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TREATMENT
- Operative :  * Continuous tube drainage
*  Marsupialization
*   Aspiration
*   Excision
- Non - Operative : Antibiotic
*** Aspiration ร่วมกับการให้ Antibiotic จะได้ผลดี
TREATMENT FOR PHYSICAL THERAPY
* Exercise
* Passive stretching
* Gait/Transfer training
* Balance/ Coordination
** รักษาร่วมกับ OT, Speech therapy.. etc.

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Poliomyelitis
ID: 003,006,017,018,022,078,080,083,087,090,091,092
pathology
The virus is ingested with fecally contaminated food or water. The initial multiplication occurs in the lymphatic tissue of the oropharynx (tonsils) and intestine (appendix). Dissemination to the regional lymphatics is followed by viremia.
mechanism
The mechanism by which circulating viruses cross the blood- brain barrier is probably by transcapillary diffusion. The term poliomyelitis indicates that:
1.     The gray matter (polio) of the spinal cord (myel) is inflamed (itis).
2.     Motor neurons are involved, but the lesions are not usually confined to the anterior horns of the cord.
3.     In fatal cases, destruction is found in the cerebral ganglia, reticular formation, cerebellar nuclei, hypothalamus, thalamus and cerebral cortex.

Common symptoms of ppost-polio syndrome (PPS) are:
* continuing muscle and joint weakness
* muscle pain that gets worse
* becoming easily exhausted or fatigued
* muscle wasting, also called muscle atrophy
* trouble breathing and swallowing
* sleep apnea, or sleep-related breathing problems
* low tolerance of cold temperatures
* new onset of weakness in previously uninvolved muscles
* depression
* trouble with concentration and memmory

TREATMENT
Stage 1: Acute stage of muscle paralysis
Feeding by nasogastric tube in those with bulbar dysfunction
Endotracheal intubation and ventilation should be instituted in case of respiratory muscle failure or bulbar and laryngeal muscle paralysis.
Rest on a firm mattress with back supported on a lumbar board. Avoid forceful exercise as this may increase paralysis. Avoid massage.
Moist hot packs to the affected muscles produce considerable relief from the pain. Analgesics can also be used to relief pain.
Feet to be supported by rigid boards at 90˚ angle. Early spinal bracing for the back if it is weak.
Hip and knees should be positioned as straight as possible and arms in abduction with mild support.
Passive range of motion for the joints to avoid contracture formation.
Positon the patient with face down and hip extended every 2 hourly to prevent pressure sore and deformities.
Stage 2: Recovery or convalescent stage
Sitting up can be encouraged if the paralysis is not severe.
Fever drops, exercises should be started to prevent contractures and return strength.
Passive, active assisted to active resisted/ strengthening exercises, sitting balance training, standing balance training in parallel bars, gait training should be started.
Crutches, leg braces(calipers) and other aids may help the child to move better and may prevent contractures or deformities.
Whenever possible make exercises fun. Active games, swimming and other activities to keep limb moving as much as they can are important throughout the child’s rehabilitation.
Stage 3: Rehabilitation (Goals of polio treatment in the stage of residual paralysis)
- Strengthening of all the innervated muscles.
- Preventing contractures and deformities.
- Making the patient as independent as possible.
- Emotional and psychological support.

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PATHOGENESIS
-  Contiguous suppurative foc : การติดเชื้อของอวัยวะข้างเคียง มักพบใน  Chronic otitis media  มากกว่า  Acute otitis media
-  Hematogenous spread from distance foci : การติดเชื้อในอวัยวะที่อยู่ไกลออกไป โรคแพร่ผ่านกระแสเลือด
- มีช่องทางติดต่อกับภายนอกร่างกาย
- ความผิดปกติของภูมิคุ้มกัน
AREA LESION
-  parietal lobe มักพบว่ามีอาการอ่อนแรงของแขนขาได้
- temporal lobe มักพบความผิดปกติของการพูด และการมองเห็น
- Cerebellar มักพบ ataxia และ nystagmus
- อาการชักพบได้ประมาณ 30-50%

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- Symptoms : * decreased speech
* decreased sensation
* decreased movement due to loss of muscle function
* changes in vision
* changes in personality or behavior
* vomiting
* fever
* chills
* Difference mental
- Stage :

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PATHOLOGY
- Cause : Bacteria ( Staphylococcus aureus ), Fungi, Virus
- Risk Factor : HIV or AIDS
* cancer and other chronic illnesses
* congenital heart disease
* major head injury or skull fracture
* meningitis
* immunosuppressant drugs, such as those used in chemotherapy
* chronic sinus or middle ear infections

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Brain stroming

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1. Pathology
2. Sign and symptom
3. Example treatment

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Meningitis

Pathology

Infection

Blood brain barrier(BBB)

Trigger inflammatory mediation(Cytokine)

Breakdown matrix metalloproteinase(MMPs),Oxidative,Block CSF

Hydrocephalus, cerebral edema,increase ICP, neural death

Sign and Symptoms

Sudden high fever

Stiff neck

Severe headache that seems different than normal

Headache with nausea or vomiting

Confusion or difficulty concentrating

Seizures

Sleepiness or difficulty waking

Sensitivity to light

No appetite or thirst

Skin rash (sometimes, such as in meningococcal meningitis)

Signs in newborns

When to see a doctor

Fever

Severe, unrelenting headache

Confusion

Vomiting

Stiff neck

Medical assessment

Lumbar puncture

Bacteria :  glucose level is lower than 50% blood serum level

Virus     :  -normal glucose level

-Mild increase in protein

-Absence of bacterial mechanism

-Mononuclear cells in the hundreds

Radiographs :  rule out fracture, sinusitis, mastoiditis

CT scan    :  brain abscess or infection

Kernig’s sign

Brudzinski’s sign

1. Kernig’s sign      B. Brudzinski’s sign

Treatment

Medical treatment

Bacterial meningitis

Acute bacterial meningitis treated with antibiotics, corticosteroids helps to ensure recovery and reduce the risk of complications, such as brain swelling and seizures.

Viral meningitis

Antibiotics can't cure viral meningitis

Bed rest

Drainage plenty of fluids

Over-the-counter pain medications to help reduce fever and relieve body aches.

Tuberculous Meningitis

Treatment usually lasts for at least 12 months. Medicines called corticosteroids.

Physical therapy treatment

Physical therapy, often started

To maintain long-term functioning.

create an environment that reduces your sensitivity to light and sound - such as a darker room to promote calm and reduce headache complaints.

Chronic fatigue, often a residual effect of bacterial meningitis, is treated by stretching your muscles to relax the body

Another lingering symptom of bacterial meningitis is abnormal posture. To support mobility of the neck and other areas

Skin care and prevention of bedsores.

Care of bowel and bladder.