HERNIATED NUCLEUS PULPOSUS

Herniated nucleus pulposus(HNP) occurs when a disk located between the vertebrae moves from position or ruptures. The disk is composed of a jelly type substance that serves to cushion the vertebrae; however, trauma or strain to the back can cause the disk to herniate. The lumbar region is the most common site for HNP. Patients could complain of severe low back pain along with pain, numbness or tingling in their legs and feet. Patients may also complain of muscle spasms or muscle weakness. The most common treatment for HNP is a combination of rest, anti-inflammatory medication followed by physical therapy. Steroid injections and surgery may be required depending on the severity of condition.

PAGET'S DISEASE

Padget's disease is the abnormal breakdown of bone tissues in which the regrowth of the bone results in a deformity. This disease is commonly seen in the spine, pelvis, legs, and arms of affected patients. The cause of Padget's disease is unknown, but is questionably linked to viral and genetic origins. Patients' can complain of joint or bone pain along with shortening in height, headaches, bowing of legs, and fracture of bones. Patients may also be asymptomatic. Diagnosis of this condition may be done through a xray, bone scan or specific blood work. In some cases, surgery is recommended to fix the broken bone, while other instances drug therapy is recommended to slow the disease process.

Hangman's Fracture

Hangman's fracture is the breakage of both pedicles of the second cervical vertebrae. Commonly referred to as a hangman's fracture due to the the times when people where hung at public gatherings, the patient's neck hyperextends at the same time the patient's body moves forward. Today, this type of fracture is commonly caused from trauma due to a fall, MVA, or sport's injury. Patients with this type of fracture to their neck usually display the symptoms of a constricted pupil in one eye. In most cases where the pedicles are fractured, the patient's spinal cord and root nerves are undamaged due to the widening of the spinal canal; whereas the absence of a fractured pedicle can cause spinal canal and nerve root damage due to the narrowing of the spinal canal. Skull traction may be done to realign the cervical spine; however, the fractured pedicles usually take a while to heal, so surgery may be preferred.

CAROTID ARTERY STENOSIS

A narrowing of the carotid artery, commonly referred to as a stenosis, results from the build up of plaque within the artery. Carotid artery stenosis can be a serious condition since the carotid artery is responsible for supplying blood to the brain; nonetheless, an ischemic stroke can occur from the condition.
Carotid artery stenosis is commonly diagnosed after a doctor hears an abnormal sound, a bruit, when listening to the artery with a stethoscope. Doctors will refer the patient to get some form of imaging study done to diagnose the stenosis. An ultrasound of the carotid artery is the most common study performed, however, stenosis may be visualised on a MR angiography of the neck as well as a CT angiography of the neck. Surgery of the carotid artery, carotid endartectomy, can be performed to treat this condition depending on the degree of stenosis. Medication or a carotid angioplasty may also be used to prevent an ischemic stroke.

Vein of Galen Malformation

Sometimes during embryonic development, a rare condition can form due to the absence of capillaries in the brain. The capillaries are tiny vessels in which blood flows from the arteries to the veins. In addition to transferring blood from the arteries to the veins, capillaries also help lower blood pressure due to a decrease in blood flow. Without the capillaries, blood flow increases causing the heart to work harder and resulting in congestive heart failure (CHF). Hydrocephalus, commonly referred to 'water on the brain', can also occur due to the increase in blood flow.

Nonetheless, the vein of Galen appears enlarged due to being a single vein collecting blood drainage from the arteries with the absence of the capillaries. There are commonly three categories to describe the vein of Galen malformation. The categories are divided according to age of the patient. A patient could be a baby with CHF and a loud intracranial bruit (category 1), an infant with an abnormally enlarged head along with developmental delays (category 2) or an older child with seizure, even strokes, along with learning disabilities (category 3). Malformations of the vein of Galen can be deadly particularly in category 1.

Treatments for this malformation would be to concerning the CHF or hydrocephalus medically or surgically to releive the stress on the heart and pressure on the brain due to the increased blood flow.

JUVENILE ANGIOFIBROMA

Juvenile angiofibroma is a benign tumor, found commonly in young boys, that appears in the nasopharynx. This condition is relatively uncommon. Patients usually display symptoms of frequent nose bleeds, nasal congestion, bloody discharge from nose, and even hearing loss.
The tumor contains several blood vessels and can spread to surrounding bone. Surgery may be needed to remove the tumor, especially if the airway is being blocked. Sometimes emoblization is successful to stop the tumor from bleeding.
Additional information on juvenile angiofibroma is available at http://www.nlm.nih.gov/medlineplus/ency/article/001572.htm.

RETINOBLASTOMA

Retinoblastoma is a malignant tumor occuring in the retina of the eye. This disease is found to be genetic related and is commonly associated with children under the age of 5. Patients with retinoblastoma usually show symptoms of leukocoria or white bloches in the eye when exposed to light. Retinoblastoma can occur in one eye or both, however in severe cases, the cancer can spread to the brain by the optic nerve. In some cases, a patient may experience blindness in the effected eye since the retina is an important aspect of vision.


Currently, chemotherapy is the most common treatment for retinoblastoma. Physicians usually try to refrain from removing the effected eye, which was a previously used method of treatment. Other experimental methods such as thermotherapy, cryotherapy, radiotherapy, or laser therapy can be used for treatment, although they have a few disadvantages. For additional information concerning retinoblastoma and the alternative treatments, please search this link http://en.wikipedia.org/wiki/Retinoblastoma.

Empty Sella Syndrome (ESS)

Empty sella syndrome(ESS) is a disease in which the sella turcica appears empty on radiographic images due to the shrinkage of the pituitary gland. ESS is commonly found in two forms, primary ESS and secondary ESS. Primary ESS(PESS) causes the shrinkage or flattening out of the pituitary gland from an increase in pressure. The increase in pressure could be caused from fluid build up in the skull or a tiny anatomical abnormality above the pituitary gland. The next type, secondary ESS(SESS), occurs from trauma, surgery, or radiation therapy. The pituitary gland will appear smaller in the secondary form also.

ESS in either form is not life threatening, however patients may expierence problems with pituitary gland functions along with some endocrine disfunctions. Surgery may be necessary to treat other medical problems cause indirectly by this syndrome.

Above is a T1 MR sagitial image in which the patient has PESS.

Mastoiditis

Mastoiditis occurs when the mastoid process of the temporal bone becomes infected. Mastoiditis is commonly the result of a progressed middle ear infection that has been left untreated. Patients usually complain of pain, redness or swelling around the mastoid area. Patients may also complain of fever or a headache, whereas infants usually display nonspecific symptoms including of diarrhea, irritability, or not eating. In worse case scenarios, patients could have ear drainage. The most common treatment for mastoiditis is intravenous antibiotics, although surgery may be necessary if the antibiotics do not work. Treatment of mastoiditis is especially important so the infection does not spread to the brain or surround structures such as the inner ear or cranial bone. Cat scans are commonly used to diagnosis mastoiditis.

Below is an axial image of a Cat Scan in which the patient has mastoiditis. Notice the mastoid air cells on the patients right side appear different compared to the patient's mastoid air cells on the left. Consequently, the patient has mastoiditis within the right mastoid air cells.

further information about mastoiditis can be found at http://en.wikipedia.org/wiki/Mastoiditis.

CHOROID PLEXUS PAPILLOMA

Choroid plexus papilloma (CPP) is a rare disease affecting mainly children in which a benign tumor is found in the ventricular system of the brain. The most common site for the tumor in children is in the lateral ventricle. Consequently, normal CSF flow is disrupted due to the location of the tumor, creating an increase in pressure within the brain. Patients usually complain of a headache, vision problems, vomiting or seizures. Surgical removal of the tumor is the most common treatment.

To the right is an CT image demonstrating CPP in which the tumor appears white.

additional information is available at:

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

http://www.emedicine.com/radio/topic171.htm