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181. Head Injury (Diagnosis)

. . Bhatt M, Desai J, Mankodi A, Elias M, Wadia N. Posttraumatic akinetic-rigid syndrome resembling Parkinson's disease: a report on three patients. Mov Disord . 2000 Mar. 15(2):313-7. . Karli DC, Burke DT, Kim HJ, Calvanio R, Fitzpatrick M, Temple D. Effects of dopaminergic combination therapy for frontal lobe dysfunction in traumatic brain injury rehabilitation. Brain Inj . 1999 Jan. 13(1):63-8. . Nahas Z, Arlinghaus KA, Kotrla KJ, et al. Rapid response of emotional incontinence to selective serotonin (...) : David A Olson, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA Share Email Print Feedback Close Sections Sections Head Injury Overview Practice Essentials Head injury can be defined as any alteration in mental or physical functioning related to a blow to the head (see the image below). According to the Centers for Disease Control and Prevention (CDC), more than 50,000 individuals die from traumatic brain injuries each year in the United States. Almost twice that many people suffer permanent

2014 eMedicine.com

182. Osteoarthritis (Diagnosis)

: Carlos J Lozada, MD; Chief Editor: Herbert S Diamond, MD Share Email Print Feedback Close Sections Sections Osteoarthritis Overview Practice Essentials Osteoarthritis (see the image below) is the most common type of joint disease, affecting more than 30 million individuals in the United States alone. [ ] It is the leading cause of chronic disability in older adults, costing the US greater than $185 billion annually. [ ] It can be thought of as a degenerative disorder arising from the biochemical (...) accessed without imaging Bone scanning - May be helpful in the early diagnosis of osteoarthritis of the hand [ ] ; bone scans also can help differentiate osteoarthritis from osteomyelitis, bone metastases, and metabolic bone diseases Arthrocentesis The presence of noninflammatory joint fluid helps distinguish osteoarthritis from other causes of joint pain. Other synovial fluid findings that aid in the differentiation of osteoarthritis from other conditions are negative Gram stains and cultures, as well

2014 eMedicine.com

183. Hypoglycemia (Diagnosis)

these conditions. Several cases of nesidioblastosis were reported recently after gastric bypass surgery. Drugs Ethanol (including propranolol plus ethanol), haloperidol, pentamidine, quinine, salicylates, and sulfonamides ("sulfa drugs") have been associated with hypoglycemia. Other drugs that may be related to this condition include oral hypoglycemics, phenylbutazone, insulin, bishydroxycoumarin, p-aminobenzoic acid, propoxyphene, stanozolol, hypoglycin, carbamate insecticide, disopyramide, isoniazid (...) in overweight and obese people who are insulin-resistant May be a frequent precursor to type 2 diabetes Possible higher risk in patients with a family history of type 2 diabetes or insulin-resistance syndrome True loss of consciousness is highly suggestive of an etiology other than reactive hypoglycemia. Gestational hypoglycemia may have the following features [ ] : More frequent in women younger than 25 years More frequent in women with a preexisting medical condition Less frequent in women whose

2014 eMedicine.com

184. Viral Infections of the Mouth (Overview)

that is clinically similar to that of HHV-1 infection. HHV-3, also known as varicella-zoster virus (VZV), causes the primary infection chickenpox and the secondary reactivation disease herpes zoster. HHV-4, also known as Epstein-Barr virus (EBV), causes the primary infection , and it is implicated in various diseases, such as , other immunoproliferative disorders, and nasopharyngeal carcinoma. HHV-4 causes oral hairy leukoplakia in patients who are immunosuppressed. [ ] HHV-5, also known as cytomegalovirus (CMV (...) ), causes a primary infection of the salivary glands and other tissues, and it is believed to have a chronic form. HHV-6, which can produce acute infection in CD4 + T lymphocytes, causes , a febrile illness that affects young children. It is believed to chronically persist in salivary gland tissue in some hosts, and oral shedding is the probable route of disease transmission. Although it has been linked to apical periodontitis in some studies, the evidence so far is mixed, so such an association remains

2014 eMedicine.com

185. Chickenpox (Overview)

and immunocompromised populations. Previous Next: Patient Education Parents of infected children should be instructed to trim their children’s fingernails to minimize skin damage from scratching and the associated complications of bacterial superinfection. Also, it is important to advise parents not to use aspirin for fever control, because the development of Reye syndrome is associated with salicylate administration in children with chickenpox. For patient education resources, see the . Also, see the patient (...) by reactivation of VZV after primary infection. VZV is a double-stranded deoxyribonucleic acid virus included in the Alphaherpesvirinae subfamily. (See .) Vesicular eruption on the trunk demonstrating papules, vesicles, and crusts. Reprinted with permission from Cutis 65: 355, 2000. See , a Critical Images slideshow, to help stay current with the latest routine and catch-up immunization schedules for 16 vaccine-preventable diseases. Also, see the slideshow for help identifying and treating various rashes. Go

2014 eMedicine.com

186. Hypoglycemia (Overview)

these conditions. Several cases of nesidioblastosis were reported recently after gastric bypass surgery. Drugs Ethanol (including propranolol plus ethanol), haloperidol, pentamidine, quinine, salicylates, and sulfonamides ("sulfa drugs") have been associated with hypoglycemia. Other drugs that may be related to this condition include oral hypoglycemics, phenylbutazone, insulin, bishydroxycoumarin, p-aminobenzoic acid, propoxyphene, stanozolol, hypoglycin, carbamate insecticide, disopyramide, isoniazid (...) in overweight and obese people who are insulin-resistant May be a frequent precursor to type 2 diabetes Possible higher risk in patients with a family history of type 2 diabetes or insulin-resistance syndrome True loss of consciousness is highly suggestive of an etiology other than reactive hypoglycemia. Gestational hypoglycemia may have the following features [ ] : More frequent in women younger than 25 years More frequent in women with a preexisting medical condition Less frequent in women whose

2014 eMedicine.com

187. CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy) (Overview)

autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common form of hereditary cerebral angiopathy (see image below). As the name implies, it is dominantly inherited. The condition was first described more than 30 years ago in a Swedish family [ ] , although the acronym CADASIL did not emerge until the early 1990s [ ] . Clinically, CADASIL is associated with progressive dementia, mood disorders, migraine, and recurrent subcortical cerebral infarctions (...) , Ducros A, Vahedi K, Chabriat H, Mouton P, et al. Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia. Nature . 1996 Oct 24. 383(6602):707-10. . Peters N, Freilinger T, Opherk C, Pfefferkorn T, Dichgans M. Effects of short term atorvastatin treatment on cerebral hemodynamics in CADASIL. J Neurol Sci . 2007 Sep 15. 260(1-2):100-5. . Meschia JF, Brott TG, Brown RD Jr. Genetics of cerebrovascular disorders. Mayo Clin Proc . 2005 Jan. 80(1):122-32. . Dichgans M

2014 eMedicine.com

188. Head Injury (Treatment)

enhances recovery in short-term memory and sustained attention after traumatic brain injury. Arch Phys Med Rehabil . 2004 Jul. 85(7):1050-5. . Khateb A, Ammann J, Annoni JM, Diserens K. Cognition-enhancing effects of donepezil in traumatic brain injury. Eur Neurol . 2005. 54(1):39-45. . Bhatt M, Desai J, Mankodi A, Elias M, Wadia N. Posttraumatic akinetic-rigid syndrome resembling Parkinson's disease: a report on three patients. Mov Disord . 2000 Mar. 15(2):313-7. . Karli DC, Burke DT, Kim HJ, Calvanio (...) intubated in the hospital setting. In this study, however, more critically ill patients required in-field intubation. [ ] Following stabilization, direct attention to prevention of secondary injury. Keep mean arterial pressures above 90 mm Hg; arterial saturations should be greater than 90%. Urgent CT scanning is a priority. Next, focus attention on reducing intracranial pressure, since elevated intracranial pressure is an independent predictor of poor outcome. If the intracranial pressure rises above

2014 eMedicine.com

189. Dengue (Treatment)

and supportive care, fatalities are rare. Convalescence is slow. Aspirin and NSAIDs are discouraged owing to potential platelet dysfunction causing bleeding. Children who receive aspirin are at risk of developing Reyes syndrome; therefore, they should never receive aspirin when Dengue fever is suspected. The mortality rate of DSS is reported to be 2%. Exposure to a serotype besides the 4 mentioned can lead to DHF or DSS, which have serious complications and may be fatal. DSS can occur after DHF (...) Manifestations of Dengue Find Us On About Membership WebMD Network Editions All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC. This website also contains material copyrighted by 3rd parties. Close encoded search term (Dermatologic Manifestations of Dengue) and Dermatologic Manifestations of Dengue What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Dermatologists

2014 eMedicine.com

190. Dengue Fever (Treatment)

. Acetaminophen may be used to treat fever and relieve other symptoms. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided. Management of severe dengue requires careful attention to fluid management and proactive treatment of hemorrhage. Single-dose methylprednisolone showed no mortality benefit in the treatment of dengue shock syndrome in a prospective, randomized, double-blind, placebo-controlled trial. [ ] The Novartis Institute for Tropical Diseases (NITD (...) syndrome may be discharged from the hospital when they meet the following criteria: Afebrile for 24 hours without antipyretics Good appetite, clinically improved condition Adequate urine output Stable hematocrit level At least 48 hours since recovery from shock No respiratory distress Platelet count greater than 50,000 cells/μL Pregnant patients Dengue in pregnancy must be carefully differentiated from preeclampsia. An overlap of signs and symptoms, including thrombocytopenia, capillary leak, impaired

2014 eMedicine.com

191. Drug-Induced Hepatotoxicity (Treatment)

. Differential diagnoses are as follows: Acute viral hepatitis Autoimmune hepatitis Nonalcoholic steatohepatitis (NASH) Shock liver/cardiovascular causes, especially right-sided heart failure Cholecystitis Cholangitis Budd-Chiari syndrome Alcoholic liver disease Cholestatic liver disease Pregnancy-related conditions of liver Malignancy Wilson disease Hemochromatosis Coagulation disorders Previous Next: Workup Laboratory studies Performing laboratory tests to assess and diagnose the effects of the suspected (...) and trends in conjunction with the patient's clinical condition. Valproic acid and divalproex sodium Microvesicular steatosis is observed with alcohol, aspirin, valproic acid, amiodarone, piroxicam, stavudine, didanosine, nevirapine, and high doses of tetracycline. Prolonged therapy with methotrexate, INH, ticrynafen, perhexiline, enalapril, and valproic acid may lead to cirrhosis. Valproic acid typically causes microsteatosis. This drug should not be administered to patients with hepatic disease

2014 eMedicine.com

192. Gastritis, Chronic (Treatment)

eradication regimens that include amoxicillin, bismuth, and metronidazole. The adverse effects of the various regimens are similar in children and adults. Bismuth toxicity is not a concern in children receiving H pylori therapy, but salicylate toxicity from the use of bismuth subsalicylate is. Inform parents of the presence of subsalicylate. Ideally, children younger than 16 years should not receive salicylate-containing compounds, because of the risk of Reye syndrome. Previous Next: Long-Term Monitoring (...) Salary Employment What would you like to print? What would you like to print? Sections Chronic Gastritis Find Us On About Membership WebMD Network Editions All material on this website is protected by copyright, Copyright © 1994-2019 by WebMD LLC. This website also contains material copyrighted by 3rd parties. Close encoded search term (Chronic Gastritis) and Chronic Gastritis What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most

2014 eMedicine.com

193. CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy) (Treatment)

disease. Acta Neuropathol . 1977 Aug 31. 39(3):247-54. . Tournier-Lasserve E, Joutel A, Melki J, Weissenbach J, Lathrop GM, Chabriat H, et al. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy maps to chromosome 19q12. Nat Genet . 1993 Mar. 3(3):256-9. . Joutel A, Corpechot C, Ducros A, Vahedi K, Chabriat H, Mouton P, et al. Notch3 mutations in CADASIL, a hereditary adult-onset condition causing stroke and dementia. Nature . 1996 Oct 24. 383(6602):707-10 (...) (CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy)) and CADASIL (Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy) What to Read Next on Medscape Related Conditions and Diseases Medscape Consult News & Perspective Tools Slideshow Most Popular Articles According to Neurologists Recommended 2002 1916852-overview Diseases & Conditions Diseases & Conditions 2002 417524-overview Diseases & Conditions Diseases

2014 eMedicine.com

194. Osteoarthritis (Treatment)

JK, Sokoloff L. Collagen of human articular and costal cartilage. Arthritis Rheum . 1969 Feb. 12(1):21-9. . Phadke K. Regulation of metabolism of the chondrocytes in articular cartilage--an hypothesis. J Rheumatol . 1983 Dec. 10(6):852-60. . Resnick D, Niwayama G. Degenerative disease of extraspinal locations. Resnick D, ed. Diagnosis of Bone and Joint Disorders . 3rd ed. 1995. 1263-1371. Poole AR. An introduction to the pathophysiology of osteoarthritis. Front Biosci . 1999 Oct 15. 4:D662-70 (...) are intermittent, then try full doses if the patient’s response is insufficient. Topical NSAID preparations, particularly diclofenac, are available. These preparations can be particularly useful in patients with symptomatic disease that is limited to a few sites or in patients who are at increased risk for adverse events with systemic NSAIDs. In patients with highly resistant pain, consider the analgesic tramadol. However, in an observational study of more than 88,000 patients, an initial prescription

2014 eMedicine.com

195. Rhinoviruses (Treatment)

appropriate handwashing, avoidance of finger-to-eyes or finger-to-nose contact, and use of nasal tissue. One study suggested that hand cleansers with salicylic acid and pyroglutamic acid prevent the transmission of rhinovirus and reduce the number of patients who become clinically infected. [ ] When a child has a viral illness, aspirin administration should be avoided to prevent Reye syndrome (though this is rare). Previous References Busse WW, Gern JE, Dick EC. The role of respiratory viruses in asthma (...) was high among the trials included in the review, the findings were consistent with those reported in another systematic review of 17 trials involving 2121 participants. [ ] Overlap of included studies was noted and methodological limitations have been raised against the two reviews. Still, in an illness that is considered a high-burden disease (with children experiencing 6-12 colds a year and adults having 2-4 episodes annually, accounting for 40% of time lost from work), [ , ] "even an only partially

2014 eMedicine.com

196. Viral Infections of the Mouth (Treatment)

that is clinically similar to that of HHV-1 infection. HHV-3, also known as varicella-zoster virus (VZV), causes the primary infection chickenpox and the secondary reactivation disease herpes zoster. HHV-4, also known as Epstein-Barr virus (EBV), causes the primary infection , and it is implicated in various diseases, such as , other immunoproliferative disorders, and nasopharyngeal carcinoma. HHV-4 causes oral hairy leukoplakia in patients who are immunosuppressed. [ ] HHV-5, also known as cytomegalovirus (CMV (...) ), causes a primary infection of the salivary glands and other tissues, and it is believed to have a chronic form. HHV-6, which can produce acute infection in CD4 + T lymphocytes, causes , a febrile illness that affects young children. It is believed to chronically persist in salivary gland tissue in some hosts, and oral shedding is the probable route of disease transmission. Although it has been linked to apical periodontitis in some studies, the evidence so far is mixed, so such an association remains

2014 eMedicine.com

197. Pityrosporum Folliculitis (Treatment)

, Barranco JC, Clotet B, Lorenzo JC. Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome. Int J Dermatol . 1992 Mar. 31(3):193-5. . Hald M, Arendrup MC, Svejgaard EL, Lindskov R, Foged EK, Saunte DM. Evidence-based Danish Guidelines for the Treatment of Malassezia-related Skin Diseases. Acta Derm Venereol . 2014 Feb 20. . Prohic A, Jovovic Sadikovic T, Krupalija-Fazlic M, Kuskunovic-Vlahovljak S. Malassezia species in healthy skin and in dermatological conditions. Int J (...) continued after successful initial treatment with oral medication. Other topicals that are used to treat Pityrosporum folliculitis are ciclopirox olamine cream, econazole cream, alcohol and salicylic acid solution (with or without benzoic acid 5%), propylene glycol 50% in water, and selenium sulfide shampoo. [ ] Other topical treatments with some reported success include tea tree oil, honey, tacrolimus, and cinnamic acid. [ ] In cases associated with antibiotic use, discontinuing the antibiotic may

2014 eMedicine.com

198. Pharyngitis, Viral (Treatment)

. [ ] Analgesics and antipyretics may be used for relief of pain or pyrexia. Acetaminophen is the drug of choice. Traditionally, aspirin has been used, but it may increase viral shedding. Aspirin should not be used in children or adolescents, especially with influenza, because of its association with Reye syndrome. One study proved that ibuprofen was superior to acetaminophen for symptomatic relief in children aged 6-12 years. A double-blind randomized study involving adult patients from 27 study centers (...) for influenza complications because of age or underlying medical conditions. Persons at higher risk for influenza complications recommended for antiviral treatment include the following: [ ] Children aged 2 years or younger Adults aged 65 years or older Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension alone), renal, hepatic, hematological (including sickle cell disease), metabolic (including diabetes mellitus), or neurologic and neurodevelopment conditions (including

2014 eMedicine.com

199. Upper Respiratory Tract Infection (Treatment)

to reduce discomfort due to cough. Avoid aspirin in children with viral illness because aspirin is associated with Reye syndrome. Inhaled cromolyn sodium is used for control of chronic asthma. Data are insufficient to permit evidence-based recommendations regarding the use of inhaled cromolyn sodium to treat URI-related cough in patients without asthma. Fever and discomfort relief Fever may be physiologically helpful in eliminating pathogens from the body. In some individuals, however, fever poses (...) a risk of provoking underlying illness. In a fragile cardiac patient, for example, increased metabolic demands associated with fever may increase the work of the heart. In children with a history of febrile seizures, avoiding high fevers may reduce the risk of seizure. Acetaminophen, rather than aspirin, is recommended for the relief of fever, sore throat, myalgias, facial pain, and other uncomfortable sensations in pediatric patients because aspirin is associated with Reye syndrome. Avoid the use

2014 eMedicine.com

200. Pneumonia, Viral (Overview)

in otherwise healthy children but does occur in immunocompromised children. Complications include secondary bacterial infections, encephalitis, hepatitis, and, with concomitant aspirin use, Reye syndrome. VZV pneumonia also tends be more severe in individuals who smoke. Measles virus virus is a member of the Paramyxoviridae family and the genus Morbillivirus . It is a single-stranded RNA virus contained within a nucleocapsid and surrounded by an envelope. Measles is a respiratory tract virus that causes (...) during outbreaks of hantavirus pulmonary syndrome, no cases of maternal fatalities secondary to this disorder have been reported to date. Sex differences in viral pneumonia Men who are infected develop viral pneumonia at a slightly higher rate than women. Pregnant women with viral pneumonia have a higher risk for severe disease than other females. Pregnant patients have a disproportionate risk of severe disease with 2009 H1N1 infection. Treatment should be initiated as soon as the diagnosis

2014 eMedicine.com

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