.:I'm just a student:.

.:أنا مجرد طالب:.

Warning!!! تحذير

All of these posts (posts in this blog) are for personal use only. ........................................................ كل هذه وظيفة (وظائف في هذا بلوق) هي للاستخدام الشخصي فقط

Cerebrospinal Fluid (CSF) Disorders

7 Ways to Lift a Bad Mood

Going Up! 7 Pointers to Lift a Bad Mood


By Dr. Maoshing Ni























No one can live a long and healthy life without the will to go on; sometimes mood swings can make us feel that life is too much for us.

A bad mood not only gives you a gloomy outlook, it also lowers your immune function, leading the way to illness. Here are some suggestions to lift your mood, your spirit, and your health.

1. A Laughing Matter
"Laugh Therapy," pioneered by Norman Cousins, has turned out to have real substance. Research has discovered that laughter and joy boost immune functions, especially the production of the natural killer cells that help defend the body from illness and cancer.

Laughter also increases the release of endorphins - compounds that give you a sense of well-being - in your brain. Without a doubt, joyful people liver longer and healthier lives. So read your favorite comics, watch your favorite comedies, and laugh it up!

2. Amino Acid for Restored Mindset
When an imbalance or deficiency is creating a bad mood, the Europeans use supplements of a natural compound found in human cells to regulate mood and restore a healthy mindset. SAMe (S-adenosyl-L-methionine) is produced from methionine, an amino acid that plays a role in the production of uplifting neurotransmitters like serotonin and dopamine.

One study indicated that SAMe worked on patients who had unsuccessful results with conventional antidepressants. To get a boost from SAMe, take a supplement combining it with vitamins B6 and B12.

3. Hands-On Healing
Human touch increases the production of endorphins, growth hormone, and DHEA, all of which lengthen your life span and lower the negative impact of stress. Studies have found that patients who are regularly touched recover faster than those who are not touched. So give someone a hug and feel both of your moods improve.

4. Boost Your "Youth Hormones"
You don't need pills to flood your body with a rejuvenating flood of growth hormones. Research has found that doing squats and leg presses will greatly increase your natural production of the "youth hormone". Increased growth hormone translates to an elevated mood, among other physical benefits. Keep it up with weight training, knee bends, push-ups, and rowing.

5. Take a Bracing Breath
Breathing correctly is important for dispelling the toxins and wastes from your body; in fact, it is estimated that we expel only about 30 percent of toxins in our bodies through the bowels and bladder-the rest is all respiratory. Breathing is also a great way to clear your mind, boost your energy, and improve your mood. Practice deep, slow, rhythmic, breathing daily with mind-body disciplines such as tai chi, yoga, qigong, and meditation.

6. Smell the Joy
Research has shown that smell has a definite impact on our bodies and minds. When you stimulate the olfactory nerves inside your nose, you activate the limbic system of your brain, which is associated with moods and memory. This concept is instrumental to aromatherapy, a natural health tradition that makes use of the healing powers of plants with strong scents.

Aromatherapy recommends treating depression with jasmine, eucalyptus for exhilaration, and grapefruit to increase alertness and joy. Just put a dab of the essential oils from these plants on your temples, back of your neck, or acupressure points. Another option? Boil the herb in water and inhale the steam through your nose.

7. Feel Fine with Flowers
There is a reason that flowers are the traditional get-well gesture. Colorful flowers have a powerful influence on moods; they can uplift a patient's mood and even combat stress. One study found that during a five-minute typing assignment, people sitting next to a flowering bouquet were more relaxed than those who sat near foliage-only plants.

I hope these tips help the good feelings flow! I invite you to visit often and share your own personal health and longevity tips with me.

May you live long, live strong, and live happy!

-Dr. Mao

Protect Your Heart at Every Age

Protect Your Heart at Every Age


By Woman's Day Staff


Follow these easy health tips specific to every stage of aging

You're never too young—or too old—to start lowering your heart disease risk. Of course, exercising, eating healthy and reducing stress are key throughout life, but due to physiological changes that happen as we age, certain risk factors do become more of a threat.

In Your 20s

Stub Out a Social Smoking Habit

Smoking is enemy number one when it comes to heart disease, and even just a few cigarettes can do damage: New research from McGill University in Montreal found that smoking just one cigarette a day stiffens your arteries by a whopping 25 percent. Plus, smoking erases the hormonal advantage you have from estrogen, which can leave you vulnerable to a heart attack before menopause, explains Dr. Bonow.

Don't Ignore the Birth Control Factor

Remember that hormonal contraceptives slightly increase the risk of blood clots, so if you've ever had one, make sure to discuss it with your doctor before going on birth control. And if you're currently a smoker, don't take oral contraceptives, because the combo can be especially dangerous, says Sharonne N. Hayes, MD, director of the Women's Heart Clinic at Mayo Clinic in Rochester, Minnesota.

Watch Your Alcohol Intake

Moderate amounts of alcohol can have a beneficial effect on your heart. (By "moderate," we mean one drink a day or about 5 ounces—but many restaurants serve far more than that.) Overdoing it can raise triglycerides, increase blood pressure and lead to weight gain, thanks to all those empty calories.


In Your 30s

Get a Grip on Stress

When you're juggling career and family, it's crucial to find stress management techniques that work. "Untamed stress has a direct negative impact on heart health," says Dr. Stevens. "The constant bombardment of adrenaline raises blood pressure and destabilizes plaque in your arteries, making it likely to cause a clot or heart attack."

Lose the Baby Weight

No, you don't have to fit into your skinny jeans by the time the baby's 6 months old, but do aim to get back to your pre-pregnancy weight within one to two years. "Carrying around extra pounds can lead to high cholesterol, high blood pressure and other heart disease risk factors," Dr. Bonow says. Also remember that it's easier to lose weight in your 30s than in your 40s, when your metabolism slows down.

Stay Social

It's important to stay connected to friends and family for the sake of your mood and heart. Research at the University of Pittsburgh School of Medicine found that high levels of loneliness increase a woman's risk of heart disease by 76 percent. On the flip side, having strong social support can help lower your blood pressure and improve other cardiovascular functions. Set aside time once or twice a week to call friends, or make a monthly dinner date.


In Your 40s

Make Sleep a Priority

Thanks to peri-menopause, fluctuating hormone levels can interfere with a good night's sleep. But not getting at least seven hours of shut-eye regularly can lead to increased blood pressure, low-grade inflammation and higher levels of the stress hormone cortisol, all of which are harmful for your blood vessels and heart, explains Jennifer H. Mieres, MD, a cardiologist at New York University School of Medicine and coauthor of Heart Smart for Black Women and Latinas. Lack of sleep has also been linked to weight gain. So establish good habits: Turn in (and wake up) at the same time every day—even on weekends—and do your best to relax before going to bed, whether it's watching a favorite funny TV show or reading.

Reassess Your Risk Factors

You may discover that your cholesterol, blood pressure and blood sugar levels have changed in this decade, even if you aren't doing anything differently, says Dr. Hayes. In fact, 22 percent of 40-something women have high blood pressure and 50 percent have high cholesterol (a jump from 38 percent of women in their 30s), according to the National Heart, Lung, and Blood Institute. Also, be sure to get your thyroid checked around 45; hypothyroidism (an underactive thyroid gland), which becomes more common as women get older, can negatively affect your cholesterol levels as well as your heart.

Step Up Strength Training

You start to lose muscle mass more rapidly in your 40s, which causes your metabolism to slow down since muscle burns more calories than fat. Unfortunately, this makes it harder to stave off those extra pounds. To help maintain muscle and keep your metabolism going, aim for two 15-minute sessions weekly of lifting weights, using a resistance band or doing other toning exercises.

Carve out Personal Time
"Between the demands of work and family, it becomes even more challenging to find time for yourself in your 40s," says Dr. Mieres. But it's crucial to do so—not only to help ease stress but also to guard against depression, which commonly crops up in this decade and can raise your risk of heart disease. "Find at least 10 minutes of ‘me' time every day to do something—even if it's just chatting on the phone with a friend—that helps you destress and regroup," says Dr. Mieres.


In Your 50s

Move More

Around menopause, you tend to gain extra weight around your belly, which can lead to insulin resistance, inflammation and heart strain. Cardiovascular fitness also starts to decline, particularly if you're not that physically active to begin with. "Unfortunately, at this point, women have to burn more calories to stay at the same weight," Dr. Stevens says. Start taking the stairs instead of the elevator whenever you can, walk faster around the mall, or jog to the mailbox to send letters instead of sticking your hand out the car window as you drive by. Small changes really do add up.

Have an ECG

Silent heart abnormalities become more common in your 50s, and an electrocardiogram (ECG) to check your heart's electrical activity can pick them up, says Dr. Goldberg. Also ask your doctor if you should have a stress test; this is especially important if you're just starting to exercise.

Add Fiber

Besides being good for your cholesterol and blood sugar, pumping up your fiber intake (think whole grains like oatmeal, brown rice and flaxseeds, as well as beans, fruits and veggies) can help prevent constipation, which becomes more of a problem as you get older and your digestive system starts to slow down.


In Your 60s

Get Even More Vigilant About Screenings

After you go through menopause and get older, your blood pressure and cholesterol tend to go up, and blood vessels get stiffer. "Have your blood sugar, blood pressure and cholesterol measured yearly," advises Dr. Goldberg.

Consider Medication

If you have hypertension or high cholesterol, the way you've been managing it before may not be enough. "As you get older, you may need more aggressive therapy," Dr. Bonow says. "High blood pressure that was controlled with one medication may now require three to control it." Talk to your doctor about whether you need to add to or adjust your medications to control your risk factors.

Be Alert to Symptoms

Now is when the first noticeable symptoms of heart disease may appear, so it's important to know what's normal for your body and be on the lookout for worrisome signs like chest discomfort, shortness of breath or changes in exercise tolerance—meaning you suddenly feel winded going up a flight of stairs or feel unusually tired for no apparent reason, says Dr. Mieres. If these appear, see your doctor pronto!

Classification of Medically Important Viruses

The classification of viruses is based on chemical and morphologic criteria.

The two major components of the virus used in classification are:
(1) The nucleic acid (its molecular weight and structure)
(2) The capsid (its size and symmetry and whether it is enveloped)

DNA viruses
(a) Noneveloped icosahedral virus families:
- Parvoviruses
- Papovaviruses
- Adenoviruses

(b) Enveloped virus families:
- Hepadnaviruses (Enveloped icosahedral viruses)
- Herpesviruses (Enveloped icosahedral viruses)
- Poxviruses (Enveloped complex viruses)

Parvoviruses

Envelope present: No
Capsid symmetry: Icosahedral
Particle size (nm): 22
DNA MW (x10^6): 2
DNA structure: Single-stranded, linear
Medically important viruses:
(i) B19 virus

Papovaviruses

Envelope present: No
Capsid symmetry: Icosahedral
Particle size (nm): 55
DNA MW (x10^6): 3-5
DNA structure: Double-stranded, circular, supercoiled
Medically important viruses:
(i) Papillomavirus

Adenoviruses

Envelope present: No
Capsid symmetry: Icosahedral
Particle size (nm): 75
DNA MW (x10^6): 23
DNA structure: Double-stranded, linear
Medically important viruses:
(i) Adenovirus

Hepadnaviruses

Envelope present: Yes
Capsid symmetry: Icosahedral
Particle size (nm): 42
DNA MW (x10^6): 1.5
DNA structure: Double-stranded, incomplete circular
Medically important viruses:
(i) Hepatitis B virus

Herpesviruses

Envelope present: Yes
Capsid symmetry: Icosahedral
Particle size (nm): 100 (neocapsid; but the envelope varies in size; the entire virus can be as large as 200 nm in diameter)
DNA MW (x10^6): 100-150
DNA structure: Double-stranded, linear
Medically important viruses:
(i) Herpes simplex virus
(ii) Varicella-zoster virus
(iii) Cytomegalovirus
(iv) Epstein-Barr virus

Poxviruses

Envelope present: Yes
Capsid symmetry: Complex
Particle size (nm): 250x400
DNA MW (x10^6): 125-185
DNA structure: Double-stranded, linear
Medically important viruses:
(i) Smallpox virus
(ii) Vaccinia virus


RNA viruses
(a) Noneveloped icosahedral virus families:
- Picornaviruses
- Caliciviruses
- Reoviruses

(b) Enveloped virus families:
- Flaviviruses (Enveloped icosahedral viruses)
- Togaviruses (Enveloped icosahedral viruses)
- Retroviruses (Enveloped icosahedral viruses)
- Orthomyxoviruses (Enveloped helical viruses)
- Paramyxoviruses (Enveloped helical viruses)
- Rhabdoviruses (Enveloped helical viruses)
- Filoviruses (Enveloped helical viruses)
- Coronaviruses (Enveloped helical viruses)
- Arenaviruses (Enveloped helical viruses)
- Bunyaviruses (Enveloped helical viruses)
- Deltaviruses (Enveloped uncertain viruses)

Picornaviruses

Envelope present: No
Capsid symmetry: Icosahedral
Particle size (nm): 28
RNA MW (x10^6): 2.5
RNA structure: Single-stranded, linear, nonsegmented, positive polarity
Medically important viruses:
(i) Poliovirus
(ii) Rhinovirus
(iii) Hepatitis A virus

Caliciviruses

Envelope present: No
Capsid symmetry: Icosahedral
Particle size (nm): 38
RNA MW (x10^6): 2.7
RNA structure: Single-stranded, linear, nonsegmented, positive polarity
Medically important viruses:
(i) Norwalkvirus
(ii) Hepatitis E virus

Reoviruses

Envelope present: No
Capsid symmetry: Icosahedral
Particle size (nm): 75
RNA MW (x10^6): 15
RNA structure: Double-stranded, linear, 10 segments
Medically important viruses:
(i) Rotavirus

Flaviviruses

Envelope present: Yes
Capsid symmetry: Icosahedral
Particle size (nm): 45
RNA MW (x10^6): 4
RNA structure: Single-stranded, linear, nonsegmented, positive polarity
Medically important viruses:
(i) Yellow fever virus
(ii) Dengue virus
(iii) West Nile virus
(iv) Hepatitis C virus

Togaviruses

Envelope present: Yes
Capsid symmetry: Icosahedral
Particle size (nm): 60
RNA MW (x10^6): 4
RNA structure: Single-stranded, linear, nonsegmented, positive polarity
Medically important viruses:
(i) Rubella virus

Retroviruses

Envelope present: Yes
Capsid symmetry: Icosahedral
Particle size (nm): 100
RNA MW (x10^6): 7 (Contains 2 identical molecules of MW 3.5x10^6)
RNA structure: Single-stranded, linear, 2 segments, positive polarity
Medically important viruses:
(i) HIV
(ii) T-cell leukemia virus

Orthomyxoviruses

Envelope present: Yes
Capsid symmetry: Helical
Particle size (nm): 80-120
RNA MW (x10^6): 4
RNA structure: Single-stranded, linear, 8 segments, negative polarity
Medically important viruses:
(i) Influenza virus

Paramyxoviruses

Envelope present: Yes
Capsid symmetry: Helical
Particle size (nm): 150
RNA MW (x10^6): 6
RNA structure: Single-stranded, linear, nonsegmented, negative polarity
Medically important viruses:
(i) Measles virus
(ii) Mumps virus
(iii) Respiratory syncytial virus

Rhabdoviruses

Envelope present: Yes
Capsid symmetry: Helical
Particle size (nm): 75x180
RNA MW (x10^6): 4
RNA structure: Single-stranded, linear, nonsegmented, negative polarity
Medically important viruses:
(i) Rabies virus

Filoviruses

Envelope present: Yes
Capsid symmetry: Helical
Particle size (nm): 80 (Particles' wide; but can be thousands of nanometers long)
RNA MW (x10^6): 4
RNA structure: Single-stranded, linear, nonsegmented, negative polarity
Medically important viruses:
(i) Ebola virus
(ii) Marburg virus

Coronaviruses

Envelope present: Yes
Capsid symmetry: Helical
Particle size (nm): 100
RNA MW (x10^6): 10
RNA structure: Single-stranded, linear, nonsegmented, positive polarity
Medically important viruses:
(i) Coronavirus

Arenaviruses

Envelope present: Yes
Capsid symmetry: Helical
Particle size (nm): 80-130
RNA MW (x10^6): 5
RNA structure: Single-stranded, circular, 2 segments with cohesive ends, negative polarity
Medically important viruses:
(i) Lymphocytic choriomeningitis virus

Bunyaviruses

Envelope present: Yes
Capsid symmetry: Helical
Particle size (nm): 100
RNA MW (x10^6): 5
RNA structure: Single-stranded, circular, 3 segments with cohesive ends, negative polarity
Medically important viruses:
(i) California encephalitis virus
(ii) Hantavirus

Deltaviruses

Envelope present: Yes
Capsid symmetry: Uncertain (The nucleocapsid appears spherical but its symmetry is unknown)
Particle size (nm): 0.5
RNA MW (x10^6): 5
RNA structure: Single-stranded, circular, closed circle, negative polarity
Medically important viruses:
(i) Hepatitis delta virus

Viral classification (Holmes classification)

Viral classification starts at the level of order and follows as thus, with the taxon suffixes given in italics:
Order (-virales)
Family (-viridae)
Subfamily (-virinae)
Genus (-virus)
Species

Holmes (1948) used Carolus Linnaeus's system of binomial nomenclature to classify viruses into 3 groups under one order, Virales. They are placed as follows:

Group I: Phaginae (attacks bacteria)
Group II: Phytophaginae (attacks plants)
Group III: Zoophaginae (attacks animals)

- Bacterial viruses:
(a) Corticoviridae
(b) Cystoviridae
(c) Inoviridae
(d) Leviviridae
(e) Microviridae
(f) Myoviridae
(g) Pedoviridae
(h) Plasmaviridae
(i) Styloviridae
(j) Tectiviridae

- Plant viruses:
(a) Alfalfa mosaic virus group
(b) Bromovirus group
(c) Carlavirus group
(d) Caulimovirus group
(e) Closterovirus group
(f) Comovirus group
(g) Cucumovirus group
(h) Hordeivirus group
(i) Ilarvirus group
(j) Lutiovirus group
(k) Nepovirus group
(l) Pea enation mosaic virus group
(m) Potexvirus group
(n) Potyvirus group
(o) Tobacco necrosis virus group
(p) Tobamovirus group
(q) Tobravirus group
(r) Tomato spotted wilt virus group
(s) Tombusvirus group
(t) Tymovirus group

- Vertebrate viruses:
(a) Adenoviridae
(b) Arenaviridae
(c) Bunyaviridae
(d) Coronaviridae
(e) Herpesviridae
(f) Iridoviridae
(g) Orthomyxoviridae
(h) Papovaviridae
(i) Paramyxoviridae
(j) Parvoviridae
(k) Picornaviridae
(l) Poxviridae
(m) Reoviridae
(n) Retroviridae
(o) Rhabdoviridae
(p) Togaviridae

- Invertebrate viruses

Perkembangan struktur & fungsi organ, serta psikomotor pada masa neonatus & perinatal (GDS-K06&K07: Versi FK USU)

Pemeriksaan fizik pada bayi baru lahir

- Bayi baru lahir: Pemeriksaan fizikal lengkap dilakukan dalam masa 24 jam pertama kelahiran. Dengar dahulu pada jantung dan paru-paru bayi baru lahir pada saat bayi diam (berhenti menangis). Hangatkan stetoskop sebelum digunakan untuk membuat pemeriksaan kepada bayi.

- Tanda-tanda vital yang perlu diperiksa:
(1) Suhu tubuh
(2) Frekuensi respirasi/ pernafasan (normal: 40-60 kali/minit)
(3) Tekanan darah
(4) Frekuensi denyutan nadi (normal: 100-180 kali/minit)

- Lingkaran kepala dan persentil: Letakkan pita pengukur disekeliling kepala sebelah depan
(diatas kening) dan pada kawasan occipital, pita tersebut seharusnya berada di atas telinga.
- Lingkaran kepala yang normal bagi bayi baru lahir adalah 32-37 cm.
- Diukur juga:
(a) Panjang dan persentil.
(b) Berat dan persentil.
(c) Penilaian usia kandungan.

- Keadaan umum yang perlu dinilai:
(a) Aktiviti
(b) Warna kulit
(c) Kelainan bawaan yang jelas (jika ada)

- Perkara yang perlu dilihat pada kulit:
(a) Warna:
* Plethora (Pekat, warna merah mawar):
-- Biasa terjadi pada bayi polycytemia.
-- Dapat dilihat terjadinya overoksigenasi dan "overheated" pada bayi tersebut.
-- Eritema (erythema) neonatorum: Fenomena normal pada waktu peralihan dan boleh terjadi pada bayi apabila bayi tersebut dirangsang secara berlebihan.
* Jaundice / pallor:
-- Pucat (Kelihatan pucat dan lesu, serta warna kulit keputih-putihan)
* Cyanosis:
(i) Cyanosis berpusat: Kulit kebiru-biruan termasuk pada bibir dan lidah.
(ii) Cyanosis periferi: Kulit kebiru-biruan dengan bibir dan lidah berwarna merah jambu (pink).
(iii) Acrocyanosis: Kulit kebiru-biruan pada tangan dan kaki sahaja.




Gambaran bayi polycytemia dan pallor


Gambaran bayi cyanosis




















* Kebiru-biruan yang meluas (ecchymoses): Disebabkan oleh kesulitan dan perpanjangan masa kelahiran.
* "Blue on pink" atau "Pink on blue": Disebabkan oleh kurangnya aliran darah dalam tubuh bayi (poor purfusion), oksigenasi yang tidak mencukupi, pengudaraan yang tidak cukup, atau polycytemia.
* "Herlequin coloration": Kelihatan garis demarkasi (demarcation) yang jelas diantara kawasan kulit yang kemerah-merahan dan kawasan kulit yang berwarna normal.
* Perubahan warna pada kawasan yang berbentuk tidak teratur (mottling) - berbentuk seperti berenda berwana merah (lacy red pattern): Kemungkinan boleh dijumpai pada bayi yang sihat dan pada bayi yang mengalami stres akibat sejuk, hipovolemia, atau sepsis.
* Persistent mottling (cutis marmorata) dijumpai pada bayi sindrom down, trisomy 13 atau trisomy 18.

Persistent mottling (cutis marmorata)

* Vernix caseosa: Bahan yang menutupi kulit sehingga minggu ke-38 kandungan.
* Bayi collodion: Kulit bayi yang kering kontang, pertumbuhan hidung dan telinga yang terbatas.
* Kulit kering: Bayi postmatur atau postdate, syphillis bawaan, dan jangkitan candidiasis.

(b) Erupsi sementara pada kulit (rashes):
* Milia: Jasad berwarna keputih-putihan, bersaiz sebesar kepala pin, terletak pada dagu, hidung, dahi, dan pipi.
* Erythema toxicum: Kawasan-kawasan kecil kulit yang berwarna merah serta terdapat sebuah tonjolan lesi (papule) berwarna kuning keputihan, berbatas jelas, dan padat di tegahnya.
* Candida albicans rash: "Erythematous plaques with sharply demercated edges."
* Transient neonatal pustular melanosis: "Pustules (lesi-lesi kulit kecil, menonjol, berbatas, dan mengandung nanah) , ruptured vesicupustules, and hyperpigmented macules (bertompok, bintik, atau penebalan di sesuatu tempat)"
* Acne (penyakit peradangan pada kulit dengan pembentukan erupsierupsi atau pustula) pada neonatorum: Comedones (sumbatan dari keratin dan sebum di dalam orifisium folikel rambut yang melebar, seringkali mengandungi bakteria Propinibacterium acnes, Staphylococcus albus, dan Pityrosporon ovale) dan papules pada dagu, pipi, serta dahi.
* Herpes simplex: "Pustular vesicular rash, vesicles, bullae (lesi-lesi kulit yang berbatas jelas, mengandung cairan, meninggi, biasanya diameter lebih dari 5 mm), or denuded skin"

(c) Nevi
* Macular hemangioma ('Stork bites'): Hilang secara spontan dalam usia 1 tahun.
* Port-wine stain (nevus flammeus): "Does not blanch with pressure and not disappear with time."
* Mongolian spot: "Dark blue or purple bruise-like makular spots, most common birthmark"
* Cavernous hemagioma: Besar, merah, berbentuk kista, padat, jasad yg sakit bila disentuh. Jika ia disertai dengan thrombocytopenia maka ia disebut sebagai sindrom Kasabach-Merrit.
* Strawberry hemangioma (macular hemangioma): "Flat, bright red, sharply demarcated lesions."

- Perkara yang perlu dilihat pada kepala neonatal:
(a) Fontanella anterior dan posterior:
* Fontanella anterior biasanya menutup pada 9-12 bulan
* Fontanella posterior biasanya menutup pada 2-4 bulan
(b) Molding: Tengkorak "asymmetry" akibat dari proses kelahiran dan ia bersifat sementara.
(c) Caput succedaneum
(d) Cephalhematoma
(e) Subgaleal hematoma

-- Peningkatan tekanan intrakranial:
(a) Membonjol pada fontanella anterior
(b) Sutura-sutura kepala terpisah
(c) Paralisis seolah-olah merenung ke atas - upward gaze (setting-sun sign)
(d) Vena-vena menonjol pada kulit kepala
(e) Meningkatkan makrosefali

Konsep dasar pertumbuhan & perkembangan (GDS-K01: Versi FK USU)

Pengenalan

(1) Definisi kanak-kanak:
- Dahulu (berdasarkan UU (Undang-undang) tenaga kerja & UU perkahwinan): Belum berusia 12 tahun/ belum berusia 15 tahun/ belum berusia 16 tahun.
- UU No.9 tahun 1979 RI (Republik Indonesia) tentang kesejahteraan kanak-kanak: Belum berusia 21 tahun dan belum berkahwin.
- Konvensi hak-hak kanak-kanak 1989: Belum berusia 18 tahun dan belum berkahwin
- UU No.23 tahun 2002 RI tentang perlindungan kanak-kanak: Belum berusia 18 tahun, termasuk janin di dalam kandungan.

(2) Perbandingan antara kanak-kanak dan orang dewasa:
- Pertumbuhan dan perkembangan:
* Kanak-kanak: (+)
* Dewasa: (-)

- Perbandingan kepala dan panjang badan:
* Kanak-kanak: (1/4)
* Dewasa: (1/8)

- Perbandingan badan dan panjang badan:
* Kanak-kanak: (1/4)
* Dewasa: (1/2)

- Pusat badan:
* Kanak-kanak: Umbilikus (pusat)
* Dewasa: Simfisis pubis

- % cairan tubuh:
* Kanak-kanak: 70-80%
* Dewasa: 50-60%

- Keperluan:
* Kanak-kanak dan orang dewasa adalah berbeza


Pengertian pertumbuhan dan perkembangan:

- Pertumbuhan dan perkembangan adalah seluruh proses kejadian sejak terjadinya persenyawaan sampai ke usia dewasa.

- Pertumbuhan: Perubahan ukuran/ besar/ bentuk sel, organ, mahupun individu. Pertambahan jumlah sel dan zat interselular. Dilihat dari sudut fizik.
Perubahan fizikal yang spesifik pada penambahan saiz yang dilihat dari segi ketinggian, berat badan, ukur lilit kepala, panjang tangan dan kaki, serta bentuk tubuh.

- Perkembangan: Perubahan struktur/ kematangan/ fungsi sel, organ, mahupun individu. Bertambahnya ketrampilan/ fungsi kompleks dalam gerak kasar, gerak halus, bicara dan bahasa, serta sosialisasi/ kemandirian. Dilihat dari sudut intelektual dan emosional.
Sesuatu pertambahan dari sudut kompleksiti/ suatu perubahan dari ringkas kepada lebih kompleks dan terperinci dari segi pengetahuan, sikap, serta kemahiran-kemahiran.


Domain-domain perkembangan:

- Gerak kasar (Motorik kasar): Kemampuan kanak-kanak dalam melakukan pergerakan dan sikap tubuh yang melibatkan otot-otot besar seperti duduk, berdiri, berjalan dan sebagainya.

- Gerak halus (Motorik halus): Kemampuan kanak-kanak dalam gerakan yang melibatkan bahagian-bahagian tubuh tertentu yang dilakukan oleh otot-otot kecil tapi memerlukan koordinasi yang cermat seperti memegang, menulis, mengamati, dan sebagainya.
Tergantung kepada kematangan otak, input daripada sistem sensorik, menambahan berat dan bilangan tisu otot, sebuah sistem saraf yang sihat dan peluang-peluang untuk melatih kemahiran-kemahiran tersebut.

- Bicara dan bahasa: Kemampuan untuk memberi respon terhadap suara, berbicara, berkomunikasi, melaksanakan perintah, dan sebagainya.
Bahasa didefinisikan sebagai suatu sistem simbol-simbol, percakapan, penulisan dan tingkah laku, untuk membenarkan manusia saling berkomunikasi. Bergantung kepada kematangan sebaik pembelajaran dari peluang-peluang yang diberikan.

- Sosialisasi dan berdikari: Kemampuan makan sendiri, membersihkan permainan selepas bermain, berpisah dengan ibu / pengasuh, berinteraksi dengan lingkungannya.
Merupakan area yang luas yang berurusan dengan bagaimana kanak-kanak merasakan tentang dirinya dan hubungan mereka dengan orang lain. Ia merujuk kepada perlakuan kanak-kanak dan respon-respon untuk bermain dan melakukan aktiviti, berhubungan dengan ibu bapa dan pengasuh serta hubungan bersama ahli-ahli keluarga serta rakan-rakannya.


Ciri-ciri pertumbuhan dan perkembangan

- Pertumbuhan dan perkembangan: Berbeza, saling berkaitan, berkesinambungan, sulit dipisahkan. Maka digunakan istilah pertumbuhan dan perkembangan.
- Pertumbuhan dan perkembangan:
(a) Pertumbuhan dan perkembangan fizikal
(b) Pertumbuhan dan perkembangan intelektual
(c) Pertumbuhan dan perkembangan emosi

- Pertumbuhan dan perkembangan fizikal: Meliputi perubahan dalam ukuran/ besar organ/ individu. Dari tingkat molekuler/ ringkas menjadi tingkat yang lebih kompleks. Perubahan bentuk fizik dari janin sehingga usia remaja.
Pertumbuhan fizikal: Sebuah proses individual yang tinggi, rumit, berhubungan dengan kemajuan di dalam area perkembangan yang lain. Keadaan perkembangan fizikal seorang kanak-kanak adalah merupakan satu indikator berkaitan kesihatan secara umum dan keadaan yang baik.

- Pertumbuhan dan perkembangan intelektual: Berkaitan dengan kepandaian berkomunikasi, kemampuan menangani material yang abstrak/ simbolik. Dari tingkat molekuler/ ringkas kepada proses kompleks. Pada bayi adalah perkembangan fungsi neurologik/ perilaku.

- Pertumbuhan dan perkembangan emosi:
Kemampuan membentuk ikatan batin, mempunyai rasa cinta/ kasih sayang, kemampuan menangani kegelisahan akibat kekecewaan/ rangsangan agresif yang lain.
Berkembang/ meluas: Dari keluarga kepada masyarakat.
Peristiwa pertumbuhan dan perkembangan: Dari waktu persenyawaan kepada usia dewasa.

** Pertumbuhan dan perkembangan mempunyai/ menimbulkan perubahan dan mempunyai beberapa ciri yang saling berkaitan:
(1) Perkembangan terjadi bersamaan dengan pertumbuhan
(2) Pertumbuhan dan perkembangan tahap awal menentukan perkembangan selanjutnya
(3) Pertumbuhan dan perkembangan mempunyai kecepatan yang berbeza
(4) Perkembangan berkadar langsung dengan pertumbuhan
(5) Perkembangan mempunyai pola yang tetap (cephalo-caudal dan proximo-distal)
(6) Perkembangan memiliki tahap yang berurutan
(7) Pola perkembangan dapat diramalkan
(8) Perkembangan merupakan hasil proses kematangan dan belajar

** Faktor yang mempengaruhi kualiti pertumbuhan dan perkembangan:
(1) Faktor dalam: Ras/ etnik/ suku bangsa, keluarga, umur, jenis kelamin, potensi genetik
(2) Faktor luar:
- Faktor prenatal: Nutrisi, mekanik, toksik / zat kimia, endokrin, radiasi, jangkitan, kelainan imunologik, dan kelainan embrio
- Faktor persalinan: Komplikasi persalinan: Trauma (cedera) lahir/ asfiksia sehingga menyebabkan kerosakan jaringan otak kanak-kanak
- Faktor pasca persalinan: Nutrisi, penyakit kronik/ kelainan bawaan, persekitaran fizik/ kimia, psikologik, endokrin, sosioekonomi, persekitaran pengasuhan, ubat-ubatan, dan rangsangan


Tahapan pertumbuhan dan perkembangan

Intra uterin (janin) -> Neonatus (Bayi baru lahir) -> Bayi -> Kanak-kanak prasekolah -> Usia sekolah -> Remaja -> Dewasa muda (18-21 tahun) -> Berkahwin -> Intra uterin

- Masa intra uterin (Prenatal):
(a) Masa embrio: Konsepsi (8-12 minggu)
(b) Masa fetus: Awal (12 minggu - trimester II), Lanjut (trimester III)

- Masa ekstra uterin (Postnatal):
(a) Masa neonatal: 0-28 hari
(b) Masa bayi: Awal (1-12 bulan), Lanjutan (1-2 tahun)
(c) Masa kanak-kanak Prasekolah: 2-6 tahun
(d) Masa sekolah: 6-12 tahun, (Pra akil baligh wanita: 6-10 tahun, Pra akil baligh lelaki: 6-12 tahun)
(e) Masa remaja: 13-18 tahun, (Akil baligh wanita: 10-18 tahun, Akil baligh lelaki; 12-18 tahun)


Tempoh pertumbuhan dan perkembangan
- Masa prenatal:
(a) Masa zigot / mudigah: Mulai konsepsi sampai usia 2 minggu kehamilan.
(b) Masa embrio: Usia kehamilan 2 minggu hingga 8 / 12 minggu
(c) Masa janin / fetus: Usia kehamilan 8 / 12 minggu sampai akhir kehamilan, Fetus awal (9 minggu hingga trimester II), Fetus lanjut (Trimester III).

- Masa bayi (infancy): Umur 0-11 bulan
(a) Masa neonatal: 0-28 hari, Neonatal awal (0-7 hari), Neonatal lanjutan (8-28 hari)
* Terjadi adaptasi terhadap persekitaran, perubahan peredaran darah, mulai berfungsinya organ.
(b) Masa post neonatal: 29 hari hingga 11 bulan

- Masa kanak-kanak bawah lima tahun: 12-59 bulan

- Masa kanak-kanak prasekolah: 60-72 bulan


Ciri-ciri pertumbuhan

- Perubahan ukuran: Pertumbuhan fizik (bertambah umur, bertambah berat badan, tinggi badan, lingkaran kepala, bertambah besar organ tubuh seperti jantung, paru-paru, usus, dan lain-lain)

- Perubahan perbandingan tubuh:
(a) Kepala:
* Bayi baru lahir relatif lebih besar.
* Dewasa relatif lebih kecil.
(b) Titik pusat tubuh:
* Bayi baru lahir di umbilikus/ pusat.
* Dewasa di atas simfisis.

- Hilangnya ciri-ciri lama: Hilangnya kelenjar thymus, tanggalnya gigi susu, hilangnya refleks primitif.

- Timbulnya ciri-ciri baru: Muncul gigi kekal, muncul tanda-tanda seks sekunder.

* Ciri pertumbuhan adalah bersifat unik, kerana:
(a) Kecepatan pertumbuhan tidak teratur
(b) Pola pertumbuhan berbeza untuk setiap organ

* Kecepatan pertumbuhan:
- Cepat I: 0-5 tahun
- Lambat I: 5-10 tahun
- Cepat II: 10-15 tahun
- Lambat II: 15-20 tahun


Grafik pertumbuhan berbagai organ


Pertumbuhan dan perkembangan janin

- Masa embrionik: 12 minggu pertama / trimester I intrauterin, differentiation cepat, ovum yang telah disenyawa akan berubah menjadi organisme yang secara anatomik telah berbentuk manusia.


- Masa fetal: Minggu 12-40, pertumbuhan cepat, fungsi organ terjadi pada minggu 38-40.
a) Tempoh praviable: Sebelum minggu 24-26
b) Tempoh viable (telah dapat hidup di luar rahim): Minggu 26-38

* Penyebab gangguan pada janin:
- Kelainan plasenta/ tali pusat sehingga terjadinya gangguan oksigenasi
- Jangkitan intrauterin: Toksoplasmosis, Rubella, Cytomegalovirus, Herpes simplex (TORCH)
- Trauma
- Radiasi
- Intoksikasi: Ubat, bahan kimia lainnya
- Gangguan imunologik: Golongan darah ABO/ Rhesus tidak compatible (sesuai)
- Kekurangan zat makanan pada ibu
- Anemia ibu hamil


Pertumbuhan dan perkembangan neonatus

- Penampilan fizik: Kepala besar, mandibula kecil, muka bundar, dada bundar, penampang A-P kurang mendatar, perut besar/ buncit, badan pendek, titik tengah tubuh di umbilikus.


- Antropometri:
(a) Berat badan lahir sekitar 3000 g, 95%: 2500-4500g
(b) Panjang badan lahir sekitar 50 cm, 95%: 45-55 cm
(c) Lingkaran kepala: 34-35 cm

- Fisiologi:
(a) Frekuensi pernafasan: 35-50 kali/minit (kurang daripada 60 kali/minit)
(b) Frekuensi denyutan jantung: 120-160 kali/minit
(c) Gerakan untuk memenuhi keperluan
(d) Memutar kepala kearah puting susu (rooting reflex)
(e) Menangis ketika lapar
(f) Menghisap (sucking reflex)
(g) Menelan (swallowing reflex)
(h) Terkejut (moro reflex)
(i) Buang air besar: 3-5 kali/hari, 24 jam pertama: hitam (mekonium), hari 3-4: peralihan ke warna coklat kehijauan

- Keperluan kalori:
(a) 55 kalori/kg berat badan/hari
(b) 110 kalori/kg berat badan/hari pada akhir minggu pertama

- Keperluan cairan:
(a) Hari pertama: 60 mL/kg berat badan/hari
(b) Hari kedua: 90 mL/kg berat badan/hari
(c) Hari ketiga: 120 mL/kg berat badan/hari
(d) 3 bulan pertama: 150-175 mL/kg berat badan/hari
(e) 3 bulan kedua: 135 mL/kg berat badan/hari
(f) 3 bulan ketiga: 125 mL/kg berat badan/hari
(g) 3 bulan keempat: 110 mL/kg berat badan/hari

- Darah:
(a) Hemoglobin: 17-19 g/dL
(b) Hematokrit: 52%
(c) Leukosit: 10 000-14 000/mm padu


Pertumbuhan dan perkembangan bayi (1 bulan-2 tahun)

Karakteristik fizik:
(a) Berat badan:
- 5 bulan: 2 kali berat badan lahir
- 1 tahun: 3 kali berat badan lahir
- 3 tahun: 4 kali berat badan lahir
- 5 tahun: 6 kali berat badan lahir
* Pertambahan berat badan (g per bulan):
- 3 bulan pertama: 700-1 000
- 3 bulan kedua: 500-600
- 3 bulan ketiga: 350-450
- 3 bulan keempat: 250-350

(b) Panjang badan:
- 1 tahun: 1.5 kali panjang badan lahir
- 4 tahun: 2 kali panjang badan lahir
- 6 tahun: 2.25 kali panjang badan lahir
- 13 tahun: 3 kali panjang badan lahir

(c) Lingkaran kepala:
- Lahir: 34-35 cm
- 6 bulan: 44 cm
- 1 tahun: 47 cm

(d) Lingkaran dada:
- Lahir: Kurang daripada lingkaran kepala
- 1 tahun: Sama dengan lingkaran kepala
* Ciri lain: Penambahan tisu subkutan (lemak).

(e) Fontanel anterior (Ubun-ubun besar):
- Lahir: 3x3 cm
- 6 bulan: Makin besar / lebar
- 9-18 bulan: Menutup

(f) Fontanel posterior (Ubun-ubun kecil):
- 4 bulan: Menutup

(g) Keluarnya gigi susu: 5-10 bulan
- Gigi kacip median bawah
- Diikuti gigi kacip median atas
- Diikuti gigi kacip lateral atas
- Diikuti gigi kacip lateral bawah
- Diikuti gigi geraham susu I
- Diikuti gigi taring
- Diakhiri gigi geraham susu II
* Umumnya pada usia 1 tahun: 6-8 gigi

Origin of key cosmic explosions unraveled

Origin of key cosmic explosions unraveled


Thu Feb 18, 3:31 am ET


CHICAGO (AFP) – Astronomers who have long used supernovas as cosmic mile markers to help measure the expansion of the universe now have an answer to the nagging question of what sparks the massive stellar explosions.

"These are such critical objects in understanding the universe," lead author Marat Gilfanov of the Max Planck Institute for Astrophysics in Germany said Wednesday in describing his team's study.

"It was a major embarrassment that we did not know how they worked. Now we are beginning to understand what lights the fuse of these explosions."

Most scientists say Type 1a supernovae are formed when a white dwarf star -- the collapsed remnant of an old star -- becomes unstable after it exceeds its weight limit.

Instability could come from the merging of two white dwarfs or accretion -- a process in which the gravity of the star draws in enough material from a sun-like companion.
Using NASA's Chandra X-ray Observatory, Gilfanov and his team studied the supernovas in five nearby elliptical galaxies and the central region of the Andromeda galaxy.

"Our results suggest the supernovae in the galaxies we studied almost all come from two white dwarfs merging," said co-author Akos Bogdan, also of Max Planck.

"If the supernova were produced by accretion, the galaxies would be roughly 50 times brighter in x-rays than actually observed."

Further study will be needed to determine if merging is also the primary cause of supernovae in spiral galaxies.

Pinpointing a possible supernova prior to the explosion is also extremely difficult, the researchers noted.

Pairs of white dwarfs are incredibly difficult to find. And once the white dwarfs spiral into distances when they are about to merge, it takes just a few tenths of a second for them to explode.

Knowing how supernovas are formed is key to better understand how they can be used to measure cosmic distances and tracing dark matter, said Mario Livio, an astrophysicist with the Space Telescope Science Institute in Maryland.

"We use Type 1a supernova to determine the properties of dark energy in order to be able to do that accurately we need to fully understand the evolution of the power of the luminosity of these supernovae," Livio said in a conference call with reporters.
"There is (also) this process that we call feedback -- namely all supernova play an important role in the evolution of their host galaxies."

The study is published in the February 18 edition of the journal Nature.

Schizophrenia

Schizophrenia

Overview




Schizophrenia is a chronic, severe, and disabling mental illness. It affects men and women with equal frequency. People suffering from schizophrenia may have the following symptoms:
- Delusions, false personal beliefs held with conviction in spite of reason or evidence to the contrary, not explained by that person's cultural context
- Hallucinations, perceptions (can be sound, sight, touch, smell, or taste) that occur in the absence of an actual external stimulus (Auditory hallucinations, those of voice or other sounds, are the most common type of hallucinations in schizophrenia.)
- Disorganized thoughts and behaviors
- Disorganized speech
- Catatonic behavior, in which the affected person's body may be rigid and the person may be unresponsive

The term schizophrenia is Greek in origin, and in the Greek meant "split mind." This is not an accurate medical term. In Western culture, some people have come to believe that schizophrenia refers to a split-personality disorder. These are two very different disorders, and people with schizophrenia do not have separate personalities.

Schizophrenia and other mental health disorders have fairly strict criteria for diagnosis. Time of onset as well as length and characteristics of symptoms are all factors. The active symptoms of schizophrenia must be present at least 6 months, or only 1 month if treated.

Who is affected?


Estimates of how many people are diagnosed with this disorder vary. The illness affects about 1% of the population. More than 2 million Americans suffer from schizophrenia at any given time, and 100,000-200,000 people are newly diagnosed every year. Fifty percent of people in hospital psychiatric care have schizophrenia.

Schizophrenia is usually diagnosed in people aged 17-35 years. The illness appears earlier in men (in the late teens or early twenties) than in women (who are affected in the twenties to early thirties). Many of them are disabled. They may not be able to hold down jobs or even perform tasks as simple as conversations. Some may be so incapacitated that they are unable to do activities most people take for granted, such as showering or preparing a meal.
Many are homeless. Some recover enough to live a life relatively free from assistance.

Causes



The causes of schizophrenia are not known. However, an interplay of genetic, biological, environmental, and psychological factors are thought to be involved. We do not yet understand all the causes and other issues involved, but current research is making steady progress towards elucidating and defining causes of schizophrenia.

In biological models of schizophrenia, genetic (familial) predisposition, infectious agents, allergies, and disturbances in metabolism have all been investigated.

Schizophrenia is known to run in families. Thus, the risk of illness in an identical twin of a person with schizophrenia is 40-50%. A child of a parent suffering from schizophrenia has a 10% chance of developing the illness. The risk of schizophrenia in the general population is about 1%.

The current concept is that multiple genes are involved in the development of schizophrenia and that factors such as
prenatal (intrauterine), perinatal, and nonspecific stressors
are involved in creating a disposition or vulnerability to develop the illness. Neurotransmitters (chemicals allowing the communication between nerve cells) have also been implicated in the development of schizophrenia. The list of neurotransmitters under scrutiny is long, but special attention has been given to dopamine, serotonin, and glutamate.

Also, recent studies have identified subtle changes in brain structure and function, indicating that, at least in part, schizophrenia could be a disorder of the development of the brain.

It is important for doctors to investigate all reasonable medical causes for any acute change in someone's mental health or behavior. Sometimes a medical condition that might be treated easily, if diagnosed, is responsible for symptoms that resemble those of schizophrenia.

Symptoms


Usually with schizophrenia, the person's inner world and behavior change notably. Behavior changes might include the following:

- Social withdrawal
- Depersonalization (intense anxiety and a feeling of being unreal)
- Loss of appetite
- Loss of hygiene
- Delusions
- Hallucinations (eg, hearing things not actually present)
- The sense of being controlled by outside forces

A person with schizophrenia may not have any outward appearance of being ill. In other cases, the illness may be more apparent, causing bizarre behaviors. For example, a person with schizophrenia may wear aluminum foil in the belief that it will stop one's thoughts from being broadcasted and protect against malicious waves entering the brain.

People with schizophrenia vary widely in their behavior as they struggle with an illness beyond their control. In active stages, those affected may ramble in illogical sentences or react with uncontrolled anger or violence to a perceived threat. People with schizophrenia may also experience relatively passive phases of the illness in which they seem to lack personality, movement, and emotion (also called a flat affect). People with schizophrenia may alternate in these extremes. Their behavior y or mayma not be predictable.

In order to better understand schizophrenia, the concept of clusters of symptoms is often used. Thus, people with schizophrenia can experience symptoms that may be grouped under the following categories:
- Positive symptoms - Hearing voices, suspiciousness, feeling under constant surveillance, delusions, or making up words without a meaning (neologisms).
- Negative (or deficit) symptoms - Social withdrawal, difficulty in expressing emotions (in extreme cases called blunted affect), difficulty in taking care of themselves, inability to feel pleasure (These symptoms cause severe impairment and are often mistaken for laziness.)
- Cognitive symptoms - Difficulties attending to and processing of information, in understanding the environment, and in remembering simple tasks
- Affective (or mood) symptoms - Most notably depression, accounting for a very high rate of attempted suicide in people suffering from schizophrenia

Helpful definitions in understanding schizophrenia include the following:
- Psychosis: Psychosis is defined as being out of touch with reality. During this phase, one can experience delusions or prominent hallucinations. People with psychoses are not aware that what they are experiencing or some of the things that they believe are not real. Psychosis is a prominent feature of schizophrenia but is not unique to this illness.
- Schizoid: This term is often used to describe a personality disorder characterized by almost complete lack of interest in social relationships and a restricted range of expression of emotions in interpersonal settings, making a person with this disorder appear cold and aloof.
- Schizotypal: This term defines a more severe personality disorder characterized by acute discomfort with close relationships as well as disturbances of perception and bizarre behaviors, making people with schizophrenia seem odd and eccentric because of unusual mannerisms.
- Hallucinations: A person with schizophrenia may have strong sensations of objects or events that are real only to him or her. These may be in the form of things that they believe strongly that they see, hear, smell, taste, or touch. Hallucinations have no outside source, and are sometimes described as "the person's mind playing tricks" on him or her.
- Illusion: An illusion is a mistaken perception for which there is an actual external stimulus. For example, a visual illusion might be seeing a shadow and misinterpreting it as a person. The words "illusion" and "hallucination" are sometimes confused with each other.
- Delusion: A person with a delusion has a strong belief about something despite evidence that the belief is false. For instance, a person may listen to a radio and believe the radio is giving a coded message about an impending extraterrestrial invasion. All of the other people who listen to the same radio program would hear, for example, a feature story about road repair work taking place in the area.

Types


Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations but relatively normal intellectual functioning and expression of affect. The delusions can often be about being persecuted unfairly or being some other person who is famous. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and argumentativeness.

Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh at the changing color of a traffic light or at something not closely related to what they are saying or doing. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.

Catatonic-type schizophrenia is characterized by disturbances of movement. People with catatonic-type schizophrenia may keep themselves completely immobile or move all over the place. They may not say anything for hours, or they may repeat anything you say or do senselessly. Either way, the behavior is putting these people at high risk because it impairs their ability to take care of themselves.

Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types but not enough of any one of them to define it as another particular type of schizophrenia.

Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no positive symptoms (delusions, hallucinations, disorganized speech or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.

When to Seek Medical Care

If someone who has been diagnosed with schizophrenia has any behavior change that might indicate treatment is not working, it is best to call the doctor. If the family, friends, or guardians of a person with schizophrenia believe symptoms are increasing, a doctor should be called as well. Do not overlook the possibility of another medical problem in addition to the schizophrenia.

On a general level, anyone with an acute change in mental status (a noticeable change in behavior), whether diagnosed with schizophrenia or not, should be taken to a hospital or a physician for evaluation. The behavior change may indicate a readily treatable medical illness that, if not treated early, can cause permanent physical damage.

Someone with schizophrenia should be taken to the hospital if medical illness is suspected. People with schizophrenia may or may not be able to communicate their symptoms in the same way as someone who does not have schizophrenia. This situation requires a doctor for diagnosis and treatment. Moreover, medical illness can aggravate schizophrenia.
Take your loved one with schizophrenia immediately to the hospital and/or call "911" or "999" (in Malaysia) if he or she is in danger of self-harm or harming others. People with schizophrenia are much more likely than the general population to commit suicide.

A quick way to assess whether someone is suicidal or homicidal is to ask the questions: "Do you want to hurt or kill yourself?" "Do you want to hurt or kill anyone?" "Are you hearing any voices?" and "What are the voices telling you?" People will tell you what is on their mind and should be taken seriously when they verbalize these thoughts.

Many families fear abusing the emergency medical system when these and similar issues arise. However, if you have any doubts, go to the emergency department. Don't worry about whether the visit should be made. If, afterward, the health concern is found not to be an emergency problem, then everyone is relieved. Likewise, if a medical emergency is found, you have made the right decision. The medical professionals can reassure you that you made the right decision in the face of unknown medical questions about someone else's health.

Exams and Tests


To diagnose schizophrenia, one has first to rule out any medical illness that may be the actual cause of the behavioral changes. Once medical causes have been looked for and not found, a psychotic illness such as schizophrenia could be considered. The diagnosis will best be made by a licensed mental health professional (preferably a psychiatrist) who can evaluate the patient and carefully sort through a variety of mental illnesses that might look alike at the initial examination.

The doctor will examine someone in whom schizophrenia is suspected either in an office or in the emergency department. The doctor's role is to ensure that the patient doesn't have any medical problems. The doctor takes the patient's history and performs a physical examination. Laboratory and other tests, sometimes including a computerized tomography (CT) scan of the brain, are performed. Physical findings can relate to the symptoms associated with schizophrenia or to the medications the person may be taking.

People with schizophrenia can exhibit a mild confusion or clumsiness.
Subtle minor physical features, such as highly arched palate or wide or narrow set eyes, have been described, but none of these findings alone allow the physician to make the diagnosis.

Most symptoms found are related to movement (motor symptoms). Some of these can be side effects of prescribed medications. Medications may, for example, cause dry mouth, constipation, drowsiness, stiffness on one side of the neck or jaw, restlessness, tremors of the hands and feet, and slurred speech.

Tardive dyskinesia is one of the most serious side effects of medications used to treat schizophrenia. It is usually seen in older people and involves facial twitching, jerking and twisting of the limbs or trunk of the body, or both. It is a less common side effect with the newer generation of medications used to treat schizophrenia. It does not always go away, even when the medicine that caused it is discontinued.

A rare, but life-threatening complication resulting from the use of neuroleptic (antipsychotic, tranquilizing) medications is neuroleptic malignant syndrome (NMS). It involves extreme muscle rigidity, sweatiness, salivation, and fever. If this is suspected, it should be treated as an emergency.

Generally, results are normal in schizophrenia for the lab tests and imaging studies available to most doctors. If the person has a particular behavior as part of their mental disorder, such as drinking too much water, then this might show as a metabolic abnormality in the person's laboratory results. Some medications can trigger a decreased immune response, reflected by a low number of white blood cells in the blood. Likewise, in people with NMS, metabolism may be abnormal.

Family members or friends of the person with schizophrenia can help by giving the doctor a detailed history and information about the patient, including behavioral changes, previous level of social functioning, history of mental illness in the family, past medical and psychiatric problems, medications, and allergies (to foods and medications), as well as the person's previous physicians and psychiatrists. A history of hospitalizations is also helpful so that old records at these facilities might be obtained and reviewed.

Treatment


(A) Self-Care at Home

Home care for a person with schizophrenia depends on how ill the person is and on the family or guardian's ability to care for the person. The ability to care for a person with schizophrenia is tied closely to time, emotional strength, and financial reserves.

In spite of these possible barriers, basic issues to address with people with schizophrenia, include the following:
- First, ensure that your loved one is taking prescribed medications. One of the most common reasons that people with schizophrenia relapse into a new episode is that they quit taking medication. Family members might see much improvement and mistakenly assume medications may no longer be needed. That is a disastrous assumption. A later psychotic outbreak will likely happen.
- The family should provide a caring, safe environment that allows for as much freedom of action as is appropriate at the time. Any hostility in the environment should be reduced or eliminated. Likewise, any criticism should be reduced.

(B) Medical Treatment

This is a time of hope for people with schizophrenia as well as for their families. New and safer medications are constantly being discovered, thus making it possible not only to treat symptoms otherwise resistant to treatment (such as negative or cognitive symptoms), but to considerably diminish the side-effect burden and to improve the quality and enjoyment of life.

In patients experiencing acutely psychotic episodes in which they are obviously a danger to themselves and others, due to either suicidal or homicidal ideation, or inability to take care of their basic needs, hospitalization and antipsychotic medications are the treatments of choice. Hospitalization is essential.

Medications


Antipsychotic medications are proven effective in treating acute psychosis and reducing the risk of future psychotic episodes. The treatment of schizophrenia thus has two main phases: an acute phase, when higher doses might be necessary in order to treat psychotic symptoms, followed by a maintenance phase, which could be life-long. During the maintenance phase, dosage is gradually reduced to the minimum required to prevent further episodes. If symptoms reappear on a lower dosage, a temporary increase in dosage may help prevent a relapse.

Even with continued treatment, some patients experience relapses. By far, though, the highest relapse rates are seen when medication is discontinued.

The large majority of patients experience substantial improvement when treated with antipsychotic agents. Some patients, however, do not respond to medications, and a few may seem not to need them.

Since it is difficult to predict which patients will fall into what groups, it is essential to have long-term follow-up, so that the treatment can be adjusted and any problems addressed promptly.

Antipsychotic medications are the cornerstone in the management of schizophrenia. They have been available since the mid-1950s, and although antipsychotics do not cure the illness, they greatly reduce the symptoms and allow the patient to function better, have better quality of life, and enjoy an improved outlook. The choice and dosage of medication is individualized and is best done by a physician who is well trained and experienced in treating severe mental illness.

The first antipsychotic was discovered by accident and then used for schizophrenia. This was chlorpromazine (Thorazine), which was soon followed by medications such as haloperidol (Haldol), fluphenazine (Prolixin), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). These medications have become known as "neuroleptics" because, although effective in treating positive symptoms (ie, acute symptoms such as hallucinations, delusions, thought disorder, loose associations, ambivalence, or emotional lability), they cause side effects, many of which affect the neurologic (nervous) system. These older medications are not as effective against symptoms such as decreased motivation and lack of emotional expressiveness.

Since 1989, a new class of antipsychotics (atypical antipsychotics) has been introduced. At clinically effective doses, no (or very few) of these neurological side effects, which often affect the extrapyramidal nerve tracts (which control such things as muscular rigidity, painful spasms, restlessness, or tremors) are observed.

The first of the new class, clozapine (Clozaril) is the only agent that has been shown to be effective where other antipsychotics have failed. Its use is not associated with extrapyramidal side effects, but it does produce other side effects, including possible decrease in the number of white cells, so the blood needs to be monitored every week during the first 6 months of treatment and then every 2 weeks to catch this side effect early if it occurs.

Other atypical antipsychotics include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify). The use of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizophrenia.

Although more effective and better tolerated, the use of these agents is also associated with side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and monitoring for the emergence of complications.

Most of these medications take 2-4 weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, and another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least 6-8 weeks (or even longer with clozapine).

Because the risk of relapse of illness is higher when antipsychotic medications are taken irregularly or discontinued, it is important that people with schizophrenia follow a treatment plan developed in collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed medication in the correct amount and at the times recommended, attending follow-up appointments, and following other treatment recommendations.

People with schizophrenia often do not believe that they are ill or that they need treatment. Other possible things that may interfere with the treatment plan include side effects from medications, substance abuse, negative attitudes towards treatment from families and friends, or even unrealistic expectations. When present, these issues need to be acknowledged and addressed for the treatment to be successful.

Other Therapy


Psychosocial treatments

In spite of successful antipsychotic treatment, many patients with schizophrenia have difficulty with motivation, activities of daily living, relationships, and communication skills. Also, since the illness typically begins during the years critical to education and professional training, these patients lack social and work skills and experience. In these cases, the psychosocial treatments help most, and many useful treatment approaches have been developed to assist people suffering from schizophrenia.

Individual psychotherapy: This involves regular sessions between just the patient and a therapist focused on past or current problems, thoughts, feelings, or relationships. Thus, via contact with a trained professional, people with schizophrenia become able to understand more about the illness, to learn about themselves and to better handle the problems of their daily lives. They become better able to differentiate between what is real and, by contrast, what is not and can acquire beneficial problem-solving skills.

Rehabilitation: Rehabilitation may include job and vocational counseling, problem solving, social skills training, and education in money management. Thus, patients learn skills required for successful reintegration into their community following discharge from the hospital.

Family education: Research has consistently shown that people with schizophrenia who have involved families fare better than those who battle the condition alone. Insofar as possible, all family members should be involved in the care of your loved one.

Self-help groups: Outside support for family members of those with schizophrenia is necessary and desirable. The National Alliance for the Mentally Ill (NAMI) is an in-depth resource. This outreach organization offers information on all treatments for schizophrenia, including home care.

Follow-up


Follow-up after an initial stay in the hospital is absolutely essential if the person with schizophrenia is to continue to improve and recover. It is especially important to take any medications as prescribed and to go to therapy sessions.

Prevention


Not enough is known, as yet, about the causes of schizophrenia to determine practical preventive measures. However, research in this area is very active, and it may be possible to offer some useful suggestions regarding prevention in the not-too-distant future.

Outlook


This is a time of hope for people with schizophrenia. New antipsychotics are currently under investigation, and brain research is progressing towards understanding the molecular and neuronal underpinnings of the illness. Currently, schizophrenia cannot be cured but the outlook for people suffering from this illness is constantly improving. Here are a few predictors of outcome worth mentioning:

How well the person with schizophrenia functioned in society and at work prior to onset of the mental illness will be important in determining the long-term outcome.

The amount of time that lapses from onset of symptoms to diagnosis and treatment can often help to predict outcome as well. The sooner someone is treated for schizophrenia once symptoms begin, the better the overall likelihood for improvement and recovery. However, at this time, the average length of time between the onset of psychosis and first treatment is 6-7 years.

Schizophrenia can be treated using multiple methods, including medication, psychotherapy, and behavioral therapy. Psychiatrists, primary care physicians, psychologists, social workers, and other mental health professionals are pivotal in helping people with schizophrenia and their families explore available resources that lead to complete treatment. Many people with schizophrenia recover to the point of living functional and rewarding lives in their communities.

Support Groups and Counseling


Self help groups: Schizophrenics Anonymous is an organization devoted to support of the person with schizophrenia.

Outside support for family members of those with schizophrenia is necessary and desirable. The National Alliance for the Mentally Ill (NAMI) is an in-depth resource. This outreach organization offers information on all treatments for schizophrenia, including home care.

Another organization that can be useful for both people with schizophrenia and their families is the National Mental Health Association or one of its state or county chapters.

Neoplasms of The Central Nervous System

NEOPLASMS OF THE CENTRAL NERVOUS SYSTEM



ASTROCYTOMAS

Astrocytomas account for approximately one third of gliomas and the incidence appears to be increasing. They occur at all ages and affect all parts of the central nervous system. Most cases in adults are seen within the cerebral hemispheres but they are found more commonly in the cerebellum, hypothalamus and brainstem in children and young adults. Incidence decreases after the fifth decade.

The degree of localisation varies considerably from cases to case and they may show widespread infiltration, the most diffuse of which is called gliomatosis cerebri. They may contain cysts. Astrocytomas show several histological variants including fibrillary, protoplasmic and gemistocytic forms and may contain foci of calcification.

The pilocytic variant is the commonest form found in children, usually in the cerebellum or floor of the 3rd ventricle. Rosenthal fibres are particularly characteristic, although not diagnostic, and the neoplastic cells tend to be bipolar.

Cytological characteristics vary from well differentiated fibre forming astrocytes to neoplasms showing greater pleomorphism and the presence of mitotic figures when the neoplasm is regarded as anaplastic. The most undifferentiated neoplasms may show evidence of vascular hyperplasia, necrosis, thrombosis and/or haemorrhage, when the neoplasm is referred to as glioblastoma multiforme.

An unusual variant, known as pleomorphic xanthoastrocytoma, tends to occur superficially in the younger age groups and be relatively well localised. It shows marked pleomorphism with multinucleate forms, but may have a favourable prognosis. Some cells contain large amounts of lipid.


GLIOBLASTOMA MULTIFORME

Glioblastoma multiforme accounts for approximately 50% of all gliomas. It usually shows areas of astrocytic differentiation, defining its cell of origin, but similar neoplasms can occasionally be derived from oligodendrocytes. A well differentiated glioma may progress to glioblastoma multiforme but some neoplasms appear with a picture of glioblastoma multiforme with no evidence of progression from a better differentiated form.

Most glioblastomas occur in middle life and have a rapidly fatal course. Most frequently they involve the white matter of the cerebral hemispheres, the frontal lobes being the most common site of origin.

Macroscopically they may appear to be relatively well demarcated and show obvious areas of haemorrhage and necrosis. The neoplastic cells show marked pleomorphism, often with multi-nucleate cells; mitotic figures are prominent and there is evidence of vascular hyperplasia and foci of necrosis. Sometimes there is a sarcomatous component.


OLIGODENDROGLIOMA

Oligodendrogliomas account for approximately 6% of gliomas. They are almost invariably found within the cerebral hemispheres and calcification is common, which may be visible on x-rays. Anaplastic forms are uncommon. The cells have a characteristic histological appearance with central round or oval nuclei surrounded by abundant clear cytoplasm. Mitotic figures are difficult to find. There are often foci of calcification. Occasionally a neoplasm composed of a mixture of oligodendrocytes and astrocytes is seen. Progression from a well differentiated to an anaplastic form may occur.


EPENDYMOMA

These constitute about 6% of intracranial gliomas and are usually seen within the region of the fourth ventricle or spinal cord in children or young adults, and less commonly, within the region of the ventricles of the cerebral hemispheres in adults. Their situation within the wall of the ventricles may result in obstructive hydrocephalus. Ependymoma is one of the common tumours of the spinal cord.

The degree of differentiation varies considerably from case to case and even within the same neoplasm. Diagnosis requires the finding of ependymal canals and/or perivascular pseudo rosettes. The former consist of tubules lined by ciliated ependymal cells; the latter consist of fibre forming ependymal cells producing a halo of fine processors between the cell nucleus and an adjacent blood vessel. Some tumours may show a papillary pattern and a particular form of ependymoma occurring in the region of the filum terminale shows marked myxomatous change and hyaline areas.


SUBEPENDYMOMA

Is a neoplasm of uncertain type, showing a highly fibrillary pattern, occurring beneath the ependyma and is thought to be a neoplasm derived from subependymal astrocytes, and is not a true ependymoma. They may cause symptoms by obstructing the CSF pathways.


NEOPLASMS OF THE CHOROID PLEXUS


Papillomas of the choroid plexus are rare and occur mainly in children and young adults. They most commonly arise within the fourth ventricle but may occur within the wall of the third or lateral ventricles. The neoplasm shows a marked papillary pattern covered by columnar or cuboidal epithelium which may be stratified It can be distinguished from papillary ependymoma by the presence of a basement membrane overlying vascularised connective tissue. Malignant forms occur and are known as choroid plexus carcinoma.

Choroid cysts are usually found within the anterior third ventricle in young adults. They may cause hydrocephalus by obstructing the foramen of Monro.


TUMOURS CONTAINING NEURONS


A variety of neoplasms containing neurons, often mixed with glial cells have been described and these show variable degrees of differentiation. The mixture is usually one of neurons and astrocytes and these neoplasms are named Gangliogliomas. They are usually found in adolescents or young adults within the temporal lobe or hypothalamus. Anaplastic variants occur. A variety of names had been used to describe neoplasms composed mainly of neurons, varying in the degree of differentiation. Gangliocytoma is composed of mature ganglion cells and Central Neurocytoma is a well differentiated neoplasm has been described in young adults, usually within the lateral ventricles, composed of uniform round cells with immunohistochemical and ultra structural features of neuronal differentiation. This lesion carries a favourable prognosis after resection.

Dysembryoplastic neuroepithelial tumour is a benign neoplasm showing mixed glial/neuronal differentiation, occurring within the supratentorial region and often associated with cortical dysplasia. It usually corresponds to grade 1 and usually does not recur after surgical resection.

Desmoplastic infantile ganglioglioma is a neoplasm of infancy and contains a dense fibrous stromal component and usually shows a favourable course after surgery.

Dysplastic Gangliocytoma of the Cerebellum is composed of cells that resemble Purkinje cells; it may be associated with a variety of congenital malformations and may be familial.

Olfactory Neuroblastoma occurs at the roof of the nose and is composed of immature neuronal cells. It tends to infiltrate adjacent structures.


MEDULLOBLASTOMA

The commonest tumour of the central nervous system in children and usually occurs in the cerebellum. It is composed of cells with hyperchromatic nuclei surrounded by small amounts of cytoplasm; the nuclei are often slightly elongated. The histological pattern is variable and may show differentiation to a variety of cell types including neuronal, glial, ependymal, melanin-producing cells, or rhabdomyoblasts. Another rare variety form contains abundant collagen and is referred to as the desmoplastic form.


MENINGIOMAS

Meningiomas are derived from the meninges and account for approximately 15% of primary intracranial neoplasms. They occur in adult life and are approximately twice as common in females as males. They are derived from arachnoidal endothelial cells and occur wherever arachnoidal villi are found. The commonest site is adjacent to the sagittal sinus. They may be multiple. They usually show evidence of slow progressive growth but malignant transformation can occur.

A variety of types have been described and they usually show some evidence of whorling. The patterns most commonly found are:

(i) Meningothelial - solid lobules of cells showing little or no evidence of whorl formation.
(ii) Fibrous - composed mainly of spindle shaped cells resembling fibroblasts.
(iii) Transitional - this shows a mixed pattern with areas of spindle shaped cells situated between endothelial cell whorl.
(iv) Psammomatous - these contain numerous calcified bodies known as psammoma bodies. They occur particularly in the spinal canal.

Rare forms are angiomatous, microcystic, secretory, clear cell or chordoid (this neoplasm shows a pattern resembling chordoma). Some tumours contain numerous lymphocytes and plasma cells and others contain a variety of mesenchymal structures such as bone, fat, and/or myxoid areas.

Atypical meningiomas show an increased number of mitotic figures, increased cellularity, prominent nucleoli and foci of necrosis.

Papillary meningioma - these are often more aggressive and show evidence of more frequent recurrence. They tend to occur in the younger age groups.
Anaplastic meningioma - these show features of malignancy.


TUMOURS OF SCHWANN CELLS


Schwannomas - these may arise wherever Schwann cells are normally found but most commonly occur on the eighth cranial nerve when they are referred as acoustic neuromas. They are composed of a mixture of spindle-shaped cells (Antoni type A) and foamy cells (Antoni type B). The spindle-shaped cells tend to form whorls and show palisading of nuclei. Malignant change is very rare.

Neurofibroma - these may occur as solitary subcutaneous or nerve-sheath tumours or they may be multiple and form part of the syndrome known as neurofibromatosis. They are usually multiple and histologically show myelinated and non-myelinated nerve fibres, Schwann cells, fibroblasts, and variable amounts of collagen. Antoni type A and B patterns are not seen but they may show focal whorling or palisading. Malignant varieties are occasionally seen. A form known as plexiform neurofibroma involves several branches of a nerve and form a racemose pattern. A significant proportion of this form of neoplasm undergoes malignant transformation.


HAEMANGIOBLASTOMA

This neoplasm is usually found in children and young adults. It is usually associated with a cyst and appears as a dark red nodule within the wall. They may be associated with extensive haemorrhage which can destroy the histological characteristics of the neoplasm. The microscopic appearance is that of numerous interweaving capillaries, which may vary considerably in size, separated by variable numbers of stromal cells of uncertain type. The stromal cells may form large groups and can closely resemble metastatic carcinoma of the kidney. Immunohistochemical staining for epithelial membrane antigen helps in the differential diagnosis in that haemangioblastoma shows a negative reaction whereas metastatic renal carcinoma is positive. Both neoplasms may contain abundant glycogen. Capillary haemangioblastoma together with retinal angiomatosis, renal cysts, and sometimes renal carcinoma can occur together as part of von Hippel-Lindau disease. The neoplasm may be associated with the production of erythropoietin, causing polycythemia.


VASCULAR MALFORMATIONS

Malformations of blood vessels of various types occur, such as capillary telangiectases, cavernous angiomas and arteriovenous malformations. These may be associated with haemorrhage and in the case of the latter in particular with progressive neurological signs and symptoms which may mimic neoplasm. Sturge-Weber disease, it is an association of cutaneous capillary angioma (port wine stain) within the trigeminal region of the face, with intracranial arteriovenous malformation.


TUMOURS OF THE PITUITARY GLAND


Pituitary adenomas are classified according to the type of hormone(s) produced by the neoplastic cells. They vary considerably in size and may compress the optic pathways or involve the hypothalamus. They are composed of polygonal cells showing variable degrees of granularity of the cytoplasm. A panel of immunohistochemical stains are used to determine this and sometimes electron microscopy can be helpful. Some pituitary adenomas show no clinical evidence of hormonal activity and these neoplasms usually present as a result of pressure on adjacent structures such as the optic chiasm, where they produce bitemporal hemianopia progressing to blindness, or destruction of other anterior pituitary endocrine cells causing hypopituitarism. Symptoms of raised intracranial pressure are rare. Radiology may demonstrate disruption of the sella turcica.

Clinical syndromes of excessive hormone production clearly depend upon the nature of the hormone, the most commonly recognised of which are due to secretion of prolactin, growth hormone, and ACTH.

Neoplasms showing no evidence of hormone secretion are referred to as null cell adenomas.


TUMOURS OF THE PINEAL GLAND AND TERATOMAS


Pinealoma is rare and mainly affects children; they can occur in adults.

Arising in the roof of the mid brain. They frequently produce abnormalities of conjugate upward gaze and they may be associated with precocious puberty in young children. Compression of the aqueduct in the mid brain may cause a rise of intracranial pressure and obstructive hydrocephalus. They are sometimes associated with disturbances of hypothalamic function.

Some neoplasms are highly cellular and composed of small cells with a high nuclear/cytoplasmic ratio, resembling medulloblastoma; they are frequently referred to as primitive neuroectodermal tumours (PNET) or pineoblastoma. Other neoplasms are composed of larger cells resembling pineocytes sometimes arranged in perivascular rosettes and these are referred to as pineocytomas. Some of these tumours show neuronal differentiation, and occasionally retinal differentiation, which may be demonstrated by the presence of a positive histochemical reaction for retinal S-antigen. Tumours showing a mixed pattern of pineoblastoma and pineocytoma also occur.

Another type of tumour produces a histological picture identical to that of seminoma of the testes or dysgerminoma of the ovary and is referred to as germinoma. They are composed of a mixture of large cells with prominent nucleoli, and small cells resembling lymphocytes.

The pineal gland has a predilection for intracranial teratoma, although these are extremely rare and are seen mainly in children. They may contain a variety of tissues from all three embryological layers (ectoderm, mesoderm and endoderm) and the tissue vary in their degree of differentiation from one case to another. Both benign and malignant forms are therefore encountered. Other tumours of germ cell type include embryonal carcinoma, yolk sac tumour, choriocarcinoma, and a variety of mixed germ cell tumours.

Occasionally a tumour identical to those found within the pineal gland is found in an extra-pineal site such as the third ventricle or hypothalamus and these are referred to as ectopic pinealoma.


CHORDOMA

Chordomas arise from remnants of notochord. They are rare but usually arise in the intrasellar region and clivus in the region of the foramen magnum or within the sacro-coccygeal region in the spinal canal. They are usually slow growing but progressively destructive and are radio-resistant. They therefore have a poor prognosis.

Histologically chordomas are composed of cells with vacuolated cytoplasm, known as physaliphorous cells, often arranged in cords or small packets within a loose myxoid matrix.

Chordoma can be difficult to differentiate from cartilaginous tumours, particularly chondrosarcoma. Chordomas stain positively for cytokeratins and epithelial membrane antigen whereas chondrosarcoma does not.


CRANIOPHARYNGIOMA

This is an epithelial cell tumour arising in the region of the pituitary fossa or hypothalamus. They are thought to be derived from remnants of the anterior pituitary gland which is derived embryologically from the stomatodeum. It is composed of trabeculae of epithelium containing squamous areas, keratin, cholesterol clefts, areas of calcification, and there may be cysts. Examination of the cyst fluid may reveal cholesterol or crystals. Some forms have a papillary pattern. Histologically they behave as grade 1 but tend to recur locally following surgery.


DERMOID AND EPIDERMOID CYSTS

These are rare neoplasms with a predilection for the posterior fossa, the intra and suprasellar regions, and the lumbosacral region of the spinal canal. The wall of an epidermoid cyst is composed of keratinizing squamous epithelium whereas that of a dermoid cyst contains a variety of structures found in the dermis such as hair follicles, sweat glands, and sebaceous glands. The lumen of the cyst may contain hairs.


TUMOUS OF THE SKULL AND SPINE


A variety of tumours derived from bone and cartilage, both benign and malignant, occur, such as chondroma, osteoma, angioma, chondrosarcoma and osteosarcoma.

Metastatic Tumours are common and particularly frequent over the age of 60. Lung and breast are the two commonest types but in many cases the primary site is uncertain. They are often multiple. Although rare in children they can occur and sometimes involve the central nervous system in relapse in acute lymphoblastic leukaemia.


LYMPHOMA

The vast majority of lymphomas occurring within the central nervous system are non-Hodgkin lymphomas of B cell type. Primary lymphomas of the central nervous system may occur sporadically or in patients showing evidence of immunodeficiency from a variety of causes. T cell lymphomas are rare. They can be classified according to the Kiel classification in a similar way to lymphomas occurring elsewhere.


PLASMACYTOMA

Plasmacytoma occurs in the skull and occasionally in the intracranial dura. Some progress to, or are associated with, multiple myeloma. Multiple myeloma is more common in men than women and has a peak incidence between the fifth and seventh decades. The lesions are osteolytic and are associated with the production of monoclonal globulin. Penetration of the dura is rare. The solitary plasmacytoma is usually better differentiated than the plasma cells of multiple myeloma.


PARAGANGLIOMA

This is a benign tumour but is histologically identical to paraganglioma occurring outside the nervous system. It usually occurs in the region of the filum terminale. They give a positive reaction for chromogranin, somatostatin or synaptophysin and dense core granules and microtubules may be demonstrated by electron microscopy.


CYSTS

A wide variety of cystic lesions occur in the nervous system:

(i) Rathke Cleft Cyst - this usually occurs in the intra or suprasellar region. The epithelium lining the cyst is cuboidal or columnar, which may be ciliated and the epithelium may contain cells containing mucin, resembling goblet cells.
(ii) Colloid cyst of the third ventricle - usually occurs in the region of the foramen of Monro and may have a very similar appearance to that of the Rathke Cleft Cyst.
(iii) Enterogenous cyst - the lining of this cyst may resemble respiratory or intestinal epithelium and contain mucin-secreting cells.
(iv) Neuroglial cyst - lined by ependyma and reactive astrocytes.


LIPOMA

A benign lesion usually situated within the midline in the region of the corpus callosum, third ventricle or midbrain. They may occur within the spinal canal and occasionally within the region of the sylvian fissure or cerebello-pontine angle. Some cases may be associated with the presence of numerous blood vessels and in this case they have been classified as angiolipoma.


PRIMARY MELANOCYTIC LESIONS AND TUMOURS CONTAINING MELANIN

A variety of neoplasms of melanocytes occur and these vary from benign to malignant. Approximately one quarter of them are associated with a neurocutaneous melanosis syndrome. Diffuse melanosis consists of the widespread proliferation of melanocytes within the leptomeninges and the brain may have a dark appearance. Melanocytes may proliferate to form a nodular lesion known as a melanocytoma and occasionally a malignant neoplasm of melanocytes occurs within the meninges which may rarely be amelanotic.

A wide variety of neoplasms of the central nervous system may contain melanin pigment, including choroid plexus papilloma, Schwannoma, neurofibroma, ependymoma, meningioma, medulloblastoma and malignant neoplasms of peripheral nerve sheath.


Source: Dokkyo Medical University, Japan (http://www.dokkyomed.ac.jp)