Coat's Disease

Coat's Disease: A very rare cogential, nonhereditary eye disorder that can cause full or partial blindness, which is characterized by abnormal development of blood vessels behind the retina. Coat's disease usually only affects one eye and occurs mainly in young males,which usually occurs in the first ten years of their life. The age of peak onset is anywhere between 6 to 8 years old, but can also range from 5 months to 71 years old. Coat's disease is normally a slow progressing disease, but at the advanced stages retinal detachment is likely to occur. Coat's is a painless disorder.

Signs and Symptoms: The most common sign is leukocoria (abnormal white reflection of the retina). Symptoms will begin with blurred vision, deteoriation of sight may begin in either the central or peripheral vision, flashes of light, floaters, and persistant color patterns may also be percieved in the affected eye. Most often these symptoms are percieved as hallucinations, but are actually retinal detachment and foreign fluids mechanically interacting with photoreceptors located on the retina. Another sign of Coat's is yellow-eye in flash photography, like the red-eye effect that is caused by the reflection of normal blood vessels in the back of a normal eye and a yellow-eye effect will glow yellow in photographs as light reflects off cholestrol deposits.

Diagnosis: Funduscopic eye exam. Ultrasound, CT, and MRI are used to diagnosis Coat's disease.

Treatment: In the early stages of Coat's laser surgery or cryotherapy (freezing) can be used to destroy the abnormal blood vessels, which can hault the progression of Coat's. If the leaking blood vessels are clustered around the optic nerve these treatments are not recommened. Coat's disease may stop progressing on its own, either temporarily or permantely. Removal of the eye is also another treatment if pain or further complications occur.

A case of Coats' disease, showing total retinal detachment with subretinal exudate containing cholesterol crystals and a fibrous nodule in the posterior pole.

Computed Tomography image of a patient with Coats' disease, showing total exudative retinal detachment in the right eye.

http://www.blogger.com/post-create.g?blogID=4031984716503884861

Cushing's Disease

Cushing's Disease: A condition in which the pituitary gland secretes to much adrenocorticotropic hormone (ACTH). ACTH stimulates the production and release of cortisol, which is a stress hormone. Cortisol is usually released during stress and it controls the bodies carbohydrates, fats, and proteins. Cortisol also helsps the bodies immune system to reduce swelling. Cushing's Disease can be caused by either a tumor or excess growth of the pituitary gland.

Symptoms: Symptoms of Cushing's Disease include upper body obesity (above the waist) and thin arms and legs, moon face appearance (round and red), slow growth rate in children, acne or skin infections, purple marks on the thighs, abdomen, and breasts, thin skin with easy bruising, backaches, bone pain or tenderness, collection of fat between the shoulders, thinning of bones and weak muscles.

Symptoms that will occur in women: Excess hair growth on the face, neck, chest, abdomen, and thighs and they will also experience irregular or stopped menstrual cycles.

Symptoms that will occur in men: Decreased fertility, decreased or no desire for sex and impotence.

Other symptoms that could occur: Mental changes, fatigue, headaches, high blood pressure, and increased thirst and urination.

Tests: A 24 hour urine cortisol and a Dexamethasone suppression test will confirm that their is to much cortisol being produced.

Treatment: If possible surgery will be performed to remove the pituitary tumor and after surgery the pituitary gland might start to slowly work again and return to normal function. Radiation treatment might also be a consideration. If the tumor does not respond well to the surgery or radiation, medication will be given to stop the body from making cortisol and if this does not work then the adrenal glands might need to be removed to stop high levels of cortisol being produced. If untreated Cushing's Disease can cause severe illness and maybe even death.




MRI images showing a cross-section of the brain through the pituitary gland in a patient with Cushing's disease. The tiny 4 mm microadenoma was detected using a 3-T MRI scanner. A minimally-invasive endoscopic surgical technique was used to remove the entire tumor, curing her of her Cushing's disease. (http://neurosurgery.ucla.edu/body.cfm?id=1123&ref=33&action=detail)

Bell's Palsy

Bell's Palsy: A disorder of the nerve that controls the movement of the muscle's in the face. If damaged the nerve will cause weakness or paralysis to these muscle's. Bell's Palsy is associated with the damage to the seventh cranial (facial) nerve. The seventh cranial (facial) nerve controls the movement of the muscles in the face. 30,000 to 40,000 are affected by Bell's Palsy each year in the United States.

Causes:  Inflammation where the nerve travels through the the bones of the skull. Bell's Palsy can also be caused by HIV, lyme disease, middle ear infection and sarcoidosis.

Symptoms: Symptoms can show up immediately or can take 2 to 3 days. Bell's Palsy either shows up on only one side of the face, and range from mild to severe.  The muscles in the face will feel stiff or pulled to one side. One will experience difficulty eating and drinking and usually the food will fall out of one side of the mouth. Drooling, drooping of the face, hard to close one eye, difficulty smiling, grimacing, or making facial expressions, and twitching and weakness of the muslces in the face will also occur. Other symptoms that may occur from Bell's Palsy is dry eye or mouth, headaches, loss of sense of taste, and sound that is louder in one ear.

Diagnosis: Often Bell's Palsy is diagnosed by taking a health history and a complete physical exam. If a tumor is expected to be causing Bell's Palsy then either a CT head or MRI head will be done.

Treatment: No treatment is often needed, but it could take weeks or even months for the facial nerves to become strong again.

Prevention: Unknown




References:

1. de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009;302:985-993. [PubMed: 19724046]
2. Shy ME. Peripheral neuropathies. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 446.