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Managing heat syndrome

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Aug 092011

Managing heat syndrome

Type and Predisposing Factors	Signs and Symptoms	Management
*Heat cramps*
Commonly affect young adults Strenuous activity without training or acclimatization Normal to high temperature or high humidity	Muscle twitching and spasms, weakness, severe muscle cramps Nausea Normal temperature or slight fever Normal central nervous system findings Diaphoresis	Hospitalization is usually unnecessary. To replace fluid and electrolytes, give a balanced electrolyte drink. Loosen patient’s clothing, and have him lie down in a cool place. Massage his muscles. If muscle cramps are severe, start an I.V. infusion with normal saline solution.
*Heat exhaustion*
Commonly affects young people Physical activity without acclimatization Decreased heat dissipation High temperature and humidity	Muscle cramps (infrequent) Nausea and vomiting Decreased blood pressure Thready, rapid pulse Cool, pallid skin Headache, mental con-fusion, syncope, giddiness Oliguria, thirst No fever Sweating Continue reading »

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Also called Huntington’s chorea, hereditary chorea, chronic progressive chorea, and adult chorea, Huntington’s disease is a hereditary disease in which degeneration in the cerebral cortex and basal ganglia causes chronic progressive chorea (involuntary and irregular movements) and cognitive deterioration, ending in dementia.

Huntington’s disease usually strikes people between ages 25 and 55 (the average age is 35); however, 2% of cases occur in children, and 5%, as late as age 60. Males and females are equally affected. Death usually results 10 to 15 years after onset from suicide, heart failure, or pneumonia.

Causes

Huntington’s disease is transmitted as an autosomal dominant trait, and either sex can transmit and inherit it. Each child of a parent with this disease has a 50% chance of inheriting it; the child who inherits it can pass it on to his own children.

Because of hereditary transmission, Huntington’s disease is prevalent in areas in which affected families have lived for several generations. Genetic testing is offered to those with a known family history of the disease.

Signs and symptoms

The onset of this disease is insidious. The patient eventually becomes totally dependent—emotionally and physically—through loss of musculoskeletal control.

Neurologic manifestations

Gradually, the patient develops progressively severe choreic movements. Such movements are rapid, usually violent, and purposeless. Initially, they’re unilateral and more prominent in the face and arms than in the legs, progressing from mild fidgeting to grimacing, tongue smacking, dysarthria (indistinct speech), athetoid movements (slow, twisting muscle contractions, especially of the hands) related to emotional state, and torticollis (neck muscle contractions).

Bradykinesia (slow movements) is commonly accompanied by rigidity. Muscle strength is generally maintained. The combination of chorea, bradykinesia, and normal muscle strength results in Continue reading »

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Introduction to Pituitary tumors

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Jul 232011

Constituting 10% of intracranial neoplasms, pituitary tumors typically originate in the anterior pituitary (adenohypophysis). They occur in adults of both sexes, usually during the third and fourth decades of life. The three tissue types of pituitary tumors are chromophobe adenoma (90%), basophil adenoma, and eosinophil adenoma.

The prognosis is fair to good, depending on the extent to which the tumor spreads beyond the sella turcica.

Causes

Although the exact cause is unknown, a predisposition to pituitary tumors may be inherited through an autosomal dominant trait. Some are part of a hereditary disorder called multiple endocrine neoplasia 1. Pituitary tumors aren’t malignant in the strict sense; however, because their growth is invasive, they’re considered a neoplastic disease.

Chromophobe adenoma may be associated with the production of corticotropin, melanocyte-stimulating hormone, growth hormone, and prolactin; basophil adenoma, with evidence of excess corticotropin production and, consequently, with signs of Cushing’s syndrome; and eosinophil adenoma, with excessive growth hormone.

Signs and symptoms

As pituitary adenomas grow, they replace normal glandular tissue and enlarge the sella turcica, which houses the pituitary gland. The resulting pressure on adjacent intracranial structures produces typical clinical features.

Neurologic features

Frontal headache
Visual symptoms, beginning with blurring and progressing to field cuts (hemianopias) and then unilateral blindness
Cranial nerve involvement (III, IV, VI) from lateral extension of the tumor, resulting in strabismus; double vision, with compensating head tilting and dizziness; conjugate deviation of gaze; nystagmus; lid ptosis; and limited eye movements
Increased intracranial pressure (secondary hydrocephalus)
Personality changes or dementia, if the tumor breaks through to the frontal lobes
Seizures
Rhinorrhea, if the tumor erodes the base of the skull Continue reading »

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