Spinal Compression Fractures

*What is a Compression Fracture?*
A compression fracture is the most common type of fracture that affects the spinal column. A compression fracture occurs when the vertebral body is squished, compressed, or reduced in height.

*Causes*
Compression fractures occur when there is blunt trauma to the spine or when the bones of the spine are not strong enough. Forceful impacts, such as an automobile accident or fall, generally causes the vertebrae to crack in the posterior portion of the back and osteoporosis affects the anterior portion of the spine. Majority of cases of compression fractures are due to osteoporosis, a disease that weakens the bone due to a loss of bone density. Different types of cancers can cause a compression fracture too. Cancers from other places in the body tend to metastasize to the spine and weaken the vertebrae, resulting in a compression fracture. A compression fracture can also occur in blunt trauma to the spine. Patients that fall or receive whiplash from a MVA can produce mild to severe cases of compression fractures.

*Symptoms*
Back pain is the most common problem that patients experience with compression fractures. Patients with osteoporosis may develop multiple compression fractures from a curving in their spinal column. Most often the spine curves forward, known as Kyphosis. With compression fractures to the posterior portion of the vertebrae, nerve complaints may be a symptom. This type of fracture can affect the spinal cord and nerves. Majority of the time pain is centered around the fracture. A traumatic compression can also cause pain to radiate down the legs.

*Treatment*
The best treatment of a compression fracture is prevention treatment before a fracture ever occurs. This is best done by treating osteoporosis by exercising, watching calcium, and taking other necessary medications. If back pain becomes severe and the compression fracture becomes problematic two types of minimally invasive procedures can be done to fix the problem. The first procedure is known as Kyphoplasty. Kyphoplasty is generally done under local anesthesia in a special procedures suite. A balloon catheter is placed in the vertebra and inflated with a liquid. The inflated balloon helps to restore the collapsed vertebra. Once the balloon is fully inflated, it is deflated and the enlarged cavity is filled with a cement to correct the compression fracture. The second procedure is Vertebroplasty. This procedure is similar to Kyphoplasty, but in this procedure the cement is injected under pressure directly into the fracture vertebra. The cement hardens in about 10 minutes and provides immediate stability. These two invasive procedures are successful about 90% of the time.

*Complications*
These two procedures are done to help alleviate pain and fix compression fractures, but like any other invasive procedure there are complications that can occur. The most common complication is the leakage of the cement out of the vertebra before it hardens. If these occurs it can compress the spinal cord and nerves, causing new pain and possible neurological problems. Majority of these cases correct the problem though and reduce or eliminate the pain the patient had been experiencing.










Lateral radiograph of the cervical spine showing compression fracture on C5, loss of pedicle, spinous process, and transverse process.



http://www.jkns.or.kr/fulltext/htm/0042002015f1.htm

Compression fracture in the lumbar vertebrae

Carotid Artery Aneurysm

*What is a Carotid Artery Aneurysm?*
An aneurysm is identified as a ballooning or bulging of an arterial wall. This occurs when the artery becomes weakened and the wall becomes thin. If the wall becomes too thin the aneurysm will most likely rupture, resulting in internal bleeding. When a carotid artery aneurysm takes place, significant damage to the brain will occur.

*Symptoms*
Carotid artery aneurysms may form clots in the brain that impede the flow of blood to the head that can cause significant damage to the brain. These aneurysms may also bring about symptoms such as transient ischemic attacks (TIAs) or even a stroke to occur. Depending on the location of the aneurysm and how large it is, it can damage and affect surrounding nerves. If this occurs, patients may experience facial swelling, difficulty swallowing, or even hoarseness to their voice. On other occasions, patients may have a carotid artery aneurysm that produces no symptoms at all.

*Treatment*
Patients with carotid artery aneurysms are evaluated and treated individually. If the aneurysm is small and not affecting the patient, the physician may just opt to watch and evaluate the aneurysm frequently. Another treatment that may be used to eliminate the clots that are blocking the blood flow is Thrombolysis. This treatment is known as thrombolytic therapy and it uses a drug to dissolve the clot. Another treatment option is endovascular stent grafting. This is a surgery that is preformed inside the artery. The graft is expanded inside the artery and helps to manage the blood flow in the artery. Finally, surgical repair can be done to treat the aneurysm. This surgery entails the reconstruction of the portion of the artery that is involved with the aneurysm and then a bypass is preformed to redirect the blood flow form the original artery to the new portion.

*Outcome*
There can be complications with any treatment option that the patient selects. The biggest concern with invasive procedures is the possibility of stroke occurring during or after the procedure. Another risk that can lead to a negative outcome is damage to surrounding vessels, nerves, and tissues during the procedure. Patients are also at risk of a procedure not working 100%. The treatment may not work properly and the aneurysm can come back or the aneurysm can reject the treatment and still be at risk of rupturing.






MRI showing a large right intracavernous carotid artery aneurysm.

http://www.nature.com/eye/journal/v20/n12/fig_tab/6702272f2.html

This coronal reformat of a CT cerebral angiogram shows a right internal carotid artery aneurysm arising from the clinoid or proximal ophthalmic segment (probably at the origin of the ophthalmic artery). The aneurysm erodes the sphenoid bone and protrudes into the sphenoid sinus.

http://www.radpod.org/2007/08/15/internal-carotid-artery-aneurysm/

Goiter

*What is a goiter?*
The thyroid gland resembles a butterfly shape and is located at the base of the neck just below the Adam’s apple. When the thyroid grows abnormally large it is known as a goiter. Most goiters are painless, but the larger they grow the more difficult it is for a patient to breathe and swallow. A goiter can occur in a gland that develops too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). Any of these conditions would indicate there is some abnormality of the thyroid.

*Causes*
One of the most common causes of goiter formation worldwide is iodine deficiency. This is not the case for majority of First-World countries, where iodine is added to table salts and other foods. Another cause of goiters can be Graves’ disease. In Graves’ disease antibodies produced by the immune system mistakenly attack the thyroid causing it to produces excess thyroxine. This overproduction of hormone (hyperthyroidism) causes the thyroid to swell. Another cause of goiters is Hashimoto’s disease. This disease is due to an underactive thyroid. The pituitary senses the low hormone level (hypothyroidism) and produces and excessive amount of thyroid-stimulating hormone (TSH), which causes the thyroid to swell. Some other causes of goiters are thyroid cancer, pregnancy, and inflammation of the thyroid.

*Symptoms*
Not all goiters show symptoms. When symptoms do take place they may include, but are not limited to: a visible swelling at the base of the neck that may range from a small nodule to a large lump, and a tight feeling in the throat. The enlarged thyroid can put pressure on the esophagus that can lead to a cough, difficulty swallowing, and difficulty breathing.

*Treatment*
Goiter treatment depends on the size of the goiter, the cause of the goiter, and the symptoms the patient experiences. Some possible treatment options include, but are not limited to: observation, if the goiter is small and the thyroid is functioning normally and not causing the patient any difficulties the doctor may choose to monitor the size of the goiter and the symptoms of the patient before taking the next step. Medications are another treatment that some patients take. There are medications that can make up for the difference of hypothyroidism and hyperthyroidism. Hypothyroidism medications slow down the release of TSH and hyperthyroidism medications normalize the hormone levels. With inflammation of the thyroid, medications such as aspirin can be prescribed to the patient to try and reduce the size of the goiter. Another treatment option is surgery. If a patients symptoms worsen and the size of the goiter becomes extremely large the patient can have a partial or total thyroidectomy. The last treatment option is radioactive iodine. Radioactive iodine is taken orally and destroys thyroid cells. This treatment reduces the size of the goiter. Hormone medicine may have to be taken by the patient after the treatment to maintain normal hormone levels.






Lateral neck x-ray shows goiter extension.


www.ispub.com/.../ija/vol10n1/goiter.xml









MRI--"red arrow" shows a goiter
http://www.learningradiology.com/caseofweek/caseoftheweekpix2006/cow231arr.jpg

An example of a grade III (visible and large) goiter

www.faqs.org/nutrition/Foo-Hea/Goiter.html

Achondroplasia

**What is Achondroplasia?**

Achondroplasia is the most common skeletal dysplasia and is caused by defective fibroblast growth factor receptor 3 in endochondral chondrocytes. Achondroplasia may have high cervical myelopathy due to stenosis of the craniocervical junction. Achondroplasia is a type of autosomal dominant genetic disorder that is a common cause of dwarfism, which is a bone growth disorder that is the most common type of growth hormone deficiency. This condition leaves the average adult at a short stature, reaching a height of only 4 feet to 4 feet ½ inches tall. This pathology affects approximately 1 in 25,000 people.

**Causes**

Achondroplasia may be inherited as an autosomal dominant trait, which means that if a child gets the defective gene from one parent, the child will have the disorder. If one parent has achondroplasia, the infant has a 50% chance of inheriting the disorder. If both parents have the condition, the infant's chances of being affected increases to 75%. Most cases appear as spontaneous mutations though.

**Symptoms**

Achondroplasia is most often evident at birth. Characteristic features can be seen with diagnostic radiology, with other imaging modalities, and ultrasound. With ultrasound, the diagnosis of achondroplasia can sometimes be suspected before birth. Some of the symptoms include, but are not limited to: Abnormal hand appearance with persistent space between the long and ring fingers, bowed legs, decreased muscle tone, disproportionately large head-to-body size difference, prominent forehead, shortened arms and legs, short stature, spinal stenosis, spine curvatures called kyphosis and lordosis. Achondroplasia symptoms may also be associated with several health problems, including breathing disorders, obesity, and recurrent ear infections.

**Treatment**

There is no specific treatment for achondroplasia. It is important that all patients with this condition have regular visits with their physician to make sure that possible symptoms of this pathology are prevented if possible. There are a number of medical complications that patients with achondroplasia will go through, but patients with this condition have normal intelligence and can live a normal life span. The most important thing for a patient that is diagnosed with achondroplasia is to remember they are capable of doing almost all the task that an average adult can. Patients just have to learn to adapt with the environment and make changes to accommodate for their height difference.







This is Amy and Matt Roloff. They are from the t.v. show Little People Big World on TLC. Amy and Matt both have achondroplasia (dwarfism). They have 4 children, 1 with achondroplasia too and the other 3 are average height.











Image of the lower limbs/pelvis of a patient with Achondroplasia.

Hand radiograph of a patient with Achondroplasia.

Blowout Fracture

I choose this pathology because this happened to my mom about 18 years ago. She was playing 3rd base in a softball game, the batter hit a line drive right at her and before she had time to react the softball hit her right in the “cheek bone,” better known to us as the maxillary bone. This blunt trauma ended up fracturing part of her maxilla and zygoma. Today, she has 2 different metal plates in her face, one medially holding together her zygoma and one across her maxillary bone.

**What is a blowout fracture?**
A blowout fracture is a fracture to the orbital floor. Blowout fractures are caused by direct trauma to the globe that may cause decompression and pressure to the eye. This blunt trauma can be caused by things such as sports accidents, automobile accidents, or even occupational injuries. The orbits around the eye socket are very thin, with enough pressure they will break. When the bone breaks the globe and surrounding muscles tend to settle into the fracture. If this occurs the muscles can become trapped in the fracture and the injured eye will not move properly. Generally, the eye itself is not affected. Luckily for my mom, she did not experience any difficulties in the movement of her eye and has had no vision problems evolve since the accident.

**Symptoms**
Symptoms of a blowout fracture may include, but are not limited to, blurred vision, difficulty in moving the eye, swelling or bruising around the eye, double vision, blood in the white area of the eye, and eye pain. These symptoms usually take place right after the trauma occurs. In the instance of my mom, she had immediate swelling and bruising of the eye. There was blood in the white area of her eye and she experienced extreme pain when trying to move her eye. One other thing that she experienced was that her entire cheek was numb immediately after contact.

**Treatment**
In some cases, blowout fractures may heal themselves, but are carefully monitored. When surgery is not required it is mostly likely because a muscle is not trapped or less than 50% of the floor of the orbit was affected. In other cases, surgical repair is required. This is usually performed when an eye muscle is trapped in the fracture, or if there is extensive involvement of the bones of the orbital floor. Majority of surgeries to repair the orbital bones is done 1 to 2 weeks after the injury has occurred so that any swelling can subside. In most cases an implant is used for reconstruction. After surgical repair the patient’s eye sight must be monitored often until discharge. The patient should also be instructed to avoid strenuous activity and blowing their nose for at least 2 days. In the case of my mom, she was immediately taken to the hospital where x-rays were preformed. She was told by the doctor that there was no injury to her orbital area. Two weeks after the accident she still had a little swelling and bruising, but the pain had diminished to a tolerable level. She had a dentist appointment about 2 weeks after the accident, and as soon as her dentist evaluated her he suggested that she get another opinion because he believed that she had a fractured orbital floor. Two days after seeing her dentist and getting another doctor referral she was going to surgery to repair her zygoma and maxilla. The doctor placed 2 metallic rigid miniplates in her face.





Blowout fracture in a 14-year-old boy after a blow to the left eye. Coronal reformatted CT image obtained with soft-tissue window settings shows a thickened and rounded appearance of the inferior rectus muscle (*), a finding indicative of muscle impingement, and depicts a hemorrhage in the left maxillary sinus (arrowhead).

A classic radiographic finding in blow-out fractures is the presence of a polypoid mass (the tear-drop) protruding from the floor of the orbit into the maxillary antrum The tear-drop represents the herniated orbital contents, periorbital fat and inferior rectus muscle.

Optic Nerve Glioma

**What is Optic Glioma?**
Optic gliomas affect the optic nerve of the eye. These tumors are created by the development of abnormal cells. The optic nerves function is to carry visual information from the brain to the eye. These tumors also affect the optic chiasm. This is the area where the optic nerve from each eye crosses over each other just anterior to the hypothalamus. Optic Gliomas are very rare and the cause of them is unknown. These tumors are benign and slow growing. They generally affect children before the age of 20. Many believe that the optic glioma is associated with neurofibromatosis Type 1 (NF1). NF1 is characterized by the growth of tumors along nerves in the brain, skin, and other parts of the body.

**Symptoms**
Patients can have vision loss in one or both of their eyes that can lead to blindness. Some patients may also have a decrease in peripheral vision. Other symptoms that may occur are squinting, bulging of one or both of the eyes, and involuntary movement of the eyeball. Some patients may also have delayed growth, loss of appetite, and a malfunction in melatonin.

**Treatments**
Treatment varies with the size of the tumor. The goal of treatment is to cure the disorder, relieve symptoms, and improve vision. Surgical removal may cure optic gliomas. Partial removal of the tumor occurs in many cases to minimize pressure on the brain from the tumor. Another form of treatment is radiation therapy. The newest technique to remove this tumor creates a 3D image of the brain and glioma and then irradiates the tumor in a number of different directions. Head CT scans and head MRI scans are used to confirm the diagnosis and location of the tumor.

**Prognosis**
The outlook is unpredictable. Early diagnosis and treatment increases the chance of a positive outcome. Majority of the time surgery cures the symptoms, while in some patients the tumor will return. This condition tends to be stable for along period of time since the tumor is very slow growing. Tumors may behave aggressively though depending on what area of the brain it affects.

Magnetic resonance image of a large retrobulbar optic nerve tumor

This child developed visual difficulties and was discovered to have a glioma (nerve tumor) in the optic nerve. The tumor has enlarged the bony opening (optic foramen), through which the optic nerve passes. This can be seen on the right side of picture.

Craniopharyngioma

**What is Craniopharyngioma?**

It is a slow growing, benign tumor that develops near the pituitary gland from embryonic tissue. This tumor is rare and generally affects children between the ages of 5 and 10. It is possible for an adult to be affected by this condition, but is uncommon. This specific tumor tends to disrupt the development of the skull completely and places stress on the pituitary gland, resulting in increasing pressure on the brain.

**Symptoms**

Symptoms tend to differ with age. Some of the most noticeable are: headaches, nausea, vomiting, delayed development in children, disruption in the proper function of the pituitary gland, and sometimes can affect the optic nerve. With disruption in the pituitary gland many children have hormone imbalances. This can lead to extreme thirst and urination abnormalities. The optic nerve damage can lead to vision problems and sometimes blindness. Symptoms that occur from Craniopharyngioma are often permanent and require surgery.

**Treatment**

The main treatment suggested by physicians to patients with Craniopharyngioma is surgery. In some cases the entire tumor is removed and in other patients on a portion of the tumor can be removed. Another choice that patients can choose is radiation therapy. This is the most recent treatment being utilized, but since it generally affects patients between the ages of 5 to 10 it is not always recommended.

**Prognosis**

After surgery, most patients can have about an 80% full recovery. There is a possibility of complete recovery if the entire tumor can be removed. The damage to the pituitary gland and optic nerve generally never completely heal and the patient can still experience hormone imbalances and often times vision problems even after surgery. In some cases these problems can become worse after surgery.

CT scan of the brain showing a craniopharyngioma (white structure in the center of the image).

www.medgle.es

Sagittal MR image obtained in a 10-year-old girl harboring a giant craniopharyngioma.

www.medscape.com