1. Examples: Methylprednisolone, betamethasone, dexamethasone, hydrocortisone, cortisone acetate, triamcinolone, deflazacort
2. Side-effects:- diabetes
- osteoporosis
- AVN of femoral head
- euphoria + other paranioa; also depression
- proximal myopathy --> muscle wasting
- peptic ulceration
- Cushing's
- suppression of growth in children
- adrenal atrophy (long-term). Important to avoid abrupt after long term use (>3 wks) as: 1) acute adrenal insufficiency; then 2) hypotension; then 3) death!
- Atypical infections
- chickenpox with atypical features (i.e. rash not a feature e.g. pneumonia, hepatitis, DIC)
- 66 yr old gentleman
- 2 yrs hx of unsteadiness on feet - shuffle when walking
- noticed weakness in the legs
- loss of balance
- increase in freqeuncy of micturition
- reduced in memory
- in recent 2-3 months, starts to develop tremors in hands when try to do something
- loss of bladder control
- symptoms get worst
- no significant finding in PMHx, DHx, FHx and SHx
Dx:
- Normal pressure hydrocephalus(NMH) aka adult onset hydrocephalus
Triad of NMH:
- ataxia
- dementia
- incontinence
Investigation:
Management:
- ventriculo-peritoneal shunt
Neurogenic (nerve root compression)
- pain on exertion (walking a distance/climbing up hills or stairs)
- relieved by bending forward
- sensory symptoms ie pins and needles
Cardiogenic (peripheral vascular disease) - pain on exertion (walking a distance/climbing up hills or stairs)
- relieved by hanging legs over side of bed (at night)
- no sensory symptoms
