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.