Esra Meltem Kayahan Ulu

MRI Features of Posterior Reversible Encephalopathy Syndrome in 33 Patients

We report the clinical and radiological features of posterior reversible encephalopathy and compare our findings to the literature.

Juvenile Dermatomyositis Presenting With Anasarca

Generalized edema can occur during the course of juvenile dermatomyositis. In this article, a 4-year-old boy with generalized nonpitting edema and proximal weakness is reported. Characteristic cutaneous lesions, laboratory tests, results of electromyography, and magnetic resonance imaging findings resulted in a diagnosis of juvenile dermatomyositis. He was treated with corticosteroids and methotrexate. It is concluded that the generalized edema may appear as the presenting cutaneous manifestation of juvenile dermatomyositis.

Stroke in Early Childhood Due to Homocystinuria

A previously healthy girl, age 3 years 9 months, presented with right-sided hemiparesis and seizures. Ischemic infarction was confirmed through magnetic resonance imaging and magnetic resonance angiography. Extensive evaluation to discover the underlying etiologies and risk factors predisposing this patient to stroke included coagulation defects, cardiac anomalies, congenital inborn metabolism deficiency, and infections and trauma. Based on the clinical and laboratory results, a diagnosis of homocystinuria was made. Homocystinuria is an inherited disorder that affects the metabolism of the amino acid methionine. Although homocystinuria is usually associated with ischemic strokes, the sudden onset of stroke as the initial clinical presentation of homocystinuria is very rare in early childhood. Based on this case, however, metabolic screening for hyperhomocystinemia is recommended in any child presenting with a stroke.

Sinonasal schwannoma of the middle turbinate.

Paranasal schwannomas are uncommon lesions, representing less than 4% of all head and neck schwannomas. They give rise to nonspecific symptoms such as nasal obstruction, epistaxis, and anosmia. Imaging features are generally nonspecific. Here, we present the radiologic features of a benign schwannoma of the middle turbinate with dural invasion in a 71-year-old woman.

Diffusion-weighted MRI of the kidneys in patients with familial Mediterranean fever: initial experience.

PURPOSE To evaluate the feasibility of diffusion-weighted magnetic resonance imaging (DW-MRI) in the assessment of renal function in patients with familial Mediterranean fever (FMF). MATERIALS AND METHODS Thirty healthy volunteers who had no history of renal disease, hypertension or vascular disease and 60 patients with FMF were included in the study. Transverse diffusion-weighted multisection echo-planar MRI was performed with the following diffusion gradient b values: 0, 111, 222, 333, 444, 556, 667, 778, 889 and 1000 s/mm(2). The apparent diffusion coefficient (ADC) values, urine protein and serum creatinine levels, and glomerular filtration rates of the healthy volunteers, patients with renal involvement, and patients without were compared by using ANOVA test. ADCs of the kidneys were calculated separately for low (ADC(low); b = 0, 111, 222, 333 s/mm(2)), average (ADC(avg); of all b values), and high (ADC(high); b = 778, 889, 1000 s/mm(2)) b values to enable the differentiation of the relative influence of perfusion fraction and true diffusion. ADC(high) reflects almost only diffusion, whereas ADC(low) is composed of both diffusion and perfusion. RESULTS There was statistically significant difference between ADC(low) values of the FMF patients with renal involvement and the control group (P < 0.05). Negative correlation was found between the duration of disease and ADC(low) values of the kidneys (r = -0.223, P = 0.087). CONCLUSION DW-MRI of the kidneys might allow early detection of the renal changes in patients with FMF. This might prevent the progression of disease by giving proper medical treatment. Further studies with larger numbers of FMF patients and more experience on MRI technique are required to help define more conclusively the precise role of DW imaging in detection of renal changes.

MRI of recurrent isolated cerebral Whipple's disease.

Whipples disease is a rare systemic bacterial infection, characterized predominantly by gastrointestinal symptoms. Neurological symptoms are frequent in the course of the disease; however, a purely neurological presentation is uncommon. Diagnosis is confirmed with biopsy and polymerase chain reaction studies. Magnetic resonance imaging (MRI) findings vary, most commonly showing increased signal intensity on T2-weighted images. Contrast-enhanced images and diffusion- weighted imaging are useful to demonstrate meningeal enhancement and any accompanying infarcts. Brain biopsy is often performed, and MRI is crucial to guide the biopsy. Cerebral Whipples disease is a long-lasting infection requiring long-term follow-up of these patients. MRI should be performed to detect any potential recurrence. We present a case of recurrent isolated cerebral Whipples disease in a 68-year-old man with atypical presentation and MRI findings.

Unusual association of tethered cord, filum terminale lipoma, and myxopapillary ependymoma.

Study Design. Case report. Objective. We report a 67-year old man with a known filum terminale lipoma causing a tethered cord extending to the subcutaneous fat tissue and a newly diagnosed concomitant ependymoma, revealed on lumbar magnetic resonance imaging (MRI). Summary of Background Data. The coexistence of filum terminale lipoma and ependymoma is very rare. The underlying reason of this coexistence is still unknown. The patients with known filar lipoma causing a tethered cord can be underdiagnosed clinically even though new symptoms develop. Methods. Case study with lumbar MRI. Results. The patient was operated, and both of the ependymoma and filum terminale lipoma were removed. The pathologic examination was consistent with the MRI findings. Three months after surgery, the patient improved significantly. Conclusion. The coexistence of filum terminale lipoma and ependymoma is rare. Patients with relevant symptoms may be referred for an MRI study; however, especially patients with known filar lipomas causing tethered cord may be missed. Therefore, including these patients, a contrast-enhanced lumbar MRI must be performed to exclude any coexistence of filum terminale lipoma and ependymoma in the early course of the disease which can also help the surgeon in guiding the appropriate treatment.

Acute sarcoid myositis with unusual radiologic findings.

A 59-year-old man presented with bilateral calf pain and swelling for two weeks. Ultrasound and magnetic resonance imaging examination showed multiple bilateral, nodular, and spindle- shaped lesions in the gastrocnemius and soleus muscles. On physical examination, hyperpigmented, papular lesions were noticed; biopsy of the skin of his right elbow showed granulomatous inflammation. His angiotensin converting enzyme level was markedly elevated. Computed tomography showed diffuse interstitial thickening, miliary nodules, and traction bronchiectases throughout the lung parenchyma. Ophthalmologic examination showed uveitis in his left eye. Based on the lung, eye, and skin findings, a clinical diagnosis of sarcoidosis was made. After two months of corticosteroid treatment, his muscle lesions largely resolved.

Extraperitoneal pelvic myolipoma

Myolipoma is a very rare adipocytic tumor occurring most frequently in adults, and usually is located in the retroperitoneum or abdomen. It has been described in the retroperitoneum, spinal cord, orbita, breast, round ligament, subcutaneous tissue, pericardium, rectus sheath of the abdominal wall, and abdominal cavity with attachment to the abdominal wall. Most of these tumors are discovered incidentally and are large when discovered. Radiological findings are nonspecific due to the nonlipomatous component of the tumor. We present radiological findings of a large extraperitoneal pelvic myolipoma adjacent to the anterior abdominal wall, detected incidentally in an elderly woman with a presenting complaint of intractable hiccups.

Inner ear lipoma.

Intracranial lipomas are uncommon congenital malformations that are often asymptomatic. They are very rarely seen in the inner ear. There are a few case reports in the literature related to intravestibular lipoma. It was also defined in the internal auditory canal and the cerebellopontine angle. We present here a case of an inner ear lipoma that diffusely infiltrated the cochlea, vestibule and the semicircular canals. To our knowledge, this is the first reported case in the literature.