Coat's Disease

As seen in my other blogs, I think that I have a knack for choosing pathologies that deal with children or seem to affect pregnant mothers. It is completely coincidental. And yet, I have still managed to randomly pick another that falls within this criteria.

Coat's disease (Exudative Retinitis) is a disorder that affects the retina of the eye. It usually starts as an abnormal growth spurt in the capillaries that supply blood to the retina. It is a progressive disease and is usually found in children, especially boys, within the first ten years of life. In some cases, it is found in young adults. There is no known cause.

Symptoms are vision loss, primarily central vision, but peripheral vision may also be affected. It can lead to mild or total blindness. However, only one eye is usually affected.

These abnormal blood vessels may dilate, malform, or leak, which may cause the retina to swell.

The leaking blood vessels may be treated with laser surgery or cryotherapy. In severe cases, if the retina becomes detached, a virectomy may be performed to replace the vitreous with a gas bubble that can help restore vision. In some cases, the disease may stop progression on its own.

Diagnosis of Coat's disease can be accomplished by looking at the back of the eye, as well as performing fluorescein angiography by injecting contrast to see the blood circulation in the back of the eye. MRI, CT and Ultrasound are also useful.

" Coat’s disease. Color Doppler USG (a) shows a large retinal detachment with hypoechoic subretinal exudates. CT (b) shows diffuse increase in the intraocular density"

Sources:

http://www.rnib.org.uk/xpedio/groups/public/documents/PublicWebsite/public_rnib003642.hcsp

http://www.palmettoretina.com/learn/conditions/coats_disease.html

Image Source:

http://www.ijo.in/viewimage.asp?img=IndianJOphthalmol_2006_54_4_227_27946_29.jpg

Prolactinoma

Prolactinoma is one type of tumor of the pituitary gland. It is almost always non-cancerous. In this case, the pituitary gland overproduces prolactin in the body. There is no known cause. People most affected are under the age of 40. It is more common in women at a younger age; affected men are usually older. Prolcatinoma is rare in children.


Signs and Symptoms

Not everyone with prolactinoma will experience signs and symptoms. The effects are different for men and women, but there are a few that are similar.


Women:

• Irregular menstruation


• Milky discharge from breast when not pregnant or breast feeding
  
• Vaginal dryness noticed during intercourse

Men:

• Erectile dysfunction or impotence


• Loss of body hair


• Enlarged breasts
  

Both:

• Loss of interest in sex


• Headaches


• Infertility


• Low bone density


• Visual Disturbances
  

Women tend to notice symptoms earlier than men, so they rarely experience headaches and visual disturbances. When men detect symptoms, the tumors are usually larger, which leads to those symptoms because of pressure buildup.

Screening

Prolactinoma can be detected in blood tests because of the overproduction of prolactin. CT and MRI images are also helpful.

The above images were found at www.ent.uci.edu/endoscopic_pituitary_tumor.htm

Complications

If untreated, prolcatinoma can lead to vision loss because of pressure on the optic nerve. If the tumor becomes too large, it can effect other hormone productions of the pituitary gland. Women may experience osteoporosis and complications with pregnancy.


Treatment

The two major treatments for prolactinoma are oral medications and surgery. The oral medications given are dopamine agonists bromocriptine and cabergoline. Bromocriptine are more commonly given to women who are wanting or having children because of its proven safety rate. Medications are taken over a long period of time, but if these are ineffective the tumor is usually removed through surgery.

The above images are of a very severe prolactinoma that resulted in death. To find out more about this case, visit

http://www.endotext.org/neuroendo/neuroendo11b/index.html

Sources:

http://www.mayoclinic.com/

Bell's Palsy

If you wake up in the morning and one side of your face is sagging, that might be a bit scary. But, if you are experiencing these symptoms, it could be Bell's Palsy, a condition that usually has a complete recovery.



The symptoms are:

• paralysis on one side of the face
  
• facial droop
  
• difficulty making expressions
  
• pain near or in the ear of affected side
  
• sound louder on affectd side
  
• headache
  
• loss of taste
  
• change in tear and saliva production

So, what causes this? A nerve that controls facial muscles becomes inflamed/swollen and gets piched between bone. That pressure can damage the protective covering of the nerve and interfere in communication between the nerve and facial muscles.

The most common cause is the herpes simlpex virus, but the other viruses that cause chicken pox, shingles, and the Epstein-Barr virus (related to mononucleosis) are also culprits.

Pregnant mothers, diabetics, and those with upper respiratory infections are more at risk.

There are no specific lab tests to confirm diagnosis. Electromyography and CT or MR images are helpful.

Treatment:

Medications for treatment is not always necessary. If something is prescribed, it is most commonly corticosteroids to reduce swelling. Massage and moist heat applications are recommended.

Usually complete recovery is expected within a few months. Complications are rare, but if there is severe damage to the nerve then it may be irreversible. Also, misdirected regrowth of new nerve fibers may cause involuntary contractions.

For more information, please check out the mayoclinic website http://www.mayoclinic.com/

Images found at:

http://www.aurorahealthcare.org/

path.upmc.edu/cases/case112.html