Bell's Palsy

Imagine you wake up one morning and you can't move one side of your face. Bell's Palsy is a condition in which your seventh cranial nerve is impaired. Usually this condition resolves it's self on it's own and does not need any special treatment. However, it is scary, and should be diagnosed to make sure that other problems are not involved. Generally a CT/MRI of the skull is performed to verify the condition and to rule out other pathology that could affect other parts of the body or worsen the condition.

This condition affects approximately 40 000 Americans each year, and usually does not reoccur but can return in some instances. The causes for Bell's Palsy are still being debated but an increased chance of occurrence exists in the last trimester of pregnancy, people with the herpes virus, upper respiratory disease, and diabetes. It is suggested that the cranial nerve gets irritated by some of the small bones that the nerve passes through and then gets damaged or infected. Once the swelling subsides and the nerves heal, the condition passes and usually the facial functions are regenerated completely.

Some doctors may prescribe some antiviral medication or steroids to fight viral infection and reduce inflammation. Vitamin B1, B6, and Zinc can also be taken as a supporting agent to heal and aid in growth of new nerve-cells. Facial massages and speech therapy can also aid in getting some of the muscle function back and regain control of speech, since this cranial nerve also controls portions of the tongue. In some severe cases special precautions should be taken if the eye-lid can not be closed. Lubricants or eye drops can prevent the eye from drying out and the eye should probably be taped shut with an eye patch during the night.

This condition is usually not noticed by the settle symptoms before the onset of the paralysis. Some symptoms could be ringing in the ears, pain behind ears, and tingling in the lips or other area of face that turn into complete numbness. Symptoms usually subside completely within three to six months. This condition is not contagious.

This is an MRI of a brain with gadolinium - enhancement of the 7th cranial nerve bilaterally, left greater than right. Bilateral Bell's Palsy is rare, it usually just occurs on one side of the face.
Read more about this image here: http://www.medscape.com/viewarticle/545953_3

2009 Nucleus Medical Media, Inc.

This is an image of the 7th cranial nerve entering the facial tissue. It branches off to control muscle functions in your face.

This is another image that shows the effects of Bell's Palsy.


Information is from: http://infolongtermcare.org/articles/article.aspx?id=87

Craniosynostosis

Craniosynostosis is a condition where the sutures in the skull close before the skull reached it's maturity. This is usually noticed within the first few months of the baby's life. There are different forms of Craniosynostosis that range from minor to severe. Some of the minor cases do not need to be corrected, and only cause minor visible deformities. When a child has Craniosynostosis then the skull will have an abnormal shape as it grows.  The sutures of the skull allow for growth, so when a suture closes to early then the affected side will not grow and push the growing brain to the opposite side of the closed suture. Depending on which suture or how many sutures close to early, will determine the name of the condition, and will also determine the severity of the deformities. In severe cases the condition will require surgery to correct the deformities but the most important consideration is if the brain has enough room. If the brain is squeezed to tightly then it can cause intracranial pressure which can lead to a delay in development of the child or permanent brain damage.

When the sagittal sutures close to early then the condition is called Dolicocephaly and this will result in a long and narrowed skull. When the metopic sutures close then that will result in Trigonocephaly and is noticeable because the forehead will appear pointed. When the coronal suture closes unilateral it is termed Plagiocephaly and results in an asymmetric skull. Trigonocephaly is the most common form of Craniosynostosis and occurs in about 1 out of 2500 births. When the coronal suture closes bilaterally then the condition is called Crouzon syndrome. Crouzon syndrome is the only form of Craniosynostosis with a 50% chance of recurrence in the next generation. All other forms only have a 0 to 4% recurrence rate. Brachicephaly is the term used when the bi coronal suture closes early, and this can result in a short appearance of the skull. Plagiocephaly is the term used when the lambdoid suture closes early and this also results in an asymmetrical skull.

To verify the condition, and to plan operative procedures, the head is scanned with CT and sometimes 3D MRI images are reconstructed to guide and plan the corrective surgery.

The causes for Craniosynostosis are still unclear but some baby's are born with the condition and others develop it.

This is an image of a child that has Craniosynostosis. The sagittal suture closed prematurely and this is called dolichocephaly.

In this image the metopic suture closed and this is termed trigonocephaly.

This is a 3D CT image of a closed metopic suture. 

Images are curtesy of http://emedicine.medscape.com/article/1281182-overview

The information came from: http://www.ccakids.com/syndrome/craniosynostosis.pdf

http://www.neurographics.org/5/1/26/Craniosynostosis%20in%20children_files/frame.htm