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)