Nur Altinors

Cerebral hydatid disease CT and MR findings

In this study, we reviewed the computed tomography (CT, n=9) and magnetic resonance (MR, n=5) imaging findings of 11 patients with pathologically confirmed cerebral hydatid disease. Among our patients, there were 10 cases of Echinococcus granulosus and 1 case of Echinococcus multilocularis. Common CT and MR imaging findings of E. granulosus lesions were well-defined, smooth thin-walled, spherical, homogeneous cystic lesions with no contrast enhancement, no calcification, and no surrounding edema. E. multilocularis lesions showed calcified round, solid pattern with definite margins, contrast enhancement, and surrounding edema.

Management of problematic intracranial hydatid cysts

SummaryThe authors report four patients with intracranial hydatic cysts. One patient had a pontine lesion which was punctured and aspirated and the cyst wall removed with a satisfactory outcome. The second patient had multiple cysts which was comparable to meningeomatosis. She had a rapidly deteriorating neurologic condition which proved to be fatal in spite of two consecutive surgical interventions. The third patient had nine lesions although only six were evident on the MRI. All of the cysts were removed, while two cysts ruptured. Multiple paracardial cysts of this patient were surgically removed shortly after the craniotomy. The last patient, again with multiple intracranial hydatid cysts had safe, total removal of all cysts. The first postoperative control CT raised the possibility of recurrence since the CT was highly suggestive of a hydatid cyst. However, this was not confirmed in the follow-up CT examination. Problems and the solutions of management are discussed.ZusammenfassungDie Autoren berichten über vier Fälle mit intrakraniellen Echinococcus-Zysten. Eine Patientin hatte eine Brückenläsion, die durch Punktion und Aspiration des Zysteninhaltes mit Entfernung der Zystenwand behandelt wurde. Die zweite Patientin wies multiple Zysten auf, die mit einer Meningomatose vergleichbar waren. Trotz zweier chirurgischer Interventionen kam es zur raschen neurologischen Verschlechterung mit tödlichem Ausgang. Der dritte Patient hatte neun Herde, von denen sich im Kernspintomogramm nur sechs darstellten. Alle Zysten wurden entfernt. Bei zwei Zysten kam es zur Ruptur. Kurz nach der Kraniotomie wurden bei diesem Patienten multiple parakardiale Zysten chirurgisch entfernt. Bei der vierten Patientin bestanden ebenfalls multiple intrakranielle Echinococcus-Zysten, die alle sicher exstirpiert werden konnten. Beim ersten postoperativen Kontroll-CT bestand aufgrund der zystenähnlichen Strukturen Verdacht auf ein Rezidiv, der sich bei der Wiederholungsuntersuchung jedoch nicht bestätigte. Probleme und therapeutisches Management werden diskutiert.The authors report four patients with intracranial hydatic cysts. One patient had a pontine lesion which was punctured and aspirated and the cyst wall removed with a satisfactory outcome. The second patient had multiple cysts which was comparable to meningeomatosis. She had a rapidly deteriorating neurologic condition which proved to be fatal in spite of two consecutive surgical interventions. The third patient had nine lesions although only six were evident on the MRI. All of the cysts were removed, while two cysts ruptured. Multiple paracardial cysts of this patient were surgically removed shortly after the craniotomy. The last patient, again with multiple intracranial hydatid cysts had safe, total removal of all cysts. The first postoperative control CT raised the possibility of recurrence since the CT was highly suggestive of a hydatid cyst. However, this was not confirmed in the follow-up CT examination. Problems and the solutions of management are discussed. Die Autoren berichten über vier Fälle mit intrakraniellen Echinococcus-Zysten. Eine Patientin hatte eine Brückenläsion, die durch Punktion und Aspiration des Zysteninhaltes mit Entfernung der Zystenwand behandelt wurde. Die zweite Patientin wies multiple Zysten auf, die mit einer Meningomatose vergleichbar waren. Trotz zweier chirurgischer Interventionen kam es zur raschen neurologischen Verschlechterung mit tödlichem Ausgang. Der dritte Patient hatte neun Herde, von denen sich im Kernspintomogramm nur sechs darstellten. Alle Zysten wurden entfernt. Bei zwei Zysten kam es zur Ruptur. Kurz nach der Kraniotomie wurden bei diesem Patienten multiple parakardiale Zysten chirurgisch entfernt. Bei der vierten Patientin bestanden ebenfalls multiple intrakranielle Echinococcus-Zysten, die alle sicher exstirpiert werden konnten. Beim ersten postoperativen Kontroll-CT bestand aufgrund der zystenähnlichen Strukturen Verdacht auf ein Rezidiv, der sich bei der Wiederholungsuntersuchung jedoch nicht bestätigte. Probleme und therapeutisches Management werden diskutiert.

The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI.

In this study we aimed to evaluate the role of closed-suction drainage on the extent of epidural fibrosis (EF) after lumbar disc surgery and to define a new grading system of epidural fibrosis in these patients, based on magnetic resonance imaging. Seventy-nine patients (34 women, 45 men) with a unilateral, single-level lumbar disc herniation were included in this study. Forty-one patients in whom closed-suction drainage was implanted were compared with 38 patients in whom the drain was not implanted. We have used a new grading system for the extent of epidural fibrosis, on the basis of follow-up magnetic resonance imaging findings. Pain intensity was evaluated by visual analog scale (VAS), and the patients’ function and working ability were measured according to the Prolo functional-economic scale. We conclude that, in patients operated on for unilateral, single-level lumbar disc hernias, implantation of closed-suction drainage into the operation site results in less formation of EF radiologically and yields better clinical outcome.

Akinetic mutism after fourth ventricle choroid plexus papilloma: treatment with a dopamine agonist

BACKGROUND Akinetic mutism is a behavioral state wherein a patient seems to be awake but does not move or speak. Several patients are reported to have developed mutism after posterior fossa surgery. We present a patient who developed akinetic mutism after total excision of a choroid plexus papilloma of the fourth ventricle, and who was treated with bromocriptine. CASE DESCRIPTION An 18-year-old woman was admitted with akinetic mutism, which had developed 6 days after posterior fossa surgery. She had had no neurologic deficit in the first 5 days after surgery and could communicate with her family. Despite antioedematous therapy and daily lumbar punctures to drain cerebrospinal fluid, there was no clinical improvement after she entered the akinetic mute state. Brain magnetic resonance revealed ventriculomegaly; brain single photon emission computed tomography revealed bilateral reduction of perfusion in the frontal region. Because daily lumbar drainage did not result in clinical improvement, shunt placement was not considered. Bromocriptine therapy was begun at a dose of 2x2.5 mg; 24 hours later, the patient started to speak and move her upper extremities. Further improvement occurred over the following week when the dose was increased to 3x2.5 mg. Bromocriptine was replaced with a placebo to determine whether the neurologic improvement was caused by the medicine. The patients neurologic status deteriorated progressively; therefore, bromocriptine was restarted and she was discharged from the hospital. During the 6 months of follow-up, the patient has remained in good health. CONCLUSIONS The etiology of akinetic mutism is not clear. Monoaminergic pathways, particularly dopaminergic cell groups, are most probably involved in this syndrome, because bromocriptine has a dramatic effect on these patients, as demonstrated in our case.

Spontaneous resolution of lumbar vertebral eosinophilic granuloma

SummaryEosinophilic granuloma (EG) is a rare disease but is more common in adults than children. It’s often self-limiting. Spinal involvement is rare. It is the localized and most benign form of Langerhans’ cell histiocytosis (previously known as histiocytosis X), characterised by lytic lesions in one or more bones. Spontaneous resolution of vertebral body lesions is very rare. In this case, the patient had one EG in a cervical vertebra and a similar lesion in a lumbar vertebra. This case is important because it featured a symptomatic lesion in the cervical spine accompanied by an asymptomatic lesion in a lumbar vertebra. We treated the cervical lesion by surgical fusion and followed the lumbar lesion up conservatively, with the patient in a corset. After 8 years of follow-up, control MRI showed that the lumbar lesion had spontaneously resolved.

Chordoid meningioma: Rare variant of meningioma

Chordoid meningioma is a rare variant of meningioma that bears a striking histological resemblance to chordoma and has greater likelihood of recurrence. Although most meningiomas occur in the intracranial, orbital and intravertebral cavities, rare meningiomas have been reported in extracranial organs; thus, it is important to be able to distinguish them from other neoplasms that have similar histology but different biological behavior and therapies. A case of chordoid meningioma in a 48‐year‐old woman who did not have Castlemans syndrome is described in the present report. The patient presented with a mass in her left frontoparietal region, and had been suffering from headaches for many years. Magnetic resonance imaging of the brain demonstrated an expansive lytic lesion in the squamous portion of the left temporal bone. The lesion extended in both directions. Histological examination of the surgical specimen revealed a tumor composed of cords and nests of eosinophilic vacuolated cells embedded in a myxoid matrix. A typical meningiomatous pattern was observed focally, and positive staining of the tumor cells for vimentin and epithelial membrane antigen confirmed the diagnosis of chordoid meningioma.

Intima-media thickness of the carotid arteries is related to serum osteoprotegerin levels in healthy postmenopausal women

Abstract Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and also plays a role in vascular calcification. The objective of this study was to evaluate the relationship between serum OPG levels, and carotid artery intima-media thickness (IMT) and carotid plaque formation in healthy postmenopausal women. We recruited 68 healthy postmenopausal women for the study. Carotid plaque presence and IMT were evaluated by high resolution B-mode ultrasound. IMT was positively correlated with presence of plaque, age, menopause age and OPG, and inversely correlated with Apolipoprotein A1 (Apo A1). Serum OPG level was positively correlated with IMT (r = 0.366; p < 0.003) and age (r = 0.324; p < 0.008), and negatively correlated with Apo A1 (r = –0.481; p < 0.0001). We did not observe any significant relation between plaque occurrence and levels of serum OPG. In regression analysis OPG (p < 0.02) and menopause age (p < 0.05) were independent risk factors for IMT, and age (p < 0.05) and IMT (p < 0.05) were independent risk factors for plaque formation. Although the role of OPG in the vascular biology is poorly understood, our results suggest that elevated levels of serum OPG is associated with IMT and may play a role in the pathogenesis of atherosclerotic disease.

Systemic administration of phosphodiesterase V inhibitor, sildenafil citrate, for attenuation of cerebral vasospasm after experimental subarachnoid hemorrhage.

OBJECTIVEOne of the phosphodiesterase isoenzymes, Type V (PDE V), specifically hydrolyzes cyclic guanosine monophosphate to cause vasoconstriction. This study analyses the effect of PDE V inhibition with sildenafil citrate (SC) on cerebral vasospasm and its effect on apoptotic changes of the vascular endothelium. METHODSTwenty-four rabbits were divided into four groups. The first group was composed of sham-surgery animals. The second group was the subarachnoid hemorrhage (SAH) group, in which cerebral vasospasm was induced. In the third group, sham-surgery rabbits were treated with SC. In the fourth group, animals were treated with SC after SAH. SC was administered for 48 hours, 0.7 mg/kg, three times per day in Groups 3 and 4. Basilar artery lumen circumferences were measured in all groups by computerized image analysis. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) method was used to evaluate the rate of apoptosis between SAH and SC-treated SAH groups. Results were compared by analysis of variance and paired t tests, and P values less than 0.05 were considered significant. RESULTSBasilar artery circumferences between groups were significantly different(P < 0.001). SC (0.7 mg/kg, three times per d) significantly dilated the basilar arteries in both the sham-surgery group (2370 ± 233 μm; P = 0.039) and the SAH group(2142 ± 195 μm; P = 0.006) after 48 hours of treatment. The TUNEL method for apoptosis revealed that actual numbers of the apoptotic endothelial cells per cross section after SAH in the control (no treatment) (73 ± 2) and SC-treated (0.7 mg/kg) groups(76 ± 3) were not significantly different (P > 0.05). CONCLUSIONThe vasodilatory effect of SC was observed to be significant on normal cerebral vessels and after SAH-induced vasospasm. SC did not prevent apoptosis of the endothelium in our study, which suggests that prevention of apoptosis is not necessary in the treatment of cerebral vasospasm.

MRI of neurologic complications in end-stage renal failure patients on hemodialysis: pictorial review

Abstract End-stage renal disease patients who have been on long-term hemodialysis tend to develop central nervous system complications. The most common neurologic complications in this patient group include white matter changes, cerebral atrophy, osmotic demyelination syndrome, dialysis encephalopathy, hypertensive encephalopathy, intracranial hemorrhage, infarct, sinus thrombosis, and infection. Clinical evaluation of these patients is somehow complicated and MRI is important before establishment of the therapy. The purpose of this article is to illustrate the range of MRI findings of neurologic complications in end-stage renal failure patients on hemodialysis with etiologic factors.

Minocycline treatment inhibits lipid peroxidation, preserves spinal cord ultrastructure, and improves functional outcome after traumatic spinal cord injury in the rat.

Study design. A prospective, randomized experimental research. Objective. To evaluate the short- and long-term neuroprotective effects of minocycline on the secondary injury process of an experimental traumatic spinal cord injury (SCI) model. Summary of Background Data. Traumatic SCI is a devastating problem of health that results in high morbidity and mortality rates. The loss of function after SCI results from both the primary mechanical insult and the subsequent, multifaceted secondary response. Methods. A total of 80 adult male Spraque-Dawley rats (breeded by the Baskent University Animal Research Center) were randomly divided into 4 groups. A T10 contusion injury was produced by using modified Allen technique in all groups except the control group. No medication was administered to the rats in the trauma group. Minocycline was administered intraperitoneally and intravenously to the treatment groups. Short-term and/or long-term neuroprotective effects of minocycline on the lipid peroxidation (malondialdehyde, glutathione), apoptosis (terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate-biotin nick end labeling), ultrastructure of spinal cord (tissue electron microscopy), and behavioral assessments (Basso-Beattie-Bresnahan) were evaluated. Results. As compared with the trauma group, tissue malondialdehyde and glutathione levels demonstrated that minocycline significantly diminishes lipid peroxidation. Electromicroscopic study showed that minocycline preserves the ultrastructure of spinal cord tissue in the early post-traumatic period. Minocycline treatment significantly reduced the number of terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate-biotin nick end labeling positive cells both 1 day and 28 days after SCI. Behavioral assessments showed significant improvement in the hind limb functions of minocycline receiving rats starting 7 days after the SCI. Any statistically significant difference was not found between intraperitoneal or intravenous routes for minocycline injection. Conclusion. Minocycline is neuroprotective and contributes to functional improvement after traumatic SCI by eliminating the destructive process of secondary injury. Having both satisfying anti-inflammatory and antiapoptotic effects in experimental models, it promises to be of therapeutic use in human SCI.