Nervous System Diseases

Alzheimer Disease

Alzheimer disease (AD) is the most common cause of dementia in western civilization. It affects more women than men, and the clinical course generally lasts approximately five years. The younger the individual is at the onset of the disease, the more severe the deficits for the patient. The cerebral cortex and some other forebrain regions atrophy so severely that the brain may weigh less than 1000g at death. Shrinkage is most pronounced in the frontal and temporal lobes. The insula and the medial part of the temporal lobe tend to demonstrate the highest number of neuritic plaques. The greater the number of plaques the higher the degree of dementia. The disease often causes vacuolization of the subpial layers of the temporal and parietal lobes. The spongy state is associated with neuronal loss and is similar to the effects of Creutzfeldt-Jakob disease.
Researchers continue to search for causes and cures for AD. The gene that codes for the B-amyloid protein located on chromosome 21 is implicated in the 20% of patients for whom there is a family history of AD. Head injury has been implicated in 3 to 5 % of AD cases. There is a 70 to 90% decrease in the production of the enzyme that makes acetylcholine. Other neurotransmitter abnormalities have also been implicated.

Broca Aphasia
Aphasia is defined by Websters Dictionary as a "loss or impairment of the power to use or comprehend words usually resulting from brain damage." In most people the Broca's area is in the lower part of the left frontal lobe. It is one of the main language areas in the cerebral cortex because it controls the motor aspects of speech. Persons with a Broca aphasia can usually understand what words mean, but have trouble performing the motor or output aspects of speech. Thus, other names for this disorder are 'expressive' and 'motor' aphasia. Depending on the severity of the lesion to Broca's area, the symptoms can range from the mildest type (cortical dysarthria) with intact comprehension and the ability to communicate through writing to a complete loss of speaking out loud.

Parkinson Disease

Parkinson disease (PD) is characterized by a slowing of voluntary movements, bradykinesia, muscular rigidity and tremor at rest. These abnormalities result from a reduction of neurons that make dopamine in the pars compacta of the substantia nigra. The axons of these neurons normally release this neurotransmitter where they synapse, in parts of the basal ganglia called the caudate nucleus and putamen or, collectively, the corpus striatum. Dopamine usually works as an inhibitory neurotransmitter in the corpus striatum where it acts on cholinergic neurons. Lewy bodies, a hyaline inclusion, are seen microscopically in the cytoplasm of residual neurons in the substantia nigra of nearly all patients with Parkinsonism. The loss of neurons results in a grossly evident depigmentation of the substantia nigra because those dopaminergic neurons also contain the pigment neuromelanin in their cytoplasm. There are various causes for the loss of dopaminergic neurons in the substantia nigra and the resultant signs of PD. Some evidence exists for involvement of genetic factors in the pathogenesis of PD. For example, several large families with an autosomal, dominant inheritance pattern of PD have now been described, and the first genetic locus for PD has been identified in one of those families.

Pituitary Adenoma These tumors are benign and are usually composed of secretory cells from the anterior lobe of the pituitary. Initially the tumor results in either an increase or decrease of hormone production depending on whether or not the adenoma is composed of cells capable of producing hormone. Increased levels of hormones can lead to either Cushing disease or acromegaly.

Secondary effects of tumor growth can lead to compression of the optic chiasm which has a position slightly above and in front of the pituitary gland. Such damage leads to visual difficulties.

Tourette Syndrome This syndrome begins in childhood and manifests itself through various forms of tics. These tics include frequent, irregular movements of the head, neck, or shoulders. They also may be more complex motor behaviors such as snorting, sniffing, and involuntary vocalization. As the syndrome progresses repetitive behaviors such as touching others, obsessive compulsive symptoms, and explosive involuntary cursing can be more common. Aggressive behavior and improper sexual impulses are the rarest and most severe expressions of the syndrome. Most often the child is hyperactive and has been given some form of CNS stimulant. The cause of Tourette syndrome is not known, but it is believed to have a genetic component. A total absence of the protein dynorphin in the striatal fibers of the globus pallidus is found in some patients. Other studies have shown a deficit in the uptake or release of dopamine and serotonin at synapses.

Fig. 3 Axial slices of statistical parametric maps demonstrating significant activations (P < 0.05, corrected for multiple comparisons) of sensory association areas during tic generation such as bilateral PO (A) particularly before tic onset (upper row) and bilateral SPL (B) at tic onset (lower row). Note motor cortex activation at tic onset, not present before tic onset (B arrows).

Wallenberg Syndrome This syndrome is characterized by difficulty in swallowing and hoarseness due to paralysis of the ipsilateral vocal cord. In some cases taste may also be affected in the ipsilateral half of the tongue. The glossopharyngeal (IX) & vagus (X) are the primary cranial nerves involved in this syndrome. Occlusion of the posterior inferior cerebellar artery (PICA) or branches from it leads to damage to the posterior lateral region of the medulla. Thus another name for this disorder is the 'lateral medullary plate syndrome'. There is also likely to be loss of pain and temperature sensation on the ipsilateral face and contralateral body because of damage to the spinal trigeminal tract and spinothalamic tract, respectively. If there is damage to the medullary reticular formation, an ipsilateral Horner syndrome may also be apparent in the patient.

Findings: restricted diffusion in the lateral medulla no flow void in the left vert and PICA, consistent with occlusion Diagnosis: Wallenberg syndrome

Weber Syndrome This syndrome is due to damage to the structures at the base of the midbrain including the third cranial nerve and the corticospinal and corticobulbar fibers in the cerebral peduncle. It is characterized by complete 3rd nerve palsy and associated with contralateral hemipelagia. Common causes of this syndrome are aneurysm in the posterior parts of the Circle of Willis, tumor, and occlusion in vessels supplying the anterior midbrain.

Wernicke Aphasia There are two main components to this type of aphasia. The first is impairment in the comprehension of written and spoken language. The second is an inability to speak substantive language; often times these patients are unable to form some words correctly and seem to inject words in their sentences that do not fit (paraphasia). These persons cannot function independently in society because they are unable to understand the meaning of written and spoken words, and they are unable to tell others what they want or think because their own speech is devoid of content. Since there may not be any difficulty making the sounds of language, another name for this disorder is 'fluent or sensory' aphasia.

Lesions producing this disorder can be found in the boundary region of the temporal and parietal lobes on the dorsolateral surface of the left (in most persons) cerebral hemisphere. When this disorder is due to a stroke there may be improvement to the point that the aphasia can no longer be detected except through specific tests.

Wilson Disease (Hepatolenticular Degeneration) This disease is caused by the inheritance of a mutation on chromosome 13. The mutation prevents the body from eliminating excess copper. Ceruloplasmin is the protein that binds and removes excess copper and its levels are greatly reduced in this disorder. Too much copper in the system damages the cells of the liver and leads to cirrhosis. Neurological damage primarily occurs in the putamen and globus pallidus, collectively known as the lenticular nucleus. Symptoms of the disease include a peculiar type of tremor in the upper extremities, slowness of movement and changes in temperament. Persons may become exceptionally argumentative, overly emotional or may experience a decrease in mental capabilities. Kayser-Fleischer rings (a rusty brown discoloration at the rims of the corneas) become evident as the copper begins to affect the nervous system. The disease first affects the liver, and if treatment is administered early enough, damage to the nervous system is dramatically reduced. Treatment includes the elimination of copper containing foods such as chocolate and mushrooms. Patients are also given drugs to chelate excess copper and eliminate it from the body.

Integumentary diseases

Eczema
Is a form of dermatitis, or inflammation of the upper layers of the skin. The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes which are characterized by one or more of these symptoms: redness, skin edema, itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed lesions, although scarring is rare.

Types of common eczemas Atopic eczema (aka infantile e., flexural e., atopic dermatitis) is believed to have a hereditary component, and often runs in families whose members also have hay fever and asthma. Itchy rash is particularly noticeable on face and scalp, neck, inside of elbows, behind knees, and buttocks. Experts are urging doctors to be more vigilant in weeding out cases that are, in actuality, irritant contact dermatitis. It is very common in developed countries, and rising. Contact dermatitis is of two types: allergic (resulting from a delayed reaction to some allergen, such as poison ivy or nickel), and irritant (resulting from direct reaction to a solvent, for example). Some substances act both as allergen and irritant (e.g. wet cement). Other substances cause a problem after sunlight exposure, bringing on phototoxic dermatitis. About three quarters of cases of contact eczema are of the irritant type, which is the most common occupational skin disease. Contact eczema is curable provided the offending substance can be avoided, and its traces removed from ones environment. Xerotic eczema (aka asteatotic e., e. craquele or craquelatum, winter itch, pruritus hiemalis) is dry skin that becomes so serious it turns into eczema. It worsens in dry winter weather, and limbs and trunk are most often affected. The itchy, tender skin resembles a dry, cracked, river bed. This disorder is very common among the older population. Ichthyosis is a related disorder.

Seborrhoeic dermatitis (aka cradle cap in infants, dandruff) causes dry or greasy scaling of the scalp and eyebrows. Scaly pimples and red patches sometimes appear in various adjacent places. In newborns it causes a thick, yellow crusty scalp rash called cradle cap which seems related to lack of biotin, and is often curable.
Less common eczemas Dyshidrosis (aka dyshidrotic e., pompholyx, vesicular palmoplantar dermatitis, housewifes eczema) only occurs on palms, soles, and sides of fingers and toes. Tiny opaque bumps called vesicles, thickening, and cracks are accompanied by itching which gets worse at night. A common type of hand eczema, it worsens in warm weather. Discoid eczema (aka nummular e., exudative e., microbial e.) is characterized by round spots of oozing or dry rash, with clear boundaries, often on lower legs. It is usually worse in winter. Cause is unknown, and the condition tends to come and go.

Venous eczema (aka gravitational e., stasis dermatitis, varicose e.) occurs in people with impaired circulation, varicose veins and edema, and is particularly common in the ankle area of people over 50. There is redness, scaling, darkening of the skin and itching. The disorder predisposes to leg ulcers. Dermatitis herpetiformis (aka Duhrings Disease) causes intensely itchy and typically symmetrical rash on arms, thighs, knees, and back. It is directly related to celiac disease and can often be put into remission with appropriate diet.

Neurodermatitis (aka lichen simplex chronicus, localized scratch dermatitis) is an itchy area of thickened, pigmented eczema patch that results from habitual rubbing and scratching. Usually there is only one spot. Often curable through behavior modification and anti-inflammatory medication. Prurigo nodularis is a related disorder showing multiple lumps. Autoeczematization (aka id reaction, autosensitization) is an eczematous reaction to an infection with parasites, fungi, bacteria or viruses. It is completely curable with the clearance of the original infection that caused it. The appearance varies depending on the cause. It always occurs some distance away from the original infection. Psoriasis (pronounced /srass/) Is a disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals. Psoriasis is hypothesized to be immune-mediated and is not contagious.

Types of psoriasis Plaque psoriasis (psoriasis vulgaris) is the most common form of psoriasis. It affects 80 to 90% of people with psoriasis. Plaque psoriasis typically appears as raised areas of inflamed skin covered with silvery white scaly skin. These areas are called plaques. Flexural psoriasis (inverse psoriasis) appears as smooth inflamed patches of skin. It occurs in skin folds, particularly around the genitals (between the thigh and groin), the armpits, under an overweight stomach (pannus), and under the breasts (inframammary fold). It is aggravated by friction and sweat, and is vulnerable to fungal infections. Guttate psoriasis is characterized by numerous small oval (teardropshaped) spots. These numerous spots of psoriasis appear over large areas of the body, such as the trunk, limbs, and scalp. Guttate psoriasis is associated with streptococcal throat infection. Pustular psoriasis appears as raised bumps that are filled with noninfectious pus (pustules). The skin under and surrounding pustules is red and tender. Pustular psoriasis can be localised, commonly to the hands and feet (palmoplantar pustulosis), or generalised with widespread patches occurring randomly on any part of the body.

Nail psoriasis produces a variety of changes in the appearance of finger and toe nails. These changes include discolouring under the nail plate, pitting of the nails, lines going across the nails, thickening of the skin under the nail, and the loosening (onycholysis) and crumbling of the nail. Psoriatic arthritis involves joint and connective tissue inflammation. Psoriatic arthritis can affect any joint but is most common in the joints of the fingers and toes. This can result in a sausage-shaped swelling of the fingers and toes known as dactylitis. Psoriatic arthritis can also affect the hips, knees and spine (spondylitis). About 10-15% of people who have psoriasis also have psoriatic arthritis. Erythrodermic psoriasis involves the widespread inflammation and exfoliation of the skin over most of the body surface. It may be accompanied by severe itching, swelling and pain. It is often the result of an exacerbation of unstable plaque psoriasis, particularly following the abrupt withdrawal of systemic treatment. This form of psoriasis can be fatal, as the extreme inflammation and exfoliation disrupt the body's ability to regulate temperature and for the skin to perform barrier functions

Acne vulgaris (commonly called Acne) Is a skin disease, caused by changes in the pilosebaceous units (skin structures consisting of a hair follicle and its associated sebaceous gland). Severe acne is inflammatory, but acne can also manifest in non-inflammatory forms. Acne lesions are commonly referred to as pimples, spots, or zits. Acne is most common during adolescence, affecting more than 85% of teenagers, and frequently continues into adulthood. For most people, acne diminishes over time and tends to disappear, or at least decrease, after one reaches his or her early twenties. There is, however, no way to predict how long it will take for it to disappear entirely, and some individuals will continue to suffer from acne decades later, into their thirties and forties and even beyond.

The term acne comes from a corruption of the Greek (acme in the sense of a skin eruption) in the writings of Atius Amidenus. The vernacular term bacne or backne is often used to indicate acne found specifically on one's back.
Impetigo (sometimes impetaigo) Is a superficial bacterial skin infection most common among children age 26 years. The name derives from the Latin impetere ("assail"). It is also known as school sores.

Syphilis Is a curable sexually transmitted disease caused by the Treponema pallidum spirochete. The route of transmission of syphilis is almost always by sexual contact, although there are examples of congenital syphilis via transmission from mother to child in utero. The signs and symptoms of syphilis are numerous; before the advent of serological testing, precise diagnosis was very difficult. In fact, the disease was dubbed the "Great Imitator" because it was often confused with other diseases, particularly in its tertiary stage. Syphilis (unless antibiotic-resistant) can be easily treated with antibiotics including penicillin. The oldest and still most effective method is an intramuscular injection of benzathine penicillin. If not treated, syphilis can cause serious effects such as damage to the heart, aorta, brain, eyes, and bones. In some cases these effects can be fatal. Types of syphilis Primary syphilis is typically acquired via direct sexual contact with the infectious lesions of a person with syphilis. Approximately 10-90 days after the initial exposure (average 21 days), a skin lesion appears at the point of contact, e.g. the genitalia. This lesion, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the spirochete, often on the penis, vagina or rectum. Rarely, there may be multiple lesions present although typically only one lesion is seen. The lesion may persist for 4 to 6 weeks and usually heals spontaneously. Local lymph node swelling can occur. During the initial incubation period, individuals are otherwise asymptomatic. As a result, many patients do not seek medical care immediately. Syphilis can not be contracted through toilet seats, daily activities, hot tubs, or sharing eating utensils or clothing.

Secondary syphilis Occurs approximately 1-6 months (commonly 6 to 8 weeks) after the primary infection. There are many different manifestations of secondary disease. There may be a symmetrical reddish-pink non-itchy rash on the trunk and extremities. The rash can involve the palms of the hands and the soles of the feet. In moist areas of the body, the rash becomes flat broad whitish lesions known as condylomata lata. Mucous patches may also appear on the genitals or in the mouth. All of these lesions are infectious and harbor active treponeme organisms. A patient with syphilis is most contagious when he or she has secondary syphilis. Other symptoms common at this stage include fever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes. Rare manifestations include an acute meningitis that occurs in about 2% of patients, hepatitis, renal disease, hypertrophic gastritis, patchy proctitis, ulcerative colitis, rectosigmoid mass, arthritis, periostitis, optic neuritis, intersitial keratitis, iritis, and uveitis. Latent syphilis Is defined as having serologic proof of infection without signs or symptoms of disease. Latent syphilis is further described as either early or late. Early latent syphilis is defined as having syphilis for two years or less from the time of initial infection without signs or symptoms of disease. Late latent syphilis is infection for greater than two years but without clinical evidence of disease. The distinction is important for both therapy and risk for transmission. In the realworld, the timing of infection is often not known and should be presumed to be late for the purpose of therapy.

Early latent syphilis may be treated with a single intramuscular injection of a long-acting penicillin. Late latent syphilis, however, requires three weekly injections. For infectiousness, however, late latent syphilis is not considered as contagious as early latent syphilis. Tertiary syphilis Usually occurs 1-10 years after the initial infection, though in some cases it can take up to 50 years. This stage is characterized by the formation of gummas which are soft, tumor-like balls of inflammation known as granulomas. The granulomas are chronic and represent an inability of the immune system to completely clear the organism. Gummas were once readily seen in the skin and mucous membranes although they tend to occur internally in recent history. They may appear almost anywhere in the body including in the skeleton. The gummas produce a chronic inflammatory state in the body with mass-effects upon the local anatomy. Other characteristics of untreated tertiary syphilis include neuropathic joint disease, which are a degeneration of joint surfaces resulting from loss of sensation and fine position sense (proprioception). The more severe manifestations include neurosyphilis and cardiovascular syphilis. In a study of untreated syphilis, 10% of patients developed cardiovascular syphilis, 16% had gumma formation, and 7% had neurosyphilis.

Neurological complications at this stage can be diverse. In some patients, manifestations include generalized paresis of the insane which results in personality changes, changes in emotional affect, hyperactive reflexes, and Argyll-Robertson pupil. This is a diagnostic sign in which the small and irregular pupils constrict in response to focusing the eyes, but not to light. Tabes dorsalis, also known as locomotor ataxia, a disorder of the spinal cord, often results in a characteristic shuffling gait. See below for more information about neurosyphilis. Cardiovascular complications include syphilitic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation. Syphilis infects the ascending aorta causing dilation and aortic regurgitation. This can be heard with a stethoscope as a heart murmur. The course can be insidious, and heart failure may be the presenting sign after years of disease. The infection can also occur in the coronary arteries and cause narrowing of the vessels. Syphilitic aortitis can cause de Musset's sign, a bobbing of the head that de Musset first noted in Parisian prostitutes. Neurosyphilis Neurosyphilis refers to a site of infection involving the central nervous system (CNS). Neurosyphilis may occur at any stage of syphilis. Before the advent of antibiotics, it was typically seen in 25-35% of patients with syphilis. Neurosyphilis is now most common in patients with HIV infection. The precise extent and significance of neurologic involvement in HIV-infected patients with syphilis, reflected by either laboratory or clinical criteria, have not been well characterized. Furthermore, the alteration of host immunosuppression by antiretroviral therapy in recent years has further complicated such characterization.

There are four clinical types of neurosyphilis: Asymptomatic neurosyphilis Meningovascular syphilis General paresis Tabes dorsalis The late forms of neurosyphilis (tabes dorsalis and general paresis) are seen much less frequently since the advent of antibiotics. The most common manifestations today are asymptomatic or symptomatic meningitis. Acute syphilitic meningitis usually occurs within the first year of infection; 10% of cases are diagnosed at the time of the secondary rash. Patients present with headache, meningeal irritation, and cranial nerve abnormalities, especially the optic nerve, facial nerve, and the vestibulocochlear nerve. Rarely, it affects the spine instead of the brain, causing focal muscle weakness or sensory loss.

Meningovascular syphilis occurs a few months to 10 years (average, 7 years) after the primary syphilis infection. Meningovascular syphilis can be associated with prodromal symptoms lasting weeks to months before focal deficits are identifiable. Prodromal symptoms include unilateral numbness, paresthesias, upper or lower extremity weakness, headache, vertigo, insomnia, and psychiatric abnormalities such as personality changes. The focal deficits initially are intermittent or progress slowly over a few days. However, it can also present as an infectious arteritis and cause an ischemic stroke, an outcome more commonly seen in younger patients. Angiography may be able to demonstrate areas of narrowing in the blood vessels or total occlusion.

General paresis, otherwise known as general paresis of the insane, is a severe manifestation of neurosyphilis. It is a chronic dementia which ultimately results in death in as little as 2-3 years. Patients generally have progressive personality changes, memory loss, and poor judgment. More rarely, they can have psychosis, depression, or mania. Imaging of the brain usually shows atrophy Leprosy, or Hansen's disease Is a chronic infectious disease caused by the bacterium Mycobacterium leprae. Leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external symptom. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs, and eyes. Contrary to popular conception,[citation needed] leprosy does not cause body parts to simply fall off, and it differs from tzaraath, the malady described in the Hebrew scriptures and previously translated into English as leprosy. Pityriasis rosea is a skin disease marked by patches of pink, oval rash. Although its exact cause is unknown and its onset is not linked to food, medicines or stress, it is thought that this essentially non-contagious condition is set off by a virus. Pityriasis rosea can affect members of either sex of any age. However, it is most common in females and those between the ages of 8 and 35. Symptoms only recur in 3% of the affected.

Herpes simplex Is a viral disease caused by herpes simplex viruses that primarily infect mucosal tissues and skin. Infection of the genitals is commonly known as herpes and is predominantly caused by the type 2 strain of herpes simplex virus (HSV-2) that is usually sexually transmitted. The type 1 strain of herpes simplex virus (HSV-1) is the usual cause of oral herpes, colloquially called cold sores. HSV-1 and HSV-2 are transmitted by direct contact with an infected sore or body fluid of an infected individual, and can cause painful fluid-filled blisters, containing millions of infectious virus particles. Following initial infection, these viruses travel from cells in the skin to sensory nerves, where they reside as life-long, latent viruses. HSV-1 lies dormant in trigeminal ganglia that provide sensation to the lips, lower mouth and neck; HSV-2 resides in sacral ganglia that supply sensation to the genitals, perineum and upper legs. Following reactivation, the viruses travel down the same nerves to reinfect the same area of skin initially infected. HSV-1 genital herpes is more infectious during primary episodes than HSV-2, but reoccurs less frequently than genital HSV-2. Both herpes infections have periods of active disease lasting 2-21 days and then remission when the sores disappear. The majority of cases are asymptomatic, however, although shedding may still occur. Over time, periods of remission generally increase in length, and the duration of lesions and viral shedding also decreases leading to reduced episodes of active disease. The frequency of recurrences is regulated by specific immunity developed against the virus. Previous HSV-1 infection tends to ameliorate the symptoms of a subsequent HSV-2 infection.

HSV-1 and HSV-2 belong to a family of herpes viruses called herpesviridae. Eight members of herpesviridae infect humans to cause a variety of illnesses including cold sores, chickenpox or varicella, shingles or herpes zoster (VZV), cytomeglovirus (CMV), and various cancers, and can cause brain inflammation (encephalitis). All viruses in the herpes family produce life-long infections. Recurrences can be triggered in some individuals by specific events, such as sunburn, ultraviolet light, wind, trauma, surgery, stress or other infections. Since viral reactivation is controlled by the immune system, in immunocompetent persons, oral and genital herpes are not typically life-threatening. However, individuals with HIV or transplant patients, with compromised immune systems, can develop serious HSV infections such as keratitis or encephalitis. Additionally, immunoincompetent newborns, infected by genital herpes at birth or shortly thereafter, are at highest risk if they acquire CNS (central nervous system) HSV infection that can cause brain damage or disseminated HSV which often results in liver failure and death. SEM (Skin eyes mouth) HSV infection usually involves only external lesions but can progress to CNS or disseminated if untreated. The risk of neonatal HSV occurring is higher when the mother has a primary infection just prior to birth and lacks protective antibodies that would otherwise reduce viable virus shedding. While great strides have been made in the treatment of neonatal herpes with the advancement of acyclovir antiviral therapy, the major impediment to its eradication remains late diagnosis with lesions appearing late in the course of the disease, or not at all.[citation needed]

Herpes zoster (or zoster)

Commonly known as shingles, is a viral disease characterised by a painful skin rash with blisters in a limited area on one side of the body. It is caused by varicella zoster virus (VZV), which is also the virus that causes chickenpox. After a chickenpox infection the virus can lodge permanently in ganglionic neurons, and less frequently in non-neuronal satellite cells, without causing any symptoms, although the mechanism is not understood. In an immunocompromised individual, perhaps years or decades after a chickenpox infection, the virus may break out of nerve cell bodies and travel down nerve axons to cause viral infection of the skin in the region of the nerve. The nerve cell bodies of dorsal root, cranial nerve or autonomic ganglion may contain the latent virus, and the virus may spread from one or more ganglia along nerves of an affected segment and infect the corresponding dermatome causing a rash, often referred to as shingles. Although the rash usually heals within two to four weeks, some sufferers experience residual nerve pain for months or years, a condition called postherpetic neuralgia. Lichen Planus Lichen planus is a relatively common skin disease that comes in episodes lasting months to years. The onset may be gradual or quick, but its cause, like many skin diseases, is unknown. It appears to be a reaction in response to more than one provoking factor. Theories include stress, genetics, infective (viral hepatitis C) and immunologic (autoimmune). There are also drugs that produce lichen planus-like allergic reactions to high blood pressure, heart disease, and arthritis medications. There is an inherited form also which is often more severe and can have a protracted course.

Lichen planus appears as shiny, flat-topped bumps that often have an angular shape. These bumps have a reddish-purplish color with a shiny cast due to a very fine scale. The disease can occur anywhere on the skin, but often favors the inside of the wrists and ankles, the lower legs, back, and neck. The mouth, genital region, hair and nails are affected in some individuals. Thick patches may occur, especially on the shins. Blisters may rarely occur. Bumps may appear in areas of trauma on some individuals. About 20 percent of the time lichen planus of the skin causes minimal symptoms and needs no treatment. However, in many cases the itching can be constant and intense. This disease occurs most often in men and women between the ages of 30 and 70 years. It is uncommon in the very young and elderly. All racial groups seem susceptible to lichen planus. There is no known cure for skin lichen planus, but treatment is often effective in relieving itching and improving the appearance of the rash until it goes away. Since every case of lichen planus is different, no one treatment does the job. Topical corticosteroids are very useful. Antihistamines may be prescribed to relieve itching. Extensive cases may require the use of oral corticosteroid (cortisone, prednisone) for a number of weeks. This usually shortens the duration of the outbreak. For severe cases powerful treatments include photo chemotherapy light treatment (PUVA), the retinoids drugs (Soriatane and Accutane), Neoral and Plaquenil. As it heals, lichen planus often leaves a dark brown discoloration of the skin. Like the bumps themselves, these stains may eventually fade with time without treatment.

Herpes zoster (or zoster)

Lichen Planus

Pemphigus Is an autoimmune disorder that causes blistering and raw sores on skin and mucous membranes. As with other autoimmune disorders, it is caused when the body's defenses mistake its own tissues as foreign, and attack the cells. This particular autoimmune reaction is sometimes associated with the use of Penicillamine. Pemphigus is derived from the Greek pemphix, meaning bubble or blister. The most common form of the disorder is pemphigus vulgaris . It occurs when antibodies attack Desmoglein 3, a protein that keeps cells bound together. Thus, cells simply fall apart, causing skin to slough off. Although pemphigus vulgaris may occur at any age, it is quite rare in children, and most common in the middle aged and elderly. Sores often originate in the mouth, making eating difficult and uncomfortable. Pemphigus vulgaris often affects people between the ages of 40-60, and mainly of Jewish, Middle Eastern, or Mediterranean descent. Some patients are associated with myasthenia gravis, but it's unusual. Foliaceus Is the least severe of the three varieties. Desmoglein 1, the protein that is destroyed by the body's immune system is only found in the top dry layer of the skin, so mouth sores do not occur. Pemphigus foliaceus is characterized by crusty sores that often begin on the scalp, and may move to the chest, back, and face. It is not as painful as pemphigus vulgaris, and is often mis-diagnosed as dermatitis or eczema.

Pemphigus

The least common and most severe type of pemphigus is the neoplastic variety, also known as paraneoplastic pemphigus. This disorder is usually found in conjunction with an already-existing malignancy. Very painful sores appear on the mouth, lips, and the esophagus. In this variety of pemphigus, the disease process often involves Bronchiolitis obliterans, a fatal destruction of alveoli in lung tissue. A diagnosis of neoplastic pemphigus may prompt a search for an existing tumor. Sometimes, the tumor is not malignant. In these cases, tumor removal may lead to a remission of the pemphigus. However, any decline in pulmonary function is generally irreversible. With Intravenous Immunoglobulin (IVIG) treatment and aggressive chemotherapy for the underlying lympoma, there are few known survivors of Paraneoplastic Pemphigus with pulmonary involvement Vitiligo (pronounced /vdlago/) or leukoderma Is a chronic skin condition that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. Basal cell carcinoma (BCC)

Is the most common form of skin cancer. It can be destructive and disfiguring. The risk of developing BCC is increased for individuals with a family history of the disease and with a high cumulative exposure to UV light via sunlight or, in the past, were exposed to carcinogenic chemicals, especially arsenic.

Treatment is with surgery, topical chemotherapy, X-ray, cryosurgery, or photodynamic therapy. It is rarely life-threatening but, if left untreated, can be disfiguring, cause bleeding, and produce local destruction (e.g., eye, ear, nose, lip). Basal cell skin cancer almost never spreads; but, if untreated, it may grow into surrounding areas and nearby tissues and bone.
Nodular: flesh-colored papule with telangiectasis; if it ulcerates, it becomes a "rodent ulcer" (ulcus rodens), an ulcerating nodule with (often) a pearly border Cystic: rarer and difficult to distinguish from the nodular form, which has a central cavity with fluid

Pigmented: a variant of the nodular form that may be confused with melanoma
Sclerosing/cicratising: a scar-like lesion Superficial: a red scaling patch. squamous cell carcinoma (SCC) is a form of cancer of the carcinoma type that may occur in many different organs, including the skin, lips, mouth, esophagus, urinary bladder, prostate, lungs, vagina, and cervix. It is a malignant tumor of squamous epithelium (epithelium that shows squamous cell differentiation).

Kaposi's Sarcoma Also called: KS Kaposi's sarcoma is a cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat or in other organs. The patches are usually red or purple and are made of cancer cells and blood cells. The red and purples patches often cause no symptoms, though they may be painful. If the cancer spreads to the digestive tract or lungs, bleeding can result. Lung tumors can make breathing hard.

URINARY DISEASES

KIDNEY STONES Kidney stones are hard masses that can grow from crystals forming within the kidneys. Doctors call kidney stones renal calculi, and the condition of having such stones nephrolithiasis. Most kidney stones are made of calcium oxalate. People with a history of kidney stone formation should talk with their doctor to learn what type of stones they haveapproximately one stone in three is made of something other than calcium oxalate and one in five contains little if any calcium in any form. Calcium oxalate stone formation is rare in primitive societies, suggesting that this condition is preventable.1 People who have formed a calcium oxalate stone are at high risk of forming another kidney stone.

Radiograph of Renal calculus

ACUTE PYELONEPHRITIS Etiology o Inflammation of the renal parenchyma and renal pelvis due to an infectious source o Most often secondary to an ascending lower urinary tract infection from gramnegative bacteria E. coli Klebsiella Proteus Pseudomonas. o Exception is S. aureus, which is spread hematogenously Pathologic Causes o Vesicoureteral reflux o Obstruction in the collecting system usually due to a calculus Radiographic Imaging Findings o Enlarged kidneys (U/S and CT) o Hydronephrosis (U/S and CT) o Wedge shaped areas of low attenuation secondary to decreased perfusion (CT) o Loss of the ability to distinguish the corticomedullary border (CT) o Perinephric stranding (CT)

Right kidney is markedly enlarged and has a wedge-shaped area of low attenuation

INTERSTITIAL nephritis Interstitial nephritis is a kidney disorder in which the spaces between the kidney tubules become swollen (inflammed). The inflammation can affect the kidneys' ability to filter waste. Alternative Names Tubulointerstitial nephritis; Nephritis - interstitial; Acute interstitial (allergic) nephritis

Fig. 2B. 51-year-old man with 2-month history of jaundice. ERCP Shows filiform stenosis of common bile duct (solid arrows). Note normal caliber of Wirsung's duct (dashed arrows). At surger tumor proved to be non-Hodgkin's lymphoma. Needle biopsy of left kidney revealed focal chronic

CYSTITIS Alternative Names Abacterial cystitis; Radiation cystitis; Chemical cystitis; Urethral syndrome acute Causes, incidence, and risk factors

Noninfectious cystitis is most common in women of childbearing years. The exact cause of noninfectious cystitis is often unknown.

Figure 52a. Pear-shaped bladder. (a) Excretory urogram demonstrates filling defects (arrow) in the bladder base, which proved to be cystitis glandularis, associated with symmetric bladder compression. (b) Although cystitis glandularis has been associated with pelvic lipomatosis, in this case, the CT scan reveals the compression is caused by psoas muscle hypertrophy.

ECTOPIC URETER Ectopic ureter is an abnormally located terminal portion of the ureter. Instead of the ureter opening in the bladder, it opens in the urethra, vagina, or uterus. The result is constant dribbling of urine.

The CT scan below shows a dilated ectopic ureter (labeled E) located within the urethral wall (this cross-section is at the level of the red arrow in the illustration above); also take note of the the smaller ectopic ureter labeled with an arrow

URINARY TRACT INFECTION A urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract. The urinary tract includes the: Bladder Kidneys Ureters -- the tubes that take urine from each kidney to the bladder Urethra -- the tube that empties urine from the bladder to the outside Alternative Names Bladder infection;; UTI

Figure 4a. Enterovesical fistula in a 61-year-old man with Crohn disease, recurrent urinary tract infections, and pneumaturia. (a) CT enterogram shows a small abscess and fistula (arrows) arising between two loops of thickened, inflamed ileum (arrowhead). (b, c) Axial (b) and coronal (c) CT enterograms reveal that the irregularly shaped fistula (arrowheads) courses anterior to a bowel loop (arrows) and extends to the urinary bladder. Air is seen within the bladder, a finding that is consistent with fistula