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.

Symptoms

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

Infants

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

Diagnosis

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.

Treatment

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 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.

Symptoms

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

Causes

There are three different types of retinal detachment:

• Rhegmatogenous 
• Tractional
• Exudative

Treatment

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

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.

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.

Symptoms

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.

Causes

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’.

Treatment

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.

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.

Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage.

Symptoms:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

When to see a doctor

See your doctor if you have:

• Pelvic pain that doesn’t go away
• Overly heavy, prolonged or painful periods
• Spotting or bleeding between periods
• Difficulty emptying your bladder

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

Causes

Doctors don’t know the cause of uterine fibroids, but research and clinical experience point to these factors:

• Genetic changes. Many fibroids contain changes in genes that differ from those in normal uterine muscle cells.
• Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do. Fibroids tend to shrink after menopause due to a decrease in hormone production.
• Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Treatments:

• Uterine artery embolization.
• Myolysis.
• Laparoscopic or robotic myomectomy.
• Hysteroscopic myomectomy.
• Endometrial ablation

Risk factors

There are few known risk factors for uterine fibroids, other than being a woman of reproductive age. Other factors that can have an impact on fibroid development include:

• Heredity. If your mother or sister had fibroids, you’re at increased risk of developing them.
• Race. Black women are more likely to have fibroids than women of other racial groups. In addition, black women have fibroids at younger ages, and they’re also likely to have more or larger fibroids.
• Environmental factors. Onset of menstruation at an early age; use of birth control; obesity; a vitamin D deficiency; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, appear to increase your risk of developing fibroids.

Symptoms:

Causes

Gout is caused initially by an excess of uric acid in the blood, or hyperuricemia. Uric acid is produced in the body during the breakdown of purines – chemical compounds that are found in high amounts in certain foods such as meat, poultry, and seafood.

Normally, uric acid is dissolved in the blood and is excreted from the body in urine via the kidneys. If too much uric acid is produced, or not enough is excreted, it can build up and form needle-like crystals that trigger inflammation and pain in the joints and surrounding tissue.

Symptoms

Gout usually becomes symptomatic suddenly without warning, often in the middle of the night.

The main symptoms are intense joint pain that subsides to discomfort, inflammation, and redness.

Gout frequently affects the large joint of the big toe, but can also affect the ankles, knees, elbows, wrists, and fingers.

TYPES

There are various stages through which gout progresses, and these are experienced as the different types of gout.

Asymptomatic hyperuricemia

It is possible for a person to have elevated uric acid levels without any outward symptoms. At this stage, treatment is not required, though urate crystals are being deposited in tissue and causing slight damage.

People with asymptomatic hyperuricemia may be advised to take steps to address any possible factors contributing to uric acid build-up.

Acute gout

This stage occurs when the urate crystals that have been deposited suddenly cause acute inflammation and intense pain. This sudden attack is referred to as a “flare” and will normally subside within 3 to 10 days. Flares can sometimes be triggered by stressful events, alcohol and drugs, as well as cold weather.

Interval or intercritical gout

This stage is the period in between attacks of acute gout. Subsequent flares may not occur for months or years, though if not treated, over time, they can last longer and occur more frequently. During this interval, further urate crystals are being deposited in tissue.

Chronic tophaceous gout

Chronic tophaceous gout is the most debilitating type of gout. Permanent damage may have occurred in the joints and the kidneys. The patient can suffer from chronic arthritis and develop tophi, big lumps of urate crystals, in cooler areas of the body such as the joints of the fingers.

It takes a long time without treatment to reach the stage of chronic tophaceous gout – around 10 years. It is very unlikely that a patient receiving proper treatment would progress to this stage.

Pseudogout

One condition that is easily confused with gout is pseudogout. The symptoms of pseudogout are very similar to those of gout.

The major difference between gout and pseudogout is that the joints are irritated by calciumphosphate crystals rather than urate crystals. Pseudogout requires different treatment to gout.

Treatment

Gout patients often have acute inflammation around their joints.

The majority of gout cases are treated with medication. Medication can be used to treat the symptoms of gout attacks, prevent future flares, and reduce the risk of gout complications such as kidney stones

Treatments:

In many cases, your doctor may simply observe a suspicious lung nodule with multiple chest X-rays over several years. However, your doctor may suggest a biopsy or removal of an entire nodule in situations like these:

• You are a smoker and the nodule is large.
• You have symptoms.
• A scan suggests the nodule might be cancerous.
• The nodule has grown.

Surgery can often be done with small incisions and a short hospital stay. If your nodule is benign, you will not need any further treatment, except to manage any underlying problems or complications related to the nodule such as pneumonia or an obstruction.

If you need invasive surgery to remove a tumor, your doctor may recommend one or more tests beforehand to ensure your health. These might include blood tests or kidney, liver, or pulmonary (lung) function tests.

Breast cancer(DCIS) is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

Causes:

Diagnosing DCIS usually involves a combination of procedures:

• Physical examination of the breasts: Your doctor may be able to feel a small lump in the breast during a physical examination, although a noticeable lump is rare with DCIS. In cases when DCIS cannot be felt during a physical exam, it can often be detected using mammography.
• Mammography: DCIS is usually found by mammography. As old cancer cells die off and pile up, tiny specks of calcium (called “calcifications” or “microcalcifications”) form within the broken-down cells. The mammogram will show the cancer cells inside the ducts as a cluster of these microcalcifications, which appear either as white specks or as a shadow.
• Biopsy: If you do have a suspicious mammogram, your doctor will probably want you to have a biopsy. There are two ways to get a biopsy done with only a little bit of surgery (more invasive biopsies are rarely needed for DCIS):
  • Fine needle aspiration biopsy: A very small, hollow needle is inserted into the breast. A sample of cells is removed and examined under the microscope. This method leaves no scars.
  • Core needle biopsy: A larger needle is inserted to remove several bigger samples of tissue from the area that looks suspicious. In order to get the core needle through the skin, the surgeon must make a tiny incision. This leaves a very tiny scar that is barely visible after a few weeks.

  If a needle biopsy is not able to remove cells or tissue, or it does not give definite results (inconclusive), a more involved biopsy may be necessary. These biopsies are more like regular surgery than needle biopsies:

  • Incisional biopsy: Incisional biopsy removes a small piece of tissue for examination.
  • Excisional biopsy: Excisional biopsy attempts to remove the entire suspicious lump of tissue from the breast.

Biopsies are done only to make the diagnosis. If DCIS is diagnosed, more surgery is needed to ensure all of the cancer is removed along with “clear margins,” which means that a border of healthy tissue around the cancer is also removed. Usually this means having lumpectomy, or in some cases (a large area of DCIS, for example), mastectomy.

After the biopsy, the pathologist analyzes the piece of breast tissue and reports back on the:

• type and grade of the DCIS: how abnormal the cells look when compared with normal breast cells, and how fast they are growing
• hormone-receptor status: Whether or not the cancer cells have receptors (proteins in a cell that receive messages from hormones) for the hormones estrogen and/or progesterone. If estrogen and/or progesterone receptors are present, this means that the cancer cells’ growth is fueled by these hormones.

Type and grade of DCIS

All DCIS is considered stage 0 breast cancer — the earliest stage possible. “Stage” describes how far the cancer has spread beyond the site of the original tumor. Even though DCIS is always considered stage 0, it can be any size and be located in any number of areas inside the breast.

Knowing the type and grade of DCIS can help you and your doctor decide on the best treatment for you.

When a pathologist looks at the tissue removed during the biopsy, he or she determines whether or not any abnormal cells are present. If abnormal cells are present, the pathologist will note how different the cells look compared with normal, healthy breast cells. The image shows the range of possible findings, from normal cells all the way to invasive ductal cancer.

Breast cancer: Stages

• Normal cells
• Ductal hyperplasia or “overgrowth” means that too many cells are present.
• Atypical ductal hyperplasia means that there are too many cells (hyperplasia) and they are starting to take on an abnormal appearance (atypical or “not typical”).
• Ductal carcinoma in situ (DCIS) means that there are too many cells and they have the features of cancer, but they are still confined to the inside of the duct. (DCIS is stage 0 breast cancer.)
• DCIS-MI (DCIS with microinvasion) means that a few of the cancer cells have started to break through the wall of the duct. DCIS-MI is stage I breast cancer.
• Invasive ductal cancer (IDC) means that the cancer cells have broken beyond the breast duct. The breast cancer is no longer a DCIS but an invasive ductal carcinoma, the most common type of breast cancer. IDC can be diagnosed at any stage from I-IV.

Symptoms:

DCIS generally has no signs or symptoms. A small number of people may have a lump in the breast or some discharge coming out of the nipple. About 80% of DCIS cases are found by mammography.

Treatments:

• Lumpectomy followed by radiation therapy: This is the most common treatment for DCIS. Lumpectomy is sometimes called breast-conserving treatment because most of the breast is saved.
• Mastectomy: Mastectomy, or removal of the breast, is recommended in some cases.
• Lumpectomy alone(radiation therapy)
• Hormonal therapy after surgery: These treatments, which block or lower the amount of estrogen in the body, are typically used if the DCIS tests positive for hormone receptors.

Chemotherapy, a form of treatment that sends anti-cancer medications throughout the body, is generally not needed for DCIS. DCIS is non-invasive and remains within the breast duct, so there is no need to treat cancer cells that might have traveled to other areas of the body.