Lumbar puncture
Lumbar puncture, also known as the spinal tap is an invasive diagnostic procedure carried out to collect a sample of cerebrospinal fluid. The fluid is collected for cytological, microbiological or biochemical investigation or at times to relieve the excess pressure in the cerebrospinal fluid pressure. This test is used to make a diagnosis or rule out primary or metastatic brain or spinal cord neoplasm, meningitis, encephalitis, autoimmune diseases of the central nervous system or cerebral hemorrhage.
The patient is requested to lie in the lateral position (on his/her side) on the bed to prepare for a lumbar puncture. The patient is made to lie perpendicular to the bed in a fetal position. A spinal needle is inserted either between the L3/L4 or L4/L5 and is pushed till the needle goes past the dura mater. The cerebrospinal fluid is then collected by removing the stylet from the spinal needle. The pressure of the cerebrospinal fluid is measured before and after extracting the sample. The entire lumbar puncture procedure takes about 20 minutes.
Basilar skull fracture
If there is a fracture or break in the cranial or skull bones, it is called a skull fracture. When the base of the skull is involved in a head injury, it is a basilar skull fracture or basal skull fracture. It is also known as depressed skull fracture and linear skull fracture. This linear fracture is rare and occurs in only 4% of patients with severe head injury. Falls, injuries caused by penetrating external objects like knives, hammers or axe or gunshot wounds may result in skull fractures. It can also occur when the skull hits a solid object with considerable force. Basilar skull fracture can be called a linear fracture at the base of the skull. Usually, dural tear is associated with this type of fracture. This fracture occurs at specific points on the skull base. While analyzing skull fractures, it is seen that 19-221% of all skull fractures happen to be basilar skull fractures.
There may be a traumatic brain injury when the skull is fractured. The area of the brain injured and the severity of injury is diagnosed by examining the fracture. If bacteria enter inside the skull through this fracture of the skull, it will lead to infection. Sudden blow to the back of the head can also result in a basilar skull fracture.
After a head injury, if there is a leak of a clear fluid from the nose or ears, it indicates that the clear fluid is cerebrospinal fluid (CSF) that surrounds the brain. CSF drains out through the ears or nose, when the skull is fractured and the Meninges or the covering of the brain is torn. The typical nasal drainage due to allergies, cold or crying is different from this drainage of CSF. It is also an indication of a fracture of the frontal bone or the base of the skull i.e. sphenoid or temporal bone or of the ethmoid bones (bones that support the nose and sinuses).
If bleeding from the ears or nose is not due to a cut or a direct blow, it may be an indication of a fracture of the base of the skull. Determine the cause of the bleeding by washing the blood thoroughly and see if the bleeding is from a cut or not. Ascertain the source of bleeding from the ear. It is an indication of a skull fracture if a nose bleed does not stop with home treatment. If bruising or dislocation develops within 24 hours after a head injury, it also indicates a basilar skull fracture. Often bleeding within the skull may occur with a basilar skull fracture. This condition may lead to infection.
- Battle's sign-bruising behind one ear.
- Raccoon eyes-bruising around both eyes.
- Abnormalities pertaining to vision.
- Weakness of facial muscles.
- Problems in hearing.
- Difficulties in smelling.
- Nasal drip due to leaking of cerebral spinal fluid.
Diagnosis is made with laboratory check of the clear dripping fluid for the presence of CSF. A CT scan of the head with the focus on bones can reveal the extent of damage to the bones. CSF otorrhea and bruising over the mastoids commonly known as 'battle sign' is an indication of a fracture of the petrous temporal bone. Rhinorrhea and bruising around the eyes (raccoon eyes) are noticed with anterior cranial fossa fractures. Depending on an associated intracranial pathologic condition, the Glasgow Coma Score and loss of consciousness may differ from patient to patient. Temporary deafness is a possibility but it resolves in about three weeks.
Hemotympanum and mucosal edema in the middle ear fossa cause this temporary hearing loss. Basilar skull fractures sometimes leads to meningitis in some patients. If the bones around the foramen magnum are broken, there is a risk of damage to the blood vessels and nerves exiting the hole.
Polio
Polio or Poliomyelitis or infantile paralysis is a viral disease caused by poliovirus that spread as a worldwide epidemic in the early twentieth century. But after the polio vaccine was introduced in 1955, the cases have drastically reduced. The polio virus spreads from contact and rapidly spreads within the blood and lymph system. The virus spreads through contaminated water, food and human waste. Polio tends to affect young children most often.
Polio can manifest as Paralytic, non-paralytic and subclinical polio, which is most common. Subclinical polio might result in symptoms such as headache, fever, vomiting and headache. With non-paralytic polio, the person would notice back pain, leg pain, muscle stiffness and tenderness, headache and pain in the legs, hands and abdomen. But with paralytic polio, the symptoms would also include muscle spasms, fever, difficulty in breathing and stiffness and sensitivity. Routine test of Cerebrospinal fluid or viral culture of CSF can help diagnose polio. Heat packs can reduce muscle cramps and pain. Physical therapy can help recover lost muscle strength. No treatment can reverse polio paralysis.
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