Çağatay Öncel

Intracranial calcifications on CT.

Computed tomography (CT) is very sensitive for detection and localization of intracranial calcifications. We reviewed in this pictorial essay the diseases associated with intracranial calcifications and emphasized the utility of CT for the differential diagnosis.

Giant arachnoid granulation in a patient with benign intracranial hypertension

We report magnetic resonance (MR), computed tomography (CT) and angiographic imaging of an unusual giant arachnoid granulation in the superior sagittal sinus in a man with headache and vertigo. Intrasinus pressure measurements revealed a significant pressure gradient across the lesion. MR imaging is useful to identify giant arachnoid granulation and dural sinus thrombosis, whereas dural sinus pressure measurement in certain cases of giant arachnoid granulations can be used to evaluate the lesion as the cause of the patient’s symptoms.

Hypertrophy of intima media of the carotid artery due to L-dopa therapy in Parkinson’s disease

IntroductionRecent studies have shown that L-dopa therapy used in patients with Parkinson’s disease might cause thickening of the carotid artery intima media. It is known that intima-media thickening is a sign of systemic atherosclerosis. The purpose of this study was to clarify the correlation between L-dopa medication and carotid artery intima-media thickness (IMT) in patients with Parkinson’s disease.MethodsTwenty-five patients with Parkinson’s disease who used L-dopa (LD+) and 17 patients who did not use L-dopa (LD-) treatment were included in this study. Colour Doppler with B-mode carotid ultrasonography was performed. The Hoehn-Yahr scale was used for staging of Parkinson’s disease in an ‘on’ state. The Student t test was used for statistical analysis.ResultsThe IMT of the left internal carotid and external carotid arteries were found to be thicker in patients treated with L-dopa. The mean IMT of the left internal carotid artery was 0.937±0.391 mm in the LD+ group and 0.677±0.138 mm in the LD-group (P=0.013). The mean IMT of the left external carotid artery was 0.956±0.531 mm in the LD+ group and 0.646±0.18 mm in the LD-group (P=0.037).ConclusionThe IMT of the carotid artery was found to be thicker in patients who were treated with L-dopa. In conclusion, patients treated with L-dopa appear to be at a higher risk of thickening of the intima media of the carotid artery.

Bilateral symmetric junctional infarctions of the cerebellum: a case report

The advances in neuroimaging have improved clinicoanatomic correlations in patients with stroke. Junctional infarct is a distinct term, used to describe border zone infarcts of the posterior fossa. We presented computed tomography (CT) and magnetic resonance imaging (MRI) findings in a rare case of bilateral symmetrical junctional infarcts between the superior cerebellar artery (SCA) and posterior inferior cerebellar artery (PICA) territories. In addition to precise knowledge of arterial territories required to achieve accurate localization of ischemic lesions on CT and MRI, the radiologist must also be aware of radiologic features and geographic territories of cerebellar arteries and their junctional infarctions.

Giovanni Battista Morgagni (1682–1771)

Giovanni Battista Morgagni (1682–1771) is considered the father of neuropathology and one of the most important innovators in the history of medicine. In his “opus magnum” De sedibus et causis morborum per anatomen indagatis (The Seats and causes of diseases investigated by anatomy), he established pathological anatomy as a science by correlating clinical histories with autopsy findings.

Syndrome of inappropriate antidiuretic hormone secretion due to excessive intake of memantine.

An 84-year-old male patient was referred to our clinic with delirium. He had a 6 years history of Alzheimer’s disease, but no other systemic disease was documented in his medical history. His doctor had prescribed a regimen of 10 mg/day of donepezil and memantine. However, his wife, i.e., his primary caregiver, had been giving him 30 mg/day of memantine for a month by mistake. He was not taking any other drugs. For the past 2 days, he had been unable to recognize his relatives, was lethargic, and was experiencing visual hallucinations. His blood pressure was 125/74 mmHg, and his pulse was 85 beats per minute. A physical examination did not show any signs of distended jugular veins, pedal edema, ascites, decreased skin turgor, or dry mucous membranes, indicating a euvolemic state. His urine output was normal. His neurological examination was normal aside from the delirium. The following tests were conducted: complete blood count (CBC), blood biochemistry, prothrombin time (PT), activated partial thromboplastin time (APTT), urine examination, sedimentation, thyroid function tests, thyroid autoantibodies, arterial blood gases, vitamin B12, folate, liver function tests, renal function tests, and electrolytes. Moreover, a lung X-ray and electrocardiogram were done. The tests revealed that his blood sodium level was below normal, i.e., 116 mmol/L. The other laboratory results and examinations were normal. The initial diagnosis was that he was suffering from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion, so we focused our examinations according to this diagnosis. The patient’s blood osmolarity had decreased to 243 mOsm/kg (\275 mOsm/kg). Sodium output in the urine had increased to 83 mmol/L (\20 mmol/L). His blood urea nitrogen and plasma uric acid were 5 mg/dL (8–23 mg/dL) and 2.9 mg/dL (3.4–7 mg/dL), respectively, and he had a normal acid/base and potassium balance. He was diagnosed with SIADH resulting in delirium, and treatment was started by administering 3 % intravenous saline with infusion rates based on the patient’s electrolyte levels checked every 12 h. We also restricted the patient’s water intake. Given the circumstances, we believed that the etiology of the SIADH in this patient was the overdose of memantine. Therefore, we stopped administering memantine. The patient’s condition improved within 1 week of treatment. When the patient was diagnosed with SIADH, we investigated other factors and etiologies. His pulmonary examination and thorax tomography were normal. Moreover, no adrenal or thyroid insufficiencies were found. Additionally, no other findings except global cerebral atrophy was evident on cranial MRI. He was not using any other drugs that might cause SIADH. After release from the hospital, the patient’s sodium level remained at normal levels. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH). It is characterized by hyponatremia, inappropriately increased urine osmolality, increased urine sodium, and decreased serum osmolality in a euvolemic & Çağatay Öncel cagatayoncel@yahoo.com

Yadigar: A Traditional Medicine Book From the 15th Century

To the Editor: Ibn-i Serif, who lived in Anatolia (which is now at the Turkish Republic borders) in the 15th century, is the writer of Yadigar, which is a traditional medicine book. This book is one of the oldest medicine books written in Turkish. Little is known about the life of Ibn-i Serif. He wrote that he was interested in and practiced medicine from his youth. He read medical books written in Arabic and Persian to gain knowledge. He described his work as collecting pearls from seas, like divers do. It is thought that, after finishing his book between 1421 and 1428, he presented it to Umur Bey, who lived in Bursa (an important cultural and political city at the west part of Anatolia). It included knowledge from the medical books of that time. Because it was written clearly and was easy to understand, it became one of the favorite books of medicine. Several copies are found at different libraries: Süleymaniye Library, Beyazit Government Library (Istanbul), Fatih National Library (Istanbul), Nuruosmaniye Library (Istanbul), Topkapi Palace Library (Istanbul), Munich Bayerisch Staats Bibliothek, and Berlin Staats Bibliothek. While writing his book, Ibn-i Serif took examples from the books of Ibn-i Sina (980–1037) and Ibn-i Baytar (1197–1248). Muslim medicine attracted Turkish medicine, and Turkish doctors obtained knowledge from those two famous doctors, who affected Europeans until the last 2 or 3 centuries. Ibn-i Serif said that the reason for writing this book was to help people recognize their own diseases and cure themselves. Dr. Feridun Nafiz Uzluk described the book in 1935, and in the same time period, Dr. Hakk{ Uzel gave some knowledge about the book. In 2004, Orhan Sakin, Yahya Okutan, Doğan Koçer, Mecit Y{ld{z, and Ayten Alt{nbaS reviewed and published the book. Yadigar consisted of five parts. In the first part, general healthcare issues and how to keep free from disease are described. These included nutrition; sleep; the right clothes; bathing; exercise; the advantages and disadvantages of alcohol; and the human body’s ways of cleansing itself, such as protection from constipation, vomiting, and sweating. The second part included therapies for diseases. Recipies for treatments for headache, articular pain, phlegm, cough, dizziness, scabies, acne, common cold, constipation, diarrhea, dyspepsia, urinary stones, epilepsy, and dyspnea are presented. The third part included drugs that could be used for malaria, varicella, and smallpox. The fourth part is about wounds. The fifth part contains knowledge on fractures and dislocation of joints. An excerpt from Yadigar related to the life of older people follows: