Chiari Malformation

Chiari Malformation is a condition in which brain tissue protrudes into the spinal cord. This condition occurs when part of the skull is abnormally small, and is pressing on the brain and forcing it downward. Chiari malformation is an uncommon condition, but there have been more improved tests to diagnose this condition. Chiari malformation, in the adult form, is a type I condition, that develops as the skull and the brain are growing. The symptoms for the type I condition may not occur until late childhood or late adulthood. The type II Chiari malformation form is most common in pediatric patients, and they are present at birth. The type I symptoms for Chiari malformation are: headaches, also can have sudden coughing, sneezing, or straining. Some more symptoms that are involved would be: neck pain, problems with balancing, poor hand coordination, dizziness, numbness and tingling of the hands and feet, difficulty swallowing, slurred speech, and vision problems. People with less often occurrence of this condition is: ringing or buzzing in the ears, poor bladder control, chest pain, abnormal breathing, and the curvature of the spine related to spinal cord impairment. The causes for Chiari malfromation is when the cerebellum is pushed into the upper spinal canal, it can interfere with the normal flow of cerebrospinal fluid (CSF) that protects the brain and spinal cord. With the abnormal flow of CSF it can lead to blockage of signals that are transmitted from the brain to the body. Chiari malformation in some people can be a progressive disorder and that will lead to serious complications. In other people, there might not be any symptoms. Some complications that would be included is: hydrocephalus, paralysis, syringomyelia, and death. If a patient has any symptoms that consist of head pain, you will likely undergo an MRI scan of your skull. The procedure will consist of a 3-D, high resolution images of any structural abnormalities. Contrast can also be injected and once it reaches the brain, it will enhance the MRI images. A CT scan can also be done to scan sectional images of the bone tissue that surrounds the spinal column. A treatment that can be done is surgery. Having this surgery done and it is successful, then it will reduce the pressure on the cerebellum and the spinal cord, and it will restore the normal flow of the CSF. Some risks that can come with this surgery are the possibility of infection or problems with the healing wound. After having the surgery done, your doctor will want you to have follow-up exams done to follow the outcome of the surgery.

MayoClinic. (November 2008). Chiari Malformation. Retrieved from http://www.mayoclinic.com/health/chiari-malformation/DS00839

Chiari Malformation. Retrieved from http://westalneuro.com/images/resources/chiari-malformation.jpg

Carotid Body Tumor

A carotid body tumors (CBT) are rare neoplasms, but they respresent 65% of the head and neck paragangliomas. These tumors are slow growing that can remain asymptomatic for years. These tumors develop at the medial aspect of the carotid bifurcation. It is a small, reddish-brown, oval structure. A healthy gland measures 3 to 5 mm in diameter and weighs less than 15 mg on average. The gland is highly vascular and receives its blood supply from the feeder vessels that are running through the Mayer ligaments, primarly from the external carotid artery. The carotid body originates in the neural crest, it is important in the bodies acute adaptation to the concentrations of oxygen, carbon dioxide, and pH. The carotid body protects the organs from hypoxic damage by releasing neurotransmitters that increase the ventilatory rate when stimulated. There are three different types of carotid body tumors and those are: familial, sporadic, and hyperplastic. The familial form is most common in younger patients , 10 to 50%. The sporadic form is the most common type, it is approximately 85% of carotid body tumors. The hyperplastic form is is very common in patients with chronic hypoxia, which includes patients that live at high altitudes. A carotid body tumor can occur in children, but also CBT's are considered to be a disease of the middle age. About 5% of CBT's are bilateral and 5 to 10% are malignant, but these rates are much higher in the patients with inherited disease. It is stated that familial tumors are found to be 5.8 times more common in patients who have had carotid body tumors as compared with patients who have paragangliomas at other sites. Patients with chronic hypoxic conditions, such as the patients that live at higher altitudes or those who have COPD, or cyanotic heart problems. This can be too much for the carotid bodies, and lead to hypertrophy, hyperplasia, and neoplasia of the cells. Approximately 10% of cases that are present with cranial nerve palsy with paralysis of the hypoglossal, glossopharyngeal, recurrent laryngeal, spinal accessory nerve, or the involvement of the sympathetic chain. CBT's can be associated with pain, dysphagia, shoulder drop, Horner syndrome, and hoarseness. As the tumor gets larger and compresses on the carotid artery, and on the surrounding nerves. Other symptoms may occur such as: pain, tongue paresis, hoarseness, Horner syndrome, and dysphagia.

Chaaban, Mohamad MD. (May 2009). Carotid Body Tumor. Retreived from http://emedicine.medscape.com/article/1575155-overview

(May 2009). Carotid Body Tumor. Retreived from http://www.ajronline.org/cgi/content-nw/full/187/2/492/FIG8

Sjogren's Syndrome

Sjogren's syndrome is a disorder of a person's immune system. It is often defined by its two most common symptoms, which are dry eyes and dry mouth. If a person has dry eyes, then it feels like they are burning or itching. Also if the person has dry mouth, then it will feel like they have a cotton mouth. It makes it hard to swallow and speak when a person has dry mouth. Other symptoms that may go along with Sjogren's syndrome is: joint pain, swelling, stiffness, prolonged fatigue, consistent dry cough, vaginal dryness, skin rashes or dry skin, and swollen salivary glands. Sjogren's syndrome is a autoimmune disorder. This basically means that an autoimmune disorder is where your own immune system attacks their body's own tissues and cells. Sjogren's system is where your immune system will first attack the moisture, the secreting glands around the eyes and mouth. This disorder can also damage other body parts like: joints, thyroid, kidneys, liver, lung, skin, and nerves. Sjogren's syndrome, with this disorder anyone is able to develop it. People over the age of 40 are more likely to develop this disorder. Sjogren's syndrome actually occurs more in women than in men. It is very common for people with this disorder to rheumatic disease, such as rheumatoid arthritis or lupus. This disorder can also run in the family. Sjogren's syndrome can be very difficult to diagnose because the signs and symptoms can vary from person to person. There are a number of tests that can be done to pinpoint the disorder to Sjogren's Syndrome. Those tests may include: blood tests, eye tests, chest x-ray, a spit test, and a urine sample. Most people may think that they can get rid of their dry eyes and dry mouth by some over-the-counter drugs or just drinking more water, but most might have to have prescribed medications given or even surgery. Surgery would involve sealing off the tear ducts to drain the tears from your eyes.








MayoClinic. (June 2009). Sjogren's Syndrome. Retrieved from http://www.mayoclinic.com/health/sjogrens-syndrome/DS00147

Mavragani, Clio P. (2006). The Management of Sjogren's Syndrome. Retrieved from http://www.nature.com/.../fig_tab/ncprheum0165_F3.html

Achondroplasia

Achondroplasia is a disorder of the bone growth that causes the most common type of dwarfism. Achondroplasia is an appearance that can be seen at birth. The symptoms that may be included are: bowed legs, clubbed feet, decreased muscle tone, abnormal hand appearance with spacing between the long and ring fingers, spine curvatures called kyphosis and lordosis, spinal stenosis, prominent forehead, shortened arms and legs, short stature, and a disproportional head to body size difference. Achondroplasia is from a group of disorders called chondrodystrophies or osteochondrodysplasias. Achondroplasia may be inherited as a dominant trait, which basically means that if the child gets the defective gene from one parent, the child will end up with the disorder. Now if one of the parents has achondroplasia, then the infant has a 50 % chance of getting the disorder. Now say both parents have achondroplasia, then the infants chances of getting the disorder increases to 75%. There have been most cases that appear as spontaneous mutations. This basically means that if neither one of the parents have achondroplasia, then they can still possibly give birth to a child with the disorder. Some tests that can be ran include: during pregnancy, a prenatal ultrasound may show excessive fluid surrounding the unborn infant, an examination of the infant after birth can show increased front to back head size, there may be signs of hydrocephalus, which means "water on the brain." Also x-rays of the long bones can show achondroplasia in the newborn infant. For people that wonder about treatments, there are no specific treatments for achondroplasia. Similar abnormalities should be treated when they are causing problems. Examples would be spinal stenosis and spinal cord compression. People that have Achondroplasia normally do not reach 5 feet in height. The intelligence rate is no different from a perosn without this disorder. Infants that have genes from both their parents do not live past a few months. Prospective parents should have genetic counseling as it may be helpful. Prevention is not always possible. You should contact the doctor if you have a family history of this disorder and you plan to have children.

Inc, A.D.A.M. (2010). Achondroplasia. Retrieved from http://health.google.com/health/ref/Anchondroplasia

Elsevier. (2010). Anchondroplasia. Retrieved from http://www.netterimages.com/image/12366.htm

Chronic Sinusitis

Chronic sinusitis may be caused by an infection, but can also be caused by growths in the sinuses, which are nasal polyps, or a deviated nasal septum. Chronic sinusitis can last more than eight weeks or will just keep coming back. Symptoms for chronic sinusitis include: cough, which may be worse at night, a decrease in the sense of smell and taste, aching in your upper jaw and teeth, pain, tenderness and swelling around your eyes, cheeks, nose, and forehead, nasal obstruction and congestion, and drainage of thick mucus. Other symptoms include: nausea, bad breath, ear pain, sore throat, and fatigue. The causes of chronic sinusitis may include: nasal polyps or tumors, allergic reactions, deviated nasal septum, trauma to the face, respiratory tract infections, allergies such as hay fever, and immune system cells. There can be a blockage of the sinuses that can create a moist environment which makes it easier for an infection to occur. The sinuses then can not drain like normal and causes a thick yellowish or greenish discharge of mucus. The main goals in treating chronic sinusitis include: reduce sinus inflammation, eliminate the underlying cause, keep nasal passages draining, and reduce the amount of sinusitis flare-ups that might occur. Treatments that a doctor will have you try would be: saline nasal spray, nasal corticosteroids, oral or injected corticosteroids, decongestants, over-the-counter pain relievers, and aspirin treatment. Antibiotics would sometimes be necessary sinusitis for a bacterial infection, but chronic sinusitis is usually caused by something other than a bacterial infection and antibiotics will not help. Surgery might also be another option if the other treatments are not working at all. The tests and diagnosis that can be done for chronic sinusitis would be: nasal endoscopy, imaging studies, nasal and sinus cultures, and an allergy test. The preventions for chronic sinusitis may include: avoid upper respiratory infections, carefully manage your allergies, avoid cigarette smoke and polluted air, and also use a humidifier.

Chronic Sinusitis. Retrieved October 11, 2008 from http://www.mayoclinic.com/health/chronic-sinusitis/DS00232

Rover, Elena. (January 2009). Chronic Sinusitis. Retrieved from www.rd.com/.../article109139.html

Orbital Cellulitis

Orbital Cellulitis is an acute infection of the tissues that are immediately surrounding the eye, this includes the eyelids, the eyebrow, and the cheek. The symptoms that are involved in orbital cellulitis are: painful or difficult eye movements, general malaise, bulging eyes, decreased vision, eye pain, especially with movement, shiny, red or purple eyelid, painful swelling of upper and lower eyelids, and fever that is geneally 102 degrees F or higher. The causes for orbital cellulitis is a dangerous infection that can have very severe complications to it. The complications that are included in this is: hearing loss, optic nerve damage and loss of vision, meningitis, septicemia or blood infection, and cavernous sinus thrombosis. Haemophilus influenzae is often the infection that occur in children. This bacteria from a sinus infection is usually the cause of this condition. Children from the ages of 6 to 7 seem to be particularly susceptible to this infection from this bacteria. It has been stated that the rate of this severe orbital cellulitis has dropped steadily ever since the introduction of HiB vaccince which means Haemophilus influenzae B. Other bacteria that might also cause orbital cellulitis is: Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci. Some more causes could be a stye on the eyelid, bug bites, or a recent eyelid injury. The infection orbital cellulitis that are in children could get worse very quickly and can lead to blindness. The treatments that need to be taken would be that the patient would have to stay in the hospital. Other treatments are giving antibiotics that are given through a vein. Surgery might also be an option because they would have to drain the abscess. The tests that could be ran to to discover this infection is: CBC which means a complete blood count, a bloood culture, and a spinal tap for very sick children. Other tests that could be run to discover this infections could be: an x-ray of the sinuses and the surrounding area, throat culture, a culture of the eye and nose drainage, and a CT scan or MRI scan of the sinuses and orbit. A prevention of this infection could be receiving the HiB vaccine according to recommened schedules that will generally prevent most haemophilus infections in children. Other younger children that are in the same household who have been exposed to this bacteria may receive antibiotics to prevent getting sick. With the proper detection and early treatments of sinus, dental, or other infections may prevent the spread of infection to the eyes. A doctor should be contacted about orbital cellulitis because it is an emergency that requires immediate treatment. Signs to confirm this infection that you can tell you doctor is swelling of the eyelids, especially with a fever.

Inc, A.D.A.M. (2010). Orbital cellulitis. Retrieved from http://health.google.com/health/ref/Orbital+cellulitis

Rubin, Peter A.D. (1999). 4 year old boy with proptosis of the left eye and an afferent pupillary defect. Retrieved from www.djo.harvard.edu/print.php?url=/physicians/gr/324&print=1

Craniopharyngioma

Craniopharyngioma is a benign tumor that develops near the pituitary gland. It is a small endocrine gland that is at the base of the brain. Symptoms of craniopharyngioma can happen in three different ways: by damaging the optic nerve, by disrupting the function of the pituitary gland, and by increasing the pressure on the brain. When people start to have increased pressure on their brain they start to have symptoms: headache, nausea, vomiting, and problems with their balance. When the pituitary gland is damaged it can cause hormonal imbalances that eventually will lead to thirst and frequent urination. Also if a person damages their optic nerve it will cause vision problems. Most of the patients will have some visual damages and a decrease in the hormone production at the time of the diagnosis. The causes for craniopharyngioma can affect children from the ages of 5 to 10 years old. Sometimes adults can be affected also with this tumor. Male and females are equal in the being afftected with this condition. For most people with craniopharngioma, surgery has always been the main treatment. Instead of the surgery though, radiation treatment might be a better option for patients. The reason for this is because if the tumor cannot be completely removed during surgery, then radiation therapy would be the next choice. Sometimes surgery is not even necessary, radiation therapy being planned alone would be fine. This tumor would best be treated at a center with the experience in craniopharyngiomas. The following tests can be done to find craniopharyngiomas: CT scan and/or MRI scan of the brain, a neurological examination, and endocrine hormone evaluations that can be ran for any imbalances. For patients that do not get the tumor completely removed, the tumor can come back. Patients should contact a doctor if they are having symptoms of headache, nausea, vomiting, any problems with imbalances, visual problems, increased thirst and urination, and poor growth in a child.

A.D.A.M., inc. (2010, March 11). Craniopharyngioma. Retrieved from http://health.google.com/health/ref/Craniopharyngioma.

Eve, Tsai C. (2010). Tumors of the skull base in children: tumors of the middle cranial base in children. Retrieved from http://www.medscape.com/viewarticle/436107_3.