Atrioventricular canal defect

Atrioventricular canal defect

Definition  :

Atrioventricular canal defect is a combination of several abnormalities in the heart present at birth (congenital abnormalities). This defect, which is sometimes called endocardial cushion defect or atrioventricular septal defect, occurs when there's a hole between the chambers of the heart and problems with the valves that regulate blood flow in the heart.

Atrioventricular canal defect allows extra blood to circulate to the lungs. Ensuing problems overwork the heart and cause it to enlarge.

Atrioventricular canal defect is often associated with Down syndrome. If left untreated, atrioventricular canal defect may cause heart failure and high blood pressure in the lungs. To fix this defect, doctors often recommend surgery during the first year of life to close the hole and reconstruct the valves.

Symptoms:
There are two common types of atrioventricular canal defect — partial and complete. The partial form involves only the two upper chambers of the heart. The complete form allows blood to travel freely among all four chambers of the heart. In either type, extra blood circulates in the lungs.

Complete atrioventricular canal defect
Signs and symptoms of complete atrioventricular canal defect usually develop in the first several weeks of life. They include:

• Difficulty breathing (dyspnea)
• Lack of appetite
• Poor weight gain
• Bluish discoloration of the lips and skin (cyanosis)

If your baby has complete atrioventricular canal defect, he or she may also develop signs and symptoms of heart failure, including:

• Fatigue
• Wheezing
• Swelling (edema) in the legs, ankles and feet
• Sudden weight gain from fluid retention
• Excessive sweating
• Decreased alertness
• Irregular or rapid heartbeat

Partial atrioventricular canal defect
Signs and symptoms of a partial atrioventricular canal defect may not appear until early adulthood. When they do become noticeable, signs and symptoms may be related to complications that develop as a result of the defect, and may include:

• Abnormal heartbeat (arrhythmia)
• Heart valve problems
• Heart failure
• High blood pressure in the lungs (pulmonary hypertension)

When to see a doctor
Contact your doctor if you or your child develops any of the following signs or symptoms. These could be indications of heart failure or another complication of atrioventricular canal defect:

• Poor appetite
• Failure to gain weight, in infants and children
• Shortness of breath
• Easily tiring
• Swelling of the legs, ankles or feet
• Bluish discoloration of the skin

Some babies with the partial form of atrioventricular canal defect may not have any signs or symptoms for weeks, months or even years, depending on the severity of the defect. But, anytime the signs or symptoms above start to appear, seek medical care.


Causes:


Atrioventricular canal defect occurs during fetal growth when your baby's heart is developing. While some factors, such as Down syndrome, may increase the risk of atrioventricular canal defect, in most cases the cause is unknown.

The normal-functioning heart
Your heart is divided into four chambers, two on the right and two on the left. In performing its basic job — pumping blood throughout your body — your heart uses its left and right sides for different tasks. The right side moves blood into vessels that lead to your lungs. In your lungs, oxygen enriches your blood, which circulates to your heart's left side. The left side of your heart pumps blood into a large vessel called the aorta, which circulates blood to the rest of your body. Valves control the flow of blood into and out of the chambers of your heart. These valves open to allow blood to move to the next chamber or to one of the arteries, and they close to keep blood from flowing backward.

What happens in atrioventricular canal defect
In partial atrioventricular canal defect, a hole exists in the wall (septum) that separates the upper chambers (atria) of the heart. Also, the mitral valve between the upper and lower left chambers often has a defect called a cleft that causes it to leak (mitral valve regurgitation).

In complete atrioventricular canal defect, there's a large hole in the center of the heart where the walls between the upper chambers (atria) and lower chambers (ventricles) meet. Instead of two separate valves — one on the right (tricuspid) and one on the left (mitral) — one large common valve exists between the upper and lower chambers. And, this valve may not close tightly.

Oxygen-rich and oxygen-poor blood mix through the hole in the septum, and the abnormal valves leak blood into the heart's lower chambers (ventricles). These problems make the heart work harder, causing it to enlarge.

Complications:

Treating an atrioventricular canal defect helps your child avoid potential complications, such as:

• Enlargement of the heart. Increased blood flow through the heart forces it to work harder than normal, causing it to enlarge.
  
• Heart failure. Untreated, atrioventricular canal defect will usually result in heart failure — a condition in which the heart is unable to pump enough blood to meet the body's needs.
  
• High blood pressure in the lungs (pulmonary hypertension). When the heart's left ventricle weakens and can't pump out enough blood, the increase in pressure backs up through the pulmonary veins to the arteries in the lungs, causing high blood pressure in the lungs.
  
• Pneumonia. If your baby has an untreated atrioventricular canal defect, he or she may have recurrent bouts of pneumonia — a serious lung infection.

Complications later in life
Although treatment greatly improves the outlook for children with atrioventricular canal defect, some who have corrective surgery may still be at risk of the following associated conditions later in life:

• Leaky heart valves (regurgitation)
• Narrowing of the heart valves (stenosis)
• Heart rhythm abnormalities (arrhythmias)
• Breathing difficulties associated with damage to the lungs (pulmonary vascular disease)

Common signs and symptoms of these complications include shortness of breath, fatigue and a rapid, fluttering heartbeat, among others. In some cases, such as a leaky heart valve, a second surgery may be needed.


Treatments and drugs:


Surgery is necessary to fix both complete and partial atrioventricular canal defects. During the procedure, the hole in the septum is closed using one or two patches. The patches remain in the heart permanently, becoming part of the septum as the heart's lining grows over it. The surgeon also
separates the one large heart valve between the upper and lower chambers into two separate valves.

For a partial atrioventricular canal defect, the surgery also involves repair of the mitral valve so it will close tightly. If repair isn't possible, the valve may need to be replaced instead.

If your baby has complete atrioventricular canal defect, the surgery also includes separation of the single valve into two valves, one on the left side and one on the right side of the repaired septum. If reconstruction of the single valve into two valves isn't possible, heart valve replacement may be necessary.

After surgery
If the atrioventricular canal defect has been successfully repaired with surgery, your child will likely lead a normal life, often with no activity restrictions.

However, your child will need lifelong follow-up care with a heart doctor (cardiologist) who specializes in congenital heart disease. The recommendation for follow-up is usually once a year, unless you have lingering problems, such as a leaky heart valve. In that case, follow-up will be more frequent.

Your child may also need to take preventive antibiotics before certain dental procedures and other surgical procedures if he or she is at risk of severe complications of endocarditis, a bacterial infection of the lining of the heart. Typically, this is when your child has some remaining defects after surgery, has received an artificial valve or has had repair with artificial (prosthetic) material.

Many people who have corrective surgery for atrioventricular canal defect don't need additional surgery. However, some complications, such as heart valve leaks, may require treatment.

Pregnancy
When an atrioventricular canal defect has been surgically corrected before any permanent lung damage has occurred, women can generally expect to have normal pregnancies. Pregnancy is not recommended, however, if serious heart or lung damage occurred before surgery. An evaluation by a cardiologist is advised before women with repaired or unrepaired atrioventricular canal defect attempt pregnancy.

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Atrial septal defect (ASD)

Atrial septal defect (ASD)

Definition  :

An atrial septal defect (ASD) is a hole in the wall between the two upper chambers of your heart. The condition is present from birth (congenital). Smaller atrial septal defects may close on their own during infancy or early childhood.

Large and long-standing atrial septal defects can damage your heart and lungs. An adult who has had an undetected atrial septal defect for decades may have a shortened life span from heart failure or high blood pressure in the lungs. Surgery is often necessary to repair atrial septal defects to prevent complications.

Symptoms:

Many babies born with atrial septal defects don't have associated signs or symptoms. In adults, signs or symptoms usually begin by age 30, but in some cases signs and symptoms may not occur until decades later.

Atrial septal defect symptoms may include:

• Heart murmur, a whooshing sound that can be heard through a stethoscope
• Shortness of breath, especially when exercising
• Fatigue
• Swelling of legs, feet or abdomen
• Heart palpitations or skipped beats
• Frequent lung infections
• Stroke
• Bluish skin color

When to see a doctor
Contact your doctor if you or your child has any of these signs or symptoms:

• Bluish discoloration of the skin
• Shortness of breath
• Tires easily, especially after activity
• Swelling of legs, feet or abdomen
• Heart palpitations or skipped beats

These could be symptoms of heart failure or another complication of congenital heart disease.

Causes:

Doctors know that heart defects present at birth (congenital) arise from errors early in the heart's development, but there's often no clear cause. Genetics and environmental factors may play a role.
An atrial septal defect allows freshly oxygenated blood to flow from the left upper chamber of the heart (left atrium) into the right upper chamber of the heart (right atrium).

There, it mixes with deoxygenated blood and is pumped to the lungs, even though it's already refreshed with oxygen. If the atrial septal defect is large, this extra blood volume can overfill the lungs and overwork the heart. If not treated, the right side of the heart eventually enlarges and weakens. In some cases, the blood pressure in your lungs increases as well, leading to pulmonary hypertension.

Complications:

A small atrial septal defect may never cause any problems. Small atrial septal defects often close during infancy.

Larger defects can cause mild to life-threatening problems, including:

• Right-sided heart failure
• Heart rhythm abnormalities
• Shortened life expectancy
• Increased risk of a stroke

Less common serious complications may include:

• Pulmonary hypertension. If a large atrial septal defect goes untreated, increased blood flow to your lungs increases the blood pressure in the lung arteries (pulmonary hypertension).
  
• Eisenmenger syndrome. In rare cases, pulmonary hypertension can cause permanent lung damage, and it becomes irreversible. This complication, called Eisenmenger syndrome, usually develops over many years and occurs only in a small percentage of people with large atrial septal defects.

Treatment can prevent or help manage many of these complications.

Atrial septal defect and pregnancy
Most women with an atrial septal defect can tolerate pregnancy without any problems. However, having a larger defect or having complications such as heart failure, arrhythmias or pulmonary hypertension can increase your risk of complications during pregnancy. Doctors strongly advise women with Eisenmenger syndrome not to become pregnant because it can endanger the woman's life.

The risk of congenital heart disease is higher for children of parents with congenital heart disease, whether in the father or the mother. Anyone with a congenital heart defect, repaired or not, who is considering starting a family should carefully discuss it beforehand with a doctor. Some medications may need to be stopped or adjusted before you become pregnant because they can cause serious problems for a developing fetus.


Treatments and drugs:


If your child has an atrial septal defect, your doctor may recommend monitoring it for a period of time to see if it closes on its own, while treating any symptoms with medications. Many atrial septal defects close on their own during childhood. For those that don't close, some small atrial septal defects don't cause any problems and may not require any treatment. But many persistent atrial septal defects eventually require surgery to be corrected.

If your child needs treatment, the timing of it depends on your child's condition and whether your child has any other congenital heart defects.

Medications
Medications won't repair the hole, but they may be used to reduce some of the signs and symptoms that can accompany an atrial septal defect. Drugs may also be used to reduce the risk of complications after surgery. Medications may include those to:

• Keep the heartbeat regular. Examples include beta blockers (Lopressor, Inderal) and digoxin (Lanoxin).
  
• Reduce the risk of blood clots. Anticoagulants, often called blood thinners, can help reduce the chances of developing a blood clot and having a stroke. Anticoagulants include warfarin (Coumadin) and anti-platelet agents, such as aspirin.

Surgery
Many doctors recommend repairing an atrial septal defect diagnosed during childhood to prevent complications as an adult. For adults and children, surgery involves plugging or patching the abnormal opening between the atria. Doctors can do this through two methods:

• Cardiac catheterization. A thin tube (catheter) is inserted into a blood vessel in the groin and guided to the heart. Through the catheter, a mesh patch or plug is put into place to close the hole. The heart tissue grows around the mesh, permanently sealing the hole.
  
• Open-heart surgery. This type of surgery is done under general anesthesia and requires the use of a heart-lung machine. Through an incision in the chest, surgeons use patches or stitches to close the hole.

Medical monitoring
Follow-up care depends on the type of defect and whether other defects are present. For simple atrial septal defects closed during childhood, only occasional follow-up care is needed. For adults, follow-up care may depend on any resulting complications.

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Atrial fibrillation

Atrial fibrillation

Definition  :

Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation symptoms include heart palpitations, shortness of breath and weakness.

Episodes of atrial fibrillation can come and go, or you may have chronic atrial fibrillation. Although atrial fibrillation itself usually isn't life-threatening, it is a serious medical condition that sometimes requires emergency treatment. It can lead to complications. Treatments for atrial fibrillation may include medications and other interventions to try to alter the heart's electrical system.

Symptoms:

A heart in atrial fibrillation doesn't beat efficiently. It may not be able to pump enough blood out to your body with each heartbeat.
Some people with atrial fibrillation have no symptoms and are unaware of their condition until it's discovered during a physical examination. Those who do have atrial fibrillation symptoms may experience:

• Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flopping in your chest
• Decreased blood pressure
• Weakness
• Lightheadedness
• Confusion
• Shortness of breath
• Chest pain

• Occasional. In this case it's called paroxysmal (par-ok-SIZ-mul) atrial fibrillation. You may have symptoms that come and go, lasting for a few minutes to hours and then stopping on their own.
• Chronic. With chronic atrial fibrillation, your heart rhythm is always abnormal.

When to see a doctor
If you have any symptoms of atrial fibrillation, make an appointment with your doctor. Your doctor should be able to tell you if your symptoms are caused by atrial fibrillation or another heart arrhythmia.
If you have chest pain, seek emergency medical assistance immediately. Chest pain could signal that you're having a heart attack.

Causes:

Your heart consists of four chambers — two upper chambers (atria) and two lower chambers (ventricles). Within the upper right chamber of your heart (right atrium) is a group of cells called the sinus node. This is your heart's natural pacemaker. The sinus node produces the impulse that starts each heartbeat.

Normally, the impulse travels first through the atria and then through a connecting pathway between the upper and lower chambers of your heart called the atrioventricular (AV) node. As the signal passes through the atria, they contract, pumping blood from your atria into the ventricles below. As the signal passes through the AV node to the ventricles, the ventricles contract, pumping blood out to your body.
In atrial fibrillation, the upper chambers of your heart (atria) experience chaotic electrical signals. As a result, they quiver.

The AV node — the electrical connection between the atria and the ventricles — is overloaded with impulses trying to get through to the ventricles. The ventricles also beat rapidly, but not as rapidly as the atria. The reason is that the AV node is like a highway on-ramp — only so many cars can get on at one time.

The result is a fast and irregular heart rhythm. The heart rate in atrial fibrillation may range from 100 to 175 beats a minute. The normal range for a heart rate is 60 to 100 beats a minute.

Possible causes of atrial fibrillation
Abnormalities or damage to the heart's structure are the most common cause of atrial fibrillation. Possible causes of atrial fibrillation include:

• High blood pressure
• Heart attacks
• Abnormal heart valves
• Heart defects you're born with (congenital)
• An overactive thyroid gland or other metabolic imbalance
• Exposure to stimulants such as medications, caffeine or tobacco, or to alcohol
• Sick sinus syndrome — improper functioning of the heart's natural pacemaker
• Emphysema or other lung diseases
• Previous heart surgery
• Viral infections
• Stress due to pneumonia, surgery or other illnesses
• Sleep apnea

However, some people who have atrial fibrillation don't have any heart defects or damage, a condition called lone atrial fibrillation. In lone atrial fibrillation, the cause is often unclear, and serious complications are rare.

Atrial flutter
Atrial flutter is similar to atrial fibrillation, but the rhythm in your atria is more organized and less chaotic than the abnormal patterns common with atrial fibrillation. Sometimes you may have atrial flutter that develops into atrial fibrillation and vice versa. The symptoms, causes and risk factors of atrial flutter are similar to those of atrial fibrillation. For example, strokes are a concern in someone with atrial flutter. As with atrial fibrillation, atrial flutter is usually not life-threatening when it's properly treated.

Complications:

Sometimes atrial fibrillation can lead to the following complications:

• Stroke. In atrial fibrillation, the chaotic rhythm may cause blood to pool in your heart's upper chambers (atria) and form clots. If a blood clot forms, it could dislodge from your heart and travel to your brain. There it might block blood flow, causing a stroke.
  
  The risk of stroke in atrial fibrillation depends on your age (you have a higher risk as you age) and on whether you have high blood pressure, diabetes, or a history of heart failure or previous stroke, and other factors. Medications such as blood thinners can greatly lower your risk of stroke or damage to other organs caused by blood clots.
  
  
• Heart failure. Atrial fibrillation, especially if not controlled, may weaken the heart, leading to heart failure — a condition in which your heart can't circulate enough blood to meet your body's needs.

Treatments and drugs:

In some people, a specific event or an underlying condition, such as a thyroid disorder, may trigger atrial fibrillation. If the condition that triggered your atrial fibrillation can be treated, you might not have any more heart rhythm problems — or at least not for quite some time. If your symptoms are bothersome or if this is your first episode of atrial fibrillation, your doctor may attempt to reset the rhythm.

The treatment option best for you will depend on how long you've had atrial fibrillation, how bothersome your symptoms are and the underlying cause of your atrial fibrillation. Generally, the goals of treating atrial fibrillation are to:

• Reset the rhythm or control the rate
• Prevent blood clots

The strategy you and your doctor choose depends on many factors, including whether you have other problems with your heart and if you're able to take medications that can control your heart rhythm. In some cases, you may need a more invasive treatment, such as surgery or medical procedures using catheters.

Resetting your heart's rhythm
Ideally, to treat atrial fibrillation, the heart rate and rhythm are reset to normal. To correct your condition, doctors may be able to reset your heart to its regular rhythm (sinus rhythm) using a procedure called cardioversion, depending on the underlying cause of atrial fibrillation and how long you've had it. Cardioversion can be done in two ways:

• Cardioversion with drugs. This form of cardioversion uses medications called anti-arrhythmics to help restore normal sinus rhythm. Depending on your heart condition, your doctor may recommend trying intravenous or oral medications to return your heart to normal rhythm. This is often done in the hospital with continuous monitoring of your heart rate. If your heart rhythm returns to normal, your doctor often will prescribe the same anti-arrhythmic or a similar one to try to prevent more spells of atrial fibrillation.
  
• Electrical cardioversion. In this brief procedure, an electrical shock is delivered to your heart through paddles or patches placed on your chest. The shock stops your heart's electrical activity momentarily. When your heart begins again, the hope is that it resumes its normal rhythm. The procedure is performed with sedation, so you shouldn't feel the electric shock.

Before cardioversion, you may be given a blood-thinning medication, such as warfarin (Coumadin), for several weeks to reduce the risk of blood clots and stroke. Unless the episode of atrial fibrillation lasted less than 24 hours, you'll need to take warfarin for at least four to six weeks after cardioversion to prevent a blood clot from forming even after your heart is back in normal rhythm. Warfarin is a powerful medication that can have dangerous side effects if not taken exactly as directed by your doctor. If you have any concerns about taking warfarin, talk to your doctor.

Or, instead of taking warfarin, you may have a test called transesophageal echocardiography — which can tell your doctor if you have any heart blood clots — just before cardioversion. In transesophageal echocardiography, a tube is passed down your esophagus and detailed ultrasound images are made of your heart. You'll be sedated during the test.

Maintaining a normal heart rhythm
After electrical cardioversion, anti-arrhythmic medications often are prescribed to help prevent future episodes of atrial fibrillation. Commonly used medications include:

• Amiodarone (Cordarone, Pacerone)
• Dronedarone (Maltaq)
• Propafenone (Rythmol)
• Sotalol (Betapace)
• Dofetilide (Tikosyn)
• Flecainide (Tambocor)

Although these drugs can help maintain a normal heart rhythm in many people, they can cause side effects, including:

• Nausea
• Dizziness
• Fatigue

Rarely, they may cause ventricular arrhythmias — life-threatening rhythm disturbances originating in the heart's lower chambers. These medications may be needed indefinitely. Even with medications, the chance of another episode of atrial fibrillation is high.

Heart rate control
Sometimes atrial fibrillation can't be converted to a normal heart rhythm. Then the goal is to slow the heart rate to between 60 and 100 beats a minute (rate control). Heart rate control can be achieved two ways:

• Medications. Doctors have prescribed the medication digoxin (Lanoxin). It can control heart rate at rest, but not as well during activity. Most people require additional or alternative medications, such as calcium channel blockers or beta blockers. Other blood pressure lowering medications, such as angiotensin-converting enzyme (ACE) inhibitors, also are sometimes used to lower blood pressure and reduce the risk of atrial fibrillation complications.
  
• Atrioventricular (AV) node ablation. If medications don't work, or you have side effects, AV node ablation may be another option. The procedure involves applying radiofrequency energy to the pathway connecting the upper and lower chambers of your heart (AV node) through a long, thin tube (catheter) to destroy this small area of tissue.
  
  The procedure prevents the atria from sending electrical impulses to the ventricles. The atria continue to fibrillate, though, and anticoagulant medication is still required. A pacemaker is then implanted to establish a normal rhythm. After AV node ablation, you'll need to continue to take blood-thinning medications to reduce the risk of stroke, because your heart rhythm is still atrial fibrillation.
  

Other surgical and catheter procedures
Sometimes medications or cardioversion to control atrial fibrillation doesn't work. In those cases, your doctor may recommend a procedure to destroy the area of heart tissue that's causing the erratic electrical signals and restore your heart to a normal rhythm. These options can include:

• Radiofrequency catheter ablation. In many people who have atrial fibrillation and an otherwise normal heart, atrial fibrillation is caused by rapidly discharging triggers, or "hot spots." These hot spots are like abnormal pacemaker cells that fire so rapidly that the upper chambers of your heart quiver instead of beating efficiently.
  
  Radiofrequency energy is directed to these hot spots through a catheter inserted in an artery near your groin and threaded up to your heart. This catheter is used to destroy these hot spots, scarring the tissue so the erratic electrical signals are normalized. This corrects the arrhythmia without the need for medications or implantable devices. In some cases, other types of catheters that can freeze the heart tissue (cryotherapy) are used.
  
  
• Surgical maze procedure. The maze procedure is done during an open-heart surgery. Using a scalpel, doctors create several precise incisions in the upper chambers of your heart to create a pattern of scar tissue. Because scar tissue doesn't carry electricity, it interferes with stray electrical impulses that cause atrial fibrillation. Radiofrequency or cryotherapy also can be used to create the scars, and there are several variations of the surgical maze technique.
  
  The procedure has a high success rate, but because it usually requires open-heart surgery, it's generally reserved for people who don't respond to other treatments or when it can be done during other necessary heart surgery, such as coronary artery bypass surgery or heart valve repair. Some people need a pacemaker implanted after the procedure.

Preventing blood clots
Most people who have atrial fibrillation or who are undergoing certain treatments for atrial fibrillation are at especially high risk of blood clots that can lead to stroke. The risk is even higher if other heart disease is present along with atrial fibrillation. Your doctor may prescribe blood-thinning medications (anticoagulants) such as:

• Warfarin (Coumadin). If you're prescribed warfarin, carefully follow your doctor's instructions on taking it. Warfarin is a powerful medication that can have dangerous side effects. You'll need to have regular blood tests to monitor warfarin's effects.
  
• Dabigatran (Pradaxa). Another option for preventing blood clots is dabigatran. Dabigatran is as effective as warfarin at preventing blood clots that can lead to strokes, and doesn't require blood tests to make sure you're getting the proper dose. Talk to your doctor about taking dabigatran as an alternative to warfarin if you're concerned about your risk of stroke.
  
• Rivaroxaban (Xarelto). Rivaroxaban is another anticoagulant medication that's as effective as warfarin for preventing strokes. Rivaroxaban is a once-daily medication. Like any other anticoagulant, follow your doctor's dosing instructions carefully and don't stop taking rivaroxaban without talking to your doctor first.

You may need to take medications to prevent blood clots in addition to medications designed to treat your irregular heartbeat. Many people have spells of atrial fibrillation and don't even know it — so you may need lifelong anticoagulants even after your rhythm has been restored to normal.

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Atopic dermatitis (eczema)

Atopic dermatitis (eczema)

Definition  :

Atopic dermatitis (eczema) is an itchy inflammation of your skin. It's a long-lasting (chronic) condition that may be accompanied by asthma or hay fever.

Eczema may affect any area of your skin, but it typically appears on your arms and behind your knees. It tends to flare periodically and then subside. The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and malfunction in the body's immune system.

Self-care measures, such as avoiding soaps or other irritants and applying creams or ointments, can help relieve itching. See your doctor if your symptoms distract you from your daily routines or prevent you from sleeping.

Symptoms:


Signs and symptoms of atopic dermatitis (eczema) include:

• Red to brownish-gray colored patches
• Itching, which may be severe, especially at night
• Small, raised bumps, which may leak fluid and crust over when scratched
• Thickened, cracked or scaly skin
• Raw, sensitive skin from scratching

Though the patches can occur anywhere, they most often appear on the hands and feet, in the front of the bend of the elbow, behind the knees, and on the ankles, wrists, face, neck and upper chest. Atopic dermatitis can also affect the skin around the eyes, including your eyelids. Scratching can cause redness and swelling around the eyes.

Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Itching may be severe, and scratching the rash can make it even itchier and cause more inflammation. Once the skin barrier is broken, the skin can become infected by bacteria, especially Staphylococcus aureus, which commonly live on the skin. Breaking this itch-scratch cycle can be challenging.

Factors that worsen atopic dermatitis
Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin, which in turn may worsen symptoms, particularly in young children.
Other factors that can worsen signs and symptoms of atopic dermatitis include:

• Dry skin
• Long, hot baths or showers
• Stress
• Sweating
• Rapid changes in temperature
• Low humidity
• Solvents, cleaners, soaps or detergents
• Wool or man-made fabrics or clothing
• Dust or sand
• Cigarette smoke
• Living in cities where pollution is high
• Certain foods, such as eggs, milk, fish, soy or wheat

Infantile eczema
When atopic dermatitis occurs in infants, it's called infantile eczema. This condition may continue into childhood and adolescence.
Infantile eczema often involves an oozing, crusting rash, mainly on the skin of the face and scalp, but it can occur anywhere. After infancy, the rash becomes dryer and tends to be red to brown-gray in color. In adolescence, the skin may be scaly or thickened and easily irritated. The intense itching may continue.

When to see a doctor
See your doctor if:

• You're so uncomfortable that you're losing sleep or are distracted from your daily routines
• Your skin is painful
• You suspect your skin is infected
• You've tried self-care steps without success

If you suspect your child has atopic dermatitis or you notice the above signs and symptoms, see your child's doctor.
Early, effective treatment helps keep atopic dermatitis from worsening. The more severe it becomes, the more difficult it is to control.

Causes:

The exact cause of atopic dermatitis (eczema) is unknown, but it's likely due to a combination of dry, irritable skin with a malfunction in the body's immune system. Stress and other emotional disorders can worsen atopic dermatitis, but they don't cause it.

Most experts believe atopic dermatitis has a genetic basis. It has been thought to be connected to asthma and hay fever, but that theory is being questioned. Not all people with atopic dermatitis have asthma or hay fever, and not all people with asthma or hay fever develop atopic dermatitis, but these diseases do seem to be present together in families of those affected.


Complications:

Complications of atopic dermatitis (eczema) include:

• Neurodermatitis. Prolonged itching and scratching may increase the intensity of the itch, possibly leading to neurodermatitis (lichen simplex chronicus). Neurodermatitis is a condition in which an area of skin that's frequently scratched becomes thick and leathery. The patches can be raw, red or darker than the rest of your skin. Persistent scratching can also lead to permanent scars or changes in skin color.
  
• Skin infections. Sometimes, scratching can break the skin and cause open sores and fissures that can become infected, a process called impetiginization. A milder form of infection is impetigo, usually due to staphylococcal infection. Having atopic dermatitis predisposes you to this infection.
  
• Eye complications. Severe atopic dermatitis can also cause eye complications, which may lead to permanent eye damage. When these complications occur, itching in and around the eyelids becomes severe. Signs and symptoms of eye complications also include eye watering and inflammation of the eyelid (blepharitis) and the lining of the eyelid (conjunctivitis). If you suspect complications with your eyes, see your doctor promptly.

Treatments and drugs:
Treatments for atopic dermatitis (eczema) aim to reduce inflammation, relieve itching and prevent future flare-ups. Over-the-counter (nonprescription) anti-itch creams and other self-care measures may help control mild atopic dermatitis.

Although atopic dermatitis is related to allergies, eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition. Allergy shots usually aren't successful in treating atopic dermatitis.

Medications

• Corticosteroid creams or ointments. Your doctor may recommend prescription corticosteroid creams or ointments to ease scaling and relieve itching. Some low-potency corticosteroid creams are available without a prescription, but you should always talk to your doctor before using any topical corticosteroid. Side effects of long-term or repeated use can include skin irritation or discoloration, thinning of the skin, infections, and stretch marks on the skin.
  
• Antibiotics. You may need antibiotics if you have a bacterial skin infection or an open sore or fissure caused by scratching. Your doctor may recommend taking antibiotics for a short time to treat an infection or for longer periods of time to reduce bacteria on your skin and to prevent recurrent infections.
  
• Oral antihistamines. If itching is severe, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be helpful at bedtime. If your skin cracks open, your doctor may prescribe mildly astringent wet dressings to prevent infection.
  
• Oral or injected corticosteroids. For more severe cases, your doctor may prescribe oral corticosteroids, such as prednisone, or an intramuscular injection of corticosteroids to reduce inflammation and to control symptoms. These medications are effective, but can't be used long term because of potential serious side effects, which include cataracts, loss of bone mineral (osteoporosis), muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.
  
• Immunomodulators. A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affect the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis. This prescription-only medication is approved for children older than 2 and for adults. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods, the Food and Drug Administration recommends that Elidel and Protopic be used only when other treatments have failed or if someone can't tolerate other treatments.

Light therapy (phototherapy)
As the name suggests, this treatment uses natural or artificial light. The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light including the more recently available narrow band ultraviolet B (NBUVB) either alone or with medications.

Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, it's important to consult your doctor before using light exposure as treatment for atopic dermatitis. Your doctor can advise you of possible advantages and disadvantages of light exposure in your specific situation.

Infantile eczema
Treatment for infantile eczema includes identifying and avoiding skin irritations, avoiding extreme temperatures, and lubricating your baby’s skin with bath oils, lotions, creams or ointments.
See your baby's doctor if these measures don't improve the rash or if the rash looks infected. Your baby may need a prescription medication to control his or her symptoms or to treat the infection. Your doctor may recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.

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Atelectasis

Atelectasis

Definition  :

Atelectasis (at-uh-LEK-tuh-sis) — a complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated. It is one of the most common breathing (respiratory) complications after surgery.

Atelectasis is also a possible complication of other respiratory problems, including cystic fibrosis, inhaled foreign objects, lung tumors, fluid in the lung, severe asthma and chest injuries.

The amount of lung tissue involved in atelectasis is variable, depending on the cause. Signs and symptoms of atelectasis also vary. Atelectasis can be serious because it reduces the amount of oxygen available to your body. Treatment depends on the cause and severity of the collapse.

Symptoms:

There may be no obvious signs or symptoms of atelectasis. If you do experience signs and symptoms, they may include:

• Difficulty breathing (dyspnea)
• Rapid, shallow breathing
• Coughing
• Low-grade fever

When to see a doctor
Significant atelectasis is likely to occur when you're already in a hospital. However, see your doctor right away if you have trouble breathing. Other conditions besides atelectasis can cause breathing difficulties and require an accurate diagnosis and prompt treatment. If your breathing becomes increasingly difficult, seek emergency care.

Causes:

Atelectasis may be the result of a blocked airway (obstructive) or of pressure from outside the lung (nonobstructive).

Almost everyone who undergoes surgery has some atelectasis from anesthesia. Anesthesia changes the dynamics of airflow within the lungs, the absorption of gases and pressures, all of which combine to cause some degree of collapse of the tiny air sacs (alveoli) in your lungs. It is particularly prominent after heart bypass surgery.

A blockage in your air passages (bronchial tubes) can cause obstructive atelectasis. Possible causes of blockage include:

• Mucus plug. Accumulation of mucus in your airways, often occurring during and after surgery because you can't cough, is the most common cause of atelectasis. Drugs given during surgery make the lungs inflate less fully than usual, so normal secretions collect in the airways. Suctioning the lungs during surgery helps clear away these secretions, but they may continue to build up afterward. This is why it's important to breathe and cough deeply during your recovery.
  Expanding the lungs gets air around the mucus plugs and makes them easier to cough out. Mucus plugs also are common in people with cystic fibrosis and during severe asthma attacks.
  
• Foreign body. Children are most likely to inhale an object, such as a peanut or small toy part, into their lungs.
  
• Narrowing of major airways from disease. Chronic infections, including fungal infections, tuberculosis and other diseases can scar and constrict major airways.
  
• Tumor in a major airway. An abnormal growth can narrow the airway.
  
• Blood clot. This occurs only if there's significant bleeding into the lungs that can't be coughed out.

Possible causes of nonobstructive atelectasis include:

• Injury. Chest trauma — from a fall or car accident, for example — can cause you to avoid taking deep breaths (due to the pain), which can result in compression of your lungs.
  
• Pleural effusion. This is a buildup of fluid between the tissues (pleura) that line the lungs and the inside of the chest wall.
  
• Pneumonia. Different types of pneumonia, an inflammation of your lungs, temporarily can cause atelectasis. An atelectatic lung that remains collapsed for a few weeks or more can result in bronchiectasis (brong-key-EK-tuh-sis), a condition in which damage to the airways causes them to widen and become flabby and scarred.
  
• Pneumothorax. Air leaks into the space between your lungs and chest wall, indirectly causing some or all of a lung to collapse.
  
• Scarring of lung tissue. Scarring could be caused by injury, lung disease or surgery. In these rare cases, the atelectasis is minor compared with the damage to the lung tissue from the scarring.
  
• Tumor. A large tumor can press against and deflate the lung, as opposed to blocking the air passages.

Complications:

The following complications may result from atelectasis:

• Low blood oxygen (hypoxemia). Atelectasis hampers your lungs' ability to get oxygen to the alveoli.
• Lung scarring. Some damage or scarring may remain after the lung is reinflated, resulting in bronchiectasis.
• Pneumonia. You're at greater risk of developing pneumonia until the atelectasis has been cleared. The mucus in a collapsed lung is a breeding ground for bacterial infections.
• Respiratory failure. A small area of atelectasis, especially in an adult, usually is treatable. But a large area, particularly in an infant or in someone with lung disease, can be life-threatening.

Treatments and drugs:

Treatment of atelectasis depends on the cause. Atelectasis of a small area of your lung may subside without treatment. If there's an underlying condition, such as a tumor, treatment may involve removal or shrinkage of the tumor with surgery, chemotherapy or radiation.

Chest physiotherapy
Techniques that help people breathe deeply after surgery to re-expand collapsed lung tissue are very important. These techniques are best learned before surgery. They include:

• Coughing.
• Clapping (percussion) on your chest over the collapsed area to loosen mucus. You can also use mechanical mucus-clearance devices such as an air-pulse vibrator vest or a hand-held instrument.
• Performing deep-breathing exercises (incentive spirometry).
• Positioning your body so that your head is lower than your chest (called postural drainage). This allows mucus to drain better from the bottom of your lungs.

Supplemental oxygen can help relieve shortness of breath.

Medications
In some cases, medications may be used. They include:

• Inhaled bronchodilators (Foradil, Serevent, others), which open the bronchial tubes of the lungs, making breathing easier.
• Acetylcysteine (Acetadote) may help thin mucus and make it easier to cough up.
• Dornase Alfa (Pulmozyme) is used to clear mucus plugs in children with cystic fibrosis. Its role in treatment of atelectasis for people without cystic fibrosis is not fully defined.

Surgical or other procedures
Your doctor may suggest removal of airway obstructions, which may be done by suctioning mucus or by bronchoscopy. Bronchoscopy uses a flexible tube threaded down your throat to clear your airways.
Use of continuous positive pressure may be helpful in some people with low oxygen levels (hypoxemia) after surgery.

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Athlete's foot

Athlete's foot

Definition:

Athlete's foot is a fungal infection that develops in the moist areas between your toes and sometimes on other parts of your foot. Athlete's foot usually causes itching, stinging and burning.

Athlete's foot, also called tinea pedis, is the most common type of fungal infection. It's closely related to other fungal infections such as ringworm and jock itch. Although contagious, athlete's foot often can be treated with over-the-counter antifungal medicatio

Symptoms:

The signs and symptoms of athlete's foot can be numerous, although you probably won't have all of them. They include:

• Itching, stinging and burning between your toes
• Itching, stinging and burning on the soles of your feet
• Itchy blisters
• Cracking and peeling skin, especially between your toes and on the soles of your feet
• Excessive dryness of the skin on the bottoms or sides of the feet
• Toenails that are thick, crumbly, ragged, discolored or pulling away from the nail bed

Onychomycosis — a fungal infection of the nail — may develop with or without other signs and symptoms of athlete's foot.

When to see a doctor
If you have a rash on your foot that doesn't improve or worsens after you've followed home and lifestyle remedies, see your doctor. See your doctor sooner if you notice excessive redness, swelling, drainage or fever, or if you have diabetes and suspect you have athlete's foot.

Causes:

Athlete's foot is closely related to other fungal infections, including ringworm and jock itch. A group of mold-like fungi called dermatophytes causes these infections. These microscopic organisms are normal inhabitants of your skin, and their growth stays in check as long as your skin is clean and dry. However, dematophytes thrive in damp, close environments.

Athlete's foot thrives in thick, tight shoes that squeeze the toes together and create warm, moist areas between them. Damp socks and shoes and warm, humid conditions also favor the organisms' growth. Plastic shoes, in particular, provide a welcoming environment for fungal growth and infection.

Athlete's foot is contagious and can be spread by contact with an infected person or with contact with contaminated surfaces, such as towels, floors and shoes.

Complications:

Athlete's foot can lead to complications, including:

• Secondary infections. Athlete's foot, a fungal infection, can create an environment that invites a secondary bacterial infection. By producing an antibiotic substance, the fungus can kill off vulnerable bacteria and favor the overgrowth of hardier, resistant bacteria. In turn, the bacteria release substances that can cause tissue breakdown — soggy skin and painful eroded areas between the toes.
  
• An allergic response. After an episode of athlete's foot, proteins might enter your bloodstream, leading to an allergic reaction that may cause an eruption of blisters on your fingers, toes or hands (dermatophytid or "id" reaction).

Treatments and drugs:

If your athlete's foot is mild, your doctor may suggest using an over-the-counter antifungal ointment, lotion, powder or spray. If your athlete's foot doesn't respond, you may need a prescription-strength topical medication or an oral (systemic) medication.

Over-the-counter medications
There are numerous over-the-counter (OTC) medications on the market. Medicated powders also will help keep your feet dry. OTC medications include:

• Butenafine (Lotrimin Ultra)
• Clotrimazole (Lotrimin AF)
• Miconazole (Desenex, Zeasorb, others)
• Terbinafine (Lamisil AT)
• Tolnaftate (Tinactin, Ting, others)

Prescription medications
If athlete's foot is severe or doesn't respond to over-the-counter medicine, you may need a prescription-strength topical or oral medication.

• Topical medications. These include clotrimazole and miconazole.
  
• Oral medications. These include itraconazole (Sporanox), fluconazole (Diflucan) and terbinafine (Lamisil). Side effects from oral medications include gastrointestinal upset, rash and abnormal liver function. Taking other medications, such as antacid therapies for ulcer disease or gastroesophageal reflux disease (GERD), may interfere with the absorption of these drugs. Oral medications for athlete's foot may alter the effectiveness of warfarin, an anticoagulant drug that decreases the clotting ability of your blood.

Your doctor may prescribe an oral antibiotic if you have an accompanying bacterial infection. In addition, your doctor may recommend wet dressings, steroid ointments, compresses or vinegar soaks to help clear up blisters or soggy skin.

Wash and dry the affected area. Then, apply a thin layer of the topical agent once or twice a day for at least two weeks, or according to package directions. If you don't see an improvement after four weeks, see your doctor.

If your athlete's foot recurs frequently, your doctor may recommend that you use a medication continuously.

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Ataxia

Ataxia

Definition  :

Ataxia describes a lack of muscle coordination during voluntary movements, such as walking or picking up objects. A sign of an underlying condition, ataxia can affect your movements, your speech, your eye movements and your ability to swallow.

Persistent ataxia usually results from damage to your cerebellum — the part of your brain that controls muscle coordination. Many conditions may cause ataxia, including alcohol abuse, stroke, tumor, cerebral palsy and multiple sclerosis. It's also possible to inherit a defective gene that may cause one of many ataxia variants.

Treatment for ataxia depends on the underlying cause. Adaptive devices, such as walkers or canes, might help you maintain your independence despite your ataxia. You may also benefit from physical therapy, occupational therapy and speech therapy.

Symptoms:

Ataxia can develop over time or come on suddenly, depending on the cause. Ataxia, actually a symptom of a number of neurological disorders, may cause:

• Poor coordination
• Unsteady walk and a tendency to stumble
• Difficulty with fine-motor tasks, such as eating, writing or buttoning a shirt
• Change in speech
• Involuntary back-and-forth eye movements (nystagmus)
• Difficulty swallowing

When to see a doctor
If you aren't aware of having a condition that causes ataxia, such as multiple sclerosis, see your doctor if you:

• Lose balance
• Lose muscle coordination in a hand, arm or leg
• Have difficulty walking
• Slur your speech
• Have difficulty swallowing

Causes:

Damage, degeneration or loss of nerve cells in the part of your brain that controls muscle coordination (cerebellum), results in loss of coordination or ataxia. Your cerebellum comprises two pingpong-ball-sized portions of folded tissue situated at the base of your brain near your brainstem. The right side of your cerebellum controls coordination on the right side of your body; the left side of your cerebellum controls coordination on the left side of your body.

Diseases that damage the spinal cord and peripheral nerves that connect your cerebellum to your muscles also may cause ataxia. Ataxia causes include:

• Head trauma. Damage to your brain or spinal cord from a blow to your head, such as might occur in a car accident, can cause sudden-onset ataxia, also known as acute cerebellar ataxia.
  
• Stroke. When the blood supply to a part of your brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients, brain cells begin to die.
  
• Transient ischemic attack (TIA). Caused by a temporary decrease in blood supply to part of your brain, most TIAs last only a few minutes. Loss of coordination and other signs and symptoms of a TIA are temporary.
  
• Cerebral palsy. This is a general term for a group of disorders caused by damage to a child's brain during early development — before, during or shortly after birth — that affects the child's ability to coordinate body movements.
  
• Multiple sclerosis (MS). MS is a chronic, potentially debilitating disease that affects your central nervous system, which comprises your brain and spinal cord.
  
• Chickenpox. Ataxia can be an uncommon complication of chickenpox and other viral infections. It may appear in the healing stages of the infection and last for days or weeks. Normally, the ataxia resolves completely over time.
  
• Paraneoplastic syndromes. These are rare, degenerative disorders triggered by your immune system's response to a cancerous tumor (neoplasm), most commonly from lung, ovarian, breast or lymphatic cancer. Ataxia may appear months or years before the cancer is diagnosed.
• Tumor. A growth on the brain, cancerous or noncancerous (benign), can damage the cerebellum.
  
• Toxic reaction. Ataxia is a potential side effect of certain medications, such as barbiturates, such as phenobarbital, and sedatives, such as benzodiazepines. Alcohol and drug intoxication; heavy metal poisoning — from lead or mercury, for example — and solvent poisoning — from paint thinner, for example — also can cause ataxia.

For some adults who develop sporadic ataxia, no specific acquired or genetic cause can be found. This is known as sporadic degenerative ataxia, which can take a number of forms, including multiple system atrophy (MSA), a progressive, degenerative disorder.

Hereditary ataxias
Some types of ataxia and some conditions that cause ataxia are hereditary. If you have one of these conditions, you were born with a defect in a certain gene that makes abnormal proteins. The abnormal proteins hamper the ability of nerve cells, primarily in your cerebellum and spinal cord, to function properly and cause them to degenerate over time. As the disease progresses, coordination problems worsen.

You can inherit a genetic ataxia from either a dominant gene from one parent (autosomal dominant disorder) or a recessive gene from each parent (autosomal recessive disorder). In the latter case, it's possible neither parent has the disorder (silent mutation), so there may be no obvious family history.
Different gene defects cause different types of ataxia, most of which are progressive. Each type causes poor coordination, but each has specific signs and symptoms.

Autosomal dominant ataxias
These include:

• Spinocerebellar ataxias. Researchers have labeled 28 autosomal dominant ataxia genes with the designation SCA1 through SCA28, generally numbered according to their order of discovery, and the number continues to grow. Cerebellar ataxia and cerebellar degeneration are common to all types, but other signs and symptoms, as well as age of onset, differ depending on the specific gene mutation.
  
• Episodic ataxia. There are six recognized types of ataxia that are episodic rather than progressive — EA1 through EA6. All but the first two are rare. EA1 involves brief ataxic episodes that may last seconds or minutes; are triggered by stress, being startled or sudden movement; and often are associated with muscle twitching. EA2 involves longer episodes, usually lasting from 30 minutes to six hours, that also are triggered by stress. If you have this type of ataxia, you also may experience dizziness (vertigo), fatigue and muscle weakness during your episodes. In some cases of episodic ataxia, symptoms resolve in later life. Episodic ataxia doesn't shorten life span, and symptoms may respond to medication, such as acetazolamide (Diamox), which also is used to treat seizures, or the anticonvulsant phenytoin (Dilantin).

Autosomal recessive ataxias
These include:

• Friedreich's ataxia. This neurological disorder involves damage to your cerebellum, spinal cord and peripheral nerves. Peripheral nerves carry signals from your brain and spinal cord to your muscles. In most cases, signs and symptoms appear between the ages of 5 and 15, but may occur as early as 18 months or as late as 30 years of age. The rate of disease progression varies. If you have Friedreich's ataxia, however, you're likely to rely on a wheelchair within 15 years of the appearance of symptoms, and your life span may be affected if the disorder includes significant heart disease.
  
  The first indication generally is difficulty walking (gait ataxia). The condition typically progresses to the arms and trunk. Muscles weaken and waste away over time, causing deformities, particularly in your feet, lower legs and hands. Other signs and symptoms that may develop as the disease progresses include slow, slurred speech (dysarthria); fatigue; rapid, involuntary eye movements (nystagmus); spinal curvature (scoliosis); and heart disease, including heart enlargement (cardiomyopathy) and heart failure.
  
  
• Ataxia-telangiectasia. This rare, progressive childhood disease causes degeneration in the brain and other body systems. Signs and symptoms usually appear by age 10. The disease causes immune system breakdown (immunodeficiency disease), which increases susceptibility to other diseases. It affects various organs.
  
  Telangiectasias are tiny red "spider" veins that may appear in the corners of your child's eyes or on the ears and cheeks. Although they're characteristic of the disease, your child may or may not develop them. Delayed development of motor skills, poor balance and slurred speech are typically the first indications of the disease. Recurrent sinus and respiratory infections are common. About 1 in 5 children with ataxia-telangiectasia develops leukemia or lymphoma because of dysfunction in the immune system. Most people with the disease need a wheelchair by their teens and die in their teens or early 20s.
  
  
• Congenital cerebellar ataxia. This type refers to ataxia that results from damage to the cerebellum that's present at birth.
  
• Wilson's disease. People with this condition accumulate copper in their brains, livers and other organs, which can cause neurological problems, including ataxia.

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