Lumbar Spinal Stenosis

Lumbar spinal stenosis is a condition in which the foramina of the lumbar spine begin to narrow. This narrowing can occur in several places in the vertebra. In cases where the spinal canal is affected it is known as central stenosis; when the foramen are affected it is called foraminal stenosis. Spinal stenosis is most often caused by degenerative arthritis. Arthritis causes a loss of the cartilage in the joints. This arthritis can cause a loss in the spaces between the vertebra; this is known as degenerative disc disease. The degeneration will also cause an overgrowth of the ligament structures. All of these problems will reduce the pathways that the nerves normally travel through. This narrowing can cause pressure to the spinal nerves. Other causes of lumbar spinal stenosis are tumor, infections and other bone diseases such as Paget’s disease.
There are a number of symptoms that are associated with lumber spinal stenosis. These symptoms include numbness and loss of sensation in the lower legs. Pain in the lower back and legs is also common. It is common for the patient to have pain shoot down their legs when they are walking. This pain will lessen when the patient sits or rests. Patients will have an increase of pain if they bend backward while they are standing, however if they bend forward the pain will lessen. This is due to the fact that the disc spaces are larger when the patient bends forward which will take the pressure off the nerves. These symptoms most often worsen over time because arthritis is a progressive disease.
Diagnosis of lumber spinal stenosis is very important because there are several diseases that can cause similar symptoms. These include peripheral vascular disease, claudication of the blood vessels and diabetic neuropathy. The diagnosis process will begin with a thorough history and physical which will include a test of the patient’s range of motion. After the doctor has determined the duration and severity of the patients’ pain, the doctor will order x-rays that could include a CT or MRI scan. In cases where extensive damage to the nerves is possible the doctor may order an electromyogram (EMG) test. This will test the conductivity of the nerves to ascertain the level of damage that has occurred. This test will also determine the exact location of the nerves that are damaged.
Treatment for lumbar spinal stenosis can be done in a number of ways. Pain medicine and oral steroids are used to relieve the pain and inflammation. Certain medications such as Neurontin and Lyicra can be administered for the nerve pain. Surgery will become the next option of treatment for those patients that do not show improvements with the other treatments. The types of surgery that are typically done typically are laminectomy, foraminotomy, and, laminotomy. These types of surgery are done to remove the areas of the vertebrae that are compressing the nerves. These types of surgery are more commonly known as lumber decompression surgeries. Because lumbar spinal stenosis typically happens as a result of aging, there really isn’t any way to prevent this disease from occurring.

my information came from

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

my picture came from

http://www.medscape.com/viewarticle/557944_2

Discitis of the cervical spine

Cervical discitis is a disease in which there is inflammation of the vertebral disk space. This inflammation is caused by an infection that has traveled from other parts of the body to the spinal column through the blood stream. It is very uncommon for the infection to start in the disk space. Discitis is not a very common disease, it will usually only affect 1 in every 100,000 people with death happening in only 2 to 12% of those affected. Death is usually a result of the spreading infection through either the nervous system or the organs. Discitis can affect both males and female but will affect males more often in usually a 2:1 ratio. Discitis can affect both children and adults but does not affect one race more than another
In adults this disease progresses very slowly which can cause the diagnosis to be delayed for months. Most individuals have beginning complaints of tenderness and or pain in the neck or back. In those individuals that are already chronically ill, there will be a higher occurrence of epidural extension of the infection. This can cause those individuals to have weakness in their legs and feet. Patients who have just had surgery will have symptoms similar to those with an acute discitis but can expect their symptoms to appear within a day or two after having surgery. IN some cases of post op discitis the symptoms may not appear for a week or two. In children the disease will present itself much faster. The more common symptoms are sudden back pain, irritability and possibly the child refusing to walk. In both children and adults there have also been instances of fever and chills being reported. In most cases the most common physical symptom is having tenderness over the affected area and spasms of the paraspinal muscles
Discitis is usually caused by the spread of infection through the blood stream from a systemic infection such as a kidney infection. The most common infections to cause discitis are pneumonia, soft tissue infections and urinary tract infections. This type of disk infection has also been known to be caused by an infection at the site of a surgical procedure of the spine such as a discectomy. However infections caused by this a very rare, usually only resulting in about .5% of cases.
Because of its slow progression it can be difficult to diagnose discitis in its early stages. X-ray can be used to diagnose discitis by showing the narrowing of the disk space but this is only after the disease has been present for weeks. CT scans are able to identify discitis earlier by highlighting the decrease in the density of the disk itself. The best way of detecting discitis is the use of MRI. BY using a T-1 weighted image, an MRI has the ability to show the narrowing of the disk space and the edema associated with the infection. MRI will also help the technologist to distinguish between an infectious discitis and other pathologies such as tuberculosis.
In some cases the doctor will do a biopsy using a needle to determine if the disease is discitis or something more. In other cases surgical biopsy may be used because it is believed by some to be a more conclusive way of diagnosing discitis. Treatment of discitis is the use of an antibiotic to keep the infection from spreading. I.V. antibiotics are the best course of action and they are given for around six to eight weeks. During the first few weeks of treatment it is recommended that the patient be on bedrest. After this period of bedrest the patient should have external immobilization in pace in the form of a brace. This bracing will allow the vertebrae that are affected to fuse in an aligned position. The patient must wear this brace for a period of 3 to 6 months. If all treatment steps are followed most discitis cases will be resolved. In rare cases (usually only 15%) permanent neurological deficits may occur. The image I have below is a T-1 wieghted image showing discitis of the lumbar spine.

My information and image came from the following website

http:www.emedicine.com/Orthoped/topic77.htm

Bow Hunter's Syndrome

Bow Hunter’s syndrome is a stroke that is caused by turning the head to the side in a forcible way. Turning the head in this way puts pressure on the vertebral arteries in the neck; this pressure will cause the blood flow to be impaired. This will in turn cause a stroke. Strokes are caused by the blockage or bursting of a blood vessel. The damage to the blood vessels will cause a loss of blood to the brain, which will in turn cause the tissues to start to die. Diagnosis of Bow Hunter’s syndrome is done by using MRI imaging and MRI angiography.
Symptoms of Bow Hunter’s syndrome are typically the same as those of a regular stroke. Stroke symptoms include dizziness, vision disturbances, trouble speaking and walking, confusion and severe headache. These symptoms will usually occur on only one side of the body. The symptoms may develop or worsen over a period of minutes up to a matter of days. If any of these symptoms are present, medical treatment should be sought immediately by going to the emergency room. The faster treatment is obtained the better the chances for a full recovery. The damage starts immediately, the cells will start to die after 4 minutes without blood. The body will compensate for this loss by directing the blood to the other areas of the brain by using the other vessels that are not damaged. The damage that is caused can be temporary or permanent. Seeking treatment early may increase the chances of decreasing the permanent damage. Patients have the best chance of regaining their capabilities in the first few months. Some other symptoms can include changes in judgment, emotions and memory. Bow Hunter’s syndrome can be treated by two methods. These include using a neck brace for the cases that are not as severe and surgery for those cases that are more severe. The picture I chose is a CT image of a hemmorhagic stroke.
My information came from

http://www.revolutionhealth.com/condtions/brain-nerves/stroke/symptoms/bow-hunters-stroke

my pictures came from

http://en.wikipedia.org/wiki/stroke

Sjogren's Disease

Sjogren’s syndrome is a disease that affects the body’s autoimmune system. This means that this disease will cause an increase in antibodies. This increase will bring the antibodies to an abnormal level. These antibodies will then start to attack certain tissues in the body. The antibodies that are associated with this disease will begin to attack the tissues in certain glands in the body, most usually in the salivary, parotid, and, lacrimal glands. Ion 90% of cases Sjogrens disease affects mainly women. In most cases it is believed that this disease is inherited. It has also been found that people who suffer from other autoimmune diseases will be more likely to have the occurrence of Sjogrens disease in their family members. Other common autoimmune diseases are lupus, erythematosus, and juvenile diabetes.
Symptoms of Sjogrens disease depend on the gland that is affected. For example if is the lacrimal gland that is affected the patient can expect to have symptoms of dry eye and eye irritation due to a decrease in the tear production, this irritation can lead to abrasion on the cornea of the eye. If the salivary gland is affected then the patient will have complaints of dry mouth and swallowing difficulty. They may also develop gum disease and tooth decay. It may also lead to the development of stones or infection in the parotid gland. This disease may also affect the joints and blood vessels by causing inflammation. The inflammation of the blood vessels is called (vasculitis). Although this is a very serious complication of Sjogrens disease it is also very rare. Thyroiditis is another disease that is associated with Sjogrens disease. This can lead to thyroid hormone levels that are extremely elevated
This disease is diagnosed by the diagnosis of the symptoms. To test for dryness of the eyes they will perform a test called a Schirmer’s test. This is done by taking a small piece of paper and placing it under the eyelid to test the eyes ability to wet the paper. Problems with the salivary gland s are tested by using a technique called the salivary flow test. To follow up on this test they will perform a salivary gland biopsy. Unfortunately there is not a cure for Sjogrens disease. The only treatment for this disease is to treat the areas that have been affected. In the cases of dry eyes, eye drops are an effective treatment. Dry mouth can be treated by an increase in the patients’ fluid intake, using a humidifier to moisten the air, and have good dental hygiene to avoid problems with gum and tooth decay. When the nasal passage is dry a saline nasal spray is effective in relieving the discomfort of the dryness.
My information came from
http://www.medicinenet.com/script/main/art.asp?articlekey=477&pf=3&page=1

Vein of Galen Malformations

Vein of Galen malformations are a very rare type of condition that affects the blood vessels of the brain and it occurs during embryonic development. This condition results from an abnormal communication between the arteries and the veins in the developing brain. The Vein of Galen is a large vein that is located deep in the base of the brain. Normally blood will flow slowly through the capillaries to allow the exchange of oxygen into the surrounding tissues. With this type of malformation the capillaries are missing. This allows the blood to flow directly from the arteries to the veins. With this type of flow it does not slow down and will not allow the release of oxygen and nutrients. The rush of blood from the brain can cause many problems. Since the blood flows almost straight to the heart so rapidly, the heart can become overwhelmed, thus possibly leading to congestive heart failure. The faster flow of blood may also interfere with the normal blood drainage, which may lead to hydrocephalus. This malformation is rare and develops in utero. This malformation is caused by the blockage of the normal flow or absorption of cerebral spinal fluid. Vein of Galen malformations can be placed in three categories. Group one is neonates that develop congestive heart failure and a noise made by blood turbulence. This is called an intracranial bruit. The second group is infants that present with developmental delays and abnormal enlargement of the head. The third group is comprised of older children who will suffer from possible seizures or epileptic fits. They are in danger of possible strokes. They will also have an enlarged head and have difficulties learning.
It is possible to detect these kinds of abnormalities during antenatal ultrasound scans. Most often it does not appear until after birth when the child experiences rapid heart failure. In severe cases while in utero the baby will have difficulty coping with the abnormal shunt and this will cause the baby to die. If the child survives through birth they will rapidly go into heart failure that can be treated medically. Even with medical treatment in some cases the heart failure is so severe that other organs will be affected and the baby will not survive. Those children who do not develop heart failure will develop the hydrocephalus. This can cause the child to be floppy and sometimes have slight developmental delays. Treatment for these children is possible when they are a few months of age. And although their heads will remain large, over time as they grow their bodies will catch up with and become proportional to their head size.
Embolization is the most effective treatment for this type of malformation. A small catheter is fed through the arteries until the defect is located. Materials will be placed by the surgeon in the artery to block the blood flow to form a clot. The materials used range from fast acting glue to small particles or coils. Although this procedure is not 100% successful on the first attempt the subsequent efforts will gradually close off the remaining blood flow. After treatment is successful patients will often make rapid advances in their development and may go on to lead normal healthy lives. Those children who do not receive treatment will become at risk for developing permanent brain damage. The permanent high pressure within the vessels may also lead to the development of seizures or stroke.

my information came from

http://www.childrenshospital.org/clinicalservices/Site2162/mainpages2162p16.html

http://www.veinofgalen.co.uk/vog.html

my pictures came from

http://www.emedicine.com/neuro/topic538.htm

Nasal Polyps

Nasal Polyps occur in the lining of the nasal cavity or sinuses. They are soft and non-cancerous. These growths are brought about by having a chronic inflammation of these linings. No one really knows what causes this chronic inflammation. Nasal polyps can affect anyone but they are more common in people over the age of forty and in those who have asthma, chronic sinus infections, hay fever and cystic fibrosis. These polyps rarely cause problems especially if they are smaller. The larger polyps can cause problems with breathing and can affect a persons’ ability to smell things properly.
It is believed that some causes of the chronic inflammation of the nasal lining might be bacterial or viral infections. In some cases it can be caused by allergies or the body’s reaction to a fungus. This inflammation causes the vessels in the nose and sinuses to accumulate water in the cells because they become more permeable. In time these vessels will sag because of the effect of gravity on the swollen tissues. The sagging vessels could develop into polyps. It is believed that people who are affected with a severe allergy to environmental fungus and children with cystic fibrosis are more likely to develop nasal polyps. People who have Churg-Stauss syndrome which is a rare disease that causes inflammation in the vessels are also very likely to develop nasal polyps. If a person has a sensitivity to NSAIDS or aspirin they are also likely to develop nasal polyps.
Some common symptoms of nasal polyps range from the simple runny nose to chronic sinus infections. Those affected complain of persistent stuffiness, a loss or decrease in the sense of smell. Complaints of dull headaches, snoring and chronic sinus infections have also been reported.
CT scans are used to test for nasal polyps by determining size, shape and the location of possible polyps. When a child has been diagnosed with having multiple nasal polyps, the doctor may decide to test the child for cystic fibrosis. This is done by doing a sweat test, which consists of measuring the amount of sodium chloride in the child’s perspiration. Small nasal polyps normally do not cause complications especially if there is only one. However, if the polyps are large or if there are several they can lead to some complications. Examples of complications are acute or chronic sinus infections, sleep apnea and altered facial structure which can lead to wide set eyes; this is most likely to occur in people with cystic fibrosis. Sleep apnea is a serious condition which causes an individual to stop breathing for short periods of times while sleeping.
Treatment for nasal polyps range from steroid treatments to surgery. Doctors will prescribe a corticosteroid nasal spray to relieve the inflammation and shrink the polyp. This treatment is usually prescribed if there are one or more small polyps. If this treatment proves ineffective the doctor may decide that surgery is the best option. Two types of surgery are used. The first is Polypectomy. This is a procedure in which the polyp is removed completely. The other type of surgery is known as an Endoscopic sinus surgery. In this surgery they not only remove the polyp, they also open the area of the sinuses where the polyps have been forming. In the cases where the chronic sinus infections have been caused by an environmental fungus the doctor may prescribe antifungal medications.

My information came from the following website.
http://www.mayoclinic.com/health/nasal-polyps/ds000498

My picture came from the following website.

http://www.ghorayeb.com/NasalPolyps.html

Retinoblastoma

Retinoblastoma is a form of cancer that can affect children during fetal development up to five years old. It is caused by immature retinal cells and can affect one or both eyes. Retinoblastoma is the most diagnosed form of eye cancer in children. It is largely believed that this form of cancer develops from a mutation of chromosome 13 (in the long arm). Common signs of retinoblastoma are a white glow in the pupil of the affected eye that is visible in dim lighting. It is also noticeable in color photos by the white appearance of the pupil. Also patients may have crossed eyes or eyes that are not properly aligned.
When patients receive prompt medical care their prognosis is good. The survival rate in the United States and Great Britain is around 85%. If the optic nerve is not involved enucleation is performed before the tumor passes through the lamina cribrosa, in these cases the cure rate is almost 90%. If the tumor extends beyond the lamina cribrosa the survival rate decreases to 60%. Some complications of retinoblastoma survivors can include the development of secondary nonocular tumors (this occurs in 50% of patients who have survived having bilateral retinoblastoma), the development of a cataract, retinal vascular damage and/or hemorrhage.
Patients suffering from retinoblastoma can be treated by radiation treatment, chemotherapy, or surgical removal of the tumor, which is known as enucleation. Enucleation is most commonly performed when the chance of preserving useful vision is unlikely. Patents receiving enucleation are those that have a total retinal detachment.
As retinoblastoma progresses the appearance of the eye becomes worse, and can develop into a large orbital mass in and around the eye. CT images are pivotal in identifying and diagnosing this form of tumor. It also allows the assessment of anatomy for possible extension of the retinoblastoma.
Retinoblastoma is one of the cancers that if discovered early can be successfully treated.

My information came from

http://www.emedicine.com/oph/topic346.htm

My picture came from

http://www.retinoblastoma.net/whatisrb.html

Craniopharyngioma

Craniopharyngioma is a tumor that develops near a small endocrine gland known as the pituitary gland which is located at the base of the brain. This is a benign type of tumor that commonly affects children between the ages of 5 and 10 years old. It can however develop in older individuals as well.This disease does not affect one sex more than another.
Craniopharyngiomas will affect the body most commonly in these three ways. It causes an increased pressure on the brain (intracranial pressure). It will also disturb the function of the pituitary gland, and it will cause damage to the optic nerve. With the increase of brain pressure patients can expect to experience nausea, vomiting (most commonly in the morning), headaches, and problems with balance. Disturbances in the function of the pituitary gland can cause hormone imbalances which can lead to diabetes insipidus. This presents itself by excessive thirst and urination. Pituitary gland problems can also lead to stunted growth. If the optic nerve is disturbed it will cause vision problems. At the time of diagnosis it is very common for patients to have some form of vision disturbances and a drop in hormone production. Disturbances in vision may be permanent and may worsen if surgery is performed to remove the tumor.
Diagnosis of this type of tumor can be obtained by using a CT or MRI scan of the brain. In the past the treatment for these tumors has been to have them surgically removed. In some patients this may not be the best choice. In these cases radiation treatment will be utilized. In the cases where surgery could not completely remove the tumor radiation therapy will be required.
I n most cases if the tumor can be completely removed or if high doses of radiation are given the prognosis is very good with most patients having an 80-90% chance for a complete cure. The prognosis will vary on a patient by patient basis depending on the severity of their individual symptoms. In most cases the vision problems and hormonal imbalances will not be resolved with the treatment and can become worse because of the treatment.
Some complications associated with the treatment of craniopharyngioma are that a very large percentage of patients will have continuing visual, hormonal and neurological problems. In the cases where the tumor couldn’t be completely removed it is common for the tumor to return.

The image I chose is of a gadolinium enhanced T-1 weighted MRI image of a craniopharyngioma in a 23 year old female.

My information was obtained from

http://www.nlm.nih.gov/medlineplus/ency/article/000345.htm

my picture was obtained from

www.emedicine.com/radio/topic196.htm

Glomus Tympanicum Tumor

Glomeus Tympanicum Tumors are tumors that grow in the portion of the ear known as the middle ear. These type tumors are often called neoplasms. Glomerus Tympancium tumors are the most common type of neoplasm found in the middle ear. Symptoms of this type of tumor include hearing a pulsing sound which is known as pulsatile tinnitus. This results from the sound the blood makes as it moves through the vessels of the tumors. The most severe symptom is that of conductive hearing loss which is caused by the tumor blocking the sound through the middle ear. Some of the other symptoms can include ear pain, and bleeding.
The diagnosis process is based on the patients’ symptoms. It is customary for a physical examination to be done first. It is in this examination that a bluish mass is found behind the ear drum. Following this a hearing test and a CT exam are performed. The CT is done to assess the location of the tumor in relation to other structures in the ear. The CT is also used to determine the size of the tumor. The CT scan will also show if there are small erosions in the bones.
Most often these tumors are treated by surgically removing them. The surgeon will remove them by making a small incision in the ear canal to remove the smaller tumors but if the tumor is larger it will be removed by making an incision behind the ear. Although these surgeries are done while the patient is under general anesthesia they are usually done as a same day surgery. If the entire tumor is successfully removed the chance of recurrence is very low.

My information came from

www.chicagoear.com/med_info/glomus_tympanicum.htm

My picture came from

www.emedicine.com/RADIO/topic309.htm

Arachnoid Cysts

Arachnoid Cysts


Arachoid cysts develop in the areas that separates the brain and spinal cord from the arachnoid membrane. These cysts consist of sacs filled with cerebrospinal fluid and are categorized as primary and secondary. Primary cysts result from developmental abnormalities of the spinal cord and brain and develop in the early weeks of a baby’s development in the womb. Secondary cysts occur as a result of injury, tumors or meningitis. These are not as common as primary cysts. There is a third type of cyst that forms around the spinal cord. Arachnoid cysts form in the middle crania fossa, which is an area located outside the temporal lobe of the brain.

Symptoms of arachnoid cysts depend largely on the size of the cyst. The size will also determine the onset of these symptoms. In most cases symptoms begin within a child’s first year or before 20 years of age. There are individuals who do not develop symptoms at all. There are a wide range of symptoms that occur with arachnoid cysts. They range from the usual such as nausea and vomiting, dizziness, headache, seizures, to problems with hearing and vision. These symptoms are associated with cysts around the brain and can also include vertigo which can cause problems with balance and walking. Individuals with cysts around the spinal cord can develop symptoms that can include numbness, tingling in the arms and legs and increasing back and leg pain.

Diagnosis of arachnoid cysts can be made using an MRI brain scan that is diffusion weighted (also known as a T-2 weighted image.) This helps enhance the arachnoid cysts that are filled with fluid and helps the radiologists to identify if it is another type of cyst. On an MRI image these cysts will appear as a white spot and on a CT the cyst will appear as a dark spot in the brain.
Treatments for these cysts include placing shunts to allow the fluid to drain from the cysts. Advances in neurosurgical techniques and endoscopic tools are giving surgeons the ability to do more non invasive surgical procedures to either remove the cyst or to open the cyst and let the fluid drain into the cerebrospinal fluid, it then can be absorbed by the body. If left untreated these cysts can cause severe and permanent damage to the brain and spinal cord. With treatment symptoms will usually improve or even be completely relieved.



The first image is a T-2 weighted MRI image of an Arachnoid Cyst in a 28 year old female. The second image is an unenhanced CT image showing a large cyst in the left frontoparietal area of a 26 year old male patient.

My information came from the National Institute of Neurological Disorders website

http://www.ninds.nih.gov/

The pictures came from the emedicine website.

http://www.emedicine.com

Introduction

Hey Everyone,

I will be posting on this site for my Radt. 413 class. The class is a CT/MRI procedures class and I will be posting pictures and information about the different pathologies we discuss in class. This is my first time using a blog site so I hope to learn a lot about blogging.