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