Schmorl's Node

Schmorl's nodes occur when the cartilage of the intervertebral disc protrude through the vertebral body endplate into the adjacent vertebra. These protrusions may contact the bone marrow of the vertebra and lead to inflammation. These protrusions may also be responsible for necrosis ( condition of death) of the vertebral bone. They may or may not be symptomatic, and it is questionable whether or not it will cause back pain.




The T-2 weighted image on the left shows a Schmorl's node in the lumbar region and has protruded into the vertebral body of L-3. Although Schmorl's node can be seen radiographically, the modality of choice would be either MRI or a CT scan for a much better and more diagnostic image.

It is believed that Schmorl's nodes develop after some type of back trauma, but the fact is that Schmorl's nodes are not well understood.

Thoracic Fracture

The spine is made up of bones called vertebrae. Vertebrae can break just like any other bone in the body. If a person takes a very hard fall or suffers from osteoporosis these vertebrae can collapse resulting in a compression fracture which occurs most commonly in the thoracic region of the spine.

Symptoms of a compression fracture are back pain, as well as leg pain. If enough compression fractures occur your spine may give the appearance of a hunchback. If the pain is severe and the compression fracture is problematic, vertebroplasty can be done. The height of the vertebrae can be restored by injecting cement into the vertebral body to expand and or prevent further collapse of the vertebra.

This image on the left is an example of vertebroplasty. The dark area in the middle of the vertebral body is the cement used to fill and expand the collapsed vertebra. It is injected under fluoroscopy and viewed in near real time so the Dr can see what and where they are to complete the procedure.

The CT image on the left hear shows a clear break in the vertebrae indicated by the yellow arrow, and a mild compression shown by the red arrow.

C- Spine Disc Herniation

Spinal disc herniation is often mistakenly called a slipped disc, it is a medical condition in which the fibrous ring, the outer layer of the disc tears and allows the soft central portion (nucleus pulposus) to bulge out. This tear in the disc ring can result in inflammatory chemical mediators being released causing severe pain even when nerve roots are not involved.

The image to the left of a c spine taken during an autopsy shows the nucleus pulposus extruding through the ruptured annulus, and compressing the spinal cord at C5-C6.

Disc herniations can occur simply from normal wear and tear during our lives especially with jobs that require a lot of lifting. Trauma injuries from falling, blunt force, or motor vehicle accidents. Simply from sitting or bending to lift, the internal pressure of the disc can go from 17 psi to 300 psi while lifting. The disc can be under a tremendous amount of pressure without getting into a strain. While these discs are quite tough, they have there limits and when reached can cause us great pain, so proper lifting techniques are important.

Disc herniation usually occurs from the front side being compressed while bending forward or just bad posture, which will cause the back side of the disc to bulge and eventually tear.

Goiter

A goiter is basically an enlarged thyroid. The thyroid gland produces hormones which aid in regulating the body's metabolism. It is located anteriorly in the neck and inferiorly to the adams apple. Goiters tend to grow slow and are not normally painful.

Goiters may be caused by abnormal levels of thyroid hormones; they may be heredity; medications like lithium, propylthiouracil, or aminoglutethimine; or regular intakes of anything that may retard the production of thyroid hormones such as cabbage, turnips, brussel sprouts, seaweed, and millet.

Iodine deficiency can cause goiters but is not usually a problem in the United States as a result of iodized salt. Women over 40 years of age are at a higher risk of goiters than men.

Symptom's may include swelling of the neck, breathing problems, coughing and or wheezing, difficulty swallowing, pressure on the neck, and or hoarseness.
A thyroidectomy may be the treatment of choice, though radioactive iodine can be helpful in reducing the size of a goiter.

Bow Hunters Syndrome

Bow Hunters Syndrome is a condition where the vertebral artery is pinched of or occluded during neck rotation. Often there are no problems while the neck is in a neutral position or turned the opposite direction.

CT angiography can be performed to aid in diagnosis though MRA might be the modality of choice.

Bow hunters syndrome may be suspected when symptoms of vertigo, dizziness, disequilibrium, hearing loss, and or ear pain occurs when turning the head and neck no matter whether laying, standing, or any other orientation to the plane of gravity. In the image you can see where the vertebral artery is being pinched as it passes through the vertebrae.

Some causes of bow hunters syndrome are, vascular compression caused by compression of the vertebral arteries by vertebrae of other structures; Lack of sensory perception; cervical cord compression, which is most common; or a cerebrospinal fluid leak caused by a tear in the cervical root sleeve.

Anterior decompression of the vertebral foramen can be performed with little or no complications as far as restriction of movement in neck.

Saccular Aneurysm

An aneurysm is a bulge or a balloon looking blood vessel or artery that has dilated and filled with blood, caused by either disease or a weak spot in the vessel.

Aneurysms are most commonly found in arteries at the base of the brain in an area called the circle of willis. The circle of Willis is ring of vessels located below the hypothalamus and the midbrain within the subarachnoid space, and supplies blood to the crebral arteries. As aneurysms begin to increase in size there is an increases risk of the aneurysm bursting, which can severe hemorrhaging and even death.

If an aneurysm is suspected, the Dr. may order a CTA (computed tomography angiography) to do some 3D reconstructions of images of the brain with contrast dye injected. Below is a video of such a 3D study of the circle of willis with an aneurysm is the left upper area. Remember that the pateints left is on your right. Trace the artery on the patients left up to the point where it bifercates or splits and makes an upperward turn, just before the upward turn is a bulg or small circle with a bright spot in the middle, that circle with the bright spot is the aneurysm.

In a true aneurysm, the layers of the artery will separate and blood will fill that area and cause pressure resulting is tha bulge or balloon appearance that is the aneurysm.

Risk fators for aneurysms are, diabetes, high blood pressure, obesity, alcohol abuse, as well as tobacco use.

Sinusitis

Sinusitis is an inflammation of the paranasal sinuses which can be caused by infection from bacterial, viral, allergic, fungal, or autoimmune problems.


This is a coronal fat-saturated T2 MRI image of an inflamed right side ethmoid sinus. The arrow points to the inflamed area of interest. When viewing radiology images the right side is always on the left for the person viewing the image, and the left side is on the right, as I said, the arrow is pointing to the right ethmoid sinus which is full of fluid. Fluid shows up bright on T2 weighted MRI images. The left side ethmoid sinus air cells are clear and show up black and empty.


There are several paranasal sinuses.

The ethmoid sinuses can cause pain and or pressure behind and between the eyes.

The maxillary sinuses can cause pressure in the cheek area and cause headaches or toothaches.

The Frontal sinuses can cause headaches and pain above and behind the eyes.

The sphenoid sinuses can cause dizziness and an imbalance of a persons equilibrium.

Some symptoms are, nasal congestion, fever, nasal discharge, vertigo, headache, lightheadedness, halitosis, and blurred vision.

Orbital Cavernous Hemangioma

Orital cavernous hemangiomas are the most common tumors of the orbit in adults. They are vascular malformations that are composed of large, dilated endothelium lined channel with a fibrous covering.

These tumors are slow growing, and usually occur in patients ages 30 to 40 years old, and most tend to be more common in females. Patients tend to have painless proptosis (swelling of the eyes).

On the right side of this image behind the left eye is a round dense cavernous hemangioma that may in many cases displace or otherwise push on the optic nerve.

Surgery or surgical resection is the normal treatment which produces a high cure rate.

Empty Sellar Syndrome

The pituitary gland is housed by the sella turcica, which lies inferior to the frontal lobe of the brain, and anterior to the fourth ventricle and pons. The darkest area in this MRI image just under the frontal lobe, surrounds the sella turcica which is outlined in white and looks like an incomplete circle. Inside the sella turcica is the pituitary gland, only in this case the sella turcica is filled with CSF or cerebral spinal fluid. This CSF has flattened the pituitary gland and this flattening of the pituitary gland gives the appearance of an empty sella turcica, thus the name, empty sella syndrome.

There is primary and secondary ESS.

Primary ESS is the increased pressure of CSF flattening out the pituitary gland along the interior walls of the sella turcica. Primary ESS related to obesity as well as high blood pressure in women, and can cause a build up of fluid pressure in the skull.

In secondary ESS, the pituitary gland becomes smaller, shrinking inside the Sella turcica due to some sort of injury or related surgery, and or radiation therapy. Due to an improperly functioning pituitary gland, a ceasing of menstrual periods, infertility, fatigue as well an intolerance to stress and infection may occur.

ESS in children may cause an early onset of puberty, and a low growth rate due to a deficiency in producing growth hormones.

MRI scans may be the modality of choice in evaluating ESS.

Typically, ESS is not a life threatening disorder.

Acoustic Neuroma

Acoustic Neuroma, technically known as vestibular schwannoma, is a noncancerous benign tumor that occurs in the superior portion of the vestibular nerve which can be found in and actually is a part of the eighth cranial nerve complex. This is important as this nerve needs to be healthy for proper equilibrium or balance, as well as hearing. The name of the tumor as with most pathologies gets it's name from the anatomy involved, in this case the nerve that it affects.

In the image on the left you can see the tumor in the middle of the picture and the blood vessels surrounding it that feed it. The contrast enhanced axial image on the right highlights the tumor in the internal auditory canal. Before CT and MRI finding and diagnosis of this type of tumor was very difficult and often missed.

Signs and symptoms associated with the growth of an acoustic neuroma could include unilateral tinnitus, unilateral hearing loss, facial nerves not functioning properly, problems with cerebellar area functions, problems swallowing, and strange sensations unilaterally in the face. In cases of the tumor becoming very large, hydrocephalus, and brain stem compression could occur causing a whole array of other problems not mentioned here.

CVA, (cerebral vascular accident) otherwise known as a stroke, is the result of the loss of blood to the brain or part of the brain which results in cell death in that area.

Blood brings nutrients and oxygen while carrying waste products away from all over the body and the brain is no different. Without life giving blood to any part of our brain, that part of the brain will die. In the image seen here, a lack of density in the right parietal area of the patients brain extending from the frontal area to the occipital area causing some midline shift can be seen. I'm no Dr, but the damage here appears to be extensive.

Symptoms of a stroke may range from slurred speech, memory loss, paralysis, loss of reasoning skills, and or drooping of one side of the mouth. Often times a patient cannot stick their tongue out straight, it will go to one side or the other.

CVA could be caused by a blood clot such as a cerebral thrombosis (formation of a blood clot inside the brain), cerebral embolism (blood clot formed somewhere else in the body and moved into the brain), or subarachnoid hemorrhage caused by tearing of veins with the end result being intracranial pressure as well as an end to normal blood flow in that area.

Strokes caused by an embolism present with symptoms that are most intense right after the stroke occurs. Symptoms present themselves more slowly in the case of a thrombosis. Patients may complain of a very bad headache, decreased vision in one or both eyes, weak or numb feeling on one side of the body, and or an unsteady gate, dizziness, and lack of coordination.

About 72 hrs will pass before a CVA will show up on a CT scan, therefore an MRI may be the scan of choice using a diffusion weighted sequence, which will demonstrate a CVA almost immediately.

Typically plasminogen activator (tPA) will be given to the patient within about 3 hrs to dissove the blood clot and restore normal blood flow. If a patient cannot have tPA, other blood thinning drugs may be given, ussually heparin.

We may want to quit smoking, limit alcohol consumption, watch our weight, and exercise regularly as a way to help prevent strokes.