Hangman's Fracture

CT,BONE WINDOW, top three sagittal, bottom two axial
Fracture-lines confirm hangman's fracture.
Fracture-lines run throught pars interarticularis.

Classification of Hangman's Fractures:

Type I (65%), hairline fracture, C2-C3 disc normal

Type II (28%), displaced C2, disrupted C2-C3 disc,ligamentous rupture with instability, C3 anterosuperior compression fracture

Type III (7%), displaced C2, C2-C3 bilateral interfacet dislocation, severe instability

A hangman's fracture is a fracture of an upper cervical vertebra similar to that suffered in hanging death. Most are caused by motor vehicle accidents. May be caused by hanging or falls.

http://www.radiologyassistant.nl/en/49021535146c5

BOW HUNTER'S SYNDROME

MRA, CORONAL IMAGE HEAD IN NEUTRAL POSITION, DEMONSTRATES NORMAL SIZE OF LEFT VERTEBRAL ARTERY

MRA, HEAD ROTATED TO RIGHT AND HYPEREXTENDED, DEMONSTRATES NARROWING OF LEFT VERTEBRAL ARTERY AT C1-C2 LEVEL

BOW HUNTER'S SYNDROME DERIVES ITS NAME FROM THE POSITION THAT BOW HUNTERS USE, TURNING THEIR HEADS SIGNIFICANTLY TO ONE SIDE FOR SHOOTING.

THE ABOVE PATIENT IS A 58 YEAR OLD MALE. HIS SYMPTOMS WERE A ONE YEAR HISTORY OF FEELING DIZZY WHILE TURNING HIS HEAD TOWARDS THE RIGHT. SYMPTOMS WOULD DISAPPEAR WHEN HE TURNED HIS HEAD BACK TO A NEUTRAL POSITION.

THE MRA DEMONSTRATED SEVERELY STENOSED RIGHT VERTEBRAL ARTERY. DIAGNOSTIC ARTERIOGRAM WAS PERFORMED IN SEVERAL POSITIONS UNTIL THE PATIENT'S SYMPTOMS WERE DUPLICATED. THE ANGIOGRAM DEMONSTRATED NARROWING OF BOTH HORIZONTAL SEGMENTS OF THE LEFT VERTEBRAL LOOP AT THE LEVEL OF C1-C2.

THE PATIENT WAS SCHEDULED FOR SURGERY TO RELEASE SOFT TISSUES SURROUNDING THE LEFT VERTEBRAL ARTERY AT C1-C2 LEVEL.

BOW HUNTER'S SYNDROME USUALLY OCCUR WHEN ONE VERTEBRAL ARTERY IS OCCLUDED OR SEVERELY STENOSED. WHEN THE HEAD IS TURNED TOWARDS THE OCCLUDED ARTERY, THIS WILL STRETCH OR OCCLUDE THE OTHER SIDE LATERAL VERTEBRAL ARTERY. SINCE THIS CUTS OFF OR SLOWS BLOOD CIRCULATION IN THE VERTEBRAL ARTERIES, THE PATIENT WILL FEEL DIZZY AND MAY EXPERIENCE SYNCOPY, IF HEAD IS NOT RETURNED TO A NEUTRAL POSITION. THIS IS THEN A MECHANICAL PROBLEM AND IS ALLEVIATED BY RELEASING THE SOFT TISSUES AROUND THE VERTEBRAL ARTERY.

http://rad.usuhs.edu/medpix/kiosk_image.html?mode=&pt_id=9108&imageid=27425&quiz=no&week_id=516&skiprows=0&this_week=&max=6&select_auth=&conf=#pic

Saccular aneurysm

Small saccular aneurysm (white arrow) arising from origin of ophthalmic artery (black arrow).
http://www.ajronline.org/cgi/content/full/184/1/305#FIG7

CT angiography, axial. Sentinel clot (arrowheads) around saccular aneurysm (arrow) arising from right internal carotid artery.

http://www.ajronline.org/cgi/content/full/184/1/305/FIG1

Causes: developmental or degenerative, traumatic, mycotic, oncotic, flow-related, vasculopathy-related, and drug related.

Associated conditions: polycystic kidney disease, coarctation of aorta, anomalous vessels, FMD, connective tissue disorders, high-flow states, and spontaneous dissections.

Treatment: clipping or coiling (coiling with or without stent).

Saccular aneurysms are berry shaped outpouchings that arise from arterial bifurcation points. The most common area inthe cirlce of Willis. They present dilations of the vascular lumen which is caused by weakening of all vessel wall layers.

CHRONIC SINUSITIS

XRAY Waters Position, Parietoacanthial projection. http://www.ghorayeb.com/ImagingMaxillarySinusitis.html

Coronal CT, Bone Window. Ethmoid and Maxillary sinusitis with deviated septum. (I'm thinking it is bone window because of the detail of the bone, yet there is soft tissue differences also. http://homepage.mac.com/changcy/sinusitis.htm

Coronal CT Soft Tissue Window, normal sinuses. There doesn't appear to be any bony detail. http://homepage.mac.com/changcy/sinusitis.htm

Xray (I believe it is the open-mouth Waters PA axial transoral projection). With only a thin bone separating the sinuses from the brain, the infection could pass through the bone and infect the meninges and/or the brain itself. The infection could also spread to the orbits with a potential to cause blindness. In addition, another rare but possible outcome would be aneurysms or blood clots which have the potential to be fatal. http://www.webmd.com/allergies/sinus-pain-pressure-9/slideshow-sinusitis

Color enhanced MRI. The blue areas are thickened mucosal surfaces in both maxillary sinuses. Ironically, 32 MILLION PEOPLE (the same number as citizens in the U.S. without health care coverage) are affected by sinusitis. http://www.webmd.com/allergies/sinus-pain-pressure-9/slideshow-sinusitis

CT Coronal Bone Window http://www.webmd.com/allergies/sinus-pain-pressure-9/slideshow-sinusitis

Pain areas of Sinusitis, including upper teeth http://www.webmd.com/allergies/sinus-pain-pressure-9/slideshow-sinusitis

Nasal Polyps http://www.webmd.com/allergies/sinus-pain-pressure-9/slideshow-sinusitis

Eighty percent of the time yellow or green mucus indicates a bacterial or viral infection http://www.webmd.com/allergies/sinus-pain-pressure-9/slideshow-sinusitis

Chronic Sinusitis is inflamation of the sinuses that lasts months (about three) to years. When the sinuses are obstructed mucus and on occasion pus builds up in the sinuses. This leads to pressure and pain.

Causes include:

allergies

polyps

nasal fractures

viral or bacterial infection

Symptoms include:
pain and pressure in forehead, nose, between the eyes, in the cheek, and or teeth

also congestion, postnasal drip, bad breath, fever, and thck nasal discharge

Diagnosis:

fever, tenderness in face in sinus areas, inflammation and mucus in nose and throat,

nasal polyps, deviated septum, enlarged lymph nodes are all indicative of sinusitis.

Sometimes an allergy test is performed to see if allergies are the culprit. CT & or MRI (usually

CT) of the sinuses will indicate whether there is structural blockage or not.

http://www.intelihealth.com/IH/ihtIH/WS/9339/10414.html?b=

Optic nerve sheath meningioma

figure 1

figure 2

figure 3

figure 1 MRI T1 weighted image, mass appears isointense to brain & optic nerve tissue.

figure 2 MRI T2 weighted image, mass appears slightly hyperintense.

figure 3 MRI T1 weighted image with fat saturation after intravenous administration of gadolinium, mass presents a homogeneous intense enhancement, showing an appearance of a "tram track" around the hyperintense optic nerve.

The mass shows no intracranial or surrounding structure invasion. This tubular mass was found in the right orbit.

The patient was a 75 year old male. He was seen six years earlier with outside proptosis (forward displacement or bulging) of the right orbital bulb. Finally after six years a MRI series was done and he was diagnosed.

Primary optic nerve sheath meningioma (ONSM) account for about 1/3 of primary optic nerve tumors and 5% to 10% of orbital tumors.

The growth may be tubular, globular, fusiform or focal.

The symptoms include ipsilateral visual loss, color vision disturbance, visual field defect, proptosis, optic disc oedema and motility disturbance.

ipsilateral : same side

optic disc oedema: swelling of the optic nerve at the point where the nerve joins the eye

In 1614 Felix Plater described meningiomas during an autopsy. In 1938 Harvey Cushing described them as a separate category of extraparenchymal tumors.

These meningioma tumors are believed to arise from arachnoid cap cells. Commonly they are attached to the dura. They can form from any location where meninges exist (nasal cavity, paranasal sinuses, middle ear, mediastinum).

"In children the more common locations include the orbit, the temporal region, the foramen magnum, the tentorial region, the subfrontal base, the sellar region, and the ethmoidal air sinus." (Gossman, emedicine).

http://www.wrongdiagnosis.com/sym/exopthalmos.htm

http://medical-dictionary.thefreedictionary.com/proptosis

http://www.medterms.com/script/main/art.asp?articlekey=4041

http://medical-dictionary.thefreedictionary.com/papilledema

http://emedicine.medscape.com/article/1217466-overview (Gossman emedicine)

Craniopharyngioma

Figure 1 (top far right) shows a large mass extending upwards to the third ventricle and posteriorly into the pre-pontine cistern (arrow).

Figure 2 (top left) shows the tumor extending quite a bit and encasing the basilar artery (small arrow).

Figure 3 (bottom right) shows calcification within a hyperdense lobulated mass at the sprasellar region (arrow).

Figure 3 is a CT image axial. Figure 1 is a MRI T1 sagittal image, Figure 2 is an axial T2 MRI image.

Craniopharyngioma can causes symptoms in three separate ways:
1) increasing the pressure on the brain
2) disruption of the functions of the pituitary gland

3) damage to the optic nerve

Headache, nausea, vomiting and difficulty with balance are attributed to increased pressure on the brain.

Disruption to the pituitary gland can result in hormone inbalance that can lead to excessive thirst and urination (diabetes insipidus) and stunted growth.

Optic nerve damage cause vision problems that may be permanent and can worsen after surgery.

Craniopharyngioma is a benign tumor that develops near the pituitary gland It is a slow growing cystic tumor that occupies the (supra) sellar region.

https://health.google.com/health/ref/Craniopharyngioma

http://emedicine.medscape.com/article/1157758-overview

http://www.urmc.rochester.edu/smd/Rad/neurocases/Neurocase16.htm

The cause of Craniopharynngiomas is unknown.

http://images.google.com/imgres?imgurl=http://www.plwc.org/oncology_content/content_images/CNS_credit_small.jpg&imgrefurl=http://www.cancer.net/patient/Cancer%2BTypes/Craniopharyngioma%2B-%2BChildhood/ci.Craniopharyngioma.printer&usg=__1kjdKwj3D_EPXMpsXnFFO0-9c1Y=&h=202&w=240&sz=55&hl=en&start=9&um=1&itbs=1&tbnid=cyjpam-aR2ezvM:&tbnh=93&tbnw=110&prev=/images%3Fq%3Dcraniopharyngioma%26um%3D1%26hl%3Den%26sa%3DG%26tbs%3Disch:1

Glomus Typanicum Tumor

A glomus typanicum tumor is a benign mass that usually form on the cochlear promontory. They are the most common neoplasms of the middle ear. The two most common symtoms are pulsatile tinnitus and conductive hearing loss. Treatment for glomua tympanicum tumors is surgical removal.

The first image to the right shows tumor as a red pulsating mass.

The second image shows a PE Tube installed with posterior half of typanic membrane pulsating and red.

The third image shows the glomus typanicum exposed by lifting the tympanomeatal flap. This tumor filled the psterior half of the middle ear space.

The fourth image is a CT axial that shows the tumor growing from the medial wall of the middle ear.

The fifth image is a Coronal CT view of the tumor growing from the medial wall of the middle ear.

The sixth surgical picture shows an excellent view of the tumor.

http://www.thefreelibrary.com/Glomus+tympanicum+tumor-a0163421963

http://www.ghorayeb.com/GlomusTympanicum.html