Hakan Selcuk

Intrathecal Gadolinium-Enhanced MR Cisternography in the Evaluation of CSF Leakage

BACKROUND AND PURPOSE: Radiologic identification of the location of the CSF leakage is important for proper surgical planning and increases the chance of dural repair. This article describes our experience in analyzing clinically suspected cranial CSF fistulas by using MR imaging combined with the intrathecal administration of a gadolinium-based contrast agent. MATERIALS AND METHODS: A total of 85 consecutive patients with suspected CSF fistulas who presented with persistent or intermittent rhinorrhea or otorrhea lasting for more than 1 month between 2003 and 2007 were included in this study. RESULTS: We observed objective CSF leakage in 64 of 85 patients (75%). The CSF leak was located in the ethmoidal region in 37 patients (58%), in the superior wall of the sphenoid sinus in 8 patients (13%), in the posterior wall of the frontal sinus in 10 patients (15%), in the superior wall of the mastoid air cells in 6 patients (9%), and from the skull base into the infratemporal fossa in 1 patient (2%). Two patients (3%) showed leakage into >1 paranasal sinus. CONCLUSIONS: MR cisternography after the intrathecal administration of gadopentate dimeglumine represents an effective and minimally invasive method for evaluating suspected CSF fistulas along the skull base. It provides multiplanar capabilities without risk of radiation exposure and is an excellent approach to depict the anatomy of CSF spaces and CSF fistulas.

Assessment of CSF Flow Dynamics Using PC‐MRI in Spontaneous Intracranial Hypotension

(Headache 2012;52:808‐819)

Evaluation of Parenchymal Neuro-Behçet Disease by Using Susceptibility-Weighted Imaging

BACKGROUND AND PURPOSE: Neurologic involvement in Behçet disease, also known as NBD, is one of the most devastating manifestations of the disease. The precise pathologic mechanism of parenchymal NBD lesions has not been established. We evaluated lesion characteristics and probable venous hemorrhage in parenchymal NBD by using SWI, and we compared the imaging results with conventional MR imaging sequences. MATERIALS AND METHODS: We performed cranial MR imaging by using a 1.5T scanner in 23 patients with a definitive diagnosis of parenchymal NBD. We compared the proportion of lesion detection and the performance of hemorrhagic detection with the T2 FSE, T2*GE, and SWI magnitude, and SWI mIP by using the χ2 test. RESULTS: The proportion of lesion detection with both SWI magnitude and SWI MinMIP was significantly larger than that with T2*GE. The proportions of lesion detection among all other pairs of methods were not significantly different according to the corresponding P value (χ2 = 17.4929, df = 3, P = .0006). Proportions of hypointense hemorrhagic lesions with T2 FSE and T2*GE were not significantly different, and likewise for the proportions of hypointense hemorrhagic lesions with SWI magnitude and SWI mIP. In contrast, the proportions of hypointense hemorrhagic lesions with SWI magnitude and SWI mIP were significantly larger than that with T2 FSE and T2*GE (χ2 = 108.5396, df = 3, P < .0001). CONCLUSIONS: Most of the lesions in parenchymal NBD were found to be hemorrhagic with SWI, supporting the proposed venous theory in pathology. In addition, compared with T2 FSE and T2*GE sequences, SWI was more successful in the determination of widespread involvement of the disease, particularly in nonchronic cases.

A case of primary Sjögren’s syndrome presenting primarily with central nervous system vasculitic involvement

Sjögren’s syndrome is primarily a chronic systemic autoimmune disease that affects exocrine organs. Neurologic symptoms frequently present as peripheral neuropathy due to small vessel vasculitis. Type and prevalence of central nervous system involvement are still controversial. In this report, we present a 35-year-old woman with primary Sjögren’s syndrome with central nervous system vasculitic involvement.

Endovascular Treatment of Persistent Epistaxis due to Pseudoaneurysm Formation of the Ophthalmic Artery Secondary to Nasogastric Tube

We present the case of a 60-year-old man with persistent epistaxis for 20 days that had started 2 weeks after removal of a nasogastric tube placed for an abdominal operation. There was no pathologic finding at selective facial and internal maxillary artery injections. An injury to the ethmoidal branches of the ophthalmic arteries or other arterial origins of bleeding was suspected. The internal carotid artery angiography revealed a pseudoaneurysm of an anterior ethmoidal branch of the left ophthalmic artery. The pseudoaneurysm was occluded with NBCA-histoacryl (25%) injection.

Breast Cancer Metastasis Involving Pterygopalatine Fossa: A Cause of Trigeminal Neuralgia

We present a case of metastatic breast cancer to pterygopalatine fossa (PPF) with a severe trigeminal neuralgia located in the V2 division of the trigeminal nerve area, which was diagnosed by computed tomography (CT) and magnetic resonance imaging (MRI). In 2002, a 62-year-old woman had a 6-month history of lancinating pain and hyphestesia on the right side of the face. The type of pain of this patient is a severe characteristic trigeminal neuralgia that causes episodes of intense, stabbing, electric shock-like pain in the areas of the face where the V2 branch of the trigeminal nerve is distributed. Carbamazepine and other medications did not provide pain relief. Therefore, she has undergone maxillary nerve blocks whenever the pain worsened. She was operated for breast cancer on the right side in 2000. There were no findings of recurrence at the original site during her followup period. One year after the operation, CT examination of the lungs revealed a mass on the upper lobe of the right lung. She had undergone surgery for this mass and pathology revealed breast cancer metastasis. Neurological examination disclosed hypesthesia on the V2 branch of the right trigeminal nerve without other neurological deficits. There were no other cranial nerve abnormalities. Neurological examination was otherwise normal. CT examination revealed bony lyses of posterior wall of the right maxillary sinus (Figure 1A). MRI showed an enhancing soft tissue mass within the right pterygopalatine fossa and posterior portion of the maxillary sinus. Preand postcontrast T1-weighted images showed a right-sided soft tissue mass obliterating the fatty tissue of PPF (Figure 1B). Tumoral involvement was not detected in

Endovascular treatment of a congenital dural caroticocavernous fistula

Carotico-cavernous sinus fistula is a rare anomaly in infancy. We report a 3-month-old boy with progressive symptoms and threatened visual loss requiring urgent therapeutic intervention. Embolization using n-butyl 2-cyanoacrylate was performed with immediate and dramatic results.

Cranial subarachnoid hemorrhage as an unusual complication of epidural blood patch

Epidural blood patch (EBP) is an effective procedure for the reatment of spontaneous or iatrogenic dural tears. Reported comlications of EBP include lumbar and neck pain, paresthesia, loss f strength in the legs, temporary bradycardia, dizziness, cranial erve paralysis, and pneumocephalus [1–3]. We report a case of 36-year-old woman who developed a headache, persistent nauea, and vomiting because of subarachnoid hemorrhage (SAH) that ccurred after EBP. We suggest that EBP can result in SAH even if nadvertent puncture is avoided.

A case with angiographic demonstration of isolated anterior spinal artery occlusion

Anterior spinal artery syndrome (ASAS) is a rare syndrome which occurs due to thrombosis of anterior spinal artery (ASA) which supplies anterior two thirds of the spinal cord. A 27-year-old female patient was admitted to emergency clinic with sudden onset neck pain, sensory loss and weakness in proximal upper extremities which occurred at rest. Thrombophilia assessment tests were negative. Echocardiography was normal. Serum viral markers were negative. In cerebrospinal fluid (CSF) examination, cell count and biochemistry was normal, oligoclonal band was negative, viral markers for herpes simplex virus (HSV) type-1 and type-2, Brucella, Borrellia, Treponema pallidum, Tuberculosis were negative. Diffusion restriction which reveals acute ischemia was detected in Diffusion weighted MRI. Digital subtraction angiography (DSA) was performed. Medical treatment was 300mg/day acetilsalycilic acid. Patient was discharged from neurology clinics to receive rehabilitation against spasticity.

High altitude-related intracranial hypotension syndrome: Unusual combined syndrome

Department of Radiology, Division of Neuroradiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Department of Radiology, Division of Neuroradiology, Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Bakirkoy, Istanbul, Turkey