Blow out fracture of the skull

A blow out fracture of the skull or orbital floor fracture is a fracture of the bones surrounding the eye. This kind of fracture usually occurs from a blow to the skull. This kind of fracture is commonly seen in automobile accidents.

Symptoms are usually swelling, bruising of the eye, nose bleeds, double vision and numbness of the checks.

Most blowout fractures heal on it's own and don't require surgery. Cold compresses to reduce swelling and time to heal the bone is all that is needed. If pain is present and severe when the eye is moved or numbness in cheeks doesn't go away then reconstructive surgery may be needed, and is usually performed within 2 weeks of the fracture.

Most blowout fractures heal without any long-term effects but sometimes the muscle of the eye is impaired and this condition is called strabismus, and causes double vision. When this occurs then surgery may be necessary to the muscles of the eye if the condition can't be corrected with glasses.

A trapdoor fracture is a relatively small orbital floor fracture with clinically significant muscle entrapment and is common in the pediatric population. Unlike a blow-out fracture though, prompt surgical intervention is necessary to avoid early tissue necrosis resulting from compromised vascular supply. Look for the same findings of a blow-out fracture, plus no supraduction, nausea, vomiting and the patient will usually exhibit intense pain. Like a blow-out fracture, a CT scan with coronal views is also indicated.

Image and caption is from: http://www.pacificu.edu/optometry/ce/courses/21042/primarycaretraumapg2.cfm

Prolactinoma

Prolactinoma is a benign tumor that arises from the pituitary gland. It can cause several problems in men and women that have this tumor. It is more common in women than in men. It is one of the most common pituitary tumors and accounts for about 30% of all tumors in the pituitary gland. The tumor causes to much prolactin production, a hormone that causes lactation of the breast in women. It can also decrease the sex drive and cause absence in a menstrual cycle. In men the tumor may cause impotence, decreased sex drive and breasts to grow.

This tumor does not have to be surgically removed unless it is so large that it is causing visual problems and starts pushing on some nerves and other brain tissue. If the tumor is small it can be controlled with medication. Typically a medication called Bromocriptine is prescribed and has to be taken for life. If surgery is needed then it should be done in the first 6 month of being on the medication for the chances of success to be higher.

Indications for this condition are blood levels like prolactin and testosterone. In order to visualize the pathology an MRI or CT of the pituitary region of the brain needs to be performed. The mass is usually small, about 1 cm in diameter but can be larger. The larger version usually occurs in men.

These are MRI images of a prolactinoma in a female. The arrows are pointing to the tumor.
Image is from: http://brentdanley.com/2009/02/17/the-prolactinoma-is-back/

MRI of a 58 years old patient with an invasive, cystic giant prolactinoma, which has destroyed the base of the scull, caused blindness, and infiltrated the lateral ventricle.
Image and caption is from:
http://www.endotext.org/neuroendo/neuroendo11b/index.html


Information was gathered at: https://health.google.com/health/ref/Prolactinoma

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