Erdal Kalkan

The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure

Objective: To evaluate the convenience and utility of optic nerve ultrasonography (ONUS) in the evaluation of emergency patients with elevated intracranial pressure (EICP) due to traumatic or non-traumatic causes. Methods: This study was conducted between May 2005 and December 2005 in the emergency department of Meram Faculty of Medicine, Selcuk University. Patients with traumatic or non-traumatic EICP were included in the study. Among these, 28 patients with EICP determined on cranial computed tomography (CCT) and a control group of 26 patients with no disease had the vertical and horizontal diameters of the optic nerves (ONs) of both eyes measured by ultrasonography (US). The measurements were done by wetting the closed eyelids and using a 7.5-MHz linear probe. Results: Horizontal and vertical diameters of both ONs of the 54 patients were measured and the averages calculated. The mean (SD) ON diameter for the group suspected of having EICP was found to be 6.4 (0.7) mm, and that for the control group to be 4.6 (0.3) mm. In the statistical analysis carried out between these two groups (t test), the difference was found to be significant at p<0.001. Conclusions: In detection and follow-up of EICP cases, such as cerebrovascular accident and trauma, ONUS is a practical, risk-free, inexpensive, convenient and, if performed by experts, reliable method. As a result, although CCT may be more useful in diagnosis, ONUS may be more efficient in detecting EICP. In those cases where CCT and other conventional imaging methods are not available, ONUS can facilitate the diagnosis and help in treatment.

Association of the polymorphisms of vitamin D receptor and aggrecan genes with degenerative disc disease.

The aim of this study was to investigate the association between the polymorphisms of the vitamin D receptor (VDR) and aggrecan genes and degenerative disc disease in young Turkish patients. Aggrecan and VDR proteins are the main components of bone and cartilage. In our study, the polymorphisms of the VDR and aggrecan genes were investigated in a total of 300 individuals regarding disc degeneration and herniation. An association was found in the patients having VDR gene TT, Tt, FF, and Ff genotypes with the protrusion type of disc herniation, whereas the patients having tt and ff genotypes were associated with extrusion/sequestration types of the disease. Also, an association was observed between TT and FF genotypes of the VDR gene and mild forms of disc degeneration; and tt, ff, and Ff genotypes and severe forms of the disease. There was also an association between shorter, normal, and longer alleles of the aggrecan gene and a protrusion type of disc herniation. An association was found between short alleles and multilevel and severe disc degeneration, as well as normal and long alleles and mild disc degeneration. This study revealed that the polymorphisms of the VDR and aggrecan genes are associated with disc degeneration and herniation.

Fibrinolytic markers and neurologic outcome in traumatic brain injury

AIMS To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma. MATERIALS AND METHODS Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P <or=0.05. RESULTS A marked negative relationship was found between GCS and PT, PTT, FDP and D-dimer levels (P < 0.001). Plt levels did not correlate with GCS. Mortality was most strongly related to GCS, PT, FDP and D-dimer levels (P < 0.001, P < 0.001, P < 0.001 and P < 0.001, respectively). We found no relationship between mortality and CT findings, nor was there any significant relationship between Plt, PTT and fibrinogen levels. CONCLUSION GCS and fibrinolytic markers measured within the first three hours were useful in determining the prognosis of patients with isolated head trauma.

Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: Imaging features

Computed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening.

Primary Spinal Intradural Extramedullary Hydatid Cyst in a Child

Abstract Background/Objective: Spinal hydatid cyst is a serious form of hydatid disease affecting less than 1% of the total cases of hydatid disease. We present a case of pathologically confirmed primary intradural spinal cyst hydatid in an otherwise healthy patient who showed no other evidence of systemic hydatid cyst disease. Case Report: An 8-year-old boy presented with back pain, left leg pain, and difficulty in walking. The patient had no other signs of systemic hydatid cyst disease. An intradural extramedullary cystic lesion was identified with magnetic resonance imaging and was shown to be a hydatid cyst by histopathologic examination after the surgical removal. Conclusion: Although extremely rare, primary intradural extramedullary hydatid cyst pathology might be the cause of leg pain and gait disturbance in children living in endemic areas.

Klippel-Feil syndrome associated with persistent trigeminal artery.

Study Design. In the present report, radiologic find-ings of the patient with the Klippel-Feil syndrome associated with persistent trigeminal artery are reviewed. In same case, there was also spina bifida occulta, cervical spondylosis, atlanto-occipital assimilation, bilateral cervical ribs, and lack of flow signal in the C4 segment of contralateral vertebral artery. The persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. It should be considered that they might be related with the insufficiency or dysfunction of the embryologic developmental process. Objectives. To draw attention to this rare presentation of Klippel-Feil syndrome associated with persistent trigeminal artery. Summary of Background Data. Klippel-Feil syndrome is a congenital spinal malformation characterized by the failure in segmentation of 2 or more cervical vertebrae. Although the anomaly is defined by its skeletal component, Klippel-Feil Syndrome may also be associated with developmental defects in many other organ systems including the inner ear, spinal cord, heart, and genitouri-nary tract. The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are persistent fetal anastomoses between the carotid and vertebrobasilar circulations. The authors report the association of a persistent trigeminal artery with the Klippel-Feil syndrome. Methods. Radiologic findings of a case of Klippel-Feil syndrome associated with persistent trigeminal artery are described. Results. There was vertebral fusion, spina bifida oc-culta, bilateral cervical ribs, atlanto-occipital assimilation, and cervical spondylosis. Magnetic resonance angiography showed the persistent trigeminal artery between the left internal carotid and basilar artery, but there was no sign of flow in the C4 segment of right vertebral artery. Conclusions. It should be kept in mind that a persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. Because of this reason, this type of case should prompt a search for the other related anomalies, and magnetic resonance angiography can be used as a noninvasive diagnostic technique in the persistent trigeminal artery determination.

Primary lumbar vertebral hydatid cyst.

Spinal hydatid cyst is a serious and rare infectious disease. We report a case of spinal hydatid cyst at the second lumbar vertebra, and we discuss the clinical presentation, diagnosis and surgical treatment of vertebral hydatid cyst.

Effects of iloprost and piracetam in spinal cord ischemia-reperfusion injury in the rabbit.

Study design:Experimental Study.Objectives:The aim of this study was to investigate the neuroprotective effects of iloprost and piracetam on spinal cord ischemia/reperfusion (I/R) injury in the rabbit.Settings:The Experimental Research Center of Selcuk University, Konya, Turkey.Methods:A total of 24 rabbits were divided into four groups of six rabbits each, as follows: group 1 (n=6) sham, laparotomy only; group 2 (n=6) I/R; group 3 (n=6) I/R+iloprost; and group 4 (n=6) I/R+piracetam. I/R was established in groups 2, 3 and 4. Subsequently, they were followed up neurologically for 24 h until the rabbits were killed; biochemical and histopathological examinations of samples from the spinal cord were carried out.Results:Neurological examination results were significantly better in the iloprost and piracetam groups compared with the I/R group (P<0.05). Neuroprotection was achieved with iloprost and piracetam by suppressing malondialdehyde (P<0.05), increasing glutathione peroxidase activity (P<0.05) and decreasing the xanthine oxidase level. In histopathological assessment, iloprost and piracetam groups were statistically different from the I/R group in terms of the number of apoptotic neurons in gray matter and white matter, as well as in terms of degenerated neurons and glial cells (P<0.05). No statistical difference was determined between the four groups in the number of degenerated glial cells (P>0.05).Conclusion:This study has shown that iloprost and piracetam have neuroprotective effects in I/R injury both neurologically and histopathologically because of inhibition of lipid peroxidation.

The effects of prophylactic zinc and melatonin application on experimental spinal cord ischemia–reperfusion injury in rabbits: experimental study

Study design:Experimental study.Objectives: To determine the neuroprotective effects of zinc and melatonin on spinal cord ischemia–reperfusion (I/R) injuries of rabbits.Setting: The Experimental Research Centre of Selçuk University, Konya, Turkey.Methods:Twenty-four male rabbits underwent spinal cord ischemia by clamping the thoraco-abdominal aorta for 20 min. Twenty minutes before the aortic clamping, animals received zinc, melatonin or a combination of both. Neurological examination of the animals was performed three times during reperfusion period. The animals were killed 24 h after reperfusion. Spinal cord samples were taken for biochemical and histopathological evaluation.Results:Pre-treated animals with zinc, melatonin or combination displayed better neurological outcomes than the I/R group (P<0.05). Zinc, melatonin and combined treatment prevented spinal cord injury by reducing apoptosis rate (P<0.05) and preserving intact ganglion cell numbers (P<0.05). Zinc pre-treatment protected spinal cord by preventing malondialdehyde (MDA) formation (P=0.002), increasing glutathione peroxidase (GPx) activity (P=0.002) and decreasing xanthine oxidase enzyme activity (P=0.026) at molecular level. Melatonin treatment also resulted with MDA formation (P=0.002), increased GPx activity (P=0.002) and decreased xanthine oxidase activity (P=0.026).Conclusion:The results of the study showed that prophylactic zinc and melatonin use in spinal cord I/R not only suppressed lipid peroxidation by activating antioxidant systems but also had significant neuroprotective effects by specifically improving the neurological and histopathological situation.

Primary spinal hydatid cyst in a patient with acquired immunodeficiency syndrome

Spinal hydatid cyst is a serious and unusual infectious disease. There is little information on infections caused by cestodes in patients with human immunodeficiency virus (HIV) infection. Although infrequent, infections by cestodes constitute a cause of disease in HIV-infected patients, especially in endemic areas. This report presents, for the first time in the literature, primary spinal cyst hydatid in a patient with acquired immunodeficiency syndrome.