavity, osteomyelitis, or endocarditis), sinus or middle ear infection, encephalitis, myelitis, or brain abscess.

This disorder may also follow skull fracture, a penetrating head wound, lumbar puncture, or ventricular shunt insertion. Aseptic inflammation of the brain and spinal cord membranes also may result from a virus or other organism. Sometimes, no causative organism can be found. Inflammation of the brain and spinal cord membranes may progress to congestion of adjacent tissues and destroy some nerve cells.
What are the symptoms of Meningitis?

The cardinal symptoms of this disorder are the same as those of infection (fever, chills, malaise) and of increased intracranial pressure (headache, vomiting and, rarely, swelling of the optic disk). Signs of meningeal irritation include rigidity at the nape of the neck, involuntary knee flexion when the neck is passively flexed, inability to extend the leg completely when sitting, exaggerated and symmetrical deeptendon reflexes, and backward arching of the back and extremities so that the body rests on the head and heels.

Other symptoms are irregular heartbeats, irritability, extreme sensitivity to light, double vision and other visual problems, and delirium, deep stupor, and coma.

An infant may show signs of infection and is often fretful and refuses to eat. Such an infant may vomit a great deal, leading to dehydration.

As this disease progresses, twitching, seizures (in 30% of infants), or coma may develop. Most older children have the same symptoms as adults. In the subacute form, onset may be gradual.
How is it diagnosed?

A lumbar puncture (spinal tap), showing typical cerebrospinal fluid findings, and certain physical exam findings usually establish this diagnosis. The fluid may appear cloudy or milky white, depending on the number of white blood cells present. Protein levels in cerebrospinal fluid tend to be high; sugar levels may be low. (In subacute disease, fluid findings may vary.) Cerebrospinal fluid culture and sensitivity tests usually identifY the infecting organism unless it’s a virus.

To help determine the major sites of infection, the doctor will take cultures of the blood, urine, and nose and throat secretions; a chest X-ray; and an electrocardiogram. An abnormally high level of white blood cells and electrolyte abnormalities also are common. Computed tomography (commonly called a CAT scan) can rule out brain hematoma, hemorrhage, or tumor.
How is it treated?

To treat this disorder, the person receives appropriate antibiotic therapy and vigorous supportive care. Usually, intravenous antibiotics are given for at least 2 weeks, followed by oral antibiotics. Such antibiotics include Bicillin, Omnipen, or Nafcil. However, if the person is allergic to penicillin, Chloromycetin or Kantrex may be given. Other drugs include a cardiac glycoside such as Lanoxin to control irregular heartbeats, Osmitrol to decrease brain swelling, an anti seizure drug (usually given intravenously) or a sedative to reduce restlessness, and aspirin or Tylenol (or another acetaminophen product) to relieve headache and fever.

Supportive measures include bed rest, reduction of body temperature, and measures to prevent dehydration. The person must be isolated if the nasal cultures are positive for certain organisms. Of course, treatment includes appropriate therapy for any coexisting conditions, such as pneumonia.

What do doctors call this condition?

Sinusitis

What is this condition?

Sinus infection refers to infection of the paranasal sinuses – the four pairs of air pockets that drain into the nose. Sinus infection may be acute, subacute, chronic, allergic, or hyperplastic. In this last, the number of sinus cells is abnormally increased.

What causes it?

Sinus infection usually is caused by viral or bacterial infection. Acute sinus infection is primarily caused by the common cold; it lingers in the subacute form in only about 10% of cases. Chronic sinus infection follows persistent bacterial infection.

Predisposing factors for sinus infection include any condition that interferes with sinus drainage and ventilation, such as:

•  chronic nasal swelling

•  a deviated septum

•  thickened mucus

•  nasal polyps

• allergic inflammation of the nasal mucous membranes (allergic rhinitis)

• a weakened state from chemotherapy, malnutrition, diabetes, a blood disease, chronic steroid use, or a depressed immune system.

Bacterial sinus invasion commonly is caused by the conditions listed above or after a viral infection. It may also result from swimming in polluted water.

Allergic sinus infection accompanies allergic rhinitis. Hyperplastic sinus infection is a combination of pus-producing acute sinus infection and allergic sinus infection or allergic rhinitis.

What are its symptoms?

Symptoms vary depending on the type of sinus infection.

Acute sinus infection

The main symptom of this type of sinus infection is a stuffy nose, followed by gradually increasing pressure in the affected sinus. For 24 to 48 hours after symptoms first appear, the person may have a runny nose. Later, the nasal discharge contains pus. Other symptoms include an overall ill feeling, sore throat, headache, and slight feye (temperature of 99° to 99.5° F [37.2° to 37.5° C]). Pain location depends on the affected sinus, but may occur over the cheeks and upper teeth, over the eyes, over the eyebrows, or behind the eyes.

Subacute sinus infection

In this type of sinus infection, pus-filled nasal drainage lasts longer than 3 weeks after an acute infection subsides. Other symptoms include stuffy nose, vague facial discomfort, fatigue, and a nonproductive cough.

Chronic sinus infection

Symptoms of chronic sinus infection resemble those of acute sinus infection, except that the chronic form causes continuous mucusand pus-filled discharge.

Allergic sinus infection

The major symptoms of this type of infection are sneezing, a headache in the front of the head, watery nasal discharge, and a stuffy, burning, itchy nose.

Hyperplastic sinus infection

This type of infection causes a chronically stuffy nose and headache.

How is it diagnosed?

To diagnose sinus infection, the doctor examines the inside of the persons nose. The doctor may also take sinus X-rays, perform a sinus puncture (rare), or order ultrasound or a computed tomography scan (commonly called a CAT scan).

How is it Treated?

The doctor may try a variety of treatments, depending on the type of sinus infection.

Acute sinus infection

Usually, the doctor prescribes local decongestants before trying oral decongestants and may also recommend inhaling steam. To combat pus­producing or persistent infection, [he doctor will prescribe antibiotics, usually for 2 to 3 weeks, because sinus infection is deep seated. Applying heat to the sinus area may also help relieve pain and congestion.

Subacute sinus infection

In subacute sinus infection, antibiotics and decongestants may be helpful.

Allergic sinus infection

To treat allergic sinus infection, the doctor must also treat allergic rhinitis. Typically, the doctor prescribes antihistamines, orders skin testing to identify the cause of allergy, and may prescribe immunotherapy, which desensitizes the person to the offending allergens bv administering them in increasingly large doses. Severe allergic symptoms may call for steroids and epinephrine.

Chronic and hyperplastic sinus infection

In both these types of infection, the doctor may prescribe antihistamines, antibiotics, and a steroid nasal spray to relieve pain and congestion. If irrigation fails to relieve symptoms, sinus surgery may be necessary.

In subdural hemorrhage blood leaks from vessels in the dura mater, the outermost of the three meninges, or membranous layersthat cover the brain. It differs from extradural hemorrhage in that the ruptured blood vessels are on the underside, rather than the outside, of the dura mater. Because these inner vessels are smaller than the outer ones, less blood is likely to leak out. The blood tends to seep quite slowly into the space between the dura mater and the arachnoid (the middle of the three meninges), and causes a hematoma, or collection of blood.Among eventual symptoms of subdural hemorrhage are drowsiness, confusion weakness or numbness down one side of the body, and persistent or recurrent headaches and nausea. During a period of days or weeks such symptoms may come and go, but they will gradually become worse.

Subdural hemorrhage occurs as a result of a head injury . It occurs most often in elderly people who have fallen. These people have sometimes forgotten about the accident by the time symptoms develop.

What Should be Done?

Consult your physician without delay if you develop the symptoms described above. Because they are similar to those of a minor stroke , be sure to tell the physician that you have recently injured your head, even if only slightly, if you remember any such incident. If any member of your family shows signs of mental deterioration and abnormal drowsiness, be sure that they see a physician. The affected person will probably be admitted to the hospital for diagnostic tests such as X-rays, arteriography, a radioisotope scan, and possibly a brain scan (known as CA T scan) to determine the cause of the symptoms. If the problem is diagnosed as subdural hemorrhage, treatment and chances for full recovery are similar to those of extradural hemorrhage .