MoyaMoya Disease

The above image demonstrates the collateral circulation associated with Moyamoya Disease.

This disease is very rare and is caused by a blockage of arteries in an area of the brain called the basal ganglia.  In japanese moyamoya means, "puff of smoke" this refers to the way all the tiny vessels look that form around the blocked area.  This disease is most common in children but is know to affect some adults.  The associated symptoms of this disease are strokes or TIA's accompanied by muscular weakness, paralysis, or seizures.  Adults with Moyamoya will most likely incurr an hemorrhagic strokes due to clots that form in the affected vessels.  Those with Moyamoya will experience speech difficulties, disturbed consiousness, sensory and cognitive impairments, involuntary movements, and vision problems.  Some researchers speculate that it is a genetic abnormality because it does tend to run in families.  Revascularization surgery is usually the best form of treatment to open the blockages.  Children usually respond better to theses surgeries than adults but for the most part neither should experience any strokes or TIA's.  Without treatment Moyamoya is fatal becuase of intracerebral strokes.

Facial Bones-blow out fracture

A blow out fracture occurs when there is trauma to the floor of the orbit.  The trauma must exceed the tolerance of the bone.  If this occurs with from a direct injury there is usually a naso-orbital fracture present as well. This is usually associated with blunt trauma and are often seen in motor vehicle accidents or an object striking the orbit.  The symptoms of a orbital fracture are edema of the tissue lid, difficulty with vertical movement of the eye, or subcutaneous emphysema.  A nose bleed could occur becuase of the connection with the maxilla and the nasal sinus.  In severe cases of this fracture the orbit of the eye can actually drop into the maxillary sinus causing entrapment.  This results in an inablitly to look superiorly or inferiorly.  This can be corrected with surgery but if left unattended permnent stenosis of the muscle can occur.  For diagnosis CT is the gold standard both axial and coronal scans should be obtained. 

Nasal Polyps

The letter P demostrates the nasal polyp

• Nasal polypls occur when tissue becomes inflamed in the nasal mucosa or lining and form a sac-like growth.  Polyps usally begin to occur by the ethmoid sinus and tend to grow in an open area.  These polyps can eventually block the entire sinus or airway.  Some of the common causes of these polyps are an aspirin sensitivity resulting in wheezing, asthma, chronic sinus infections, cycstic fibrosis, or hay fever (allergic rhinitis).  The symptoms that tend to accompany polyps are a cold that will not go away, breathing only through the mouth, a nasal blockage, reduced or inability to smell, or runny nose.  To diagnose polyps a CT is the gold standard, the polyps will show us as an opaque area on the scan.  Treatment options are nasal steriod sprays but if discontinue use the symptoms will re occur, corticosteriod pills or liquid, antibiotics only if accompanied by a bacterial infection.  In severe options individuals may need a surgical procedure called functional endoscopic sinus surgery. If surgery is indicated removal of the polyps will make it easier to breathe but the polyps will often return.