The clinical hallmarks of acute viral encephalitis include fever, headache, and an altered level of consciousness. Other common clinical findings include behavioral changes, speech disturbances, and focal or diffuse neurologic signs such as seizure or hemiparesis.
Establishing a diagnosis of viral encephalitis may be difficult, so clinicians should inquire about certain epidemiologic features:
- Season of the year
- Prevalent diseases within the community
- History of travel
- Recreational activities
- Occupational exposures
- Animal contacts (insects or animal bites)
The use of neurodiagnostic tests, including electroencephalogram
(EEG), computed tomographic scan, and magnetic resonance imaging (MRI), can provide useful information in the evaluation of encephalitis. Although only herpes simplex encephalitis has specific treatment, the confirmation of other viral causes can provide helpful prognostic information and minimize unnecessary and ineffective therapies. Evaluation and management of acute viral encephalitis can be complex, and practitioners should seek consultation with an infectious diseases specialist for assistance.
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Archive for February, 2011
Melanie similarly described the difference between her appearance concerns and those of other people. “My concern is totally obsessive—it’s on my mind for hours a day—and it makes me miserable. Other peoples’ appearance concerns don’t make them so depressed, stop them from walking out the door, or make them unable to laugh at a joke. My concerns take all of my concentration, and they take over my life.”
Kathleen’s and Melanie’s BDD concerns echoed normal concerns echoed normal concerns, but they were more intense and severe. They worried too much, and they suffered. Many people with BDD have some additional normal concerns about their appearance, which they can usually easily differentiate from their BDD concerns.
Thus, BDD appears to differ quantitatively—by a matter of degree—from normal appearance concerns, lying at the severe end of a continuum or dimension of appearance preoccupation and dissatisfaction. But does BDD also differ from normal concerns in a more substantial and fundamental way? Is it also qualitatively different from normal appearance concerns? In other words, is there a point of rarity or discontinuity that suggests a natural cutoff point between BDD and health?
The answer to this question is probably yes. BDD does seem to differ from normal appearance concerns in ways other than its severity. One difference is that BDD appears to affect an approximately equal number of men and women, whereas studies of the general population indicate that more women than men are unhappy with how they look. In addition, surveys of the general population have generally found that people usually dislike their weight or weight-related aspects of appearance, such as the size of their abdomen, hips, or thighs. For example, in a 1972 Psychology Today survey, 48% of women were dissatisfied with their weight, 50% with their abdomen, and 49% with their hips and upper thighs. Only 11% were dissatisfied with their face. And in the 1997 Psychology Today survey I previously mentioned, 44% of women said that looking at their stomach in the mirror was very upsetting, whereas only 16% said this about their face. Among people with BDD, however, facial concerns are most common.
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Just because you have nose symptoms that act like allergy doesn’t mean that you are allergic. The first step in determining whether or not your nasal symptoms would benefit from immunotherapy is to be certain that you have allergic rhinitis. That requires your doctor to ensure that you actually make IgE antibodies (allergic antibodies) to the common airborne allergens and that it is these allergens that are causing your symptoms. To do this your doctor must take a very detailed medical history, perform a physical examination, and then do skin or serological (blood) tests to confirm the presence of IgE antibodies to common airborne allergens. Once these allergy tests are obtained, they are correlated with the history and physical examination findings and a treatment program is planned.
The steps that should be taken prior to your beginning any immunotherapy program are summarized below:
Before Beginning Immunotherapy
Be sure that your nose problem is allergic and not some other problem that causes similar symptoms.
Be sure that you have IgE antibodies to airborne allergens (pollens, dust mites, animals, etc.).
Your symptoms should be uncomfortable and poorly controlled by avoidance measures and medications.
Be sure that you are willing to take the time to participate in the treatments.
Be sure that the physician giving your immunotherapy is experienced in the diagnosis and treatment of allergic rhinitis.
Anyone who embarks on a course of immunotherapy should make a commitment to complete the entire course of therapy. Taking a course of immunotherapy for a few months, stopping it, and then starting it again is a waste of your time and money. If immunotherapy is to be effective, a high dose of allergen extract must be given regularly over a prolonged period of time. If you stop and start on the program, you will never achieve the dose needed, nor will you take it long enough for it to help.
Immunotherapy is time consuming and expensive. If you are going to make such a commitment to time and funds, then for goodness’ sake seek out a specialist in allergic diseases. Ask for references from your regular physician or friends who have undergone immunotherapy.
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