Spina Bifida

Spina Bifida is a congenital condition in which part of the spinal cord is not enclosed by the spinal column. It develops one month into fetus development, and is usually diagnosed before birth by ultrasound or bloodwork. Causes are unknown, but having a high fever during pregnancy can increase the likelihood of spina bifida developing. There are different levels of severity, with some people experiencing no symptoms and some people being extremely disabled with nerve damage. Myelomeningocele is the most severe form. Most patients with disabling Spina Bifida also have hydrocephalus, and will need shunt placement to drain fluid off the brain. Shunts often malfunction or get infected, so it's likely you'll take shunt images at some point to evaluate them.

Carotid Artery Stenosis

In Interventional Radiography we've been learning about Carotid Artery Stenosis. This is a narrowing of the carotid artery, usually because of artherosclerosis (fat/cholesterol buildup in the blood vessels). The big danger of carotid stenosis is an ischemic stroke, or transient ischemic attacks. A stent can be placed in the artery(s) that is blocked, or if it's too blocked, surgical endarterectomy can scrape the blockage out of the artery. The picture above shows the carotid artery being cut into by a surgeon.

The picture below is a 3D rendering (CT) of cartoid stenosis. The artery itself isn't narrowed, just the blood flow is narrowed so it appears thinned when it's reconstructed. The last picture is an MRI of the carotids.

Laryngeal Cancer

I saw a gentlman with this type of throat cancer while I was working as a patient care tech. He began vomiting copious amounts of blood and it couldn't stop. He was taken to surgery so that the bleeding vessels could be cauterized, but it was so bad he died. Cancer on the larynx is called laryngeal cancer. Usually it will be discovered when a person has pain or trouble swallowing, or hoarseness and pain when talking. Other symptoms include earache, the feeling of a persistent lump in your throat, trouble breathing, a persistent cough, and bad breath.

You probably know that smoking is a huge risk factor for this type of cancer, but drinking alcohol is also a biggie. Men are 4x more likely to have this type of cancer, and it occurs mainly in people older than 55. African Americans are more likely than people of Caucasian ethnicities to get laryngeal cancer, and gastric reflux disease puts you at a higher risk also. Also, breathing asbestos is a risk factor.

To diagnose, a doctor will do a physical exam, and/or laryngoscopy and CT. Laryngoscopy involves a tube with a camera down your throat and CT will use contrast to show tumors. After that, a biopsy will determine whether the tumor is malignant or not.

I think this type of cancer is particularly bad, in part because I saw the poor man who couldn't stop vomiting blood, but because it affects your breathing, your talking, and your swallowing. Patients might have to have a feeding tube put in, a tracheostomy, and may lose their ability to speak.

Bell's Palsy

Bell's Palsy causes facial paralysis, usually on one side of the face or the other. This paralysis causes drooping, tearing, drooling. It's a temporary condition that can last from weeks or months, but usually a full recovery is made because the nerve regenerates itself. The onset is very quick-either a person wakes up with the paralysis, or it develops within a day or two. It is recurring in about 10% of people who experience a Bell's Palsy attack.

It's caused by inflammation around Cranial Nerve 7 (Facial nerve). Nerve 7 originates in the Pons and divides into many branches in the Parotid Gland. There's a picture below of that. When I say it's caused by inflammation, that can be caused by anything from a viral infection to brain surgery. Herpes Simplex 1 (think cold sores) is a frequent cause, although most people have been exposed to Herpes 1, but not everybody that carries Herpes 1 develops Bell's Palsy. HIV and pregnancy can also put you at higher risk for developing Bell's Palsy.

Diagnosing Bell's Palsy usually doesn't require radiologic imaging, but sometimes a doctor may order a CT or MRI to rule out other causes before determining Bell's Palsy.

Sinus Tumors

Usually, sinus tumors are benign, although malignant tumors sometimes do occur. When a tumor in the sinus is malignant, it is probably squamous cell carcinoma, which can also form in the nasal cavity. The usual treatment for these tumors is surgical removal, radiation treatment, and chemotherapy.

Malignant tumors are most often slow growing and are often diagnosed late because the symptoms mimic sinusitis. The cause of malignant sinus tumors is unknown, but like other cancers, certain risk factors can increase your odds of getting one. The risk factors include smoking and airborne pollutants as well as exposure to industrial chemicals or other workforce environment factors like excess dust (think woodworkings). Also, being male and over 40 increases your risk (yet another downside to turning 40).

CT and/or MRI with contrast can be helpful to diagnose sinus tumors, and biopsies can determine malignancy. The MRI images below show a maxillary sinus tumor.

Optic Nerve Meningiomas

Optic Nerve Meningiomas are benign tumors on along the optic nerve. They can be on the outside of the nerve or in between the arachnoid and dura layers of the nerve. They are not uniformly shaped, but will wrap around the nerve. This causes problems because removing the tumor surgically can damage the optic nerve. Symptoms of an optic nerve meningioma usually involves vision loss. Radiation therapy can also be used to treat these tumors, but there is the risk of radiation damage to the eyes and surrounding neural tissues.

The black arrows in these images show optic nerve meningiomas.

Pituitary Disorder: Cushing's Syndrome

You're obese in the upper body, face, and neck, yet your arms and legs are slender. Your skin is easily bruised or torn, and your bones are weak. If you're a woman, you may be extremely hairy and have irregular menstral periods. If you're a man, you may be infertile and have a decreased sex drive. You may even have a fatty "buffalo hump" on your shoulders. If these attributes describe you, you may have a rare disease known as Cushing's Syndrome.

Cushing's is caused when the body is excessively exposed to cortisol. The pituitary secretes a hormone that causes the adrenal glands to secrete cortisol. So, Cushing's can happen when either the pituitary gland or the adrenal glands have malfunctioned, or if a medication such as long-term steriods is being administered. If the pituitary is to blame, it's likely because of a benign adenoma on the pituitary.

Surgery or radiotherapy can be used to treat Cushing's of the pituitary. If MRI and CT have ruled out the pituitary as a cause of Cushing's, it's likely that medication or an adrenal tumor are causing the disorder.

Here is a child with Cushing's (Sam). The second picture is after her surgery.