Orbits: Brown's syndrome

What is Brown's syndrome?


Brown's syndrome is know as Superior Oblique Tendon Sheath syndrome.  Brown's syndrome was named after Dr. Harold W. Brown.  The syndrome consists of a mechanical problem in which the superior oblique muscle doesn't move freely.  Patients have trouble looking up and in with the affected eye. Brown's syndrome patients are 90% of the time affected in one eye and majority of the time it is the right eye that is affected. The figure below is just an image to show which muscle is affected.

http://www.aapos.org/faq_list/brown_syndrome

 

 

 

What causes Brown syndrome?
The cause of Brown's syndrome is unknown.  Heredity cases of Brown's syndrome are quite rare.  People 
 just seem to have Brown's syndrome randomly. "These abnormalities may include a reduced elasticity of the superior oblique muscle and tendon, a thickened tendon, a short and/or tight sheath, or fibrous adhesions (scarring) of the tendon" (http://www.aapos.org/faq_list/brown_syndrome).  Brown's syndrome can also be caused post-surgery around the upper portion of the eye, from blunt trauma to the upper corner of the eye area, or from inflammation. The picture below shows how people are affected by the syndrome.

Clinical Characteristics of Brown Syndrome

1." Vision and stereo acuity usually normal"

2. "Chin up face points to opposite side"

3."Deficient elevation in adduction"

4. "Usually some elevation limitation in straight upgaze and in abduction"

5. "Widened palpebral fissure on adduction"

6. "May or may not have downshoot of involved eye in adduction"

7. "May be acquired"

8. "May be intermittent with or without pain"

(all info above from:  http://www.cybersight.org/bins/volume_page.asp?cid=1-3-4-18 ) 

Axial section of T1 contrast MRI  (http://webeye.ophth.uiowa.edu/eyeforum/cases/50-Acquired-Brown-Syndrome-Ethmoid-Mucocele.htm)

 

 

Treatment 

Treatment of Brown's syndrome varies with the severity of the disease. Occasionally Brown's syndrome cures itself.  Nonsurgical and surgical advise is given for differently acquired Brown's syndrome.  Nonsurgical treatment is recommended for patient that acquired Brown's syndrome after traumatic accidents or newly developed cases.  Patients with inflammation from Brown's syndrome will sometimes receive corticosteroids or take anti-inflammatory medications.  "Surgical treatments are recommended if any of the following are present: eye turns down when looking straight ahead, significant double vision, compromised bincocular vision or pronounced abnormal head position" (http://www.aapos.org/faq_list/brown_syndrome).

For more information on Brown's syndrome, please visit:

http://www.aapos.org/faq_list/brown_syndrome
http://www.cybersight.org/bins/volume_page.asp?cid=1-3-4-18

Ashli

Pituitary: Macroadenoma

What is it?

Macroadenoma is a benign growth of more than 10 mm in size in the pituitary gland.  A microadenoma is different because it is a growth of less than 10 mm in size.  The image below shows the differences in sizes of the macroadenomas or microadenomas. 

radonc.ucla.edu

 

Macroadenomas are not as common as microadenomas.  There are several types of pituitary macroadenomas depending on if they produce hormones or not.  A functioning pituitary macroadenoma makes one or more pituitary hormones; whereas, a nonfunctioning pituitary macroadenoma does not make hormones.  Each type of pituitary macroadenoma can have different symptoms depending on the hormones produced in the individual.  For example, functioning pituitary macroadenoma include:

• "Prolactin-producing macroadenomas"
• "Growth hormone-producing macroadenomas"
• "ACTH-producing macroadenomas"
• "Thyroid hormone-producing macroadenomas" 

(http://endocrine-system.emedtv.com/pituitary-macroadenoma/pituitary-macroadenoma-p2.html)

 Symptoms

The symptoms of macroadenoma can range from simple to complex.  Some symptoms could be headaches, vomiting, or dizziness. Symptoms vary because of the size of the macroadenoma.  If the macroadenoma grow larger, it could possibly press on certain parts of the brain.  A macroadenoma could press on the optic nerve, which could cause vision problems. Symptoms also vary depending on the hormones produced by the macroadenoma. Hormones tumors could cause hyperthyroidism, Cushing syndrome, or hyperprolactinemia.

radiopaedia.org

 

Diagnosis/Treatments

Diagnosis could be concluded by the tests listed:

 

• "Blood tests to measure hormone levels"
• "Computed tomography (CT) scans"
• "Magnetic resonance imaging (MRI) scans"
• "Petrosal sinus samplings"
• "Eye exams." 

(http://endocrine-system.emedtv.com/pituitary-macroadenoma/pituitary-macroadenoma-p3.html)

Pituitary macroadenoma treatment options vary based on:

 

• "The type of pituitary macroadenoma (see Types of Pituitary Tumors)"
• "The symptoms of its hormone activity"
• "How far the macroadenoma has spread into the brain"
• "The patient's age and overall health." 

(http://endocrine-system.emedtv.com/pituitary-macroadenoma/pituitary-macroadenoma-p3.html)

Treatments for a pituitary macroadenoma can include radiation therapy, surgery, and drug therapy.f

mayfieldclinic.com

If you would like any additional information on macroadenoma go visit:

-http://emedicine.medscape.com/article/123223-overview
-http://endocrine-system.emedtv.com/pituitary-macroadenoma/pituitary-macroadenoma-p3.html

Ashli House

 

 

 

IAC/Temporal Pathology: Otosclerosis

Otosclerosis

What is it?

I wanted to research Otosclerosis because I had no idea as to what it was.  I didn’t realize how many individuals were affected by Otosclerosis.  Otosclerosis is an abnormal growth of the bone in the middle ear which causes hearing loss in people.  I always assumed individuals had loss of hearing because of loud noises but there are several reasons which affect hearing loss.  The cause of Otosclerosis is unknown, but is thought to be passed down in families.  The most common cause of middle ear hearing loss in young adults is Otosclerosis.  It normally begins in early adulthood and affects both ears.  Often times, women are affected by Otosclerosis more commonly than men.

squidoo.com

Symptoms/ Tests

Some different symptoms and tests can help diagnose a patient with Otosclerosis.  According to Pub Med Health, some symptoms are: 

·         “Hearing loss may occur slowly at first but continue to get worse.”

·         “You may hear better in noisy environments that quiet ones.”

·         “Ringing in the ears (tinnitus) may also occur.”

(http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002031/)

The main tests used to diagnose Otosclerosis are a hearing test and a CT of the temporal bone. 

Possible Treatments

Treatments vary with Otosclerosis.  Some patients can take medications such as calcium or vitamin D to prevent or slow their hearing loss.  A hearing aid can help in hearing loss but will not cure Otosclerosis.  Surgery is another option that can cure or prevent hearing loss from getting worse.  A total replacement of the stapes with prosthesis is stapedectomy.  If surgery is unsuccessful then the patient may have to learn to cope with deafness.  Complications include complete deafness, infection, dizziness, pain, or nerve damage. 

audiologyonline.com

 

imaging.consult.com

If you want to learn more about Otosclerosis, here is a link:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002031/

Ashli