Pars Fracture

Pars fractures, also know as pars defect, are fractures to the area of the vertebrae called the pars. The pars is in the posterior aspect of the vertebrae and connects the lamina and the transverse processes. Trauma or repeat injuries to the low back are what cause pars fractures. They are common in teens, especially gymnasts and football players. Commonly both pars are fractured, but it is possible that only one be fractured. Symptoms are low back pain, stiffness, tingling, numbness and weakness in the lower extremities. Diagnosis can be made in three ways, x-rays, CT scans, and nuclear medicine bone scans. Treatment starts with bracing and restricted activities. It symptoms persist, surgical treatment is necessary. Laminectomy and lumbar fusion are the two types of surgeries performed. A CT sagital image of an L5 pars fracture is shown above.

Thoracic Compression Fractures

Thoracic compression fractures are something that I am very familiar with because one of the radiologists that I work with regularly specializes in treatment of compression fractures. Compression fractures are when the vertebral body breaks and then collapses. This can occur in any vertebral body, but the thoracic spine is the most common area. It is typically caused by some sort of trauma to the spine, but can also be due to osteoporosis. Symptoms are severe back pain and kyphosis. Treatment varies depending on the severity of the fracture. Oral pain medication, bracing, physical therapy, osteoporosis treatment, and surgical procedures are all used as treatment. The surgical procedures are kyphoplasty and vertebroplasty. These surgeries treat the fracture by expanding the vertebral body with a balloon like device and then filling them with a form of hardening material that will work like a vertebral body. Typically other treatments are used along with surgical treatment. Surgery must be performed shortly after the fracture occurs or the body will start to repair the fracture on its own and surgery cannot be performed. Diagnosis is typically made with plain film x-ray but can also be better imaged on CT, and MRI. Included is a CT image of a thoracic compression fracture.

CHIARI MALFORMATION

Chiari malformation is a deformity affecting the cerebellum and upper area of the cervical. It is imaged well on MRIs of the cervical spine. Two of these images are shown to the left. Chiari malformation is a congenital defect that occurs when the cerebellar tonils extend below the foramen magnum and into the spinal canal. Many times this is not diagnosed until teenage years or adulthood. Symptoms can include headache, neck pain/tension, tingling in extremeties, vision problems, difficulty swallowing and dizziness. Symtoms typically increase with sneezing and coughing. Treatment can range from pain management to surgery. The surgery is called a posterior fossa decompression. Part of the skull is surgically removed to decrease the pressure on the brain stem. Surgical treatment is only used in extreme cases.

Carotid Artery Stenosis

Carotid artery stenosis, or disease, is due to a build up of plaque in the carotid artery. This build up causes a narrowing in the artery, which supplies blood to the brain. Many people do not realize that they have carotid artery stenosis until it is too late and they have a TIA or stroke. If caught early, carotid artery stenosis can be treated and preventive measures taken against stroke or TIA. These treatments can be oral prescriptions, life style changes, and/or surgical procedures. There are two type of surgical procedures, carotid endarterectomy and carotid artery stenting. Carotid artery stenting is when a stent is placed via catheter into the area of stenosis to open up the area and prevent complete clogging of the artery. Carotid endarterectomy is when the stenosed section of the artery is removed completely. Those that are at increased risk of carotid artery stenosis are those that drink, smoke, eat fatty and high in cholesterol foods, have diabetes, are older, are obese, are not physically active, or have a family history of the disease. Diagnosis can be made with MRA, CTA, carotid ultrasound, and cerebral angiography. Regular physicals are the best way to detect carotid artery stenosis before a stroke or TIA occurs. The image above is an MRA showing carotid artery stenosis.

Soft Tissue Neck Abscess

Soft tissue neck abscess occur in the spaces between the structures of the neck. An abscess is a collection of puss. The location of the abscess is how the name of the abscess is determined. They can be found behind the pharynx, beside the tonsils, and below the tongue. There are a variety of ways to diagnose, including blood tests, throat culture, biopsy, x-ray, and CT scans. The cause is due to infection, either bacterial or viral, in the area of the head and neck. The infection can spread, causing a pocket of infection to form and puss to grow. Symptoms of an abscess are fever, chills, body aches, swelling in the tongue and/or throat, difficulty swallowing, and difficulty breathing. Treatment depends on the location and cause but can be either antibiotic treatment or drainage of the abscess. A CT axial image of a retropharyngeal (located behind the pharynx) abscess is shown.

Sacular Aneurysm

Cerebral sacular aneurysms typically occur in the middle cerebral artery within the Circle of Willis. It is a ballooning of the artery that can be caused by a variety of things. It has been thought to be congenital, but recently this has been thought to be incorrect. It can also be caused by polycystic kidney disease, degenerative vascular disease, cocaine use, trauma, tumor, or infection. Symptoms range from none to headache, nausea, distorted vision, and loss of consciousness. MRI and MR Angiography can be used to diagnose sacular aneurysms. The image on the left is an MRA and the image of the right is an MRI FLAIR. Treatement involves surgical placement of coils or clips.

Blowout Fracture of the Orbit

Blowout fractures of the orbit are fractures of the orbital wall that are caused by trauma to the orbit. There are a variety of different locations that orbital fractures can occur depending on the force and location of the direct blow. "Buckling" and "Retropulsion" are the two ways to describe what happens to cause an blowout fracture. With the idea of "buckling", the orbital floor fractures due to the buckling of the orbital rim and the transferred pressure to the orbital wall. The idea behind "retropulsion" is that the trauma causes an increased pressure within the orbital cavity, which results in a fracture. Blowout fractures are the result of "retropulsion". These most commonly occur in the floor of the orbit, but cal also occur in the medial wall of the orbit. They are caused by a direct blow to the orbit by an object that is larger in diameter than the orbital socket itself. Naso-orbital fractures also occur from a direct blow, but from an object smaller than the diameter of the orbit. These fractures typically occur to the medial wall in combination with the nasal bones and ethmoid sinus. CT imaging is used to best visualize the location on the fracture. A coronal image is shown above with a orbital floor fracture. Surgery is primarily the only way to treat blowout fractures, because of the location and severity of the fracture they are not likely to heal on their own.

Brown's Syndrome

Brown's Syndrome occurs when the the superior oblique muscle does not move correctly, causing difficulty looking up and in. It can occur as a congenital defect or can occur later in life from surgery, trauma, inflammatory disease, or tumors. The image above is an example of Brown's Syndrome that is caused by a tumor in the sinus. Brown's syndrome is more common in the right eye, and almost always occurs in only one eye. Treatment of this syndrome varies from oral NSAIDs, steroidal injections into the muscle, and surgery. The cause and severity of the syndrome dictate the treatement used. It is not life threatening, and in most cases can be treated.

Pituitary Microadenoma

Pituitary microadenomas are benign tumors affecting the pituitary gland that smaller than 10mm. They can be functional or non-functional. Functional microadenomas produce one of several different types of hormones, while non-functional do not produce any hormones. Some examples of hormones produce by functional microademonas are thyroid, prolactin, growth, and ACTH. Symptoms vary depending on if the tumor is functional or not and also the location of the tumor. Symptoms can include tiredness, restlessness, headaches, vomiting, and dizziness. These tumors can be diagnosed in a variety of ways. MRI, CT, blood tests, petrosal sinus testing, and eye exams are all used in determining a diagnosis. Treatment again is dependent upon the type and location of the microadenoma. It ranges from drug therapy to surgery to radiation treatment. I have included 2 MRI images showing pituitary microadenomas.

Labyrinthitis

Labyrinthitis is an inflammation and irritation of the inner ear. Symptoms include dizziness, loss of balance, tinnitus, nausea, vomiting, hearning loss, and trouble focusing the eyes. The cause of labyrinthitis can be from upper respiratory infections, colds, flu, ear infections or other viral or bacterial infections. Allergies, trauma, and brain tumors can also cause inflammation of the inner ear. Over use of some medications or alcohol can be yet another cause. Diagnosis of labyrinthitis can be made with a physical and neurological examination. If further testing is done it is normally to rule out any other cause of the symptoms. These test may include CT, MRI, EEG, and hearing tests. Treatment of symptoms may be necessary during the few weeks until the inflammation decreases and symptoms subside. Treatments can include antibiotics and other medications depending on the patient's symptoms. Therapeautic movement of the head may also help decrease symptoms by moving the small stones within the labyrinth that cause dizziness back to the location they need to be. Both my parents as well as my grandma have all experienced labyrinthitis within the past year. Each had to have a different type of treatment, and after a few weeks the symptoms did subside. I have included an image of a T1 weighted MRI with and without contrast.

Arachnoid Cyst

Arachnoid cysts are cerebrospinal fluid filled cysts located within the brain and/or spinal canal. Within the brain they are commonly found in the middle cranial fossa and rarely are found intracranially. They are more common in men, and normally appear on the left side of the brain. These cysts are typically asymptomatic. When symptoms do occur they can be headaches or seizures. Often arachnoid cysts are found accidentally with imaging. The best imaging to diagnosis arachnoid cysts is MRI; this is because special sequences such as FLAIR and diffusion weighted images can differienciate between arachnoid cysts and other types of cysts. Included are two T2 weighted MRI images of brains with arachnoid cysts.