Ozlem Taskapilioglu

Can ID MigraineTM be Used as a Screening Test for Adolescent Migraine

Although the ID MigraineTM has been developed and used for adults, it can also be used in adolescents. We aimed to investigate the validity of the ID MigraineTM in the adolescent student population. The study was performed on 1064 adolescents aged 12-17 years. A face-to-face semistructured interview was conducted with students after they had answered a 17-item questionnaire on sociodemographics and headache. Students who had had two or more headache attacks during the last 3 months then answered the ID MigraineTM. The sensitivity and specificity of the ID MigraineTM were 62.1± and 71.1±, respectively. The sensitivity was higher for patients with migraine with aura (71.1±), for girls (71.3±) and for younger adolescents (69.1±). The specificity was higher for boys (77.9±) and for older adolescents (73.3±). The K value was 0.316 (P< 0.001). Although the K value of the ID MigraineTM is low, the test may be a useful tool in screening adolescent migraine after some changes are made.

Neuronal protective effects of focal ischemic pre- and/or postconditioning on the model of transient focal cerebral ischemia in rats.

We investigated the neuroprotective effects of pre- and postconditioning on infarct volume in the transient middle cerebral artery occlusion (MCAo) model in rats. Thirty-two male rats were divided into occlusion, preconditioning, postconditioning and both pre- and postconditioning groups. MCAo (120 minutes) was monitored with continuous cerebral tissue oxygen (O2) pressure (PtiO2). Pre-conditioning comprised 10 minutes of MCAo, 24 hours prior to the 120 minute MCAo. The postconditioning algorithm was 30 seconds of reperfusion followed by 30 seconds of MCAo. This cycle was repeated 3 times at the onset of reperfusion. Comparison of infarct volumes showed a significant difference between the conditioned groups and occlusion group. Although there was better protection in the preconditioning group compared with the other two conditioned groups, the results did not reach statistically significant levels. The results suggest that preconditioning, postconditioning and pre/post conditioning have protective effects on cerebral ischemia.

Tumor lysis syndrome as a contributory factor to the development of reversible posterior leukoencephalopathy

IntroductionReversible posterior leukoencephalopathy syndrome (RPLS) is a recently described clinical and radiological entity comprising headache, seizures, altered level of consciousness and visual disturbances in association with transient posterior cerebral white-matter abnormalities.MethodWe report a young woman with Burkitt’s lymphoma who developed RPLS after combined chemotherapy administered during the tumor lysis syndrome.ResultsThe symptoms in this patient fitted well with those of RPLS; they included abrupt alterations in mental status, seizures, headache, visual changes and characteristic neuroradiological findings. She was given further combination chemotherapy without any neurological complications, at which time she had already recovered from both RPLS and tumor lysis syndrome.ConclusionAlthough many etiological factors have been reported in the development of RPLS, the underlying mechanism is not yet well understood. With prompt and appropriate management, RPLS is usually reversible, and chemotherapy can be continued after complete recovery from RPLS. We suggest that tumor lysis syndrome should be considered as a contributory factor to the development of RPLS in patients for whom treatment with combined chemotherapy for hematological malignancies is planned.

Neurochemical–structural changes evaluation of brain in patients with obstructive sleep apnea syndrome

PURPOSE To evaluate neurochemical and structural changes in the patients with newly diagnosed obstructive sleep apnea syndrome (OSAS) by MR spectroscopy (MRS), T2 relaxometry, and diffusion weighted imaging (DWI). MATERIAL AND METHODS Following the acquisition of routine cranial MR, MRS, T2 relaxometry, and DWI images; spectroscopic metabolite ratios and DWI-T2 relaxometry findings of the thalami, hippocampi, frontal white matter (FWM) and frontal cortex of 24 OSAS patients and 9 controls were statistically compared. The relationship between two groups was evaluated with Mann-Whitney test. RESULTS Spectroscopic measurements in the frontal cortex and frontal white matter of the OSAS patients revealed significantly lower NAA/Cr ratios than those of the control group (P=0.004 and P=0.006, respectively). The measurements in the frontal white matter of the OSAS patients exhibited significantly lower NAA/Cho ratios compared with those of the control group (P=0.005). Thalamic Cho/Cr ratios of the patient group were significantly higher than those of the control group (P=0.002). In terms of the ADC-T2 relaxometry values, there was no significant relationship between the patient and the control groups (P>0.05). CONCLUSION MRS is a useful and non-invasive modality in showing neurochemical changes in various regions of the brain but our data does not show any change on diffusion weighting or T2 quantification in the OSAS group. DWI and T2 relaxometry appear to be not effective techniques to evaluate the brain structural changes of the patients with newly diagnosed OSAS.

Morphologic Features and Flow Void Phenomenon in Normal Pressure Hydrocephalus and Other Dementias: Are They Really Significant?

RATIONALE AND OBJECTIVE The aim of this study was to determine the distinctive features of normal-pressure hydrocephalus (NPH) and other dementias on routine T1-weighted and T2-weighted magnetic resonance (MR) images. Also, the contribution of these parameters to the diagnosis and treatment of NPH was investigated. MATERIALS AND METHODS Routine MR images were used to investigate the morphologic features (dilatation of Sylvian cisterns, narrowness of convexity sulci, thickness of corpus callosum (TCC), and dilatation of perihippocampal fissures) and the flow void phenomenon (FVP) in patients with idiopathic NPH (INPH) and other dementias. Routine MR images of 18 patients with INPH, 11 with dementias other than INPH, and 20 controls were retrospectively examined. Morphologic features and the FVP were graded subjectively. The TCC was measured quantitatively. Morphologic parameters, the FVP, and the shunt response were assessed using Kruskal-Wallis and Mann-Whitney U tests. RESULTS The mean FVP score was significantly higher in patients with INPH (2.89 +/- 0.75) than in controls and patients with other dementias (1.1 +/- 0.85 and 1.09 +/- 0.83, respectively) (P < .001). There was significant difference in terms of TCC between patients with INPH (3 +/- 0.7 mm), those with other dementias (1.9 +/- 0.7 mm), and controls (5.2 +/- 0.8 mm) (P < .001). Significant differences in terms of other morphologic features were found between patients with INPH and those with other dementias (P < .05). No significant difference was found between morphologic parameters and the FVP and the outcome of cerebrospinal fluid diversion (P > .05). CONCLUSIONS Intense FVP is a signature of but is not pathognomonic for INPH. The morphologic analysis of MR images can be distinctive for the diagnosis of INPH or dementias other than INPH. Detailed evaluation of morphologic features and the FVP in routine MR workup of dementia will be useful for accurate diagnosis.

Detection of CSF leaks with magnetic resonance imaging in intracranial hypotension syndrome

Intracranial hypotension syndrome (IHS) is a rare disorder characterized by postural headache, low cerebrospinal fluid (CSF) pressure, dural thickening and pachymeningeal contrast enhancement as a consequence of decreased CSF volume. The present report is a case of spontaneous IHS due to dural leak at the level of T12-L1. The site of CSF leakage was not detectable on either conventional magnetic resonance imaging (MRI) or T2-weighted MR myelography. However, it was evident on contrast-enhanced MR myelography (CE-MRM). The present report discusses the efficacy of CE-MRM in the detection of CSF leaks according to the literature so far.

Active MS plaques: efficiency of contrast-enhanced magnetization transfer subtraction technique

PURPOSE T1-weighted (T1W) magnetic resonance images with magnetization transfer (MT) are widely used in the evaluation of multiple sclerosis (MS) plaques. We aimed to evaluate the contribution of the subtraction technique with MT in the detection of acute MS plaques. MATERIALS AND METHODS Sixty-four patients during an MS attack were enrolled in the study. Axial T1W spin echo (SE) with MT, axial-sagittal T2W fast SE, axial FLAIR and postcontrast axial T1W SE magnetic resonance imaging sequence with MT were acquired from all patients. The subtraction (postcontrast-precontrast) images were obtained on the workstation. FLAIR and T2W images were used as reference for plaque imaging. Contrast material enhanced plaques were considered as acute plaques. Qualitatively, both subtracted and contrast-enhanced with MT images were evaluated visually. Quantitatively, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. RESULTS A total of 464 plaques were detected on T2W and FLAIR images. Thirty-five acute plaques were detected on both postcontrast MT and subtracted images. Additionally, 66 acute plaques were only detected on subtracted images visually. CNR and SNR values of acute MS plaques were significantly higher on subtracted MT images than on postcontrast MT images (P < 0.001). CONCLUSION The subtraction technique seems to facilitate the detection of acute MS plaques by intensifying the visibility of poorly enhanced plaques without use of high dose contrast medium. We suggest the use of subtraction technique in routine imaging work-up of MS patients with acute attacks.

Hairy cell leukemia presenting with Guillain-Barre syndrome.

Hairy cell leukemia (HCL) is a chronic B-cell lymphoproliferative disorder, which mainly infiltrates the bone marrow and the spleen, resulting in peripheral cytopenias and splenomagaly [1]. Unusual complications including autoimmune phenomena have been described in HCL [2 – 4]. Of these, to the best of our knowledge, Guillain-Barre syndrome (GBS) was reported only in two cases so far [5,6]. Here, we describe a HCL patient who presented with GBS at the time of diagnosis. A 61-year-old previously healthy male was referred to our department complaining of weight loss, night sweats, and pain, weakness and parasthesia progressing from distal to proximal limb muscles for the last 3 weeks. There was no preceding history of viral illness or vaccination or any medication. His physical examination revealed pale appearance, hepatomegaly (3 cm) and splenomegaly (3 cm). Precise neurological examination demonstrated second motor neuron type tetraparesis prominent in the lower extremities (20% muscle strength in lower, 80% in the upper extremities) with hypoactive deep tendon reflexes and loss of vibration sense. Blood picture showed Hb 10.9 g/dl, MCV 96 fl, WBC 10.66 10 l with 44% lymphocytes, 37% hairy cells, 17% PNL, and 2% band leukocyte differentiation, and a platelet count of 2126 10 l. Erythrocyte sedimentation rate was elevated (130 mm/h). Biochemistry tests were normal except for alkaline phosphatase. Serum cobalamin level was found in normal limits. Cytomorphological examination of the bone marrow demonstrated a normocellular marrow with hairy cells infiltration. Flow cytometry of the bone marrow cells revealed positivity for CD19 (64%), CD20 (96.1%), CD11c (98.8%), CD25 (99.1%), CD22 (98.9%), and CD103 (29.3%) and negativity for CD23 (8.5%) and CD5 (3.4%). Histopathological examination of the bone marrow established the diagnosis of HCL (Figure 1). Then, the patient was referred to the Neurology department for consultation. Whole spine magnetic resonance imaging was normal. Lumbar puncture was performed. Protein content of cerebrospinal fluid (CSF) was 201 mg/dl and CSF was acellular. Electroneuromyography (ENMG) was consistent with sensorymotor demyelinating polyneuropathy. The patient was diagnosed as GBS with albuminocytologic dissociation of CSF and ENMG findings reflecting demyelination in both sensory and motor nerves. He was treated with

The first Susac's syndrome case in Turkey

Susacs syndrome is a vasospastic disease resulting from bilateral microangiopathy of the brain, cochlea and retina. It is characterized by encephalopathy, bilateral sensorineural fluctuating hearing loss and visual loss. It is very uncommon and usually affects women during young adulthood. Since all three symptoms of the triad may not be present, the clinical diagnosis is difficult. Therefore, neuroimaging, particularly magnetic resonance imaging, has an important role in establishing the diagnosis. In this case report, we present a young woman who had all the symptoms of Susacs syndrome. This is the first Susacs syndrome case reported in Turkey.

Delayed diagnosis of a neuroBehçet patient with only brainstem and cerebellar atrophy: Literature review

We report a 34-year-old male neuroBehçets Disease (NBD) patient with atypical magnetic resonance imaging (MRI) findings, whose behavioral problems were followed by progressive neurological symptoms. The patient was hospitalized due to forgetfulness, irritability, behavioral dyscontrol and a choking sensation. T2-weighted MRI showed prominent atrophy of cerebellar hemispheres, the cerebellar peduncle, the midbrain and the pons. He was diagnosed with NBD after an evaluation of his medical history together with neuropsychiatric and laboratory findings. There are few reports of NBD with only brainstem and cerebellar atrophy. We discuss our patient in the context of the four previously reported cases. In NBD without evident mucocutaneo-ocular symptoms, neurologists should always consider the medical and family history. Early diagnosis of NBD helps to initiate appropriate treatment, thereby modulating the course of the disease and preventing complications.