AtoZ Diseases

Cerebral” means braincentered, and “palsy,” paralysis. This is a condition present in children after birth, and affects brain centers having to do with muscular control. There is a considerable range in severity and nature of symptoms. Some afflicted persons walk with scissoring, floundering movements, awk­ward armflinging and head tossing and speak with difficult guttural sounds if at all. Some who are mildly afflicted do not appear to be conspicuously strange.

The cause or causes of cerebral palsy are not too clearly established. Some cases are due to brain injury during diffi. cult childbirth, but many babies born with difficulty do not have cerebral palsy. Some cases are thought to be due to infections suffered by the mother or to toxic substances in her blood that reach and damage the brain of the fetus during its early developmental stages. Rh· factor incompatibilities are sometimes implicated.

The afflicted person may show chiefly one or a combination of symptoms such as chorea (involuntary jerking move· ments of different muscle groups), athetosis (a slow, writhing type of constant movement, chiefly in the fingers), poor sense of balance, tremor, and spastic muscles. Frequently, though by no means always. there is mild to severe impair:ment of intelligence; sometimes a normal may be hidden behind difficulties of communication.

There are no preventive measures of celebral palsy, other than careful prenantal and obstetrical care which maycorrect recognized abnormalities. Physical.and speech therapy may overcome handcaps to some degree, and braces and other supportive measures may be helpful in individual cases.

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Dizziness is almost as common a complaint, especially among older people, as headache. Dizziness is the lay equivalent the medical term, veTtigo. Dizziness is often loosely applied to include giddiness. giddiness refers to a mild form of dizziness frequently seen among elderly people in which there is a momentary sensation of clouding of the mind and reeling or unsteadiness when they suddenly change position, as from a reclining to a sitting or standing position, or “hen they suddenly bend to pick up an object. It is believed to be due to hardening of the brain arteries, in which a sharp mange in posture leads to a momentary flooding of the brain with blood, or the emptying of blood from the brain. Giddiness may prove frightening to some patients, but does not lead to any serious consequences and most patients learn to avoid making sudden postural changes.

Dizziness refers to a slightly more disturbing situation than giddiness that may last a few minutes to a half hour, inuring which there is some unsteadiness in walking and a slight reeling sensation, perhaps nausea, but rarely vomiting. It is usually due to a temporary impoverishment of brain circulation, caused by hardening of the brain arteries, by poor heart heart function, or by a drug that suddenly lowers the blood pressure. The patient will generally seek a sitting position for a few minutes until the unpleasant sensation passes.

Meniere’s disease or syndrome is characterized by attacks that commence suddenly with violent dizziness, ringing in the ear, vomiting, a reeling sensation and unsteadiness of body equilibrium so severe that if the person does not lie down, he would fall to the floor. During the course of a severe attack, the patient is confined to bed and cannot move his head from one side to the other without experiencing disturbing sensations that the floor, bed, and chairs are turning around him. Such a bout may last several weeks before there is complete recovery.

Milder attacks may last a half hour to several hours. The attacks may recur at irregular i

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As with cerebral hemorrhages , the cause of a subarachnoid hemorrhage is a ruptured blood vessel. The disorder differs from a cerebral hemorrhage because the blood escapes over the surface of the brain instead of seeping into the brain tissue.The surface of the brain is covered by three thin, membranous layers called the meninges. The outside membrane, the dura mater, adheres to the skull; the innermost one, the pia mater, adheres to the brain; and the middle one, the arachnoid, is much closer to the dura mater than to the pia mater. Thus there is a space between the arachnoid and the pia mater. This space is called the subarachnoid space and it is normally filled with a liquid called cerebrospinal fluid. A subarachnoid hemorrhage occurs when blood leaks into the subarachnoid space. This is usually caused by a burst aneurysm in a cerebral artery wall. The blood either remains in the fluid or seeps its way through the pia mater and into the brain tissue.

What are the Symptoms?

The main symptom is a sudden headache, which is likely to be far more painful than an ordinary headache or even a migraine . A stiff neck and virtual inability to endure bright light (photophobia) often follow, and there may also be faintness, dizziness, confusion, drowsiness, nausea and vomiting. A major attack can cause sudden loss of consciousness.

What are the Risks?

Subarachnoid hemorrhage usually occurs in people aged 40 to 60 and is slightly more common in women. Anyone with high blood pressure or diabetes mellitus may be more susceptible.

Up to 45 per cent of major attacks (those that cause unconsciousness) are fatal, and one in three people who survive a first attack have additional attacks. There is a risk of permanent brain damage due to the pressure of blood on the brain surface. In many cases, either blood spreads into the brain tissue, causing stroke-like symptoms, or the blood vessels constrict, causing similar problems.

What should be Done?

If you get a sudden severe headache, especially if it is accompanied by a stiff neck and sensitivity to light, call a physician without delay. If someone in your presence complains of a sudden headache and then lapses into unconsciousness, two possible causes are stroke and subarachnoid hemorrhage. In either case, while waiting for a physician, follow the first-aid instructions given in Accidents and emergencies.

With an unconscious person the physician’s first step is to initiate life-saving procedures to restore circulation and breathing. Once the patient is out of danger, the next step is to determine the cause of the problem. If an examination suggests a subarachnoid hemorrhage, the best way to confirm the diagnosis is to do a lumbar puncture, a test that involves taking a specimen of cerebrospinal fluid. (The fluid in the subarachnoid space of both the brain and the spinal cord is the same.) The easiest place to take the specimen and check it for blood is in the lumbar region, at the base of the spine.

What is the Treatment?

If blood is found in your cerebrospinal fluid, your physician’s main concern will be to prevent further bleeding. No drug treatment can heal a burst artery, but if you survive the first few days after a subarachnoid hemorrhage, the rupture that caused the problem has probably been sealed (at least temporarily) by natural clotting of blood, and healing is under way. The basic treatment then is several weeks of bed test, usually in the hospital. One purpose of this rest is to prepare you for surgery, if it is necessary. (In some cases, surgery is done almost immediately.) During this period of rest, the doctor may prescribe a painkiller to relieve headaches. If your blood pressure is high, you will also have to take medication to reduce it.

Within three days of the attack, you will probably have special X-rays of the major arteries that supply your brain. These are called arteriograms. They are done to locate the site of an aneurysm or any other defective spots in arterial walls. If the arteriograms indicate a danger of later attacks, surgery to prevent more leakages may be advisable. The surgery involves sealing off an aneurysm by means of a tiny metal clip.

What are the Long-Term Prospects?

If you regain consciousness after a major attack and survive for six months without further problems, you are probably out of danger. Chances of full recovery from surgery, if it is advised, are also good. Residual damage from an attack varies according to what areas of the brain are affected. Partial paralysis, weakness, or numbness may linger or even be permanent, as may sight and speech difficulties (for further information, . You should have your blood pressure checked regularly, and high blood pressure controlled if possible.

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