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ABSTRACT: A 21-year-old woman was admitted with right hemiparesis, bilateral papilledema, negative myoclonus of right upper extremity, and bilateral pyramidal findings. An MRI showed no venous flow in the inferior sagittal sinus. Lipoprotein a (Lp [a]) level was high and iron deficiency anemia (IDA) was found. The coexistence of IDA and Lp (a) in patients with cerebral venous thrombosis is a very rare condition in adult patients. These risk factors should be investigated in patients with cerebral venous thrombosis.
Neurosciences 10/2012; 17(4):374-7. · 0.12 Impact Factor
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ABSTRACT: In a retrospective study, we investigated and compared the angulation and the length of the styloid process between patients
operated for Eagle’s syndrome and a control group by means of lateral skull and Towne’s radiographs. Thirty patients with
51 symptomatic elongated styloid processes underwent surgery. As a control group, patients with chronic otitis media and trauma
were included in the study and none of them had symptoms characteristic of an elongated styloid process. The length, medial
and anterior angulation of the styloid processes of the patient and the control groups were measured on lateral skull and
Towne’s radiographs. The mean length of the styloid process was 5cm on the right and 5.2cm on the left in the patient group,
whereas they were 2.8 and 2.6cm, respectively, in the control group. The mean degree of anterior angulation in the patient
group was 33.6° on the right, 36.7° on the left, whereas these were 21.4° and 18.5°, respectively, in the control group. There
was a significant difference between the two groups for length and anterior angulation (P=0.001). The mean medial angulation was 14° on the right and 18.1° on the left in the patient group, whereas these were
15° and 16.3° in the control group, respectively, and there were no significant differences between the two groups. The anterior
angulation and the length of the styloid process are responsible for the symptoms of Eagle’s syndrome.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 04/2012; 265(11):1393-1396. · 1.29 Impact Factor
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ABSTRACT: Ligamentum flavum (LF) thickness was measured by using lumbar magnetic resonance imaging in patients with low back or leg pain.
This study investigated whether LF thickening is due to hypertrophy or buckling related to disc degeneration and examined the correlations between the thickness of the LF and age, sex, body mass index (BMI), degree of pain, lumbar spinal stenosis (LSS), and disc herniation.
"LF thickness" and "LF hypertrophy" are used interchangeably in the literature, although they are not necessarily the same thing. Thickness may increase by buckling without a change in the mass of the LF, and whether LF thickening is due to tissue hypertrophy or buckling remains controversial.
The thickness of 896 LFs at the L2-L3, L3-L4, L4-L5, and L5-S1 levels of 224 (mean age, 47.8 ± 16.7 yrs) patients was measured prospectively on axial T1-weighed magnetic resonance images, obtained at the facet joint level. The presence of disc degeneration, spinal stenosis, and disc herniation was evaluated.
At all of the levels investigated, LF thickness was significantly greater in patients with grades IV to V degeneration compared with the patients with grades I to III degeneration (P < 0.05). LF thickness at all levels increased significantly with age (P < 0.05). Sex and the degree of pain were not correlated with the thickness of the LF. Patients with a BMI of 25 kg/m or greater had the thickest LF at the L3-L4 level (P < 0.01). LF thickness was significantly greater at the L2-L3, L3-L4, and L4-L5 levels in subjects with LSS and significantly greater at all levels in subjects with disc herniation (P < 0.05).
Thickening of the LF is correlated with disc degeneration, aging, BMI, LSS, spinal level, and disc herniation. The authors concluded that thickening of the LF is due to buckling of the LF into the spinal canal secondary to disc degeneration more than to LF hypertrophy. Sex and the degree of pain were not correlated with the thickness of the LF.
Spine 02/2011; 36(16):E1093-7. · 2.08 Impact Factor
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ABSTRACT: Moyamoya syndrome (MMS) is a progressive disorder. We report a 19-year-old boy with beta-thalassemia who presented with a left hemiparesis. Brain MRI showed old middle cerebral artery and left frontal subcortical white matter infarcts. Brain magnetic resonance angiography and digital subtraction angiography revealed occlusion of the bilateral internal carotid arteries with a rich network of basal collateral vessels. To our knowledge this is the third report of beta-thalassemia intermedia and MMS, and the first report of a patient in Turkey. It emphasizes the potential for cerebral infarct due to anemia, protein S and thrombocytosis.
Journal of Clinical Neuroscience 07/2010; 17(7):919-20. · 1.25 Impact Factor
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ABSTRACT: Contrast agents are associated with a number of adverse effects, including central nervous system effects. These agents are primarily filtered and excreted by the kidney. Contrast-associated encephalopathy is a rare complication. We report the case of a 55-year-old male on chronic hemodialysis who developed confusion and agitation after receiving ioversol during abdominal angiography. Although hemodialysis was performed his healing took 15 days. Patients with end-stage renal disease may be at an increased risk of adverse effects of contrast agents.
Renal Failure 01/2010; 32(9):1128-30. · 0.82 Impact Factor
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ABSTRACT: To evaluate cranial findings in patients with neurologically symptomatic sickle cell disease (SCD).
We studied 50 consecutive patients with SCD and neurologic symptoms. All patients underwent brain MR examinations: all 50 underwent classic MR imaging; 42, diffusion-weighted MR imaging; 10, MR angiography; four, MR venography; and three patients, digital subtraction angiography.
Of the 50 SCD patients, 19 (38%) had normal MR findings, and 31 (62%) showed abnormalities on brain MR images. Of the 50 patients, 16 (32%) had ischemic lesions; two (4%), subarachnoid hemorrhage; one (2%), moya-moya pattern; one (2%), posterior reversible encephalopathy; one (2%), dural venous sinus thrombosis; 12 (24%), low marrow signal intensity and thickness of the diploic space; 12 (24%), cerebral atrophy; and two (4%), osteomyelitis. Twenty-seven patients (54%) presented with headache, which was the most common clinical finding.
The cranial involvement is one of the most devastating complications of SCD. Early and accurate diagnosis is important in the management of cranial complications of SCD.
European journal of radiology 07/2009; 76(2):151-6. · 2.65 Impact Factor
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ABSTRACT: Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and sparing of the supratentorial regions. In this study, the clinical and neuroimaging features of a 39-year-old woman with hypertensive encephalopathy and magnetic resonance imaging (MRI) findings localized to pons and bilateral middle cerebellar peduncles were described. Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely shows isolated brainstem and cerebellum involvement, and it is important to be familiar with the lack of correlation between the severity of the radiological abnormality and the clinical status.
Acta neurologica Belgica 07/2009; 109(2):142-5. · 0.54 Impact Factor
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ABSTRACT: Cerebral venous thrombosis (CVT) is a rarely encountered cerebrovascular disease. The incidence of CVT associated with pregnancy or the puerperium is not exactly known. It is thought that only small proportion of patients develop CVT during pregnancy, and most of them occur during puerperium or in the last trimester of pregnancy. The presence of pregnancy itself is a predisposing factor for thrombosis associated with the hypercoagulable state. However, additional various etiologies may be determined for CVT during pregnancy. Here, we present a woman with CVT during the first trimester of her pregnancy with additional risk factors of MTHFR C677 T heterozygote mutation, protein S deficiency, and activated protein C resistance. We want to emphasize that additional various etiologies may be determined for CVT during pregnancy and this is important during establishing the long-term follow-up and treatment of the patient.
Neurosurgery Quarterly 05/2009; 19(2):144-146. · 0.10 Impact Factor
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ABSTRACT: We report the results of a retrospective analysis of radiological and clinical findings in 45 cases of midbrain-hindbrain anomalies and review recent advances in embryology and molecular neurogenetics. Among 45 patients with midbrain-hindbrain malformations, 16 cases of molar tooth malformation, 12 of cerebellar hypoplasia, ten of posterior fossa cyst and cerebellar vermian hypoplasia, three of rhombencephalosynapsis, two of Fukuyama congenital muscular dystrophy and two cases of isolated cerebellar dysplasia were identified. Twenty-six patients presented with motor-mental retardation, which was the most common clinical finding. Eleven patients were born to consanguineous parents. The correct diagnosis of cerebellar malformation is important for determining prognosis, the risk of recurrence and the need for genetic counselling. Integrated classification of malformations based on morphology, embryology and molecular neurogenetics may be useful.
The Cerebellum 05/2009; 8(3):355-65. · 3.21 Impact Factor
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ABSTRACT: To determine if any difference exists between a set of nasal dimension measurements in choanal atresia patients and in a control group.
A retrospective study was undertaken to define the variation of values for a series of nasal dimension measurements through axial computed tomography in 9 patients with bilateral choanal atresia and compare the same dimensions with a control group 104 patients of similar gender and age distribution. The statistical significance of the differences in these dimensions was examined.
Nine of 17 variables showed a significant difference between normal and choanal atresia group. The result showed that the growth of the nasal complex can be influenced by nasal obstruction.
These findings might serve in understanding the differential growth patterns of nasal structures in the face of the nasal breathing obstruction. Computed tomography is valuable in defining the exact anatomical extent of the disease and also in preoperative evaluation of the patient.
International Journal of Pediatric Otorhinolaryngology 01/2009; 73(2):329-35. · 1.17 Impact Factor
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ABSTRACT: Metastatic pulmonary calcification characterized by diffuse calcium deposition in the lungs is known to occur in patients with chronic renal failure. We present a case of a 47-year-old man with chronic renal failure presented with dyspnea, high-resolution computed tomography of the chest revealed multiple, centrilobular, calcified nodules and patchy areas of ground-glass opacity throughout both lungs, consistent with metastatic pulmonary calcification. Calcification was also seen in the bronchi and trachea.
Journal of Radiology Case Reports 01/2009; 3(4):14-7.
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ABSTRACT: Guillain-Barré syndrome is a relatively common, acute, and rapidly progressive, inflammatory demyelinating polyneuropathy. The diagnosis is usually established on the basis of symptoms and signs, aided by cerebrospinal fluid findings and electrophysiologic criteria. Previously, radiologic examinations have been used only to rule out other spinal abnormalities. We report a case of systemic lupus erythematosus associated with Guillain-Barré syndrome with marked enhancement of nerve roots of the conus medullaris and cauda equina on MR imaging. These MR observations may help confirm the diagnosis of Guillain-Barré syndrome.
Journal of Radiology Case Reports 01/2009; 3(3):25-8.
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ABSTRACT: Reversible posterior leukoencephalopathy syndrome (RPLS) describes a syndrome with potentially reversible specific imaging appearance and symptomatology, which is associated with varied causes including hypertension, eclampsia and preeclampsia, immunosuppressive drugs, thrombocytopenic syndromes, and various causes of renal failure. The most common clinical presentations are headaches, mental abnormalities, seizures, and visual disturbances. The typical neuroimaging findings in RPLS include the parietal and occipital lobes. Involvement of additional areas of the brain or main lesions in areas other than the parieto-occipital lobes have been also reported in patients with RPLS. In this report, we describe a 25-year-old man with uremia presented with reversible quadriparesis and lesions in anterior circulation areas of the cerebral hemisphere sparing parieto-occipital regions on magnetic resonance imaging.
Neurosurgery Quarterly 11/2008; 18(4):294-296. · 0.10 Impact Factor
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ABSTRACT: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors.
We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS> or =50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or < or =25%, 25-49%, and > or =50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded.
ECAS<70% in 42 patients and ECAS> or =70% in 141 patients. ICAS was found in 51 patients and ICAS> or =50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS.
We found ICAS in 27.8% of the patients with ECAS>50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.
European journal of radiology 06/2008; 71(3):450-5. · 2.65 Impact Factor
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ABSTRACT: Basal ganglia lesions in uremic-diabetic patients may present with a favorable outcome along with a complicated clinical course and poor prognosis. In this report, we present a diabetic patient with uremia in whom acute Parkinsonism developed, associated with increase in blood urea nitrogen and serum creatinine levels. T2, flair, and diffusion-weighted scans of cerebral magnetic resonance imaging showed hyperintensity. Ten days after this clinical presentation, she developed acute abdominal pain and mesenteric artery occlusion. Surgical operation was performed to remove gangrenous intestine, but she died 5 days after the operation.
Neurosurgery Quarterly 05/2008; 18(2):144-145. · 0.10 Impact Factor
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ABSTRACT: In a retrospective study, we investigated and compared the angulation and the length of the styloid process between patients operated for Eagle's syndrome and a control group by means of lateral skull and Towne's radiographs. Thirty patients with 51 symptomatic elongated styloid processes underwent surgery. As a control group, patients with chronic otitis media and trauma were included in the study and none of them had symptoms characteristic of an elongated styloid process. The length, medial and anterior angulation of the styloid processes of the patient and the control groups were measured on lateral skull and Towne's radiographs. The mean length of the styloid process was 5 cm on the right and 5.2 cm on the left in the patient group, whereas they were 2.8 and 2.6 cm, respectively, in the control group. The mean degree of anterior angulation in the patient group was 33.6 degrees on the right, 36.7 degrees on the left, whereas these were 21.4 degrees and 18.5 degrees , respectively, in the control group. There was a significant difference between the two groups for length and anterior angulation (P = 0.001). The mean medial angulation was 14 degrees on the right and 18.1 degrees on the left in the patient group, whereas these were 15 degrees and 16.3 degrees in the control group, respectively, and there were no significant differences between the two groups. The anterior angulation and the length of the styloid process are responsible for the symptoms of Eagle's syndrome.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 05/2008; 265(11):1393-6. · 1.29 Impact Factor
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ABSTRACT: Spondylolisthesis is the forward displacement of a lumbar vertebra relative to the adjacent vertebra, occurs as result degeneration or surgery and is a special type of lumbar instability. There is no consensus about which radiologic modality or findings truly reflect the lumbar instability and the exact incidence after single level disk surgery is unknown.
In this prospective study, we have included 90 patients who were operated by the same surgeon with single level disk herniation. We aimed at evaluating the post-operative lumbar spondylolisthesis, with flexion and extension lateral radiographs in addition to standard magnetic resonance imaging (MRI).
We have seen spondylolisthesis in six of 90 cases with standing lateral flexion-extension radiographs, which were undefinable with MRI. Pain intensity and functional-economic rating scale (Prolo scale) were unremarkable.
We have concluded that standing flexion-extension radiographs should be routinely combined in patients with failed back surgery syndrome and even if lumbar instability is clinically suspected, especially when conventional MR examination is normal. When the MR examination showed spondylolisthesis, standing flexion-extension radiographs could not give additional information.
Neurological Research 10/2007; 29(6):540-3. · 1.52 Impact Factor
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ABSTRACT: The objective of this study was to present the etiology, clinical presentation, diagnosis, and management for 14 cases of gossypiboma [retained surgical sponge (RSS)] treated at a single center and to emphasize the importance of this potential complication.
Data for 14 cases of RSS treated between January 1999 and December 2004 were retrospectively assessed. The details of preoperative evaluation, demographic features, and operative findings were recorded. Use of, and findings from, abdominal x-ray, ultrasonography, computed tomography, magnetic resonance imaging, and upper-gastrointestinal endoscopy were also noted.
In all cases, the RSS was surgically removed. Thirteen of the 14 patients were symptomatic, and the most frequent finding was nonspecific abdominal pain and intestinal obstruction. Four patients required urgent surgery because the sponges were causing intestinal obstruction or intraabdominal sepsis. Based on history, physical examination findings, and diagnostic imaging, RSS was diagnosed preoperatively in five of the patients. Postoperative complications, including surgical site infection and evisceration, occurred in five cases.
RSS can lead to significant medical and legal problems between the patient and the doctor. RSS may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. Strict measures must be taken to prevent this complication.
Langenbeck s Archives of Surgery 09/2006; 391(4):390-5. · 1.81 Impact Factor
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ABSTRACT: It is still not clear whether mitral valve prolapse (MVP) is a risk factor for ischemic stroke. The aim of this study was to evaluate whether uncomplicated MVP is a risk factor for silent cerebral ischemic events. Fifty-two patients with uncomplicated MVP and 46 control subjects without MVP were included in the study. All subjects were evaluated for silent cerebral infarct (SCI) with a magnetic resonance imaging. Five (9.6%) of the patients who had MVP but no other risk factors for ischemic cerebral events had SCI. The results suggest that uncomplicated MVP is a risk factor for SCI, and that patients with MVP should receive anti-platelet-aggregating drugs.
International Journal of Neuroscience 12/2005; 115(11):1527-37. · 0.97 Impact Factor
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ABSTRACT: An unusual presentation of unilateral cerebellar abscesses due to neurobrucellosis observed in a patient is reported. He gave a history of fever, headache, vomiting and had unilateral cerebellar signs. The abscess was detected on magnetic resonance imaging (MRI) and analysis of cerebrospinal fluid revealed neurobrucellosis. Patient treated by only antibiotics therapy, evolving to complete clinical and radiological resolution, without neurosurgical intervention. We are presenting a case of cerebellar abscess due to neurobrucellosis diagnosed by MRI, treated medically, and had both radiologic and clinical follow-up. We also made a review of the literature concerning the cerebellar abscess due to neurobrucellosis.
Journal of Infection 08/2005; 51(1):77-80. · 4.13 Impact Factor
