Search

Cerebral venous sinus thrombosis (CVST) is a rare and potentially deadly condition. Common etiologies include hypercoagulable diseases, low flow states, dehydration, adjacent infectious processes, oral contraceptives, hormonal replacement therapy, pregnancy, and puerperium. Symptoms include nausea, seizures, severe focal neurological deficits, coma, and headache (the most common presenting symptom). Anticoagulation is the mainstay of treatment for CVST. Transvenous clot lysis can be performed using injected thrombolytic agents and specialized catheters for clot retrieval.

Following acute multiple trauma, hypothalamic stimulation of the sympathetic nervous system and adrenal glands causes an increase in circulating corticoids and catecholamines, or a stress response. In individuals with severe traumatic brain injury or a Glasgow Coma Scale score of 3-8, this response can be exaggerated and episodic. A term commonly used by nurses caring for these individuals to describe this phenomenon is storming. Symptoms can include alterations in level of consciousness, increased posturing, dystonia, hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and agitation. These individuals generally are at a low level of neurological activity with minimal alertness, minimal awareness, and reflexive motor response to stimulation, and the storming can take a seemingly peaceful individual into a state of chaos. Diagnosis is commonly made solely on clinical assessment, and treatment is aimed at controlling the duration and severity of the symptoms and preventing additional brain injury. Storming can pose a challenge for the nurse, from providing daily care for the individual in the height of the storming episode and treating the symptoms, to educating the family. Careful assessment of the individual leads the nurse to the diagnosis and places the nurse in the role of moderator of the storming episode, including providing treatment and evaluating outcomes.

Cancer is the hyperactive state of cell growth in which the multiplication and division of cells occur abnormally. Malignant cancer to the brain frequently begins and ends with the loss of self or quality of life. Cancer of the central nervous system can be in the form of a primary or secondary brain tumor commonly known as metastatic cancer. Primary brain tumors can be benign or malignant on the basis of the cell type or location within the brain. Metastatic cancer has a primary source of origin, from which it has traveled to the brain by direct extension (tumors arising from the skull or vertebral column), or most commonly by hematogenous spread (through the blood supply, lymphatic system, or cerebral spinal fluid). As the cancer grows, the individual can experience headache, seizures, or focal neurologic deficits, all impinging on quality of life. This article addresses malignant central nervous system cancer including metastatic cancer and malignant gliomas (anaplastic astrocytoma, grade III, and glioblastoma multiforme, grade IV). Epidemiology, diagnostic workup, treatment, and outcome also are reviewed.

Quality of life issues remain at the forefront for individuals with life-threatening disease, such as metastatic cancer. The pain of metastatic bone cancer can severely hamper an individual's quality of life. Percutaneous vertebroplasty offers a minimally invasive way to reinforce bony elements, provide substantial improvement in pain control, allow for mobilization, and overall improve quality of life in these patients.

The object of this study was to find what degenerative changes are present in the ankle (talotibiofibular) joints in former elite high jumpers at least 10 years after their retirement from competition, whether there are differences between takeoff and swinging leg, and whether correlations between any particular training history parameters, former injuries, and the degenerative changes can be recognized.A cross-sectional case control study with matched controls for radiological outcomesThe Orthopedic Department at the University of Heidelberg, Germany.The subjects were 40 male high jumpers (required personal best at least 2.18m), featured in the lists of top athletes kept by the German Athletics Association (DLV) from 1972 to 1986. All radiological findings were compared with X-rays of male age, and BMI-matched controls.All underwent clinical and radiological examinations. In addition to eliciting data on the training history with the aid of a questionnaire, we assessed symptoms affecting the ankle by means of the Freiburg Ankle Score and the Kitaoka Score and scored the radiological findings according to Bargon and Scranton and MacDermott.Differences between takeoff and swinging leg were small (Freiburg takeoff leg 93/swinging leg 95, Kitaoka takeoff 89/swinging leg 93 points on a 100 points scale) in both clinical scores, but statistically significant (p0.005). The more jumps were performed during the active phase, the worse the radiological scores (r(s) = 0.4, p = 0.01). Radiological differences between takeoff and swinging leg were not found. Comparison with controls revealed no radiological differences between athletes and age- and BMI-matched men (all p-values0.40). It was found that one takeoff and one swinging leg ankle was affected by grade 2 arthritis (Bargon). Scranton grade 3 was found in four takeoff and in three swinging legs. No further correlations with training history data were found. Athletes who reported injuries in the past tended to have poorer radiological scores, although statistically not significant. None of the athletes had an instable ankle.The talotibiofibular joints in former high jumpers showed only slight signs of wear and tear with no clinically relevant side-related differences; severe arthrosis with narrowing of the joint space was rare. The risk of arthrosis connected with high-jumping seems not to be elevated.