MUNCHAUSEN’ S SYNDROME
M
FEATURES OF MULTIPLE SCLEROSIS
The disease can affect any area ofthe white matter ofthe brain
and spinal cord. The plaques ofdemyelination are areas in
which the fatty myelin sheaths ofthe nerve fibres have been
destroyed. The affected fibres cannot conduct nerve impulses,
so functions such as movement and sensation may be lost.
The patchy distribution ofplaquescausesveryvaried effects.
Multiple sclerosis
and the spine
Multiple sclerosis
often affects nerve
fibres in the spinal
cord, thus blocking
impulses to and from
the brain.
Effects of multiple sclerosis
The fibre of the nerve tract is not usually
destroyed, but the loss of insulating myelin
alters normal ion movements, so thatthe fibre
can no longer conduct impulses.
AFFECTED AREAS
T h e n e r v e t r a c t s t h a t c a r r y
i m p u l s e s f o r s e n s a t i o n a r e
o f t e n in v o l v e d . T h is c a u s e s
a r e a s o f n u m b n e s s , o r a
f e e l i n g o f p i n s - a n d - n e e d l e s
in t h e s k i n .
B a l a n c e
D a m a g e t o n e r v e s in
t h e b r a i n s t e m m a y
a f f e c t b a l a n c e .
The brain and spinal cord control
all parts ofthe body, so damage
to these parts by multiple
sclerosis may affect any
function or any organ.
C o o r d in a t i o n
W h e n t h e n e r v e f i b r e s in t h e
b r a i n s t e m a r e in v o lv e d , t h e r e
m a y b e i n c o o r d i n a t i o n , l o s s o f
b a l a n c e , a n d d o u b l e v is i o n .
S e n s a t i o n
V is io n
T h e o p t i c n e r v e s m a y b e
in v o lv e d , c a u s i n g s e v e r e
( b u t u s u a lly t e m p o r a r y )
l o s s o f t h e c e n t r e o f t h e
v is u a l f i e l d .
S t r e n g t h
D a m a g e t o t h e
n e r v e f i b r e s in t h e
s p i n a l c o r d c a n
c a u s e w e a k n e s s
a n d h e a v i n e s s in
t h e a r m s .
B l a d d e r
In p e o p l e s e v e r e l y
a f f e c t e d b y m u lt ip le
s c l e r o s i s , s p i n a l c o r d
d a m a g e o f t e n l e a d s to
i n c o n t i n e n c e d u e t o l o s s
o f s p h i n c t e r c o n t r o l in
t h e b l a d d e r .
M o v e m e n t
P l a q u e s o n t h e l o n g
m o t o r n e r v e t r a c t s in
t h e b r a i n o r s p i n a l c o r d
m a y a f f e c t w a lk in g ,
s o m e t i m e s c a u s i n g
d r a g g i n g o f o n e l e g o r
a f e e l i n g o f w e a k n e s s .
p a r o t i d g l a n d s
,
w h i c h a r e s i t u a t e d i n s i d e
t h e
a n g l e
o f
t h e
j a w .
O n e
a t t a c k
o f
m u m p s c o n f e r s l i f e l o n g i m m u n i t y . S i n c e
r o u t i n e
M M R v a c c i n a t i o n
,
e p i d e m i c s
o f
m u m p s n o l o n g e r o c c u r .
CAUSE
T h e m u m p s v i r u s i s s p r e a d i n a i r b o r n e
d r o p l e t s . T h e
i n c u b a t i o n p e r i o d
i s t w o t o
t h r e e w e e k s ; a n a f f e c t e d p e r s o n i s i n -
f e c t i o u s f o r a b o u t a w e e k b e f o r e a n d u p
t o t w o w e e k s a f t e r s y m p t o m s a p p e a r .
SYMPTOMS
I n f e c t e d c h i l d r e n o f t e n h a v e n o s y m p -
t o m s ,
o r t h e y m a y f e e l s l i g h t l y u n w e l l
a n d h a v e s o m e d i s c o m f o r t a r o u n d t h e
p a r o t i d g l a n d s . I n m
o r e s e r i o u s
c a s e s ,
t h e r e
i s
p a i n
a r o u n d
t h e
g l a n d s
a n d
c h e w i n g b e c o m e s d i f f i c u l t ; o n e o r b o t h
g l a n d s t h e n b e c o m e s w o l l e n a n d t e n d e r .
A f e v e r a n d h e a d a c h e m a y d e v e l o p . T h e
s w e l l i n g s u b s i d e s w i t h i n a w e e k t o t e n
d a y s . W
h e n o n l y o n e g l a n d i s a f f e c t e d ,
t h e
s e c o n d
g l a n d
o f t e n
s w e l l s
a s
t h e
s w e l l i n g i n t h e f i r s t s u b s i d e s .
COMPLICATIONS
M u m p s m a y l e a d t o a n u m b e r o f o t h e r
c o n d i t i o n s i n c l u d i n g v i r a l
m e n i n g i t i s
( i n -
f l a m m a t i o n o f t h e m e m b r a n e s c o v e r i n g
t h e b r a i n a n d s p i n a l c o r d ) ,
p a n c r e a t i t i s
( i n f l a m m a t i o n o f t h e p a n c r e a s ) ,
o r , i n
a d o l e s c e n t
o r
a d u l t
m a l e s ,
e p i d i d y m o -
o r c h i t i s
( i n f l a m m a t i o n o f t h e t e s t e s ) .
DIAGNOSIS AND TREATMENT
D i a g n o s i s
i s
u s u a l l y
m a d e
f r o m
t h e
s y m p t o m s . T h e r e i s u s u a l l y n o t r e a t m e n t ;
r e s t a n d p a i n k i l l e r s m a y e a s e s y m p t o m s .
M u n c h a u s e n ’s s y n d ro m e
A c h r o n i c
f a c t i t i o u s d i s o r d e r
i n w h i c h a
p e r s o n c o m p l a i n s o f p h y s i c a l s y m p t o m s
t h a t
a r e
p r e t e n d e d
o r
s e l f - i n d u c e d
i n
o r d e r t o p l a y t h e r o l e o f p a t i e n t .
T h e u s u a l c o m p l a i n t s a r e a b d o m i n a l
p a i n , b l e e d i n g , n e u r o l o g i c a l s y m p t o m s ,
r a s h e s ,
a n d
f e v e r .
P e o p l e
t y p i c a l l y
i n v e n t d r a m a t i c h i s t o r i e s . M
o s t s u f f e r -
e r s a r e r e p e a t e d l y a d m i t t e d t o h o s p i t a l ,
a n d m a n y h a v e d e t a i l e d m e d i c a l k n o w l -
e d g e
a n d
s c a r s
f r o m
s e l f - i n j u r y
o r
p r e v i o u s
t r e a t m e n t .
I n
M
u n c h a u s e n ’s
s y n d r o m e
b y
p r o x y ,
p a r e n t s
s i m u l a t e
d i s o r d e r s i n c h i l d r e n .
T r e a t m e n t c o n s i s t s o f p r o t e c t i n g t h e
s u f f e r e r s
f r o m
u n n e c e s s a r y
o p e r a t i o n s
a n d d r u g t r e a t m e n t s .
520
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