Intracranial Hematoma

Head injuries account for approximately 70% of traumatic accident deaths. Intracranial hematoma plays an important role in the death and disability that are associated with head injury. Intracranial hematoma is a serious and possibly a life threatening condition that often requires immediate medical attention. Many patients with intracranial hematoma harbor mass lesions that require emergency decompression. Other causes include brain tumors, liver disease, autoimmune syndromes and bleeding disorders.

The human brain floats within the skull. It is surrounded by cerebrospinal fluid which cushions the brain from the bounces of everyday movements. Sometimes it becomes impossible for the fluid to absorb the force of a sudden blow or a quick stop. Under such situations, the brain may slide forcefully against the inner wall of the skull and get bruised. An intracranial hematoma occurs when the blood vessel ruptures between the skull and the brain. The blood leaks between the brain and the skull. This collection of blood, hematoma, which is possibly clotted, compresses the brain tissue. Some hematomas require surgery to remove the blood clot whereas some others can be treated without surgery.

Symptoms of intracranial hematoma include headache, nausea, vomiting, lethargy and slurred speech. The pupils may appear of unequal size. Memory loss is often associated with head trauma. One may even forget that they have suffered a blow. These symptoms of intracranial hematoma may occur either immediately or several weeks or months after a blow has been received in the head.

Injury in the head is the most common cause of intracranial hematoma. Among elderly persons, even a mild head trauma is more likely to cause a hematoma in the brain. Hematoma resulting from injury in the head is classified as:

Subdural hematoma: This occurs when the blood vessels, most often the veins rupture between the brain and the dura mater which is the outermost of three membrane layers that covers the brain. The blood that leaks forms a hematoma. This compresses the brain tissue. The danger here is that if the hematoma keeps growing then there is a progressive decline in consciousness and possible death. The risk of subdural hematoma is greater in people who use aspirin or other anticoagulants regularly. Alcoholics and very young and very old people also stand to be affected by subdural hematoma. All types of subdural hematomas require medical attention as soon as the symptoms become apparent. Other wise permanent brain damage may be the result.

Epidural hematoma: This type of hematoma occurs when the blood vessel, usually the artery, ruptures between the surface of the dura mater and the skull. Morbidity and mortality from epidural hematoma is substantial unless immediate medical attention is given. The cause of epidural hematoma is most of the time road automobile accidents or any other traumatic injuries.

Intraparenchymal hematoma: When blood pools in the white matter of the brain, Intraparenchymal hematoma occurs. There may be multiple severe Intraparenchymal hematomas after a head trauma. Serious brain damage can occur, as the neurons can no longer communicate. A physician may find it difficult to diagnose intracranial hematoma, as it may not be immediately apparent. It is better to seek medical advice after any significant blow has been received to the head and if the patient has lost consciousness or experiences symptoms such as headache, lethargy, nausea and vomiting. A CT scan or MRI scan is suggested to define the position and size of a hematoma.

After a head injury, doctors use medications such as corticosteroids and diuretics to control the edema in the brain after head injury. Often surgery is required. If the blood clot is localized and there is no excessive clotting, then perforation is made through the skull and the liquid is removed by suction. Large hematomas require opening of a section of the skull to remove blood clots. It is essential to wear appropriate safety equipment and gadgets during sports, including helmet when riding, motorcycling, horseback riding, skating or doing any other activity that may result in injury to head. Chances of motor vehicle accidents can be minimized by wearing a seat belt.

Epiglottitis

Epiglottitis is a serious condition that can affect children and adults. In children, epiglottitis can be life-threatening and usually manifests between 2 and 6 years. In adults, it is more likely to affect men than women. Earlier there were more number of pediatric epiglottitis cases. But with the introduction of the HIB vaccine, cases of children being affected by this condition has reduced. This condition occurs when the flap of cartillage found at the back of the tongue (epiglottis) swells can causes respiratory distress. The epiglottis serves to keep food from going into the trachea while swallowing. An inflamed epiglottis can result in swallowing problems and difficulty in breathing. The patient suffers fever and chills and may develop a bluish skin coloring (cyanosis). If the airways become totally obstructed, it can be fatal. Sore throat, difficulty in speaking and difficulty in swallowing and breathing are typical symptoms of epiglottitis that occur within a few hours. Persons affected by this condition tend to lean forward to breathe and appear restless.

Epiglottitis is believed to be caused by vrirus such as Streptococcus pneumoniae, Haemophilus parainfluenzae, varicella-zoster, herpes simplex virus type 1 and Staphylococcus aureus. Any damage to the epiglottis can also cause this condition. While mild cases of epiglottitis manifest as sore throat and pain while swallowing, acute cases can suffer severe respiratory distress or even a respiratory arrest. Physical examination and study of medical history is the first step towards diagnosing epiglottitis. X-ray of the neck and blood tests are also conducted. If there is severe discomfort and labored breathing, hospitalization may be necessary. Humified oxygen helps alleviate some of the distress while intravenous fluids keep the patient well hydrated. Antibiotics and corticosteroids are used to treat the condition. Intravenous (IV) antibiotics are adminstered to treat the infection.

Rheumatoid Arthritis

Painful, stiff joints are the primary symptoms of rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease resulting in chronic inflammation of the joints. More than one joint is usually affected. Women are more predisposed to contracting rheumatoid arthritis. It usually sets in when a person is between 40 - 60 years. The exact reason for the autoimmune system attack is not known. This condition is heriditary and can be brought about by environmental and hormonal factors. Tissues around the joint become inflamed in a rheumatoid arthritic condition. During an attack of rheumatoid arthritis, symptoms such as fatigue, lack of appetite, low grade fever and joint stiffness are noticed. The symptoms are most notable in the morning or after long periods of inactivity. These attacks come and go. Rheumatoid arthritis is a progressive disease that can lead to joint destruction and functional disability. Multiple joints including small joints of the hands and wrist are often affected. Rheumatoid arthritis can be extremely debilitating, thereby making simple chores painful. In fact, rheumatoid arthritis can even affect the salivary glands, tear glands and heart and lungs.

A rheumatologist will diagnose the condition based on blood test, x-rays and physical examination. The joints are examined for inflammation and deformity and presence of rheumatoid nodules. In persons suffering from rheumatoid arthritis, blood antibodies such as citrulline are noticed. Arthrocentesis or extraction of joint fluid is also conducted. There is no known cure for rhematoid arthritis. Medication is prescribed to relieve joint inflammation and prevention deformation of the joints. First-line drugs like corticosteroids or aspirin are used to reduce pain and inflammation whereas second-line drugs such as methotrexate and hydroxychloroquine are prescribed for preventing progressive joint destruction. An exercise regimen may need to be followed for preventing work disability and strenghtening the joints.