Burcu Ekmekci

The Diagnostic and Grading Value of Diffusion Tensor Imaging in Patients with Carpal Tunnel Syndrome

RATIONALE AND OBJECTIVES In this study, we investigated the diagnostic and grading value of diffusion tensor imaging (DTI) in patients with carpal tunnel syndrome (CTS). MATERIALS AND METHODS Of the 120 subjects included in the present study, 72 were in the CTS group and 48 were in the healthy control group. In addition, the patients with CTS were further divided into three subgroups based on severity (mild, moderate, and severe) according to electrophysiological studies (EPS). DTI-derived parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) were evaluated at four median nerve levels. The mean FA and ADC values of the CTS groups and healthy controls were compared separately. Correlations and possible relationships between DTI parameters and EPS results were analyzed. Receiver operating characteristics analysis was used to calculate the FA and ADC cutoff values for CTS diagnosis and grading. RESULTS Statistically significant differences were observed in mean FA and ADC between the normal and mild, mild and moderate, and moderate and severe subgroups. Significant correlations were found between DTI parameters and EPS measurements based on severity. FA and ADC threshold values, as well as the sensitivity and specificity levels, for diagnosing and grading CTS were determined. CONCLUSIONS DTI parameters can provide helpful information for CTS. The correlations of FA and ADC measurements versus EPS measurements based on severity were significant. Moreover, FA and ADC threshold values were sufficient for the diagnosis and grading of CTS.

The relationship between white matter abnormalities and cognitive functions in new-onset juvenile myoclonic epilepsy

Diffusion tensor imaging (DTI) has revealed evidence of subcortical white matter abnormalities in the frontal area in juvenile myoclonic epilepsy (JME). Decreased fractional anisotropy (FA) and increased mean diffusivity (MD) in the corticothalamic pathway have been detected in adult patients with JME. It has been demonstrated that, in adult patients with JME, frontal dysfunction is related to subcortical white matter damage and decreased volume in frontal cortical gray matter and the thalamus. Many studies have focused on adult patients. Twenty-four patients and 28 controls were evaluated. The group with JME had significantly worse results for the word fluency, trail-B, and Stroop tests that assessed executive functions. A significant decrease in FA values in the dorsolateral prefrontal cortex (DLPFC), the supplementary motor area (SMA), the right thalamus, the posterior cingulate, the corpus callosum anterior, the corona radiata, and the middle frontal white matter (MFWM) and an increase in ADC values in patients with JME were detected. The correlation between FA values in DLPFC and the letter fluency test results was positive, and the correlation with the Stroop and trail-B test results was negative. We found a negative correlation between SMA, anterior thalamus, and MFWM FA values and the trail-B test results and a positive correlation between the SMA, anterior thalamus, and MFWM FA values and the letter fluency test results. We detected white matter and gray matter abnormalities in patients with new-onset JME using DTI. In addition, we determined the relationship between cognitive deficit and microstructural abnormalities by evaluating the correlation between the neuropsychological test battery results and DTI parameters. We evaluated newly diagnosed patients with JME in our study. That leads us to believe that microstructural abnormalities exist from the very beginning of the disease and that they result from the genetic basis of the disease.

False-negative diffusion-weighted imaging in acute stroke and its frequency in anterior and posterior circulation ischemia.

Objective We aimed to investigate the location and size of ischemic stroke lesions that were frequently overlooked by diffusion-weighted imaging (DWI). Materials and Methods We retrospectively reviewed the medical records of 162 patients who had symptoms suggesting ischemic stroke. National Institutes of Health Stroke Scale and Modified Rankin Scale scores, lesion size, magnetic resonance imaging (MRI) findings, delay between onset of symptoms and initial MRI (MRI latency), and vascular distribution of the stroke lesions were analyzed in patients with false-negative DWI findings. Results Of the 116 patients with a final diagnosis of acute ischemic stroke, 11 patients (9.48%) had false-negative DWI findings in the initial period. The mean (SD) MRI latency was 4.3 (1.2) hours. There was no statistically significant difference in point of lesion size, the National Institutes of Health Stroke Scale, and the Modified Rankin Scales scores. Conclusions False-negative DWI findings in acute stroke can be observed both in association with the posterior circulation/small lesions and the anterior circulation/large lesions.

Use of diffusion tensor imaging for nonsurgical treatments of carpal tunnel syndrome

Introduction: This study evaluated the applicability of diffusion tensor imaging (DTI) of therapeutic ultrasound (US) and wrist splints in addition to clinical and electrophysiological assessments of patients with carpal tunnel syndrome (CTS). Methods: This prospective study analyzed 41 patients (30 women, 11 men; 56 wrists) with CTS. Therapeutic US and wrist splints were performed for 3 and 4 weeks, respectively. Fractional anisotropy and the apparent diffusion coefficient (ADC) were evaluated in addition to a visual analog scale (VAS), symptom severity scale (SSS), functional status scale (FSS), and electrodiagnostic studies (EDX) before and after treatment. Results: There were significant decreases in the mean ADC, VAS, SSS, FSS, and EDX after treatment. Conclusions: This study suggests that DTI parameters provide helpful information that complements clinical and electrophysiological assessments for evaluating the efficacy of nonsurgical treatment of patients with CTS. Muscle Nerve 50: 950–955, 2014

Similar effectiveness of the open versus endoscopic technique for carpal tunnel syndrome: a prospective randomized trial

This prospective randomized study aims at evaluating the electrophysiological results of endoscopic and open carpal ligament release in patients with carpal tunnel syndrome. Included in the study were 41 patients diagnosed with carpal tunnel syndrome (21 hands in the endoscopic group and 20 hands in the open group). The Boston questionnaire was administered preoperatively and postoperatively to the patients, and their functional capacities and symptom severities were recorded. Physical examination was carried out preoperatively and in the postoperative sixth month. Demographic data and preoperative Boston symptomatic and functional scores were similar between both groups. A significant improvement was obtained in the Boston symptomatic and functional scores of both groups, but no significant difference was found between the groups in terms of improvement in the symptomatic and the functional scores. A significant shortening in median nerve motor distal latency and an increase in the velocity of sensory conductions were determined in both groups in the postoperative electromyography, but no difference was found between them in terms of improvement in the electromyography values. It was shown both clinically and electrophysiologically that endoscopic carpal tunnel surgery was as effective as open surgery as a treatment method for carpal tunnel syndrome.

A Rare Reflex Epilepsy: Bathing-Related Epilepsy

Bathing-related epilepsy (BRE), which is also known as water immersion epilepsy, is a rare, benign, reflex epilepsy. It presents with focal seizures that occur during bathing with hot water and has a favorable prognosis (1). The exact mechanism underlying these seizures is unknown (1). This epilepsy is frequently confused with hot water epilepsy (HWE) and is generally seen during childhood and in males (2,3). The most common seizure type is partial complex, and the seizures are often non-convulsive and autonomic (4).

Hydatid Cyst of Paravertebral Muscle Mimicking Disc Herniation

Study Design. Case report. Objective. To present a case of primary hydatid cyst in the lumbar subcutaneous tissue affecting posterior paravertebral muscle and mimicking disc herniation. Summary of Background Data. Cystic hydatid disease is a rare but significant parasitic disease in endemic areas. Musculoskeletal or soft tissue hydatidosis accounts for about 0.5% to 5% of all echinococcal infections in endemic areas and is almost secondary to the hepatic or pulmonary disease. Primary lumbar subcutaneous hydatid cyst affecting paravertebral muscle and extending to neural foramina is a very rare condition even in endemic areas. Methods. A 25-year-old-female patient was admitted with swelling and pain in the right lumbar region for 3 months. The pain was reflecting in the right gluteal region and the right leg. Lumbar extension and right lateral flexion was painful and straight leg raising test was positive at right side. There was a mild hypoesthesia at L5 dermatome. According to the magnetic resonance image that the clinician obtained for initial diagnosis of lumbar disc herniation, we found multi-cystic masses located at the right paravertebral muscle at the level of L3–L5 which extended to L4–L5 neural foramina and at subcutaneous tissue at the right gluteal region. Results. The patient was operated for the purpose of removal of cysts. Postoperatively, diagnosis of hydatid cyst was confirmed by histopathology. Conclusion. By this case, we emphasize that cystic hydatid disease should be taken into consideration in the differential diagnosis of low back pain and could mimic disc herniation. Level of Evidence: N/A