Chronic headache causes

chronic headache causes

Everyone has headaches from time to time, but if you experience a headache more days than not, you may have a variety of head pain, known as chronic headaches or chronic daily headaches. By definition, it's called chronic daily headaches when occuring 15 days or more a month, for at least 3 months. It can be divided into primary and secondary chronic headaches. To be considered primary (true) chronic headaches, they must also not be the result of other underlying condition.

Chronic headache causes
Until now, the exact causes of many cases with chronic headaches are not well understood. Primary chronic headache doesn't have an identifiable underlying cause. There is a part of brain that suppresses pain signals but doesn't work properly.
Secondary chronic headache can be caused by:

• Inflammation or infection on the brain tissue or blood vessels around them, including stroke, meningitis
• High intracranial pressure
• Brain tumor
• Traumatic brain injury

Chronic headache risk factors

• Depression 
• Sleep disorders
• Anxiety
• Obesity
• Snoring
• Overuse of caffeine
• Abuse of pain killers
• Regular use of physical postures that put a strain on neck or head

There are 4 types of chronic headache  and symptoms:

1. Chronic migraine: affect only one side of head, cause a pulsating sensation, cause moderate until severe pain, induced by routine physical activity. The symptoms are: nausea, vomiting, sensitivity to sound and light.
2. Chronic tension-type headache: it happens on both sides of head, cause mild until moderate pain, the pain is not pulsating but pressing or tightening, the pain is not aggravated by routine physical activity. In chronic tension-type headache, it doesn't cause sensitivity to sound or light and if there is nausea, it's mild only.
3. Hemicrania continua: this type of headache cause pain only at 1 side that doesn't shift sides. Other characteristics are: daily and continuous with no pain-free periods, cause moderate to severe pain, responsive with pain reliever such as Indocin, sometimes the pain becomes severe with development of migraine-like symptoms. The symptoms are: tearing or redness of the eye on the affected side, runny nose, dropping of the eyelid or pupil constriction.
4. New daily persistant headache: this type of headache becomes constant within a few days of the moment from the first headache. These characteristics are: hurt on both sides of head, cause mild until moderate pain, no pulsating pain but feels like pressing, and not induced by routine physical activity.

Chronic headache treatment

There are some preventive therapies that your doctor may recommend, such as:

• Antidepressants. It can be indicated for chronic headache. It also treat the depression, anxiety and sleep disturbances
• Beta blockers. It can treat episodic migraines.
• Anti seizure drugs. It can prevent chronic headache as well as prevent migraines.
• Nonsteroidal anti inflammatory drugs. It may be helpful especially if you're going through withdrawal from other pain killers. It can also be used periodically when the headache becomes more severe.

Source: Mayo Clinic

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Seizure Medications

seizure-medications

The term "seizure" is often used interchangeably with "convulsion." Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly. There are many different types of seizures. Some have mild symptoms and no body shaking. By definition, a convulsion or seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain.

Causes of Seizure

• Abnormal levels of sodium or glucose in the blood
• Brain infection, including meningitis
• Brain injury that occurs to the baby during labor or childbirth
• Brain problems that occur before birth (congenital brain defects)
• Brain tumor
• Head injury
• Fever (febrile convulsion)
• Choking
• Electric shock
• Drug abuse
• Epilepsy
• Heart disease
• Heat illness
• High fever
• Illicit drugs, such as angel dust (PCP), cocaine, amphetamines
• Kidney or liver failure
• Hypoglycemia
• Phenylketonuria (PKU), which can cause seizures in infants
• Poisoning
• Stroke
• Pregnancy
• Uremia on kidney failure
• Severe hypertension
• Venomous bites and stings (snake bite) 
• Withdrawal from alcohol after drinking a lot on most days
• Withdrawal from certain drugs, including some painkillers and sleeping pills
• Withdrawal from benzodiazepines (such as Valium)

Seizure Medications

Medications for epilepsy are mainstays in controlling epileptic seizures. But surgical procedures are another dimension in treatment. Learn about your options.

Most people with epilepsy can become seizure-free by using a single anti-epileptic drug. Others can decrease the frequency and intensity of their seizures. More than half the children with medication-controlled epilepsy can eventually stop medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.

Finding the right medication and dosage can be complex. Your doctor likely will first prescribe a single drug at a relatively low dosage and may increase the dosage gradually until your seizures are well controlled.

The type of treatment prescribed will depend on several factors, including the frequency and severity of the seizures and the person's age, overall health, and medical history.

Ketogenic Diet

This is one of the oldest treatments for epilepsy, and helps lessen seizures.

Alternative Treatments

Biofeedback, melatonin, and large vitamin doses can help. Read on.

Vagus Nerve Stimulation

Learn the risks and benefits of this epilepsy surgery.

Epilepsy Treatments: Find the Right Medication

There is no cure for epilepsy, but medications may help keep symptoms under control.

New Epilepsy Treatments

Treatments for epilepsy have come a long way in the last decade. Doctors have more than twice as many epilepsy medications to choose from than they did 10 years ago.

Epilepsy Drugs for Children

There are a wide number of medications available for treating epilepsy in children, and advances in the past years have made a difference.

Multiple Subpial Transection (MST)

Sometimes, brain seizures begin in a vital area of the brain -- for example, in areas that control movement, feeling, language, or memory.

Temporal Lobe Resection

A temporal lobe resection is a surgery performed on the brain to control seizures. In this procedure, brain tissue in the temporal lobe is resected, or cut away, to remove the seizure focus.

Lesionectomy

Lesionectomy may be an option for people whose epilepsy is linked to a defined lesion and whose seizures are not controlled by medication.

Functional Hemispherectomy

This procedure generally is used only for people with epilepsy who do not experience improvement in their condition after taking many different medications and who have severe, uncontrollable seizures.

Corpus Callosotomy

A corpus callosotomy, sometimes called split-brain surgery, may be performed in people with the most extreme and uncontrollable forms of epilepsy, when frequent seizures affect both sides of the brain.

Extratemporal Cortical Resection

An extratemporal cortical resection is an operation to resect, or cut away, brain tissue that contains a seizure focus.

Drug Treatments for Essential Tremor

With the use of medication, people with essential tremor may see improvement in their ability to control their tremor and improvement in activities such as drinking from a cup or using food utensils.

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Obesity increases the risk of migraine

obesity increases the risk of migraine

Migraine is more likely in women than in men and occurs most commonly in those of younger adult age.  In addition, more women are obese than men. Obesity people ages 20 to 55, either by a measure of belly fat or using the standard BMI (body mass index) are more likely to have migraines and other severe headaches.

Migraines are severe headache that also may include nausea, vomiting and light sensitivity. They are likely to happen in women and often hereditary. According to National Headache Foundation, migraines affect about 30 million people in USA, approximately 10% of the population. Migraines occur most frequent on ages 20 to 45. The study concluded that after age 55, the increased risk of migraines for obese people was no longer present.

Relationship between Migraine and Obesity

The researchers look hard to clarift the link between migraines and obesity after previous studies had produced conflicting conclusions. Obesity can also increases the risk of metabolic diseases such as diabetes, hypertension, heart disease, stroke, sleep apnea, arthritis, cancer, etc.

How episodic and chronic daily headache links to obesity is not known. It is likely that pathways which overlap and regulate feeding and migraine play a role.  One region of the brain involved in this pathway is the hypothalamus. The hypothalamus participates in the regulation of feeding and becomes activated during acute migraine attacks. Serotonin and orexin are hypothalamic brain nerve chemicals known to regulate food intake. They appear to have a role in migraine or chronic daily headache.  Adiponectin and leptin are predominantly fat cell produced hormones which have receptors in the brain. They have a role in inflammation and also appear to play a role in migraine or chronic daily headache. Further research into the role of these and other obesity-related proteins and chemicals may help us to understand migraine and lead to new treatment strategies.

Limited data exists on the role of weight loss and exercise in the reduction of migraine frequency.  However one small pilot study suggests that aerobic exercise may decrease headache frequency, while another small study suggests weight loss with a low fat diet could help decrease headache frequency and intensity. Taken together, this data suggests that those who are obese and have episodic headaches or chronic daily headaches should avoid weight gain. Additionally, the provider and obese patient should consider options for migraine prevention that are not associated with weight gain. Also, the obese patient who suffers with headaches should attempt weight loss. Following these ideas will decrease the risk of obesity related disorders, (such as elevated cholesterol and heart disease,) and could help reduce headache frequency.

Sources:

• Reuters
• Ache News

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Blood Clot Treatments

blood clot treatments

Blood clotting is one of the most important mechanism of the body to help repairing injured blood vessels. When an injury happens, such as damaged blood vessels, platelets are transported to the injured area to form an initial plug. This process will activate a clotting cascade, using a series of clotting factors produced by the body. In the end, fibrin is formed. Fibrin is a protein that crosslinks with itself to make a mesh that completes the final blood clot.

The medical terminology for a blood clot is thrombus. Once it is formed, as a normal recovery process of the body, there will be little consequence. Unfortunately, there are times when thrombi (plural form of thrombus) will form but it is not needed, and it can make significant problems for the body itself.

In the US, approximately there are 2 million people develop blood clot symptoms every year. Most people are over age 40. Blood clots in the lung can cause death at least 650,000 people/year, making it the third most common cause of death. 

Blood clot, risk factors

The risk factor of blood clots are common with the risk factors to all diseases that cause narrowing of blood vessels, rupture of plaque, and also cholesterol plaque formation, such as:

• Hypertension
• High cholesterol levels
• Diabetes mellitus
• Family history of blood clot
• Cigarette smoking

Other conditions are also risk factors for blood clot formation:

• Recent surgery
• Prolonged immobility, bed rest or sitting (during flight, a long car ride)
• Heart attack
• Heart failure
• Fractures in the hip, thigh, or lower leg
• Live in high altitude
• Recent childbirth
• Obesity
• Contraceptive users
• Old age

Blood clot symptoms

There are 2 locations of blood clot formation:

1. Venous clots. The clots prevent blood not to return to the heart. Most often happening in the arms or legs. Symptoms are:
• Warmth
• Swelling
• Redness
• Pain
2. Arterial clots. The clots prevent blood not to get to the affected area. Injured body tissue becomes lack of oxygen and begin to die.

blood clot treatments

Blood clot treatments

The treatments depend on the location of clots, and it can be symptomatic or agressive treatment.

1. Venous blood clots
• Warm compresses 
• Drugs: ibuprofen, acetaminophen
• Deep vein thrombosis (DVT) needs special treatment called anticoagulation, such as: enoxaparin, warfarin. Patients need hospitalization.
• Blood clots below the knee have lower risks for emolization to the lung. It may need serial ultrasonography examinations to monitor the clot's growth.
• If pulmonary emboli occurs, the treatment is similiar to DVT and also need hospitalization to monitor patients' condition.
2. Arterial blood clots
• It should be more seriously treated.
• Surgery is needed to remove the clot
• Medications: tenecteplase, alteplase (TPA), especially for peripheral arterial disease to restore blood supply.
• If blood clots occur in the heart, cardiac catheterization is need to relocate blocked artery and a ballon is used to open the occluded area, restore blood circulation, and then a stent (ring) is placed to keep it open. If there is no contraindication, blood clots in brain (stroke) need TPA to restore brain blood flow and prevent more damage.

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How to prevent migraine headaches

how to prevent migraine headaches

Migraine is a common disorder for many people, approximately affects more than 10 percents of the world population. To prevent migraine headaches, there are some healthy habit you can do. 

One thing you should remember is that the cure of migraine headaches is not permanently working. After few days, sometimes there will be another migraine attacks. It is believed that a healthy diet can prevent migraine headaches naturally. But bad lifestyle and habit can trigger it. 

Here are some ways of how to prevent migraine headaches:

1. On time eating. Skipping meals for any reason can affect our health. A strict diet is also a contributing factor for migraine attacks. If you think that strict diet will reduce your body fat, this will end up as a suddenly increased blood glucose and trigger migraine attack.
2. Regular exercise. A healthy body will make a healthy mind. To stay fit and active, do exercise regularly. This will help prevent migraine headaches.
3. Enough sleep. Too many sleep or lack of sleep will interfere your body rhythm. Ideally, an adult needs 6-7 hours of sleep and not more than 9 hours a day. Maintain your sleep schedule for a better result.
4. Stop smoking. Smoking and alcohol drinking can increase the risk of migraine attack. If you think that you can cope a migraine by smoking, please rethink. Nicotine doesn't only cause an inflammation in throat and lungs, but also can make you psychically addicted. Alcohol contains tyramine that can trigger migraine. If you excessively consume it, alcohol can cause migraine attacks.

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Obesity Increases The Risk of Migraine

obesity increases the risk of migraine

Body weight and chronic headache and also migraine are closely related, according to the research of Drexel University College of Medicine, Philadelphia, USA. "If you can reduce your weight, it will help you lower the risk of migraine", Dr. Lee Peterlin said.

Dr. Lee Peterlin has observed a population consists of overweight people age 20-55. Their Body Mass Index (BMI) are measured. 37% women with obesity have experienced many complaints related to headache, compared to 29% women with normal BMI. For men, 20% with obesity have experienced migraine compared with 16% who have normal BMI. Overall, this research consists of 22,000 subjects.

"We know that exercise and physical activity can reduce the risk of migraine, which directly can reduce the pain", Peterlin explained. The complete explanation will be published in annual meeting of The American Academy of Neurology in Seattle. As we know, migraine is a form of headache, accompanied by some symptoms such as nausea, vomiting, aura, and increased sensitivity to sound and light. The study also conclude that people age 55 and older are the highest risk to have migraine.

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Sciatica Treatment

sciatica treatment

Sciatica is a clinical diagnosis that refers to an inflammation of the sciatic nerve. Sciatic nerve is a nerve that covers any movements to the leg and sends information about sensations back to the brain. Sciatic nerve is the largest peripheral nerve in our body. It consists of lumbar and sacral nerve roots from the spine, exits the lower part of the lumbosacral area, passes behind the hip and runs down the back of the thigh.

Causes of sciatica

• Spinal disc herniation. It is a rupture of normal cushion of the spine vertebrae. It causes compression to the nerve and the manifestations are: pain, weakness, and numbness. 
• Spinal stenosis
• Spondylolisthesis
• Piriformis syndrome.

Sciatica symptoms

• Burning sensation of the thigh
• Shooting pains from the buttock, down the leg
• Cramping sensation of the thigh
• Tingling sensation in the thighs and legs
• Pins and needles sensation
• Symptoms can be worse by coughing or squatting because there is an increased intraabdominal pressure that increases pressure around the nerve.

Sciatica treatment

• Reduce your activities, take more rest.
• Analgetic and antiinflammatory drugs, such as:
• Motrin
• Celebrex
• Muscle relaxant drugs 
• Corticosteroid, such as: Medrol Dose-Pak. There is also epidural steroid injection that can deliver antiinflammatory medication directly to the sick area.
• Physical therapy and exercises
• Supporting therapy, such as ice packs. It can soothe the muscles
• Alternative medicine:
• Chiropractic
• Acupuncture
• Massage
• Hypnosis
• If the problems persist up to 3 months, you may need a surgery procedure to remove the ruptured disc.

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Cerebral Palsy Stem Cell Therapy

cerebral palsy stem cell therapy 

As we have discussed in the former article (click here), cerebral palsy is a congenital disorder that caused by brain damage during pregnancy, delivery, or rapidly after birth. Many scientists around the world have been looking for its therapy. The trend of cerebral palsy therapy is now stem cell therapy. 

CT scan of children with cerebral palsy shows many hypoperfusion areas (hypoperfusion = lack of blood flow). Stem cell therapy has benefits to help repair this condition by:

• Repairing white matters area to produce more glial cells
• Repairing grey matters by stimulating the growth factors and nerve cells.
• Stimulating the formation of blood vessels (angiogenesis) to the damaged areas.
• Stimulating more new neurons to get more oxygen and nutrient supply.
• Muscle tissue strengthening.
• Increasing immunity system.
• Improving neuroprotection.

Several studies conclude that cerebral palsy is the best responder to stem cells. In a study of 20 participants, about 85% showed mild to significant improvement after 5 months therapy. Symptoms and signs of improvements are: muscle tone, increased vocabulary, increased comprehension and socialization. Good respond is caused by the cells differentiate predominantly into glial progenitors that promote brain cells repair. After that, it must be followed by physiotherapy, occupational and speech therapy.

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What Is Amyotrophic Lateral Sclerosis ALS

what is amyotrophic lateral sclerosis als

Amyotrophic lateral sclerosis, or known as ALS, motor neuron disease, or upper and lower motor neuron disease, is a severe neurological disorder in brain and spinal cord that is characterized by disorders of voluntary muscle movement such as muscle weakness, permanent disability, until death. It is also called Lou Gehrig's disease because there was a basketball player named Lou Gehrig who died of this disease. Amyotrophic lateral sclerosis is a very uncommon disease who occurs at 5 of 100,000 people in the world. The risk exact causes of amyotrophic lateral sclerosis is still unknown, but generally it is a hereditary disease. Researchers also found that amyotrophic lateral sclerosis is caused by gene mutation, bad immune response, and chemical substance imbalance such as too much glutamate.

Symptoms of amyotrophic lateral sclerosis (ALS)
Symptoms usually start after age 50. As quoted from Mayo Clinic, early symptoms of ALS are:

1. Start with weakness in the upper extremities (clumsiness) 
2. Weakness in the lower extremities (leg, feet, ankles), footdrop
3. Slurred speech, inability in swallowing
4. Twitching in tongue, shoulders, and arms
5. Generally muscle cramps

Further symptoms of amyotrophic lateral sclerosis are:

1. Paralysis
2. Difficulty of breathing
3. Difficulty of swallowing
4. Progressive muscle weakness, difficulty of walking, lifting, etc
5. Head drop (neck muscle weakness)
6. Muscle cramps
7. Speech disorder

How to diagnose amyotrophic lateral sclerosis ALS?

1. Physical examination
2. Medical history
3. Blood test, to rule out another diseases that have similar symptoms
4. Electromyography (EMG): to record muscle's electrical activity.
5. Muscular biopsy by a pathologist.
6. Head CT-scan and MRI, lumbal puncture, to rule out another brain and nervous disorders.

Treatment

The goals of treatment in ALS patients are to slow the progression of the disease, and make the patients more comfortable and independent in doing basic daily activities.

1. Pharmacologic. 
• Riluzole (Rilutek) is recommended by FDA to slow the progression of ALS. It reduces the levels of glutamate in the brain
• Symptomatic therapies to cure: pain, muscle cramps, fatigue, depression, constipation, etc
2. Physical therapy: to maintain cardiovascular and neuromuscular fitness.
3. Speech therapy: to gain alternative methods of communication, so the ALS patients can still be capable in communicating.
4. Occupational therapy: find devices to support daily activities (if needed) such as wheelchair, walker, etc.

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Treatment Of Migraine During Pregnancy

treatment of migraine during pregnancy

Migraine may be the  common disease that affects people around the world. People with migraine experience headache (from mild, moderate, and severe), nausea, vomiting, and sometimes photophobia (hypersensitivity with light). The causes of migraine is definitely uncertain. The role of hormones makes migraine more frequently happen in women, especially between ages 20-45. According to National Center for Biotechnology Information, a beneficial effect of migraine during pregnancy, mainly in the last 2 trimesters, has been observed in 55 to 90% of women who are pregnant, irrespective of their migraine type. In fact, there is a higher percentage of women with menstrual migraine find that their condition becomes worse when they are pregnant. Migraine during pregnancy however may appear only in the first time of pregnancy. The effect of migraine during pregnancy which becomes worse after birth delivery is because the high and stable estrogen levels during pregnancy and the rapid fall off after pregnancy. 

Treatment of migraine during pregnancy

1. Non pharmacological therapy. It is better for you to try such as: relaxation, smooth massage, aromatherapy, sleep, ice packs, before you start taking drugs that probably have more side effects to the fetus.
2. Pharmacological treatment of migraine during pregnancy  
• Acetaminophen (paracetamol) 1000 mg used as rectal suppository is highly recommended for acute migraine.
• Ibuprofen and aspirin are second line drugs. They are avoided to take in the third trimester.
• Triptans (sumatriptan, naratriptan, zolmitriptan) are probably safe but we have lack of data that support them. Please review the last part below.
• Metoclopramide is recommended to treat disturbed nausea, and safe to use in the second and third trimester.
• Ergotamine tartrate is contraindicated for pregnant women.
• Betablockers (propanolol, metoprolol) can be used as prophylactic drugs but they are less indicated for pregnant women.

Correlation of NSAIDs drugs during pregnancy and the risk of spontaneous abortion

All types of non aspirin NSAIDs are proven to increase the risk of spontaneous abortion. Please avoid using NSAIDs to treat migraine while you are pregnant or actively trying to get pregnant. The better choice to treat migraine and headache during pregnancy is acetaminophen.

Correlation of Triptan during pregnancy and the risk of adverse pregnancy outcomes and major congenital disorders

Based on FDA, triptans includes in Category C during pregnancy and there are no increased risk shown in fetal abnormalities. The use of triptans during the first trimester is NOT proven to increase the risk of congenital malformation, but triptans that are used in the last trimester of pregnancy was found to be associated with a mild increase of bleeding during labor and atonic uterus.

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Chronic Inflammatory Demyelinating Polyneuropathy CIDP

chronic inflammatory demyelinating polyneuropathy cidp

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired, rare,  and autoimmune disorder of nerve the peripheral nerves, characterized by gradually increasing weakness of the lower extremities and, to a lesser extent, the upper extremities. It is also called chronic inflammatory demyelinating polyradiculoneuropathy. 

Chronic inflammatory demyelinating polyneuropathy is caused by myelin damage. Myelin is nerve's cover. The weakness happens at least two month or more. The exact cause of CIDP is auto immune disorder in which the body's immune system recognizes myelin as foreign substance and attacks it. 

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) : Signs and symptoms

There are some symptoms of suspected CIDP:

• First complain: walking difficulty which worsens progressively. Sensory function may be altered if the patients' sensory nerve myelin is damaged. 
• On physical examination: decreased or loss of reflexes, such as knee and ankle reflexes
• Electromyography (EMG): slowing of conduction of electrical signals and in worse condition, it may be totally blocked conduction
• Cerebrospinal fluid (CSF) analysis: elevated protein levels with normal CSF white cell count.
• Blood and urine tests: to define the causes of CIDP and if there is any underlying diseases.
• Nerve biopsy: to establish the diagnosis.
• MRI. It is a useful tool to support the diagnosis criteria of CIDP.
• Holistic evaluation of genetic neuropathy.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) : Treatment and Management

Basically, the treatment for all kinds of autoimmune disease is slightly similar. Here are several protocols to manage patient with CIDP:

• Steroid. The goal of steroid is reduce inflammation. It can be used for initial treatment because it can improve strength, can be taken orally, and relatively cheap. Please be careful of the side effects of long term steroid.
• Intravenous Immunoglobulins (IVIG). It is a blood protein that taken from healthy individuals, given through arm vein 
• Plasmapheresis or plasma exchange. The goal is removing harmful antibodies that found in plasma. CIDP patient's blood will be removed, and the blood cells returned without its plasma.

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Heat Stroke Symptoms And Treatment

heat stroke symptoms and treatment

One of true medical emergency that can be fatal and needs proper treatment is heat stroke. It is one kind of hyperthermia which the body temperature is rapidly increased, accompanied by nervous system disturbances. In extreme heat, the body temperature can dramatically raises, it can reach 42 C and may be higher. Heat stroke can be caused by dehydration. As quoted from MedicineNet, a dehydrated person may not be able to dissipate heat, which causes the body temperature to rise. Infants, high activities people (such as athletes), people who work under the sun, and elderly people are very susceptible to heat stroke. 

Heat stroke symptoms and treatment

Symptoms and signs of rapidly heat stroke are:

• Nausea and vomiting
• Brain and nervous system disorders: dizziness, disorientation anxiety, unconsciousness, seizure, confusion, severe restlessness, until coma
• Difficulty of breathing, from moderate to severe
• Increased heart rate until cardiac arrythmia
• A rectal temperature over 40 C (104 F)
• Red, hot, and very dry skin
• Muscle cramps

When you find someone with suspected heat stroke, please remember that he must receive immediate treatment to prevent permanent organ damage. Here are some steps of heat stroke treatment.

• Find a help, call 911
• Remove the victim from heat
• Begin cooling: apply cool water to the skin, place ice packs under groins and armpits, give him cool water to drink
• Monitor body temperature, especially by rectal temperature examination
• In most cases, victims must be hospitalized.

Heat stroke management in a medical facility (taken from American Academy of Family Physicians)

• Continue cooling until core temperature of 38 C (100.4 F)
• Laboratory tests to rule out other entities, such as: electrolyte imbalance, hyperthyroid storm, neuroleptic malignant syndrome, phechromocytoma, etc
• Monitor renal function 
• Caution patient about re-exposure

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Essential Tremor Treatment

essential tremor treatment

What is Essential Tremor?

There are so many types of movement disorder, the most common tremor is essential tremor. It is a syndrome that usually affect both upper extremities, characterized bu a slowly progressive postural and/or kinetic tremor. Essential tumor manifests as involuntary shaking movement which the patients shake without trying to do so. The exact cause of essential tremor until now cannot be identified. It mostly occurs at people older than age 65. Some researchers suggest that there is a part of the brain that controls muscle movements that doesn't work properly. Genes play a role in essential tremor; some cases show that essential tremor occurs in more than one member of a family. It is inherited, with dominant trait.

Essential tremor can affect:

• The head
• The vocal cord, making the voice sounds shaky
• The limbs, causing tremor in hands and arms (this is the most common)

So what is the difference between essential tremor and Parkinson's tremor? Principally, essential tremor happens when muscles are used. Essential tremor will not present when the limbs are relaxed or at rest.

ESSENTIAL TREMOR TREATMENT

The goal of essential tremor treatment is to improve quality of life. The choice of treatment depends on the severity of essential tremor and side effects of each treatment.

• Pharmacological. 
• Propanolol, a beta blocker. Side effects of propanolol are worsening the asthma, slowering heart beat, causing fatigue, stuffy nose, etc.
• Primidone, an antiseizure. Side effects of primidone are nausea, drowsiness, balance and coordinating problems.
• Alprazolam, an antianxiety. It is used to slow down the nervous system.
• Surgical. It will be chosen if the tremor gets severe and drugs cannot relieve it. There are two types of surgical intervention in essential tremor treatment:
• Deep Brain Stimulation (DBS). This procedure can also be done in certain neurology centre. DBS is effective to treat people with hard-to-manage limb tremor. It has fewer side effects than thalamotomy. 
• Thalamotomy. This procedure is typically done in one side of the brain only. It is effective for limb tremor that is no respond to drugs. Thalamotomy in both sides of the brain is not recommended because of high risk of irreversible side effects. 

Essential Tremor Treatment; A Summary.

Not every treatments give the same effect to all the patients. Please contact your neurologist so he will advice you an individual treatment plan. Your underlying medical conditions also play an important role for selecting the best treatment.  

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Diet Soda And Stroke Risk

diet soda and stroke risk

A recent study has concluded that diet soda causes increasing in heart disease, stroke risk, diabetes, and other metabolic syndromes. As quoted from Glamour, a study presented in American Stroke Association in London concluded that people who consume a diet soda have risk of stroke attack and died from it.

The research was carried out for 9 years with more than 2,500 subjects. It has shown that 48 percent of subjects who drink diet soda everyday can easily have  heart attack, stroke, and end up as death. This group was compared with subjects who were rarely and didn't consume diet soda. 

Therefore we can conclude that diet soda is an alternative to regular soda, but it is not health so you should limit the diet soda consumption. Consuming diet soda is just like replacing the calories from sugar to chemicals which their goodness is still questionable.

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Parkinsons Early Symptoms

Parkinsons Early Symptoms

The early symptoms of Parkinson disease can widely vary from one person to another. Parkinson's early symptoms may be silent, subtle and then can go unnoticed. Most of Parkinson's early symptoms happens unilaterally. Unilateral means "one side". These symptoms begin at one side but later it will be both sides in worst condition. Early recognition will be better for proper treatment. The Parkinson early symptoms are listed below:

Resting tremor is one of Parkinson early symptoms. By definition, it is a slight trembling in the hand when the hand is at rest. The trembling will stop when the hand is moved or does something. The tremor may continue to lower extremity at the same side, and ascendently move to lips and jaw (rare cases). Sometimes, the patient can feel a trembling inside the body (internal tremor).

The next Parkinson early symptoms is rigidity. Rigidity is muscle stiffness that typically happens in the limbs. But in Parkinson disease, whole body rigidity is also possible, called as cog-wheel rigidity, refers to a arm motion that resembles cogs in a wheel, similar to a spring like action. This muscle stiffness may happen in all daily activitie, like when turning over in bed, buttoning the clothes, etc.

Postural instability also happens as Parkinson early symptoms. The patient may have problems with body balance. He is not able to walk in a straight line, sometimes easy to fall. 

Parkinson disease can cause generalized fatique that persist up to 2 weeks. Patients feel tired, exhausted, but sometimes it is confusing with a lot of sleep.

One characteristic of Parkinson early symptoms is bradikinesia (slowed motion). It is when the patient need longer time to do things that it used to, or feel like lost the swing in the arm while walking.

Personality change is also happen at Parkinson disease at early stage. Close families can feel that the patient's personality has changed, such as more rigid, more withdrawal, not flexible as usual, etc.

Slurred speech may also happen as Parkinson early symptoms. The voice become softer, emotionless, and stumble over words more frequently than usual. It really bothers the self confidence at social life.

Bowel habit change sometimes occurs at Parkinson disease. The patients become constipated even the diet contains enough fiber.

Sleep disorder. Patients with Parkinson early symptoms take more sleep during the day. There is a REM behaviour disorder while sleeping, so without waking up, it seems to be seeing something and reacting to them as it is real. Then he awakes and recall the dream where in the dream he is attacked by animal or something.

In case you have all symptoms above, you should consult a neurologist and will be generally evaluated. You DO NOT need to have all of those symptoms above to be diagnosed with Parkinson disease. Some people never develop those symptoms but overall, most people who end up getting Parkinson disease have all of them before accepting the actual diagnosis.

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What Is Arachnoid Cyst

what is arachnoid cyst

Arachnoid Cyst is not the same with common cysts found in other body parts. Quoted from wikipedia, arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen. This cysts locates between the surface of the brain and the skull base; or in the arachnoid membrane which is one of three membranes covering the brain and spinal cord. Besides in the brain, arachnoid cysts can be found on the spine. Arachnoid cysts are congenital abnormalities of the fetus, infant or delayed until adolescence. What causes arachnoid cyst is unknown yet, but presumably due to developmental disorders.

What is Arachnoid Cyst; Symptoms
The symptoms depends on its size and location. Relatively small-sized cyst give less specific symptoms, but large cysts may cause cranial deformation or macrocephaly (enlarged head), produce symptoms as listed below:

1. Headaches 
2. Seizure
3. Hydrocephalus, or swelling due to fluid head
4. Increased intracranial pressure: spreading vomitus in the morning, cephalgia, dizziness
5. Developmental disorders until behavior change (in large form)
6. Hemiparesis is interference on one side of the body
7. Reduced muscle control or called ataxia

What is Arachnoid Cyst ; Treatment
The treatment's purpose is mainly to reduce the intracranial pressure. It is mostly surgical. You should consult a neurologist and neurosurgeon to perform it. On first visit, if it is asymptomatic, you will be suggested to have a CT-scan control periodically every 1 year. If it doesn't enlarge, basically it doesn't to be removed. But if there are symptoms of high intracranial pressure, you should be hospitalized and performed surgery.

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