Q. My husband has a small brain aneurysm. What are the chances that it will rupture?
A. Brain aneurysms are weak, bulging areas in arteries that supply blood to the brain. They have a greater chance of rupturing if they are growing larger than if they remain stable, according to recent research. About one in 50 Americans has a brain aneurysm, frequently with no symptoms. However, about 30,000 people annually suffer a rupture, with blood leaking into the brain and causing serious damage or even death. In past years, aneurysms smaller than seven millimeters (mm) have often been left untreated, but researchers have found that over a lifetime, about one-third of all brain aneurysms eventually ruptured, including around 25 percent of smaller aneurysms, with size having little effect on rupture risk. Risk factors such as smoking, age, hypertension, location of the aneurysm, and alcohol consumption all appear to play an important role in rupture risk. Women who smoke and have aneurysms that measure seven mm or more are particularly at risk, while non-smoking men with low blood pressure have a very low risk, according to a recent study.
Q. What are the causes of chronic fatigue syndrome, and what are some of the symptoms and treatments? I’ve heard it’s not considered a “real” disease.
A. Chronic fatigue syndrome (CFS), which affects about one million Americans, at one time was not taken seriously by many health practitioners, but recent findings have caused it to be viewed anew. CFS is marked by constant, enervating fatigue that lasts six months or longer, headaches, joint and muscle pain, and gastrointestinal problems. Other symptoms include: short-term memory and concentration impairment; joint pain; exercise that exacerbates the condition; sleep disturbances; tender lymph nodes in the neck and/or armpit; and frequent sore throat. New research indicates that CFS may be a biological illness, linked to abnormalities in the immune system. Biological factors include genetic factors, viruses such as Epstein-Barr, rubella, herpes, and enterovirus, hypotension, and immune irregularities. In addition, scientists have uncovered differences in the brain in people who suffer from CFS, including reduced amounts of the white matter that enables communication among brain cells, and increased gray matter in two areas of the brain, as well as an abnormality in the brain area that connects the frontal and temporal lobes of the brain. Further findings link CFS with gynecological problems such as endometriosis and pelvic pain, which may explain why CFS is more common in women. Treatment includes cognitive behavioral therapy, graded exercise therapy, and medications such as antidepressants and nonsteroidal pain drugs, as well as avoiding stress and overexertion. Patients should work closely with their health caregiver to diagnose and manage CFS.
Q. A dear friend has just been diagnosed with amyotrophic lateral sclerosis. Are there new treatments in recent years for the disease?
A. Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease (after the famous baseball player of the 1930s), is a disease of the nervous system that progressively weakens muscles, causing loss of physical function so you can no longer walk, talk, eat or breathe, and eventually resulting in death; most people die within three to five years of diagnosis, though some can live more than 10 years with the disease. Early symptoms include muscle cramps, muscle twitches, tight, stiff muscles, muscle weakness, slurred and nasal speech, and difficulty chewing or swallowing. To date, there is no cure for the disease, though some medications can slow its progression. In ALS, motor neurons in your brain and spinal cord break down and die, preventing your brain from sending messages to your muscles. This causes them to weaken, leading eventually to loss of control over their movements, and inhibiting activities of daily living. ALS is a heritable disease and frequently runs in families. It’s thought that genetic changes are associated with ALS. However, “sporadic” ALS is more common and the cause of 90 to 95 percent of all cases. There currently are two FDA-approved drugs, riluzole (Rilutek) and edaravone (Radicava), that slow progression of the disease, while physical therapy can help strengthen unaffected muscles. ALS usually afflicts people between ages 40 and 70, and the Centers for Disease Control and Prevention estimate that between 14,000 and 15,000 Americans have ALS.
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