Sunday, December 12, 2010

Lumbar Spondylosis


Lumbar Spondylosis

Spondylosis is a deterioration that affect the lumbar spine but can also affect the cervical and thoracic spine.
As the body goes through changes, normally from old age, the spine degenerates. The margin between discs in the lumbar vertebrae becomes constricted which can bring about tingling, numbness, and pain that appear to emit out from the area. These indicators are the reaction of force on the nerves as they leave the spinal cord.

If the degeneration is permitted to advance, it can cause insufficient space of the spinal canal. With this limited space, it can produce impingement of the spinal canal which can create an unsteady walk, deficient bladder control and other serious nerve problems. With Lumbar Spondylosis, osteophytes form
which is excess bone growth that is mainly seen around the anterior, lateral, and less often at the posterior side of the superior and inferior borders of the vertebral bodies.

Generally Spondylosis is identified with a manual exam and x-rays of the spine. Sometimes a neurological exam is performed to establish if there are problems in the spinal canal that might be caused by spondylosis.

Treatment can be determined once the doctor evaluates how seriousness of the spondylosis and the patients age. There are several treatments that can be used to control the pain such as nonsteroidal anti-inflammatory drugs, acupuncture, osteopathic manipulative medicine, trigger-point therapy, massage, chiropractic and osteopathic care. Surgery can be performed to take out the osteophytes or occasionally sections of the intervertebral disc are routinely removed to try and ease the compression on the adjoining nerve roots and possibly the spinal cord. If a patients age is in question it may not be worth it the risk of surgery.




Sunday, December 5, 2010

Schmorl's Node in the Throacic Spine


Schmorl's Node

Schmorl's node is described as a herniation of the spinal disc's soft tissue into the bony tissue of the adjoining vertebrae. Schmorl's node is a lesion considered to be linked with trauma, frequently located in the thoracic and lumbar vertebrae, however there is a chance that the node can be a congenital defect of the vertebral end-plate. Schmorl's nodes are usually the start of degenerative-disc disease. X-rays are used to diagnose this spinal defect.

A physical exam will show soreness directly over the concerned vertebrae. Schmorl's nodes typically cause no symptoms nevertheless an inflammatory response can take place producing severe pain. Generally the patient cannot remember what they did to cause the pain. Not requiring substantial medical care, rest and spinal manipulation are usually required to alleviate the pain. Oral supplements can assist elasticity and non-steroidal anti-inflammatory drugs can relieve pain and swelling. If the discs need repaired, advanced Arthroscopic surgery can be performed to relieve nerves that are crushed.

(Image shows Schmorl's node at T11 and T12)

Sunday, November 28, 2010

Clay Shoveler's Fracture

Clay Shoveler's Fracture
Clay Shoveler's fracture is an uncommon but stable fracture customarily seen at the level of C7 succeeded by C6 and T1. This fracture usually happens in people who work lifting some type of weights quickly with arms lengthened causing the muscles to forcefully tighten. The force from the muscle pulling on the spinous process results in the base of its neck to break.

With Clay Shoveler's fracture, a person will feel a "knife-like" burning pain between the shoulder blades. Usually the fracture is so painful that the person can not continue with the activity they were performing.

A radiography is used to diagnose a Clay Shoveler's fracture. However if there is nerve loss, an MRI should be performed.


The majority of patients do not need medical care. Massage, physical therapy, pain medication
or a cervical collar can be used to aid in the patients treatment.

Sunday, November 21, 2010

Carotid Body Tumor

Carotid Body Tumor

Carotid body tumors
develop in the upper region of the neck where the carotid artery bifurcate. These tumors can also be called chemodectoma or paraganglioma.

Carotid body tumors often show up as a slow-growing asymptomatic touchable mass on the anterior aspect of the neck. Sy
mptoms will appear, such as pain, tongue paresis, Horner Syndrome, hoarseness, and dysphagia as the tumor grows and constricts the carotid artery and the encompassing nerves.

Usually removal of a carotid body tumor is proposed and occasionally radiation therapy is used in conjunction with surgery. Embolization is done to lower or cease the blood supply to the tumor and then a resection is performed on the carotid artery.

Treatment for carotid body tumors is typically very safe, and the end result is extremely good. However, there is always risk with any surgical procedure.

A very rare complication of the resection of carotid tumors is stroke. Carotid body tumors with nerves connected will need accompanying resection of the vagus nerve which might result in the dysfunction of the nerve. Facial nerves and hypoglossal nerves can also be involved depending on the size of the tumor. Less than 5 percent of patients progress to metastasis.

Sunday, November 14, 2010

Ranula


Ranula
A ranula is a mucus filled cyst from an obstruction in the salivary gland. Ranula can be found in the mouth known as oral ranula or in the neck known as cervical ranula. The oral ranula usually can be found under the tongue which produces a sublingual ranula.

Ranula vary in size and in color hinging on how deep-rooted the cyst is. Depending on the size of the cyst, it can may make it unbearable to eat or talk. Periodically, the cyst will subside on its own but if that is not the case then a marsupialization may have to be performed by an oral surgeon. A marsupialization is when the oral surgeon creates a pocket by opening the cyst to enable the cyst to fill with liquid again. If this doesn't repair the cyst then the it will have to be removed along with the gland that is blocked to keep it from coming back.


Sunday, October 31, 2010

Vein of Galen Malformation

Vein of Galen Malformation

Vein of Galen malformation is a very rare disorder known as cerebral vascular malformation which affect the blood vessels in the brain. The irregularity occurs during embryonic development when there is flaw in the connection between arteries and the deep draining veins. Capillaries which allows the blood to send oxygen and nutrients slowly to the brain is lacking in the connection which makes the blood run too fast which prompts the heart to work to hard. Too much blood accumulates in a deep draining vein causing it to expand which can cause heart failure. Heart failure is the most standard concern in newborns.

Sometimes a Vein of Galen malformation may be diagnosed by an ultrasound before a baby is born, yet it may not be found until after the baby is born and it undergoes heart failure. Every so often, children with Vein of Galen malformation never develop heart failure but because of the miscommunication between the arteries and veins, the water inside the brain cannot be completely consumed. The baby's head expands but over time the baby will grow into it.

To determine if the baby symptoms or heart failure is caused by Vein of Galen malformation, some test may be performed such as an Angiogram, CT or MRI. Embolization may be required as treatment which decreases blood flow by cutting off encompassing blood vessels.




Saturday, October 16, 2010

Chronic Sinusitis

Chronic Sinusitis

Chronic sinusitis is one of the most frequently diagnosed chronic conditions. Chronic sinusitis is a common recurring inflammation of the air filled cavities in and around the nose that makes it difficult to breathe through the nose, which obstructs drainage and causes mucus to build up.

Some of the symptoms of chronic sinusitis may involve trouble breathing through the nose, tenderness in the cheeks, headaches, eyes and face may feel swollen and painful, nasal discharge, or sinus congestion.

Chronic sinusitis is a long-term infection that can last longer than 12 weeks. Most occurrences start with the common cold causes by a viral or bacterial infection and some originate from allergies, upper respiratory tract infection or deviated septum.

To diagnose chronic sinusitis, the healthcare provider will need to do an in-depth medical history and physical examination focusing on the sinuses and nose. If the physician suspects that the chronic sinusitis is causes by allergies, a person should be referred to an allergy specialist. Imaging of the sinuses may involve an X-ray or CT to decide the severity of the infection.

Treatment of chronic sinusitis depends on the patients medical history, whether there are complications and the severity of the symptoms. Non-medical treatments include using a humidifier to dampen and release nasal discharge and to keep the head elevated while sleeping to reduce pressure. Medical treatments include medications such as decongestants, saline nasal spray or non-steroidal anti-inflammatory drugs. If these treatments do not work, surgery may be an option to enlarge the nasal passage of the infected sinus.

Saturday, October 9, 2010

Retinoblastoma

Retinoblastoma

Retinoblastoma is a fast growing malignant tumor of the retina. This cancer mainly affects children under the age of 6 and is more often than not diagnosed in children ages 1-2 years.

Symptoms and signs of Retinoblastoma range from the most apparent sign such as a peculiar appearance (white glow) of the pupil to less specific or common signs such as a red and irritated eye, degeneration of vision, the iris may be a different color in each eye, or stalled growth or delayed maturation. The eyes of some children with Retinoblastoma can become cross-eyed.

Retinoblastoma happens when a cell of a developing retina forms an anomaly and grows out of control and becomes cancerous. This cancer can be a genetic, inherited form or non-genetic, non-inherited form and can affect one or both eyes.

To diagnose a child, an eye examination with dilation of the pupil is needed along with an ultrasound of the eye. A CT scan or MRI of the head should also be done to assess the tumor and the risk of the cancer spreading.

Almost all patients can be cured if the cancer has not extended beyond the eye. In the case of a tumor spreading past the eye, such as the brain, lungs and bones, the possibility of a cure is reduced. The course of action in treating Retinoblastoma will be contingent on each individual case. Options include chemotherapy laser therapy, radioactive plaques, cryotherapy, surgery or a collaboration of any of these treatments.

Sunday, October 3, 2010

Craniopharyngioma


(T1 wt coronal-enhanced MRI)


Craniopharyngioma

Craniopharyngioma can be diagnosed at any age, however it is usually found in children and young adults. This type of brain tumor derives from pituitary gland embryonic tissue called Rathke's pouch. The Rathke's pouch begins in the throat area and moves upward to the brain where the tumor develops from the remnants of Rathke's pouch. Craniopharyngiomas are also known as Rathke's pouch tumors, adamantinomas, or hypophyseal duct tumors.

Because Craniopharyngiomas are almost invariably benign, the tumors are not detected until they becomes rather large which then causes symptoms as they start to apply pressure to other parts of the brain surrounding them. Craniopharyngiomas can range from one, to more than four inches in diameter. The symptoms presented by this brain tumor vary depending on where it is and what part of the brain it is pressing on. If it includes the hypothalamus, a person may have drowsiness, weight gain, mood changes and depression, or problems with temperature control. Loss of peripheral vision can occur when pressure is applied on the nerves that regulate vision. If the pituitary stalk or pituitary gland is compressed it can halt production of part of the pituitary hormones causes symptoms such as fatigue, dry skin, unexplained weight gain, irregular periods, delayed puberty, etc.

There are several test that are done to assess whether or not a person has craniopharyngioma. A blood test is performed to check hormone level along with a complete Pituitary Function test to gauge all the major pituitary hormones and a Visual field test to check if there is any compression of the nerves managing vision. An MRI is used to see the size of the tumor and where the pressure is being applied on the brain. Craniopharyngiomas consist of fluid and sometimes calcium which gives it a distinct look. When scanned, this brain tumors unusual appearance helps differentiate it from other pituitary tumors.

If suspected, craniopharyngioma can be treated largely by surgery, however, even with surgery the tumor may not be able to be entirely removed. Sometimes the tumor will have to be treated with radiation combined with surgery to help destroy it.

Sunday, September 26, 2010

Mastoiditis

Mastoiditis

(On the left is an MRI axial T1-weighted image with IV contrast which shows Acute Mastoiditis on the left mastoid process)


Mastoiditis is a bacterial infection of the mastoid air cells within the mastoid process which is the bump located behind each ear. In most occurrences, it happens when an ear infection extends to the mucus membrane encompassing the mastoid process and finally reaches the walls of the mastoid bone itself.
If mastoiditis continues and is not treated it can end in hearing loss and bone destruction in the skull. At the present time, the possibility is good for a full recovery if it is treated without any delay otherwise it could lead to worst problems such as facial paralysis, labyrinthitis, meningitis and brain abscess.

There are various bacteria that can cause mastoiditis such as beta-hemolytic streptococci, staphylococci, hemophilus influenzae, gram-negative organisms and pneumococcus (typically in children under the age of six). Mastoiditis is commonly a complication of Chronic and acute otitis media.
Indications of mastoiditis may consist of low-grade fever, edema of the tympanic membrane, dull ache and tenderness in the area of the mastoid process, thick purulent discharge that commonly becomes more prolific possible conductive hearing loss and postauricular erythema and edema. In order to treat mastoiditis, intense parenteral antibiotic therapy is used which can be done intravenous or intramuscular. If the bone has minimal damage, a myringotomy is done to drain the purulent fluid. A simple mastoidectomy would be required if the infection persists or recurs but if the mastoid is habitually inflamed a radial mastectomy would be necessary. With both the simply or radical mastectomy, the patient would still undergo oral antibiotic therapy.

Saturday, September 18, 2010

Medullablastoma (MRI)

Medullablastoma

Medullablastoma is a fast- growing tumor of the cerebellum. The cerebellum controls posture, balance and complex motor functions like speech and balance. Tumors found in the cerebellum are called infratentorial tumors. In adults this tumor can usually be found in the body of the cerebellum especially toward the edges. In children, medullablastomas arise most often near the vermis.


There are different types of medullablastomas: classical medullablastoma, large-cell or anaplastic medullablastoma, desmoplastic nodular medullablatoma, melanotic medulloblastoma, medulloblastoma with glial differentiation, medulloblastoma with neuroblastic or neuronal differentiation and medullomyoblastoma. The early signs of this disease are “flu-like” – loss of appetite, irritability and lethargy so at first a Medullablastoma tends to go unnoticed because the signs are so non-specific. The first symptoms in infants may be irritability and increased head size and the first symptoms in older children and adults may be headaches and vomiting upon awakening. The person usually feels better after vomiting but as the tumor continues to grow, the pressure in the brain increases causing their vomiting, headaches and drowsiness to increase. Since Medullablastomas are found in the cerebellum, which controls movement and balance, a common problem with coordination and dizziness arises.


The first course of action a doctor needs to take in making a diagnosis is to get a symptom history of the patient and to run a neurological examination. MRI is the modality performed to identify the presence of a tumor in the brain and is done with and without contrast.

Once the tumor is established as being a medullablastoma, treatment currently consists of surgery to remove as much of the tumor as viable. The person’s doctor will recommend a treatment plan constructed of details that show the risk of the tumor returning. The doctor will also look at the patients age, how much of the tumor persists or spreads after surgery and amount of metastases to verify risk.


The most crucial measure in treating medullablastoma is to take out as much of the tumor as attainable to help ease the cerebrospinal fluid buildup from either swelling or tumor. After surgery, radiation therapy is typically used to treat medullablastoma because there may be some microscopic tumor cells that persist in the adjoining brain tissue. Chemotherapy can be used in children to decrease the risk of tumor cells extending through the spinal fluid. This treatment may not aid adults because their tumors tend to relapse in the cerebellum.


Prognosis of a patient depends upon how well they respond to treatment, which relies on their age, the size and magnitude of the tumor, the amount of the tumor that can be taken out safely and the stage of metastatic disease.

Thursday, September 2, 2010

Getting Started in CT/MRI Procedures

Hello,
My name is Rhoda Stanton. This is my second semester of classes towards receiving my certification in MRI. I have worked for the past 9 years at Methodist Sports Medicine/The Orthopedic Specialist in Indianapolis Indiana as a General Diagnostic x-ray technologist. The clinic has recently formed a partnership with CDI and we now have an MRI center in our new facility at our north office. My wish is to someday be able to work in the MRI center.
This should be a really interesting class and I am looking forward to getting started! I am excited to read everyones blogs and I want to wish everyone a great semester.