What are the leading causes of bacterial meningitis in the United States? Which age groups are more susceptible to certain types of bacterial meningitis?

Bacterial Meningitis: An Overview

Bacterial meningitis is a serious infection that can lead to severe complications, including brain damage, hearing loss, and even death. This infectious disease is caused by various types of bacteria, with the leading causes in the United States including Streptococcus pneumoniae, Group B Streptococcus, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, and Escherichia coli.

Causes of Bacterial Meningitis

The bacteria that can cause meningitis are often associated with another serious illness, sepsis. Sepsis is the body’s extreme response to an infection, and it can quickly lead to tissue damage, organ failure, and death if not treated promptly.

Certain age groups are more susceptible to specific types of bacterial meningitis:

• Newborns: Group B Streptococcus, S. pneumoniae, L. monocytogenes, E. coli
• Babies and young children: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, M. tuberculosis
• Teens and young adults: N. meningitidis, S. pneumoniae
• Older adults: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, L. monocytogenes

Risk Factors for Bacterial Meningitis

Certain factors can increase a person’s risk of developing bacterial meningitis, including:

1. Age: Babies are at a higher risk compared to other age groups, but anyone can develop bacterial meningitis.
2. Group settings: Infectious diseases tend to spread more easily in places where large groups of people gather, such as college campuses.
3. Certain medical conditions and treatments: Individuals with HIV infections, cerebrospinal fluid leaks, or without a spleen, as well as those who work with meningitis-causing pathogens, are at increased risk.
4. Travel: Travelers may be at higher risk of contracting meningococcal disease, especially when visiting the meningitis belt in sub-Saharan Africa or during the Hajj and Umrah pilgrimages in Mecca.

How Bacterial Meningitis Spreads

Bacterial meningitis can spread in various ways, depending on the type of bacteria involved. Some bacteria, like Listeria monocytogenes, can be transmitted through contaminated food, while others, such as Haemophilus influenzae, Mycobacterium tuberculosis, and Streptococcus pneumoniae, are typically spread through respiratory droplets during close contact with infected individuals.

Neisseria meningitidis is often spread through the sharing of respiratory or throat secretions, which can occur during close contact, such as coughing or kissing, or prolonged contact, like living together.

It’s important to note that some people can carry these bacteria without showing any symptoms, but they can still spread the infection to others.

Signs and Symptoms of Bacterial Meningitis

The signs and symptoms of bacterial meningitis can vary depending on the type of bacteria involved and the age of the affected individual. Common symptoms include fever, headache, stiff neck, nausea, vomiting, and altered mental status.

Pregnant individuals with a Listeria infection may not experience any symptoms or may only have a fever and other flu-like symptoms, such as fatigue and muscle aches. However, the infection can still lead to serious complications, including miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn, including meningitis.

Newborns can also contract group B Streptococcus from their mothers during delivery, which can result in meningitis and other severe health issues.

Preventing Bacterial Meningitis

To prevent the spread of bacterial meningitis, it’s important to practice good hygiene, such as frequent handwashing, and to avoid close contact with individuals who are sick. Vaccination is also an effective way to reduce the risk of certain types of bacterial meningitis, such as those caused by Neisseria meningitidis and Haemophilus influenzae.

Travelers to high-risk areas should consult with their healthcare providers about the need for specific vaccinations or other preventive measures.

Seeking Medical Attention

If an individual is experiencing symptoms of bacterial meningitis, it’s crucial to seek medical attention immediately. Early diagnosis and treatment are essential to prevent serious complications and improve the chances of a full recovery.

About Bacterial Meningitis Infection | CDC

Bacterial meningitis is serious. Some people with the infection die and death can occur in as little as a few hours. However, most people recover from bacterial meningitis. Those who do recover can have permanent disabilities, such as brain damage, hearing loss, and learning disabilities.

Causes

Several types of bacteria can cause meningitis. Leading causes in the United States include

• Streptococcus pneumoniae
• Group B Streptococcus
• Neisseria meningitidis
• Haemophilus influenzae
• Listeria monocytogenes
• Escherichia coli

Mycobacterium tuberculosis, which causes tuberculosis or TB, is a less common cause of bacterial meningitis (called TB meningitis).

Many of these bacteria can also be associated with another serious illness, sepsis. Sepsis is the body’s extreme response to infection. It is a life-threatening medical emergency. Sepsis happens when an infection triggers a chain reaction throughout your body. Without timely treatment, sepsis can quickly lead to tissue damage, organ failure, and death.

Some causes of bacterial meningitis are more likely to affect certain age groups:

• Newborns: Group B Streptococcus, S. pneumoniae, L. monocytogenes, E. coli
• Babies and young children: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, M. tuberculosis
• Teens and young adults: N. meningitidis, S. pneumoniae
• Older adults: S. pneumoniae, N. meningitidis, H. influenzae, group B Streptococcus, L. monocytogenes

Risk Factors

Certain factors increase a person’s risk for getting bacterial meningitis. These risk factors include:

• Age: Babies are at increased risk for bacterial meningitis compared to people in other age groups. However, people of any age can develop bacterial meningitis. See section above for which bacteria more commonly affect which age groups.
• Group setting: Infectious diseases tend to spread where large groups of people gather. For example, college campuses have reported outbreaks of meningococcal disease, caused by N. meningitidis.
• Certain medical conditions: Certain medical conditions, medications, and surgical procedures put people at increased risk for meningitis. For example, having an HIV infection or a cerebrospinal fluid leak, or not having a spleen can increase a person’s risk for several types of bacterial meningitis.
• Working with meningitis-causing pathogens: Microbiologists routinely exposed to meningitis-causing bacteria are at increased risk for meningitis.
• Travel: Travelers may be at increased risk for meningococcal disease, caused by N. meningitidis, if they travel to certain places, such as:
  • The meningitis belt in sub-Saharan Africa, particularly during the dry season
  • Mecca during the annual Hajj and Umrah pilgrimage

In many countries, TB is much more common than in the United States. Travelers should avoid close contact or prolonged time with known TB patients in crowded, enclosed environments (for example, clinics, hospitals, prisons, or homeless shelters).

How It Spreads

Certain germs that cause bacterial meningitis, such as L. monocytogenes, can spread through food. But most of these germs spread from one person to another.

How people spread the germs often depends on the type of bacteria. It is also important to know that people can have these bacteria in or on their bodies without being sick. These people are “carriers.” Most carriers never become sick, but can still spread the bacteria to others.

Here are some of the most common examples of how people spread each type of bacteria to each other:

• Group B Streptococcus and E. coli: Mothers can pass these bacteria to their babies during birth.
• H. influenzae, M. tuberculosis, and S. pneumoniae: People spread these bacteria by coughing or sneezing while in close contact with others, who breathe in the bacteria.
• N. meningitidis: People spread these bacteria by sharing respiratory or throat secretions (saliva or spit). This typically occurs during close (coughing or kissing) or lengthy (living together) contact.
• E. coli: People can get these bacteria by eating food prepared by people who did not wash their hands well after using the toilet.

People usually get sick from E. coli and L. monocytogenes by eating contaminated food.

Signs and Symptoms

Being pregnant increases a person’s risk of getting a Listeria infection  (L. monocytogenes). Pregnant people with a Listeria infection may not have any symptoms or may only have a fever and other flu-like symptoms, such as fatigue and muscle aches. However, infection during pregnancy can lead to miscarriage, stillbirth, premature delivery, or life-threatening infection of the newborn, including meningitis. Find out which foods are more likely to contain Listeria and steps you can take to protect your and your baby’s health.

Pregnant women can pass group B Streptococcus (group B strep) to their baby during delivery. Newborns infected with group B strep can develop meningitis or other serious infections soon after birth. Talk with your doctor or midwife about getting a group B test when you are 36 through 37 weeks pregnant. Doctors give antibiotics (during labor) to women who test positive in order to prevent infections in newborns.

Meningitis symptoms include sudden onset of

• Fever
• Headache
• Stiff neck

There are often other symptoms, such as

• Nausea
• Vomiting
• Photophobia (eyes being more sensitive to light)
• Altered mental status (confusion)

Newborns and babies may not have, or it may be difficult to notice the classic symptoms listed above. Instead, babies may

• Be slow or inactive
• Be irritable
• Vomit
• Feed poorly
• Have a bulging fontanelle (the “soft spot” on a baby’s head)
• Have abnormal reflexes

If you think your baby or child has any of these symptoms, call the doctor right away.

Typically, symptoms of bacterial meningitis develop within 3 to 7 days after exposure; note, this is not true for TB meningitis, which can develop much later after exposure to the bacteria.

People with bacterial meningitis can have seizures, go into a coma, and even die. For this reason, anyone who thinks they may have meningitis should see a doctor as soon as possible.

Diagnosis

If a doctor suspects meningitis, they will collect samples of blood or cerebrospinal fluid (fluid near the spinal cord). A laboratory will test the samples to see what is causing the infection. Knowing the specific cause of meningitis helps doctors treat it.

Treatment

Doctors treat bacterial meningitis with a number of antibiotics. It is important to start treatment as soon as possible.

Prevention

Vaccination

Vaccines are the most effective way to protect against certain types of bacterial meningitis. There are vaccines for 4 types of bacteria that can cause meningitis:

• Meningococcal vaccines help protect against N. meningitidis
• Pneumococcal vaccines help protect against S. pneumoniae
• Haemophilus influenzae serotype b (Hib) vaccines help protect against Hib
• Bacille Calmette-Guérin vaccine helps protect against tuberculosis disease, but is not widely used in the United States

Make sure you and your child are vaccinated on schedule.

Like with any vaccine, these vaccines do not work 100% of the time. The vaccines also do not protect against infections from all the types (strains) of each of these bacteria. For these reasons, there is still a chance vaccinated people can develop bacterial meningitis.

Prophylaxis

When someone has bacterial meningitis, a doctor may recommend antibiotics to help prevent people around the patient from getting sick. Doctors call this prophylaxis. CDC recommends prophylaxis for:

• Close contacts of someone with meningitis caused by N. meningitidis
• Household members of someone with a serious Hib infection when the household includes one or more people at increased risk of Hib based on age, vaccination status, and/or immunocompromising conditions

Doctors or local health departments recommend who should get prophylaxis.

Healthy Pregnancy Practices

Pregnant women should talk to their doctor or midwife about getting tested for group B Streptococcus. Women receive the test when they are 36 through 37 weeks pregnant. Doctors give antibiotics (during labor) to women who test positive in order to prevent passing group B strep to their newborns.

Pregnant women can also reduce their risk of meningitis caused by L. monocytogenes. Women should avoid certain foods during pregnancy and safely prepare others.

Healthy Habits

You can also help protect yourself and others from bacterial meningitis and other health problems by maintaining healthy habits:

• Don’t smoke and avoid cigarette smoke as much as possible
• Get plenty of rest
• Avoid close contact with people who are sick
• Wash your hands often with soap and water (use hand sanitizer if soap and water aren’t available)
• Cover your mouth and nose with a tissue when you cough or sneeze (use your upper sleeve or elbow if a tissue isn’t available)

These healthy habits are especially important for people at increased risk for disease, including:

• Young babies
• Older adults
• People with weak immune systems
• People without a spleen or a spleen that doesn’t work the way it should

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Fungal Meningitis | CDC

Causes

Fungal meningitis can develop after a fungal infection spreads from somewhere else in the body to the brain or spinal cord.

Some causes of fungal meningitis include Cryptococcus, Histoplasma, Blastomyces, Coccidioides, and Candida.

How It Spreads

Many fungi that can cause meningitis live in the environment:

• Cryptococcus lives in the environment throughout the world.
• Histoplasma lives in the environment, particularly in soil that contains large amounts of bird or bat droppings. In the United States, the fungus mainly lives in the central and eastern states.
• Blastomyces lives in moist soil and in decaying wood and leaves. In the United States, the fungus mainly lives in midwestern, south central, and southeastern states.
• Coccidioides lives in the soil in the southwestern United States, south-central Washington State, and parts of Mexico and Central and South America.

These fungi are too small to see without a microscope. People can get sick if they breathe in fungal spores. People get meningitis if the fungal infection spreads from the lungs to the brain or spinal cord. Fungal meningitis does not spread between people.

The fungus Candida can also cause meningitis. Candida normally lives inside the body and on the skin without causing any problems. However, in certain patients who are at risk, Candida can enter the bloodstream or internal organs and cause an infection.

Risk Factors

Although anyone can get fungal meningitis, people with weakened immune systems are at increased risk. Certain health conditions, medications, and surgical procedures may weaken the immune system. HIV infection and cancer are examples of health conditions that can weaken the immune system. Medications that can weaken the immune system include:

• Steroids (such as prednisone)
• Medications given after organ transplantation
• Anti-TNF (tumor necrosis factor) medications, which are sometimes given for treatment of rheumatoid arthritis or other autoimmune conditions

Premature babies with very low birth weights are also at increased risk for getting Candida bloodstream infection, which may spread to the brain.

Living in certain areas of the United States may increase the risk for fungal lung infections, which can spread to the brain or spinal cord, causing meningitis.

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Signs and Symptoms

Signs and symptoms of fungal meningitis include the following:

• Fever
• Headache
• Stiff neck
• Nausea and vomiting
• Photophobia (eyes being more sensitive to light)
• Altered mental status (confusion)

Diagnosis

If a doctor suspects meningitis, he or she may collect samples of blood or cerebrospinal fluid (fluid surrounding the spinal cord). Then laboratories can perform specific tests, depending on the type of fungus suspected. Knowing the cause of fungal meningitis is important because doctors treat different types of fungal infections differently.

Treatment

Doctors treat fungal meningitis with long courses of high-dose antifungal medications, often given directly into a vein through an IV. After that, patients also need to take antifungal medications by mouth. The total length of treatment depends on the patient’s immune system and the type of fungus causing the infection. Treatment is often longer for people with weak immune systems, like those with AIDS or cancer.

Prevention

No specific activities are known to cause fungal meningitis. People with weak immune systems should

• Try to avoid areas with a lot of dust like construction or excavation sites. If you can’t avoid these areas, wear an N95 respirator (a type of face mask) while you’re there. Click for more information about respirators.
• Stay inside during dust storms and close your windows.
• Avoid activities that involve close contact to dirt or dust, including yard work, gardening, and digging.
• Use air filtration measures indoors.
• Clean skin injuries well with soap and water to reduce the chances of developing a skin infection, especially if the wound was exposed to dirt or dust.
• Take preventive antifungal medication if your healthcare provider says you need it.

This is especially true if they live in a geographic region where fungi like Histoplasma, Coccidioides, or Blastomyces exist.

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Meningitis – Causes, Symptoms, Treatment, Diagnosis

The Facts

Meningitis means “inflammation of the meninges.” The meninges (plural of meninx) are membranes that cover the brain and spinal cord. They can become inflamed when an infection occurs in the cerebrospinal fluid (CSF) surrounding these membranes. Other things such as medications, tumours, and chemical exposure can also cause meningitis.

The majority of people with meningitis that is not caused by bacteria (e.g., meningitis caused by a virus) recover quickly and completely. However, bacterial meningitis is fatal for 1 in 10 people who get it, even with treatment. Up to 1 in 5 people will be left with problems such as deafness or brain injury.

Quick diagnosis and treatment are vital to reduce the risk of death or complications from bacterial meningitis.

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Causes

The most common causes of meningitis are bacteria or viruses, although there are many other causes. Rarer causes such as fungi can be seen, but often only in people with poor immune systems. Some of the more exotic causes of meningitis, such as parasites, usually are restricted to tropical countries.

Meningitis commonly occurs when bacteria or viruses make their way into the fluid surrounding the brain. Sometimes they enter directly as a result of an operation such as brain surgery. Sometimes they erode through the small bones in our skull, for instance in extreme cases of severe sinusitis. Sometimes they are carried there by our blood from an infection occurring elsewhere in our body such as pneumonia (a lung infection). But in most cases, we don’t really understand how and why this happens.

Cryptococcus, a fungus, can also cause meningitis. It usually occurs in people with weakened immune systems, such as people with AIDS. But recently there has been a more aggressive strain found on Vancouver Island’s eastern coast that can infect healthy people. Tuberculosis (TB) can cause meningitis, but in Canada it is usually seen in people who became infected with TB in their youth while growing up in other countries.

Certain medications and chemical irritants can cause in inflammation of the brain similar to meningitis. There have also been rare reports of vaccines causing meningitis. Viral or chemically-induced meningitis often goes away on its own.

Bacterial meningitis, on the other hand, is a very serious illness. The different types of bacteria that can cause it aren’t normally dangerous – over half the population carries one or another of these bacteria in the back of the nose and throat. They’re commonly transmitted by coughing, sneezing, and kissing, but they can’t live outside the human body for very long. When they manage to enter the cerebrospinal fluid and begin multiplying, the bacteria cause inflammation and other symptoms of meningitis.

There are many species of bacteria that can cause meningitis. The most common causes of bacterial meningitis depend on the person’s age and underlying medical conditions:

• newborns: group B streptococcus, E. coli (Eschericia coli), Listeria monocytogenes
• infants and children: Streptococcus pneumoniae, Neisseria meningitides, Haemophilus influenzae type b
• adolescents and young adults: Streptococcus pneumoniae, Neisseria meningitides
• older adults (usually over 65 years old): Streptococcus pneumoniae, Neisseira meningitides, Listeria monocytogenes
• people with alcohol use disorder, weakened immune systems: Listeria monocytogenes

Before 1992, the bacteria Haemophilus influenzae type b (Hib) was the most common cause of bacterial meningitis. Now that infants in Canada are immunized with the Hib vaccine, meningitis caused by Hib is very rare.

Children under the age of 2 are most susceptible to meningitis. Other things that increase the risk are:

• brain or spinal cord surgery
• head injury
• impaired or abnormal immune system
• kidney failure
• the use of corticosteroids (e.g., prednisone)
• pre-existing ear infection
• cancer, especially breast, lung, skin, leukemia, and lymphoma. When cancer is the cause of the meningitis it is called carcinomatous meningitis or leptomeningeal metastasis.

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Symptoms and Complications

People with bacterial meningitis quickly become very sick, usually within hours, and shouldn’t wait to get medical treatment. For people with non-bacterial meningitis (e.g., viral, chemical), the symptoms usually follow flu-like symptoms and include fever and headaches. Symptoms develop more slowly and are not as severe.

Symptoms of meningitis can include:

• high fever over 39°C (102°F)
• stiff and sore neck, especially when it’s moved, turned, or bent (the discomfort is caused by inflammation of the meninges) – this may not be obvious in people whose immune systems are not functioning properly, such as:
• people taking corticosteroids
• people with AIDS
• people taking cancer or transplant medications
• seniors
• children less than 24 months of age and especially those less than 6 months of age.
• severe headache due to extra pressure in the head – look for signs of fussiness and irritability in children too young to complain of a headache

If blood vessels in the brain become inflamed, the brain won’t get enough oxygen. This can make a person drowsy and less responsive, and, in extreme situations, they can fall into a coma. Lack of oxygen to the brain can also cause seizures.

Inflammation results in increased pressure on the brain, which sometimes causes vomiting. You might also notice a rash that resembles clusters of tiny red or purple pinpricks. When you press on the spots, they won’t turn white, as skin normally does. The skin itself can develop cyanosis, a bluish tinge caused by a lack of oxygen. Not all symptoms of meningitis appear at once, however, and they may be less obvious for seniors.

Symptoms for very young children can include:

• fever, with cold hands and feet
• vomiting
• not eating
• difficulty waking up
• high-pitched moaning or crying
• arching their backs and pulling at their necks
• not settling down or taking comfort when held
• having a vacant expression
• showing a pale, mottled complexion
• rash (red or purple pinpricks)

Long-term complications can occur and last long after the infection has been treated. These include deafness, mental impairment, paralysis, and sometimes seizures that require lifelong treatment.

Making the Diagnosis

Your doctor will ask you questions about your symptoms and perform a physical exam. Your doctor will want to confirm the diagnosis by analyzing a sample of cerebrospinal fluid.

Fluid is drawn through a needle from the lower part of the spinal cord in a procedure called a lumbar puncture (spinal tap). The fluid is then checked for the presence and type of bacteria. Knowing which species of bacteria is responsible for the meningitis allows your doctor to tailor the treatment for best results.

Your doctor may also order other tests such as blood tests and computed tomography (CT) or magnetic resonance imaging (MRI) scans.

Treatment and Prevention

The infection that causes bacterial meningitis is treated with a combination of antibiotics. The antibiotics you receive will depend on the bacteria that are suspected, your age, and other factors. The antibiotics are injected into a vein. You might have to receive the antibiotics for as long as 3 weeks.

For the first few days of antibiotic treatment, you may also be given dexamethasone* (a corticosteroid) to help reduce the risk of meningitis complications. People with meningitis, regardless of the cause, may need supportive treatment such as intravenous fluids and fever-reducing medications.

Children are routinely immunized with the Hemophilus influenzae type b (Hib) vaccine. This is an important preventive measure, since the Hib bacteria used to be the most common cause of meningitis in children. For infants, the Hib vaccine is recommended at 2, 4, 6, and 18 months.

Other recommended vaccines such as those against meningococcal group C bacteria and pneumococcal bacteria promise to greatly reduce the risk for meningitis caused by these organisms. Health Canada recommends that children be immunized with the meningococcal vaccine routinely at 12 months, although some provinces may start immunization earlier. . Another dose is given around 12 years of age. Pneumococcal conjugate vaccine is also being recommended for infants at 2, 4, and 12 months, or at 2, 4, 6, and 12 to 15 months of age.

For adults over 65, a different pneumococcal vaccine is available to reduce the risk of getting meningitis from the pneumococcal bacteria. It’s also recommended for people without a spleen or those whose immune systems are not working properly.

If you’ve been in close contact with someone who has meningitis caused by a Meningococcus or H. influenzae infection, your doctor likely will prescribe antibiotics for you as a precautionary measure.

Carcinomatous meningitis is usually treated with chemotherapy which is administered in the cerebrospinal fluid (CSF) by lumbar puncture or via an Ommaya reservoir.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Meningitis

Bacterial Meningitis | Johns Hopkins Medicine

What is bacterial meningitis?

Meningitis is an infection of the membranes (meninges) that protect the spinal cord and brain. When the membranes become infected, they swell and press on the spinal cord or brain. This can cause life-threatening problems. Meningitis symptoms strike suddenly and worsen quickly.

What causes bacterial meningitis?

Bacteria or a virus can cause meningitis. Viral meningitis is more common, but bacterial meningitis is more serious. It can lead to brain damage, paralysis, or stroke. In some cases, it can be fatal.

Many different types of bacteria can cause meningitis. Vaccines are available that target many of these bacteria. For this reason, it’s important to know what’s causing meningitis. Even though all types affect the same area of the body, they can have different outcomes and need different treatments.

What are the risk factors for bacterial meningitis?

Experts don’t always know why meningitis happens. Some people get it when their immune system is weak or they’ve recently been sick. A head injury may also increase risk.

Bacterial meningitis is more common in infants under 1 year of age and people ages 16 to 21. College students living in dorms or other close quarters are at increased risk. Also at risk are adults with certain medical problems, including those without a spleen.

What are the symptoms of bacterial meningitis?

The most common symptoms of bacterial meningitis are:

• Painful, stiff neck with limited range of motion
• Headaches
• High fever
• Feeling confused or sleepy
• Bruising easily all over the body
• A rash on the skin
• Sensitivity to light

These are symptoms to look for in children:

• Irritability
• Vomiting from a high fever
• Frequent crying
• Swelling of the head
• Lack of appetite
• Seizures (sometimes also seen in adults if the meningitis is advanced)

Symptoms typically come on quickly, in as little as a couple of hours or up to a day or two. If you think you or your child may have meningitis, go to an emergency room right away.

How is bacterial meningitis diagnosed?

To diagnose this condition, a healthcare provider will do a spinal tap (also called a lumbar puncture) to take a sample of fluid from around the spinal cord. The fluid is then tested for bacteria. The healthcare provider will also ask about your symptoms and do a physical exam.

Other tests may include:

• Brain imaging (CT scan)
• Blood and urine testing
• Swab of fluids from your nose or throat

How is bacterial meningitis treated?

Prompt treatment of bacterial meningitis is crucial. It can save your life. Once the type of bacteria has been identified, you’ll start taking antibiotics.

Antibiotics are given through a needle placed into a vein (usually in the arm or hand). They may also be given along with a corticosteroid to help reduce inflammation and swelling. Treatment also includes plenty of fluids to prevent dehydration.

What are the complications of bacterial meningitis?

With quick treatment, many people with bacterial meningitis don’t have any permanent problems. However, even with prompt treatment, some may battle seizures, brain damage, hearing loss, and disability for the rest of their lives. Meningitis can be fatal and some people with this infection will die.

Can bacterial meningitis be prevented?

Vaccines are available to help prevent bacterial meningitis. Children now routinely get a meningitis vaccine around ages 11 to 12. A booster shot is given at age 16. Ask your healthcare provider if you or your children should be vaccinated.

Bacterial meningitis is contagious. If you’ve been around someone who has it, call your healthcare provider to talk about how to keep from getting sick.

Key points about bacterial meningitis

• If you feel like you’ve got the flu with unusual stiffness in your neck, it could be meningitis.
• Get any symptoms checked out and treated as soon as possible to help ward off complications. 
• Ask your healthcare provider about vaccines that may protect you from bacterial meningitis.
• If you’ve been around someone who has bacterial meningitis, call your healthcare provider to talk about how to keep from getting sick.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your provider if you have questions.

Meningitis

Overview

What is meningitis?

Meningitis is an infection of the meninges. The meninges are a protective lining around your brain and spinal cord. There are three main types of meningitis. All types can cause fever, a headache and a stiff neck. Meningitis can be very serious or even fatal. See your healthcare provider immediately if you develop signs of meningitis.

What are the different types of meningitis?

The different types of meningitis include:

• Bacterial meningitis, caused by bacteria.
• Fungal meningitis, caused by fungus.
• Viral (or aseptic) meningitis, caused by a virus.
• Parasitic meningitis, caused by a parasite (an organism that attaches to you and causes harm).
• Amebic meningitis, a rare but severe brain infection caused by a tiny organism called an ameba.
• Noninfectious meningitis, which can be caused by cancers, lupus, certain medications, brain surgery or a head injury.

Healthcare providers also categorize meningitis by how quickly the symptoms develop:

• Acute meningitis: Symptoms develop quickly.
• Chronic meningitis: Symptoms develop over a few weeks or months.

What is bacterial meningitis?

Acute bacterial meningitis can be life-threatening. Approximately 80% of all meningitis cases are bacterial, making it the most common type. With bacterial meningitis, tissues swell around the brain. The swelling can reduce blood flow to the brain, resulting in paralysis or stroke.

Is bacterial meningitis contagious?

Most people don’t catch meningitis from casual contact. But if you have meningitis, let close friends and family members know. Anyone you’ve had close contact with should seek preventive treatment.

Who is at risk for developing bacterial meningitis?

Children younger than 2 months old have the highest incidence of bacterial meningitis. About 70% of all bacterial meningitis cases occur in children under age 5.

Adults may develop this condition, too, especially if they have risk factors, such as certain illnesses, injuries and surgeries:

Other risk factors include:

• Alcohol use disorder.
• Group living, such as in a dorm.
• Travel to certain parts of the world.
• Work with meningitis-causing bacteria.

What is viral meningitis?

Viral, or aseptic, meningitis results when a virus causes a meningitis infection. People of all ages can get viral meningitis. The risk increases for those who:

What is chronic meningitis?

Chronic meningitis develops over weeks or months. Chronic meningitis typically affects people with weakened immune systems, such as those who have:

• AIDS.
• Cancer.
• Had cancer treatment using medication, such as chemotherapy.
• Used prednisone (a steroid) long term.

Is meningitis the same as encephalitis?

The two diseases aren’t the same, but they have similar causes. When an infection affects the membranes around the brain, it’s meningitis. When it affects the brain itself, it’s encephalitis.

How common is meningitis?

Approximately 600 to 1,000 people develop meningitis in the United States every year. The number of cases is decreasing, likely due to more people getting the meningitis vaccine.

Symptoms and Causes

What causes bacterial meningitis?

Bacteria enter your bloodstream and travel to the meninges, causing an infection. Meningitis can also happen after a head injury or an infection that weakened your immune system. Often, healthcare providers can’t identify the cause of bacterial meningitis.

What are bacterial meningitis symptoms?

Signs of bacterial meningitis include:

• Fever.
• Headaches.
• Inability to lower chin to chest because of neck stiffness.

Symptoms in young children:

• Vomiting.
• Refusal to eat.
• Irritability and crying.
• Seizures.
• Swelling in the head due to fluid buildup around the brain.

Older children and adults may also experience:

• Confusion.
• Irritability.
• Drowsiness.
• Seizures and stroke.

What causes viral meningitis?

A certain group of viruses called the non-polio enteroviruses are the most common cause of viral meningitis in the U.S. Other viruses that can cause meningitis include:

What are symptoms of viral meningitis?

Symptoms of viral meningitis are similar to symptoms of bacterial meningitis:

• Fever.
• Headache.
• Irritability.
• Lack of appetite.
• Sensitivity to light.
• Sleepiness or a hard time waking up.
• Stiff neck.
• Vomiting and nausea.
• Weakness.

What causes chronic meningitis?

Chronic meningitis typically affects people with weakened immune systems, such as those who have:

• AIDS.
• Cancer.
• Had cancer treatment using medication, such as chemotherapy.
• Used prednisone (a steroid) long term.

What are symptoms of chronic meningitis?

Symptoms of chronic meningitis are similar to symptoms of bacterial meningitis. The difference is that signs develop slowly, over weeks or months, and are less severe. Symptoms include:

• Fever.
• Headache.
• Confusion.
• Facial numbness.
• Some paralysis.

Diagnosis and Tests

What tests might I have to diagnose meningitis?

Your healthcare provider will decide if the cause of meningitis is bacterial, viral or fungal. The right treatment depends on identifying what type of meningitis it is.

You may need a spinal tap to analyze your spinal fluid. You may also need tests to analyze your:

• Blood.
• Urine.
• Mucus from nose and throat.

How is bacterial meningitis diagnosed?

If you or a loved one has signs of bacterial meningitis, get medical help as soon as possible. The healthcare provider will perform a physical exam, looking for:

• Purple or red skin rash.
• Neck stiffness.
• Hip and knee flexion (bending ability). The hip and knee may automatically flex when the provider flexes the neck.

How is viral meningitis diagnosed?

Your healthcare provider will want to rule out other causes of your symptoms. You may need a:

• Nose and throat swab.
• Spinal tap to look for an increase in white blood cells and any bacteria.
• MRI scan.
• CT scan.
• Blood test.
• Stool sample.

How is chronic meningitis diagnosed?

Often, your healthcare provider needs to rule out other illnesses to confirm a diagnosis of chronic meningitis. You will likely need a:

• Spinal tap.
• MRI scan.
• CT scan.

Management and Treatment

How is bacterial meningitis treated?

You’ll need antibiotics to treat bacterial meningitis. Your healthcare provider may start treatment even before all the test results are in. The provider may prescribe an intravenous antibiotic (delivered through an IV needle) with a corticosteroid to reduce inflammation.

Once the results come in, identifying the specific bacteria, your provider may change antibiotics to most effectively target the disease. You’ll also need to replenish fluids you may have lost from sweating, vomiting, diarrhea and loss of appetite. You may have IV fluids to help.

How is viral meningitis treated?

If you have severe symptoms, your provider may prescribe antiviral medications. If symptoms are not severe, your provider may choose not to treat the disease and let it run its course. Most people who have a mild illness get better within a week to 10 days.

How is chronic meningitis treated?

Chronic meningitis treatment depends on whether you have an infectious type or a noninfectious type.

• Noninfectious meningitis: Your provider may prescribe prednisone.
• Fungal meningitis: You may need antifungal medications.
• Viral meningitis: Symptoms often clear up without treatment.

Prevention

Is there a bacterial meningitis vaccine?

Yes, a vaccine is available for bacterial meningitis. The Centers for Disease Control and Prevention (CDC) has guidelines regarding who should get the vaccine:

• All preteens at 11-12 years old.
• All teenagers at 16 years of age.

Additionally, an extra meningitis vaccine is recommended for:

• First-year college students living in dorms.
• Military recruits.
• Scientists working with the meningococcal bacteria.
• People traveling to or living in areas where the disease is common, such as Africa.
• Those with a damaged spleen or who have had their spleen removed.
• People with terminal complement component deficiency (an immune system disorder).

Who shouldn’t get the bacterial meningitis vaccine?

The CDC doesn’t recommend the vaccine for people who had:

• Severe, life-threatening allergic reaction to a previous dose of the meningococcal vaccine.
• Severe reaction to any part of the vaccine.

Wait before receiving the vaccine or talk further with your provider if you:

• Are moderately or severely ill at the time of your scheduled vaccination appointment. Wait until you recover to receive the vaccine.
• Had Guillain-Barré syndrome.
• Are pregnant. Typically, pregnant people should only get the vaccine if there is a clear need.
• Have any severe allergies.

Is there a viral meningitis vaccine?

There is no vaccine for viral meningitis. The best way to stay healthy is:

• Wash hands often.
• Avoid close contact with people who are sick.
• Stay home if you’re sick, and keep children who are sick out of school.
• Get vaccinated on schedule to protect against diseases that can lead to viral meningitis.

Outlook / Prognosis

What is the outlook for people with bacterial meningitis?

Bacterial meningitis requires prompt treatment. People who receive treatment quickly can make a full recovery. Your healthcare provider will monitor you to help manage any long-term health issues, including problems with:

In rare cases, meningitis leads to a blood infection. Because of the infection, the body reduces blood supply to the extremities — fingers, toes, hands and feet — causing those body parts to die. Providers may need to amputate the damaged extremities.

Can bacterial meningitis be cured?

Most people recover fully from bacterial meningitis if they get prompt diagnosis and treatment. The disease has a high death rate (10%) if untreated.

Is bacterial meningitis fatal?

Typically, symptoms develop quickly, over 24 hours. If the symptoms continue without treatment, bacterial meningitis may be fatal.

Are there complications of bacterial meningitis?

Bacterial meningitis requires prompt medical care. Without it, there’s a risk of permanent damage. It can cause life-threatening blood poisoning called septicemia. Lifelong complications from untreated meningitis include:

• Seizures.
• Mental impairment.
• Paralysis.

What is the outlook for people with viral meningitis?

People with viral meningitis typically recover without any treatment. And viral meningitis usually does not cause long-term complications.

Living With

What should I ask my healthcare provider?

Ask your healthcare provider:

• What type of meningitis do I have?
• What treatment will I need?
• How can I avoid getting meningitis again?
• Will I have any long-term problems from meningitis?
• How can I avoid spreading it to my friends and family?

A note from Cleveland Clinic

If you or a loved one has meningitis symptoms, such as fever and neck stiffness, seek immediate medical care. People who get quick treatment can make a full recovery from meningitis. It’s important to stick to the vaccine schedule for you and your children. The meningitis vaccine (along with other vaccines) reduces your risk of developing this disease. Talk to your healthcare provider about signs of meningitis and how to stay safe.

Symptoms, Causes, Transmission, and Treatment

What Is Meningitis?

Meningitis is a rare infection that affects the delicate membranes — called meninges — that cover the brain and spinal cord. You or your children can catch it.

Types of Meningitis

Bacterial meningitis

It’s an extremely serious illness. You or your child will need to get medical help right away. It can be life-threatening or lead to brain damage unless you get quick treatment.

Several kinds of bacteria can cause bacterial meningitis. The most common ones in the U.S. are:

A bacteria called Haemophilus influenzae type b (Hib) was a common cause of meningitis in babies and young children until the Hib vaccine became available for infants. There are also vaccines for Neisseria meningitidis and Streptococcus pneumoniae. Experts recommend that all children get them, as well as all adults who are at a higher risk for the disease.

In many cases, bacterial meningitis starts when bacteria get into your bloodstream from your sinuses, ears, or throat. The bacteria travel through your bloodstream to your brain.

The bacteria that cause meningitis can spread when people who are infected cough or sneeze. If you or your child has been around someone who has bacterial meningitis, ask your doctor what steps you should take to avoid catching it.

Viral meningitis

Viral meningitis is more common than the bacterial form and generally — but not always — less serious. A number of viruses can trigger the disease, including several that can cause diarrhea.

Fungal meningitis

Fungal meningitis is much less common than the bacterial or viral forms. Healthy people rarely get it. You’re more likely to get this form of meningitis if you have a problem with your immune system, like AIDS.

Parasitic meningitis

Parasitic meningitis is also rare. It’s caused by parasites that usually affect animals. You can get it from eating animals like snails, slugs, snakes, fish, or poultry that are infected by parasites or their eggs, or produce that contains parasite eggs. The risk is higher with raw or undercooked foods. You can’t pass on this type of meningitis to other people.

Amoebic meningitis

Amoebic meningitis is a rare, usually fatal infection by a single-celled bug called Naegleria fowleri. This amoeba lives in soil or warm, fresh water, but not salt water. People typically get it from swimming in water where the amoeba lives, not drinking it. Amoebic meningitis isn’t contagious.

Non-infectious meningitis

Non-infectious meningitis is caused by diseases like lupus or cancer, or if you’ve had a head injury, brain surgery, or take certain medications. It isn’t contagious.

Chronic meningitis

Chronic meningitis has similar symptoms as acute meningitis, but develops over a couple of weeks. It results from infections with a fungus or the mycobacteria that cause tuberculosis. These organisms get into the tissue and fluid surrounding your brain to cause meningitis.

Meningitis Symptoms

Meningitis symptoms can develop within hours or days and may include:

Symptoms of meningitis in infants

In infants, meningitis symptoms may include:

• High fever
• Crying that’s constant and gets louder when you hold the baby
• Baby seems overly sleepy, sluggish, or inactive
• Stiff neck or body
• Bulge on the soft area on the top of the baby’s head
• Poor ability to feed
• Crankiness

Risk Factors for Meningitis

Anyone can get meningitis, but research shows that it’s more common in these age groups:

• Children under 5
• Teenagers and young adults ages 16-25
• Adults over 55

Meningitis is more of a danger for people with certain medical conditions, such as a damaged or missing spleen, long-term disease, or immune system disorders.

Because certain germs that cause meningitis can spread easily, outbreaks are most likely to happen in places where people live close to each other. College students in dorms or military recruits in barracks can be more likely to catch the disease. So are people who travel to areas where meningitis is more common, such as parts of Africa

Causes of Meningitis

Meningitis almost always results from a bacterial or viral infection that begins somewhere else in your body, like your ears, sinuses, or throat.

Less common causes of meningitis include:

• Autoimmune disorders
• Cancer medications
• Syphilis
• Tuberculosis

Meningitis Diagnosis

Your doctor will ask about your medical history and do a physical exam, including checking your neck for stiffness and looking for a skin rash that might suggest a bacterial infection. They will also need to do tests that can include:

• Blood tests to find bacteria
• CT or MRI scans of your head to find swelling or inflammation
• Spinal tap, in which a health care worker uses a needle to take fluid from around your spinal cord. It can tell what’s causing your meningitis.

Treatment for Meningitis

Your treatment will depend on the type of meningitis you have.

Bacterial meningitis needs treatment with antibiotics right away. The doctor might give you a general, or broad-spectrum, antibiotic even before they’ve found the exact bacteria that caused your illness. Once they do, they’ll change to a drug that targets the specific bacteria they find. You might also get corticosteroids to ease inflammation.

Viral meningitis usually goes away on its own without treatment. Your doctor might tell you to stay in bed, drink plenty of fluids, and take over-the-counter pain medicines if you have a fever or aches. If a virus like herpes or influenza caused your illness, you might take antiviral medication.

Antifungal medications can treat fungal meningitis.

Complications of Meningitis

Meningitis can cause severe complications in adults and children, especially if you delay treatment. Possible complications include:

• Seizures
• Brain damage
• Loss of hearing
• Memory problems
• Learning problems
• A hard time walking
• Kidney failure
• Shock
• Death

Prevention of Meningitis

You may be able to prevent meningitis by avoiding infection with the viruses or bacteria that cause it. These infections are passed to others when you cough, sneeze, kiss, or share toothbrushes or eating utensils. Take these steps to prevent infections:

• Wash hands often. Rinse well. Teach your kids to wash their hands often too, especially after eating, using the toilet, or when you’re in public places.
• Don’t share items like toothbrushes, eating utensils, or lipstick.
• Don’t share foods or drinks with other people.
• Cover your mouth and nose when you cough or sneeze.
• Stay healthy. Eat a healthy diet, get plenty of exercise, and rest at night.
• If you’re pregnant, eat food that’s well-cooked. Avoid foods made from unpasteurized milk.
• Get immunized. Follow your doctor’s advice on getting immunization shots for diseases that may cause bacterial meningitis, including flu and pneumonia vaccines.

What is Meningitis?

Meningitis is an infection of the meninges that are membranes that cover the brain and the spinal cord.

What are meninges?

Meninges are 3 connective tissue layers. They consist of the pia mater (closest to the central nervous system organs), the arachnoid and the dura mater (farthest from the brain and spinal cord).

They also include blood vessels and contain cerebrospinal fluid. These are the structures involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Managing Meningitis – Mayo ClinicPlay

What is meningitis?

Meningitis is an infection of the meninges. The infection may be caused by bacteria or a virus, and it leads to the meninges becoming inflamed (swollen). This can cause serious damage to the nerves, brain and the spinal cord.

Symptoms of meningitis

Meningitis is commonly manifested by:

• severe headache
• vomiting
• high fever
• stiffness of the neck
• sensitivity and eye pain on exposure to light
• skin rash

Symptoms can differ in young children and babies.

Types of meningitis

Meningitis may be caused by bacteria and viruses and both types have some distinctive features. Meningococcal disease is the leading infectious cause of death in early childhood.

Bacterial meningitis

Bacterial meningitis is very serious and should be treated as a medical emergency. Left untreated this may lead to severe brain damage and infect the blood causing septicimeia. The most common infecting bacteria are Neisseria meningitidis bacteria.

In 2008 and 2009 in England and Wales saw 1,166 cases of meningitis due to this bacteria. However, with the successful vaccination against this bacteria also known as meningococcal bacteria the number of cases have declined. However, there is currently no vaccine to prevent meningococcal group B disease, which is the most common cause of bacterial meningitis in the UK.

Bacterial meningitis is most common in children who are under five years old and is often life threatening in infants under the age of one. It is also common among teenagers aged 15 to 19 years. Of all the cases around 15% are bacterial meningitis and 25% may manifest with septicaemia. In 60% of cases both may present together.

Viral meningitis

Viral meningitis is the more common but less severe type of meningitis. The number of cases are difficult to estimate since the symptoms are akin to a bout of flu. Viral meningitis is most common in children and is more widespread during the summer months.

Who gets meningitis?

Meningitis may affect people of all age groups. Infants and young children and the elderly are however more at risk. Viral meningitis is the most common cause of the condition. Every year around 2,500 cases of bacterial meningitis, and nearly 5,000 cases of viral meningitis, occur in the UK.

The people most at risk of getting meningitis include:

• those who have CSF shunts placed in their brain for another pathology
• those with defects in the dura
• use of spinal procedures (eg spinal anaesthetics)
• diabetics
• those with bacterial endocarditis
• alcoholism and liver cirrhosis
• intravenous drug abuse
• renal insufficiency
• thalassemia
• cystic fibrosis
• hypoparathyroidism
• splenectomy
• sickle cell disease etc.

Crowding (e.g. schools, day care, military recruits and college students) raises risk of meningitis.

Prognosis or outcome

Viral meningitis usually gets better within a couple of weeks but bacterial meningitis needs aggressive treatment.

Bacterial meningitis needs to be treated with antibiotics, admission to the hospital and even admission to the intensive care units.

Meningococcal disease (the combination of meningitis and septicaemia) causes death in around one in 10 cases. In spite of cure some children may go on to develop complications, such as hearing loss, after having bacterial meningitis. Prevention is by complete vaccinations against the infection.

Further Reading

Brain tumor | barnaclínic +

BRAIN TUMOR SURGERY

In the brain tumor surgery , precise planning is very important in the first place. Barnaclinic + has state-of-the-art technological resources to achieve the greatest possible tumor removal with minimal damage .These resources are as follows: neuronavigation (a system that allows you to localize any brain structure with high accuracy), Intraoperative Magnetic Resonance (is a necessary tool to control at each moment of intervention the amount of tumor remaining for removal and in which zone) and physiological neuromonitoring (this is a resource that allows you to find out which areas of the brain can be removed and which cannot, depending on the importance of functions, such as, mainly, movement and speech).

Surgery is usually performed under general anesthesia. In some cases, when it is necessary to control speech functions during removal of a brain tumor , the patient can be operated while awake under local anesthesia. During surgery, when the patient is conscious and does not feel pain, he takes part during a short period of tumor removal in the area adjacent to the language centers. The rest of the time of surgery, the patient is in deep anesthesia.

On a technical level, Brain tumor surgery consists in opening a hole in the bone in order to get the most direct access to injury, avoiding causing damage. With the help of a surgical microscope and with very precise removal instruments, brain tumor is gradually removed as much as possible, depending on the area and function.

Upon completion of the operation, the various layers are closed (meninges, bone, skin). In some cases, a subcutaneous drain is inserted to prevent subcutaneous bruising.

After surgery, the patient is transferred to the intensive care unit, where he stays for 24 hours. In the absence of complications, the next day he is transferred to a regular ward, where he gradually recovers over 5-6 days.

Examination of the extracted tissues is obtained 7-10 days after the intervention with detailed analysis. Based on this study, a decision is made on the appointment of subsequent treatment.

90,000 Spinal tumors – treatment, symptoms, causes, diagnosis

Spinal tumors are benign or malignant growths of cells in the spinal cord or surrounding tissues.These tumors can put pressure on the spinal cord or its nerve roots. Even benign tumors can lead to permanent disability without treatment. Cancers and tumors of the spine and spinal cord are relatively rare. Pain is the most common symptom of spinal tumors. Since lower back and neck pain is very common, this symptom can be indicative of various medical conditions. Fortunately, tumors are rarely the cause of lower back and neck pain.However, if cancer is detected after a long period of “conservative” treatment for low back pain, most patients begin to feel that the diagnosis was not made on time (at the onset of the disease). Therefore, the problem is to really exclude the tumor cause of the pain at the very beginning of the onset of pain.

Reasons

Tumors of the spine may originate from the spinal cord, within the pia mater covering the spinal cord (intradural), between the pia mater and the bones (extradural) of the spinal column, or they may be localized elsewhere.

Most tumors of the spine are located extradurally. These can be primary tumors originating in the spine, or secondary tumors that result from the spread of cancer (metastasis) from other organs (primarily the lungs, mammary glands, prostate, kidney, or thyroid gland).

Any type of tumor can occur in the spine, including lymphoma, leukemia, multiple myeloma and others. A small percentage of spinal tumors are found within the location of the spinal cord nerves themselves (most often, these are ependymomas and other gliomas).

The cause of primary tumors of the spinal cord and spine is unknown. Some tumors are associated with genetic defects. Tumors of the spine and spinal cord are much less common than brain tumors.

As the tumor grows, the tissues of the spinal cord, the roots of the spinal cord, blood vessels of the spine and bone tissues are involved. Exposure to the tumor causes symptoms similar to other compression syndromes (spinal injuries). In addition, tissue ischemia occurs due to the invasion of tumor cells or due to pressure on the vessels.

Risk factors

Most of us are aware of some of the risk factors that are associated with cancer. Cigarette smoking, unhealthy diet, chemical and radiation exposure, family history of cancer such as breast or ovarian cancer, and hyperinsolation are common risk factors for cancer. These types of cancer generally occur in various organs, metastasize to the spine only after long-term development in the primary focus. The circulatory system is well developed in the spine, and tumor cells can metastasize to the spine from other organs hematogenously (with blood flow).Low back pain is usually not the first symptom of malignant cancer from another part of the body. And therefore, doctors examine the patient for potential primary cancer, but not for the presence of cancer in a patient with low back pain. Regular breast examinations (mammograms), smears (to detect cervical cancer), chest x-rays (to detect lung cancer), fecal occult blood test (to detect bowel cancer).

Types of tumors of the spine

Benign Tumors

The term benign tumor is used to describe tumors with a low probability of spreading (metastasizing) to other organs and tissues.But, nevertheless, benign tumors can also cause big problems, due to the compression of tissues or blood vessels. Fortunately, most benign tumors can be successfully treated.

The following are examples of benign tumors that can occur in the spine or surrounding tissues:

Osteoid osteoma is a benign tumor that has the unique characteristic of developing on the back of the vertebrae during puberty.It develops primarily in the legs and back, and not in the vertebral body. This type of tumor occurs in approximately 10% of all bone tumors of the spine. Usually presents with back pain, especially at night, and the use of aspirin or other NSAIDs (such as ibuprofen) is quite effective. Often, it is poorly visualized on radiography and therefore is preferable to CT. Treatment options include long-term use of NSAIDs or surgery (especially radiofrequency ablation).With surgical treatment, pain quickly disappears and relapse is extremely rare.

Osteoblastoma is a variant of osteoid osteoma larger than 2 cm. It is also characterized by localization in the back of the vertebrae. But the symptoms of osteoblastomas are more pronounced and surgical treatment is usually required. The recurrence rate is significantly higher than that of osteoid osteoma and is up to 10% (and in the same place).

Aneurysmal bone cyst. This is a benign tumor that often occurs in the cervical spine, and can affect the posterior elements of the vertebrae or the vertebral body itself. These tumors are more common in older adolescents and present with pain and, in some cases, other neurological disorders. Therapeutic measures for this type of tumor are excision of the tumor, curettage of the affected area and, if necessary, decompression of the spinal structures.

Giant cell tumors are poorly understood.They tend to be localized in the vertebral body (the anterior side of the spinal column), and although formally “benign”, they can be very aggressive and sometimes spread to other tissues. They can present with pain or symptoms of spinal cord compression. Most often they occur between the ages of 20 and 40, but they are also possible at a different age. Treatment of these tumors is surgical (resection or total removal of abnormal tissue) and surgical treatment is the treatment of choice.In some cases, tumor embolization and preoperative radiation are performed and this improves the results of surgical treatment. They can present with local pain as well as symptoms of spinal cord compression. These tumors require a careful preoperative approach. Incomplete removal of a giant cell tumor can lead to a possible malignant transformation.

Eosinophilic granuloma : benign lesion of bone tissue, characterized by pain and a characteristic picture on radiography “vertebra plana” – flat vertebrae, thinning of the vertebral bodies.It occurs in both children and adults. These tumors can occur both independently and as part of a syndrome with damage to other organs and tissues. The treatment of such tumors is selected individually, and different methods of treatment, both surgical and radiation, are used.

Enchondromas – benign tumors consisting of cartilage. Potentially, when enlarged, these tumors can affect the spinal structures. Surgical treatment is the recommended treatment.Sometimes it is possible to transform these tumors into a poorly differentiated malignant cartilaginous tumor – chondrosarcoma. Fortunately, this rarely happens. But the rapid development of the tumor requires a mandatory biopsy and this helps to prevent the malignancy of a benign tumor into a malignant one.

Malignant Tumors

Physicians use the term malignant to indicate the possible invasion of a tumor into other tissues and organs. Accordingly, the treatment of malignant tumors is much more difficult than the treatment of benign tumors (less prone to invasive growth)

The following are examples of malignant tumors that can occur in the spine and surrounding tissues:

Metastases. Any malignant tumor can metastasize to bone tissue, but it is most likely to spread from the following organs: mammary gland, prostate gland, kidneys, thyroid gland, and lungs. Hematogenous metastasis can occur in two ways through the venous system or through the arterial system. The spine and its surrounding tissues have a good blood supply, with drainage of many structures in the pelvic area through a venous system called Batson’s plexus. Lymphatic channels can also be a pathway for metastasis, but only in a third of cases.Spread or metastasis of tumors from anywhere from the body to the spine is possible after a long period of tumor growth in the primary focus. Metastatic tumors, as a rule, are accompanied by severe pain syndrome. If the metastatic tumor is large enough, then a compression effect on the spinal cord is possible, which can manifest itself as a violation of the conduction of motor functions of the limbs, dysfunctions of the intestines and bladder. As a rule, metastatic cancer is not curable, and the goal of treatment is to reduce pain and decompression of neural structures (by surgical methods) and, thus, preserve the patient’s quality of life as much as possible.Surgery, chemotherapy, and metered-dose radiation therapy can help relieve pain in metastatic spine disease.

Multiple myeloma – the most common type of primary, malignant tumor of bone tissue. Typically, the disease occurs in adults over 40 years of age. The process involves various bone tissues, including the spine. Pain syndrome is most typical for this disease. But sometimes lesions of the spine can proceed up to a certain time without pain.Treatment for this condition is palliative (meaning only symptom relief, not cure). Chemotherapy is used to relieve pain and slow tumor progression. Surgical treatment is used in the presence of fractures or the need for decompression of the spinal structures.

Osteosarcoma – the second, most common, primary malignant tumor of bone tissue. There are two age groups in which this type of tumor develops more often – adolescents, young adults, and the elderly.The defeat of the spine with this tumor is quite rare. Recent advances in neuroimaging, chemotherapy, and surgery for osteosarcoma have significantly improved 5-year patient survival by up to 80 percent. This is a significant medical advance since 20 years ago this tumor was almost always fatal.

Leukemia . Various forms of leukemia can be accompanied by pain in the lower back or neck, which are caused by degeneration of the bone marrow of the vertebrae.But with leukemia, general symptoms such as anemia, fever, general weakness bother the patient much earlier than back pain.

Symptoms

Pain can be a symptom of a tumor of the spine, especially with resistance to treatment and accompanied by other symptoms such as weight loss, fatigue. The pain can be worse at night and does not have to be related to the level of activity. When there are other neurological symptoms (fecal incontinence, urinary dysfunction, radiating pain), then suspicions in favor of the tumor nature of the symptoms increase.In addition, the presence of hematomas, skin changes or other manifestations of the possible presence of a tumor in other parts of the body is important.

Symptoms depend on the location, the type of tumor, and the general health of the person. Metastatic tumors (those that have spread to the spine from other organs) often progress rapidly, while primary tumors often progress slowly over weeks or years.

Intramedullary (within the spinal cord) tumors usually cause symptoms of damage to most of the trunk.Extramedullary (outside the spinal cord) tumors can develop for a long time before causing nerve damage. The following symptoms are most typical for spinal tumors:

Back pain

• Can be in any area, but more often in the middle of the back and lower back
• Worsens lying
• Aggravated by coughing, sneezing, exertion, etc.
• Pain can radiate to the thigh, leg, arms
• Pain can be in all limbs, diffuse.
• Pain may be local to a specific area of ​​the spine.
• Pain tends to progress
• The pain is intense and cannot be relieved by analgesics

Sensitivity disorders

• More at the feet
• Sensory disturbances tend to progress.

Motor disorders (muscle weakness)

• More at the feet
• Gait disorders (difficulty walking)
• Muscle weakness tends to progress.
• Falls while walking or standing
• Feelings of cold feet or hands
• • Fecal incontinence
• • Urinary incontinence
• • Paresis or paralysis of muscles
• Fasciculations (muscle twitching)

Diagnostics

Most tumors of the spinal column are found during routine examinations for neck or lower back pain. The examination begins with a physical examination.In the presence of tumors in other organs, it is necessary to inform the doctor as it is necessary for an adequate examination. X-rays are used to diagnose bone changes in the spine. But the results of radiography are not informative enough. And when there is a need for clearer visualization of both bone tissue and soft tissues, then CT or MRI is prescribed. In addition, if a malignant tumor in the spine is suspected, scintigraphy may be prescribed. Laboratory studies are necessary to clarify the nature of the tumor and possible complications from other organs and systems (especially in malignant tumors).

Treatment

The type of tumor, the degree of damage to the spine, localization are important for the choice of the method of treatment and prognosis. Often, a consultation of surgeons, radiologists and oncologists is held to develop treatment tactics. Modern methods of treatment (surgery, radiation therapy, chemotherapy), if properly prescribed, can significantly improve the prognosis for survival in most cases of spinal tumors and maintain a sufficiently high quality of life.

Prevention and treatment of diseases of teeth and gums in dogs

Did you know that small pets (dogs and cats) suffer from diseases of the oral cavity, including dental diseases, just like humans.The task of the veterinary dentist is, first of all, to help preserve the healthy teeth and gums of our pets, and even when pathologies appear, to heal the patient as efficiently as possible.

In recent years, the range of services rendered in veterinary dentistry in Russia has significantly expanded, but their quality is often still low. Nevertheless, the interest of veterinarians in dentistry in our country is growing, which allows this science to develop rapidly. Until recently, any tooth with signs of inflammation was subject to ruthless removal, and today we have the opportunity in many cases to preserve it by subjecting it to treatment.As in humane dentistry, the treatment process can be carried out in one or in several stages, sometimes taking quite a long period of time.

Veterinary dentistry is a science that studies diseases of the oral cavity of animals, methods of their diagnosis, treatment and prevention. This science is based on knowledge of the anatomical and topographic structure of the oral cavity and the physiological processes occurring in it.

Small and decorative dog breeds (up to 85%) are in the first place in terms of the spread of oral diseases, medium breeds suffer a little less often (up to 70%), and in large breeds, diseases of this group reach 50% of the total number of patients.The most susceptible to dental diseases are the following dog breeds: Toy Terriers, Yorkshire Terriers, Chihuahuas, Cocker Spaniels, Small and Dwarf Poodles, Pekingese, Lapdogs, Dachshunds. Among cats – British, Persian, Cornish Rex, Sphynx.

Unfortunately, many dog ​​and cat owners have no idea that the oral cavity of their pet needs to be looked after. There are also completely curious cases: only at the doctor’s office do people learn that animals generally have a process of changing teeth from milk to permanent ones.

Veterinary dentist visits should begin just as soon as the change of teeth begins. In most cases, this process does not cause any concern and goes unnoticed. But in small and decorative breeds of dogs, false polydontia is common – the non-loss of milk teeth with a fully formed arcade of permanent ones. More often this happens with canines, sometimes with incisors, premolars. Loose baby teeth can cause malocclusion and require timely removal.Multiple teeth also lead to close adhesion of the teeth to each other. There is a delay of food debris between the teeth and, as a result, the formation of dental plaque and tartar, the development of diseases of the gums and the teeth themselves, the risk of fistulas and fistulas in the jaw increases.

Extraction of milk teeth must be carried out in a veterinary clinic and only under general anesthesia. Often, owners, fearing general anesthesia, trust their pets to “specialists” who promise to carry out the manipulation without general anesthesia, at home.As a rule, these people only break off the crowns of milk teeth without removing the roots. After such manipulations, patients go to the surgeon’s table to remove protruding fragments of teeth, with an already developed inflammatory process of the gingival mucosa.

It is important to know that milk teeth, especially canines, have rather long roots and their removal without anesthesia is painful. Therefore, the procedure requires a rigid fixation of the patient. If such a manipulation is performed for a miniature dog, then complications such as dislocations and even fractures of the jaws, limbs, and painful shock are possible.Therefore, the use of short-term general anesthesia for this operation is less dangerous than long-term and painful fixation of the animal.

Owners of middle-aged and older dogs and cats should consult a veterinarian if their pets have bad breath, drooling, difficulty eating, swelling on the face (especially in the infraorbital region), discoloration of the teeth, as well as any injuries. for a thorough dental examination. In some cases (aggressive animals, painful procedures, taking care of the patient’s psyche), even a detailed examination and examination of the patient’s oral cavity can be carried out only with the use of sedatives.

Examination of a patient with an unpleasant odor from the oral cavity usually reveals tartar. It is a dense structure of brown or gray-green color and forms on the enamel of the teeth. Bacteria living in the mouth in the course of their vital activity release mineral, insoluble compounds that settle on the surface of the tooth and, layering on top of each other, form tartar. The factor contributing to the formation of this pathology is, first of all, the breed predisposition, as well as feeding with the use of finely dispersed feed (cereals, crackers, cottage cheese), free (not portioned) food intake.All this leads to chronic clogging of the oral cavity with food particles, which are a substrate for the growth and reproduction of bacteria. In the oral cavity, Ph changes, which in turn leads to a change in the structure of the bacterial flora from conditionally pathogenic to pathogenic. Dental plaque is formed, and then tartar, inflammation can develop in the oral cavity. In advanced cases, the infection can penetrate into deeper tissues and even the bones of the skull, causing osteomyelitis, sepsis.

Distinguish between supragingival (supragingival) and subgingival (subgingival) dental calculus. Being above the gums and in contact with them, the stone causes inflammation of the gums – gingivitis. The supragingival stone is rough to the touch, therefore, touching closely to the mucous membrane of the cheeks, lips and tongue, it causes mechanical injury to these structures of the oral cavity. The animal begins purulent or ulcerative stomatitis, often causing a complete or partial refusal to take the usual food.The subgingival stone is located under the gums, it is not so noticeable, but irritates the gums, supports the growth of bacteria and inflammation in the oral cavity and is one of the main causes of periodontitis, pardontosis, promotes the formation of granulomas, fistulas, and abscesses.

Abundant formation of dental calculus leads to exposure of the necks of the teeth, then loosening, and later – loss of teeth. Some animals have so much stone that it lies in a monolith on several teeth at the same time.In such patients, when removing tartar, the teeth may fall out on their own, since they were held on it like on an orthodontic bridge.

Treatment is aimed at removing tartar and plaque. Removal of non-viable and pathologically mobile teeth is mandatory; if necessary, antibacterial therapy of the oral mucosa is performed.

There are two ways to remove dental calculus: mechanical and ultrasound. When using only the first method, the stone is simply chipped off from the enamel.This process is very traumatic for the gums and teeth of patients. Complete removal of calculus with this manipulation cannot be achieved, and its reappearance occurs rather quickly.

Complete and detailed removal of tartar can be achieved only with the use of special dental equipment and only under general anesthesia (without anesthesia, reliable fixation of the animal is impossible, which can cause injury). An ultrasound apparatus (scaler) injures the enamel of teeth and gums less, and removes the subgingival calculus more thoroughly.But even when working with a scaler, serious injuries can be caused to the patient’s teeth if the technique of working with the device is incorrect, if the specialist does not have sufficient knowledge. Many doctors mistakenly believe that it is enough just to buy a scaler, and you can remove tartar correctly and painlessly. However, this is not so: it is important to know how to choose the right attachment, at what angle and which side to apply it to the enamel, to know the exposure and the degree of force exerted by the scaler on the tooth. In some cases, such tartar removal can do more harm than good.Thoughtless, inept use of this device can lead to the development of complications in the animal such as acute pulpitis (often with the development of pain), mechanical trauma to the enamel (cracks, chips), subsequently leading to the development of caries.

The final stage is to polish the teeth with special attachments using dental pastes. stone forms more slowly on a ground tooth. Resurfacing teeth also requires certain skills and knowledge from the dentist.

Small pets are much less common than humans, but caries still occurs.Caries is a violation of the mineralization of tooth enamel caused by the activity of bacteria in the oral cavity. Contrary to popular belief, carious teeth (unfortunately not all) can and should be treated. With this pathology, a seal is installed, with deep caries – with depulpation. The sooner caries is detected in an animal, the higher the chance to save the tooth. Therefore, it is important to visit a veterinary dentist once a year, even if there are no complaints.

In cats, especially over 5 years old, there is odontoclastic resorptive tooth damage (ARDI) – a disease in which uncontrolled resorption (destruction) of the crowns and roots of the teeth occurs, resulting in the total loss of the tooth.In this case, the tooth does not fall out, but the coronal part breaks off, leaving the root or its fragments in the jaw. The causes of this disease are unknown, but there is research confirming that cats affected by ARVD experience severe pain. There is no conservative treatment, it is important to timely and correctly remove the tooth with resorption areas.

In young dogs, especially those picked up on the street or taken from a shelter, systemic hypoplasia (underdevelopment) of tooth tissues (most often enamel) occurs.The disease occurs when metabolic processes in the rudiments of teeth are disturbed under the influence of a violation of mineral and protein metabolism in the body (in the prenatal and neonatal period). Hypoplasia of milk teeth, which are formed during the prenatal period, is caused by disorders in the mother’s body during pregnancy (viral infections, severe poisoning, etc.). Hypoplasia of permanent teeth develops under the influence of various diseases (rickets, tetany, acute infectious diseases, gastrointestinal diseases, toxic dyspepsia, alimentary dystrophy, brain disorders) that arose during the formation and mineralization of these teeth, that is, in the period from 2 weeks to 6 months.The severity of hypoplasia depends on the severity of the disease. A weak degree of underdevelopment of the enamel manifests itself in the form of spots more often white, less often yellowish, with clear boundaries and the same size. A more severe form of enamel hypoplasia is its underdevelopment, which manifests itself in different ways (wavy, dotted, furrowed enamel). Depressions or grooves are found on the surface of the enamel. The most rare form of hypoplasia is its absence (aplasia) in a certain area.Dentin and dental pulp are often affected.

Systemic hypoplasia is an incurable disease, but you can stop the progression of the disease leading to the complete loss of teeth. For this, the restoration of crowns using light-cured fillings, glass ionomer cement, deep fluoridation of the teeth is carried out.

Periodontitis – inflammation of the periodontal tissues. Periodontium is a complex of tissues surrounding the tooth and having close genetic, morphological, functional connections. It includes the gum, bone tissue of the alveoli, periodontium, root cement.Periodontitis is characterized by progressive destruction of the periodontium and bone. If the integrity of the gingival joint is violated, a pathological periodontal pocket is formed, if it extends beyond the gums, a periodontal pocket is formed. All this can lead to the development of fistula abscesses in the oral cavity, tooth loss. The development of this disease is facilitated by the presence of tartar in an animal. The treatment of periodontitis is competent sanitation of the oral cavity – removal of non-viable teeth, removal of dental plaque, opening of abscesses, cleaning and curettage of periodontal pockets, antibacterial therapy is required.

Pulpitis is quite common in dogs – inflammation of the pulp (the living part of the tooth, where the vessels and nerves are located). This disease is characterized by a change in the color of the enamel. Pulpitis treatment – pulpotomy (partial removal of the pulp) or pulpectomy (complete removal of the pulp) with subsequent filling of the cavity of the crown and the canal of the tooth.

In older animals, oral neoplasms are common, and the percentage of malignancy in cats is significantly higher than in dogs. Often, the clinical signs of a periodontal abscess and neoplasms of the oral or nasal cavity are similar, so it is important to make a correct diagnosis; for this purpose, a histological examination of a biopsy material is used.

In large dogs, sometimes in cats, there are fractures (chips) of the crowns of the teeth. Such teeth can often be saved from removal with timely access to the dentist. In this case, filling of the tooth canals is performed.

It should be noted that after sanitation of the oral cavity, active prevention of dental diseases is required, which includes several points:
1. Regular (1-2 times a week, for some animals – every day) cleaning of the pet’s teeth using special brushes and pastes to remove soft plaque.Massage the gums.
2. Refusal from fine-dispersed feed in favor of coarse-dispersed feed.
3. Accustoming the animal to the use of specially processed industrial hard treats (bones from veins, pig ears, special sticks for small breeds, etc.) in moderation.
4. Elimination of sweet and fatty foods from the diet of animals.
5. Regular visits to the veterinary dentist.

And the most important thing: it is necessary from childhood to teach a young animal to domestic daily dental care.The owner should be able to freely explore the oral cavity of his pet and carry out all the necessary manipulations with it. The learning process is gradual. First, just lift the lips of the animal. The next step is to teach him to calmly endure touching the gums. Then you can wrap a bandage or a soft cloth on your finger and brush your teeth, and then – with a special brush and paste. Home care should be part of a comprehensive program. The main goal of care is to remove plaque before it turns into stone.

There is a veterinary dentist in our clinic. We offer services in the following areas of dentistry:

• periodontology, i.e. treatment of periodontitis, gingivitis (in this case, the removal of calculus is carried out using an ultrasonic scaler, followed by polishing of the enamel of the teeth),
• splinting of teeth of the incisor group in dogs
• surgery – removal of persistent (not fallen out) milk teeth, removal of permanent teeth of any degree of complexity (incl.including removal of dystopic teeth, tooth fragments, teeth with ORPD)
• endodontics is the treatment of teeth with caries, pulpitis, fractures (chips) of teeth with the installation of light polymerization fillings, including root canal filling with depulpation
• Treatment of systemic enamel hypoplasia – restoration of crowns using light-cured fillings, glass ionomer cement, deep fluoridation of teeth
• Dental X-ray – The clinic has a Kodak dental X-ray machine.Radiography is performed during endodontic treatment of teeth, in cases with ORPZ, with complex tooth extractions, severe periodontal disease, it is possible to determine the reason for the absence of teeth (adontia) in pedigree dogs.

There is a veterinary dentist at our clinic.

We offer services in the following areas of dentistry:

• aradontology, i.e. treatment of periodontitis, gingivitis (in this case, the removal of calculus is carried out using an ultrasonic scaler, followed by grinding of the enamel of the teeth), splinting of the teeth of the incisor group in dogs
• surgery – removal of persistent (not fallen out) milk teeth, removal of permanent teeth of any degree of complexity (incl.including removal of dystopic teeth, tooth fragments, teeth with ORPD)
• endodontics is the treatment of teeth with caries, pulpitis, fractures (chips) of teeth with the installation of light polymerization fillings, including root canal filling with depulpation
• therapy – treatment of systemic enamel hypoplasia, restoration of crowns using light polymerization fillings, glass ionomer cement, deep fluoridation of teeth.
• orthodontics – bite correction (according to medical indications),
• orthopedics – prosthetics and implantation.
• Dental X-ray – The clinic has a Kodak dental X-ray machine. Radiography is performed during endodontic treatment of teeth, in cases with ORPZ, with complex tooth extractions, severe periodontal disease, it is possible to determine the reason for the absence of teeth (adontia) in pedigree dogs.

Dura and sense of smell …

The olfactory nerve (I) is not a truly peripheral nerve.

It is a fibrous tract that enters the inferior surface of the frontal lobe.Paired olfactory nerves are formed from sensory receptors located on the nasal mucosa (mucous membranes) of the upper nasal cavities. There are about 20 fibers without a myelin layer on each side, which extend from these sensory receptors through narrow openings in the ethmoid plate
up to the olfactory bulb of the brain.

When the smell (consisting of the smallest chemical particles, molecules or ions) reaches the fornix of the nasal cavity, the sensitive receptors of the nasal mucosa translate the chemical action into nerve impulses.In order for sensitive receptors to respond to odor, the chemicals must be dissolved in the liquid secreted by the mucous membranes.

Without particles entering the mucous fluid, the receptors are not activated.
A common cause of loss of smell (called olfactory desensitization
) is dry nose. You may have noticed a loss in your sense of smell when you are in dry climates or when taking medications that dry out your nasal mucous membranes.Of course, the nose must also be open so that odor particles can enter the upper nasal cavities. When you have a bad cold with rhinitis (runny nose) and the turbinates are swollen, access to the olfactory sensory areas is limited and the sense of smell is also diminished.

The hard sheath must be flexible, otherwise it can cause mechanical deformation and abnormal tension of the olfactory nerve bundles. The sense of smell can be compromised.

The hard shell is attached to the ethmoid and frontal bones. Therefore,
mechanical interference with the free movement of either of the two bones
can lead to abnormal tension of the hard shell and to secondary problems in the area of ​​smell.

An injury to the nose that causes excessive stress on the hard membranes,
may also be related to the sense of smell. Although the dura merges into the
periosteum of the nasal bones, it can be easily seen that post-traumatic
misalignment of these bones can cause abnormal tension in the dura.

It should also take into account the effect of dysfunction of the vomer, ethmoid bone,
frontal and sphenoid bones in case of impaired sense of smell. The cells of the olfactory receptor
are located on the superior concha and on the superior septum of the ethmoid bone. The bundles of the olfactory nerve should pass without interference through the narrow openings in the sieve plate of the ethmoid bone.

The sphenoid bone controls the vomer to a large extent. The vomer has
extensive articulation with the ethmoid bone laterally and in front of its articulation with the sphenoid bone.The opener-to-wedge articulation presents the tongue shape and furrow-shaped construction, which is well suited for this purpose, but becomes overly vulnerable to pinching under pressure.

Since the sphenoid bone is powerfully controlled by the fluid sacral system
to which it is directly connected, the movement of this bone is rarely limited to such an extent as to impair olfactory function. The ethmoid bone has almost no mechanically significant or direct connections with the fluid aspect of the cranio-sacral system, except through the anterior attachment of the sickle-shaped part of the brain to the sieve plate.Ethmoid dysfunction caused by the sphenoid bone is common, but less common than secondary dysfunctions due to restriction of the function of the frontal bone or vomer.

So, between the olfactory (sensory) receptors of the nose and the entry of
olfactory fibers into the brain substance, we can expect
possible problems in various areas:

• Interference in the nasal passages

• Abnormally dry or wet nasal passages

• Abnormal tension of the rigid sheath affecting the fibers of the olfactory nerve

• Bone dysfunctions directly affecting the olfactory fibers or creating an abnormally increased tension of the hard shell

The olfactory nerve may serve as an entryway for infections of the brain and meningeal membranes.The patient may not be aware of the loss of smell. Instead, in connection with the disappearance of his sense of smell, he may complain of a violation of taste sensations, since the perception of smells is very important for the formation of the taste of food (there is a connection between the olfactory system and the Latin nucleus tractus solitarii).

Olfactory hallucinations are observed in some psychoses. They can be an aura of an epileptic seizure, which is caused by the presence of a pathological focus in the temporal lobe.

Inside the brain matter, the olfactory system is extensively connected to the
limbic system, which makes up about 20% of the total brain volume. In the light of the connections of the olfactory-limbic system, it is not surprising that perfumery is so well developed. It is very possible that certain scents evoke romantic or sentimental feelings in us.

Research methodology

The state of smell is characterized by the ability to perceive odors of varying intensity by each half of the nose separately and to identify (recognize) different smells.With calm breathing and closed eyes, the wing of the nose is pressed with a finger on one side and the odorous substance gradually approaches the other nostril. Better to use familiar non-irritating scents (volatile oils): laundry soap, rose water (or cologne), bitter almond water (or valerian drops), camphor. The use of irritating substances such as ammonia or vinegar should be avoided, as this simultaneously causes irritation of the endings of the trigeminal nerve (lat.n.trigeminus). It is noted whether odors are correctly identified. In this case, it is necessary to keep in mind whether the nasal passages are free or there are catarrhal phenomena from them. Although the subject may not be able to name the test substance, the very knowledge of the presence of odor precludes anosmia.

Bing Robert Compendium of topical diagnostics of the brain and spinal cord. A brief guide for the clinical localization of diseases and lesions of the nerve centers Translation from the second edition – P.P. Soikina – 1912

Gusev E. I., Konovalov A. N., Burd G. S. Neurology and neurosurgery: Textbook. – M .: Medicine, 2000

Craniosacral Therapy II – John E. Upledger – (pp. 1-20).

Duus P. Topical diagnosis in neurology Anatomy. Physiology. Clinic – M. IPC “Vazar-Ferro”, 1995

90,000 Swelling during pregnancy | Nutriclub

What you need to know about edema: why it appears, how to deal with it, how to distinguish normal physiological edema from a symptom of a serious illness

It is believed that edema inevitably accompanies the pregnancy of most women – you just need to endure their unaesthetic appearance.However, swelling can be a signal of health problems and pose a danger to both the expectant mother and the development of the fetus. Nutriclub knows when to worry if you develop swelling.

• Edema – excessive accumulation of fluid in the interstitial space – occurs in pregnant women quite often. Swelling can occur at any time and on different parts of the body.
• Swelling on the face (especially bags under the eyes and severe swelling of the eyelids) are especially noticeable and cause maximum discontent, because they directly affect the appearance.
• It is very common for pregnant women to have swelling of the legs, especially after a long walk. That is why it is so important to get comfortable shoes for the entire period of pregnancy.
• Hands tend to be swollen in women who work at the computer or do handicrafts. They begin to crush the rings, the fingers look like “sausages”. In such cases, you need to temporarily abandon jewelry.
• Edema of the nasal mucosa is often mistaken by pregnant women for a runny nose or allergies. The latter is more likely because allergic reactions during pregnancy are exacerbated.Also, pregnant women, due to changes in hormonal levels, can develop a condition called rhinitis of pregnancy, which is accompanied by severe nasal congestion. It is better to get tested and be sure to discuss the situation with a doctor who will prescribe a drug that is allowed during pregnancy. It is not recommended to ignore nasal congestion – breathing problems in the mother can make it difficult for the baby to get oxygen.

All these edema can be both physiological and pathological.

Physiological edema

Physiological usually do not cause complications.They are explained by natural changes in the body of the expectant mother: the uterus presses on neighboring organs, slowing down blood circulation, and sodium accumulates in the blood – it slows down the excretion of fluid from the body. Moreover, during pregnancy, the total amount of fluid circulating throughout the body almost doubles (some of it is contained in the amniotic fluid and the placenta).

At the same time, the woman’s hormonal background changes, which may be the reason for the legendary cravings “for salty”, which, in turn, provokes thirst and excessive fluid intake.

Summer heat or stuffiness in transport and premises, physical overload also affects health and appearance.

Physiological edema is considered natural at any stage of pregnancy – and does not pose a threat to a woman’s health.

But at the first signs of puffiness, you definitely need to contact your obstetrician-gynecologist. The doctor will prescribe the necessary examinations and tests to exclude pathological edema, indicating health problems and complications of pregnancy.

Pathological edema

Pathological edema in the early stages can signal hypothyroidism – a condition in which there is a lack of thyroid hormones in the body. Doctors try to identify the disease before swelling appears – pregnant women with a deficiency or excess body weight, with severe toxicosis, are prescribed a blood test for thyroid hormones. If the results do not correspond to the norm, treatment is prescribed.

Also, starting in the first trimester, edema may appear due to kidney problems.It is very important to have a urine test every two weeks, as recommended in the antenatal clinic. Erythrocytes, high leukocytes, protein, which should not be in the urine – a reason for referral to a urologist and ultrasound of the kidneys. It is important to exclude an infection in the kidneys, and if it is diagnosed, to treat it qualitatively. Otherwise, it is possible premature obstructed labor or the birth of a baby with low weight.

Starting from the 20th week, edema may indicate varicose veins. Impaired circulation due to pressure from the uterus leads to the formation of “knots” and pain in the legs.If you suspect varicose veins, you will be referred to a phlebologist who will give the necessary recommendations.

Edema also accompanies heart failure, which is considered a serious complication of pregnancy. In this case, the appearance of edema is preceded by shortness of breath and cyanosis of the mucous membranes.

However, most often pathological edema indicates late toxicosis – gestosis. This is a problem in the third trimester of pregnancy, but the first signs may begin to appear between the 18th and 20th weeks.Gestosis almost always requires the help of a doctor and the presence of a pregnant woman in the hospital.

What is preeclampsia and how is it dangerous?

However, preeclampsia, in addition to edema, has other symptoms: high blood pressure, protein in the sea (normally absent), nausea, vomiting, headaches, convulsions, fever, drowsiness, or, conversely, severe agitation.

There are four degrees of gestosis. The first degree is known as dropsy of pregnancy, mainly expressed in edema.The second degree is edema, protein in the urine, pressure disorder. The third degree of preeclampsia is called preeclampsia. It is characterized by a decrease in cerebral circulation and even hemorrhage. In the most severe, fourth stage of the disease, convulsions (eclampsia) are observed. A pregnant woman may have a stroke or placental abruption.

Thus, even if everyone around you says that the swelling is completely natural, and they do not cause discomfort to the pregnant woman herself, it is very important to inform the doctor about the first appearance of swelling – precisely in order to make sure that the swelling is physiological, not pathological, and there are no complications for the development of the fetus and the process of childbirth will not entail.

When you need to see a doctor immediately

The following problems can be considered a reason for an urgent visit to a doctor:

• edema is visible in the morning, immediately after getting up;
• edema is accompanied by increased pressure;
• the swelling becomes very severe: it is impossible to clench the hand into a fist, the shoes are painful and uncomfortable to wear, it is difficult to open the eyes due to swelling;
• dyspnea, palpitations occur regularly;
• headaches last for several days;
• nausea and vomiting occur regularly after 12 weeks;
• desires for small need are rare and are accompanied by the release of dark urine;
• there are pains in the upper abdomen;
• painful convulsions appear;

How to deal with edema?

If, according to the results of examination and analyzes, it is established that the edema is physiological, you can get rid of them (or at least reduce) using the following methods.

• Eliminate fried, smoked, spicy, pickled and sweet foods from the diet. Steam or bake, eat fruits and vegetables regularly.
• The use of salt should be limited – it contains sodium, it is he who retains fluid in the body.
• Many people advise limiting water intake, even in broth form. In fact, it threatens dehydration. It is better to drink plain water in small sips – and consume most of the daily allowance of one and a half to two liters in the morning.Soda should be avoided.
• It is contraindicated to stay in the heat or in stuffy rooms for a long time.
• On the recommendation of a doctor, you can wear special compression underwear, while giving up tight tights, uncomfortable shoes and heels.
• It is necessary to sleep at least 8-10 hours. It is also recommended to lie down for 15-20 minutes every day with the legs raised up, to do a foot massage and foot baths with sea salt.

Violation of the requirements of Art.20 of the Code of Criminal Procedure of the RSFSR, expressed in the failure to take measures to establish a mechanism for inflicting bodily harm that caused the death of the victim, led to the cancellation of the sentence (Extract) – Supreme Court of the Russian Federation

             1. Violation by the court of the requirements of Art. 20 CPC
               RSFSR, expressed in the failure to take measures
            to the establishment of a mechanism for applying bodily
               injuries causing death
              the victim, resulted in the cancellation of the sentence

                       (Conclusion)


     Moskovskiy District CourtTver February 7, 1996 Suslov
convicted under Part 2 of Art. 108 of the Criminal Code of the RSFSR.
     He was found guilty of intentionally inflicting grave crimes against Shafranova.
bodily harm resulting in the death of the victim.
     The crime, as established by the court, was committed with the following
circumstances.
     August 30, 1993 after 7 pm in the apartment of Khlundina Suslov
and Shafranov drank alcohol. During a quarrel, Suslov inflicted
Saffron multiple punches to the head and body than
caused bruises on her neck related to light bodily
injuries, fractures of three ribs without damage to the lungs and
parietal pleura, related to less severe bodily
injuries, and a closed craniocerebral injury, life-threatening
at the time of infliction and relating to grievous bodily harm,
resulting in the death of the victim.Judicial Collegium for Criminal Cases of the Tver Regional Court
She changed the sentence against Suslov and reduced his sentence.
     Deputy Chairman of the Supreme Court of the Russian Federation in protest

raised the issue of canceling court decisions and referring the case to
major new trial
Art. 20 of the Code of Criminal Procedure of the RSFSR.
     Presidium of the Tver Regional Court July 18, 1997 protest
satisfied on the following grounds.In accordance with the requirements of Art. 20 of the Code of Criminal Procedure of the RSFSR, the court must
take all measures prescribed by law for a comprehensive, complete
and an objective study of the circumstances of the case, to identify how
incriminating and acquitting the accused, as well as mitigating and
circumstances aggravating his responsibility.
     These requirements of the law have not been fulfilled by the court.
     At the hearing, Suslov did not admit his guilt for the crime and
explained that on August 30, 1993was in Khlundina's apartment,
where did his acquaintance Shafranova (with whom he had
cohabited) and asked him to go out to talk. Since she
grabbed his sleeve, he pushed her away with great force, as a result
why she hit the back of her head on the corner of the refrigerator, which stood on
kitchen. Then Shafranova and Khlundina, leaving the kitchen, quarreled. He
I heard screams and, entering the room, began to separate them. During this
quarrels Shafranova said that she was cheating on him.He lost control of
himself and hit her hard on the cheek with his palm, Shafranova fell and
hit the back of her head on the floor, after which she went into hysterics. She
rolling on the floor and banging my head. Suslov left, and when he returned,
saw her sitting in a chair and crying. He carried her to the bed
Shafranova at the same time asked him for forgiveness. No bodily
he did not notice the injuries on her face and body, there was only blood under
nose. Then he went to bed next to Shafranova, and waking up at night,
saw that her neck and face were swollen and bruised.They
Zvonarev took her to the hospital, where she died 12 days later.
     As proof of Suslov's guilt in deliberately inflicting
the victim of grievous bodily harm resulting in her death, the court

referred to the acts of forensic medical examinations carried out in the case,
testimony of witnesses Khlundina and Zakharova.
     However, examination of this evidence shows that the judicial
the proceedings were superficial, one-sided and
incomplete.Many circumstances that are significant for
correct resolution of the case, were not examined by the court and therefore did not
have received proper marks.
     The four forensic reports pending
an expert on the nature and severity of bodily injury and their
localization, there are significant contradictions that influenced
the validity of the sentence.
     From the expert's conclusion of October 18, 1993, it follows that when
the study of Shafranova's corpse revealed the following
damage: hemorrhage under the membranes and into the substance of the head
brain, bruising in both periorbital areas and on
scalp, occipital hemorrhage,
fractures of 7-10 ribs on the right, bruises on the neck.All specified
damage caused by a blunt solid object
(items) shortly before Shafranova's admission to the hospital.
Hemorrhage in the soft tissues of the occipital region of the head, under
membranes and into the substance of the brain could occur during a fall
Saffronova from a standing position and hitting the back of the head with a blunt hard
item. Shafranova's death came from a closed craniocerebral
trauma with hemorrhage under the membranes and into the substance of the brain.The expert's opinion of October 26, 1993 states: taking into account
multiplicity and localization of injuries, all injuries
Shafranova could not have occurred when falling from a standing position and
hitting furniture and floors.
     According to additional forensic medical examination from 1
September 1995 to determine from the impact in which area of ​​the head

hemorrhage formed under the membranes and into the substance of the head
the brain from which Shafranova's death occurred does not appear
possible.Therefore, Shafranova's head injury could
occur both when struck with a blunt object on the head, and in
as a result of her fall from a standing position and upon impact with the back of the head about
dull solid object.
     From the additional conclusion of the forensic medical expert
it follows that it is not possible to concretize the subject
or objects from which a head injury was formed in
Shafranova, since from the moment the victim was admitted to the hospital
12 days passed before her death and the moment of examination of her corpse and in
the medical history does not describe the shape, size of the
bruising and hematomas of soft tissues.All four reports were given by the same forensic
expert. However, as can be seen from the findings in the case
expert, they contain directly opposite conclusions about the possibility
causing bodily harm that Shafranova had.
     Thus, contained in these conclusions
conflicting judgments do not give reason to come to a certain
the conclusion that there is a causal relationship between Suslov's strikes
Shafranova and the onset of her death.With such data, the inconsistency of which excludes
the opportunity to give a certain legal assessment of the deed
Suslov, the verdict cannot be considered justified.
     The court should be in accordance with the requirements of Art. 20 of the Code of Criminal Procedure of the RSFSR
comprehensively and fully investigate the established in the case
evidence, give them an assessment.
     As there are several conflicting findings in the case
forensic expert and during the judicial investigation the court did not
managed to establish the reasons for the contradictions, with a new judicial
the proceedings should appoint a more competent,

qualified commission forensic medical examination,
putting to its solution the question of the mechanism of causing bodily
injuries found on the victim Shafranova, which caused her
death.Taking into account the data obtained in the case, the court should decide the issue of
the correctness of the legal assessment of Suslov's actions.
     The verdict was canceled, the case was sent to a new court
consideration.


                           ____________
 

Induction of Experimental Autoimmune Hypophysitis in SJL Mice

Experimental Protocol

Once the pituitary gland is ready (see accompanying article), it is injected subcutaneously into SJL mice (Jackson Laboratories, stock 000 686).The second identical injection is repeated after 7 days. The mice are then used to collect in vivo and posthumous results.

Step 1. Subcutaneous injection of pituitary immunogen into SJL mice

Mice are first anesthetized by injecting 0.5 ml 20 mg / ml 2,2,2-Tribromoethanol (Avertin, TCI America, T-1420) intraperitoneally. The mice were then injected subcutaneously with 100 μl of the pituitary emulsion, which, as indicated in the Jupiter satellite article 2181, contains 1 mg of the pituitary gland extract and 0.25 mg of Freund’s complete adjuvant.Emulsions are injected into the left dorsal posterior region of the leg ((50 μl) and the right groin (50 μl). Pituitary emulsions are injected again on day 7 at the opposite sites (50 μl in the right dorsal hind leg and 50 μl region in the left groin). The mice are monitored on a daily basis for the first 3 days and then once a week until the day of the victim, which is usually 28 days after the first immunization

Step 2. Collection of in vivo results: Blood tests

Tissue most often used to evaluate the results of experimental mice while still alive in the blood.Blood is usually drawn 14 days after the first immunization to measure serum levels of pituitary antibodies or other markers like cytokines and chemokines.

Blood is collected from live mice as follows. The mice pass securely through the collar and the back of the jaw is located. Once the posterior part of the jaw is located, 4 mm lancets are used to pierce the submandibular vascular bundle. After the blood is collected, pressure on the area using an alcohol swab to avoid bruising.The blood collection is centrifuged at 2000 g for 20 minutes, and stored at -80 ° C until use.

Step 3. Compilation of posthumous results: pituitary gland histopathology

Mice are usually donated 28 days after the first immunization. The cardinal function to be diagnosed with EAH is penetration of the pituitary gland by hematopoietic monocytes.

Mice are euthanized by placing them in a sealed plastic chamber that is illuminated with CO _2. Mice are kept in the chamber for a total of 8 minutes.After euthanasia, the pituitary gland is harvested as described in the companion’s article. Sick pituitary gland appears swollen and more firmly adherent to the surrounding meninges. Sharp forceps are used to loosen the meninges surrounding the pituitary gland. After the pituitary gland moves freely on the sphenoid bone, one end of the pituitary gland is grabbed with forceps and the pituitary gland is carefully removed. The glands are placed in a tube containing microcentrifuge fixative ⁵ Beckstead’s. The pituitary gland is fixed at night, wrapped in a paper lens, and placed in a cassette.The glands are then processed using the following protocols:

After processing, the pituitary gland is embedded in paraffin and at least 5 inconsistent sections (5 μm) are excised from each gland.