Spasticity

Definition

Spasticity is stiff or rigid muscles with exaggerated, deep tendon reflexes (for example, a knee-jerk reflex). The condition can interfere with walking, movement, or speech.

See also: Muscle cramps

Alternative Names

Muscle stiffness

Considerations

Spasticity generally results from damage to the part of the brain that controls voluntary movement. It may also occur when you have damage to the nerves traveling from brain down to spinal cord.

Symptoms of spasticity include:

• Exaggerated deep tendon reflexes (the knee-jerk reflex)
• Scissoring (crossing of the legs as the tips of scissors would close)
• Repetitive jerky motions (clonus)
• Unusual posturing
• Carrying the shoulder, arm, wrist, and finger at an abnormal angle

Spasticity may also interfere with speech. Severe, long-term spasticity may lead to contracture of muscles, causing joints to be bent at a fixed position.

Causes

• Cerebral palsy
• Brain damage caused by lack of oxygen, as can occur in near drowning or near suffocation
• Brain trauma
• Severe head injury
• Spinal cord injury
• Stroke
• Adrenoleukodystrophy
• Phenylketonuria
• Neurodegenerative illness
• Multiple sclerosis

This list is not all inclusive.

Home Care

Exercise, including muscle stretching, can help make your symptoms less severe.

When to Contact a Medical Professional

Contact your health care provider if:

• The spasticity worsens
• Contracture deformities appear to be developing
• Your condition gets worse

What to Expect at Your Office Visit

Your doctor will perform a physical exam and ask questions about your symptoms, including:

• When was it first noticed?
• How long has it lasted?
• Is it always present?
• How severe is it?
• What muscles are affected?
• What makes it better?
• What makes it worse?
• What other symptoms are also present?

Your doctor may refer you to a physical therapist. Physical therapy consists of variety of exercises, including muscle stretching and strengthening exercises. Physical therapy exercises can be taught to parents who may then help their child perform them at home.

Medicines for spasticity include baclofen, tizanidine, cyclobenzaprine, and benzodiazepines. In rare cases, a pump may be inserted into the spinal fluid to directly deliver medicine to the nervous system.

Botox injections may help relieve spasticity symptoms in some patients.

Sometimes, a person may need surgery to release the tendon or to cut the the nerve-muscle pathway.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003: 236, 247, 254.

Goldman L, Ausiello D. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa: WB Saunders; 2004:2324.

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Multiple Endocrine Neoplasia

- Diverse endocrine and metabolic infringements
- Symptoms are caused by infringements of secretion of one or several hormones
- Tumors often happen malignant
- The majority of tumors has a neuroectodermal origin
- Quite often syndromes of multiple endocrine neoplasia are accompanied of dysplasia of other organs and telas
- Both sporadic and family cases of multiple endocrine neoplasia are caused by genetic defects and inherited autosomal-dominant

The historical information:

- Communication between plural endocrine infringements and plural tumors of endocrine glands has been noticed by pathologists in the end of the last century. However modern representations about syndromes of multiple endocrine neoplasia have started to be formed in 50th years XX of a century. First Wermer has found out in several patients a combination of a hyperplasia of epithelial body, tumors of a hypophysis and tumors from insular cells and has suggested to name this syndrome plural endocrine adenomatosis (the modern name - multiple endocrine neoplasia type 1). A little bit later J. H. Sipple has described a syndrome including a medullar cancer of a thyroid gland and chromaffinoma. Today this syndrome can be named multiple endocrine neoplasia type 2a. Then R. N. Schimke has allocated a version of this syndrome, shown plural neuroma and other hereditary infringements (multiple endocrine neoplasia type 2b).

- Some hereditary syndromes, traditionally considered independent diseases, can be components of syndromes of multiple endocrine neoplasia. For example, the some endocrinologists consider Zollinger-Ellison syndrome as a component of multiple endocrine neoplasia type 1.

Genetics:

- All syndromes of multiple endocrine neoplasia are inherited autosomal-dominant and are characterized with high penetrance. In half of cases multiple endocrine neoplasia arises sporadically, i.e. is caused by again appeared mutation in sexual or somatic cells. The risk of disease at the child of the patient with sporadic multiple endocrine neoplasia makes 50 %. In families with multiple endocrine neoplasia the risk exceeds 75 %. Genealogic, cytogenetic and molecular-genetic researches have revealed the mutations underlying known types multiple endocrine neoplasia. These mutations can be found out by ПЦР with the subsequent hybridization about a site-specific oligonucleotides and to calculate individual and family risk of multiple endocrine neoplasia.

- Hypotheses. Tumors, characteristic for syndromes of multiple endocrine neoplasia, occur from cells of system APUD. According to the theory Pearse (1966), all cells of system APUD are derivatives of cells neuroectoderm (a nervous crest). Assume, that syndromes of multiple endocrine neoplasia are caused by mutations in cells of a nervous crest. These mutations are inherited by cells of endocrine glands and other cells of system APUD and lead to their tumoral transformation. In favour of this hypothesis existence of the so-called mixed types МЭН including hyperplasia of single cells of system APUD or tumours from such cells testifies. To mixed types of multiple endocrine neoplasia carry, for example, neurofibromatosis with attributes of multiple endocrine neoplasia types 1, 2а and 2b.

Against this hypothesis shows that fact, that at syndromes of multiple endocrine neoplasia quite often there are the new growths having an endodermal or a mesenchymal origin. It is not excluded, that the mutation causes transformation of cells only in one endocrine gland, and accompanying infringements have secondary character and are caused by hypersecretion of a hormone by cells of a primary tumour. It is known, for example, that at of multiple endocrine neoplasia type 1 hypersecretion of insulin by cells insulinoma causes hyperplasia of adenohypophysis.

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Etiology of Bacterial meningitis

The main activators of a bacterial meningitis is Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae. All over the world they cause 75-80 % of cases of this disease, though a parity between these three activators in the different countries variously.

The meningitis caused Haemophilus influenzae, meets almost exclusively at children till 6 years. More than 90 % of Haemophilus influenzae's stock concern to type B; all of them encapsulated. To a meningitis precedes carrier state of microorganisms in a nasopharynx with their subsequent penetration into a blood-groove.

Neisseria meningitidis (meningococcus) usually causes a meningitis in children and young men. Epidemics usually caused by microorganisms are possible in serogroups A and B, less often in others serogroups. Neisseria meningitidis of serogroup B cause the majority of sporadic cases of a meningococcal meningitis. About 50 % of cases of a meningitis in the USA are caused by activators of this serogroup. Recently frequency of the infections caused Neisseria meningitidis serogroup B increases in Northern America, - first of all stocks which concern to clone ЕТ-15. These stocks cause flashes of disease with high fatality rate is more often. Stocks of serogroup Y cause a pneumonia. About 20 % of bacterial meningitises in the USA - meningococcal. One of the reasons of disease can be carrier state Neisseria meningitidis in a nasopharynx. The contributing factor - insufficiency of components of complement С5, С6, С7, С8 and, probably, С9 (membrane attack complex); thus the risk of the infections caused Neisseria spp., increases in 8000 times, however fatality rate decreases.

Activators of a bacterial meningitis at people 30 years are more senior more often happens Streptococcus pneumoniae (pneumococcus). In the age of 60 years a pneumococcus meningitis are more senior meets much more often, than at children. Streptococcus pneumoniae causes about 15 % of cases of a bacterial meningitis in the USA. At extramural contamination (from 1962 to 1988) has shown the analysis of 262 cases of a meningitis, that the most frequent activators were Streptococcus pneumoniae (37 %), Neisseria meningitidis (13 %) and Listeria monocytogenes (10 %). Ftality rate at a pneumococcus meningitis at adults remains high - 19-30 %.

The pneumococcus meningitis is usually complication of a pneumonia, an average otitis, mastoid disease, a sinusitis or infectious endocarditis. Contributing factors heavy pneumococcus infections - splenectomy, congenital asplenia or functional asplenism, erythroid myeloma, hypogammaglobulinemia, an alcoholism, a cirrhosis of a liver and Wiscott-Aldrich syndrome. Streptococcus pneumoniae - the most frequent activator of a meningism at crises of the basis of the skull, complicated by liquorrhea.

The meningitis caused Listeria monocytogenes, seldom meets in the USA, however fatality rate at it there is high. These microorganisms amaze newborns/elderly, the people, suffering with an alcoholism, a diabetes, malignant new growths, as well as adult population with the weakened immunity (for example, after transplantation of a kidney or at AIDS) is more often.

Encephalomeningitis, caused by Listeria monocytogenes, after transplantation of a kidney it is possible to reduce desease by means of preventive purpose trimethoprim/sulfamethoxazole. About in 30 % of cases circling disease at adults and in 50 % - at children do not find any contributing factors. Flashes of heavy circling disease are possible at the use in food of the infected milk, cheese or salad from crude cabbage, carrots and an onions.

The meningitis caused aerobic by gram-negative sticks, meets seldom. Exception newborns and make older people. So, at newborns the activator of a bacterial meningitis in 30-50 % of cases happens Escherichia coli. The meningitis after a craniocereberal trauma and neurosurgerical interventions, at older people, at an immunodeficiency, strongyloidosis or bacillemia can be caused Klebsiella spp., Escherichia coli and Pseudomonas aeruginosa. Prevalence of the meningitis caused by gram-negative sticks, is rather insignificant, but death rate remains high. Gram-negative sticks often happen activators of hospital infections, however frequency of the meningitis caused by these microorganisms at extramural contamination, recently increases - especially among the older people weakened, suffering an alcoholism and a diabetes.

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What can be a result of hepatitis?

Infection with a virus of a hepatitis, most probably leads to development of a hepatitis.

After infection there comes the incubatory period - time from penetration of a virus into blood before the first signs of disease (so - and developments of the certain changes in a liver). At a hepatitis A, B, C this period can be from 10-20 to 100-200 days and it depends on many factors. Development of a hepatitis passes a sharp phase - the first displays of an infection which can be appreciable and even heavy.

Then the recover could happens, when the virus leaves an organism and the condition of a liver comes to norm. Recover comes after all cases of a sharp hepatitis A and in most cases a of hepatitis B.If it will not occur, the chronic hepatitis develops.
The reasons on which there does not come recover after a sharp infection, usually carry to a condition of immune system. Unequivocally to tell, at whom there will come recover and at whom - is not present, it is impossible.

The chronic hepatitis develops at 5-10 % infected by a virus of a hepatitis B and at, at least, 60 % infected by a virus of a hepatitis C.

How the hepatitis can long proceed?

Sharp hepatitis usually come to the end with recover within 6 months. If the hepatitis proceeds longer than 6 months, speak about a chronic infection. Chronic hepatitis C and B have long-standing, long-term current. Even if thus long time is not observed displays of a hepatitis, the virus can be kept in a liver and continues. The risk of dangerous consequences of all this time is kept. At absence of displays of a hepatitis, but a constant tracking down of signs of a virus (markers of a virus hepatitis) speak about the chronic carrier. The carrier of a virus can become the reason of infection of other people. However carrying does not mean safety for the carrier.

What most dangerous consequences of a hepatitis?

The most dangerous consequence of a sharp hepatitis - development heavy fulminant forms of disease. It occurs seldom: nearby 1 % of cases of a hepatitis A and B in fulminant forms. The most dangerous consequences of a chronic hepatitis - development of a cirrhosis of a liver and a cancer (hepatocellular carcinoma). It occurs on a regular basis. The cirrhosis of a liver develops in 20% of cases of a chronic hepatitis B and in 5-20% of cases of hepatitis C. Virus hepatitis may cause the majority of cases of a cancer of a liver and serve as a principal cause of its change.

Whether can bring a hepatitis to ruin ill?
When it occurs?

The risk of a lethal outcome at sharp forms of a virus hepatitis is insignificant. It fulminant forms of a hepatitis B, as well as 0,1-2,1 % of cases of a hepatitis A with greater probability at adults. The risk of destruction from consequences of a chronic hepatitis makes 15-50 %. At development of a cirrhosis of a liver up to 50 % sick of a chronic hepatitis B and C perishes within 5 years. Outcomes of a chronic hepatitis In are included into number 10 of principal causes of death at men in developing countries (data the CART).

What hepatitis are more dangerous?

All a virus hepatitis are dangerous in their own way, one during the sharp period, others in connection with chronic current and risk of development of a cirrhosis of a liver.
No hepatitis can be disregarded.

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Health and Human Services Announces 5-Year Plan for Infection Prevention

The U.S. Department of Health and Human Services (HHS) has issued a statement setting up a five-year plan to prevent infections caused by the health care industry. Most of these infections can be avoided by implementing better procedures for in-care hospital treatment and surgical practices. Known as health care-associated infections, or HAIs, the plan outlines a variety of different areas that should be looked at as part of the prevention techniques for example, infections acquired from a surgical site.

In The Action Plan to Prevent Health Care-Associated Infections, is a compiled list of programs and agencies nationwide supported by the HHS who are collaborating to reduce the death toll from HAIs and to alleviate some of the cost involved in health care as a result of inaccurate treatments or procedures that can initiate HAIs. The Centers for Disease Control and Prevention’s (CDC) recent statistics from 2002 estimate about 1.7 million HAIs were reported throughout hospitals in the United States and were affiliated with over 99,000 deaths. The CDC also reports that HAIs are also estimated to be causing up to 20 billion dollars a year in the health industry.

A common infection found in hospitals, Methicillin-resistant Staphylococcus aureus (MRSA) is one that might have been on the news in the past year for the fight over whether or not a universal screening should be used on all patients. However, while screening for the infection may be costly, statistics show that MRSA infections since the year 2000 have more than tripled, partially due to HAIs.

By proposing a universal plan including state and local organizations, the HHS might have greater results by enabling everyone to work together toward the same uniformed goal.

HHS Secretary Mike Leavitt says in a statement, “This plan will serve as our roadmap on how the department addresses this important public health and patient safety issue….This collaborative interagency plan will help the nation build a safer, more affordable health care system.”

Accounting for 75 percent of the active HAIs, there are four types of infections to be aware of while staying in or visiting a hospital. The first category is surgical site infections (SSIs), followed by central line-associated bloodstream infections, pneumonia related to use of a ventilator, and urinary tract infections from catheter-insertions. MRSA comes in close behind on that list with a smaller number of infections contracted.

In order to control and eventually try to eradicate the occurrence of HAIs, the HHS came up with a five-point draft strategy for starting their plan. The first point is to establish a steering committee for HAI prevention to further a plan of action. Point two is to prioritize the science and research components among the 1,200 clinical practices in order to facilitate a widespread healthcare implementation. The third point is to investigate the policy options of the recommended practices and oversights in order to start a hospital-wide compliance assistance program. Point four is working towards a better consistency of HAI data by using a standard form of definitions. The fifth and final point to ensuring the plan’s progress is to continue to build on the principle of patient support and choice to come up with more motivation for healthcare providers and organizations to give the best care possible.

With HAIs as a leading cause of death in the United States, it makes sense that the HHS would make these specific infections a high priority for 2009. The five-year prevention plan largely relies on the cooperation of all healthcare organizations and an agreement on the guidelines associated with patient care and prevention of HAIs as a universal standard. Remember HAIs can occur in many different settings whether on the surgical floor of a hospital, within a typical outpatient procedure room, or in long-term facilities like assisted-living or rehabilitation centers.

HHS will update the plan after public response starts to come in and they will be holding meetings throughout the spring where the public can share their comments, concerns, and ideas for regulating implementation. With lives at stake and insurmountable debt a possibility for many people and organizations because of errors involved with spreading HAIs, the HHS seems to be starting the New Year with a great resolution.

For a complete medical description of The Action Plan to Prevent Health Care-Associated Infections from the Introduction to the Appendix, including the index of abbreviation codes to understand it all go to he Department of Health and Human Services website.

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National Brain Injury Month

March inevitably brings everyone closer to the arrival of spring and away from the dreariness of winter but our third month also hosts a widespread awareness of many disorders and conditions. Among them is National Brain Injury Month, the goal of which is to maintain awareness of brain deterioration and cases of sudden diagnosis across the nation.

In 2008, Capitol Hill hosted the “Brain Crane Project” at the Congressional Brain Injury Awareness Fair asking for patients or family members of someone who has suffered a brain injury to make a crane to display on Capitol Hill. Hundreds of colored cranes lined the exhibit increasing the participants’ awareness of these traumatic brain injuries (TBI) by sharing their personal stories with all of America. This year we look towards the future by saving children by focusing awareness on youth sports.

The theme for the Brain Injury Association of America’s (BIAA) 2009 awareness month is Sports and Concussions. The BIAA estimates that there are over 5.3 million Americans living with a disability caused by an injury to the brain and that the costs of such injuries maintained over a lifetime exceeded $60 billion according to the totals from the year 2000.

It has been said that a TBI occurs every 23 seconds and that almost 1.5 million Americans will endure one over the next year. The 2009 theme is focusing primarily on youth sports because many adolescents sustain concussions without realizing it and an untreated concussion is dangerous and can cause severe neurological damage. By bringing awareness to schools, after-school sports programs, and intramural leagues, the BIAA, as well as parents, teachers, and coaches, can only hope to prevent some of the traumatic brain injuries in children this year.

The Centers for Disease Control and Prevention (CDC) estimate that each year between 1.6 and 3.8 million concussions happen as a result of recreation and sports related incidents. As concussions are the most common type of injury to the brain during activity, one can occur after a severe blow or hit to the head.

Symptoms of a concussion can vary and may not appear for hours, days or weeks after the initial contact. Some concussions can happen when a direct hit to another body part causes the impact to go right to the brain. Signs of a concussion are usually any combination of the following: headache, nausea, dizziness or a problem standing or walking, blurred or double vision, general feelings of sluggishness, sensitivity to any noise or lights, a lingering groggy feeling, confusion, and trouble remembering things or focusing on one thing.

Doctors advise parents, teachers, supervisors, and coaches to never ignore a blow to the head. If there is a visible bump, take the victim out of the game or activity immediately and watch them for the symptoms of a concussion. If symptoms are visible take the player to see a doctor right away and only return to the game with consent from a health care provider.

Remember to remind your children/students to always tell an adult if he or she hits their head because a concussion is serious. Also remember to tell your child that the main myth about concussions is that people blackout or lose consciousness, however only in rare and very extreme cases does this actually happen.

The most common activities in which children ages 5 to 18 often receive concussions are: playground structure activities, bicycling, basketball, soccer, and football.

To learn more about the local events related to brain injury awareness in your area this month, look at the BIA-chartered website for your state.

For the month of March (and every month after) stay aware of traumatic brain injuries and teach your sports fanatics, rambunctious neighborhood kids, and professional athletes-in-training about the dangers and signs of a concussion while keeping them safe.

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Optic neuritis

Optic neuritis (optical neuritis, visual neuritis) is the sharp disease, shown an inflammation of an optic nerve. It often meets in a combination to the neurologic illnesses described demyeliniation. Demyeliniation is a loss of an external fatty layer of a nervous fibre which provides fast conductivity of a nervous impulse. More often neuritis an optic nerve it is combined with a multiple sclerosis - slowly progressing disease of the nervous system shown just this most demyeliniation. The inflammation of an optic nerve is frequent is a debut of a multiple sclerosis or precedes development of a multiple sclerosis for some years. Sometimes the reason of development neuritis an optic nerve remains to the unknown person.

The majority of patients with neuritis of an optic nerve test sharp deterioration of sight in a combination to a pain arising at movement by a sick eye. This disease is usually shown on one eye and can periodically give relapses, as for example often happens at a combination to a multiple sclerosis.

Attributes (symptoms)

Following symptoms of an optic nuritis do not meet in all cases, but they happen more often.

- Pain at movement by an eye (in 90 % of cases)
- Pain in an eye without movement
- Reduction of visual acuity
- Sight as in darkness
- The lowered perception of color
- Narrowing of a peripheral field of vision
- Blind spot in the center
- Fever
- Headache
- Nausea
- Decrease in sight after physical activities, baths, a hot shower or a bath (at rise of a body temperature)

Diagnostics

The doctor considers some factors at diagnostics an optic neuritis. Disease not always finds verification at survey of a disk of an optic nerve on eye day by means of ophthalmoscope. A pain at movement by an eye - the characteristic complaint for this disease. The doctor can check up reaction of pupils to light and appoint electrophysiological research of an optic nerve, research of fields of vision, colour perception and a computer tomography or a Magnetic resonance tomography of a brain.

Treatment

Treatment of this disease in overwhelming majority of cases is spent by purpose of steroid hormones and not steroid anti-inflammatory preparations in drops, ointments, tablets and injections. Also antibiotics are applied also. Very seldom resort to surgical operation at neuritis an optic nerve. It refers to decompression environments of an optic nerve and consists in its opening for pressure decrease in an optic nerve which at this disease is inevitably raised owing to an inflammatory hypostasis.

From long-term research of treatment an optic neuritis (Optic Neuritis Treatment Trial) doctors have learned, that purpose of steroid hormones in a vein (instead of in tablets) reduces risk of progress of a multiple sclerosis in the future. This find is of great importance, as at half of patients with neuritis an optic nerve in the future the multiple sclerosis develops. Though this treatment has the minimal influence on vision, it is important for the general health of the patient.

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