İsmail Gülşen

Indications of brain computed tomography scan in children younger than 3 years of age with minor head trauma

Objective. To investigate the indications to receive brain computed tomography (CT) scan and to define the pathological findings in children younger than three years of age with minor head trauma in emergency departments. Methods. In this study, hospital case notes of 1350 children attending the emergency department of Bitlis State Hospital between January 2011 and June 2013 were retrospectively reviewed. 508 children under 3 years of age with minor head trauma were included in this study. We also asked 37 physicians about the indications for requiring CT in these children. Results. This study included 508 children, 233 (45,9%) of whom were female and 275 were male. In 476 (93,7%) children, the brain CT was completely normal. 89,2% of physicians asked in the emergency department during that time interval reported that they requested CT scan to protect themselves against malpractice litigation. Conclusion. In infants and children with minor head trauma, most CT scans were unnecessary and the fear of malpractice litigation of physicians was the most common reason for requesting a CT.

Neuroprotective Effects of Thymoquinone on the Hippocampus in a Rat Model of Traumatic Brain Injury.

BACKGROUND Traumatic brain injury is a leading cause of morbidity and mortality worldwide. We evaluated the neuroprotective effects of thymoquinone (TQ) in a rat model of traumatic brain injury by using biochemical and histopathologic methods for the first time. MATERIALS AND METHODS Twenty-four rats were divided into sham (n = 8), trauma (n = 8), and TQ-treated (n = 8) groups. A moderate degree of head trauma was induced with the use of Feeneys falling weight technique, and TQ (5 mg/kg/day) was administered to the TQ-treated group for 7 days. All animals were killed after cardiac perfusion. Brain tissues were extracted immediately after perfusion without damaging the tissues. Biochemical procedures were performed with the serum, and a histopathologic evaluation was performed on the brain tissues. Biochemical experiments included malondialdehyde (MDA), reduced and oxidized coenzyme Q10 analysis, DNA isolation and hydroylazation, and glutathione peroxidase, and superoxide dismutase analyses. RESULTS Neuron density in contralateral hippocampal regions (CA1, CA2-3, and CA4) 7 days after the trauma decreased significantly in the trauma and TQ-treated groups, compared with that in the control group. Neuron densities in contralateral hippocampal regions (CA1, CA2-3, and CA4) were greater in the TQ-treated group than in the trauma group. TQ did not increase superoxide dismutase or glutathione peroxidase antioxidant levels. However, TQ decreased the MDA levels. CONCLUSIONS These results indicate that TQ has a healing effect on neural cells after head injury and this effect is mediated by decreasing MDA levels in the nuclei and mitochondrial membrane of neurons.

Does the removal of spinal implants reduce back pain

Background The importance of the removal of spinal implants is known in the presence of infection. However, the benefits and/or risks of the removal of spinal implant for the management of back pain are not clear. Methods In this retrospective study, we aimed to evaluate the beneficial effects of the removal of spinal implants for back pain. Study included 25 patients with thoracolumbar instrumentation. Results Seventeen (68%) of them were male. Indications for spinal instrumentation were vertebra fracture (n = 9), iatrogenic instability due to multiple segment laminectomy (n = 12), and instrumentation after recurrent disk herniations (n = 4). Mean visual analog score (VAS) before the removal was 8.08. Mean VAS was 3.36 after the removal. Spinal instruments were removed after the observance of the presence of fusion. All patients were prescribed analgesics and muscle relaxants for 3 weeks before removal. Back pain did not decrease in five (20%) patients in total. Four of them had been instrumented due to recurrent lumbar disk herniation. None of the patients reported the complete relief of pain. Conclusion In conclusion, patients should be cautioned that their back pain might not decrease after a successful removal of their instruments.

Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly

Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.

Intracranial Meningioma Diagnosed during Pregnancy Caused Maternal Death

Brain tumors are rarely diagnosed during pregnancy. Accelerated growth of intracranial meningiomas during pregnancy sometimes requires urgent surgical intervention. We describe a 41-year-old pregnant woman with severe neurological decompensation requiring immediate neurosurgery. Cesarean section resulted in maternal death. Meningioma diagnosed during a viable pregnancy should be managed according to the severity of maternal neurological symptoms and gestational age of pregnancy. Early intervention for intracranial tumors during pregnancy may save maternal and fetal lives.

Chiari III malformation with a giant encephalocele Sac: case report and a review of the literature.

A boy was delivered via cesarean section at 37 weeks of pregnancy of a 37-year-old female who was referred to our hospital because of breech presentation. A giant cystic lesion was palpated on the cervical-occipital and upper thoracic regions of the fetus. The skin covering the lesion was intact ( fig. 1 ). There was neither a history of suspicious medication in the pregnancy period nor evidence of maternal infection during pregnancy. The amniotic fluid was stained with meconium. The infant did not cry immediately after birth. He was hypotonic with decreased spontaneous movements and had respiratory distress. On physical examination, the child weighed 2.9 kg. The child’s hematological and biochemical parameters showed no abnormality. On cranial CT, frontal bone scalloping (the lemon sign), a defect at the posterior region of the occipital bone and the C1–C4 vertebras, enlargement of the foramen magnum, and a 130 × 107 × 80-mm encephalocele sac containing cerebral tissues were detected. In addition, there was a 20-mm hyperdense hematoma in the left portion of the herniated parenchyma ( fig. 2 ). Brain MRI showed a defect at the lower occipital/upper cervical region and a large encephalocele sac herniated from this defect, which contained the right cerebral occipital lobe, the bilateral cerebellar Cleland [1] first described Chiari malformation in 1883; however, the first classification and documentation of the entity was accomplished by Hans von Chiari in 1891 [2] . Chiari malformation type III is an extremely rare anomaly, characterized by the herniation of the posterior fossa contents, including the cerebellum, brain stem and fourth ventricle, and in some cases, the upper cervical spinal cord through a low occipital and/or upper cervical osseous defect. Other potentially related anomalies that have been reported include a small posterior fossa, hydrocephalus, syringomyelia, tectal beaking, medullary kinking, low-lying transverse sinuses, heart-shaped incisura, hypoplastic tentorial cerebelli, fenestrated falx cerebelli, concave clivus and petrous bone and corpus callosum dysgenesis [3] . High rates of early mortality and severe neurological deficits in the surviving patient population have been reported. The presence of hydrocephalus and infections, the sizes of the sacs and the nature of their contents, and other related abnormalities are accepted as indicators of an unfavorable prognosis [4, 5] . To our knowledge, approximately 30 cases of Chiari III malformation have been reported in the literature thus far. In this presentation, we demonstrated the computed tomography (CT) and magnetic resonance imaging (MRI) findings of a Received: April 25, 2014 Accepted after revision: July 2, 2014 Published online: September 25, 2014

Resveratrol treatment prevents hippocamal neurodegeneration in a rodent model of traumatic brain injury

AIM Traumatic brain injury (TBI) is a complex process. Increasing evidence has demonstrated that reactive oxygen species contribute to brain injury. Resveratrol (RVT) which exhibits significant antioxidant properties, is neuroprotective against excitotoxicity, ischemia, and hypoxia. The aim of this study was to evaluate the neuroprotective effects of RVT on the hippocampus of a rat model of TBI. MATERIAL AND METHODS Twenty eight rats were divided into four groups. A moderate degree of head trauma was induced using Feeneys falling weight technique. Group 1 (control) underwent no intervention or treatment. Head trauma was induced in Group 2 (trauma) and no drug was administered. Head trauma was induced in Group 3 and low-dose RVT (50 mg/kg per day) was injected. In Group 4, high-dose RVT (100 mg/kg per day) was used after head trauma. Brain tissues were extracted immediately after perfusion without damaging the tissues. Histopathological and biochemistry parameters were studied. RESULTS Brain tissue malondialdehyde (MDA) levels in the trauma group were significantly higher than those in the control, lowdose RVT-treated, and high-dose-RVT-treated groups. The superoxide dismutase (SOD) levels in the control group were significantly higher than those in the trauma, low-dose RVT-treated, and high-dose RVT-treated groups. Glutathione peroxidase (GSH-Px) levels in the control group were significantly higher than those in the trauma and low-dose RVT-treated groups. The level of oxidative deoxyribonucleic acid (DNA) damage (8-OHdG/106 dG) in the trauma group was higher than that in the control group, low-dose RVT-treated, and high-dose RVT-treated groups. CONCLUSION Resveratrol has a healing effect on neurons after TBI.

Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis

Background Because loss of cervical lordosis leads to disrupted biomechanics, the natural lordotic curvature is considered to be an ideal posture for the cervical spine. The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. The aim of this study was to compare the vertebral artery values between subjects with and without loss of cervical lordosis. Material/Methods Thirty patients with loss of cervical lordosis and 30 controls matched for age, sex, and body mass index were included in the study. Sixty vertebral arteries in patients with loss of cervical lordosis and 60 in controls without loss of cervical lordosis were evaluated by Doppler ultrasonography. Vertebral artery hemodynamics, including lumen diameter, flow volume, peak systolic velocity, end-diastolic velocity, and resistive index, were measured, and determined values were statistically compared between the patient and the control groups. Results The means of diameter (p=0.003), flow volume (p=0.002), and peak systolic velocity (p=0.014) in patients were significantly lower as compared to controls. However, there was no significant difference between the 2 groups in terms of the end-diastolic velocity (p=0.276) and resistive index (p=0.536) parameters. Conclusions The present study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity. Further studies are required to confirm these findings and to investigate their possible clinical implications.

Spontaneous Rupture of the Middle Fossa Arachnoid Cyst into the Subdural Space: Case Report

Summary Background Arachnoid cysts are congenital, benign and intra-arachnoidal lesions. A great majority of arachnoid cysts are congenital. However, to a lesser extent, they are known to develop after head trauma and brain inflammatory diseases. Arachnoid cysts are mostly asymptomatic and they can develop anywhere in the brain along the arachnoid membrane. Case Report Arachnoid cysts form 1% of the non-traumatic lesions which occupy a place and it is thought to be a congenital lesion developed as a result of meningeal development abnormalities or a lesion acquired after trauma and infection. There is a male dominance at a rate of 3/1 in arachnoid cysts which locate mostly in the middle fossa. Our patient was a 2-years-old boy. Conclusions As a conclusion, spontaneous subdural hygroma is a rare complication of the arachnoid cysts. Surgical intervention could be required in acute cases.

Prognostic Factors in Oligodendrogliomas: a Clinical Study of Twenty-Five Consecutive Patients

BACKGROUND The purpose of this study was to evaluate the prognostic significance of Ki-67 and subjective microvascular density (SMVD) indexes together with other factors in patients with oligodendroglioma. MATERIALS AND METHODS In this retrospective study, oligodendroglioma specimens obtained from twenty-five consecutive patients were evaluated for Ki-67 and SMVD indices to help determine histological grading and investigate the fidelity of these markers in clinical prognosis. Other potentially prognostic factors were Karnofsky performance scale, tumor histological grade, and adjuvant radiotherapy. RESULTS The Ki-67 proliferation index appeared to have a strong correlation with the grade of the tumor and the survival. Age, gender, adjuvant radiotherapy, surgical resection type (complete versus incomplete) did not have any influence on recurrence. The SMVD index correlated significantly with the 3 to 5-year survival. CONCLUSIONS Ki-67 and MVD indexes are important and useful markers in estimating the prognosis of oligodendrogliomas.