Mehmet Tiryaki

Nocardial brain abscess: Review of clinical management

Nocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here.

A laboratory training model in fresh cadaveric sheep brain for microneurosurgical dissection of cranial nerves in posterior fossa.

A neurosurgical laboratory training model is designed for residents of neurosurgery to handle surgical microscopes and microneurosurgical instruments. The material consists of a one-year-old fresh cadaveric sheep cranium. A four-step approach was designed to simulate microneurosurgical dissection along the posterior fossa cisterns, and to dissect cranial nerves emerging from the brain stem. We conclude that this laboratory training model is useful to allow trainees to gain experience with the general use of an operating microscope, and familiarity with handling cranial nerves.

Spontaneous Cervical Epidural Hematoma with Hemiparesis Mimicking Cerebral Stroke

Aim. Spontaneous cervical epidural hematoma (SCEH) is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INR results were 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding.

Choroid plexus carcinoma in adults: an extremely rare case.

Choroid plexus tumors are rare intraventricular papillary neoplasms derived from choroid plexus epithelium, which account for approximately 2% to 4% of intracranial tumors in children and 0.5% in adults. Almost all choroid plexus carcinomas are seen in children and are extremely rare in adults. Headache, diplopia, and ataxia are the most common symptoms usually caused by mechanical obstruction of cerebrospinal fluid flow followed by hydrocephalus, regardless of tumor location. We present an illustrative case with 73 years old male patient who was consulted with headache to our neurosurgery department. In cranial computed tomography, there was a mass in 4th ventricle and we confirmed the mass with magnetic resonance imaging. After surgery had been performed, pathology specimen was diagnosed as choroid plexus carcinoma which was rarely seen in this age group.

Spinal Intramedullary Metastasis of Breast Cancer

Objective. Breast cancer accounts for approximately one-third of all cancers in females. Approximately 8.5 % of all central nervous system metastases are located in the spinal cord. These patients have rapidly progressing neurological deficits and require immediate examination. The aim of surgery is decompression of neural tissue and histological evaluation of the tumor. In this paper, we present a case of breast cancer metastasis in thoracic spinal intramedullary area which had been partially excised and then given adjuvant radiotherapy. Case. A 43-year-old female patient with breast cancer for 8 years was admitted to our hospital with complaints of weakness in both legs. Eight years ago, she received chemotherapy and radiotherapy. On her neurological examination, she had paraparesis (left lower extremity: 2/5, right lower extremity: 3/5) and urinary incontinence. Spinal MRI revealed a gadolinium enhancing intramedullary lesion. Pathologic examination of the lesion was consistent with breast carcinoma metastasis. The patient has been taken into radiotherapy. Conclusion. Spinal intramedullary metastasis of breast cancer is an extremely rare situation, but it has a high morbidity and mortality rate. Microsurgical resection is necessary for preservation or amelioration of neurological state and also for increased life expectancy and quality.

Intradural Disc Herniation Presenting with Acute Onset Bilateral Isolated Foot Drop

Intradural disc herniation is a rare entity that occurs most frequently in the lumbar spine. Most often it is diagnosed intraoperatively. Acute onset of bilateral foot drop due to intradural disc herniation without any sign of the cauda equina syndrome is also extremely rare. We described a case of a 41-yearold male who presented to us with acute onset bilateral foot drop without any sign of the cauda equina syndrome. He had previously been diagnosed as having multiplelevel intervertebral herniations and managed conservatively. He was admitted to the emergency room with acute onset bilateral foot drop. Lumbar MRI revealed multiple-level disc herniations and extruded disc fragment at L2-L3 level. L2 and L3 laminectomies were performed and a hard intradural mass was palpable. On opening the dura a fragment of intervertebral disc was found with a small defect in the anterior dura. The fragment was removed and the dura was sutured. The patient recovered well from the surgery. Intradural disc herniation must be considered in the differential diagnosis of acute onset bilateral foot drop without any sign of the cauda equina syndrome.

Spontaneous Resolution of a Sylvian Arachnoid Cyst in a Child: A Case Report.

We report the case of a 7-year-old boy with an incidentally diagnosed left sylvian arachnoid cyst. At a clinical follow-up of 2 years, cranial computed tomography scans found the cyst to be totally resolved. The mechanism of this rare spontaneous resolution of an arachnoid cyst is discussed.

Thalamic abscess caused by a rare pathogen: streptococcus constellatus

Streptococcus constellatus is a microorganism that lives commensally in the oropharyngeal region, urogenital region, and intestinal tract. However, it can cause infection in patients with certain predisposing factors. Rarely, this microorganism can cause a brain abscess. Thalamic localization of brain abscesses is much rarer than abscesses in other locations of the brain. Brain abscess caused by streptococcus constellatus are very rarely been reported in the literature. We present a rare case of a left-sided thalamic abscess caused by streptococcus constellatus in a 25-year-old male patient who was injured by shrapnel pieces in the head and who was malnourished. The patient was successfully treated by stereotactic aspiration and antibiotherapy.

Thoracic Disk Herniation Mimicking Spinal Mass Lesion: An Illustrative Case and Review of the Literature

The incidence of intervertebral disk herniation in the thoracic region of the spine is very rare when compared with cervical and lumbar regions. The sequestered disk fragments mimic spinal mass lesions because of lack of noticeable clinical features. The common symptoms are unilateral radicular pain and pain radiating from the upper or middle back to the chest. The differential diagnosis includes not only diverse neoplasms but also other epidural processes such as synovial cysts, hematomas, and inflammatory lesions. Magnetic resonance imaging and computed tomography can be used for diagnosis; however, histologic examination is the exact technique. A variety of surgical approaches have been described to reach these anatomically challenging lesions. We describe a 43-year-old female patient with a sequestrated disk fragment in the thoracic spine that mimics a mass lesion of the spinal canal. We will discuss systematic diagnostic approach, differential diagnosis, and treatment modalities of these lesions.

Extradural Dumbbell-shaped Hydatid Cyst of the Thoracolumbar Junction and Paravertebral Region Compressing the Left Kidney

Although rare, hydatid cyst disease remains a serious parasitic infection in some developing and underdeveloped countries. Radiologically, the appearance of a dumbbell-shaped mass in the spine is highly suggestive of neurofibroma. Extradural spinal hydatid cyst, although very rare, may also have the same appearance. In this report, a case of hydatid cyst disease involving the T11 to L2 vertebrae with extensions through the neural foramina to the adjacent perirenal fascia and compressing the left kidney is presented. The clinical presentation of the patient was a loss of strength in the legs; this patient initially underwent surgery to decompress the spinal cord by laminectomy and posterior stabilization with bilateral T11 and L1 posterior pedicular screw fixation. Then a retroperitoneal approach to excisea paravertebral mass compressing the left kidney was carried out. The serology was positive for hydatid cyst. Hydatid cyst disease should be considered in the differential diagnosis of spinal mass lesions.