Dissections

I had one of my radiologist tell me one time that he would NEVER go see a chiropractor. He told me how he had read an MRA of the carotids on a patient that had a dissection of her vertebral and carotid arteries from visiting a chiropractor and the doctor had twisted the patient's head the "crack her neck" because she was having neck pain and headaches. I told my radiologist that was telling the story that I would have just stuck with the headaches.

Dissections of the carotid arteries are caused by trauma to the head and/or neck area. A tear forms in the inner lining of the artery and blood begins to fill between the internal and external linings of the artery. This can then cause stenosis or even complete occlusion of the artey. Some patients will not have any symptoms after a carotid dissection. Others can have headaches, neck pain and possibly a CVA. Treatment includes observation of the patient and anticoagulants to prevent a blood clot from forming at the area of the dissection. The patient may also have to undergo surgery a stent or carotid artery ligation.

The image above from Medscape.com shows an angiogram of the Rt carotid artey with an occlusion of the Rt internal carotid artery where the dissection occurred. This occlusion also caused a CVA which is shown in the diffusion weighted MRI image on the left.

Goiters

This week I decided to research goiters for my pathology blog. I have never seen any one with a goiter, but I have had a few patients tell me that they have has surgery to remove a goiter.

A goiter is an enlargement of the tyroid gland in the throat. The most common cause for this enlargement is from a defect hormone synthesis which causes in increase of the Thyroid Stimulating Hormone (TSH). TSH comes from the pituitary gland in the brain. The increase in TSH causes the thyroid to grow. Other cause for a goiter could be malignancy or even a diet deficient of iodine. But the one of the website where I was reading says that this is rare because our diets are sufficient in supplying the iodine we need to prevent this.

Treatment for a goiter can sometimes be taken care of by just taking a pill, which stop the TSH and decrease the size of the thyroid. But as the goiter grows it can begin to cause problems for patients; because it can be compressing structures in the neck, such as the trachea and the esophagus and even some blood vessels. These patients would need to have surgery to remove the goiter to keep it from compressing these organs and causing major damage.