Cervical Spondylosis

Cervical Spondylosis is characterized as the gradual wearing away of the cervical vertebrae as we age. Though it happens with everyone, certain extremes can cause additional problems. The bones that make up our spine will deterioate over time and create spurs, which are outgrowths of the bone. These irregularities have the potential to compress nerves, in a condition called radiculopathy; or they can narrow the opening containing the spinal cord, causing myelopathy. Therefore, nerve function may be inhibited but it is not that common. Patients may not exhibit symptoms or the symptoms may be worse depending on the severity. These symptoms include: stiffness and pain in the neck, shoulder, and chest; tingling and/or numbness in extremities; trouble walking; changes in reflexes; and loss of bladder/bowel control.
Also known as cervical osteoarthritis, it often occurs in men and women over 40 (although usually affects men at an earlier age compared to women). Around age 30, an x-ray may show some degeneration, however, symptoms aren't likely to show up until later. It is often caused by the changing consistency of the disks and ligaments associated with the spine. The spinal disks become dry and loose elasticity; while ligaments and muscles become stiff. Bulging disks also may be a cause, due to the disk material protruding from the space. The risk may be reduced early on by exercise and practicing good posture. This pathology can be diagnosed utilizing a physical assesment of neck flexibility, neurological exams (to determine pressure on the nerves and spinal cord), x-rays of the neck and spine, CT, MRI, or a Myelogram (when dye is injected into the spinal cord). Mild cases may be treated with a brace, anti-inflammatory drugs, and exercise; while extreme cases may require bed rest, traction, muscle relaxants, or corticosteroid injections. Although surgery has its own associated risks, it is also an option in severe cases.
http://www.mayoclinic.com/health/cervical-spondylosis/DS00697/TAB=multimedia

http://www.medscape.com/content/2004/00/48/28/482834/art-sp482834.fig2.jpg

Carotid Artery Disease

http://www.nhlbi.nih.gov/health/dci/images/cad_anatomy.jpg


Carotid Artery Disease is the buildup of plaque in the vessels (the carotid arteries) that allow blood flow to the head/brain. This process is slow and happens gradually over time; therefore, patents may not exhibit symptoms until further complications occur. The plaque can cause stenosis of the artery (slowing blood flow) or completely occlude the artery (stopping blood flow). As mentioned before, in the developing stages the patient may not have symptoms until blood flow to the brain is inhibited; this is known as a stroke or a TIA (Transient Ischemic Attack). Symptoms that indicated a stroke include: weakness (typically on a single side of the body), trouble speaking, and sudden vision problems. It is critical that patients seek help at the onset of stroke-like symptoms; as this indicates that the brain isn't getting accurate blood flow. While a TIA isn't considered a full blown stroke, it is often a warning sign for such an incident.

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Risk factors for carotid artery disease include: age, obesity, smoking, hypertension, heredity, sedentary lifestyle, and diabetes. All of the factors play into plaque buildup in the artery and changing of the artery walls from smooth and healthy to stiff and narrow. Plaques is a combination of cholesterol, calcium, fibrous tissue, and other cellular debris; and can build in various vessels throughout the body. The disease can be diagnosed using different imaging modalities, such as MRI, CT, Ultrasound, or Arteriography. While lifestyle changes can reduce progression of the pathology in early stages, medications and/or invasive procedures may be utilized if complications occur. These medications may include blood thinners, such as aspirin. More serious cases may call for endarterectomy (surgical removal of plaque) or carotid stenting/ angioplasty (a catheter is used to deploy a stent into the vessel). These procedures have there own risks involved. For example, a piece of plaque can be dislodged and cause problems else where in the vessel, dissection of the vessel (break in the artery wall), or hemorrhage (bleeding out).
http://www.mayoclinic.com/health/carotid-artery-disease/DS01030/DSECTION=tests-and-diagnosis

LYMPHADENOPATHY

www.radpod.org

Lymphadenopathy is a condition in which the lymph nodes throughout the body become swollen. These lymph nodes filter lymph fluid as it circulates through the body, as well as aid in immune system functions. They are found in various places, including the neck, groin, chest, and abdomen. Occuring most often in the neck, lymphadenopathy is a result of accumulating fluid and infection fighting cells. This is a common pathology in children and can be caused by many different types of infections. The location of the swollen lymph node is often indicative of the area of infection. The condition may also be related to malignancy or drug reactions. Patients will exhibit redness, tenderness, and swelling of the area, in addition to fever. While the patient's symptoms and history of illness are often enough to diagnose this pathology, other tests may be performed to specify the affected node. For example, a biopsy may be conducted, as well as such imaging procedures as CT and MRI. Most often, the lymph node will be palpable, making a non-invasive diagnosis acheivable. Treatment is based on condition and severity of the pathology. Often times the underlying infection will be treated with antibiotics. If the swelling persists, actions may be taken upon the lymph node itself. Lymphadenopathy is rarely fatal; most related deaths are due to malignancy rather than the inflammation itself.
http://www.biomedcentral.com/
http://www.healthsystem.virginia.edu/uvahealth/peds_ent/lymphpathy.cfm

http://emedicine.medscape.com/article/956340-treatment

http://www.aafp.org/afp/20021201/2103.html

Achondroplasia

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Achondroplasia is an inherited disorder affecting bone growth. Although the name means "without cartilage formation," the body fails to convert cartilage into bone. Affecting an average of 1 in 25,000 births, this defect results in short stature and disproportionate limbs. Patients may display an abnormally large head, long torso and short limbs. Upon closer inspection, you may notice a pronounced forehead, and trident-like fingers (meaning the 3rd and 4th digits diverge to opposite sides). Patients may also exhibit abnormalities in joint movement; for instance, the elbow may not be capable of extending fully, while the knee may hyperextend without intention. Lordosis may be apparent in the lumbar spine, and the patients legs are often bowed. As seen in the MRI image above, patients also display a depressed nasal bridge, and a narrowed foramen magnum. While Achondroplasia patients tend to run slightly behind schedule with motor development, intelligence is not compromised. Megacephally, enlargement of the brain, is also common among these patients.

http://www.bordeauxactu.com/

Diagnosis of Achondroplasia can come from many modalities. For example, before birth the defect may be detected with the use of ultrasound. If either of the parents, or both, are affected a molecular diagnosis may also be key. This disorder is an autosomal dominant trait, and all those who have the gene will have Achondroplasia. While these patients may lead normal lives, continued monitoring is often required especially of growth measurements. Weight management is also key because obesity can aggravate the existent joint problems.

http://www.medicinenet.com/achondroplasia/article.htm

Chronic Sinusitis

Chronic Sinusitis is described as inflammation and swelling within the cavities surrounding the nasal passages, known as the sinuses. This causes a disruption in drainage causing mucus to fill the cavities. Due to the backup of mucus in the cavities, a moist environment exists which is ideal for infection to occur. Patients may complain of abnormally thick drainage (often yellow or green) from the nose or down the back of their throat (often leading to a sore throat), difficulty breathing, swelling of the nose and eyes, coughing and fatigue. While the signs and symptoms are the same with acute sinusitis, chronic is associated with sinusitis that lasts longer than 8 weeks or is recurrent. Common causes include: nasal polyps, allergies, deviated septum, facial trauma, and respiratory tract infections. These incidents often cause obstruction of the sinus passages. People are more at risk for this pathology if they have abnormalities within their nasal passages, allergies, and/or other respiratory complications, such as asthma. While cultures or allergy tests may be used to diagnose this pathology, CT is the ideal tool within the Imaging department. Nasal sprays, decongestants, and steroids may be used for treatment, as well as antibiotics to clear the infection. The patient should also get plenty of rest and increase their fluid intake during recovery. Immunotherapy consisting of allergy shots may be used to prevent recurrent infections; while in treatment resistant cases surgery may be an option.

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http://www.mayoclinic.com/health/chronic-sinusitis/DS00232

Orbital Cellulitis

Orbital cellulitis is infection in the orbit. More specifically, the condition affects the soft tissues directly behind the orbital septum. Patients may complain of fever, headaches, and recent infections of the sinuses and/or upper respiratory tract. They may also experience visual impairment, swelling of the eye lid, and pain upon movement of the eyes. Symptoms may have a gradual or immediate onset. Though the infection may have spread from another area, other common causes include trauma and surgery. The infection most commonly comes from the ethmoid sinuses. Upon injury, orbital cellulitis can occur due to perforation of the orbital septum. This condition can also have a fungal origin, resulting from the Mucor and Aspergillus species.

Those suffering with orbital cellulitis should be hospitalized and administered intravenous or oral antibiotics. While this generally treats the condition, if the infection is fungal, surgical debridement may be required. Surgical drainage may be needed if the abscess doesn't decrease in size in a 72 hour period, or is vision loss occurs. Follow-up CT scans may be required if symptoms worsen. During the time following treatment, regular eye exams or monitoring by a disease specialist. Other complications may rarely occur due to the infection; for example, meningitis or permanent vision loss.

www.emedicine.medscape.com

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www.mypacs.net

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Prolactinoma

Prolactinoma is the overproduction of prolactin caused by a benign tumor of the pituitary gland. The increase in prolactin (hyperprolactemia) is associated with decreased sex hormones (estrogen and testosterone). Certain symptoms are a result of increased pressure to tissues surrounding the pituitary gland when the tumor is relatively large. These symptoms include headaches and visual impairments. Other symptoms that characterize this condition are specific to each sex. For example, women may experience irregular, or lack of, menstruation; lactation when not pregnant; uncomfortable intercourse; and loss of bone density. For males, symptoms include erectile dysfunction, and rarely, enlarged breasts. Symptoms tend to go unnoticed for longer periods of time in males. Such symptoms are not likely to become evident until the tumor becomes larger. On the other hand, females may notice changes in their menstrual cycle while the tumor is of a smaller size. In extreme cases these tumors could cause infertility in either sex.

Though the tumors aren't likely to spread to other areas of the body, they can increase in size; and because of the limited space around the pituitary gland, the can cause problems at a much smaller size than other brain tumors may. These tumors are more likely to occur in people under the age of 40 but rarely in children. Physicians may diagnose this condition using blood tests to judge hormone levels, but typically tumors are discovered using CT or MR imaging. Vision exams may also determine if there is increased pressure in the areas surrounding the pituitary gland. Many treatments may target symptoms and decrease prolactin production, but they may also decrease the size of the tumor itself. Certain medications may mimic dopamine, which is a chemical produced by the brain that regulates prolactin production. Other drugs may target infertility. In other cases where medication isn't effective, the tumor may be surgically removed. Depending on the size and location of the tumor, it may be removed through the upper portion of the skull, or even through the nasal cavity.

http://www.mayoclinic.com/

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http://www.neurosurgery.ucla.edu/

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Ramsay Hunt Syndrome

Ramsay Hunt Syndrome, also known as herpes zoster oticus, is caused by the same virus responsible for chickenpox, the varicella-zoster virus. It is an infection of the facial nerve resulting from a dormant virus present after chickenpox heals. If the immune system fails to destroy the virus it can reactivate resulting in this or other pathologies, such as shingles. Treatment within seven days of onset of symptoms can reduce chance for longterm complications. Since early detection is so important, here are some symptoms to watch for: pain in ear, hearing loss, tinnitus (ringing in ears), vertigo (disorientation), taste perversion, and painful red rash and blisters in the mouth or ear area. Sometimes confused with stroke symptoms, patients may also experience facial weakness on one side (the same side as the affected ear).
Though Ramsay Hunt often occurs in people over the age of 60, anyone who has had chickenpox can be affected. Because this disorder can be spread by touch, until blisters have scabbed over those affected should avoid contact with the following: anyone who has never had chickenpox, anyone with a weak immune system, newborns, and pregnant women. Failure to seek prompt treatment could result in permanent hearing loss and/or facial weakness. If there is severe damage to the facial nerve, it may not repair correctly resulting in abnormal facial movements. Other longterm possibilities include damage to the eye because of inability to close the eyelid; and spread of the virus to other nerves or brain, resulting in headaches, confusion, and overall weakness.
In order to treat Ramsay Hunt Syndrome, doctors may prescribe medication to target the virus and/or the symptoms. Such medications include: antiviral, corticosteroids (to reduce swelling), valium (for vertigo), or pain relievers. Certain exercises and Botox injections may help with facial weakness and the patients inability to close their eye. Treatment could take weeks or even months to take effect. Though there is no way of preventing the virus, the risk may be reduced by the varicella virus vaccine. This vaccine is usually administered between the ages of 12 and 18 months, but may be given to older children who have not had chickenpox.

http://www.mayoclinic.com/health/ramsay-hunt-syndrome/DS00878/DSECTION=prevention

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http://www.ramsayhunt.org/

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http://www.medscape.org/

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Brainstem Glioma

Brainstem gliomas are cancerous tumors found in the area of the brain between the cerebral aqeduct and the fourth ventricle, known as the brainstem. Occuring more commonly in children, brainstem gliomas are primary brain tumors, meaning they rarely metastasize to other areas of the body. There are several ways to characterize these tumors, a few of which are as follows: origin, location, extent of growth, hemorage, and necrosis. A greater probability of survival has been found in gliomas located in the tectal and cervicomedullary areas. However, intrinsic pontine gliomas, as demonstrated in the image to the left, carry a greater risk.
http://emedicine.medscape.com/article/1156030-media


MRI is typically the modality of choice when diagnosing a brainstem glioma. The patient will usually complain of and/or demostrate lack of facial control, double vision, headaches, nausea, vomiting, weakness, fatigue, and seizures. The onset of symptoms my be abrupt or gradual depending on the growth rate of the tumor; and symptoms may differ depending on location of the tumor. In older children, changes in speech and handwriting abilities may occur; whereas behavioral changes will likely be seen in all ages affected by this pathology.

Because of the location of these gliomas, neurosurgery is not often the treatment chosen. However, not all tumors are created equally and some are operable, as seen in the images below. Chemotherapy and radiation therapy are the more common treatments in such cases. Clinical trials are being conducted to explore other methods of treatment, however due to the aggressiveness of these tumors the prognosis is grim. Even with treatment only 37% survive more than a year beyond diagnosis, while 20% survive two years, and a mere 13% survive three or more years. Though there is no known cause, brainstem gliomas account for roughly 10-20% of childhood brain tumors.

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Information from: www.wikipedia.com;

http://emedicine.medscape.com/article/1156030-overview;

http://www.neuroendoscopy.info/