Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory process that affects the collagen joints of the vertebral column. Chronic inflammation of the spine will cause stiffness and eventually the spine may become fused. Joint changes are difficult to visualize on a radiograph until the inflammatory process has progressed for several years and joint damage is present. Utilizing MR imaging can aid in early detection of ankylosing spondylitis. Also, blood test performed during inflammatory episodes can be used to support the diagnosis of ankylosing spondylitis. The disease process affects caucasian men between the ages of 15-30 years old, three times more than women. The signs and symptoms are fatigue, constant stiffness in the lower back and tendonitis. The treatment for ankylosing spondylitis includes the use of analgesics to reduce pain and corticosteroids to reduce inflammation.

Bow Hunter’s Syndrome

Bow Hunter’s syndrome or stroke is a condition that affects the blood flow to the posterior cerebrum. The vertebral artery becomes stenosed or occluded in severe cases, when the head is turned in a specific manner. When the artery is occluded, the person is experiencing an ischemic stroke. The signs and symptoms of Bow hunter’s syndrome are nausea, vomiting, dizziness and decreased level of consciousness. The symptoms may resolve quickly when the head returns to neutral position and the vertebral artery is no longer occluded. An angiography is the “gold standard” for diagnosing the presence of Bow Hunter’s syndrome. The simplest and most non invasive treatment for Bow Hunter’s is to remind the patient to limit of head movement. Surgical intervention is the second treatment option which can include freeing the vertebral artery at the compression site or cervical fusion to limit head movement. The treatment options should be carefully weighed according to the severity of involvement.

Lipoma

What is lipoma?
Lipoma is a non-malignant fatty tumor that forms between the dermis and muscle tissue. The etiology of lipoma tumors is unknown but a genetic link has been established. Lipomas are most commonly seen in people that are middle age. Lipomas grow slowly therefore a person may remain undiagnosed until symptoms arise or it was an incidental finding. Lipomas can be identified by there mushiness when palpated and the tumor is moveable when scant amount of force is applied. A lipoma tumor may form anywhere on body, however it is most prevalent in the neck, arm and thigh regions.
Signs and Symptoms
Typically, lipomas are slow growing with little to no pain, but if the tumor begins to grow in size or compress on surrounding nerves than pain may be intensified. The tumor will be moveable and spongy to the touch. Lipomas are most commonly less than 2 inches in size and may remain undetectable for several years.
Treatment
A physician may order a CT scan to rule out the presence of liposarcoma which is a malignant tumor within fatty tissue. A biopsy taken at the doctor’s office can also rule out the diagnosis of liposarcoma. Treatment is largely based on the patient’s symptoms. If the tumor is not obstructing the patient’s ability to perform activities of daily living and there are no complaints of pain or tenderness, then the physician may only monitor the tumor over the years for a change in status. If pain is present or activity is affected then the tumor can be removed in the physician’s office.

Brachial Cleft Cyst

Brachial cleft cyst is a cyst that is formed when one of the four brachial cleft does not properly close during the embryonic stage. The cyst may become filled with thick yellowish fluid from sinus drainage. The brachial cleft cyst may also become infected. Brachial cleft cysts appear as a raised smooth area on the lateral portion of the neck. It may not be noticeable until the infant reaches adolescents. Typically 1-2% of the patients that are diagnosed present bilateral cysts. There may be a congenital link with the formation of brachial cleft cyst. The cyst is painless and does not diminish the health or wellness of the patient unless an infection develops. If the cyst becomes infected then antibiotics should be prescribed. The second treatment option is to have the cyst surgically removed.
The first image is MRI in sagittal view. The middle image is an MRI in coronal view. The last image is of a Brachial Cleft Cyst being
surgically removed.

Trigeminal Neuralgia

The trigeminal nerve is the fifth cranial nerve. It is the largest of the twelve cranial nerves. The trigeminal nerve is responsible for relaying information to and from facial area as both sensory and motor functions. People that have trigeminal neuralgia live with intense paralyzing facial pain that may occur for a matter of seconds up to several minute. This horrific pain may increase in occurrence and in duration over the years. Trigeminal neuralgia can be stimulated by performing basic tasks such as mastication, brushing of the teeth or even delinquently touching the face. The exact cause of trigeminal neuralgia is not known but it is speculated that pressure is placed on the nerve from a surrounding blood vessel or artery. Although TN has been seen in family members and their off spring it is still undetermined if it possesses a hereditary link.
Who is affect?
Trigeminal neuralgia is more prevalent in women than in men and it does not age discriminate, however; it is seen more often in persons fifty years of age and older.
Treatment
There are a few treatment options of which to choose, however; the use of opiates or analgesics is not among these options. According to the Mayo Clinic, the pharmacological relief for trigeminal neuralgia includes:
· Anticonvulsant
· Antispasticity agents (muscle relaxer)
Alternative treatments include:
· Alcohol injection (numbs the nerves)
· Surgery
Microvascular decompression which involves removal veins that may be compression the trigeminal nerve or placement of a pad between the nerve and an artery.
Balloon compression which presses on the trigeminal nerve until the nerve damaged and pain signals are no longer conveyed.
Electric shock
Partial sensory rhizotomy (severing of the nerve)
Radiation directly to the nerve.
· Alternative treatments (acupuncture)
An MRI is performed, but it is not ordered to diagnosis trigeminal neuralgia rather to rule of the presence of multiple sclerosis.

Chronic Sinusitis

Chronic Sinusitis
Chronic sinusitis, also known as common rhinosinusitis, is caused by the inability for the sinuses cavities to properly drain, causing inflammation and swelling. Mucus will then build up in the cavity that is not draining and symptoms of inflammation will increase. The diagnosis of chronic sinusitis is used for sinus problems which last a minimum of eights weeks or are reoccurring.

What causes chronic sinusitis?
The development of chronic sinusitis can be contributed to the following:
• Infection
• Deviated septum
• Polyps
• allergies

Signs and symptoms
Some of the signs and symptoms of chronic sinusitis include:
• The persistent discharge of yellowish mucus from the nares.
• Difficulty breathing due to congestion
• Facial swelling or tenderness
• Headache

Treatment
The treatment for chronic sinusitis can include pharmacological therapy or the removal of polyps. A nasal spray may be ordered by the physician. This spray which consists of normal saline is used to cleanse the maxillary sinus. Pharmacological treatments may include: a corticosteroid (via oral or intramuscular route), over-the-counter medication such as Tylenol or aspirin which can decrease pain that is associated with sinusitis, and decongestants which help reduce the amount of mucus produced within the sinus cavity.

Retinoblastoma

Retinoblastoma
The primary job of the retina is to transfer light into electrical impulses and send those impulse traveling through the optic nerve until it reaches the brain where it is converted into images. A retinoblastoma is a tumor within the retina. Retinoblastoma is seen primarily in children from birth to the up to the age of five. The tumor is malignant and can metastasize if gone untreated.
Is it hereditary?
Yes and No. Retinoblastoma has seen a genetic link in approximately 10% of those affected however; the other 90% have no history of family members diagnosed with retinoblastoma.
What are the signs and symptoms?
The most identifiable, BUT NOT DEFINITIVE, sign of retinoblastoma is the white glow of the eye instead of the common red eye syndrome when having your picture taken. Other signs or symptoms may include, squinting of the eye or crossed eye, pain or redness of the eye.
What are The Treatments?
A definitive diagnosis should be obtained through the use of CT or MR images. Depending on the size of the tumor, the severity of the tumor involvement (e.g. has metastases occurred), if vision can be restored or preserved and the wishes of the parents are areas to be considered when choosing the course of treatment.
Treatment can include:
Enucleation which is the removal of the eye. The child would be fitted with a prosthetic eye.
Radiotherapy may preserve some of the child’s vision but reoccurrence of retinoblastoma is highly probable.
Cryotherapy which is the freezing of the tumor can be used if the tumor is small. The chance that vision will be affected is minimal.
Lastly, chemotherapy is the follow-up therapy to the option that was selected from above. Even with two forms of therapy being delivered, the chance of bilateral involvement and/or reoccurrences is sixty percent.