Jefferson's Fracture

Normal alignment of lateral masses and superior facets of C2

Displaced lateral masses on C1 with respect to the superior facets on C2

This image shows a fracture to the anterior arch of C1

The top image shows the offset of both the right and left lateral masses of C1 relative to C2

The bottom image shows the classsic Jefferson fracture where both anterior and posterior arches of C1 are fractured on both the right and left sides.

What kind of fracture is this?

This fracture involves cervical vertebra number one or the Altas. This fracture classically presents itself as having right and left side breaks on both the anterior and posterior arches of C1 for a total of 4 fractures of C1, but can present with varied numbers of breaks on either side of the anterior and posterior arches depending on how the force is exerted to the head. This type of fracture is also called a burst fracture. This type of fracture is an axial compression fracture where the force of the trauma or injury initiates from a superior or anterior aspect of the skull and then transmits to the cervical spine causing damage. The damage occurs when the downward force compressed C1 onto C2. Some of the more common examples of how these fractures occur are from diving into a shallow pool of water where the head strikes the bottom of the pool, motorcycle accidents where the head strikes the windshield causeing hyperextension and compression, and also falling down onto the head at a decent height.

What kinds of symptoms to patients present with this type of fracture?

-upper neck pain

-there is usually no neurological symptoms displayed initially but if not treated this can cause severe neurological problems if fracture is not stablized

Diagnosis?

-plain film xrays initially taken (open mouth is usually the best image to show the bilateral offset of C1 onto C2)

-CT (Demonstrates the number of fractures and their locations and the degree of displacement of bone fragments)

Treatment?

-Depends on the severity and the stability of the fractures

-The stability of the injury depends on how intact the ligaments are between the vertebra and will determine if surgery is needed to stabilize the fractures

References

www.learningradiology.com/archives06/COW%20188-Jeffersons%20FX/jeffersonsfxcorrect.htm

www.gentili.net/image1.asp?ID=11&imgid=JeffersonCT2.jpg&fx=Jefferson+Fracture

Bow Hunter's Syndrome

What is this?

Bow Hunter's syndrome or commonly called Bow Hunter's Stroke is an ischemic stroke that is caused by the constriction of the vertebral arteries which provide blood flow to the posterior part of the brain.

How does this happen?

Bow Hunter's syndrome can occur by either voluntary or forced rotational movements of the head. As the head is rotated right or left these vessels can become constricted. As the head is rotated to the right, the left vertebral artery is affected as is the right vessel is constricted when the head is rotated to the left. The constriction can occur due to an abnormal congenital deformity of the cervical verebrae. The level at which this commonly occurs is at C1-C2. With this constriction comes occlusions or even a complete stenosis of the artery leading to a loss of blood flow to that side of the brain. Complications due to this affliction can range from TIA like symptoms to a full blown CVA.

Signs and Symptoms?

-Dizzyness

-Nystagmus (involutary eye movements)

-Nausea/Vomiting

-Hemiparesis (weakness or partial paralysis of one side of the body)

-Sensory Changes

-Swallowing difficulties

-Loss of Consciousness

Diagnosis?

-MRI imaging of the brain or cervical spine

-MRA

-Angiogram

Treatment?

-Surgical Fusion of the vertebrae

-Vertebral Artery Decompression

-Neck Brace

References

www.thebarrow.org/Education/Barrow_Quarterly/Vol._17_No._2_2001/047231

www.riversideonline.com/health_reference/Nervous-System/AN00291.cfm

Goiter

What is a Goiter?

A Goiter is an enlargement of any gland that is producing too much (hyperthyroidism), too little (hypothyroidism), or just enough hormone (euthyroidism). Typically, when speaking of a goiter, we often refer to the thyroid gland. When a goiter has been noted, it basically means that there is something going on with the gland to make it grow bigger than normal.

Causes?

The number one cause of goiters worldwide today is iron deficency. This is rarely seen today in the U.S. simply for the fact that the salt we intake has iodine added to it. The Morton salt company was the first to add iodine to their salt in 1924. Without iodine the thyroid gland is unable to produce the proper amount of hormone. The pituitary gland in the brain then senses this difficency and sends the thyroid a signal to produce TSH (thyroid stimulating hormone) which is basically telling the thyroid to produce more thyroid hormone. This is what causes the enlargment or abnormal growth of the thyroid gland.

Another cause of a goiter more commonly seen in the U.S. today is called Hashimoto's thyroiditis. This is an autoimune disease where one's own body basically attacks itself or the thyroid gland which causes a difficency in the production of thyroid hormone. Again, the pituitary gland senses this abnormality and tells the thyroid to produce more TSH in order to produce more thyroid hormone causing the gland to enlarge.

Diagnosis?

The diagnoisis of a goiter is usually found on physical examination. Once found it is important to find the cause. Initially a thyroid functioning test will be performed to determine if the thyroid gland is overactive or underactive in producing hormone. Depending on the activity of the thyroid other tests are performed to determine the type of goiter the patient has. Tests like radioactive iodine scans and thyroid ultrasounds are performed to determine the causes of goiters.

Treatment?

Treatment is specific to the type of goiter one has. If the cause is due to an iron deficency, then the patient would be given iron supplements orally. Iron supplements will reduce the size of the goiter but they will not completely resolve the goiter.

If the goiter is due to Hashimoto's thyroiditis or an autoimmune issue the patient would receive a hormone pill that would be taken daily to regulate the thyroid hormone to a normal level. This treatment would most likely cause the goiter to reduce in size, but again would probably not reduce it completely. Thyroid hormone treatment will keep the goiter from becoming larger in size.

References

www.thyroid.org/patients/patient_brochures/goiter.html

www.mortonsalt.com/faqs/food_salt_faq.html#q5

Arteriovenous Malformation (AVM)

What is an AVM?

An AVM is a cluster or nest of blood vessels that create a direct connection between arteries and veins of the brain. This direct connection creates what is called a shunt where the oxygenated blood by-passes brain tissue due to the improper connection of arteries and veins. The blood then flows directly back to the heart never having the opportunity to feed the brain the proper nourishment it needs from the oxygen rich blood.

In a normal circulatory system, arteries and veins are connected between a network of capillaries. Capillaries are extremely small vessels which have very thin walls that allow for an exchange of newly oxygenated blood to tissues and to pick up deoxygenated blood for veins to take back to the heart and lungs for re-oxygenation.

AVMs can be located virtually anywhere in the body, but are common to form in the vascular system of the brain. AVMs are said to be congenital and are formed either during the gestation period or during birth.

Symptoms?

Most people do not display symptoms but the more generalized symptoms can be seizures and headaches. Symptoms are not the same for each individual and are dependent on the location of the AVM within the brain due to the fact that each part of the brain is responsible for different functions of the body. Diagnosing an AVM can be tricky due to the fact that symptoms are not consistent from patient to patient and it is not uncommon to find that most times AVM's are found incidentally on studies that are being done for other health issues. AVMs are also detected when the individual is actively bleeding or hemorraging at the AVM site.

Complications?

AVMs can damage the brain in three major ways:

- reduction of the proper amount of oxygen to brain tissue

- bleeding or hemorrage into the tissues of the brain

- compressing parts of the brain or spinal cord due to the enlarged mass of blood vessels taking

up space that would normally house normal brain tissue or spinal cord

Where do AVMs form in the brain?

They can basically form wherever arteries and veins are located deep within or on the surface of the brain. They can also form on the spinal cord. Typically though, they form either in the dura or pia mater layers of the brain.

Treatment?

Depending on the size, location, and the factors of each individual's case there are a few options for treatment of AVMs.

- Conventional Surgery is used to completely remove the AVM.

- Endovascular Embolization where a surgeon inserts a catheter through an artery to the

AVM site and inserts a substance to occlude or plug the AVM.

- Radiosurgery where localization of the AVM is achieved and then a beam of highly focused

radiation is aimed directly over the AVM. This highly intense beam of radiation damages the

vessel walls and gradually the vessels of the AVM will degenerate and close to resolve the

AVM.

References

www.ninds.nih.gov/disorders/avms/detail_avms.htm

Fibrous Dysplasia

What is it?

Fibrous Dysplasia is a bone disorder where an abnormal development of fibrous bone tissue occurs and replaces normal bone. As a result of this, the normal bone expands and becomes weakened and more suseptible to fractures. Some of the more common bones that are affected are facial bones (maxilla), skull, femur, humerus, and tibia. Minor cases of this disorder don't usually display any noticable signs or symptoms, but more severe cases result in bone pain, and deformity which normally occurs by the age of 15.

What is the cause?

There is no real known cause of this disorder but, medical professionals believe that there is a possibility that a chemical irregularity occurs in bone protein. This abnormality maybe a result of a gene mutation that is present at birth. There is no evidence to support that this is an inherited disorder.

What are the symptoms?

-Bone pain due to the expansion of the fibrous tissue in the bone

-Bone deformity

-Bone fracture

How is this diagnosed?

The most common ways of diagnosing this disorder are by:

-plain film xray

-CT scans

-Biopsy of the bone itself

-blood tests

What is the treatement?

Treatment consists of:

-surgery to the affected bone with the possiblity of bone grafts

-medication for pain management

-physical thearpy depending on what bone is affected

References

www.mayoclinic.com/health/fibrous-dysplasia/DS00991

www.healthsystem.virginia.edu/UVAHealth/adult_bone/fibrdys.cfm

Graves' Disease

What is Graves' Disease?

Graves' disease is an autoimmune disease. An autoimmune disease is when the body attacks its own immune system by destroying its healthy cells and tissues. Graves' disease is a result of hyperthyroidism. Hyperthyroidism is a disorder in which the thyroid gland produces more thyroid hormone than the body needs.

The thyroid gland produces two different types of hormones. T-3(triiodothyronine) and T-4(thyroxine) which play a part in many important bodily functions and processes. Some of which include:

-metabolism

-brain developement

-body temperature

-menstrual cycles

-weight

-cholesterol levels

The production of thyroid hormone is regulated by another hormone which is called thyroid stimulating hormone(TSH). This hormone is produced by the pituitary gland which is located within the brain.

In reguards to this particular auto-immune disease, the body's immune system makes up antibodies called thyroid stimulating immunoglobulin(TSI). These antibodies attach to healthy thyroid cells and trick the body into thinking they are TSH. As a result, the thyroid gland is over stimulated and produces too much T-3 and T-4.

Common signs and symptoms of Hyperthyroidism

-nervousness or irritability

-fatigue or muscle weakness

-heat intolerance

-trouble sleeping

-hand tremors

-rapid or irregular heartbeat

-frequent BM's or diarrhea

-weight loss

-goiter(enlarged thyroid which looks like neck is swollen)

How does all of this relate to our eyes?

People who are diagnosed with Graves' disease can have a mulitple array of symptoms but one in particular is that the eyes can become or appear enlarged. So much, that the eyes look like they are bulging out from their sockets. This condition is called Graves' ophthalmopathy.

What is Graves' Ophthalmopahy?

This condition is when the immune system attacks the muscles and tissues around the eyeball itself. There is a buildup of tissue and fat behind the eye socket which causes inflammation and the bulging we can noticibly see in patients. In cases that are extremely severe, inflammation can pose a threat in which compression of the optic nerve can occur and cause vision problems or loss.

References

Information retrieved from: www.endocrine.niddk.nih.gov/pubs/graves/

Images retrieved from: www.redatlas.org/fr_index.htm?/RAPages/D/D012.htm

Empty Sellar Syndrome

What is Empty Sellar Syndrome (ESS)?


ESS is a disorder where CSF builds up between the pituitary gland itself and the sella turcia, which houses the pituitary gland. This build up of CSF then places stress or pressure on the pituitary and compresses the gland so that it looks as if there is an "empty space" or an abcence of a pituitary within the sella turcia space on an MRI, CT, or radiographic image. ESS can also be caused by tumors pressing on the pituitary to cause that "empty" looking area on an image.

Diagnosis?

This disorder is most often times detected while the patient is being tested or imaged for pathology that is totally unrelated to ESS. In most cases, pitutary function is normal and is not compromised by the pinning of the pituitary gland. In some cases though paitients will have symptoms of headache, vision problems, and hyperprolactinemia. Hyperprolactinemia causes irregular mentral cycles and spontaneous breast milk flow in women, and in men, causes hypogonadism (low testosterone), infertility, and erectile disfunction.

Treatment?

As far as treatment for this disorder, there is not any one specific treatment across the board. Treatment is dependant on the symptoms of the individual and they are handled case by case. In some cases though, surgury maybe needed.

Information retreived from: www.pituitary.org/disorders/empty_sella_syndrome.aspx
Picture retreived from: www.googleimages.com