Epilepsy

Epileptic seizures are commonly traced to brain injury or family history. About 0.5% to 2% of the population is likely to suffer an epileptic seizure at some point in time. When the delicate balance of electrical activity in the brain is disturbed, a person suffers seizures. When there are more than a couple of episodes of seizures, it is a condition of epilepsy. In a typical epileptic seizure, the neuronal activity is hampered bringing on convulsions, muscle spasms and possible loss of consciousness. Each person has a different threshold of resistance to seizures. Inherited condition of neurological disorder can lead to electrical instability causing epileptic seizures. Those dependent on alcohol or drugs may experience seizures during withdrawal. Rarely is a brain tumor the cause of epilepsy. Brain injury is a possible cause of epilepsy. This can be due to a birth defect or head injury or infection such as meningitis. Sometimes a person may experience idiopathic epilepsy where there is no clear cause for the seizures.

Diagnosis of epilepsy can be made with investigative tests such as EEG, CT scan or MRI scan. Anti-epilepsy drugs (AEDs) can control the seizures though there is no cure. These medications help the patient in leading a better quality of life. AEDs are prescribed after studying the person's nature of seizures, general health, age and gender. These medications must be taken in prescribed doses to maintain desired level in the body to prevent further seizures. When some possible triggers have been identified for epileptic seizures, the patient must try and avoid them. These triggers could range from emotional disturbance to lack of sleep. The vagus nerve stimulator(VNS) has been approved by the FDA for the treatment of epilepsy. The VNS is surgically implanted into the chest, near the collarbone. It is a small device, much like a pacemaker that sends weak electrical impulses to the brain through the vagus nerve. These electrical signals are helpful in preventing sudden electrical bursts in the brain that trigger off an epileptic attack.

Shaken Baby Syndrome

Also known as SBS, shaken baby syndrome is a type of imposed head trauma. This trauma may occur from either throwing the child, or hitting the child on the head or by shaking the child too much. This is unlike regular head injuries because it can happen only if somebody harms the child. Many parents bring their children to the doctor very late, as they have not observed the problem in the infant in an early stage. SBS can also lead to severe brain injury, thus parents who leave their children with caretakers have to be on extra vigil for unusual symptoms. Depending on the duration of the harm caused the symptoms vary.

• Lassitude and nausea and petulance are the main symptoms.
  
• Poor sucking, decline in appetite and lack of smile.
  
• Breathing trouble and seizures.
  
• Unable to lift the head and to center the eyes or follow movement.
  
• Pupil sizes may vary and stiffness will occur.

When the baby is shaken continuously, the head rotates in frenzy as the infant neck muscles are hardly developed and offer very little support to the head. The movement causes the brain to move back and forth inside the skull and thereby causes injury to the nerves and blood vessels and also tears off the brain tissue. As the brain hits against the inside of the skull, damage is caused to brain in the form of bruising and bleeding. If the baby's head is hit against any hard object, then the damage caused is even worse. With less damage caused the injury will heal within a period of time. If the damage caused is severe, then specific treatment has to be provided depending on the area of damage. Speech loss and hearing impairment has to be treated accordingly. The child has to be given special care and kept under constant vigil under the right care for the right kind of support.

Basilar skull fracture

If there is a fracture or break in the cranial or skull bones, it is called a skull fracture. When the base of the skull is involved in a head injury, it is a basilar skull fracture or basal skull fracture. It is also known as depressed skull fracture and linear skull fracture. This linear fracture is rare and occurs in only 4% of patients with severe head injury. Falls, injuries caused by penetrating external objects like knives, hammers or axe or gunshot wounds may result in skull fractures. It can also occur when the skull hits a solid object with considerable force. Basilar skull fracture can be called a linear fracture at the base of the skull. Usually, dural tear is associated with this type of fracture. This fracture occurs at specific points on the skull base. While analyzing skull fractures, it is seen that 19-221% of all skull fractures happen to be basilar skull fractures.

There may be a traumatic brain injury when the skull is fractured. The area of the brain injured and the severity of injury is diagnosed by examining the fracture. If bacteria enter inside the skull through this fracture of the skull, it will lead to infection. Sudden blow to the back of the head can also result in a basilar skull fracture.

After a head injury, if there is a leak of a clear fluid from the nose or ears, it indicates that the clear fluid is cerebrospinal fluid (CSF) that surrounds the brain. CSF drains out through the ears or nose, when the skull is fractured and the Meninges or the covering of the brain is torn. The typical nasal drainage due to allergies, cold or crying is different from this drainage of CSF. It is also an indication of a fracture of the frontal bone or the base of the skull i.e. sphenoid or temporal bone or of the ethmoid bones (bones that support the nose and sinuses).

If bleeding from the ears or nose is not due to a cut or a direct blow, it may be an indication of a fracture of the base of the skull. Determine the cause of the bleeding by washing the blood thoroughly and see if the bleeding is from a cut or not. Ascertain the source of bleeding from the ear. It is an indication of a skull fracture if a nose bleed does not stop with home treatment. If bruising or dislocation develops within 24 hours after a head injury, it also indicates a basilar skull fracture. Often bleeding within the skull may occur with a basilar skull fracture. This condition may lead to infection.

• Battle's sign-bruising behind one ear.
  
• Raccoon eyes-bruising around both eyes.
  
• Abnormalities pertaining to vision.
  
• Weakness of facial muscles.
  
• Problems in hearing.
  
• Difficulties in smelling.
  
• Nasal drip due to leaking of cerebral spinal fluid.

Diagnosis is made with laboratory check of the clear dripping fluid for the presence of CSF. A CT scan of the head with the focus on bones can reveal the extent of damage to the bones. CSF otorrhea and bruising over the mastoids commonly known as 'battle sign' is an indication of a fracture of the petrous temporal bone. Rhinorrhea and bruising around the eyes (raccoon eyes) are noticed with anterior cranial fossa fractures. Depending on an associated intracranial pathologic condition, the Glasgow Coma Score and loss of consciousness may differ from patient to patient. Temporary deafness is a possibility but it resolves in about three weeks.

Hemotympanum and mucosal edema in the middle ear fossa cause this temporary hearing loss. Basilar skull fractures sometimes leads to meningitis in some patients. If the bones around the foramen magnum are broken, there is a risk of damage to the blood vessels and nerves exiting the hole.