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.

http://upload.wikimedia.org/wikipedia/commons/e/eb/Tumor_BrainstemGlioma2.JPG

http://www.neuroendoscopy.info/img/paediatric_3.jpg

http://www.scielo.br/img/revistas/anp/v63n1/23596f3.jpg

Information from: www.wikipedia.com;

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

http://www.neuroendoscopy.info/