Empty sellar syndrome

What is Empty Sellar Syndrome?

Empty sella syndrome is the apperance, by a radiograph, that shows the sella turcica which usually houses the pituritaty gland, empty! After making a statement like this, one might ask how can a human function without the presence of the body's most important endocrine gland. After all, it only plays a major role in regulating the body's entire endocrine system by producing secretions that controls other endocrine glands that influence growth, metabolism and maturation. I don't mean to harp on this but the pituitary gland plays a part in every physiolocial process in the body. However, there is a reason for everything and the empty space is not always truly empty.

In Primary ESS, the voided appearance is a result of CSF that has entered the space normally occupied by the pituitary and has compressed the hypophysis against the wall of the sella turcica. Secondary ESS is the result of the pituitary gland regressing within the cavity after an injury, surgery or radiation therapy. Disease or tramua may reduce the size of the pituitary or completly eliminate it! Statistics from autopsies show that 5% to 25% empty sellar syndrome is found incidentally.

Causes and Symptoms

There are no known triggers or causative factors that relates to Primary ESS. Because of the unknown etiologic factors it is thought to be a congenital and accidental occurence by a failure or opening of the diaphragma sella. Secondary ESS is an acquired cause through a medical procedure, disease or truama. All of these reasons can contribute to the reduction in size or a complete absence of the gland. Sheehan's syndrome, is a specific type of acquired empty sellar syndrome, that is caused by infarction of the pituitary induced by shock or hemorrhage after labor and delivery.

Primary ESS: symptoms are usually associated with obesity and high blood pressure in women.

Secondary ESS: the condition is a byproduct of some other process leading to destruction and loss of pituitary functions, such as the ceasing of mestrual periods, inpotence, infertility, fatigue and an intolerance to stress and infection.

TREATMENT

Replacement therapy for any deficient hormone. All treatment would be symptomatic and supportive.

DIAGNOSIS

Empty sella syndrome is always diagnosed by some type of imaging study of the brain (x-ray, ct or mr)

PROGNOSIS

ESS is not a life-threatening illness but is a lifelong illness.

References:

http://www.nlm.nih.gov/medlineplus/ency/article/0

http://health.nytimes.com/health/guides/disease/empty

http://www.thamburaj.com/empty_sella.htm

Labrynnitis

Overview

Labyrinthitis is a pathogen that causes inflammation of the inner ear. Bacteria and viral infections from the head or respiratory tract can spread causing a disorder that involves swelling, fluid build-up(perilymph) and irritation of the inner ear. Labyrinthitis can also arise from exstreme stress, head injury, an allergy or as a reaction to medication.

Symptoms

Abnormal sensation of movement(vertigo)

Difficulty focusing the eyes because of involuntary eye movement

Dizziness

Hearing loss in one ear
Loss of balance, such as falling toward one side.
Nausea and vomiting
Tinnitus or other noises in the ear

Description

In structure, the labyrinth is a group of interconnected canals and chambers that houses the vestibular system of the inner ear. The vestibular system is made up of three semicircular canals that sense changes in rotational motion, gravity and linear motion. The brain combines visual cues with sensory signals from the semicircular canals to determine adjustments needed to retain balance. Labyrinthitis is caused by the inflammation of the labyrinth. When inflammation occurs the signal from the semicircular canals to the brain becomes affected resulting in it's most prominent and debilitating symptom acute vertigo.

Treatment

Labyrinthitis usually subsides within a few weeks. If infection continues your doctor may prescribe an antibiotic if bacteria is found to be the cause. In result of a viral infection, surgery may be required to drain fluid (perilymph) in the inner and middle ear. Treatment is focused on controlling the infection since most labyrinthitis usually resolves on it's own.

Diagnosis

A CT scan or MRI scan may be ordered if there is no history of recent infection. These scans help rule out other causes for vertigo, such as tumors. Blood test or fluid drainage from the ear can be tested to determine if bacteria is the cause of infection.

References

http://www.webmd.com/brain/tc/labryrinthitis-topic-overview

http://www.emedicinehealth.com/labyrinthitis/article_em.htm

http://www.healthscout.com/ency/68/644/main.html#cont

Medulloblastomas

Medulloblastomas is a genetic disease that originates from changes in the DNA of brain cells. These changes develop highly malignant invasive tumors in the cerebellum or posterior fossa of the brain. Also referred to as infratentorial tumors because of the location of where the tumors are develop. The tentorium is a thick membrane that separates the cerebral hemispheres and the cerebellum of the brain. Medulloblastomas are most commonly diagnosed in children and are rarely diagnosed in adults. Of all the primary brain tumors meaning that they originate in the brain, Medulloblastomas only account for less than 2%. More than 70 % are diagnosed in children under age 10. Very few instances occur in infants under 1.

Scientist have yet to discover what triggers these tumors but are progressively learning it's biology. Changes in the genes and chromosomes have been noted as an important role in the development of these tumors. One- third of all pediatric medulloblastomas contain a change on chromosome 17. Similar changes on chromosomes 1,7,8,9,10, 11 and 16 may also play a part. Medulloblastomas is a genetic pathology that occurs through changes in the DNA of brain cells and should not be mistaken as an inherited disease.

Flu- like symptoms experienced by patients diagnosed with this tumor-lethargy, irritable and loss of appetite- are often gone undetected in the early stages because they are non-specific. Abnormal head size and irritable can be the first signs in infants. Older children and adults usually experience vomiting and headaches first thing in the morning. As time passes and the pressure in the brain increases from fluid accumulation (hydrocephalus), the symptoms become more severe.

A MRI with and with out contrast is usually done to locate and receive a thorough diagnosis. The dye will be concentrated in abnormal tissues making the tumor appear much brighter than normal tissues in a T1 weighted contrast image . The tumor will be attempted to be removed surgically followed by crainospinal radiation or chemotherapy.

References:

Robert Packer(2010) Medulloblastoma. Retrieved Feburary 3, 2010 from http://www.childhoodbraintumor.org/index.php/brain-tumor-types-and-imaging/34-brain-tumor-types-and-imaging/97-medulloblastoma.html

http://cancer.emedtv.com/medulloblastoma/medulloblastoma.html

http://www.abta.org/sitefiles/sitePages/D3A2C571CD0CDE16C0FFE57607F22A65.pdf