Mutlu Cihangiroglu

Fat containing unusual tumor of the pancreas

Abstract. Fat-containing pancreatic tumors are very rare. In the literature, less than ten cases of lipoma originating from the pancreas have been reported. We present a case of pancreatic lipoma in a 65-year-old woman with findings of ultrasonography, computed tomography, and magnetic resonance imaging in addition to a brief review of the literature.

Giant aneurysm of the azygos pericallosal artery: case report and review of the literature.

BACKGROUND Pericallosal aneurysms are encountered less than 6.7%, and giant aneurysms among them even less. Giant azygos pericallosal artery aneurysm at the callosomarginal bifurcation is extremely rare, and our case presented herein is the second one. The case is discussed with thorough review of the literature. METHODS A 65-year-old woman presented with an extremely rare giant aneurysm on the azygos pericallosal artery manifesting as subarachnoid hemorrhage in World Federation of Neurosurgical Societies Grade 3. Computed tomography (CT), magnetic resonance angiography (MRA), and four vessel angiography revealed a giant azygos pericallosal artery aneurysm associated with a second aneurysm at the left M1. RESULTS After recovery to Grade 2, she underwent surgery via the right frontal interhemispheric approach for the azygos artery aneurysm on the 17th day after bleeding. The true dimensions of the aneurysm were greater than indicated by angiography because of partial thrombosis. Trilobulate aneurysm was carefully dissected from the surrounding structures. Postoperative cerebral angiography showed no filling of the clipped aneurysm and preservation of circulation. CONCLUSIONS The treatment of distal anterior cerebral artery aneurysms is often difficult, because of their broad-based irregular configurations and adherence to surrounding tissue, tendency to bleed irrespective of size and the coexistence of other cerebral aneurysms. However, excellent outcomes can be obtained based on thorough preoperative radiologic evaluation, including magnetic resonance imaging (MRI), and correct selection of surgical approach.

CT and MRI findings of ameloblastoma in two cases

We report CT and MRI findings in two patients with ameloblastoma. One case had a multilocular mixed lesion and the other had a unilocular solid pattern. The second case is probably one of the youngest reported. CT and MRI can be used to delineate and show the extent of the tumour.

Iatrogenic vertebral artery pseudoaneurysm: US, CT and MRI findings

Vertebral artery pseudoaneurysm (VAP) is the result of the penetrating neck trauma, chiropractic manipulation, vasculopathies and rarely iatrogenic due to internal jugular vein (IJV) catheterization. It should be identified and treated immediately because of its potential risk of rupture. We present a case of a right VAP resulting from jugular vein catheterization, with the Doppler ultrasonography (US), Computed tomography (CT) and magnetic resonance imaging (MRI) findings. Although angiography is a well known gold standard modality, Doppler US, CT and MRI findings can be sufficient to demonstrate VAP.

Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy.

Spinal subarachnoid hemorrhage (SAH) is rare clinical entity possible owing to the diluting and fibrinolytic effects of cerebrospinal fluid (CSF). When it occurs, it is most commonly encountered in the thoracic segment of the subarachnoid space. We present a case of a 50-year-old man who sustained spinal SAH in the cervical and thoracic segments related to anticoagulant therapy. He progressed to significant neurological deficit since he was inoperable, an observation that supports the need for decompression surgery. We should be aware of potential hematomyelia should a patient on anticoagulant therapy develop neurological symptoms localized to the spinal cord. When available, magnetic resonance (MR) imaging is the modality of choice to diagnose and follow-up spinal SAH.

Transverse sinus air after cranial trauma.

Air in vascular compartments has been rarely reported. We report a case in whom air within transverse sinus and sinus confluence through ruptured superior sagittal sinus (SSS) due to fractures of parietal and frontal bones was disclosed by computed tomography (CT). Although air in transverse sinus has been reported rarely this could be the first case with air in transverse sinus through the SSS after cranial trauma.

Effects of Cervical Rotation on Hemodynamics in Vertebral Arteries

The purpose of this study was to assess the effects of cervical rotations on flow velocity and volumes of vertebral arteries in healthy individuals and patients with cervical spondylosis and vertebrobasilar insufficiency. Twenty-eight patients with degenerative changes in the cervical spine (group 1), 24 patients with clinically proven vertebrobasilar insufficiency (group 2), and 20 healthy individuals (group 3) were evaluated. Significant difference was found in flow velocities of both vertebral arteries during neutral, 30-degree, 60-degree, and maximum rotations between groups 1 to 3 and groups 2 to 3. No significant difference was observed in flow velocities and volumes of the vertebral artery between groups 1 and 2. This occurrence might be explained by the fact that both groups have been affected not only by atherosclerotic changes but also by external pressure due to degenerative changes in the cervical spine.

Isolated Septum Pellucidum Agenesis in an Adult

Septum pellucidum agenesis is frequently associated with other cerebral malformations. Its isolated agenesis is quite rare. In the literature, all reported cases were diagnosed in early childhood. The authors present an unusual case of isolated septum pellucidum agenesis detected in adulthood with computed tomography and magnetic resonance imaging.

Giant aneurysm of the azygos pericallosal artery: Case report and review of the literature: Commentary

BACKGROUND Pericallosal aneurysms are encountered less than 6.7%, and giant aneurysms among them even less. Giant azygos pericallosal artery aneurysm at the callosomarginal bifurcation is extremely rare, and our case presented herein is the second one. The case is discussed with thorough review of the literature. METHODS A 65-year-old woman presented with an extremely rare giant aneurysm on the azygos pericallosal artery manifesting as subarachnoid hemorrhage in World Federation of Neurosurgical Societies Grade 3. Computed tomography (CT), magnetic resonance angiography (MRA), and four vessel angiography revealed a giant azygos pericallosal artery aneurysm associated with a second aneurysm at the left Ml. RESULTS After recovery to Grade 2, she underwent surgery via the right frontal interhemispheric approach for the azygos artery aneurysm on the 17th day after bleeding. The true dimensions of the aneurysm were greater than indicated by angiography because of partial thrombosis. Trilobulate aneurysm was carefully dissected from the surrounding structures. Postoperative cerebral angiography showed no filling of the clipped aneurysm and preservation of circulation. CONCLUSION The treatment of distal anterior cerebral artery aneurysms is often difficult, because of their broad-based irregular configurations and adherence to surrounding tissue, tendency to bleed irrespective of size and the coexistence of other cerebral aneurysms. However, excellent outcomes can be obtained based on thorough preoperative radiologic evaluation, including magnetic resonance imaging (MRI), and correct selection of surgical approach.

Recombinant Tissue Plasminogen Activator Therapy for Pacemaker-Induced Thrombosis

A 50-year-old male who developed subclavian vein thrombosis following insertion of a demand pacemaker was treated with a short period of high-dose recombinant tissue plasminogen activator (100 mg over 3 hours). Total thrombolysis was achieved without complications.