What Is Intracerebral Hemorrhage?

Intracerebral hemorrhage (ICH) is when blood suddenly bursts into brain tissue, causing damage to the brain.

Symptoms usually appear suddenly during ICH. They include headache, weakness, confusion, and paralysis, particularly on one side of the body. The buildup of blood puts pressure on the brain and interferes with its oxygen supply. This can quickly cause brain and nerve damage.

This is a medical emergency requiring immediate treatment. ICH is not as common as ischemic stroke (when a blood vessel is blocked by a clot), but it’s more serious.

Treatment generally involves surgery to relieve the pressure from the accumulation of blood and to repair damaged blood vessels. Long-term treatment depends on the hemorrhage location and the amount of damage. Treatment may include physical, speech, and occupational therapy. Most people have some level of permanent disability

What Are the Causes of Intracerebral Hemorrhage?

High blood pressure is the most common cause of intracerebral hemorrhage. In younger people, another common cause is abnormally formed blood vessels in the brain. Other causes include:

• head injury or trauma
• ruptured cerebral aneurysm (weak spot in a blood vessel that bursts)
• arteriovenous malformation (a grouping of malformed blood vessels in the brain that disrupts normal blood flow)
• use of blood thinners
• bleeding tumors
• cocaine use (can cause severe hypertension and lead to hemorrhage)
• bleeding disorders (e.g., hemophilia, sickle cell anemia)

Anyone can have an intracerebral hemorrhage, but your risk increases with age.

What Are the Symptoms of Intracerebral Hemorrhage?

Symptoms of ICH include:

• sudden weakness, tingling, or paralysis in the face, arm, or leg, especially if it occurs on only one side of the body
• sudden onset of severe headache
• trouble swallowing
• trouble with vision in one or both eyes
• loss of balance and coordination, dizziness
• trouble with language skills (reading, writing, speaking, understanding)
• nausea, vomiting
• apathy, sleepiness, lethargy, loss of consciousness
• confusion, delirium

What Are the Complications of Intracerebral Hemorrhage?

Depending on the location of the hemorrhage and how long your brain was without oxygen, complications may include:

• impaired language skills
• fatigue
• problems with swallowing
• vision loss
• difficulty with sensations or movements on one side of the body
• pneumonia
• cognitive dysfunction (memory loss, difficulty reasoning), confusion
• swelling on the brain
• seizures
• depression, emotional problems
• fever

How Is Intracerebral Hemorrhage Treated?

Treatment within the first three hours of the onset of symptoms generally results in a better outcome.

Surgery can relieve pressure on the brain and repair torn arteries. Certain medications can help manage symptoms, such as painkillers to ease severe headaches. Antianxiety drugs may be necessary to control blood pressure. If your doctor determines that you’re at risk for seizures, antiepileptic drugs may be necessary.

Long-term treatment will be needed to overcome symptoms caused by damage to the brain. Depending on your symptoms, treatment may include physical and speech therapy to help restore muscle function or improve communication. Occupational therapy may help a person regain certain skills and independence by practicing and modifying everyday activities.

How Can I Prevent Intracerebral Hemorrhage?

You can decrease your chances of ICH by:

• not smoking
• treating heart disease
• treating high blood pressure
• keeping diabetes under control
• maintaining a healthy lifestyle

What is Vestibular Hypofunction

What are varicose veins?

Higher than normal hemoglobin levels can be seen in people living at high altitudes and in people who smoke. Dehydration produces a falsely high hemoglobin measurement that disappears when proper fluid balance is restored.

Some other infrequent causes are high hemoglobin levels are:

• advanced lung disease (for example, emphysema);
• certain tumors;
• a disorder of the bone marrow known as polycythemia rubra vera, and;
• abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes (increasing the amount of oxygen available to the body by chemically raising the production of red blood cells).

Sickle cell disease is a genetic condition in which the quality of hemoglobin is defective. This condition can cause abnormal hemoglobin that can result in abnormally-shaped (sickled) red blood cells (see illustration). These abnormal red blood cells cannot easily pass through small blood vessels leading to inadequate oxygen for the tissues of the body.

Sickle cells also have a shorter life span than normal red blood cells (10 to 20 days compared to 120 days). This rapid turnover may result in inadequate time to replace the red blood cells and may result in anemia.

In sickle cell anemia, one defective hemoglobin gene is inherited from each parent. If only one gene is inherited from one parent, then the condition is milder and referred to as sickle cell trait.

Symptoms of sickle cell anemia vary depending on its severity. Patients with sickle cell trait may experience mild, if any, symptoms at all. In sickle cell disease, symptoms are more significant, especially in episodes of acute crisis. These symptoms can include:

• generalized body aches and pain,
• chest pain,
• bone pain,
• shortness of breath,
• ulceration of skin,
• fatigue,
• strokes,
• blindness, and
• delayed growth and puberty.

Thalassemia is a group of hereditary conditions with quantitative hemoglobin deficiency. The body’s failure to make globulin molecules will lead to a compensatory mechanism to make other less compatible globulin molecules. The different types of thalassemia are defined based on what type of globulin molecule is deficient. The severity of these conditions depends on the type of deficient globulin chain, the number of deficient globulins, and the severity of the underproduction. Mild disease may only present as mild anemia whereas severe deficiency may not be compatible with life.

There are a number of ways to increase hemoglobin levels. In general, low hemoglobin levels that need to be increased are caused by three circumstances: decreased red blood cell production (for example, altered bone marrow hemoglobin production, iron deficiency), increased red blood cell destruction (for example, liver disease), and by blood loss (for example, trauma from a gunshot or knife wound). Addressing these underlying causes of low hemoglobin levels initially determines what method to use to increase hemoglobin levels.

Methods to increase hemoglobin levels are varied and their use depends on the underlying problems. Some of the ways to increase hemoglobin include:

• transfusing red blood cells
• receiving erythropoietin (a hormone used to stimulate red blood cell production in individuals with decreased red blood cell production or increased red cell destruction)
• taking iron supplements
• increasing the intake of iron-rich foods (eggs, spinach, artichokes, beans, lean meats, and seafood) and foods rich in cofactors (such as vitamin B6, folic acid, vitamin B12, and vitamin C) important for maintaining normal hemoglobin levels. Such foods include fish, vegetables, nuts, cereals, peas, and citrus fruits.

Individuals should not take iron supplements or other treatments for low hemoglobin levels without first discussing such treatments with their physician as side effects from these treatments and/or excess iron intake may cause additional problems. Also, iron supplements should be kept away from children as iron poisoning in young children can be fatal

Loss of vision is considered sudden if it develops within a few minutes to a couple of days. It may affect one or both eyes and all or part of a field of vision. Loss of only a small part of the field of vision (for example, as a result of a small retinal detachment) may seem like blurred vision. Other symptoms, for example eye pain, may occur depending on the cause of vision loss.

Causes:

Sudden loss of vision has three general causes:

• Clouding of normally transparent eye structures

• Abnormalities of the retina (the light-sensing structure at the back of the eye)

• Abnormalities of the nerves that carry visual signals from the eye to the brain (the optic nerve and the visual pathways)

Light must travel through several transparent structures before it can be sensed by the retina. First, light passes through the cornea (the clear layer in front of the iris and pupil), then the lens, and then the vitreous humor (the jellylike substance that fills the eyeball). Anything that blocks light from passing through these structures, for example, a corneal ulcer or bleeding into the vitreous humor, can cause loss of vision.

Most of the disorders that cause total loss of vision when they affect the entire eye may cause only partial vision loss when they affect only part of the eye.

An Inside Look at the Eye

When the Visual Pathways Are Damaged

Nerve signals travel along the optic nerve from each eye. The two optic nerves meet at the optic chiasm. There, the optic nerve from each eye divides, and half of the nerve fibers from each side cross to the other side. Because of this arrangement, the brain receives information via both optic nerves for the left visual field and for the right visual field. Damage to an eye or the visual pathway causes different types of vision loss depending on where the damage occurs.

HOW AND WHY BLINDNESS DEVELOPS

Anything that blocks the passage of light from the environment to the back of the eye or disrupts the transmission of nerve impulses from the back of the eye to the brain will interfere with vision. Legal blindness is defined as a visual acuity of 20/200 or worse in the better eye, even after correction with eyeglasses or contact lenses, or a visual field restricted to less than 20° in the better eye. Many people who are considered legally blind can distinguish shapes and shadows but not normal detail. Blindness can occur under the following circumstances: Light cannot reach the retina. Damage to the cornea caused by infections such as herpes keratoconjunctivitis or an infection that follows contact lens overwearing, which results in an opaque corneal scar Damage to the cornea caused by vitamin A deficiency (keratomalacia), which causes dry eyes and results in an opaque corneal scar (rare in developed nations) Damage to the cornea caused by a severe injury that results in an opaque corneal scar A cataract, which causes loss of clarity of the lens Light rays do not focus on the retina clearly. Imperfect focusing of light rays on the retina (refraction errors) that cannot be fully corrected with eyeglasses or contact lenses (such as from certain types of cataracts) The retina cannot sense light rays normally. Detached retina Diabetes mellitus Macular degeneration Retinitis pigmentosa Inadequate blood supply to the retina, usually due to a blockage of the retinal artery or vein, which may be caused by inflammation of the blood vessel wall (such as that caused by giant cell arteritis), or due to a blood clot that travels to the eye from somewhere else (such as from the carotid artery in the neck) Infection of the retina (such as from Toxoplasma,parasites, or fungi) in people who have AIDS Nerve impulses from the retina are not transmitted to the brain normally. Disorders affecting the optic nerve or its pathways inside the brain, such as brain tumors, strokes, infections, and multiple sclerosis Glaucoma Inflammation of the optic nerve (optic neuritis) The brain cannot interpret information sent by the eye. Disorders that affect the areas of the brain that interpret visual impulses (visual cortex), such as strokes and tumors

Common causes

The most common causes of sudden loss of vision are

• Blockage of a major artery of the retina (central retinal artery occlusion)

• Blockage of an artery to the optic nerve (ischemic optic neuropathy)

• Blockage of a major vein in the retina (central retinal vein occlusion)

• Blood in the jellylike vitreous humor near the back of the eye (vitreous hemorrhage)

• Eye injury

Sudden retinal artery blockage can result from a blood clot or small piece of atherosclerotic material that breaks off and travels into the artery. The artery to the optic nerve can be blocked in the same ways and can also be blocked by inflammation (such as may occur with giant cell [temporal] arteritis). A blood clot can form in the retinal vein and block it, particularly in older people with high blood pressure or diabetes. People with diabetes are also at risk of bleeding into the vitreous humor.

Sometimes what seems like a sudden start of symptoms may instead be sudden recognition. For example, a person with long-standing reduced vision in one eye (possibly caused by a dense cataract) may suddenly become aware of the reduced vision in the affected eye after covering the unaffected eye.

Less common causes:

Less common causes of sudden loss of vision (see Table: Some Causes and Features of Sudden Loss of Vision) include stroke or transient ischemic attack (TIA), acute glaucoma, retinal detachment, inflammation of the structures in the front of the eye between the cornea and the lens (anterior uveitis, sometimes called iritis), certain infections of the retina, and bleeding within the retina as a complication of age-related macular degeneration.

Treatment

• Treatment of the cause

The disorder causing the loss of vision is treated as rapidly as possible, although treatment may not be able to save or restore vision. However, prompt treatment may decrease the risk of the same process occurring in the other eye.

Key Points

• Sudden loss of vision is an emergency, so people should go directly to a hospital.

• The presence or absence of pain helps indicate which causes are most likely.

• If vision returns quickly on its own, transient ischemic attack and ocular migraine are among the likely causes.

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside the mother. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).

Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both together.

What Causes a Cleft Lip and Cleft Palate?

In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.

Another potential cause may be related to a medication a mother may have taken during her pregnancy. Some drugs may cause cleft lip and cleft palate. Among them: anti-seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis.

Colorectal cancer, also known as bowel cancer, colon cancer or rectal cancer, is any cancer (a growth, lump, tumor) of the colon and the rectum.

A colorectal cancer may be benign or malignant. Benign means the tumor will not spread, while a malignant tumor consists of cells that can spread to other parts of the body and damage them.

The colon and rectum

The large intestine is also called the colon or large bowel.

The colon and rectum belong to our body’s digestive system – together they are also known as the large bowel.

The colon reabsorbs large quantities of water and nutrients from undigested food products as they pass along it.

The rectum is at the end of the colon and stores feces (stools, waste material) before being expelled from the body.

Symptoms of colorectal cancer

• Going to the toilet more often.
• Diarrhea.
• Constipation.
• A feeling that the bowel does not empty properly after a bowel movement.
• Blood in feces (stools).
• Pains in the abdomen.
• Bloating in the abdomen.
• A feeling of fullness in the abdomen (maybe even after not eating for a while).
• Vomiting.
• Fatigue (tiredness).
• Inexplicable weight loss.
• A lump in the tummy or a lump in the back passage felt by your doctor.
• Unexplained iron deficiency in men, or in women after the menopause.

As most of these symptoms may also indicate other possible conditions, it is important that the patient sees a doctor for a proper diagnosis. Anybody who experiences some of these symptoms for four weeks should see their doctor.

Causes of colorectal cancer

Experts say we are not completely sure why colorectal cancer develops in some people and not in others. However, several risk factors have been identified over the years – a risk factor is something which may increase a person’s chances of developing a disease or condition.

The possible risk factors for colorectal factors are:

• Being elderly – the older you are the higher the risk is.
• A diet that is very high in animal protein.
• A diet that is very high in saturated fats.
• A diet that is very low in dietary fiber.
• A diet that is very high in calories.
• A diet that is very high in alcohol consumption.
• Women who have had breast, ovary and uterus cancers.
• A family history of colorectal cancer.
• Patients with ulcerative colitis.
• Being overweight/obese.
• Smoking. This study found that smoking is significantly associated with an increased risk for colorectal cancer and death.
• Being physically inactive.
• Presence of polyps in the colon/rectum. Untreated polyps may eventually become cancerous.
• Having Crohn’s disease or Irritable Bowel Disease have a higher risk of developing colorectal cancer.

Most colon cancers develop within polyps (adenoma). These are often found inside the bowel wall.

TMJ Disorders

TMJ disorders are a family of problems related to your complex jaw joint. TMJ stands for temporomandibular joint, which is the name for each joint (right and left) that connects your jaw to your skull. If you have had symptoms like pain or a clicking sound in your jaw, you’ll be glad to know these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles do not work together correctly. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

Causes

• Clenching or grinding your teeth.
• Tightening your jaw muscles and stressing your TM joint.
• You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments.

As a result of the above, the disk which is made of cartilage and functions as the “cushion” of the jaw joint can slip out of position.

Regardless of the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth, or you may have trouble opening your mouth wide.

Do You Have a TMJ Disorder?

• Are you aware of grinding or clenching your teeth?
• Do you wake up with sore, stiff muscles around your jaws?
• Do you have frequent headaches or neck aches?
• Does the pain get worse when you clench your teeth?
• Does stress make your clenching and pain worse?
• Does your jaw click, pop, grate, catch or lock when you open your mouth?
• Is it difficult or painful to open your mouth, eat or yawn?
• Have you ever injured your neck, head or jaws?
• Have you had problems (such as arthritis) with other joints?
• Do you have teeth that no longer touch when you bite?
• Do your teeth meet differently from time to time?
• Is it hard to use your front teeth to bite or tear food?
• Are your teeth sensitive, loose, broken or worn?

The more times you answered “yes”, the more likely it is that you may have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

Treatment

Once an evaluation confirms a TMJ diagnosis, our doctors will determine the proper course of treatment. It is important to note that the treatment typically works better with a team approach of self-care joined with professional care.

• The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory agent or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation.

• Self-care treatments often work well and include resting your jaw, keeping your teeth apart when you are not swallowing or eating, eating soft foods, applying ice and heat, exercising your jaw and practicing good posture.

• Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. The splint (or night guard) fits over your top and bottom teeth and helps keep your teeth apart, thereby relaxing the muscle and reducing pain.

• Different types of appliances serve different purposes. A night guard helps you stop clenching or grinding your teeth and reduces muscle tension at night, helping to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relieves pressure on parts of your jaw and aids in disk repositioning. An orthotic stabilization appliance is worn 24 hours/day or just at night to move your jaw into proper position.

• If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment, orthodontics with or without jaw reconstruction, or restorative dental work.

• Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed, but are reserved for severe cases. TMJ surgery is generally only considered when the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or if the patient has undergone appliance therapy treatment unsuccessfully.