Reye‘s syndrome

Reye‘s syndrome

Reye’s syndrome most commonly affects children under the age of 15. It usually starts about a week after a viral infection, such as a cold, flu, or measles. Doctors are still not sure what exactly is causing Reye’s syndrome. However, research shows that Reye’s syndrome can be activated if aspirin is given to children for the treatment of viral diseases.

Children who develop Reye’s syndrome tend to get better after a common viral infection. But not long after, things changed for the worse. They start vomiting, often feeling unwell or drowsy. In just a few hours, the children become nervous, confused and irritable. In some cases, the symptoms may be absent at first. But as the disease gets worse, the symptoms get more severe, and in the most severe cases, deep coma can occur.

Reye’s syndrome can become a very serious health condition. If parents suspect the possibility of this disease, they are advised to seek immediate medical attention.

Although Reye’s Syndrome can affect any organ in the body, it is most harmful to the brain and liver. If treated promptly there is a good chance of recovery. Therefore, it is best to seek professional medical attention, as doctors in hospitals can respond quickly to any health problems that may arise. They can help reduce swelling in the brain, reducing the risk of permanent brain damage.

Etiology

The etiology and pathogenesis of the disease have not been fully elucidated. It is assumed that this is a congenital deficiency or a reduced amount of enzymes involved in ureagenesis. The disorder is characterized by encephalopathy, impaired liver function and hyperammonemia (increased ammonia in the blood). In 25-50% of cases it is a fatal outcome.

Symptoms

The symptoms of Reye’s syndrome appear a few days after the onset of the flu or chickenpox. The patient has frequent and abundant vomiting that persists for more than 12 hours. Fever may also be a symptom of the syndrome, but this sign may likewise be a symptom of early-stage viral disease.

In the case of Reye’s syndrome, vomiting and fever are accompanied by disorders related to brain dysfunction (gaze, amazement, strange behavior, delirium, apathy, irritability, sleepiness). If the patient does not receive assistance quickly, the loss of consciousness can degenerate into convulsions and coma.

aspirin may cause Reye's syndrome

Diagnosis

For the diagnosis of Reye’s syndrome, it is considered whether there is any unexplained brain dysfunction (encephalopathy), vomiting and liver dysfunction in a child. A recent viral infection and aspirin use certainly support the diagnosis. In general, laboratory studies that reveal an increase in liver enzymes and ammonia levels and a marked decrease in blood sugar (hypoglycemia) increase the certainty of the diagnosis. However, it should be noted that other metabolic disorders can exhibit similar symptoms.

Treatment

Unfortunately, there is no absolutely effective treatment for Reye’s syndrome. First, the treatment is aimed at reducing the effects of metabolic dysfunction. Patients with Reye’s syndrome are hospitalized in an intensive care unit and monitored to prevent a worsening of the neurological and metabolic conditions. The primary goal is to manage electrolyte imbalances and brain edema. It is difficult to predict which patients may be affected by the progressive disease, however, it is advisable to use some drugs that tend to reduce ammonia levels (a substance that is known to be one of the causes of brain swelling). In addition, in some cases of progressive and difficult to placate Reye’s syndrome, hemodialysis is used to remove toxins, which are believed to be partly responsible for swelling of the brain.

Brain aneurysm

Brain aneurysm

A brain aneurysm is an abnormal enlargement of a blood vessel in the brain. Arteries that supply the brain are branched out from the set of arteries that is located at the base of the brain. Those branching sites are the most common locations where brain aneurysms occur. Brain aneurysms can affect anyone, including children, but the are more commonly seen in adults 35 to 60-year-old, slightly more common in women.

How does it happen?

The wall of the artery becomes weaker in some places over time and due to long-lasting pressure, an enlargement (bulge) occur. That bulge may be in the form of a sac (balloon-like) and then it is called a saccular aneurysm, which represents the most common form of this condition. The other form of brain aneurysm represents a spindle and then it‘s called a fusiform aneurysm.

As the enlargement grows, the sack expands and creates a neck that makes a connection to the artery. When the brain aneurysm is small it doesn‘t pose a greater danger, but as it grows larger it gets prone to a rupture which causes the leakage of blood into the area between the brain and the lining that separates it from the skull, called subarachnoid hemorrhage.

Signs and symptoms

In some cases, people with an aneurysm do not have any symptoms at all. Because the growth of the aneurysm can pressure the surrounding tissue, symptoms such as headache, diplopia (double images), lower eyelid, pain behind or above the eye, trigeminal neuralgia, or uneven pupils may occur.

Symptoms of aneurysm rupture: sudden, extremely (as never before) severe headache, nausea, vomiting, neck stiffness, changes in consciousness to coma.

Massive intraventricular hemorrhage usually gives a very difficult clinical picture: deep coma, hyperpyrexia, decerebrate rigidity. It almost always ends in death.

brain

Brain aneurysm rupture

The rupture of brain aneurysms involves the breaking of blood vessels in the brain. This leads to hemorrhage in the area of the brain membranes, sometimes leading to hematoma or penetration of blood into the ventricular system. All of this together causes brain damage. In 40 percent of cases of a brain aneurysm that suddenly cracks can be the cause of death, and if the patient survives, each new rupture in the next 15 days increases the mortality rate by up to 70 percent.

Risk factors for brain aneurysm rupture

The most common risk factors for brain aneurysm rupture are hypertension, smoking, patient age (ruptures are more common after 40 years), atherosclerosis, use of medications such as aspirin or anticoagulant therapy, cocaine use, alcohol consumption, head injury, and low doses of estrogen after menopause. Brain aneurysms are more common in women after menopause. A family history of aneurysms is another risk. It should also be noted that certain diseases, such as polycystic disease and AV brain malformations, formerly associated with aneurysms.

Brain aneurysm rupture vs stroke

The concepts of brain aneurysm rupture and stroke should be separated. In the case of a rupture, bleeding occurs in the brain, which gives a clinical picture of a sudden headache, unlike a stroke, where the clinical picture is followed by a sudden resulting half-body paralysis and loss of speech. However, after a rupture, there may be a stroke as a result of the blood vessel spasm. The classic cause of brain infarction is the closure of a blood vessel by a thrombus, most often scattered from the heart during arrhythmia, or stenosis of the blood vessels of the neck and brain.

brain aneurysm

Treatment

In cases of aneurysm rupture or significant enlargement, treatment is always surgical. Before surgery, it is necessary to determine the condition of the cardiovascular system of the patient, since atherosclerosis is also present in a large number of patients.

Whether it is an aneurysm rupture or not, therapy is surgical, in the domain of a neurosurgery specialist.

Surgical clipping on the neck of the aneurysm involves a neurosurgical procedure in which a thin metal clip is placed in a place of the neck of the aneurysm, which presses the neck of the sacral aneurysm and prevents blood supply to it.

Endovascular coiling is a procedure similar to angiography when an aneurysm catheter is placed and a small metal coil or balloon is placed in it to stop the blood flow to the aneurysm.

In cases where a person is found to have a small, asymptomatic aneurysm, depending on the size, location, growth of the aneurysm, and on the age of the patient, it depends on whether one of these methods is immediately followed, or whether the patient will be monitored.

Alzheimer‘s disease

Alzheimer‘s disease

Alzheimer’s disease is a neurodegenerative disease that causes disorders of memory, thinking, and behavior and is not part of the normal aging process. It is caused by the decrease in the amount of the neurotransmitter called acetylcholine, due to the death of cholinergic neurons.

Signs and symptoms

Alzheimer‘s disease starts with a progressive loss of memory and later other symptoms. About 8 – 10 years pass since the beginning of the disease and the death,

Early stage

A patient is forgetting the new events that happen in their everyday life in the early stage of Alzheimer‘s disease. Those cognitive disturbances are starting to get in the way of doing normal activities, so a patient is unable to regulate their finances, drive a vehicle or do chores around the house. Some patients are aware of their disease, while some of them don‘t know that they are ill. Change of the environment, such are new places or new situations are making them uncomfortable, as they have a problem with spatial orientation.

Moderate stage

In this stage of the Alzheimer‘s disease patients are unable to live and take care of themselves. Besides the problems with memory that now become more prominent even for earlier memories and knowledge, new cognitive disorders such as aphasia, apraxia, agnosia, and reduced ability for judging and reasoning may occur.

Aphasia – an inability to comprehend or formulate speaking (difficulty speaking)

Apraxia – a loss of the ability to do voluntary movements or tasks including dressing up, maintenance of personal hygiene, washing, eating or solving simple puzzles

Agnosia – a loss of the ability to recognize people, even their children or a spouse

Patients in this stage of the disease are not able to do simple calculations, remember the date, they stop caring about themselves and about people who are close to them, acting apathetic and indifferent, sometimes even aggressive or restless. Because of the impaired spatial orientation, they can‘t even find a way to their homes.

Alzheimer's disease

Advanced stage

Patients in the advanced stage of Alzheimer‘s disease lose the ability to reason and think. They can be upset, get up in the evening, disturb their family, wander in random locations, or walk on the same spot repeatedly. During that time they lose normal inhibitions, so they may remove their clothes in front of the people, act aggressively or showing other signs of change in behavior. Personality can drastically change, so people close to them can gain an impression that this is a stranger. Patients ignore the need for food which leads to loss of weight.

End-stage

In the end-stage of the Alzheimer‘s disease patients become bedbound in the fetal position, unable to control urination and defecation reflexes. They die from the complication associated with immobilization such as septicemia, pneumonia, lung embolism, urinary infections or infections of pressure ulcers, not from the disease on itself.

Pharmacological treatment

The pharmacological treatment of Alzheimer‘s disease is based on the use of acetylcholinesterase inhibitors with central effects in monotherapy in the early or moderate stage of the disease or NMDA receptor inhibitors in monotherapy or in combination with acetylcholinesterase inhibitors in moderate to advanced and end-stage of the disease.