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.