Blowout Fractures

Blowout Fractures are caused by direct trauma to the eye by on object larger in diameter than the orbital rim. There are two theories behind the mechanics of the blowout process. The first theory is the buckling theory. It postulates that the orbital rim buckles under sufficient force and subsequently causes fractures in the orbital wall and floor. The retropulsion theory claims that when excessive force is applied over the orbit that the intraorbital pressure increases beyond the capacity of the bony structures to contain the pressure. Decompression must then occur through fracturing of the orbital wall and floor. In either case, the end result is fracturing of the orbital wall and floor as result of a blunt force trauma to the orbit.




Radiographically, fragments may be visualized in the maxillary sinus. The maxillary sinus may also appear opacified due to blood filling the cavity. Surgical repair may be necessary and is often performed by emplacing an orbital implant.

Orbital Pseudotumors

Orbital Pseudotumors are caused when tissues around the eye become inflamed. Certain orbital inflammations can look like tumors and are therefore call Pseudotumors. Orbital Pseudotumors can affect one or both eyes of relatively young patients (less than 50 years old). They are not considered cancer, because orbital Pseudotumors cannot invade other tissues or spread throughout the body. Most common symptoms include pain to the eye, decreased vision, eyelid swelling, and red eye. Severe cases of orbital Pseudotumors may push the eye forward to the extent that the lids can no longer protect the cornea, leading to drying of the affected eye. There is no known cause for orbital Pseudotumors. In most mild cases there is no need for treatment. Severe cases may require high does of steroids or surgical removal.

This is an axial contrast CT of the orbits shows abnormal right scleral thickening, assiciated with stranding in the orbital fat and mild thickening of the extraocular muscle tendon attachments. The right medial rectus muscle is slightly larger than the left.

Craniopharyngioma


A benign tumor that develops near the pituitary gland is a craniopharyngioma. The pituitary gland is a small endocrine gland at the base of the brain. Craniopharyngioma is a benign, slow growing tumor that predominantly involves the sella and suprasella space. These craniopharyngiomas behave like malignant tumors. They can metastasis, and patients can have severe symptoms that usually require surgery. Craniopharyngioma causes symptoms in three different ways: by increasing the pressure on the brain, disrupting the function of the pituitary gland, and by damaging the optic nerve. Increasing pressure on the brain may cause headache, nausea, vomiting, and difficulty with balance. Hormone imbalance that can lead to excessive thirst and urination is caused when the pituitary gland is damaged. Surgery is normally the main treatment for craniopharyngioma. However, radiation treatment instead of surgery may be the best choice for some patients. Both CT and MRI scans are used in diagnosing craniopharyngioma.

Bell’s palsy

Bell’s palsy is a temporary form of facial paralysis that occurs with damage to the seventh cranial nerve. This nerve controls facial movement. It is linked to inflammation of the nerve in the area where it travels through the bones of the skull. Sometimes the condition results in permanent changes. Most often, 60%-80% of cases go away completely with a few weeks to a few months. This disorder is not life threatening. Symptoms are normally sudden. The following are symptoms that may be experienced: change in facial expression, difficulty with drinking or eating, drooling, droopy eyelid, dry eye, facial paralysis, headache, loss of sense of taste, twitching in face and weakness in the face. Most of the time there is no treatment, only relieving symptoms. MRI is most often used to determine Bell’s palsy, because MRI is the only modality that can clearly demonstrate the nerves.

ENCEPHALITIS

Encephalitis means inflammation of the brain. It is normally caused by a virus. The disease is most commonly seen in children, the elderly, and people with weakened immune systems. Encephalitis can be caused by many different types of viruses/bacteria and transmitted in various methods. Some of these methods are as follows herpes simplex virus (HSV), lyme disease, mosquitoes, childhood illness, and bacterial inflammation. Milder cases of Encephalitis may cause fever, headache, poor appetite, loss of energy, and a general feeling of malaise. In more severe cases a person will experience high fever, severe headaches, nausea and vomiting, stiff neck, confusion, seizure, hallucinations, memory loss, drowsiness, or a coma. CT scans and MRI studies are frequently ordered on someone experiencing symptoms of Encephalitis. The studies will check for swelling, bleeding, or other abnormalities of the brain.

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