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Keratoconus: Causes, Symptoms & Treatments

Symptoms and signs:

As the cornea becomes more irregular in shape, it causes progressive nearsightedness and irregular astigmatism to develop, creating additional problems with distorted and blurred vision. Glare and light sensitivity also may occur.


Normal eye vs. eye with keratoconus


New research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward.

Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family.

Keratoconus also is associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fitted contact lenses and chronic eye irritation.

What Warnings Should I Know About Corneal Cross-Linking?

Ulcerative keratitis, a potentially serious eye infection, can occur. Your doctor should monitor defects in the outermost corneal layer of the eye for resolution.

Who Should Not Receive CXL?

The safety and effectiveness of CXL has not been studied in pregnant women, women who are breastfeeding, patients who are less than 14 years of age and patients 65 years of age or older.

What Are The Side Effects Of CXL?

In progressive keratoconus patients, the most common side effects in any CXL treated eye were haze, inflammation, fine white lines, disruption of surface cells, eye pain, reduced sharpness of vision, and blurred vision. In patients with corneal ectasia following refractive surgery, the most common side effects in any CXL treated eye were haze, disruption of surface cells, fine white lines, dry eye, eye pain, inflammation, light sensitivity, reduced sharpness of vision, and blurred vision.

These are not all of the side effects of the CXL treatment. Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

Keratoconus treatment:

In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses and regular soft contact lens designs no longer provide adequate vision correction.

Corneal crosslinking diagram that shows anchors between collagen fibers in the cornea.
The aim of corneal cross-linking is to strengthen the cornea by increasing the number of “anchors” that bond collagen fibers together. 
Normal eye vs. eye with keratoconus. The keratoconic cornea bulges slightly, for a more cone-shaped surface.

Treatments for progressive keratoconus include:

1. Corneal crosslinking

Treatment by providing contact lenses

  1.  Custom soft contact lenses
  2.  Gas permeable contact lenses
  3.  Silicone hydrogel contact lenses
  4.  Hybrid contact lenses
  5.  Scleral and semi-scleral lenses
  6.  Prosthetic lenses

Surgery Option:

  1.  Intacs (Addition Technology)
  2. Topography-guided conductive keratoplasty
  3. Corneal transplant


Nephrogenic Systemic Fibrosis: Causes, Symptoms & Treatments

Nephrogenic systemic fibrosis is a rare disease that occurs mainly in people with advanced kidney failure with or without dialysis. Nephrogenic systemic fibrosis may resemble skin diseases, such as scleroderma and scleromyxedema, with thickening and darkening developing on large areas of the skin.

Nephrogenic systemic fibrosis can also affect internal organs, such as the heart, kidneys and lungs, and it can cause a disabling shortening of muscles and tendons in the joints (joint contracture).

For some people with advanced kidney disease, being exposed to certain gadolinium-containing contrast agents during magnetic resonance imaging (MRI) and other imaging studies has been identified as a trigger for development of this disease.


Nephrogenic systemic fibrosis can begin days to months after exposure to gadolinium-containing contrast, but progresses quickly. Some signs and symptoms of nephrogenic systemic fibrosis may include:

  • Swelling and tightening of the skin
  • Thickening and hardening of the skin, typically on the arms and legs and sometimes on the body, but almost never on the face or head
  • Skin that may feel “woody” and develop an orange-peel appearance and darkening (excess pigmentation)
  • Burning, itching or severe sharp pains in areas of involvement
  • Skin thickening that inhibits movement, resulting in loss of joint flexibility
  • Rarely, blisters or ulcers

In some people, involvement of muscles and body organs may cause:

  • Muscle weakness
  • Limitation of joint motion caused by muscle tightening (contractures) in arms, hands, legs and feet
  • Bone pain
  • Reduced internal organ function, including heart, lung, diaphragm, gastrointestinal tract, or liver, but direct evidence is often lacking
  • Yellow plaques on the white surface (sclera) of the eyes
  • Blood clots

The condition is generally long term (chronic), but some people may improve. In a few people, it can cause severe disability, even death.


The exact cause of nephrogenic systemic fibrosis isn’t fully understood. Exposure to gadolinium-containing contrast agents during magnetic resonance imaging (MRI) has been identified as a trigger for development of this disease. The Food and Drug Administration (FDA) recommends avoiding gadolinium-containing contrast agents in people with acute kidney injury or chronic kidney disease.

Other conditions that may lead to or promote the disease when severe kidney disease and exposure to gadolinium-containing contrast are present include:

  • Use of high-dose erythropoietin (EPO), a hormone that promotes the production of red blood cells, often used to treat anemia
  • Recent vascular surgery
  • Blood-clotting problems
  • Severe infection


There is no cure for nephrogenic systemic fibrosis, and no treatment is consistently successful in halting or reversing the progression of the disease. Nephrogenic systemic fibrosis only occurs rarely, making it difficult to conduct large studies.

  • Hemodialysis.
  • Physical therapy.
  • Kidney transplant.
  • Ultraviolet A phototherapy.
  • Extracorporeal photopheresis.
  • Plasmapheresis.

Osteoarthritis: Causes, Symptoms & Treatments

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage on the ends of your bones wears down over time. Although osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, knees, hips and spine.


Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

  • Pain. Your joint may hurt during or after movement.
  • Tenderness. Your joint may feel tender when you apply light pressure to it.
  • Stiffness. Joint stiffness may be most noticeable when you wake up in the morning or after a period of inactivity.
  • Loss of flexibility. You may not be able to move your joint through its full range of motion.
  • Grating sensation. You may hear or feel a grating sensation when you use the joint.
  • Bone spurs. These extra bits of bone, which feel like hard lumps, may form around the affected joint.


Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints gradually deteriorates. Cartilage is a firm, slippery tissue that permits nearly frictionless joint motion.

In osteoarthritis, the slick surface of the cartilage becomes rough. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone.


Currently, the process underlying osteoarthritis cannot be reversed, but symptoms can usually be effectively managed with lifestyle changes, physical and other therapies, medications, and surgery. Exercising and achieving a healthy weight are generally the most important ways to treat osteoarthritis. Your doctor may also suggest:


  • Acetaminophen.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Duloxetine (Cymbalta).


  • Physical therapy.
  • Occupational therapy.
  • Tai chi and yoga.

Surgical and other procedures:

If conservative treatments don’t help, you may want to consider procedures such as:

  • Cortisone injections. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint, then places a needle into the space within your joint and injects medication. The number of cortisone injections you can receive each year is generally limited to three or four injections, because the medication can worsen joint damage over time.
  • Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee, though some research suggests these injections offer no more relief than a placebo. Hyaluronic acid is similar to a component normally found in your joint fluid.
  • Realigning bones. If osteoarthritis has damaged one side of your knee more than the other, an osteotomy might be helpful. In a knee osteotomy, a surgeon cuts across the bone either above or below the knee, and then removes or adds a wedge of bone. This shifts your body weight away from the worn-out part of your knee.
  • Joint replacement. In joint replacement surgery (arthroplasty), your surgeon removes your damaged joint surfaces and replaces them with plastic and metal parts. Surgical risks include infections and blood clots. Artificial joints can wear out or come loose and may need to eventually be replaced.

Hemodynamic instability: Causes, Symptoms & Treatments

Hemodynamic stability can be simply explained as the stable blood flow. If a person is hemodynamically stable, it means that he/she has a stable heart pump and good circulation of blood. Hemodynamic instability is defined as any instability in blood pressure which can lead to inadequate arterial blood flow to organs. It is also a state where there is a requirement for physiological and mechanical support to ensure there is adequate cardiac input and output or blood pressure.

Abnormal hemodynamic parameters include heart rate, blood pressure, cardiac output, central venous pressure, and pulmonary artery pressure.

Signs and symptoms

Following are some signs and symptoms of hemodynamic instability:

1. Hypotension

2. Abnormal heart rate

3. Shortness of breath

4. Pulmonary congestion

5. Cold extremities

6. Peripheral cyanosis

7. Decreased urine output

8. Alternative consciousness (restlessness, loss of consciousness, confusion)

9. Chest pain

Hypotension can produce insufficient perfusion in the brain and heart due to autoregulation of these organs. The individual is mostly affected, when the particular threshold of the blood pressure become drop down and may cause cerebral and coronary ischemia.

Who is at risk?

Hemodynamic instability is common during surgery conducted under general anesthesia. An anesthesiologist is continuously monitoring the patient for maintaining the normal hemodynamic. Usually anesthesiologist plan a clinical management before commencing the surgery, depending upon the pre-existing condition of the patient.

For made an effective plan for hemodynamic management, it is necessary to have thorough knowledge of medical history. The risk of hemodynamic instability is more with patient having cardiovascular diseases and major surgery need relatively more complex planning for  hemodynamic management than healthy patient.

Recognizing hemodynamic instability

For recognizing the critically ill patient and avoidance of hemodynamic instability, the following diagnostic tests should pursue:

Clinical assessment in the seriously ailing is mainly utilized for the initial three rationales: for example to decide whether the individual patient has hemodynamic instability, to decide whether the individual patient is countering to treatment and to stratify threat of instability.

When a healthcare staff checking the systolic BP (blood pressure) or vessels fills up time the measuring of the result should be exact, precise, and offer further direction to specify the presence of any cardiac syndrome. If the obtained result provides any information which can direct the clinician about the presence of hemodynamic instability or shock, then it is easier to make some decision about the management of the hemodynamic instability, before onset of the condition.

What Does a High Red Blood Cell Count Mean for a Cancer Patient?

Blood pressure recording

Method of clinical assessment of Hemodynamic Instability

The assessment of  vital sign and surrogate bio markers for assessing the organ perfusion, including urine output and capillary refill time have frequently used clinical assessment method to estimate hemodynamic instability. The below mentioned techniques are used as diagnostic tests for hemodynamic instability.

Vital signs

The monitoring of the vital signs is the primary clinical assessment for evaluating hemodynamic instability of a patient. Vital signs measurement is very important in judging the severity of the patient’s condition and to decide the any emergency medical intervention need to support for life saving of the patient or not. The following are the included elements of the vital signs.


Variation of pulse rate may provide initial symptom of the development of the hemodynamic instability. The factors which mainly affect the pulse rate are fever, physical exhaustion or exercise, disorder of the thyroid gland and certain medications.

The increase level of catecholamine hormone during stress, haemorrage or dehydrations are different causes which influence pulse rate.  The postural alteration can affect pulse rate and provide the indication of  hypovolemia. Increase or decrease rate of pulse is a marker for arranging of a medical emergency team.

Respiratory rate

Respiratory rate is an important element to assessing the hemodynamic instability, as it is a marker of severity of illness. Respiratory rate become drop down for acute respiratory failure and immediate emergency medical assistance is required  to manage the patient ill health. Respiratory rate also provides guidance of patient reaction after giving any therapy.

Mean Arterial Pressure / Blood Pressure

Proper maintenance of the blood pressure is required to maintain the autoregulation of the heart and brain by keeping sustain perfusion. Mean Arterial Pressure / Blood Pressure is a good marker of hemodynamic instability. Less than 90 mm Hg in systolic blood pressure or less than 65 mm Hg of  Mean Arterial Pressure indicates severe sepsis and septic shock.


High body temperature is also used as an indicator of clinical condition of the patient, though it is not sensitive marker of hemodynamic instability.

Toe- Temperature Gradient

Most of the clinicians suggest Toe- Temperature or rectal temperature gradient is useful diagnostic measure for adequacy of circulation. Toe- Temperature Gradient is a better indicator than  Mean Arterial Pressure, cardiac index or lactate to discriminate between survivors or non survivors for patient admitted to a ICU.

Organ perfusion

Organ perfusion is very important marker for diagnosing hemodynamic instability. hypoperfusion in specific organ indicative of insufficient perfusion in kidney or cardiac output.

Urine Output

The small quantity of urine production (oliguria) is another way to diagnose hemodynamic instability, but may associate with other clinical conditions, so it is an important but not specific clinical marker for hemodynamic instability.  insufficient renal perfusion is one of the cause of oliguria. 0.5ml/kg/hour urine output is a sarogate marker for severe sepsis.

Capillary refill time (CRT)

This clinical element is used to diagnosis the severity of instability of a patient treating under emergency care unit or ICU. The CRT is usually measure by preseeing the finger nail bed to occlute the circulation and then release the pressure and time is noted for how long normal coloration is achieved. CRT more than 6 seconds indicates emergency condition. The abnormal level of CRT along with cardiac index and urine output may indicate acute lung injury.



Cellulitis: Causes, Symptoms & Treatments

Cellulitis is a common infection of the skin and the soft tissues underneath. It happens when bacteria enter a break in the skin and spread. The result is infection, which may cause swelling, redness, pain, or warmth.

You’re at risk if you have:

  • Trauma to the skin
  • Diabetes
  • Circulatory problems, such as not enough blood flow to your arms and legs, poor drainage of your veins or lymphatic system, or varicose veins — twisted, enlarged veins near the surface of the skin
  • Liver disease such as chronic hepatitis or cirrhosis
  • Skin disorders such as eczema, psoriasis, or infectious diseases that cause sores, such as chickenpox


  • Injuries that tear the skin
  • Infections after surgery
  • Long-term skin conditions such as eczema or psoriasis
  • Foreign objects in the skin
  • Bone infections underneath the skin. (An example is a long-standing, open wound that is deep enough to expose the bone to bacteria.)


Cellulitis can appear on almost any part of the body. It usually shows up on damaged skin such as inflamed wounds, dirty cuts, and areas with poor circulation. It needs to be treated by a doctor. Common symptoms include:

  • Redness
  • Red streaking
  • Swelling
  • Warmth
  • Pain or tenderness
  • Leaking of yellow, clear fluid or pus

When to see doctor:

Go to the emergency room if you have any of the following:

  • High fever or chills
  • Nausea and vomiting
  • Enlarging or hardening of the reddened area
  • Increased pain
  • Numbness of the area when touched
  • Other medical problems that may be affected by even a minor infection

Exams and Tests for Cellulitis

Your doctor will do a medical history and physical exam. Additional procedures include:

  • A blood test if the infection is suspected to have spread to your blood
  • An X-ray if there’s a foreign object in the skin or the bone underneath is possibly infected
  • A culture. Your doctor will use a needle to draw fluid from the affected area and send it to the lab.

Treatment for Cellulitis

  • Rest the area.
  • Elevate the area to help reduce swelling and relieve discomfort.
  • Use over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Motrin) to ease the pain, as well as keep your fever down
If the infection isn’t too bad, you can take antibiotics by mouth for a week to 14 days. Your doctor will schedule a follow-up appointment. Your doctor may use IV or intramuscular antibiotics if:

  • The infection is severe.
  • You have other medical problems.
  • You are very young or very old.
  • The cellulitis covers large areas, is on your hands, or is close to body parts like your eyes.
  • The infection worsens even after taking antibiotics for 2 to 3 days.

In serious cases, you may need to stay in the hospital. You’ll get IV antibiotics until the infection is under control (2 to 3 days), and then go home with oral medicines.

Surgery for Cellulitis

Rarely, severe cases may need surgery. For example, doctors may need to open and drain an abscess or pus that has collected in the tissue. They may also need to cut away dead tissue to allow healing.

Prevention of Cellulitis

  • Practice good personal hygiene and keep your skin clean.
  • Wear sturdy, well-fitting shoes or slippers with loose-fitting cotton socks. Avoid walking barefoot outdoors.
  • Wash injured skin with soap and water. Make sure it heals over the next few days.

Some injuries are at greater risk for cellulitis than others. Be sure to contact your doctor if you have:

  • Animal or human bites
  • Puncture wounds deeper than a half-inch, such as from stepping on a nail
  • Crushed tissue that bleeds
  • Burns that blister
  • Frostbite
  • Deep injuries with dirt in them
  • Injuries that touch sea water (making them more prone to infection), especially if you have liver disease
  • Diabetes or other significant medical conditions, such as liver or kidney disease
  • Swelling in your arms and legs that does not go away

Edema (brain swelling) : Causes, Symptoms & Treatments

Brain swelling, also known as cerebral edema in medical terminology is a serious neurological condition. Swelling can occur in any organ of the body. It is body’s response to any type of injury, infection or an overuse of that particular organ or part of the body. Brain edema can develop as a result of an injury to brain or infection in the brain. It may involve certain part of brain or the whole brain.

Brain swelling produces increase in intracranial pressure. Intracranial pressure prevents proper blood flow to the brain as a result the brain cells are deprived of vital food that is oxygen and glucose.

Raised pressure in brain also blocks the cerebrospinal fluid which makes the matter worse. Edema in brain can cause damage to brain cells which may lead to cognitive and behavioral defect. Brain swelling needs to be treated immediately as the condition has fatal outcome if left untreated.



  • Brain Injury: An injury on the head can damage the brain. Usually a severe injury to the skull such as in vehicular accidents, falling from a height, etc is responsible for swelling in brain.

    The injury can cause swelling of the brain tissue. The broken pieces of skull can injure the blood vessels which can lead to swelling of brain.

  • Stroke and high blood pressure: Brain stroke caused due to ischemia of the blood vessel in the brain or hemorrhage inside the brain caused due to trauma or high blood pressure can cause cerebral edema.
  • Infections: Bacterial infection or viral infection such as meningitis, encephalitis can cause swelling of brain tissues.
  • Brain tumor: Edema of brain can be caused due to brain tumor. The growing brain tumor can compress the adjacent area of brain and block the circulating spinal fluid. These may cause rise in intracranial pressure and brain swelling. The growing blood vessels in and around the tumor can also cause brain edema.
  • High altitude: Brain swelling can be one of the symptoms of high altitude sickness although not very common. The swelling is more likely to develop at an altitude 5000 feet and above. The condition is often accompanied with acute mountain sickness.


  • Headache
  • Neck pain or stiffness
  • Nausea or vomiting
  • Dizziness
  • Irregular breathing
  • Vision loss or changes
  • Memory loss
  • Inability to walk
  • Difficulty speaking
  • Stupor
  • Seizures
  • Loss of consciousness

Treatment for Edema:

Minor cases of brain swelling due to causes such as moderate altitude sickness or a slight concussion often resolve within a few days. In most cases, however, more treatment is needed quickly.

The goal is to assure that the brain receives enough blood and oxygen to remain healthy while the swelling is relieved and any underlying causes are treated. This may require a combination of medical and surgical treatments. Prompt treatment usually results in quicker and more complete recovery. Without it, some damage may remain.

Treatment for brain edema may include any combination of the following:

  • Oxygen therapy: Providing oxygen through a respirator or other means helps make sure that the blood has enough oxygen in it. The doctor can adjust the respirator to help reduce the amount of swelling.
  • IV fluids: Giving fluids and medicine through an IV can keep blood pressure from dropping too low. This helps to make sure that the body — including the brain — is receiving enough blood. However, some fluids can make swelling worse. Doctors attempt to use the right amounts of the right fluids in someone with brain swelling.
  • Lowering body temperature (hypothermia): Lowering the temperature of the body and brain helps relieve swelling and allows the brain to heal. Hypothermia as a treatment for brain swelling is not widely used because it is difficult to perform correctly.
  • Medication: In some cases of brain edema, your doctor may start a drug to help relieve the swelling. Medication may also be given for other reasons, such as to slow your body’s response to the swelling or to dissolve any clots. The drugs your doctor gives you depend on the cause and symptoms of brain swelling.
  • Ventriculostomy: In this procedure, a surgeon cuts a small hole in the skull and inserts a plastic drain tube. Cerebrospinal fluid is drained from inside the brain, helping to relieve the pressure.
  • Surgery: Surgery may have one or more of these goals:
    • Removing part of the skull to relieve intracranial pressure; this procedure is called decompressive craniectomy.
    • Removing or repairing the source of the swelling, such as repairing a damaged artery or vein or removing a growth

Hydrocephalus: Causes, Symptoms & Treatments

Hydrocephalus is the buildup of fluid in the cavities (ventricles) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. Cerebrospinal fluid normally flows through the ventricles and bathes the brain and spinal column. But the pressure of too much cerebrospinal fluid associated with hydrocephalus can damage brain tissues and cause a range of impairments in brain function. Hydrocephalus can happen at any age, but it occurs more frequently among infants and adults 60 and over. Surgical treatment for hydrocephalus can restore and maintain normal cerebrospinal fluid levels in the brain. Many different therapies are often required to manage symptoms or functional impairments resulting from hydrocephalus.


The signs and symptoms of hydrocephalus vary somewhat by age of onset.


Common signs and symptoms of hydrocephalus in infants include:

Changes in the head

  • An unusually large head
  • A rapid increase in the size of the head
  • A bulging or tense soft spot (fontanel) on the top of the head

Physical signs and symptoms

  • Vomiting
  • Sleepiness
  • Irritability
  • Poor feeding
  • Seizures
  • Eyes fixed downward (sunsetting of the eyes)
  • Deficits in muscle tone and strength
  • Poor responsiveness to touch
  • Poor growth

Toddlers and older children

Among toddlers and older children, signs and symptoms may include:

Physical signs and symptoms

  • Headache
  • Blurred or double vision
  • Eyes fixed downward (sunsetting of eyes)
  • Abnormal enlargement of a toddler’s head
  • Sleepiness or lethargy
  • Nausea or vomiting
  • Unstable balance
  • Poor coordination
  • Poor appetite
  • Seizures
  • Urinary incontinence

Behavioral and cognitive changes

  • Irritability
  • Change in personality
  • Decline in school performance
  • Delays or problems with previously acquired skills, such as walking or talking

Young and middle-aged adults

Common signs and symptoms in this age group include:

  • Headache
  • Lethargy
  • Loss of coordination or balance
  • Loss of bladder control or a frequent urge to urinate
  • Impaired vision
  • Decline in memory, concentration and other thinking skills that may affect job performance

Older adults

Among adults 60 years of age and older, the more common signs and symptoms of hydrocephalus are:

  • Loss of bladder control or a frequent urge to urinate
  • Memory loss
  • Progressive loss of other thinking or reasoning skills
  • Difficulty walking, often described as a shuffling gait or the feeling of the feet being stuck
  • Poor coordination or balance

When to see a doctor

Seek emergency medical care for infants and toddlers experiencing these signs and symptoms:

  • A high-pitched cry
  • Problems with sucking or feeding
  • Unexplained, recurrent vomiting
  • An unwillingness to move the head or lay down
  • Breathing difficulties
  • Seizures


A diagnosis of hydrocephalus is usually based on:

  • Your answers to the doctor’s questions about signs and symptoms
  • A general physical
  • A neurological exam
  • Brain imaging tests

Neurological exam

The type of neurological exam will depend on a person’s age. The neurologist may ask questions and conduct relatively simple tests in the office to judge muscle condition, movement, well-being and how well the senses are functioning.

Brain imaging

Brain imaging tests can show enlarged ventricles caused by excess cerebrospinal fluid. They may also be used to identify underlying causes of hydrocephalus or other conditions contributing to the symptoms. Imaging tests may include:

  • Ultrasound. Ultrasound imaging, which uses high-frequency sound waves to produce images, is often used for an initial assessment for infants because it’s a relatively simple, low-risk procedure. The ultrasound device is placed over the soft spot (fontanel) on the top of a baby’s head. Ultrasound may also detect hydrocephalus prior to birth when the procedure is used during routine prenatal examinations.
  • Magnetic resonance imaging (MRI) uses radio waves and a magnetic field to produce detailed 3-D or cross-sectional images of the brain. This test is painless, but it is noisy and requires lying still.Children may need mild sedation for some MRI scans. However, some hospitals use a very fast version of MRI that generally doesn’t require sedation.
  • Computerized tomography (CT) scan is a specialized X-ray technology that can produce cross-sectional views of the brain. Scanning is painless and quick. But this test also requires lying still, so a child usually receives a mild sedative.Drawbacks to CT scanning include less detailed images than an MRI, and exposure to a small amount of radiation. CT scans for hydrocephalus are usually used only for emergency exams.


One of two surgical treatments may be used to treat hydrocephalus.

1. Shunt

The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate.

One end of the tubing is usually placed in one of the brain’s ventricles. The tubing is then tunneled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed — such as the abdomen or a chamber in the heart.

People who have hydrocephalus usually need a shunt system for the rest of their lives, and regular monitoring is required.

2. Endoscopic third ventriculostomy

Endoscopic third ventriculostomy is a surgical procedure that can be used for some people. In the procedure, your surgeon uses a small video camera to have direct vision inside the brain. Your surgeon makes a hole in the bottom of one of the ventricles or between the ventricles to enable cerebrospinal fluid to flow out of the brain.

Complications of surgery

Both surgical procedures can result in complications. Shunt systems can stop draining cerebrospinal fluid or poorly regulate drainage because of mechanical malfunctions, blockage or infections. Complications of ventriculostomy include bleeding and infections.

Any failure requires prompt attention, surgical revisions or other interventions. Signs and symptoms of problems may include:

  • Fever
  • Irritability
  • Drowsiness
  • Nausea or vomiting
  • Headache
  • Vision problems
  • Redness, pain or tenderness of the skin along the path of the shunt tube
  • Abdominal pain when the shunt valve is in the abdomen
  • Recurrence of any of the initial hydrocephalus symptoms

Other treatments

Some people with hydrocephalus, particularly children, may need additional treatment, depending on the severity of long-term complications of hydrocephalus.

A care team for children may include a:

  • Pediatrician or psychiatrist, who oversees the treatment plan and medical care
  • Pediatric neurologist, who specializes in the diagnosis and treatment of neurological disorders in children
  • Occupational therapist, who specializes in therapy to develop everyday skills
  • Developmental therapist, who specializes in therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills
  • Mental health provider, such as a psychologist or psychiatrist
  • Social worker, who assists the family with accessing services and planning for transitions in care
  • Special education teacher, who addresses learning disabilities, determines educational needs and identifies appropriate educational resources

Retinal Detachment: Causes, Symptoms & Treatments

Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position. Retinal detachment separates the retinal cells from the layer of blood vessels that provides oxygen and nourishment. The longer retinal detachment goes untreated, the greater your risk of permanent vision loss in the affected eye.

Warning signs of retinal detachment may include one or all of the following: the sudden appearance of floaters and flashes and reduced vision. Contacting an eye specialist (ophthalmologist) right away can help save your vision.


Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as:

  • The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision
  • Flashes of light in one or both eyes (photopsia)
  • Blurred vision
  • Gradually reduced side (peripheral) vision
  • A curtain-like shadow over your visual field


There are three different types of retinal detachment:

  • Rhegmatogenous 
  • Tractional
  • Exudative


Surgery is almost always used to repair a retinal tear, hole or detachment. Various techniques are available. Ask your ophthalmologist about the risks and benefits of your treatment options. Together you can determine what procedure or combination of procedures is best for you.

Retinal tears

When a retinal tear or hole hasn’t yet progressed to detachment, your eye surgeon may suggest one of the following procedures to prevent retinal detachment and preserve vision.

  • Laser surgery (photocoagulation). The surgeon directs a laser beam into the eye through the pupil. The laser makes burns around the retinal tear, creating scarring that usually “welds” the retina to underlying tissue.
  • Freezing (cryopexy). After giving you a local anesthetic to numb your eye, the surgeon applies a freezing probe to the outer surface of the eye directly over the tear. The freezing causes a scar that helps secure the retina to the eye wall.

Both of these procedures are done on an outpatient basis. After your procedure, you’ll likely be advised to avoid activities that might jar the eyes — such as running — for a couple of weeks or so.

Retinal detachment

Illustration depicting pneumatic retinopexy

Pneumatic retinopexy

If your retina has detached, you’ll need surgery to repair it, preferably within days of a diagnosis. The type of surgery your surgeon recommends will depend on several factors, including how severe the detachment is.

  • Injecting air or gas into your eye.
  • Indenting the surface of your eye.
  • Draining and replacing the fluid in the eye.Vitrectomy may be combined with a scleral buckling procedure.

After surgery your vision may take several months to improve. You may need a second surgery for successful treatment. Some people never recover all of their lost vision.

Musculoskeletal disorders: Causes, Symptoms & Treatments

What are musculoskeletal disorders?

Musculoskeletal disorders (MSDs) are conditions that can affect your muscles, bones, and joints. MSDs include:

  • tendinitis
  • carpal tunnel syndrome
  • osteoarthritis
  • rheumatoid arthritis (RA)
  • fibromyalgia
  • bone fractures

MSDs are common. And your risk of developing them increases with age.

The severity of MSDs can vary. In some cases, they cause pain and discomfort that interferes with everyday activities. Early diagnosis and treatment may help ease symptoms and improve long-term outlook.

Image result for images of musculoskeletal system


  • recurrent pain
  • stiff joints
  • swelling
  • dull aches

They can affect any major area of your musculoskeletal system, including the following:

  • neck
  • shoulders
  • wrists
  • back
  • hips
  • legs
  • knees
  • feet

In some cases, the symptoms of MSDs interfere with everyday activities like walking or typing. You may develop a limited range of motion or have trouble completing routine tasks


Your risk of developing MSDs is affected by:

  • age
  • occupation
  • activity level
  • lifestyle
  • family history

Certain activities can cause wear and tear on your musculoskeletal system, leading to MSDs. These include:

  • sitting in the same position at a computer every day
  • engaging in repetitive motions
  • lifting heavy weights
  • maintaining poor posture at work


  • Injections with anesthetic or anti-inflammatory medications in or around the painful sites
  • Exercise that includes muscle strengthening and stretching
  • Physical or occupational therapy
  • Acupuncture or acupressure
  • Relaxation/biofeedback techniques
  • Osteopathic manipulation (a whole system of evaluation and treatment designed to achieve and maintain health by restoring normal function to the body)
  • Chiropractic care
  • Therapeutic massage

Vitreous Haemorrhage: Causes, Symptoms & Treatment

The eye is filled with a clear vitreous ‘gel’. When blood leaks into this gel, usually from blockage or damage to the blood vessels of the retina, is known as a vitreous haemorrhage. This usually results in blurred vision, as the leaked fluids block the light that passes into the eye.


Vitreous haemorrhage normally occurs suddenly, and without any pain. Symptoms range from the sudden appearance of spots or floaters in your vision, to a sudden blurring of vision, and in severe cases, sudden blindness.

Some people find that their vision tends to be worse in the morning, as the blood has settled to the back of their eye during the night.


There are three main causes of vitreous haemorrhage:

Damage to normal blood vessels
Retinal blood vessels that are damaged through injury or trauma can cause a vitreous haemorrhage. Some eye problems can also cause damage to the blood vessels of the retina, such as retinal tears. A retinal vein occlusion can also cause vitreous haemorrhage, as it blocks the veins that feed the retina, which may then bleed into the vitreous ‘gel’.

Growth of abnormal blood vessels
Some eye conditions can cause the growth of abnormal blood vessels that bleed into the vitreous ‘gel’ of the eye. The later stages of diabetic retinopathy, some retinal vein occlusions , and occasionally wet AMD can cause abnormal, delicate blood vessels to grow and bleed into the vitreous cavity.

Bleeding from other parts of the eye
Occasionally, blood from another source can cause a vitreous haemorrhage. While it is very rare, a haemorrhage in another part of the eye, or even a tumour, can cause blood to leak through into the vitreous ‘gel’.


Vitreous haemorrhage sometimes goes away by itself, or it can be removed with vitrectomy surgery, which may also be required to treat the cause of the haemorrhage.