Alp İskender Göçer

Prognosis and prognostic factors in nonaneurysmal perimesencephalic hemorrhage: A follow-up study in 29 patients

BACKGROUND Perimesencephalic nonaneurysmal hemorrhage is a benign form of subarachnoid hemorrhage with a low risk of rebleeding. The authors conducted a retrospective study to investigate the prognosis, possible prognostic factors, and long-term natural history in perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH). METHODS This report contains a retrospective analysis of 29 patients with PNSH who were followed from 1 month to 8 years with an average follow-up period of 5.4 years. We evaluated computed tomography (CT) scan features; clinical grade; loss of consciousness during hemorrhage; ventricular ratio; angiographic spasm; complications such as ischemic complications, early rebleeding, late rebleeding, epilepsy, hydrocephalus, and fixed ischemic deficit; and outcome. RESULTS There were 7 men and 22 women, and the ages ranged from 22 to 69 years (mean 49.5 years). In the group with PNSH 93% of the patients were in grade I-II, as compared to 70.8% of patients with non-PNSH according to the Hunt and Hess system. Loss of consciousness during hemorrhage was detected in 9 patients (31%). We observed acute hydrocephalus in 4 patients (13.7%). The first cerebral four-vessel angiograms disclosed vasospasm in 3 patients (10.3%). Patients with PNSH have the best outcome according to the activities of daily living (ADL) grading system when compared with other groups of patients with negative angiogram (aneurysmal pattern and invisible blood). CONCLUSION This study provides evidence that patients with PNSH have an uncomplicated course and a particularly favorable outcome.

The evaluation and comparison of cerebellar mutism in children and adults after posterior fossa surgery: report of two adult cases and review of the literature.

Summary.Summary. Background: Although there are some cases of cerebellar mutism in adults after posterior fossa surgery for cerebellar tumour it generally occurs in children. Reversible pathophsiology and the anatomical substrate of this syndrome still remain unclear. The predominance of cerebellar mutism in children is suggested to be related to the higher incidence of posterior fossa tumours in children. However, the question regarding the reason for the obvious difference in the incidence of this syndrome between the paediatric and adult population still remaing unanswered. The aim of this study was to evaluate and compare children and adult groups separately to understand the incidence and the clinical characteristics better and to elucidate the pathophysiological basis and predictive factors for this syndrome. Method: We reviewed, analysed, and compared the cases of cerebellar mutism individually in children and in adults reported in the English literature. We found 106 reported cases in children and 11 cases in adults which were suitable for analysis. We added two adult cases to these. Findings: The ages of the patients ranged from 2 to 16 (mean, 6.4 year) in children and from 17 to 74 (mean, 38.7 year) in adults. Although vermis was the main location in both groups, the incidence of vermis lesions was considered higher in the paediatric population (%91.5 versus %69.2). The rate of brain stem invasion was prominent in children (%31.1) when compared with adults (%7.6). The latency for the development of mutism and the duration of the mutism were similar in children and adults (mean, 1.4 d versus 2 d and mean, 5.07 wk versus 4.2 wk respectively). Mutism was transient in all the cases of both groups. Interpretation: Recent concepts of cerebellar physiology disclose the importance of the cerebellum in learning, language, and mental and social functions. Pontine nuclei, the thalamus, motor and sensory areas and supplementary motor areas have been proven necessary for the initiation of speech. It can be hypothesized that uncompleted maturation of the reciprocal links in childhood connecting the cerebellum to these structure makes the children more vulnerable to have postoperative cerebellar mutism in comparison to the adult population.

Isolated trigeminal neuralgia secondary to distal anterior inferior cerebellar artery aneurysm

A 43-year-old woman complaining of severe pain of the right side of the face was admitted to the Department of Neurosurgery. It had been present for three months and diagnosed as trigeminal neuralgia. The CT scan without contrast material had been considered normal at that time. Three months later, after a favourable response to carbamazepine, she suddenly developed right occipital headache and drowsiness. On admission, she was alert, and neurological examination revealed only mild neck stiffness. Computed tomographic scan demonstrated an acute hematoma in the right cerebellopontine angle and in the fourth ventricle. Vertebral angiography revealed an aneurysm of the right anterior inferior cerebellar artery (AICA). A posterior fossa approach disclosed a large, nearly totally thrombosed, saccular AICA aneurysm, which showed minimal compression to the pons at the trigeminal root entry zone. The aneurysm was clipped and excised. She showed an excellent recovery and was free of pain in the early postoperative period and at the last examination 16 months later. Aneurysms in the distal AICA are very rare lesions. Only 31 cases have been published so far. Distal AICA aneurysm in an extremely unusual cause of trigeminal neuralgia secondary to aneurysmal compression. The literature concerning AICA aneurysms and their clinical manifestations is reviewed and discussed.

Percutaneous radiofrequency rhizotomy of lumbar spinal facets : the results of 46 cases

The results of percutaneous radiofrequency rhizotomy of lumbar spinal facets in 46 patients followed at least three months (mean 15 months) are reported and compared with those reported previously. Satisfactory pain relief three months after the procedure was achieved in 36.4 percent of patients without operations and in 41.7 percent of patients with operations other than fusion.No patient had previously undergone fusion.Treatment of low-back pain by using radio-frequency thermocoagulation of spinal facets is a simple, safe, and well-tolerated procedure. It can be used to relief of pain in spite of decreasing rates of success within the follow-up period.

Choroid plexus papilloma of bilateral lateral ventricle

Summary. Background: Choroid plexus papillomas are rare, accounting for less than 1% of all intracranial tumours in adults. However, they are relatively more common in childhood and constitute 1.5 to 4% of intracranial tumours. They are most often located in the lateral ventricle, followed by the fourth and third ventricles and, rarely, in the cerebellopontine angle. Bilateral lateral ventricle choroid plexus papilloma is very rare and only a few cases has been reported. Clinical presentation: A 3-year-old boy was admitted to our hospital with a history of irritability and vomiting. Neurological examination on admission was normal. A head computed tomographic scan and magnetic resonance imaging showed tumours in both lateral ventricles, hydrocephalus and a left temporal arachnoid cyst. The bilateral intraventricular mass enhanced densely and homogeneously. A presumptive diagnosis of choroid plexus papillomas was made. Intervention: The initial surgery was performed for removal of the lesion in the right lateral ventricle, and 20 days later removal of the left lateral ventricle tumour was carried out. Bilateral temporoparietal craniotomy and total removal of tumours was performed. Hydrocephalus was controlled by total tumour resection from both sides. The histology of these tumours was the same and revealed choroid plexus papilloma. Interpretation: Bilateral choroid plexus papilloma is extremely rare and distinct from diffuse villous hypertrophy and their surgical approaches are different from each other. Differential diagnosis should be made by MRI preoperatively. If bilateral choroid plexus papilloma is detected, total surgical resection should be performed. Total surgical removal of the neoplasm not only cures the tumour but also may lead to complete resolution of the hydrocephalus.

Effects of trapidil on ATPase, lipid peroxidation, and correlation with ultrastructure in experimental spinal cord injury

Abstract The present study was performed to investigate the effect of trapidil on ischemic damage of cells after spinal cord injury. The injury was produced by extradural clip compression of the exposed spinal cord in rats according to Rivlin and Tator. The ten rats in group 1 were used to determine normal findings without any surgery or medication. On the 15 rats in group 2, only six-level laminectomy was performed to determine the influence of the total laminectomy on the biochemical factors measured and the light and ultrastructural findings. The 15 rats each in groups 3 and 4 were used as trauma and trapidil (40 mg/kg) treatment groups, respectively. The injury actually produced a significant decrease in Na+–K+/Mg+2 ATPase activity of the injured segments as early as 10 min after trauma. Trapidil attenuated Na+–K+/Mg+2 ATPase inactivation in the traumatized rats for 120 min after treatment (P<0.05) and significantly reduced the malone dialdehyde content below that in the traumatized group at all determined times (P<0.05). Light and electron microscopic findings supported the biochemical results.

Intracranial arterial aneurysm complicating Behçet's disease

Behçets disease, a rare condition in central Europe but more common in Turkey where it was originally described, is characterized clinically by the presence of a diagnostic triad of oral and genital aphthous ulcers, meningitis, and relapsing iridocyclitis. Vascularlesions including arterial and venous occlusions, arterial aneurysms and varices are one of the common complications of Behçets disease occur most commonly in the abdominal aorta, femoral arteries and pulmonary arteries. There have been only four reports of aneurysms of cerebral arteries in the literature. The authors describe a patient with Behçets disease who suffered secondary subarachnoid hemorrhage due to a ruptured aneurysm of the anterior communicating artery 3 years after the initial diagnosis. This case report draws further attention to this rare entity in patients with Behçets disease.

The effects of the pretreatment of intravenous high dose methylprednisolone on Na(+)-K(+)/Mg(+2) ATPase and lipid peroxidation and early ultrastructural findings following middle cerebral artery occlusion in the rat.

SummaryThe sodium-potassium activated and magnesium dependent adenosine-5′-triphosphatase (Na+-K+/Mg+2 ATPase EC.3.6.1.3.) activity and lipid peroxidation and early ultrastructural findings were determined in rat brain at the acute stage of ischaemia produced by permanent unilateral occlusion of the middle cerebral artery (MCA). The effects of the pretreatment with intravenous high-dose methylprednisolone (MP) on these biochemical indices and ultrastructural findings were also evaluated in the same model. The rats were divided into four groups. In group I, 10 rats were used to determine Na+-K+/Mg+2 ATPase activity and the extent of lipid peroxidation by measuring the malondialdehyde (MDA) content and normal ultrastructural findings. In group II on 20 rats, only subtemporal craniectomy was done in order to determine the effects of the surgical procedure on these indices and findings. This group was treated intravenously with saline solution before occlusion. In group III with MCA occlusion, saline solution was administered intravenously to 20 rats in the same amount of methylprednisolone used in group IV, ten minutes before the occlusion. In Group IV, a single high-dose (30 mg/kg) of methylprednisolone was administered intravenously, ten minutes before occlusion in 20 rats. After occlusion of the middle cerebral artery, Na+-K+/Mg+2 ATPase activity was decreased promptly in the first ten minutes in the ischaemic hemisphere and remained at a lower level than the contralateral hemispheres in the same group and the normal levels in group I, during 120 minutes of ischaemia. A single dose methylprednisolone pretreatment prohibited the inactivation of Na+-K+/Mg+2 ATPase. On the other hand, there was significant difference in malondialdehyde content between group I and group III. Malondialdehyde levels were significantly increased following ischaemia and a non-significant increase was observed in the contralateral hemisphere. Methylprednisolone treatment significantly decreased malondialdehyde content on the side of the ischaemic hemisphere. We conclude that there is a positive relationship between membrane-bound enzyme Na+-K+/Mg+2 ATPase activity, malondialdehyde content and early ultrastructural changes in the treated group with MP.These data suggest that the pretreatment injection of high doses (30 mg/kg) methylprednisolone contribute to the protection of the brain from ischaemia with stabilization of the cell membrane by effecting the lipid peroxidation and the activation of Na+-K+/Mg+2 ATPase.

The effect of immediate decompression on the optic nerve in retrobulbar hematoma

We produced retrobulbar hematoma in both orbits of 10 pigs in order to assess the effects of blood elements and pressure created by the hematoma on the optic nerves. Ten other pigs were used as a control group. Following decompression in the right orbits, ocular movements, fundi, and intraocular pressure were evaluated for 6 weeks. At the end of the 6th week the optic nerves of 20 pigs were dissected bilaterally for measurements of ATP-ase activity and ultrastructural examination. The results of the ultrastructural examination of the optic nerves of the control group were normal. Optic nerves with decompressed retrobulbar hematoma showed minimal degeneration, whereas the nerves subjected to retrobulbar hematoma with no decompression showed significant degenerative changes. For all groups ATP-ase activities were measured and evaluated. Na+, K+ATP-ase activities decreased, while Ca++, Mg++ ATP-ase activities increased with the extent of degeneration. Optic nerve damage can develop after trauma. Decompression procedures are not among the causes of optic nerve degeneration but retrobulbar hematoma can result in optic neuropathy caused by the compression from the hematoma and the direct effect of blood waste products on the optic nerve.

A giant dissecting aneurysm mimicking serpentine aneurysm angiographically : Case report and review of the literature

Intracranial dissecting and giant serpentine aneurysms are rare vascular anomalies. Their precise cause has not yet been completely clarified, and the radiological appearance of such lesions can be different in each case according to the effect of hemodynamic stress on a pathologic vessel wall. For berry aneurysms, available evidence overwhelmingly favors their causation by hemodynamically induced degenerative vascular disease and there is an obvious need to determine the hemodynamic parameters most likely to induce the precursor atrophic lesions. In this study, a case of a giant dissecting aneurysm angiographically mimicking serpentine aneurysm of the right ophthalmic artery is reported and the relevant literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. In the present case, radiological investigation of the lesion suggested a serpentine aneurysm, but the diagnosis was corrected to dissecting aneurysm subsequent to the pathological examination of the resected aneurysm.A giant dissecting aneurysm angiographically mimicking serpentine aneurysm and developing as the result of a circumferential dissection located between the internal elastic lamina and media is of particular interest when the etiology of these aneurysms is considered. To our knowledge this is the first report on intracranial dissecting aneurysm mimicking serpentine aneurysm angiographically. Our case illustrates the importance of careful serial section studies for a better understanding of the vascular pathology underlying the processes involved in intracranial serpentine aneurysms. We conclude that serpentine, dissecting and berry aneurysms may all arise by way of similar pathophysiological mechanisms.