Saccular Aneurysms

Left: A CT scan revealing a large intraparenchymal hemorrhage in the right frontal lobe. Right: A arteriogram of the same patient demonstrating a saccular aneurysm of the left callosomarginal artery.

Aneurysms develop because of a weakness in the wall of the vessel. Because of the weakness, a particular spot will balloon out and fill with blood. The pressure from the ballooning can affect surrounding nerves or brain tissue. The blood vessel can rupture, causing bleeding in the brain. The cause of most aneurysms is unknown. In a small number of patients, aneurysms are inherited with multiple family memebers affected. Studies have found that people with connective tissue disorders, polycystic kidney disease and certain circulatory disorders, such as arteriovenous malformations, are more likely to get aneurysms. Other potential causes include head trauma, cancer, high blood pressure, infection, tumors, cigarette smoking, and drug abuse. Oral contraceptives have also been a suspected cause.

A saccular aneurysm is a sac of blood attached by a neck to a blood vessel. Aneurysms fall into three size classifications: small (under 11mm in diameter), larger (11mm to 25mm) and giant (greater than 25mm). Aneurysms typically have no symptoms unless they rupture. If the aneurysm gets big enough to put pressure on surrounding organs there may be warning symptoms before it ruptures. These syptoms include loss of vision, double vision, headaches, pain behind the eyes, drooping eyelids, and nausea or vomiting with possible speech impairment, seizures, and neck pain.

Being diagnosed with a brain aneurysm is like having a ticking time bomb in your head. A person can go their entire life with an aneurysm and never notice anything. If an aneurysm ruptures, it can cause stroke, nerve damage, and even death. If a brain aneurysm is found before it ruptures, most likey the means of treatment will be a minimal invasive endovascular surgery to place coils, embolization or balloons to minimize the aneurysm, or even clipping to isolate the aneurysm.

Chronic Sinusitis

Coronal CT images of the sinuses before treatment and after.


Chronic sinusitis affects 32 million people each year and accounts for 11.6 million visits to the physicians offices. Chronic sinusitis affects people in all age groups and is a common disease worldwide. The cavities around the nasal passages known as the sinuses become inflamed and swollen and this interferes with the drainage and causes mucus to build up. Chronic sinusitis may be caused by an infection but can also be caused by growths in the sinuses known as nasal polyps, or a deviated nasal septum. While most people have a short-lived bout of sinusitis known as acute sinusitis, chronic sinusitis is sinusitis that lasts more than eight weeks or keeps coming back.

Patients with chronic sinusitis usually present the following symptoms:
Nasal stuffiness, nasal discharge, drainage of a thick, yellow or greenish discharge from the nose or down the back of throat, pain, tenderness and swelling around your eyes, cheeks, nose or forehead, headache, sore throat, fatigue or irritability,as well as a chronic unproductive cough.

To look for the cause of these symptoms a doctor may use several methods to help screen for chronic sinusitis such as Nasal Endoscopy, imaging sudies utilizing CT or MRI, nasal and sinus cultures along with allergy testing. Treatment for chronic sinusitis includes prescribing antibiotics, if allergies are a contributing factor immunotherapy (allergy shots) will be administered. In cases that continue to resist treatment or medication, endoscopic sinus surgery may be the only option.

Optic Nerve Glioma's

Coronal noncontrast T1-weighted MRI reveals a large intraorbital mass (arrow) centered on the optic nerve.

Coronal postgadolinium T1-weighted MRI with fat saturation (same patient as in Image above) reveals diffuse, intense enhancement of the intraorbital mass (arrow).


Axial postgadolinium T1-weighted MRI with fat saturation (same patient as in Images above) reveals diffuse, intense enhancement of the intraorbital mass. The lesion is confined to the orbit.

Optic nerve glioma's are the most common primary neoplasm of the optic nerve. They are found in or around the nerves that send messages from the eyes to the brain. A low-grade form of this neoplalm occurs most often in pediatric patients and presents itself as a benign tumor. Optic nerve and optic chiasmal gliomas are slow-growing and the tumor sometimes produces additional symptoms as it grows. In most young patients the presenting symptom is painless proptosis. Also other symptoms include optic atrophy, reduced visual acuity and large lesions may compress the optic chiasm causing nystagmus, or the glioma may also compress the third ventricle resulting in obstructive hydrocephalus accompanied by headache, nausea, and vomiting. Hypothalamic syptoms such as changes in appetitie or sleep may also occur. The benign glioma is usually very slow growing, if at all, over extended periods. However some lesions can progress causing visual impairment, so ongoing follow up is recommended.

Twenty percent of optic gliomas that extend to the optic chiasm or beyond into the optic radiations, demonstrate a more agressive course. Aggressive glioma is most common in adults and it is frequently fatal even with treatment. Despite aggressive radiation, chemotherapeutic, or surgical treatment, aggressive glioma is an almost uniformly fatal disease.

MRI is the prefered method of evaluation of the optic nerve glioma. Both the intraorbital lesion and its intracranial extent can be effectively characterized through MRI. Gadolinium enhanced T1-weighted images with the fat saturation can define the extent of the aggressive glioma.