FitSugar

What's the Deal With: Pins and Needles

FitSugar — Wed, 22 Aug 2007 09:30:00 -0700

Occasionally I'll wake up from a deep sleep and realize my arm has also fallen asleep. When it "wakes up," I do everything I can to keep still and control the almost unbearable sensation of "pins and needles."

There's actually a medical term for this called Transient Paresthesia. Usually, you feel this temporary yet bizarre sensation after you've been putting pressure on part of your body, like when you're sitting on a foot or sleeping on your arm. When you apply this pressure for a prolonged period of time, you actually cut off communication from your brain to parts of your body. This pressure squeezes nerve pathways so that the nerves can't transmit electrochemical impulses properly.

Nerve impulses carry sensation information from nerve endings in the body to the brain, as well as instructions from the brain to the rest of your body. The information transmitted from the "sleeping" body part becomes somewhat jumbled, and the brain receives strange messages. Some nerve cells don't transmit any information and others start sending impulses erratically. This causes you to feel a strange numbing, burning, prickly, or tingling sensation, which actually serves an important function. Your foot falling asleep for 10 minutes doesn't pose any health threat, but if you were to cut off circulation for an extended period of time -- several hours -- you could suffer serious nerve damage. The initial tingling sensation tells you that you might want to readjust your position.

Just thought you might want to know...

Source

Fibromyalgia

FitSugar — Wed, 08 Oct 2008 17:35:11 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Fibromyalgia is a chronic condition characterized by pain in the muscles, ligaments, and tendons; fatigue; and multiple tender points on the body. While no one knows what causes it, there is evidence that people with fibromyalgia may be more sensitive to pain because something is wrong with the body's usual pain perception processes. More women than men have fibromyalgia. Fibromyalgia, while different for everyone who has it, tends to come and go throughout life. Although it can be debilitating for some people, it is not degenerative or life threatening, and you can manage your symptoms and improve your quality of life with professional and self care.

Signs and Symptoms

Widespread pain and stiffness
Fatigue or trouble sleeping
Paresthesia (tingling)
Irritable bowel syndrome
Skin sensitivity
Heightened sensitivity to noises, bright lights, smells
Depression
Headaches
Pain after exertion
Memory lapses or difficulty concentrating
Restless legs syndrome
Dizziness
Anxiety

It is not uncommon for people with fibromyalgia to have other conditions, including temporomandibular joint disorder and bladder problems.

What Causes It?

No one knows what causes fibromyalgia, although there are several theories, and multiple factors may bring on the condition.

Changes in brain chemicals -- Some people with fibromyalgia have abnormal levels of brain chemicals called neurotransmitters. Specifically, they have low levels of serotonin, which affects mood, promotes sleep, and helps reduce the perception of pain. They often have high levels of substance P, which transmits the "pain message" to the brain.
Disregulation of the autonomic nervous system -- The autonomic nervous system releases hormones that affect how you react to stress. Some doctors think people with fibromyalgia release these hormones differently when they experience stress, and the hormones affect the perception of pain.
Sleep problems -- The majority of people with fibromyalgia report sleep problems, and especially have trouble with stage 4 sleep, the most restful stage in which the body repairs itself. Some doctors believe that the lack of restful sleep means that the muscles of people with fibromyalgia are not able to repair the tiny tears and trauma that occur everyday, leading to muscle pain and fatigue. Other doctors believe that sleep problems are a result, not a cause, of fibromyalgia.
Injury and infection -- Fibromyalgia can be triggered by an injury, especially to the upper spine or neck, or an infection caused by a virus or bacteria.
Genetics -- The tendency to get fibromyalgia may sometimes be inherited.
Having another rheumatic disease -- You may be more likely to get fibromyalgia if you have a disease such as rheumatoid arthritis or lupus.

What to Expect at Your Provider's Office

There is no laboratory test for fibromyalgia, but your doctor may order several tests, including blood tests and x-rays to rule out other diseases. Your doctor may also press firmly on specific "tender points" on your head and body to see which ones are abnormally sensitive under pressure. Be sure to tell your health care provider about all of your symptoms. You may be referred to a rheumatologist, who specializes in treating rheumatic conditions like fibromyalgia and arthritis.

Treatment Options

The goal is to help you function as well as possible on a day-to-day basis. While it is probably not possible to completely relieve all your symptoms, medication and certain complementary and alternative therapies may help reduce symptoms.

Drug Therapies

Your health care provider may prescribe the following drugs:

Sleep disturbances are often treated successfully with low doses of tricyclic antidepressants, such as amitriptyline (Elavil), doxepin (Sinequan), and nortriptyline (Pamelor, Aventyl). Sometimes doctors may prescribe sleeping pills for short-term use.
Analgesics treat pain. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen sodium (Aleve), ibuprofen (Advil, Motrin), or prescription NSAIDs. Sometimes these drugs may lessen pain, but they are not effective for everyone. Your doctor may also prescribe tramadol (Ultram), which is often used to treat fibromyalgia pain.
Muscle relaxants, such as cyclobenazaprine (Flexeril), can help treat muscle spasms.
A technique called "spray and stretch" is sometimes used. A prescription spray coolant is applied to painful a muscle while the muscle is stretched.
Pain in specific spots in muscles can be treated with lidocaine or procaine (injected into points where pain is greatest), or with capsaicin (used topically).
Ibuprofen may also help briefly reduce muscle pain.
Depression can be treated with antidepressants, such as fluoxetine (Prozac) and sertraline (Zoloft).
Armour Thyroid, a natural thyroid hormone medication, may be helpful if tests show abnormal thyroid function. People with fibromyalgia may want to have their tests examined by both conventional and holistically oriented physicians because levels of thyroid hormone in the blood are often interpreted differently. Specifically, people with fibromyalgia may want to ask for an assessment of T3 levels, a lab test often not done by conventional doctors.

Complementary and Alternative Therapies

Nutritional support, exercise, herbs, and mind-body techniques may help reduce symptoms.

Nutrition and Supplements

These nutritional tips may help reduce symptoms:

Eliminate potential food allergens, including dairy, wheat (gluten), corn, soy, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as kale, spinach, and bell pepper).
Avoid refined foods, such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid alcohol, tobacco, and caffeine, and limit foods that are high in sugar, salt, and fat. Avoid foods with additives such as monosodium glutamate (MSG).
Drink six to eight glasses of filtered water daily.

You can address nutritional deficiencies with the following supplements:

Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoons of oil daily, to help decrease inflammation and improve immunity. Talk to your health care provider before taking omega-3 supplements if you are taking blood thinning medications, such as aspirin or warfarin (Coumadin).
A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.
Vitamin C, 500 - 1,000 mg daily, as an antioxidant and for immune support.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
L-carnitine, 500 - 2,000 mg daily, for muscular support.
Magnesium, 200 mg three times daily, with malic acid 1,200 mg three times daily, for symptoms of fibromyalgia.
S-adenosylmethionine or SAMe, 800 mg daily, for mental and immune support.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. Some acidophilus products may need refrigeration -- check labels carefully.
Calcium/vitamin D supplement, 1 - 2 tablets daily, for support of muscle and skeletal weakness.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
Chlorella (Chlorella pyrenoidosa), a blue-green algae, may help lessen symptoms. Participants in a clinical study took a specific dose of 10 g of Sun chlorella tablets and 100 ml of the liquid chlorella extract Wasaka Gold and showed significant improvement in symptoms. More studies are needed.
NADH (nicotinamide adenine dinucleotide), 5 - 20 mg daily, for energy.
Melatonin, 0.5 - 3 mg, one time daily before bed, for sleep and immune support. Talk to your doctor first if you are using any anti-depressants or other neurological or psychiatric medications.

Exercise

It may seem odd to suggest exercising when your muscles are sore and you are in pain, but a number of studies have shown that regular, low-intensity exercise is one of the most effective treatments for fibromyalgia. Although you may experience a slight increase in pain and soreness when you start, as you continue you will help lessen muscle tension and stiffness, improve sleep quality, and raise serotonin and endorphin levels, helping to reduce pain. Many people with fibromyalgia find warm-water aquatic exercises to be helpful. Talk to your doctor or physical therapist to design an exercise program that is best for you.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. of herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day. You may use tinctures alone or in combination as noted.

Herbal therapies aim to reduce the symptoms of fibromyalgia, or those of common conditions associated with fibromyalgia.

Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation, immune, and antifungal activity.
Bromelain (Ananus comosus) standardized extract, 40 mg three times daily, for pain and inflammation.
Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for imflammation.
Rhodiola (Rhodiola rosea) standardized extract, 100 - 600 mg daily, for antioxidant, antistress, and immune activity.
Capsicum or capsaicin (Zostrix), as a cream containing .025% capsaicin, applied topically (on the skin) one to three times daily.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Some of the homeopathic remedies used for fibromyalgia are below.

Arnica, for someone who feels sore and bruised, and does not want to be touched. Laying down is difficult, and the patient is restless when trying to find a comfortable position. Soreness stays after gentle exercise.
Bryonia, used when the slightest movement aggravates pain. The person is usually very thirsty. Pain is worse at night and upon waking in the morning.
Calcarea carbonica, for people who tend to move slowly, look pasty, and are always chilly. Exertion leaves them weak and breathless. They feel better when lying down. Being warm relieves symptoms.
Rhus toxicodendron, for joint stiffness, worse when starting to move, then easing with more movement. Stiffness is worse in the morning and in cold or damp weather.
Ruta graveolens, for sore, bruised pain in the joints and tendons that feel worse when lying on the affected area.

Mind-Body Therapies

Stress makes symptoms of fibromyalgia worse, so mind-body therapies including meditation and biofeedback can be helpful in learning relaxation techniques.

Physical Medicine

Two to four cups of Epsom salts in a warm bath can soothe aching muscles.

Acupuncture

The National Institutes of Health recommends acupuncture as a treatment for fibromyalgia. Acupuncturists treat people with fibromyalgia based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In fibromyalgia, a qi deficiency is usually detected in the spleen or kidney meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is used to strengthen the entire energy system. Qualified practitioners may also advise people with fibromyalgia on lifestyle and diet, and provide recommendations on the use of herbal medicines.

Chiropractic

Because fibromyalgia generally includes low back pain or neck pain (for which spinal manipulation is beneficial), chiropractors commonly treat people who have this condition. In one small study, women with fibromyalgia reported that they experienced a 77% reduction in pain intensity, 63% improvement in sleep quality, and 75% improvement in fatigue level after receiving 30 chiropractic treatments. Symptom relief continued for 1 month after treatment ended.

Massage

Massage may reduce stress, improve circulation, and soothe sore muscles. Find a massage therapist who has experience working with fibromyalgia.

Following Up

Education and support groups may help you manage your condition.

Supporting Research

Bartecchi CE. Fibromyalgia and complementary and alternative medicine. Mayo Clin Proc. 2005;80(6):826; author reply 826-7.

Chakrabarty S, Zoorob R. Fibromyalgia. Am Fam Physician. 2007;76(2):247-54.

McBeth J, Jones K. Epidemiology of chronic musculoskeletal pain. Best Pract Res ClinRheumatol. 2007;21(3):403-25.

Müller W, Schneider EM, Stratz T. The classification of fibromyalgia syndrome. Rheumatol Int. 2007;27(11):1005-10.

Reiter RJ, Acuna-Castroviejo D, Tan DX. Melatonin therapy in fibromyalgia. Curr Pain Headache Rep. 2007;11(5):339-42.

Staud R. Treatment of fibromyalgia and its symptoms. Expert Opin Pharmacother. 2007;8(11):1629-42.

Review Date:
2/12/2008
Reviewed By:
Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2010 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Aging changes in the bones - muscles - joints

admin — Thu, 04 Sep 2008 19:18:38 -0700

Overview

Alternative Names
Information

Illustrations

Osteoarthritis

Osteoporosis

Flexibility exercise

The structure of a joint

HEALTH GUIDE REFERENCE FROM A.D.A.M

Alternative Names

Osteoporosis and aging; Muscle weakness associated with aging

Information

Changes in posture and gait are as universally associated with aging as changes in the skin and hair.

The skeleton provides support and structure to the body. Joints are the areas where bones come together. They allow the skeleton to be flexible for movement. In a joint, bones do not directly contact each other. Instead, they are cushioned by cartilage, membranes, and fluid.

Muscles provide the force and strength to move the body. Coordination, although directed by the brain, is affected by changes in the muscles and joints. Changes in the posture and gait, weakness, and slowed movement are caused by changes in the muscles, joints, and bones.

AGING CHANGES

Bone mass or density is lost as people age, especially in women after menopause. The bones lose calcium and other minerals.

The spine is made up of bones called vertebrae. Between each bone is a gel-like cushion (intervertebral disk). The trunk becomes shorter as the disks gradually lose fluid and become thinner.

In addition, vertebrae lose some of their mineral content, making each bone thinner. The spinal column becomes curved and compressed (packed together). Bone spurs, caused by aging and overall use of the spine, may also form on the vertebrae.

The shoulder blades (scapulae) and other bones may become porous - on an x-ray they may look "moth-eaten." The foot arches become less pronounced, contributing to slight loss of height.

The long bones of the arms and legs, although more brittle because of mineral losses, do not change length. This makes the arms and legs look longer when compared to the shortened trunk.

The joints become stiffer and less flexible. Fluid in the joints may decrease, and the cartilage may begin to rub together and erode. Minerals may deposit in some joints (calcification). This is common in the shoulder.

Hip and knee joints may begin to lose structure (degenerative changes). The finger joints lose cartilage and the bones thicken slightly. Finger joint changes are more common in women and may be hereditary.

Some joints, such as the ankle, typically experience little change with aging.

Lean body mass decreases, caused in part by loss of muscle tissue (atrophy). The rate and extent of muscle changes seems to be genetically determined. Muscle changes often begin in the 20s in men and the 40s in women.

Lipofuscin (an age-related pigment) and fat are deposited in muscle tissue. The muscle fibers shrink. Muscle tissue is replaced more slowly, and lost muscle tissue may be replaced with a tough fibrous tissue. This is most noticeable in the hands, which may appear thin and bony.

Muscle tissue changes, combined with normal aging changes in the nervous system, cause muscles to have reduced tone and contractility. Muscles may become rigid with age and may lose tone even if exercised regularly.

EFFECT OF CHANGES

Bones become more brittle and may break more easily. Height decreases, primarily caused by shortening of the trunk and spine.

Inflammation, pain, stiffness and deformity may result from breakdown of the joint structures. Almost all elderly people are affected by joint changes, ranging from minor stiffness to severe arthritis.

The posture may become progressively stooped (bent) and the knees and hips more flexed. The neck may become tilted, and the shoulders may narrow while the pelvis, on the other hand, may become wider.

Movement slows and may become limited. The walking pattern (gait) becomes slower and shorter. Walking may become unsteady, and there is less arm swinging. Fatigue occurs more readily, and overall energy may be reduced.

Strength and endurance change. Loss of muscle mass reduces strength. However, endurance may be enhanced by changes in the muscle fibers. Aging athletes with healthy hearts and lungs may find that performance improves in events that require endurance, and decreases slightly in events that require short bursts of high-speed performance.

COMMON PROBLEMS

Osteoporosis is a common problem, especially for older women. Broken bones occur more readily, and compression fractures of the vertebrae can cause pain and reduce mobility.

Muscle weakness contributes to fatigue, weakness, and reduced activity tolerance. Joint problems are extremely common. This may be anything from mild stiffness to debilitating arthritis (see osteoarthritis).

Injury risk is greater because of falls related to gait changes, instability, and loss of balance.

Some elderly people have reduced reflexes. This is most often caused by changes in the muscles and tendons rather than changes in the nerves. Decreased knee jerk or ankle jerk is not unexpected.

Some changes, such as a positive Babinski's reflex, are always considered abnormal.

Involuntary movements (muscle tremors and fine movements called fasciculations) are more common in the elderly. Inactive or immobile elderly people may experience weakness or abnormal sensations (paresthesias).

Muscle contractures may occur in those unable to move voluntarily or to have their muscles stretched through exercise. Restless leg syndrome may occur.

PREVENTION

Exercise is one of the best ways to slow or prevent problems with the muscles, joints, and bones. A moderate exercise program can help you maintain strength and flexibility. Exercise helps the bones to remain strong.

Consult with your health care provider before beginning a new exercise program.

A well-balanced diet with adequate amounts of calcium is important. Women need to be especially careful to get enough calcium as they age. Postmenopausal women need 1,200-1,500 mg of calcium per day. If you have osteoporosis, talk to your doctor about prescription treatments.

Numbness and tingling

admin — Thu, 04 Sep 2008 19:07:16 -0700

Overview

Definition
Alternative Names
Common Causes
Home Care
Call your health care provider if
What to expect at your health care provider's office
References

Illustrations

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Numbness and tingling are abnormal sensations that can occur anywhere in your body, but are often felt in your hands, feet, arms, or legs.

Alternative Names

Sensory loss; Paresthesias; Tingling and numbness; Loss of sensation

Common Causes

There are many possible causes:

Remaining in the same seated or standing position for a long time
Injury to a nerve -- for example, a neck injury may cause you to feel numbness anywhere along your arm or hand, while a low back injury can cause numbness or tingling down the back of your leg
Pressure on the spinal nerves such as that due to a herniated disk
Lack of blood supply to an area -- for example, plaque buildup from atherosclerosis in the legs can cause pain, numbness, and tingling while walking (this is called vascular claudication)
Other medical conditions, including:
- Carpal tunnel syndrome
- Diabetes
- Migraines
- Multiple sclerosis
- Seizures
- Stroke
- Transient ischemic attack (TIA)
- Underactive thyroid
Abnormal levels of calcium, potassium, or sodium in your body
A lack of vitamin B12 or other vitamin
Certain medications
Toxic action on nerves, such as that from lead, alcohol, or tobacco
Radiation therapy

Home Care

The underlying cause of numbness or tingling should be identified and then treated by your doctor. Treatment of the underlying condition may reverse the symptoms or prevent them from becoming worse. For example, if you have carpal tunnel syndrome or low back pain, certain exercises may be recommended.

If you have diabetes, your doctor will discuss ways to control your blood sugars.

Medications that cause numbness or tingling may need to be switched or adjusted. DO NOT make any changes to your medications without instructions from your doctor.

Low levels of vitamins will be treated with vitamin supplements.

Because of the decrease in feeling, a numb hand or foot from any cause may be more prone to accidental injury. Take care to protect the area from cuts, bumps, bruises, burns, or other injury.

Call your health care provider if

Go to a hospital or call 911 if:

Weakness or paralysis occurs with numbness or tingling
Numbness or tingling occur just after a head, neck, or back injury
You cannot control the movement of an arm or a leg or you have lost bladder or bowel control
You are confused or have lost consciousness, even briefly
You have slurred speech, change in vision, difficulty walking, or weakness

Call your doctor if:

Numbness or tingling has no obvious cause (like a hand or foot "falling asleep").
You have pain in your neck, forearm, or fingers.
You are urinating more often
Numbness or tingling is in your legs and worsens when you walk
You have a rash
You have dizziness, muscle spasm, or other unusual symptoms

What to expect at your health care provider's office

Your health care provider will take a medical history and perform a physical examination, with careful evaluation of your nervous system.

Medical history questions may include the following:

What part or parts of your body have numbness or tingling? The trunk? Your legs or feet? Your arms and hands?
Which side of your body is involved?
Which aspect of the specific body part? For example, is your inner thigh, calf, or foot affected? Your palm, fingers, thumb, wrist, or forearm?
Does the numbness or tingling affect your face? Around your eyes? Your cheeks? Around your mouth? Is one or both sides of your face involved?
Do you have other abnormal sensations?
Do you ignore everything on the affected side?
How long have you had the numbness or tingling?
When did it start?
Does anything make it worse like exercise or standing for long periods of time?
Do you have any other symptoms?

Your doctor may also ask you questions to determine your risk for stroke, thyroid disease, or diabetes, as well as questions about your work habits and medications.

Tests that may be done include:

Blood tests such as CBC, electrolytes, thyroid function tests, and vitamin levels
Imaging studies like a CT scan of the head, CT scan of the spine, MRI of the head, or MRI of the spine
Electromyography and nerve conduction studies to measure how your muscles respond to nerve stimulation
X-ray of the affected area
Lumbar puncture to rule out central nervous system disorders
Ultrasound of neck vessels to determine your risk for TIA or stroke

References

Viera AJ. Management of carpal tunnel syndrome. Am Fam Physician. 2003; 68(2): 265-272.

Smeal WL, Tyburski M, Alleva J, Prather H, Hunt D. Conservative management of low back pain, part I. Discogenic/radicular pain. Dis Mon. 2004; 50(12): 636-669.

Review Date: 5/22/2007

Reviewed By: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_003206

Focal neurological deficits

admin — Thu, 04 Sep 2008 19:07:03 -0700

Overview

Definition
Alternative Names
Considerations
Common Causes
Home Care
Call your health care provider if
What to expect at your health care provider's office

Illustrations

Brain

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

A focal neurologic deficit is a problem in nerve function that affects:

A specific location -- such as the left face, right face, left arm, right arm, left leg, right leg, even just a small area such as just the tongue
A specific function -- for example, speech may be affected, but not the ability to write

The problem occurs in the brain or nervous system. It may result in a loss of movement or sensation. The type, location, and severity of the change can indicate the area of the brain or nervous system that is affected.

In contrast, a non-focal problem is NOT specific -- such as a general loss of consciousness.

Alternative Names

Neurological deficits - focal

Considerations

Focal neurologic changes can include any function. Sensation changes include paresthesia (abnormal sensations), numbness, or decreases in sensation. Movement changes include paralysis, weakness, loss of muscle control, increased muscle tone, and loss of muscle tone.

Other types of focal loss of function include:

Speech or language difficulties such as aphasia or dysarthria (impaired speech and language skills), poor enunciation, poor understanding of speech, impaired writing, impaired ability to read or to understand writing, inability to name objects (anomia)
Vision changes such as reduced vision, decreased visual field, sudden vision loss, double vision (diplopia)
Neglect or inattention to the surroundings on one side of the body
Loss of coordination, or loss of fine motor control (ability to perform complex movements)
Horner's syndrome: one-sided eyelid drooping, lack of sweating on one side of the face, and sinking of one eye into the socket
Poor gag reflex, swallowing difficulty, and frequent choking

Common Causes

Stroke
Brain tumor
Cerebral palsy
Disorders of a single nerve or nerve group (for example, see carpal tunnel syndrome)
Infection
Trauma
Neurodegenerative illness
Vascular malformation

Home Care

Home care depends on the type and the cause of neurologic loss. (See the specific causative disorder.)

Call your health care provider if

If any loss of movement, sensation, or function occurs, call your health care provider.

What to expect at your health care provider's office

The medical history will be obtained and a physical examination performed.

Medical history questions documenting neurological deficits in detail may include:

Where is the loss of function?
- Right arm?
- Right leg?
- Left arm?
- Left leg?
- Another location (be specific)?
What deficits are present?
- Loss of vision?
- Numbness?
- Loss of movement?
- Loss of strength?
- Loss of hearing?
- Speech problem or language problem?
- Other (be specific)?
What other symptoms are also present?

The physical examination will include a detailed examination of nervous system function.

Diagnostic tests vary depending on other symptoms and the suspected cause of the nerve function loss.

Review Date: 3/5/2007

Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_003191

Syphilitic myelopathy

admin — Wed, 03 Sep 2008 17:51:37 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention

Illustrations

Superficial anterior muscles

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Syphilitic myelopathy is a complication of untreated syphilis that involves muscle weakness and abnormal sensations.

Alternative Names

Tabes dorsalis

Causes, incidence, and risk factors

Syphilitic myelopathy is a form of neurosyphilis, which is a progressive, life-threatening complication of late or tertiary syphilis infection. The condition called tabes dorsalis includes syphilitic myelopathy and additional symptoms of nerve damage.

The infection damages the tissue of the spinal cord and peripheral nervous tissue. This causes decreased muscle function (myelopathy), including progressive weakness of the legs, arms, and other areas. Loss of function may eventually result in paralysis.

Coordination difficulties contribute to problems walking. There are often changes in sensation, including painful paresthesia (abnormal sensations), which are also referred to as "lightning pains."

In syphilitic myelopathy, the muscle problems are accompanied by other symptoms characteristic of nervous system damage caused by syphilis. These include vision changes, stroke, and psychiatric illness.

Syphilitic myelopathy is now very rare because syphilis is usually treated early in the disease or as a result of screening blood tests that identify the disease in its latent (silent) form. Such blood tests are performed, for example, on individuals who donate blood.

Symptoms

Muscle weakness
Loss of coordination
Difficulty walking
Wide-based gait (the person walks with the legs far apart)
Abnormal sensations, often called "lightning pains"
Loss of reflexes

Signs and tests

Physical examination may suggest myelopathy. Decreased or absent reflexes may be present due to nerve damage.

Tests may include the following:

Head CT, spine CT, or MRI scans of the brain and spinal cord to rule out other diseases
Serum VDRL, RPR, or FTA to detect syphilis infection
CSF (cerebrospinal fluid) examination
- abnormal results indicating chronic meningitis
- a positive neurosyphilis test (CSF VDRL test)

Treatment

The goals of treatment are to cure the infection and to reduce progression of the disorder. Treatment of the infection reduces new nerve damage and may reduce symptoms but does not cure existing nerve damage.

For neurosyphilis, aqueous penicillin G (by injection) is the drug of choice. Some patients with penicillin allergies may undergo desensitization to penicillin so that they can be safely treated with it.

Treatment of symptoms is required for existing neurologic damage. Assistance or supervision may be needed if the person is unable to perform self-care activities (eating, dressing, etc.). Rehabilitation, physical therapy, occupational therapy, or other interventions may be appropriate for people with muscle weakness.

Analgesics may be required to control pain. These may include over-the-counter medications such as aspirin (oral salicylates) or acetaminophen for mild pain but narcotics may be required. Anti-epilepsy drugs such as carbamazepine may have a role in the treatment of lightning pains.

Expectations (prognosis)

Progressive disability is possible if the disorder is left untreated.

Complications

Difficulty with walking and balance
Complications of neurosyphilis, including dementia, strokes, eye disease
Complications of late-stage syphilis infection, which may include:
- Inflammation of the aorta (aortitis) with aortic aneurysm
- Disease of the heart valves
- Destructive changes in bones, skin, and other organs

Calling your health care provider

Call your health care provider if loss of coordination, loss of muscle strength, or loss of sensation occurs.

Prevention

Adequate treatment and follow-up of primary syphilis infections reduces the risk of developing syphilitic myelopathy. Safer sex behaviors and regular use of protective barriers (such as condoms) may reduce the risk of developing the initial syphilis infection.

Review Date: 8/8/2006

Reviewed By: D. Scott Smith, M.D., MSc, DTM&H, Chief of Infectious Disease & Geographic Medicine, Kaiser Redwood City, CA & Adjunct Assistant Professor, Stanford University. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000729