PopSugar

Ask E. Jean For DearSugar: What Are My Rights?

E Jean Carroll — Thu, 14 Aug 2008 10:00:00 -0700

Dear E. Jean.

I write this and I don't know where to start or end, because it seems it’s gone on forever and I'm afraid of how it might end. I have a stepdaughter that I love like she were my very own. She has been in my life since she was born. She is now a very confused 24 year old.

Her own mother is and has been heavily involved with drugs my daughter’s whole life. After many attempts over the years, my husband and I finally got full custody of her at 10 years old. I thought and prayed we got her in time, but by the time she was 13 it all started coming out: Now we can't believe anything she says; she lies constantly and steals from us.

We have tried to get her in counseling, I’d make the appointments and she would not show up. She gets fired from most of her jobs. She hangs out with some very scary, druggy people. She’s almost gone to prison for a felony and managed to get out of it. She was raped at gun point twice and she still won’t stop.

If all this is not frightening enough, she now has a three-and-half-year-old son. She does not know who the father is. She slaps the child in the mouth, berates him for everything he does. If he’s being quiet she will agitate him till he fusses, puts him in timeout, and then harasses him the whole time.

I keep trying to talk to her about it. She won’t listen. Luckily she leaves him with us six or seven days a week. We pay for daycare. We buy all his clothes and we feel like he is our child. Sometimes she won’t call or see him for a week and then out of the blue she wants him overnight. He cries and says he doesn't want to go.

She has no patience with him and he’s such a sweet, smart little boy! He has an uncanny knack of reading people. I’ve spoken with a child psychologist and asked what the chances are of getting custody. He said the court would probably not take her parental rights away, and that they would merely recommend parenting classes.

The last time we tried to intervene, she took the child away from us for a week! He acted like a different boy when he came home. We can't risk putting him jeopardy. At this point we have him most of the time and I feel blessed about that, but I'm so afraid of what goes on when he’s with her and her friends. We don't have the money to hire a good attorney and I have looked in to hiring a PI; we couldn't afford that either. We feel stuck. All we want is to protect him before something worse happens. Any advise will be welcomed. - Aching Heart

To see E. Jean's answer, read more.

My Dear Aching Heart,

I’ve contacted the celebrated defense attorney and child custody expert, A.J. Reiber, in Indianapolis. (This is the closest big city to you.) Mr. Reiber, believes that there may be a “cause of action available which would allow the court to find that (you and your husband) are de facto custodians and thereby award (you) custody.” Mr. Reiber added:

At the same time, we should address the issue of possible supervised parenting time with the mother.

Mr. Reiber has agreed to discuss the matter with you pro bono. When you’re an old advice columnist like Auntie Eee, you soon come to realize that rarely does anyone step forward with any genuine help, let alone do it for free. Thank you, Mr. Reiber!

That said, as soon as I read your letter, I called you (as you know) and hearing your lovely voice, listening to the wonderful stories about your grandson, and feeling your alarm and fear that your daughter may harm him . . . the dilemma became clear. You are presented with two options:

Keep the Status Quo: The child lives with you six or seven days a week. For all intents and purposes, he’s living with you. Ergo, you already have custody of him.
Or, Get the Courts Involved and Try to Obtain Legal Custody: After talking with you, and hearing that your daughter is highly vindictive - i.e. if she suspects you’re even considering taking her to court, she’ll whisk the child out of your house and never let you see him again.

At this time, because you have the child with you, I’m leaning towards the first choice. We should wait, of course, till you’ve had your first meeting with Attorney Reiber to make a final decision. Till then, perhaps Dear Sugar can weigh in and help with her much-needed insight. . . .

To see more advice from E. Jean visit Elle Magazine and AskEJean.com

Website of the Day: Bulbstorm

GeekSugar — Wed, 07 Oct 2009 13:50:17 -0700

You've got an idea burning up your brain right now, I can feel it. If you're obsessed with shows like Shark Tank and American Inventor because you keep thinking "my idea is way better than his," then take note: Bulbstorm allows you to ease in to the product development arena by uploading your idea safely and securely to their site, and then get feedback from your friends.

After all your pals weigh in on your invention or product, you can open the door to the Bulbstorm community for their two cents, which has been known to lead to production deals, partnerships, and advice on how to polish your product before you look for financing. Not to mention giving you some street cred and serious word-of-mouth advertising. But Blubstorm isn't just a place for inventors. Find out who else can use this service when you read more.

Industry professionals and consultants can log in and give advice to new and budding inventors to help them with their product. You can also find legal advisers with profiles on Bulbstorm, looking to find new clients to take on. Just think as Blubstorm as one big Rolodex filled with contacts to help you along.

Have an interesting website you want to share? Here's how you can post your site in our Website of the Day group:

First of all, join the Website of the Day group.
Click "New Post" under the website of the day tab at the top of the page.
Give your story a "Title."
Fill in the "Body" with a link to your favorite website and the reasons why you love it.
Type "Technology and Gadgets" in the Categories box
Add keyword(s) in the tag field with relevant tags (for example mine for this story was "Website of the Day").
Choose whether you want the post to be private or public.
Click "Create Post" to submit content.

So join the Website of the Day group and share information about all your favorite sites! Yours just might end up on the GeekSugar homepage!

Ask Someone Dealing With Depression: Should I Be Mad at My Friend For Telling People I'm Depressed?

TresSugar — Mon, 31 Aug 2009 04:00:00 -0700

Conventional Wisdom is a different kind of advice column. Your questions will be answered by people from all walks of life rather than by advice experts. This week, someone who deals with depression gives advice to a woman who is mad at her friend for telling people in her circle that she is depressed. If you have a question, you can submit them here.

This week's question:

I shared my struggles with depression with my closest female friend and told her that I did not want anyone else to know about it. She decided that because I wasn't answering her calls she would call the wife of a leader in our church and ask her for my husband's cell phone number so she could call him, asking about me. My "best friend" told the woman that I was going through something serious and when the woman said, "At least she's not seeking outside help" my friend said, "Well, I don't know for sure if she is or isn't."

Why else would she call her and say those things unless her intentions were to let her know about my situation and to inform her I "might" be seeking outside help for my depression? I found out about this conversation from the leader's wife and she only admitted to it after she knew that I knew about it. She insists that she only had my good in mind.

The thing is, it was a really huge deal to me that these people not be in on it because I know that they would attack me for being depressed in the first place, and also if I sought help outside of the church. The last thing I needed at that time was some church discipline. I was really suffering! I am so mad at my best friend for saying anything; should I forgive her?

Signed,

Angry and Depressed

To hear what someone dealing with depression has to say, read more.

Dear Angry and Depressed,

There seem to be three related but separate issues here: one is your anger at your friend, the second is the question of how your church is handling this, and the third is how to actually manage your struggle with depression.

As someone who has been through a lot with both depression and anxiety, I empathize with your situation. Depression hurts. As for your friend, I think you need to assess who this friend is to you, and whether she reached out to others because she was simply worried and didn't know how to handle it. While the outcome might have been a problem, if she did it out of legitimate concern I think she may be a real friend who just handled things badly because she cares and was confused about what to do.

My major concern with what you have said is that your church community thinks there is something wrong with getting outside help. Admittedly, I am not religious and have never belonged to a church, but I strongly feel that a community of any kind that is truly concerned with one of their members' well-being will support them in what they need, and not be judgmental about what that support might be. I think it would be worth explaining to your friend that what she might have considered finding you support actually feels like discipline, and that she needs to be more sensitive to what you need.

Finally there is the question of your depression itself. I do not want to assume you are in a situation where professional help from a therapist or doctor would be appropriate, but severe depression is something you need to talk to a professional about. If you feel like you are not getting help from your friends, family, or church, you're taking care of yourself by asking for outside help. Doctors are legally required to respect your privacy, and you could ask if they would refer you to a therapist.

Far more people struggle with depression than we can imagine when we are sitting alone with our thoughts, and there is support out there for you. You may just have been going through a rough patch and not need anything further, but depression is too serious a condition not to explore your options. Don't be discouraged if it doesn't seem like you can't find the right person to help you right away, but there are also lots of great people out there who can help. As for your friend, tell her how her action made you feel, give her the benefit of the doubt, and seek some relief for your pain from professionals. Good luck!

Katie Kisses Her Possible Porn Star Boyfriend

PopSugarUK — Mon, 24 Aug 2009 07:00:00 -0700

Katie Price and Alex Reid showed their love with yet another PDA-fest over the weekend, this time at Santa Maria Polo Club in Sotogrande. Kate is abroad to launch her KP Equestrian range in Spain, but as usual the focus is on her private life rather than her products. The latest reports to emerge about her boyfriend Alex is that he is starring in a porn film. The news has allegedly led Kate's friends to insist she split up with Alex, while Peter is reportedly seeking legal advice about custody. Alex's spokesman said the film "is not a porn film, it is a gangster movie in which Alex is the main character. The rape scene has been taken completely out of context and Alex is speaking to lawyers." Let's hope this gets sorted out.

To see more pictures of Kate and Alex in Spain, just read more.

View 10 Photos ›

Enfoque/BigPicturesPhoto.com

Website of the Day: LivePerson

GeekSugar — Tue, 21 Jul 2009 14:03:55 -0700

There's a variety of subjects I'm not familiar with, but would love to know more about (like web design), and it would be awesome to have my own personal expert to give me tips and advice whenever I needed it. If real-time advice is what you seek, then LivePerson will provide.

LivePerson is a live and online chat service that lets you speak with an expert on almost any subject under the sun. Just find an expert from those that are online and waiting (legal advice, perhaps?), agree to the advice fee (which can be anywhere from a dollar a minute to $20 dollars an hour), and you're on your way to getting awesome advice from someone who knows their stuff. But what's more, if you are an expert on something (say photography, knitting, or dog grooming), you can get paid to stay at home and toss out tasty nibbles of advice. What a way to earn a living.

Link Time!!!

PopSugar — Fri, 15 May 2009 13:00:25 -0700

Rebecca Romijn shows off the twins! - lilsugar
Bette Midler offers Jen some love advice - Wonderwall
Heidi and Spencer get thrown out of an airplane (not really) - Pink is the New Blog
Bridget Moynahan and Selena Gomez get down to work - Lainey Gossip
Vanessa Hudgens can feel your Halo - JustJared
Mischa Barton's nude scene (NSFW) - Egotastic
Jamie Spears had the "legal right" to hit Sam Lutfi? - The Superficial
Holly Madison's bikini parade - Hollywood Tuna
Kate Moss is having a variety of property issues - Hollywood Rag
The drunk celeb hair trick - cityrag
Hmm . . . what to make of Joe Jonas all wet? - D-Listed

In This Economy! Jim Cramer Nearly Cries on The Daily Show

CitizenSugar — Fri, 13 Mar 2009 08:07:42 -0700

Lordy! I thought Jim Cramer was going to crack last night on The Daily Show when CNBC's ongoing kerfuffle with Jon Stewart came to a head. His voice wavered as Jon accused him of one-sided journalism - dishing out financial advice while not acknowledging the dirty work that goes on behind the markets.

How would old man Cramer know? Well, he used to run a hedge fund and manipulated the market for sport. Jon submits evidence with video clips from his hedge-fund days that goes a lot like this:

I would encourage anyone in a hedge fund to do it. Because it's legal. And it's a very quick way to make money - and very satisfying. By the way no one else in the world would ever admit that but I don't care. I'm not gonna say it on TV.

To see more of Cramer's voice cracking while apologizing for everything and nothing, read more.

Creutzfeldt-Jakob disease

admin — Wed, 03 Sep 2008 17:51:59 -0700

Illustrations

Creutzfeldt-Jakob disease

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Creutzfeldt-Jakob disease (CJD) is a form of brain damage that causes a rapid decrease of mental function and movement.

Alternative Names

Transmissible spongiform encephalopathy; vCJD; CJD; Jacob-Creutzfeldt disease

Causes, incidence, and risk factors

CJD is believed to result from a protein called a prion. A prion folds abnormally. This seems to encourage other proteins to have bad shapes, which affects their ability to function.

There are several types of CJD. The disorder is rare, occurring in about 1 out of 1 million people. It usually first appears between ages 20 and 70, with average age at onset of symptoms in the late 50s.

CJD can be grouped into classic or new variant disease.

The classic types of CJD are:

Sporadic CJD makes up the most cases. It often occurs for no known reasons.
Familial CJD results when a person inherited the abnormal protein (prion). Inherited CJD is rare.

Classic CJD is not related to mad cow disease (bovine spongiform encephalitis).

However, new variant CJD (nvCJD) is an infectious form that is related to mad cow disease. The infection responsible for the disease in cows is believed to be the same one responsible for vCJD in humans.

New variant CJD accounts for less than 1% of cases, and tends to affect younger people. It can result when someone is exposed to contaminated products.

Some cases of nvCJD have occurred in adolescents who have received growth hormone made from the pituitary glands of cadavers (dead bodies). Prions cannot be destroyed by ordinary disinfection techniques used to prevent transmission of viruses and bacteria. As a result, the hormone remains contaminated. Cadaver-derived growth hormone has been replaced by synthetically manufactured growth hormone, so this source of contagion is no longer a problem.

Other nvCJD cases have occurred when people were given corneal transplants from infected donors, and from contaminated electrodes that were used in brain surgery (before it was known how to properly disinfect instruments).

There have not been any cases of nvCJD reported in the U.S.

CJD may be related to several other diseases also thought to be caused by prions, including kuru (seen in New Guinea women who ate the brains of deceased relatives as part of a funerary ritual), scrapie (found in sheep), and other rare human diseases, such as Gerstmann-Straussler-Scheinker disease and fatal familial insomnia.

Symptoms

Blurred vision (sometimes)
Changes in gait (walking)
Hallucinations
Lack of coordination (for example, stumbling and falling)
Muscle twitching
Muscle stiffness
Myoclonic jerks or seizures
Nervous, jumpy feelings
Personality changes
Profound confusion, disorientation
Rapidly developingdelirium or dementia
Sleepiness
Speech impairment

Additional symptoms that may be associated with this disease:

Memory loss
Anxiety, stress, and tension

Once symptoms appear, the disorder progresses rapidly and may be confused with other types of dementia -- like Alzheimer's disease. Both forms of CJD, however, are distinguished by extremely rapid progression from onset of symptoms to disability and death.

Signs and tests

A neurological and motor system examination shows muscle twitching and spasm. There is a strong startle response. Muscle tone may be increased, or there may be weakness and muscle wasting (loss of muscle tissue). There may be abnormal reflexes or an increase in the response of normal reflexes.

There is loss of coordination related to visual-spatial perception changes and changes in the cerebellum, the area of the brain that controls coordination (cerebellar ataxia). An eye examination shows areas of blindness that the person may not realize are present.

Tests used to diagnose this condition may include:

EEG
Spinal tap

Ultimately, the disease can only be confirmed by brain biopsy or autopsy.

Treatment

There is no known cure. Custodial care may be required early in the course of the disease. Medications may be needed to control aggressive behaviors. These include sedatives, antipsychotics, and others.

Provding a safe environment, controlling aggressive or agitated behavior, and meeting physiologic needs may require monitoring and assistance in the home or in an institutionalized setting. Family counseling may help in coping with the changes required for home care.

Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in caring for the person with CJD.

Behavior modification may be helpful, in some cases, for controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.

Legal advice may be appropriate early in the course of the disorder to form advance directives, power of attorney, and other legal actions that may make it easier to make ethical decisions regarding the care of an individual with CJD.

Expectations (prognosis)

The outcome is usually very poor. Complete dementia commonly occurs within 6 months or less of the onset of symptoms, with the person becoming totally incapable of self-care.

The disorder is fatal in a short time, usually within 7 months, but a few people survive as long as 1 or 2 years after diagnosis of the disorder. The cause of death is usually infection, heart failure, or respiratory failure.

Complications

Infection
Heart failure
Respiratory failure
Loss of ability to function or care for oneself
Loss of ability to interact with others
Death

Calling your health care provider

CJD is not a medical emergency, but early diagnosis and treatment may make the symptoms easier to control, allow patients time to make advance directives, and give families additional time to come to terms with the condition.

Prevention

Medical equipment is sterilized to kill organisms that may cause the disease. Persons who have a medical history of diagnosed or possible CJD are not used as cornea donors.

Most countries now have strict guidelines for management of infected cows and strict restrictions regarding what they are fed, to avoid the potential for transmission of CJD to humans.

References

Llewelyn CA, Hewitt PE, et al. Possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion. Lancet 2004;363:417-421.

Peden AH, Head MW, et al. Preclinical vCJD after blood transfusion in a PRNP codon 129 heterozygous patient. Lancet 2004;264:527-529.

Brown P, Will RG, Bradley R, Asher DM, Detwiler L. Bovine Spongiform Encephalopathy and Variant Creutzfeldt-Jakob Disease: Background, Evolution, and Current Concerns. EID. January-February 2001; 7(1):6-16.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:1551-1569.

Review Date: 8/6/2007

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., 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. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Source Doc: 1_000788

Hemorrhagic stroke

admin — Wed, 03 Sep 2008 17:51:49 -0700

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Hemorrhagic stroke involves bleeding within the brain, which damages nearby brain tissue. See also:

Alternative Names

Brain bleeding; Brain hemorrhage; Stroke - hemorrhagic

Causes, incidence, and risk factors

Hemorrhagic stroke occurs when a blood vessel bursts inside the brain. The brain is very sensitive to bleeding and damage can occur very rapidly, either because of the presence of the blood itself, or because the fluid increases pressure on the brain and harms it by pressing it against the skull.

Bleeding irritates the brain tissue, causing swelling. The surrounding tissues of the brain resist the expansion of the bleeding, which is finally contained by forming a mass (hematoma). Both swelling and hematoma will compress and displace normal brain tissue.

Most often, hemorrhagic stroke is associated with high blood pressure, which stresses the artery walls until they break.

Another cause of hemorrhagic stroke is an aneurysm. This is a weak spot in an artery wall, which balloons out because of the pressure of the blood circulating inside the affected artery. Eventually, it can burst and cause serious harm. The larger the aneurysm is, the more likely it is to burst. It is unclear why people develop aneurysms, but genes may play a role, since aneurysms run in families.

Stroke can also be caused by the accumulation of a protein called amyloid within the artery walls, particularly in the elderly. This makes the arteries more prone to bleeding.

Amyloid protein is also implicated in the brain damage related to Alzheimer's disease, but the difference is that people with Alzheimer´s disease have amyloid accumulation in the brain tissue instead of in the arteries. Therefore people with Alzheimer´s usually do not develop brain bleeding.

Some people with brain hemorrhage have abnormal connections between arteries and veins. Under normal circumstances, circulating blood travels through the arteries into the capillaries, where it provides nutrients and oxygen to the tissues. Once the blood has deposited the nutrients and oxygen, it is carried back to the heart from the capillaries via the veins.

In some people, however, a brain artery may connect directly to a vein, instead of going through the capillaries first. This is called an arterial-venous malformation (AVM). Since blood pressure in the arteries is much greater than in the veins, the veins may rupture, causing bleeding into the brain.

Another important brain disease that can cause bleeding is cancer. This is especially true for cancers that spread to the brain from distant organs, such as the breast, skin, and thyroid.

About 20% of strokes are hemorrhagic -- but the other 80% are caused by the opposite problem: too little blood reaching an area of the brain, which is usually due to a clot that has blocked a blood vessel. This is called "ischemic stroke." This type of stroke can sometimes lead to a brain hemorrhage because the affected brain tissue softens and this can lead to breaking down of small blood vessels.

In addition, brain hemorrhage can occur when people have problems forming blood clots. Clots, which are the body's way of stopping any bleeding, are formed by proteins called coagulation factors and by sticky blood cells called platelets. Whenever the coagulation factors or platelets do not work well or are insufficient in quantity, people may develop a tendency to bleed excessively.

Some medications (often used, ironically, to prevent ischemic stroke) prevent clot formation. These work by blocking the production of clotting factors (such as the blood thinner warfarin) or interfering with the function of platelets (such as aspirin). The most common side effects of such medications is bleeding, which may occasionally affect the brain. Controlling bleeding to avoid stroke is a very fine balancing act.

Illicit drugs, such as cocaine, can also cause hemorrhagic stroke.

Symptoms

Stroke symptoms are typically of sudden onset and may quickly become worse. The following is a list of possible problems:

Weakness or inability to move a body part
Numbness or loss of sensation
Decreased or lost vision (may be partial)
Speech difficulties
Inability to recognize or identify familiar things
Sudden headache
Vertigo (sensation of the world spinning around)
Dizziness
Loss of coordination
Swallowing difficulties
Sleepy, stuporous, lethargic, comatose, or unconscious

Signs and tests

A neurologic exam is almost always abnormal. The patient may look drowsy and confused. An eye examination may show abnormal eye movements, and changes may be seen upon retinal examination (examination of the back of the eye with an instrument called ophthalmoscope). The patient may have abnormal reflexes. However, these findings are not specific to brain hemorrhage.

The most important test to confirm the presence of a brain hemorrhage is a CT scan, which provides pictures of the brain. A CT scan should be obtained without delay. A brain magnetic resonance imaging (MRI) scan can also be obtained later to better understand what caused the bleeding. A conventional angiography (x-ray of the arteries using dye) may be required to identify aneurysms or AVM.

Other tests may include:

CBC
Bleeding time
Prothrombin/partial thromboplastin time (PT/PTT)
CSF (cerebrospinal fluid) examination (rarely needed)

Treatment

Treatment includes life-saving measures, relieving symptoms, repairing the cause of the bleeding, preventing complications, and starting rehabilitation as soon as possible. Recovery may occur over time as other areas of the brain take over functioning for the damaged areas.

IMMEDIATE TREATMENT

Treatment is ideally administered in an intensive care unit, where complications can immediately be detected. Medical personnel pay careful attention to breathing because sometimes persons with brain hemorrhage develop very irregular breathing patterns or even stop breathing entirely.

A person having a hemorrhagic stroke may be unable to protect the airway during coughing or sneezing because of impaired consciousness. Saliva or other secretions may go "down the wrong pipe," which is potentially serious and may cause lung problems such as aspiration pneumonia. To treat or prevent these breathing problems, a tube may need to be placed through the mouth into the trachea to start mechanical ventilation.

The blood pressure may be too high or too low in patients with brain hemorrhage. These problems need to be addressed immediately by doctors. In addition, brain bleeding may cause swelling of surrounding brain tissue, and this may require therapy with some drugs called hyperosmotic agents (mannitol, glycerol, and hypertonic saline solutions).

Bedrest may be advised to avoid increasing the pressure in the head (intracranial pressure). This may include avoiding activities such as bending over, lying flat, sudden position changes or similar activities. Stool softeners or laxatives may prevent straining during bowel movements (straining also causes increased intracranial pressure).

Medications may relieve headache but should be used with caution because they may reduce consciousness. This may produce the wrong impression that the patient is getting worse. Antihypertensive medications may be prescribed to moderately reduce high blood pressure. Medications such as phenytoin may be needed to prevent or treat seizures.

Nutrients and fluids may need to be supplemented if swallowing difficulties are present. This can be intravenous or through a feeding tube into the stomach (gastrostomy tube). Swallowing difficulties may be temporary or permanent.

Positioning, range-of-motion exercises, speech therapy, occupational therapy, physical therapy, and other interventions may be advised to prevent complications and promote maximum recovery of function.

SURGERY

Sometimes, surgery is needed to save the patient's life or to improve the chances of recovery. The type of surgery depends upon the specific cause of brain bleeding. For example, a hemorrhage due to an aneurysm requires special treatment (see aneurysm).

For other types of bleeding, removal of the hematoma may occasionally be needed, especially when bleeding occurs in the back of the brain. Some physicians are currently investigating whether the injection of a "clot buster" inside the hematoma can facilitate the removal of brain hemorrhages through needles or catheters, allowing less invasive surgery.

One common problem related to brain bleeding is hydrocephalus, which is the accumulation of a water-like fluid within the brain cavities called ventricles. To solve this problem, the fluid may need to be drained with a special procedure called ventriculostomy.

For AVM, different treatments are available, including surgical removal of the AVM network, radiosurgery (using ionizing radiation to reduce the size of the AVM), and intra-arterial embolization (a procedure in which glue is injected into the AVM to close the connection between arteries and veins).

LONG-TERM TREATMENT

Recovery time and the need for long-term treatment are highly variable in each case. Physical therapy may benefit some patients. Activity should be encouraged within the person's physical limitations. Alternative forms of communication such as pictures, verbal cues, demonstration or others may be needed depending on the type and extent of language deficit. Speech therapy, occupational therapy, or other interventions may increase the ability to function.

Urinary catheterization or bladder or bowel control programs may be required to control incontinence.

A safe environment must be considered. Some people with stroke appear to have no awareness of their surroundings on the affected side. Others show a marked indifference or lack of judgment, which increases the need for safety precautions.

In-home care, boarding homes, adult day care, or convalescent homes may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiologic needs.

Behavior modification may be helpful for some patients in controlling unacceptable or dangerous behaviors. This consists of rewarding appropriate or positive behaviors and ignoring inappropriate behaviors (within the bounds of safety). Reality orientation, with repeated reinforcement of environmental and other cues, may help reduce disorientation.

Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful.

Legal advice may also be appropriate early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with hemorrhagic stroke.

Expectations (prognosis)

Stroke is the third leading cause of death in developed countries. About one-forth of people who have a stroke die as a result of the stroke or its complications, about one-half have long-term disabilities, and about one-forth recover most or all function.

Hemorrhagic stroke is less common but more frequently fatal than ischemic stroke.

Complications

Pressure sores
Permanent loss of movement or sensation of a part of the body
Joint contractures
Muscle spasticity
Permanent loss of cognitive or other brain functions (dementia)
Disruption of communication, decreased social interaction
Decreased ability to function or care for self
Decreased life span
Urinary and respiratory tract infections

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms of stroke occur. A stroke is a "brain attack," and minutes can make a huge difference in disability and death rates.

Emergency symptoms include seizures or breathing difficulties, loss of consciousness, sudden difficulties with movement or sensation, eating or swallowing difficulties, sudden vision change or loss of vision in one or both eyes, rapid onset of speech changes, and sudden (severe) headache.

Call your health care provider if the condition of a family member with stroke deteriorates to the point that the person cannot be cared for at home.

Prevention

Most cases of hemorrhagic stroke are associated with specific risk factors, such as high blood pressure, smoking, or cocaine use. Controlling blood pressure and avoiding smoking and cocaine can reduce the chances of brain bleeding. Surgery to correct blood vessel abnormalities like aneurysms or AVMs is sometimes advisable to prevent bleeding.

Review Date: 9/10/2006

Reviewed By: Daniel Kantor, MD, 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_000761

Multi-infarct dementia

admin — Wed, 03 Sep 2008 17:51:43 -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

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

Multi-infarct dementia (MID) is a form of vascular dementia -- damage in mental function caused by strokes.

Alternative Names

MID

Causes, incidence, and risk factors

Multi-infarct dementia (MID) is the most common form of vascular dementia, and the second most common cause of dementia (after Alzheimer's disease) in people over age 65.

An estimated 10 - 20% of all dementias are caused by strokes. MID affects men more often than women. The disorder usually affects people between ages 55 and 75.

"Multi-infarct" means that many areas in the brain have been injured due to a lack of blood.

Risk factors for MID include a history of:

Hardening of the arteries (atherosclerosis)
High blood pressure (hypertension)
Smoking
Stroke

Some research suggests that MID may cause Alzheimer's disease or make it get worse faster. MID may be misdiagnosed as Alzheimer's, or may be found along with Alzheimer's.

Symptoms

Confusion at night
Decreased ability to function independently
Decreased interest in daily living activities
Difficulty making judgments
Extreme emotional disturbance (agitation)
Frustration, depression, anxiety, stress, and tension from loss of mental function
Inability to be spontaneous
Lack of emotion
Memory loss
Numbness or tingling
Slowly worsening memory loss (dementia) and:
- Confusion, disorientation
- Decline in many brain functions that gets worse
- Difficulties with attention, concentration, judgment, and behavior
- Difficulty thinking
- False beliefs (delusions)
- Hearing sounds or seeing things that are not there (hallucinations)
- Personality changes
- Problems with language (aphasia)
- Uncoordinated or weak movements
Swallowing difficulty
Sudden involuntary laughing or crying
Urinary incontinence
Withdrawal from social interaction
- Inability to interact in social or personal situations
- Inability to keep a job

Signs and tests

Diagnosis rules out other causes of dementia, including dementia due to metabolic causes.

Signs of multi-infart dementia include:

Abnormal reflexes
Local nervous system (neurologic) signs (on the modified Hachinski ischemia scale)
Past stroke or high blood pressure
Periods of quick worsening alternating with stable periods of very little change
Quick onset
Weakness or loss of function on one side, one area, or many areas

Tests may include:

Treatment

There is no treatment for MID. The goal is to control symptoms and correct risk factors such as high blood pressure and high cholesterol. The health care provider may recommend other treatments.

DIAGNOSIS AND TREATMENT

The diagnosis and treatment environment should be pleasant, comfortable, non-threatening, and physically safe. Some patients may need to stay in the hospital for a short time. The health care provider will try to find the cause and treat it.

Stopping or changing medications that worsen or cause confusion may improve mental function. Medications that may cause confusion include:

Anticholinergics (including antidepressants such as amitriptyline or imipramine)
Central nervous system depressants
Cimetidine
Lidocaine
Pain relievers

Disorders that may contribute to confusion include:

Anemia
Heart failure
Infections
Low oxygen (hypoxia)
Mental conditions such as depression
Nutritional disorders
Thyroid disorders

Treating medical and mental disorders often greatly improves function.

Medications may be needed to control aggressive, agitated, or dangerous behaviors. The health care provider will usually prescribe these medicines in very low doses and adjust the dose as needed. Such medications may include:

Antipsychotics (olanzapine, quetiapine)
Beta-blockers
Serotonin-affecting drugs (trazodone, buspirone, or fluoxetine).

Medications used to treat Alzheimer's disease have not been shown to work for MID.

Hearing aids, glasses, or cataract surgery may be needed if the person has sensory problems.

LONG-TERM TREATMENT

The following may be helpful in caring for a person with MID:

Adult day care
Adult protective services
Boarding homes
Community resources
Convalescent homes
Family counseling
Homemakers
In-home care
Visiting nurses or aides
Volunteer services

Other care tips:

Keep familiar objects and people around
Leave lights on at night
Stick to a simple schedule of activities
Use behavior modification to help control unacceptable or dangerous behaviors
Use reality orientation with environmental cues to help reduce disorientation

Seek legal advice early in the course of the disorder. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of the person with MID.

Expectations (prognosis)

The disorder gets worse over time.

Death may occur from:

Heart disease
Pneumonia or other infection
Stroke

Complications

Heart disease
Infections anywhere in the body
Loss of ability to function or care for self
Loss of ability to interact
Pneumonia
Reduced lifespan
Side effects of medications
Stroke

Calling your health care provider

Call your health care provider if symptoms of vascular dementia occur. Go to the emergency room or call the local emergency number (such as 911) if there is a sudden change in mental status. This is an emergency symptom of stroke.

Treatment that is started within 3 hours after symptoms begin may reduce damage caused by strokes.

Prevention

Control conditions that increase the risk of hardening of the arteries (atherosclerosis) by:

Controlling high blood pressure
Controlling weight
Reducing saturated fats and salt in the diet
Treating related disorders

Review Date: 2/13/2008

Reviewed By: Luc Jasmin, MD, PhD, Departments of Anatomy & Neurological Surgery, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000746