Ali Kurtsoy

Torticollis secondary to posterior fossa and cervical spinal cord tumors: report of five cases and literature review

Torticollis is either congenital or acquired in childhood. Acquired torticollis is not a diagnosis but rather a sign of an underlying disorder. The causes of acquired torticollis include ligamentous, muscular, osseous, ocular, psychiatric, and neurologic disorders and may be a symptom of significant abnormalities of the spinal cord and brain, such as spinal syrinx or central nervous system neoplasia. Torticollis is rarely considered to be an initial clinical presentation of posterior fossa and cervical spinal cord tumors. We report five cases of pediatric tumors with torticollis at the onset: an astrocytoma originating from the medulla oblongata, another presumptive astrocytoma of the spinal cord located between C1 and C6 cervical vertebrae (not operated), an ependymoma located throughout the whole cervical spinal cord extending into the bulbomedullary junction, an astrocytoma originating from the bulbus and extending into the posterior fossa, and another case of a eosinophilic granuloma located extradurally through the anterior and posterior portions of the vertebral bodies from C3 to C7 producing the collapse of the sixth cervical vertebra. All five cases were seen in children, aged between 3 and 12 years. All these cases reflect the misinterpretation of this neurological sign and the lack of association with the possibility of spinal or posterior fossa tumor. This delay in the diagnosis of these diseases led to progressive neurological deterioration and to the increase in the tumor size, which made surgical intervention difficult and the prognosis unfavorable. Although torticollis secondary to tumors is rarely seen, it is necessary to be kept in mind in the differential diagnosis.

Nocardia brain abscess mimicking brain tumour in immunocompetent patients: report of two cases and review of the literature

SummaryNocardia brain abscess is a rare intracranial lesion and has been reported in immunocompromised patients. An optimal treatment approach has not been established. However, early diagnosis and appropriate antimicrobial therapy are very important factors for a good outcome. We report two unusual cases of Nocardia brain abscess simulating brain tumour in immunocompetent patients. One of the cases was presumed to be a primary brain tumour and the other a metastatic brain tumour. They underwent surgical gross total resection. After Nocardia asteroides was seen on Gram’s stain and subsequently identified by culture, appropriate antibiotic therapy was initiated.

Lipid peroxidation in experimental spinal cord injury

Ischaemia-induced lipid peroxidation is one of the most important factors producing tissue damage in spinal cord injury. In our study, the protective effects ofGinkgo biloba, thyroid releasing hormone (TRH) and methylprednisolone (MP) on compression injury of the rat spinal cord were investigated. For this study 45 rats in four groups, including control, MP, TRH andGingko biloba, were used to determine the formation of malondialdehyde (MDA). All the animals were made paraplegic by the application clip method of Rivlin and Tator. Rats were divided randomly and blindly to one of four treatment groups (ten animals in each). MP andGinkgo biloba treatments significantly decreased MDA levels (F=54.138,P<0.01). These results suggest that MP andGinkgo biloba may have a protective effect against ischaemic spinal cord injury by the antioxidant effect.

Cervical spondylotic myelopathy and radiculopathy treated by oblique corpectomies without fusion

Oblique corpectomy (OC) is an alternative technique for the resection of spondylotic spurs ventral to the cervical spinal cord contributing to cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR). To evaluate the efficacy of OC for the treatment of cervical spondylotic myeloradiculopathy, we reviewed our experience with OC. Twenty-six patients, 18 males and 8 females, were studied. They averaged 51.3 years of age (range 30–72), Thirteen had myelopathy and 13, radiculopathy. Both magnetic resonance (MR) imaging and computed tomography (CT) were performed preoperatively to define the extent of pathology. The Modified Japanese Orthopedic Association (JOA) score was used to grade the quality of the outcome. Neurologic and radiologic results were assessed. Good and excellent results were observed in 76.9% of the cases with myelopathy. Improvement of radicular symptoms was noted in 84.6% of the cases with radiculopathy. Neuroimaging studies confirmed satisfactory anatomical decompression in all patients. Sagittal alignment decreased from 13° to 12°. The degree of postoperative recovery seemed to be directly related to the age and severity of the preoperative myelopathy. This surgical technique has shown excellent clinical outcomes with fast recovery and adequate anatomical decompression in patients with CSM and CSR.

Ultrasound Guidance in Intracranial Tumor Resection: Correlation with Postoperative Magnetic Resonance Findings

Purpose: To determine the inter-method agreement between intraoperative ultrasonography and postoperative contrast-enhanced magnetic resonance imaging (MRI) in detecting tumor residue. Material and Methods: After resection was completed, the cavity borders of 32 tumors were examined with a 7 MHz intraoperative probe. Any echogenic region>5 mm in thickness extending from the surgical cavity into the brain substance was taken as the sonographic criterion for residual tumor. A continuous echogenic rim<5 mm was considered normal. Results were correlated with gadolinium-enhanced MRI obtained within 48 h after surgery. Results: The kappa value for inter-method agreement was 0.72. There were four cases in whom MRI showed residue despite a negative sonography: extensive edema or Surgicel along the cavity borders (three cases with glioblastoma multiforme) and the cystic component in the vicinity of cerebrospinal fluid (a case with pituitary macroadenoma) may be the reason for the residue going undetected. In a case with glioblastoma multiforme, residual enhancement was<5 mm in thickness. Conclusion: Intraoperative ultrasound is an effective tool for maximizing the extent of intracranial tumor resection. Surgical use has to be minimized if intraoperative ultrasound is to be used as an adjunct to surgery. Tumors with preoperatively detected cystic components in the proximity of CSF-containing spaces have to be carefully evaluated with intraoperative ultrasound if residual cystic components are to be detected. A low-thickness echogenic rim should not be considered a reliable sign of the absence of residue.

Acute spontaneous subdural hematoma of arterial origin : A report of five cases

Acute spontaneous subdural hematoma of arterial origin is very rare. We report five patients who presented with a history of sudden onset of severe headache and vomiting and who developed progressive neurologic deficits, three becoming comatose. The symptomatologic onset was indistinguishable from other cerebrovascular disorders; none of the patients had a history of head trauma. In all our patients, the source of bleeding was identified at operation as a cortical artery located near the Sylvian region. Comparable cases in the literature are reviewed and the etiologic possibilities are discussed.

Migration of bullet in the spinal canal: A case report

As the spinal canal expands at T10 level naturally, it has been thought that the migration of a bullet within the spinal canal above this level is prevented and the migration of a bullet may only occur between T10 and S1 level. Here, a very rare case of a bullet traversing the length of the spinal canal is reported.

Cranioplasty with bone flaps preserved under the scalp

Cranial bone defects in 27 patients were repaired with bone flaps preserved under the scalp. Head trauma (thirteen patients), cerebrovascular disorder (five patients), postoperative brain swelling (seven patients), and cerebral infective disease (two patients) accounted for the cranial defects. The bone flaps are reimplanted after 14–98 days. The follow-up period was 6 to 26 months. We have encountered no complications releated to this technique in 27 consecutive cases.

Iatrogenic Epidermoid Tumor: Late Complication of Lumbar Puncture:

Intraspinal epidermoid tumors can be congenital and acquired. Acquired intraspinal epidermoid tumors are extremely rare. Epidermal elements are implanted into the arachnoid space by trauma, spinal anesthesia, surgery, bullet wounds, myelography, or lumbar puncture. Approximately 40% of acquired epidermoid tumors are considered a late complication of lumbar puncture. The authors report the case of an 8-year-old boy who presented with a 1-year history of back and hip pain and radiating pain to both thighs posterior. Lumbar puncture was performed in the neonatal intensive care unit to rule out meningitis in the patients past medical history. The patient underwent total surgical excision of the epidermoid tumor. Pathologic examination revealed the diagnosis of epidermoid tumor. Keywords: intraspinal epidermoid tumor; lumbar puncture; children

Childhood Stroke: Results of 130 Children From a Reference Center in Central Anatolia, Turkey

BACKGROUND Although stroke among children is rare, it can cause significant morbidity and mortality. We aim to share our experience of children with arterial ischemic stroke. METHODS The initial symptoms, demographical features, risk factors, neurological examination, neuroradiological findings, and clinical follow-up data of 130 Turkish children seen between 2002 and 2013 were retrospectively analyzed. RESULTS Sixty-eight patients were male. Thirty of the children were aged from 1 to 12 months (seven of them died in this period). Focal neurological signs were the most common presentation, and hemiplegia or hemiparesis were the most common focal signs. Underlying risk factors were detected in 103 patients. Infections and congenital heart disease were the most common risk factors. Seven of the nine children with recurrent arterial ischemic strokes had one or more underlying diseases (moyamoya disease in two children along with factor V Leiden mutation, tuberculous meningitis, congenital heart disease, homocystinuria, and hemiconvulsion-hemiplegia-epilepsy syndrome). The arterial ischemic stroke was located in the middle cerebral circulation in 68 (36 left and 32 right) and in the posterior cerebral artery in 41. Eighteen children died. The neurological outcome was assessed in 98 children. Of these children, 66 children have neurological deficits and 52 children have seizures. Stroke in the first year of life is more often fatal. Recurrent stroke is associated with poor prognosis. CONCLUSION Tuberculous meningitis is still a risk factor for arterial ischemic stroke in Turkey. Arterial ischemic stroke in the first year of life and recurrent arterial ischemic stroke represent poor prognostic features.