Brain aneurysm

Brain aneurysm

Definition:

A brain aneurysm (AN-u-rizm) is a bulge or ballooning in a blood vessel in the brain. It often looks like a berry hanging on a stem.

A brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). Most often a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering the brain. This type of hemorrhagic stroke is called a subarachnoid hemorrhage. A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment.

Most brain aneurysms, however, don't rupture, create health problems or cause symptoms. Such aneurysms are often detected during tests for other conditions. Treatment for an unruptured brain aneurysm may be appropriate in some cases and may prevent a rupture in the future.

Symptoms:

Ruptured aneurysm
A sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often described as the "worst headache" ever experienced. Common signs and symptoms of a ruptured aneurysm include:

• Sudden, extremely severe headache
• Nausea and vomiting
• Stiff neck
• Blurred or double vision
• Sensitivity to light
• Seizure
• A drooping eyelid
• Loss of consciousness
• Confusion

'Leaking' aneurysm
In some cases, an aneurysm may leak a slight amount of blood. This leaking (sentinel bleed) may cause only a:

• Sudden, extremely severe headache

A more severe rupture almost always follows leaking.

Unruptured aneurysm
An unruptured brain aneurysm may produce no symptoms, particularly if it's small. However, a large unruptured aneurysm may press on brain tissues and nerves, possibly causing:

• Pain above and behind an eye
• A dilated pupil
• Change in vision or double vision
• Numbness, weakness or paralysis of one side of the face
• A drooping eyelid

When to see a doctor
A ruptured aneurysm is a medical emergency. In about 30 percent of cases, ruptured brain aneurysms are fatal.

Seek immediate medical attention if you develop a:

• Sudden, extremely severe headache

If you're with someone who complains of a sudden, severe headache or who loses consciousness or has a seizure, call 911 or your local emergency number.


Causes:

Brain aneurysms develop as a result of thinning and degenerating artery walls. Aneurysms often form at forks or branches in arteries because those sections of the vessel are weaker. Although aneurysms can appear anywhere in the brain, they are most common in arteries at the base of the brain.

Complications:

When a brain aneurysm ruptures, the bleeding usually lasts only a few seconds. The blood can cause direct damage to surrounding cells, and the bleeding can damage or kill other cells. It also increases pressure inside the skull. If the pressure becomes too elevated, the blood and oxygen supply to the brain may be disrupted to the point that loss of consciousness or even death may occur.
Complications that can develop after the rupture of an aneurysm include:

• Re-bleeding. An aneurysm that has ruptured or leaked is at risk of bleeding again. Re-bleeding can cause further damage to brain cells.
  
• Vasospasm. After a brain aneurysm ruptures, blood vessels in your brain may narrow erratically (vasospasm). This condition can limit blood flow to brain cells (ischemic stroke) and cause additional cell damage and loss.
  
• Hydrocephalus. When an aneurysm rupture results in bleeding in the space between the brain and surrounding tissue (subarachnoid hemorrhage) — most often the case — the blood can block circulation of the fluid surrounding the brain and spinal cord (cerebrospinal fluid). This condition can result in hydrocephalus, an excess of cerebrospinal fluid that increases pressure on the brain and can damage tissues.
  
• Hyponatremia. Subarachnoid hemorrhage from a ruptured brain aneurysm can disrupt the balance of sodium in the blood supply. This may occur from damage to the hypothalamus, an area near the base of the brain. A drop in blood sodium levels (hyponatremia) can lead to swelling of brain cells and permanent damage.

Treatments and drugs:


Surgery
There are two common treatment options for a ruptured brain aneurysm.

• Surgical clipping is a procedure to close off an aneurysm. The neurosurgeon removes a section of your skull to access the aneurysm and locates the blood vessel that feeds the aneurysm. Then he or she places a tiny metal clip on the neck of the aneurysm to stop blood flow to it.
  
• Endovascular coiling is a less invasive procedure than surgical clipping. The surgeon inserts a hollow plastic tube (catheter) into an artery, usually in your groin, and threads it through your body to the aneurysm. He or she then uses a guide wire to push a soft platinum wire through the catheter and into the aneurysm. The wire coils up inside the aneurysm, disrupts the blood flow and causes blood to clot. This clotting essentially seals off the aneurysm from the artery.

Both procedures pose risks, particularly bleeding in the brain or loss of blood flow to the brain. The endovascular coil is less invasive and may be initially safer, but it also has a higher risk of subsequent re-bleeding, and additional procedures may be necessary. Your neurosurgeon will make a recommendation based on the size of the brain aneurysm, your ability to undergo surgery and other factors.

Other treatments
Other treatments for ruptured brain aneurysms are aimed at relieving symptoms and managing complications.

• Pain relievers, such as acetaminophen (Tylenol, others), may be used to treat headache pain.
  
• Calcium channel blockers prevent calcium from entering cells of the blood vessel walls. These medications may lessen vasospasm, the erratic narrowing of blood vessels that may be a complication of a ruptured aneurysm. One of these medications, nimodipine, has been shown to reduce the risk of delayed brain injury caused by insufficient blood flow after subarachnoid hemorrhage of a ruptured aneurysm.
  
• Interventions to prevent stroke from insufficient blood flow include intravenous injections of a drug called a vasopressor, which elevates blood pressure to overcome the resistance of narrowed blood vessels. An alternative intervention to prevent stroke is angioplasty. In this procedure, a surgeon uses a catheter to inflate a tiny balloon that expands a narrowed blood vessel in the brain. A catheter may also be used to deliver to the brain a drug called a vasodilator, which causes blood vessels to expand.
  
• Anti-seizure medications may be used to treat seizures related to a ruptured aneurysm. These medications include levetiracetam (Keppra), phenytoin (Dilantin, Phenytek, others) and valproic acid (Depakene).
  
• Ventricular or lumbar draining catheters and shunt surgery can lessen pressure on the brain from excess cerebrospinal fluid (hydrocephalus) associated with a ruptured aneurysm. A catheter may be placed in the spaces filled with fluid inside of the brain (ventricles) or surrounding your brain and spinal cord to drain the excess fluid into an external bag. Sometimes, it may then be necessary to introduce a shunt system — which consists of a flexible silicone rubber tube (shunt) and a valve — that creates a drainage channel starting in your brain and ending in your abdominal cavity.
  
• Rehabilitative therapy. Damage to the brain from a subarachnoid hemorrhage usually results in the need for physical, speech and occupational therapy to relearn skills.

Treating unruptured brain aneurysms
Surgical clipping or endovascular coiling can be used to seal off an unruptured brain aneurysm and help prevent a future rupture. However, the known risks of the procedures may outweigh the potential benefit.

A neurologist and a neurosurgeon can help you determine whether the treatment is appropriate for you. Factors that they would consider in making a recommendation include:

• The size and location of the aneurysm
• Your age and general health
• Family history of ruptured aneurysms
• Congenital conditions that increase the risk of a ruptured aneurysm

If you have high blood pressure, talk to your doctor about medication to manage the condition. If you have a brain aneurysm, proper control of blood pressure may lower the risk of rupture.

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Avascular necrosis

Avascular necrosis

Definition:

Avascular necrosis is the death of bone tissue due to a lack of blood supply. Also called osteonecrosis, avascular necrosis can lead to tiny breaks in the bone and the bone's eventual collapse.

The blood flow to a section of bone can be interrupted if the bone is fractured or the joint becomes dislocated. Avascular necrosis of bone is also associated with long-term use of high-dose steroid medications and excessive alcohol intake.

The hip is the joint most commonly affected by avascular necrosis. While avascular necrosis of bone can happen to anyone, it usually occurs in men between the ages of 30 and 60.


Symptoms:

Many people have no symptoms in the early stages of avascular necrosis of bone. As the disease worsens, your affected joint may hurt only when you put weight on it. Eventually, the joint may hurt even when you're lying down.

Pain can be mild or severe and usually develops gradually. Joints most likely to be affected are the hip, shoulder, knee, hand and foot. Pain associated with avascular necrosis of the hip may be focused in the groin, thigh or buttock. Some people experience avascular necrosis bilaterally — for example, in both hips or in both knees.

When to see a doctor
See your doctor if you experience persistent pain in any joint. Seek immediate medical attention if you believe you have a broken bone or a dislocated joint.


Causes:

Avascular necrosis occurs when blood flow to a bone is interrupted or reduced, which may be caused by:

• Joint or bone injury. A traumatic injury, such as a dislocated joint, may reduce the blood supply to a section of bone, leading to bone death. Cancer treatments involving radiation also can weaken bone and harm blood vessels.
  
• Pressure inside the bone. Some medical conditions, such as sickle cell anemia or Gaucher's disease, can increase the pressure inside the bone — making it more difficult for fresh blood to enter.

Complications:

 Avascular necrosis that goes untreated will worsen with time. Eventually the bone may become weakened enough that it collapses. When the bone loses its smooth shape, severe arthritis can result.


Treatments and drugs:
The treatment goal for avascular necrosis is to prevent further bone loss. What treatment you receive depends on the amount of bone damage you already have.

Medications
In some people, avascular necrosis symptoms may be reduced with medications such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Medications such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve) may help relieve the pain and inflammation associated with avascular necrosis.
  
• Osteoporosis drugs. Some studies indicate that osteoporosis medications, such as alendronate (Fosamax, Binosto), may slow the progression of avascular necrosis.
  
• Cholesterol drugs. Reducing the amount of fat (lipids) in your blood may help prevent the vessel blockages that often cause avascular necrosis.
  
• Blood thinners. If you have a clotting disorder, blood thinners such as warfarin (Coumadin, Jantoven) may be prescribed to prevent clots in the vessels feeding your bones.

Therapy
In the early stages of avascular necrosis, your doctor might suggest:

• Rest. Reducing the amount of weight and stress on your affected bone may slow the damage of avascular necrosis. You may need to restrict the amount of physical activity you engage in. In the case of hip or knee avascular necrosis, you may need to use crutches to keep weight off your joint for several months.
  
• Exercises. Certain exercises may help you maintain or improve the range of motion in your joint. A physical therapist can choose exercises specifically for your condition and teach you how to do them.
  
• Electrical stimulation. Electrical currents may encourage your body to grow new bone to replace the area damaged by avascular necrosis. Electrical stimulation can be used during surgery and applied directly to the damaged area. Or it can be administered through electrodes attached to your skin.

Surgical and other procedures
Because most people don't start having symptoms until the disease is fairly advanced, you may need to consider surgeries such as:

• Core decompression. In this operation, your surgeon removes part of the inner layer of your bone. In addition to reducing your pain, the extra space within your bone stimulates the production of healthy bone tissue and new blood vessels.
  
• Bone transplant (graft). This procedure can help strengthen the area of bone affected by avascular necrosis The graft is a section of healthy bone taken from another part of your body.
  
• Bone reshaping (osteotomy). This procedure removes a wedge of bone above or below a weight-bearing joint to help shift your weight off the damaged bone. Bone reshaping may allow you to postpone joint replacement.
  
• Joint replacement. If your diseased bone has already collapsed or other treatment options aren't helping, you may need surgery to replace the damaged parts of your joint with plastic or metal parts.

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Autonomic neuropathy

Autonomic neuropathy

Definition:

Autonomic neuropathy is a nerve disorder that affects involuntary body functions, including heart rate, blood pressure, perspiration and digestion.

It isn't a specific disease. Autonomic neuropathy refers to damage to the autonomic nerves. This damage disrupts signals between the brain and portions of the autonomic nervous system, such as the heart, blood vessels and sweat glands. This can cause decreased or abnormal performance of one or more involuntary body functions.

Autonomic neuropathy can be a complication of a number of diseases and conditions. And some medications can cause autonomic neuropathy as a side effect. Signs, symptoms and treatment of autonomic neuropathy vary depending on the cause, and on which nerves are affected.

Symptoms:

Signs and symptoms of autonomic neuropathy vary, depending on which parts of your autonomic nervous system are affected. They may include:

• Dizziness and fainting upon standing caused by a drop in blood pressure.
• Urinary problems, including difficulty starting urination, urinary incontinence and an inability to completely empty your bladder, which can lead to urinary tract infections.
• Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men, and vaginal dryness and difficulties with arousal and orgasm in women.
• Difficulty digesting food, due to abnormal digestive function and slow emptying of the stomach (gastroparesis). This can cause a feeling of fullness after eating little, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn.
• Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature.
• Sluggish pupil reaction, making it difficult to adjust from light to dark and causing problems with driving at night.
• Exercise intolerance, which may occur if your heart rate remains unchanged instead of appropriately increasing and decreasing in response to your activity level.

When to see a doctor
Seek medical care promptly if you begin experiencing any of the signs and symptoms of autonomic neuropathy. If you have diabetes, a compromised immune system or another chronic medical condition, see your doctor regularly to be checked for nerve damage.
The American Diabetes Association (ADA) recommends that people with type 2 diabetes be screened every year for autonomic neuropathy starting as soon as they receive their diabetes diagnosis. For people with type 1 diabetes, the ADA advises annual screening beginning five years after being diagnosed with diabetes.


Causes:

Autonomic neuropathy can be caused by a large number of diseases and conditions or can be a side effect of treatment for diseases unrelated to the nervous system. Some common causes of autonomic neuropathy include:

• Abnormal protein buildup in organs (amyloidosis), which affects the organs and the nervous system.
• Autoimmune diseases, in which your immune system attacks and damages parts of your body, including your nerves. Examples include Sjogren's syndrome and systemic lupus erythematosus. Autonomic neuropathy may also be caused by an abnormal attack by the immune system that occurs as a result of some cancers (paraneoplastic syndrome).
• Diabetes, which is the most common cause of autonomic neuropathy, can gradually cause nerve damage throughout the body.
• Injury to nerves caused by surgery or radiation to the neck.
• Treatment with certain medications, including some drugs used in cancer chemotherapy, some antidepressants and some heart medications.
• Other chronic illnesses, such as Parkinson's disease.
• Certain infectious diseases. Some viruses and bacteria, such as botulism, leprosy and diphtheria, can cause autonomic neuropathy.
• Inherited disorders. Certain hereditary disorders can cause autonomic neuropathy. 

Treatments and drugs:

Treatment of autonomic neuropathy includes:

• Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you'll need to control your blood sugar to keep it as close to normal as possible. Treating the underlying disease can help stop autonomic neuropathy from progressing.
  
• Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms
Your doctor may recommend:

• Modifying your diet. This could include increasing the amount of fiber you eat and fluids you drink. Supplements containing fiber, such as Metamucil or Citrucel, also may help. Be sure to increase the fiber in your diet slowly to avoid gas and bloating.
  
• Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication may cause drowsiness, and its effectiveness wears off over time.
  
• Medications to ease constipation. Over-the-counter laxatives may help ease constipation. Ask your doctor how often you should use these medications. In addition, increasing the amount of fiber in your diet may help relieve constipation.
  
• Antidepressants. Tricyclic antidepressants, such as imipramine (Tofranil) or nortriptyline (Pamelor), can help treat diarrhea and abdominal pain. Dry mouth and urine retention are possible side effects of these medications.

Urinary symptoms
Your doctor may suggest:

• Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder's capacity and retrain your bladder to empty completely at the appropriate times.
  
• Medication to help empty the bladder. Bethanechol is a medication that helps ensure complete emptying of the bladder. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
  
• Urinary assistance (catheterization). During this procedure, a tube is threaded through your urethra to empty your bladder.
  
• Medications that decrease overactive bladder. These include tolterodine (Detrol) or oxybutynin (Ditropan XL). Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.

Sexual dysfunction
For men with erectile dysfunction, your doctor may recommend:

• Medications that enable erections. Drugs such as sildenafil (Viagra), vardenafil (Levitra) or tadalafil (Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and altered color vision. Men with a history of heart disease, stroke or high blood pressure need to use these medications with caution and medical supervision. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
  
• An external vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.

For women with sexual symptoms, your doctor may recommend:

• Vaginal lubricants. If vaginal dryness is a problem, vaginal lubricants may make sexual intercourse more comfortable and enjoyable.

Heart rhythm and blood pressure symptoms
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor may prescribe:

• Medications that help raise your blood pressure. If you get dizzy or feel faint when you stand up, your doctor may suggest a drug called fludrocortisone acetate. This medication helps your body retain salt, which helps regulate your blood pressure. Other drugs that can help raise your blood pressure include midodrine (ProAmatine) and pyridostigmine (Mestinon). High blood pressure when lying down is a possible side effect of midodrine.
  
• Medication that helps regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if your heart rate doesn't respond normally to changes in activity level.
  
• A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high fluid diet may help maintain your blood pressure.

Sweating
If you experience excessive sweating, your doctor may prescribe:

• A medication that decreases perspiration. The drug glycopyrrolate (Robinul, Robinul Forte) can decrease sweating. Side effects may include dry mouth, urinary retention, blurred vision, changes in heart rate, loss of taste and drowsiness.

There is no medication to increase sweating if you have lost the ability to sweat.

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Autoimmune hepatitis

Autoimmune hepatitis

Definition:

Autoimmune hepatitis is inflammation in your liver that occurs when your body's immune system attacks your liver. Although the cause of autoimmune hepatitis isn't entirely clear, some diseases, toxins and drugs may trigger autoimmune hepatitis in susceptible people, especially women.

Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system.

A liver transplant may be an option when autoimmune hepatitis doesn't respond to drug treatments or when liver disease is advanced.


Symptoms:

Signs and symptoms of autoimmune hepatitis can range from minor to severe and may come on suddenly or develop over time. Some people have few, if any, recognized problems in the early stages of the disease, whereas others experience signs and symptoms that may include:

• Fatigue
• Abdominal discomfort
• Joint pain
• Itching (pruritus)
• Yellowing of the skin and whites of the eyes (jaundice)
• An enlarged liver
• Abnormal blood vessels on the skin (spider angiomas)
• Nausea and vomiting
• Loss of appetite
• Skin rashes
• Dark-colored urine
• In women, loss of menstruation

When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.


Causes:

Autoimmune hepatitis occurs when the body's immune system, which ordinarily attacks viruses, bacteria and other pathogens, instead targets the liver. This attack on your liver can lead to chronic inflammation and serious damage to liver cells. Just why the body turns against itself is unclear, but researchers think autoimmune hepatitis could be caused by an interaction between several risk factors, such as infections, medications and a genetic predisposition.

Types of autoimmune hepatitis
Doctors have identified two main forms of autoimmune hepatitis:

• Type 1 (classic) autoimmune hepatitis. This is the most common type of the disease. It can occur at any age. About half the people with type 1 autoimmune hepatitis have other autoimmune disorders, such as thyroiditis, rheumatoid arthritis or ulcerative colitis.
  
• Type 2 autoimmune hepatitis. Although adults can develop type 2 autoimmune hepatitis, it's most common in young girls and often occurs with other autoimmune problems.

Complications:

Autoimmune hepatitis may be associated with a variety of other autoimmune diseases, including:

• Pernicious anemia. Associated with a number of autoimmune disorders, pernicious anemia occurs when a lack of vitamin B-12 interferes with your body's ability to form red blood cells.
  
• Hemolytic anemia. In this type of anemia, your immune system attacks and breaks down red blood cells faster than your bone marrow can replace them.
  
• Ulcerative colitis. This inflammatory bowel disease can cause severe bouts of watery or bloody diarrhea and abdominal pain.
  
• Autoimmune thyroiditis (Hashimoto's thyroiditis). In this condition, the immune system attacks the thyroid gland.
  
• Rheumatoid arthritis. Rheumatoid arthritis occurs when the immune system attacks the lining of your joints, leading to stiffness, pain, swelling, and sometimes deformity and disability.
  
• Celiac disease. This disease causes an abnormal reaction to gluten, a protein found in many grains. Eating gluten sets off an immune response that damages the small intestine.

Complications of liver damage
Autoimmune hepatitis that goes untreated can cause permanent scarring of the liver tissue (cirrhosis). Complications of cirrhosis include:

• Increased blood pressure in the portal vein. Blood from your intestine, spleen and pancreas enters your liver through a large blood vessel called the portal vein. If scar tissue blocks normal circulation through your liver, this blood backs up, leading to increased pressure within the portal vein (portal hypertension).
  
• Enlarged veins in your esophagus (esophageal varices). When circulation through the portal vein is blocked, blood may back up into other blood vessels — mainly those in your stomach and esophagus. The blood vessels are thin walled, and because they're filled with more blood than they're meant to carry, they're likely to bleed. Massive bleeding in the esophagus from these blood vessels is a life-threatening emergency that requires immediate medical care.
  
• Fluid in your abdomen (ascites). Liver disease can cause large amounts of fluid to accumulate in your abdomen. Ascites can be uncomfortable and may interfere with breathing and is usually a sign of advanced cirrhosis.
  
• Liver failure. This occurs when extensive damage to liver cells makes it impossible for your liver to function adequately. At this point, a liver transplant is the only option.
  
• Liver cancer. People with cirrhosis have an increased risk of liver cancer.

Treatments and drugs:

Whatever type of autoimmune hepatitis you have, the goal of treatment is to slow or stop your body's immune system from attacking your liver. This may help slow the progression of the disease.

Medications to control your immune system (immunosuppressants)
Medications used to treat autoimmune hepatitis include:

• Prednisone. Doctors usually recommend an initial high dose of the corticosteroid drug prednisone for people with autoimmune hepatitis. The medication is reduced to the lowest possible dose that controls the disease over a few weeks. Most people need to continue taking the prednisone for at least 18 to 24 months, and some people remain on it for life. Although you may experience remission a few years after starting treatment, the disease often returns if the drug is discontinued.
  
  Prednisone, especially when taken long term, can cause a wide range of serious side effects, including diabetes, thinning bones (osteoporosis), broken bones (osteonecrosis), high blood pressure, cataracts, glaucoma and weight gain.
  
  
• Azathioprine (Azasan, Imuran). Azathioprine, another immunosuppressant medication, is sometimes used along with prednisone. Using both medications may allow you to take a smaller dose of prednisone, reducing its side effects. Side effects of azathioprine may include difficulty fighting infections and nausea. Rare side effects include liver damage, pancreas inflammation (pancreatitis) and cancer.
  
• Other immunosuppressants. If you don't respond to prednisone or azathioprine, your doctor may prescribe stronger immunosuppressants, such as mycophenolate (CellCept), cyclosporine (Neoral, Sandimmune, others) or tacrolimus (Prograf).

Liver transplant
When medications don't halt the progress of the disease, or you develop irreversible scarring (cirrhosis) or liver failure, the remaining option is a liver transplant.
During a liver transplant, your diseased liver is removed and replaced by a healthy liver from a donor. Liver transplants most often use livers from deceased organ donors. In some cases, a living-donor liver transplant can be used. During a living-donor liver transplant, you receive only a portion of a healthy liver from a living donor. Both livers begin regenerating new cells almost immediately.

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Autism

Autism

Definition:

Autism is one of a group of serious developmental problems called autism spectrum disorders that appear in early childhood — usually before age 3. Though symptoms and severity vary, all autism spectrum disorders affect a child's ability to communicate and interact with others.

The number of children diagnosed with autism appears to be rising. It's not clear whether this is due to better detection and reporting of autism or a real increase in the number of cases or both.
While there is no cure for autism, intensive, early treatment can make a big difference in the lives of many children with the disorder.

Symptoms:

Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because autism symptoms and severity vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, children with severe autism have marked impairments or a complete inability to communicate or interact with other people.

Some children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life, but then suddenly become withdrawn or aggressive or lose language skills they've already acquired.

Though each child with autism is likely to have a unique pattern of behavior, these are some common autism symptoms:

Social skills

• Fails to respond to his or her name
• Has poor eye contact
• Appears not to hear you at times
• Resists cuddling and holding
• Appears unaware of others' feelings
• Seems to prefer playing alone — retreats into his or her own world
• Doesn't ask for help or request things

Language

• Doesn't speak or has delayed speech
• Loses previously acquired ability to say words or sentences
• Doesn't make eye contact when making requests
• Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
• Can't start a conversation or keep one going
• May repeat words or phrases verbatim, but doesn't understand how to use them
• Doesn't appear to understand simple questions or directions

Behavior

• Performs repetitive movements, such as rocking, spinning or hand-flapping
• Develops specific routines or rituals and becomes disturbed at the slightest change
• Moves constantly
• May be fascinated by details of an object, such as the spinning wheels of a toy car, but doesn't understand the "big picture" of the subject
• May be unusually sensitive to light, sound and touch, and yet oblivious to pain
• Does not engage in imitative or make-believe play
• May have odd food preferences, such as eating only a few foods, or craving items that are not food, such as chalk or dirt
• May perform activities that could cause self-harm, such as headbanging

Young children with autism also have a hard time sharing experiences with others. When read to, for example, they're unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.

As they mature, some children with autism become more engaged with others and show fewer disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have difficulty with language or social skills, and the teen years can bring worse behavioral problems.

Most children with autism are slow to gain new knowledge or skills, and some have signs of lower than normal intelligence. Other children with autism have normal to high intelligence. These children learn quickly, yet have trouble communicating, applying what they know in everyday life and adjusting in social situations. A small number of children with autism are savants — they have exceptional skills in a specific area, such as art, math or music.

When to see a doctor
Babies develop at their own pace, and many don't follow exact timelines found in some parenting books. But children with autism usually show some signs of delayed development within the first year. If you suspect that your child may have autism, discuss your concerns with your doctor. The symptoms associated with autism can also be associated with other developmental disorders.The earlier that treatment begins, the more effective it will be.

Your doctor may recommend more developmental tests if your child:

• Doesn't respond with a smile or happy expression by 6 months
• Doesn't mimic sounds or facial expressions by 9 months
• Doesn't babble or coo by 12 months
• Doesn't gesture — such as point or wave — by 12 months
• Doesn't say single words by 16 months
• Doesn't say two-word phrases by 24 months
• Loses previously acquired language or social skills at any age

Causes:

Autism has no single, known cause. Given the complexity of the disease, and the fact that symptoms and severity vary, there are probably many causes. Both genetics and environment may play a role.

• Genetic problems. Several genes appear to be involved in autism. Some may make a child more susceptible to the disorder. Others affect brain development or the way that brain cells communicate. Still others may determine the severity of symptoms. Each problem in genes may account for a small number of cases, but taken together, the influence of genes is likely substantial. Some genetic problems seem to be inherited, while others happen spontaneously.
  
• Environmental factors. Researchers are currently exploring whether such factors as viral infections, complications during pregnancy and air pollutants play a role in triggering autism.

No link between vaccines and autism
One of the greatest controversies in autism is centered on whether a link exists between autism and certain childhood vaccines, particularly the measles-mumps-rubella (MMR) vaccine. Despite extensive research, no reliable study has shown a link between autism and the MMR vaccine.
Avoiding childhood vaccinations can place your child in danger of catching and spreading serious diseases, including whooping cough (pertussis), measles or mumps.


Treatments and drugs:


No cure exists for autism, and there is no one-size-fits-all treatment. The range of home-based and school-based treatments and interventions for autism can be overwhelming.
The goal of treatment is to maximize your child's ability to function by reducing autism symptoms and supporting development and learning. Your doctor can help identify resources in your area. Treatment options may include:

• Behavior and communication therapies. Many programs address the range of social, language and behavioral difficulties associated with autism. Some programs focus on reducing problem behaviors and teaching new skills. Others focus on teaching children how to act in social situations or how to communicate better with other people. Though children don't always outgrow autism, they may learn to function well.
  
• Educational therapies. Children with autism often respond well to highly structured education programs. Successful programs often include a team of specialists and a variety of activities to improve social skills, communication and behavior. Preschool children who receive intensive, individualized behavioral interventions often show good progress.
  
• Family therapies. Parents and family members can learn how to play and interact with their children in ways that promote social interaction skills, manage problem behaviors, and teach daily living skills and communication.
  
• Medications. No medication can improve the core signs of autism, but certain medications can help control symptoms. For example, antidepressants may be prescribed for anxiety, and antipsychotic drugs are sometimes used to treat severe behavioral problems. Other medications may be prescribed if your child is hyperactive.

Managing other medical conditions
Children with autism may also have other medical conditions, such as epilepsy, sleep disorders, limited food preferences or stomach problems. Ask your child's doctor how to best manage these conditions together. Keep all of your child's health care providers updated on any medications and supplements your child is taking. Some medications and supplements can interact, causing dangerous side effects.
Teens and young adults with autism may have issues with body changes, increased social awareness and transitions. Your health care provider and community advocacy and service organizations can offer help.

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Atypical hyperplasia of the breast

Atypical hyperplasia of the breast

Definition:

Atypical hyperplasia is a precancerous condition that affects cells in the breast. Atypical hyperplasia describes an accumulation of abnormal cells in a breast duct (atypical ductal hyperplasia) or lobule (atypical lobular hyperplasia).

Atypical hyperplasia isn't cancer, but it can be a forerunner to the development of breast cancer. Over the course of your lifetime, if the atypical hyperplasia cells keep dividing and become more abnormal, your condition may be reclassified as noninvasive breast cancer (carcinoma in situ) or breast cancer.

If you've been diagnosed with atypical hyperplasia, you have an increased risk of developing breast cancer in the future. For this reason, doctors sometimes recommend more frequent breast cancer screening and careful consideration of medications and other strategies to reduce breast cancer risk.

Symptoms:

Atypical hyperplasia doesn't cause any specific signs or symptoms.

When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
Atypical hyperplasia doesn't cause signs and symptoms, but it's usually discovered during a breast biopsy to investigate breast signs and symptoms caused by another condition or an abnormality found on a mammogram.


Causes:
It's not clear what causes atypical hyperplasia. Atypical hyperplasia forms when breast cells become abnormal in number, size, shape, growth pattern and appearance. Location of the abnormal cells within the breast tissue — the lobules or the milk ducts — determines whether the cells are atypical lobular hyperplasia or atypical ductal hyperplasia.

Atypical hyperplasia is thought to be part of the complex, multistep process by which breast cancer develops. The process begins when normal cell development and growth become disrupted, causing an overproduction of normal-looking cells (hyperplasia). Atypical hyperplasia occurs when the excess cells stack upon one another and begin to take on an abnormal appearance.

The abnormal cells can continue to change in appearance and multiply, evolving into noninvasive (in situ) cancer, in which cancer cells remain confined to the area where they start growing. Left untreated, the cancer cells may eventually become invasive cancer, invading surrounding tissue, blood vessels or lymph channels.

Complications:

Increased risk of breast cancer
If you've been diagnosed with atypical hyperplasia, you have an increased risk of breast cancer in the future. Women with atypical hyperplasia have a risk of breast cancer that is about four times higher than that of women who don't have atypical hyperplasia.

Being diagnosed with atypical hyperplasia at a younger age may increase the risk of breast cancer even more. Women diagnosed with atypical hyperplasia before age 45 have a greater risk of developing invasive breast cancer during their lifetimes, compared with older women, especially those older than 55.

Treatments and drugs:

Atypical hyperplasia is generally treated with surgery to remove the abnormal cells and to make sure no in situ or invasive cancer also is present in the area. Doctors often recommend more frequent screening for breast cancer and strategies to reduce your breast cancer risk.

Follow-up tests to monitor for breast cancer
Your doctor may recommend you undergo follow-up tests to screen for breast cancer. This may increase the chance that breast cancer is detected early, when a cure is more likely. Talk about your breast cancer screening options with your doctor. Your options may include:

• Self-exams of your breasts to develop breast familiarity and to detect any unusual breast changes
• Clinical breast exams by your health care provider once or twice a year
• Screening mammograms every year
• Screening breast magnetic resonance imaging (MRI), depending on other risk factors, such as a strong family history or a genetic predisposition to breast cancer

Ways to reduce your risk of breast cancer
To reduce your risk of developing breast cancer, your doctor may recommend that you:

• Take preventive medications. Treatment with a selective estrogen receptor modulator (SERM), such as tamoxifen or raloxifene (Evista), for five years may reduce the risk of breast cancer. These drugs work by blocking estrogen from binding to estrogen receptors in breast tissue. Estrogen is thought to fuel the growth of some breast cancers. Another option for certain women may be exemestane (Aromasin), which decreases production of estrogen in the body.
  
• Avoid menopausal hormone therapy. Researchers have concluded that combination hormone therapy to treat symptoms of menopause — estrogen plus progestin — increases breast cancer risk in postmenopausal women. Many breast cancers depend on hormones for growth.
  
• Participate in a clinical trial. Clinical trials test new treatments not yet available to the public at large that may prove helpful in reducing breast cancer risk associated with atypical hyperplasia. Ask your doctor if you're a candidate for any clinical trials.
  
• Consider risk-reducing (prophylactic) mastectomy. For women at very high risk of breast cancer, risk-reducing mastectomy — surgery to remove one or both breasts — reduces the risk of developing breast cancer in the future. You might be considered at very high risk of breast cancer if you have a genetic mutation in one of the breast cancer genes or you have a very strong family history of breast cancer that suggests a likelihood of having such a genetic mutation.

But this surgery isn't right for everyone. Discuss with your doctor the risks, benefits and limitations of this risk-reducing surgery in light of your personal circumstances. If you have a strong family history of breast cancer, you might benefit from also meeting with a genetic counselor to evaluate your risk of carrying a genetic mutation and the role of genetic testing in your situation.

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Atypical depression

Atypical depression

Definition  :

Any type of depression can make you feel sad and keep you from enjoying life. However, if you have atypical depression, certain key signs and symptoms tend to occur. These include increased hunger, weight gain, sleeping a lot, feeling that your arms and legs are heavy, and difficulty maintaining relationships.

Atypical depression often starts in the teenage years and is more common in women than in men. Despite the name, atypical depression isn't uncommon or unusual. Similar to other forms of depression, treatment for atypical depression includes medications, psychological counseling (psychotherapy) and lifestyle changes.


Symptoms:

Depression of any kind can cause feelings of sadness and a decreased ability to enjoy life. But atypical depression includes these main signs and symptoms:

• Depression that temporarily lifts when you're cheered up by good news or positive events but returns later
• Increased appetite with unintentional weight gain
• Increased desire to sleep, usually more than 10 hours a day
• Heavy, leaden feeling in your arms and legs that lasts an hour or more in a day
• Trouble maintaining long-lasting relationships because of sensitivity to rejection or criticism, which affects your relationships, social life or job

When to see a doctor
If you feel depressed, make an appointment to see your doctor as soon as you can. Depression may get worse if it isn't treated. Untreated depression can lead to other mental and physical health problems or problems in other areas of your life. Feelings of depression can also lead to suicide.
If you're reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.

If you have suicidal thoughts
If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

• Reach out to a close friend or loved one.
• Contact a minister, a spiritual leader or someone in your faith community.
• Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
• Make an appointment with your doctor, mental health provider or other health care provider.

When to get emergency help
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.
If you have a loved one who is in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes:

It's not known exactly what causes atypical depression. As with other types of depression, a combination of factors may be involved. These include:

• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. When these chemicals are out of balance, it may lead to depression symptoms.
  
• Inherited traits. Depression is more common in people whose biological (blood) relatives also have the condition.
  
• Life events. Events such as the death or loss of a loved one, financial problems, and high stress can trigger depression in some people.
  
• Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause changes in the brain that make you more susceptible to depression.

Complications:

Like other types of depression, atypical depression is a serious illness that can cause major problems. Atypical depression can result in emotional, behavioral and health problems that affect every area of your life. Complications associated with atypical depression may include:

• Excess weight or obesity, which can lead to heart disease and diabetes
• Alcohol or drug abuse
• Anxiety and panic disorder or social phobia
• Family conflicts, relationship difficulties, and work or school problems
• Social isolation
• Suicidal feelings or suicide

Treatments and drugs:

Treatment for atypical depression is generally the same as for other types of depression. In some cases, a primary care doctor can prescribe medications to relieve symptoms. However, many people with atypical depression need to see a psychiatrist. Most people also benefit from seeing a psychologist or other mental health counselor. Usually the most effective treatment is a combination of medication and psychotherapy.

Atypical depression most often occurs as part of mild, long-lasting depression. However, it can cause more severe symptoms in some people, such as feeling suicidal or not being able to do basic day-to-day activities.
Here's a closer look at your treatment options.

Medications
Many types of medications are available to treat depression. They include:

• Selective serotonin reuptake inhibitors (SSRIs). Doctors often start treatment by prescribing an SSRI. These medications are safer and generally cause fewer side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may go away as your body adjusts to the medication. They can include digestive problems, jitteriness, restlessness, headache and insomnia.
  
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. These medications can cause increased sweating, dry mouth, fast heart rate and constipation.
  
• Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It's one of the few antidepressants that doesn't cause sexual side effects, and it usually doesn't cause weight gain. At high doses, bupropion may increase your risk of having seizures.
  
• Atypical antidepressants. These medications don't fit neatly into another antidepressant category. They include trazodone and mirtazapine (Remeron). Both are sedating and usually taken in the evening. A newer medication called vilazodone (Viibryd) has a low risk of sexual side effects. The most common side effects of vilazodone are diarrhea, nausea, vomiting and insomnia.
  
• Tricyclic antidepressants. Tricyclic antidepressants — such as imipramine (Tofranil) and nortriptyline (Pamelor) — tend to cause more severe side effects than newer antidepressants. So tricyclics generally aren't prescribed unless you've tried an SSRI first without improvement. Side effects may include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat, confusion or weight gain, among others.
  
• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate) and phenelzine (Nardil) — may be prescribed as a last resort, when other medications haven't worked, because they can have serious side effects. Use of MAOIs requires a strict diet because of dangerous (or even deadly) interactions with foods — such as certain cheeses, pickles and wines — and some medications including birth control pills, decongestants and certain herbal supplements. Selegiline (Emsam), a newer MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs. These medications can't be combined with SSRIs.
  
• Other medications. Other medications may be added to an antidepressant to enhance antidepressant effects. Your doctor may recommend combining two antidepressants or medications, such as mood stabilizers or antipsychotics. Anti-anxiety and stimulant medications might also be added for short-term use. In addition, the FDA approved a medical food — a prescription that provides dietary management for a disease or condition — called Deplin, which contains L-methylfolate, a form of the vitamin folate. Studies have shown that adding Deplin to an antidepressant can be helpful, especially in women and those who can't process (metabolize) folate — a condition identified through a genetic test.

Finding the right medication
If a family member has responded well to an antidepressant, it may be one that could help you. You may need to try several medications before you find one that works. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts.

If you're bothered by side effects, don't stop taking an antidepressant without talking to your doctor first. Some antidepressants can cause withdrawal symptoms unless you slowly taper off, and quitting abruptly may cause a sudden worsening of depression. Don't give up until you find a medication that's suitable for you.

If antidepressant treatment doesn't seem to be working, your doctor may recommend a blood test called the cytochrome P450 (CYP450) to check for specific genes that affect how your body processes antidepressants. This may help identify which antidepressant might be a good choice for you, although these genetic tests may not be widely available and they have limitations.

Antidepressants and pregnancy
If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning to become pregnant.

Antidepressants and increased suicide risk
Most antidepressants are generally safe, but the Food and Drug Administration (FDA) requires that all antidepressants carry "black box" warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So these age groups need close monitoring by loved ones, caregivers and health care providers. If you — or someone you know — have suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Psychotherapy
Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as talk therapy, counseling or psychosocial therapy.

Through these talk sessions, you can learn how to identify and make changes in unhealthy behavior or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals for your life. Psychotherapy can help you regain a sense of satisfaction and control in your life and help ease depression symptoms such as hopelessness and anger.

Hospitalization and residential treatment programs
In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if you can't care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Partial hospitalization or day treatment programs also are helpful for some people. These programs provide the support and counseling you need while you get symptoms under control.

Other treatments
Other options include:

• Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain and typically offers immediate relief of even severe depression when other treatments don't work. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also have memory loss, which is usually temporary. ECT is usually used for people who don't get better with medications, can't take antidepressants for health reasons or are at high risk of suicide.
  
• Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven't responded to antidepressants. During TMS, you sit in a reclining chair with a treatment coil placed against your scalp. The coil sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression. Typically, you'll have five treatments each week for up to six weeks.
  
• Vagus nerve stimulation. This treatment uses electrical impulses with a surgically implanted pulse generator to affect mood centers of the brain. This may be an option if you have long-term, treatment-resistant depression.

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