Narcolepsy
Narcolepsy is a medical condition where there is inability of the brain to regulate waking and sleeping cycles normally. A person suffering from narcolepsy is likely to have an overwhelming urge to fall asleep. While in some cases, a person may fall asleep for a few seconds or few minutes, others may remain asleep for much longer. Such episodes of daytime sleepiness can be dangerous and disabling. Narcolepsy can result in excessive daytime sleepiness or sudden sleep attacks. In many cases, narcolepsy remains undiagnosed.
Major symptoms of narcolepsy include REM sleep disturbance, cataplexy, hallucinations and sleep paralysis. Cataplexy indicates sudden loss of muscle control leading to weakness. This can occur during the initial attacks of narcolepsy. Such episodes are not to be confused with seizures. While some patients notice weakness in some muscles such as eyelids, others may suffer a loss of tone in all voluntary muscles. Hallucinations are another symptom of narcolepsy. The patient is likely to experience delusions that can often be frightening. Sleep paralysis refers to a temporary inability to move while suffering a sleeping attack during narcolepsy. The patient might notice this while falling asleep or waking up.
Diagnostic tests such as overnight polysomnography or Multiple Sleep Latency Test (MSLT) are used. Polysomnogram involves placement of electrodes on your scalp before falling asleep. This test measures the movement of the eyes and muscles and monitors the electrical activity of the brain. MSLT is a test to check how long it takes you to fall asleep. This throws light on the sleep patterns of the patient and helps in understanding and measuring sleep latency. Medications for narcolepsy can help reduce signs and symptoms. These medicines may interfere with other health conditions such as hypertension and diabetes. Antidepressants can reduce symptoms of cataplexy and sleep paralysis.
Anterior Cord Syndrome
Anterior Cord Syndrome refers to the Anterior Spinal Artery Syndrome. The anterior spinal artery originates from the vertebral arteries and basal artery at the base of the brain. It supplies the anterior two thirds of the spinal cord to the upper thoracic, that is chest, region. Anterior cord syndrome results from injury to the motor and sensory pathways in the anterior cord. Patients suffering from Anterior Cord Syndrome may feel some crude sensations, but their movement and more detailed sensation is lost. In Anterior cord syndrome there is damage primarily in the anterior 2/3 cord. This is related to vascular insufficiency, sparing the posterior columns. Anterior cord syndrome usually results from the compression of the artery that runs in front of the spinal cord. The compression may be from bone fragments or a large disc herniation.
In Anterior Spinal cord syndrome, there is usually complete loss of strength below the level of the injury. Anterior spinal artery syndrome produces variable loss of motor function and of sensitivity to pinprick and temperature. Thus the patient undergoes complete sensory loss. But the sensitivity to vibration (vibratory sense) and position sense (proprioception) is preserved.
In Anterior Cord syndrome, the anterior section of the spinal cord is injured. This results in loss of movement and sensory perception. In anterior cord syndrome, there is complete motor paralysis.
In Anterior Cord Syndrome, there is sparing of the dorsal column. The patient therefore exhibits greater motor loss in the legs than arms.
It is interesting to note 80% of spinal cord injuries occur in males. Children suffer spinal cord injuries due to sports activities. Adult suffer spinal cord injuries that are work related.
MRI is a most accurate imaging test for spinal disorders. This is because in MRI the spinal cord parenchyma, soft tissue lesions like hematomas, tumors and interverterbral disks, bony lesions like erosion, hypertrophic changes, collapse, fracture and subluxation are revealed. Myelography with a radiopaque agent is used less often. Physicians normally use CT scans to demonstrate bony fragments compressing the anterior spinal cord. X rays may help to detect bony lesions.
Anterior cord syndrome is said to have the worst prognosis of all cord syndromes. The prognosis is usually good if the recovery is evident and progressive in the patient during first 24 hours. However, if there are no signs of sacral sensibility to pinprick or temperature are present after 24 hours, then the prognosis for functional recovery can be said to be poor. There is no standard course of treatment or cure for anterior cord syndrome. Physicians adopt drug therapies and surgery as part of the treatment program. There have been some exceptional cases where sensations that travel along pathways are still intact after the injury. Normally, it is observed that only 10 to 15% of anterior cord syndrome sufferers demonstrate any improvement in functions over a period of time.
Femur fracture
The word 'femur' is taken from Latin meaning 'thigh'. The femur is the thigh bone and it is the largest and strongest bone in the human body. The femur bone extends from the hip to the knee joint. A femur fracture can be life threatening. Since the inside of the thigh is a place of major blood vessels, broken femur means break in the artery. Femur fracture is also called femoral shaft fracture, femur injury, femur stress fracture, fractured femur, femur trauma and femoral diaphyseal fracture. Femur is a tremendously strong bone. It usually requires a great deal of force to break the femur bone. The most common causes for femur fractures include:
Falls from a great height
Blows that are strong in force
Car accidents and Collisions
Severe twists
Bones weakened by osteoporosis, tumor or infection leading to a condition called pathologic femur fracture.
Proximal femur fracture: This involves fracture in the uppermost portion of the thighbone adjacent to the hip joint. are further sub divided into different types.
Femoral shaft fracture: The femoral shaft fracture is a severe injury that occurs during high-speed motor vehicle collisions and significant falls. Injuries caused by femoral shaft fractures are usually severe. Treatment of femoral shaft fracture is always with surgery. The common procedure is to insert a metal rod bone, called 'intramedullary rod' down the center of the thigh. The two ends of the bone are connected by the rod. This intramedullary rod usually remains in the bone for the life of the patient but can be removed if it causes pain and other problems.
Supracondylar femur fracture: In this kind of fracture, the injury occurs just above the knee joint. Cartilage surface of the knee joint is usually involved in this fracture. Patients who sustain supracondylar femur fracture are at high risk of developing knee arthritis later. Supracondylar femur fracture is common in patients with severe osteoporosis. Patients who have undergone total knee replacement surgery also run the risk of this fracture. Treatment for supracondylar femur fracture is highly variable. A cast or brace, external fixator, plate, screws or intramedullary rod are used for treatment.
Symptoms of femur fracture include swelling, bruising and severe pain. There may be numbness or paralysis in the leg below the femur fracture. Femur fractures are apparent and visible in many cases. Apart from clinical examination by the orthopaedician, for non-apparent fractures, a bone scan is required. Treatment for fractures of femur depends upon various factors such as the patient's age, type of fracture, location of the break, bone stability in the injured, mechanism of injury, direction of the blow, factors of twisting, existence of internal bleeding and extent of soft tissue damage. Some of the methods of treatment are:
Reduction or re-alignment
Immobilization whereby the movement is restricted
Insertion of an intramedullary fixation
A cast
External fixation such as a frame on the outside of the leg anchored into the bone using pins.
Potential complications from fracture of femur
Pain or arthritis
Rotational deformity due to misalignment
Infections in open fractures
Uneven leg length
Injury of blood vessels
Nerve damage
Compartment syndrome
Amputation
Failure to heal - 'non-union' is also a possibility
Intra articular sepsis, arthritis and knee stiffness are some of the permanent complications that can occur among persons who have undergone femur fracture and treatment. Sometimes femur fracture is bound to cause permanent disability in injured persons. This is due to the thigh muscle pull and incorrect reunion of fragments when they overlap. Femur fracture patients should be careful not to put weight on the leg as this can delay the healing process.
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