A to Z of Medical Conditions

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Trigeminal Neuralgia – what are the signs and symptoms of Trigeminal Neuralgia?

Trigeminal neuralgia

Trigeminal neuralgia

Trigeminal neuralgia is sudden, severe facial pain. It’s often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.

It usually occurs in short, unpredictable attacks that can last from a few seconds to about two minutes. The attacks stop as suddenly as they start.

In most cases trigeminal neuralgia affects part or all of one side of the face, with the pain usually felt in the lower part of the face. Very occasionally it can affect both sides of the face, although not usually at the same time.

People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases attacks may occur hundreds of times a day.

It’s possible for the pain to improve or even disappear altogether for several months or years at a time (remission), although these periods tend to get shorter with time.

Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person’s quality of life, resulting in problems such as weight loss, isolation and depression.

Read more about the symptoms of trigeminal neuralgia.

When to seek medical advice

See your GP if you experience frequent or persistent facial pain, particularly if standard painkillers, such as paracetamol and ibuprofen, don’t help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.

However, diagnosing trigeminal neuralgia can be difficult and it can take a few years for a diagnosis to be confirmed.

Read more about diagnosing trigeminal neuralgia.

What causes trigeminal neuralgia?

Trigeminal neuralgia is usually caused by compression of the trigeminal nerve. This is the nerve inside the skull that transmits sensations of pain and touch from your face, teeth and mouth to your brain.

The compression of the trigeminal nerve is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

In rare cases trigeminal neuralgia can be caused by damage to the trigeminal nerve as a result of an underlying condition, such as multiple sclerosis (MS) or a tumour.

Typically the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind – even a slight breeze or air conditioning – or movement of the face or head. Sometimes the pain can occur without any trigger at all.

Read more about the causes of trigeminal neuralgia.

Who’s affected

It’s not clear how many people are affected by trigeminal neuralgia, but it’s thought to be rare, with around 10 people in 100,000 in the UK developing it each year.

Women tend to be affected by trigeminal neuralgia more than men, and it usually starts between the ages of 50 and 60. It’s rare in adults younger than 40.

Treating trigeminal neuralgia

Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. However, most cases can be controlled with treatment to at least some degree.

An anticonvulsant , which is often used to treat epilepsy, is the first treatment usually recommended to treat trigeminal neuralgia.

Carbamazepine needs to be taken several times a day to be effective, with the dose gradually increased over the course of a few days or weeks so high enough levels of the medication can build up in your bloodstream.

Unless your pain starts to diminish or disappears altogether, the is usually continued for as long as necessary, sometimes for many years.

If you’re entering a period of remission and your pain goes away, stopping the medication should always be done slowly over days or weeks, unless you’re advised otherwise by a doctor.

Iy wasn’t originally designed to treat pain, but it can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

If this medication is ineffective, unsuitable or causes too many side effects, you may be referred to a specialist to discuss alternative medications or surgical procedures that may help.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals – but these are generally only effective for a few years.

Alternatively, your specialist may recommend having surgery to open up your skull and move away any blood vessels compressing the trigeminal nerve.

Research suggests this operation offers the best results in terms of long-term pain relief, but it’s a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.

Read more about treating trigeminal neuralgia.

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Necrotising fasciitis – signs and symptoms of necrotising fasciitis

Necrotising fasciitis

Necrotising fasciitis

Introduction

Necrotising fasciitis is a rare but serious bacterial infection that affects the tissue beneath the skin, and surrounding muscles and organs (fascia).

It’s sometimes called the “flesh-eating disease”, although the bacteria that cause it don’t “eat” flesh – they release toxins that damage nearby tissue.

Necrotising fasciitis can start from a relatively minor injury, such as a small cut, but gets worse very quickly and can be life-threatening if it’s not recognised and treated early on.

 

Symptoms of necrotising fasciitis

The symptoms of necrotising fasciitis develop quickly over hours or days. They may not be obvious at first and can be similar to less serious conditions such as flu, gastroenteritis or cellulitis.

Early symptoms can include:

a small but painful cut or scratch on the skin

intense pain that’s out of proportion to any damage to the skin

a high temperature (fever) and other flu-like symptoms

After a few hours to days, you may develop:

swelling and redness in the painful area – the swelling will usually feel firm to the touch

diarrhoea and vomiting

dark blotches on the skin that turn into fluid-filled blisters

If left untreated, the infection can spread through the body quickly and cause symptoms such as dizziness, weakness and confusion.

When to get medical help

Necrotising fasciitis is a medical emergency that requires immediate treatment.

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Go to your nearest accident and emergency (A&E) department as soon as possible if you think you have it. Call 999 for an ambulance if you’re too unwell to get yourself to A&E.

Blood tests and scans may be carried out to find out what’s causing your symptoms, although a diagnosis of necrotising fasciitis can usually only be confirmed by having an operation to examine the affected tissue.

Treatments for necrotising fasciitis

Necrotising fasciitis needs to be treated in hospital.

The main treatments are:

surgery to remove infected tissue – this may be repeated several times to ensure all the infected tissue is removed, and occasionally it may be necessary to amputate affected limbs

antibiotics – usually several different types are given directly into a vein

supportive treatment – including treatment to control your blood pressure, fluid levels and organ functions

People with the condition will often need to be looked after in an intensive care unit and may need to stay in hospital for several weeks.

While in hospital, they may be isolated from other patients to reduce the risk of spreading the infection.

Outlook for necrotising fasciitis

Necrotising fasciitis can progress very quickly and lead to serious problems such as blood poisoning (sepsis) and organ failure.

Even with treatment, it’s estimated that one or two in every five cases are fatal.

People who survive the infection are sometimes left with long-term disability due to amputation or the removal of a lot of infected tissue.

They may need further surgery to improve the appearance of the affected area and may need ongoing rehabilitation support to help them adapt to their disability.

Causes of necrotising fasciitis

Necrotising fasciitis can be caused by several different types of bacteria.

The bacteria that cause the infection live in the gut, in the throat, or on the skin of some people, where they don’t usually cause any serious problems.

However, in rare cases, they can cause necrotising fasciitis if they get into deep tissue – either through the bloodstream, or an injury or wound, such as:

cuts and scratches

insect bites

puncture wounds caused by injecting drugs

surgical wounds

Necrotising fasciitis typically occurs when bacteria already on the skin or in the body get into deep tissue. The infection can also be spread from person to person, but this is very rare.

Anyone can get necrotising fasciitis – including young and otherwise healthy people – but it tends to affect older people and those in poor general health.

Preventing necrotising fasciitis

There’s no vaccine for necrotising fasciitis and it’s not always possible to prevent it.

The following measures may help to reduce your risk:

Treat wounds quickly – after stopping any bleeding, clean wounds with running water and pat them dry with a clean towel.

Keep wounds clean and dry – after a wound has been cleaned, cover it with a sterile dressing (such as a plaster); change the dressing if it gets wet or dirty.

Wash your hands regularly with soap and warm water – alcohol-based hand gels can also help, but washing with soap and water is generally best.

If you’re in close contact with someone who has necrotising fasciitis, you may be given a course of antibiotics to reduce your risk of infection.

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Keratosis pilaris – the signs, symptoms and treatments of this condition

Keratosis pilaris or chicken skin

Keratosis pilaris or chicken sk

Keratosis pilaris is a common and harmless condition where the skin becomes rough and bumpy, as if covered in permanent goose pimples.

There’s no cure for keratosis pilaris, but you may be able to improve the rash by using soap-free cleansers, moisturising, and gently removing dead skin cells from the surface of the skin (exfoliating).

There’s no real need to see your GP unless the condition is causing you concern. It usually improves as you get older and sometimes disappears completely in adulthood.

This page provides more information on keratosis pilaris and explains what you can do if you have the condition.

Where keratosis pilaris occurs

Keratosis pilaris most commonly affects the back of the upper arms, and sometimes the buttocks and the front of the thighs. Less often, the forearms and upper back may be affected.

There are also rare variants of keratosis pilaris that can affect the eyebrows, face and scalp, or the entire body.

How it affects the skin

The patches of affected skin will be covered in tiny spiky bumps, which may be white, red or skin-coloured. This spotting looks like “chicken skin” or permanent goose pimples, and the skin feels rough, like sandpaper.

In some people, the skin itches and there may be inflammation and pinkness around the bumps.

Keratosis pilaris can’t be spread from person to person (contagious).

The skin tends to improve in summer and get worse during winter months or dry conditions.

Who’s affected

Keratosis pilaris is very common, affecting up to one in three people in the UK.

It can affect people of all ages, but it’s particularly common in:

children and adolescents

females

people with eczema or a condition called ichthyosis

people of Celtic origin

The condition typically starts during childhood, although it can sometimes occur in babies, and gets worse in adolescence, around puberty.

Keratosis pilaris sometimes improves after puberty, and may even disappear in adulthood, although many adults still have the condition in their 40s and 50s. It’s uncommon in elderly people.

What causes keratosis pilaris?

Keratosis pilaris runs in families and is inherited from your parents. If one parent has the condition, there’s a one in two chance that any children they have will also inherit it.

Keratosis pilaris occurs when too much keratin builds up in the skin’s hair follicles. Keratin is a protein found in the tough outer layer of skin, which causes the surface of the skin to thicken, hence the name “keratosis”.

The excess keratin blocks the hair follicles with plugs of hard, rough skin. The tiny plugs widen the pores, giving the skin a spotty appearance.

It’s often associated with other dry skin conditions, such as eczema and ichthyosis, which make the rash worse.

Treating keratosis pilaris

There’s little that can be done to treat keratosis pilaris, and it often gets better on its own without treatment.

However, if it’s bothering you, the following measures may help improve your rash:

use non-soap cleansers rather than soap – ordinary soap may dry your skin out and make the condition worse

moisturise your skin when it’s dry – your GP or pharmacist can recommend a suitable cream, although moisturisers and emollients only reduce the dryness of your skin and won’t cure the rash; creams containing salicylic acid, lactic acid or urea are thought to be the most effective

gently rub the skin with an exfoliating foam pad or pumice stone to exfoliate the rough skin – be careful not to scrub too hard and rub off layers of skin

take lukewarm showers rather than hot baths

You can also ask your GP about “off-label” treatments that may help. These are products that haven’t been officially approved and licensed for treating keratosis pilaris, but are sometimes used because they’ve helped people in the past.

Examples include:

creams containing retinol, which is derived from vitamin A

chemical peels

microdermabrasion – a cosmetic exfoliation treatment that is sometimes offered in health spas

There’s no strong evidence to suggest that these therapies are effective treatments for keratosis pilaris. You may also have to pay for some of them privately.

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Kyphosis – an introduction

Kyphosis

Kyphosis

Kyphosis is curvature of the spine that causes the top of the back to appear more rounded than normal.

Everyone has some degree of curvature in their spine. However, a curve of more than 45 degrees is considered excessive.

Sometimes kyphosis doesn’t cause any symptoms other than the back appearing abnormally curved or hunched. However, in some cases the condition causes:

back pain and stiffness

tenderness of the spine

tiredness

Back pain can be particularly problematic in adults with kyphosis because the body has to compensate for the spinal abnormality.

If you have severe kyphosis, your symptoms may get worse over time. You may also have difficulty breathing and eating.

What causes kyphosis?

In kyphosis, the normal curve in the middle section of vertebral column (the thoracic vertebrae) is more curved than normal. There are a number of reasons why this might happen, including:

poor posture (postural kyphosis) – slouching, leaning back in chairs and carrying heavy bags can stretch supporting muscles and ligaments, which can increase spinal curvature

abnormally shaped vertebrae (Scheuermann’s kyphosis) – if the vertebrae don’t develop properly, they can end up being out of position

abnormal development of the spine in the womb (congenital kyphosis) – if something disrupts the spine’s normal development, two or more vertebrae sometimes fuse together

age – as people get older, their spinal curvature can be expected to increase

Kyphosis can also develop as a result of a spinal injury.

Read more about the causes of kyphosis.

Treating kyphosis

If you have kyphosis, your treatment depends on how curved your spine is, whether you have any additional symptoms such as back pain, and the underlying causes.

Children with kyphosis may be able to be treated using non-surgical methods, such as bracing, to limit the progression of kyphosis as they grow. Treatment for mild kyphosis may not be necessary.

Kyphosis rarely requires surgical treatment. It’s only needed in some severe cases to correct the curvature of the spine.

Read more about treating kyphosis.

Emotional issues

Older children with kyphosis may become concerned or embarrassed about the effect the condition has on their appearance, or having to wear a back brace.

These concerns can affect different children in different ways. Some children can become socially withdrawn and they may be reluctant to take part in activities, such as PE, where their condition may be exposed.

There are no easy answers to these problems, but it can sometimes help to reassure your child that their feelings will improve with time.

Complications

Complications of kyphosis usually only occur in more severe cases. They include:

persistent pain that can’t be controlled with medication

breathing difficulties caused by the spine compressing the lungs and airways

Occasionally, people with kyphosis can have difficulties when the nerves running through the spine become compressed or pinched. This can disrupt nerve signals and cause symptoms such as:

numbness or weakness in the arms and legs

problems with sense of balance

loss of normal bladder or bowel control

These serious complications require urgent medical attention and surgery would usually be recommended.

Can kyphosis be prevented?

Postural kyphosis can be prevented by being aware of your posture and by taking care of your back. You should encourage your child to:

avoid slouching

sit correctly – sit upright, ensuring that the small of the back is supported

avoid carrying heavy schoolbags that can pull on the back muscles and ligaments; the best schoolbags are well-designed backpacks

take regular exercise (see below) to help strengthen the back and keep it flexible; activities such as swimming, running, walking, yoga and pilates are ideal for helping to prevent back problems

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Intracranial hypertension – causes, signs and treatments

Intracranial hypertension

Intracranial hypertension

Intracranial hypertension

Intracranial hypertension (IH) is the medical name for a build-up of pressure around the brain.

It can come on suddenly – for example, as the result of a severe head injury, stroke or brain abscess. This is known as acute IH.

It can also be a persistent, long-lasting problem – known as chronic IH. This is rare and sometimes it’s not clear why it happens.

 

Symptoms of chronic IH

Symptoms of chronic IH can include:

a constant throbbing headache – this may be worse in the morning, or when coughing or straining; it may improve when standing up

blurred or double vision

temporary loss of vision – your vision may become dark or “greyed out” for a few seconds at a time; this can be triggered by coughing, sneezing or bending down

feeling and being sick

drowsiness and irritability

Chronic IH can sometimes result in permanent vision loss, although treatment can help reduce the chances of this happening.

Causes of chronic IH

Possible causes of chronic IH include:

a blood clot on the surface of the brain – known as a chronic subdural haematoma

a brain tumour

a brain infection – such as meningitis or encephalitis

hydrocephalus – a build-up of fluid around and inside the brain

blood vessel abnormalities – such as an arteriovenous fistula or arteriovenous malformation

a blood clot in one of the veins of the brain – known as a venous sinus thrombosis

Rare causes include a blockage in the circulation of fluid at the bottom of the skull (Chiari malformation), inflammation of the blood vessels in the brain (vasculitis) and abnormal skull growth in children (craniosynostosis).

Idiopathic IH

In many cases, the cause of chronic IH is unclear. This is known as idiopathic IH, or sometimes benign IH.

It mainly affects women in their 20s and 30s, and has been associated with:

being overweight or obese – most cases occur in overweight women, although it’s not clear why

hormone problems – such as Cushing’s syndrome, hypoparathyroidism, an underactive thyroid or an overactive thyroid

certain medications – including some antibiotics, steroid medication and contraceptive pills

a lack of red blood cells (iron deficiency anaemia) or too many red blood cells (polycythaemia vera)

chronic kidney disease

lupus – a problem with the immune system

But these are only linked with idiopathic IH, they’re not necessarily causes. You can find a full list of conditions and medications associated with idiopathic IH (PDF, 21kb) on the IIH UK website.

Tests for chronic IH

IH may be suspected if you have symptoms of increased pressure on your brain, such as vision problems and headaches.

Several tests may be carried out to diagnose it, such as:

an examination to check functions like your muscle strength, reflexes and balance – any issues could be a sign of a problem with your brain or nerves

an assessment of your eyes and vision

a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan of your brain

a lumbar puncture – where a needle is inserted into your spine – to check for high pressure in the fluid that surrounds your brain and spinal cord

Idiopathic IH may be diagnosed if you have increased pressure on your brain and no other cause can be found.

Treatments for chronic IH

Treatment for IH depends on the underlying cause, if this is known.

The main treatments for idiopathic IH are:

losing weight if you’re overweight – this can often help reduce symptoms and may sometimes relieve them altogether

stopping any medication that may be causing your symptoms

medication to remove excess fluid from the body (diuretics)

medication to reduce the production of cerebrospinal fluid in your brain

a short course of steroid medication to relieve headaches and reduce the risk of vision loss

regular lumbar punctures to remove excess fluid from your spine and help reduce the pressure on your brain

Surgery

Surgery may be considered if other treatments don’t help.

The main types of surgery for chronic IH are:

shunt surgery – a thin, flexible tube is inserted into the fluid-filled space in your skull or spine to divert excess fluid to another part of your body

optic nerve sheath fenestration – the protective layer surrounding your optic nerve, the nerve connecting the eye to the brain, is opened up to relieve pressure on it and allow fluid to drain away

These procedures can provide relief from your symptoms, but they also carry a risk of potentially serious complications. Talk to your surgeon about what your operation involves and what the risks are.

Outlook for chronic IH

Chronic IH can be life threatening if it remains undiagnosed and the underlying causes are not treated. You should be referred to a specialist as soon as possible if your doctor suspects it.

Idiopathic IH isn’t usually life threatening, but can be a lifelong problem. While many people find their symptoms are relieved with treatment, the symptoms can recur and can have a significant impact on your life.

There’s also a risk that you could lose your vision, even though treatment can help reduce this risk.

Permanent vision loss is estimated to occur in between 1 in every 5 to 20 people with idiopathic IH.