Meningitis

Meningitis is an infection affecting the lining surrounding the brain and spinal cord. This infection can be caused by either virus, bacteria, fungi or other parasites. There is inflammation in the membranes (meninges) covering the brain and spinal cord. Infection starting here can travel to other parts of the body and even enter the central nervous system. Bacterial meningitis can be life threatening if not treated at once. Complications of bacterial meningitis can involve hearing loss, visual impairment, seizures and learning disabilities. Viral meningitis is more common. Viral meningitis is also called aseptic meningitis. Meningitis spreads through person-to-person contact and sharing infected utensils or items.

Symptoms of viral meningitis are flu-like - fever, diarrhea and runny nose. The patient is likely to feel lethargic and irritable. Headaches and stiffness in the neck are not uncommon. There may be sensitivity to light. Meningitis can lead to skin rashes that look like red pin pricks. In rare cases, there may be seizures. To diagnose meningitis, a doctor may resort to throat culture or CT scan of the chest, skull or sinuses. A spinal tap allows analysis of cerebrospinal fluid.

Cases of viral meningitis resolve on their own in a week or so. Pain medications can alleviate fever and body ache. The patient must get sufficient rest and drink plenty of fluids. Antibiotics are suggested in certain cases, even for persons who are in close contact with the patient.

Precocious Puberty

Precocious puberty is an uncommon condition that occurs when puberty begins before the age of eight in girls and before age nine in boys. The signs and symptoms of precocious puberty:

In Girls:

• Development of breasts
  
• Hair development underarm or in public parts
  
• Rapid height growth
  
• Onset of menstruation
  
• Acne
  
• Adult body odor

In Boys:

• Enlargement of testicles
  
• Hair growth in face (usually grows first on the upper lip), public parts /underarm
  
• Rapid height gain
  
• Deepening of voice
  
• Acne
  
• Adult body odor

In some children 'partial' precocious puberty could be seen. Girls may show breast development that later disappears or may persist without any other physical changes of puberty. Such children with partial precocious puberty should be evaluated by a medical professional to rule out any other health problems. By and large such instances do not require any treatment and usually will show the other expected signs of puberty at the right age.

Causes for Precocious Puberty

Abnormalities in ovary and testicles may contribute to precocious puberty. Problems in the ovaries, thyroid gland disorders can also cause the onset of puberty ahead of schedule. Sometimes precocious puberty is the result of a structural problem in the brain such as a tumor, brain injury due to head trauma, infection such as meningitis that triggers puberty to begin early. In a majority of girls there is no underlying medical problem but they simply start puberty too early for no known reason. Certain types of environmental contamination like environmental toxins could play a role in causing precocious puberty.

Central precocious puberty

• Tumor in the brain or spinal cord
  
• Infection such as encephalitis or meningitis
  
• A birth defect in the brain such as hydrocephalus or hamartoma (tumor)
  
• Radiation to brain or spinal cord
  
• Injury to brain or spinal cord
  
• Ischemia
  
• McCune Albright Syndrome - a genetic disease that affects the bones and skin color and causes hormonal problems
  
• A group of inherited disorders known as Congenital adrenal hyperplasia which involves abnormal hormone production by the adrenal glands.
  
• Hypothyroidism

Optic Disk Swelling

A doctor checks into the eye with an ophthalmoscope when there are regular complaints of headache, nausea or vomiting. This is to check for the appearance of the optic nerve and the blood vessels that pass through the eye. Swelling of the optic nerve is called Papilledema.

The optic nerve is a thick cord that connects the back of each eyeball and its retina to the brain. The cerebral spinal fluid protects the nerve between the brain and eye. Even if there is a slight increase in the pressure of this fluid, due to swelling in the brain, the optic nerve can get compressed around its whole circumference in a choking manner. The optic nerve can bulge whenever it develops inflammation on its own - causing Papilledema.

Such swelling of the optic nerve head can also be caused due to intracranial pressure. This could be due to an underlying brain tumor or brain infection such as abscess, meningitis or encephalitis. In fact many who are diagnosed with brain tumors exhibit Papilledema. Sometimes this can be caused due to high blood pressure.

Causes of Papilledema :

• Tumor of the Brain, Skull, Spinal column or cord, optic nerve
  
• Hydrocephalus - accumulation of cerebrospinal fluid within the skull
  
• Intracranial infections such as encephalitis, meningitis
  
• Abscess - Accumulation of Pus, Hemorrhage or trauma to the head
  
• Craniosynostosis - Abnormal closure of the skull bones
  

Symptoms of Papilledema :

• Headaches - especially the types which become severe on awakening; headaches that become exacerbated by coughing or holding breath
  
• Nausea and Vomiting
  
• Changes in vision manifesting in the form of double vision, flickering, transient blurring or graying
  

Pseudo tumor cerebri or benign intracranial hypertension is one condition which can cause increased pressure in the cerebral spinal fluid. This is caused when the body makes too much spinal fluid. This is common in women especially who are obese and of child bearing age, and at such times when the body is adjusting to hormone changes such as pregnancy, the first menstrual period or menopause. It is better to go in immediately for neuro-imaging and MRI to check the cerebral cenous sinuses. A lumbar puncture could be done to check the opening pressure as well as CSF (cerebro spinal fluid) test, Fluorescein Angiography - an eye test specifically intended to check the blood flow in the Retina and Choroid, if there is diagnostic uncertainty. In some cases ultrasonography and Retinal Tomography may be used to get 3D data and image.

Although a swollen optic nerve tends to improve over a period of time, it may take months for complete restoration of normal vision. Doctors usually treat with intravenous steroid drugs but this process may have little effect on vision in some cases, although it may help to improve overall health.