Ramazan Kutlu

The crowned dens syndrome : a rare form of calcium pyrophosphate deposition disease

The crowned dens Syndrome has been termed as acute neck pain ascribed to CPPD deposits associated with a tomographic appearance of calcification surrounding the odontoid process. This rare entity resulting in cervical cord compression is generally seen in older female patients. We present a 26-year-old woman with cervical cord compression due to massive calcification in the periodontoid area and discuss the X-ray and CT findings of the disease.

Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis

The purpose of this study was to evaluate the Doppler sonographic blood‐flow parameters and spectral patterns in the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) in patients with active and inactive (remission‐phase) ulcerative colitis (UC).

Cervical myositis ossificans traumatica: a rare location

Abstract. An unusual case of myositis ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.

Delayed myelination in a rhizomelic chondrodysplasia punctata case: MR spectroscopy findings

Rhizomelic chondrodysplasia punctata is a member of genetic peroxisomal disorders. Delayed myelination, which is probably related to the inadequacy of plasmalogens biosynthesis, is an important feature of this disorder. Direct assessment of neuropathologic aspects of RCDP syndrome such as neuronal degeneration and delayed myelination is possible with MR spectroscopy. In this report, MR spectroscopy findings (decreased Cho/Cr and increased Ins-Gly/Cr ratios and increased levels of mobile lipids) of a rhizomelic chondrodysplasia punctata case supporting delayed myelination are presented. This is the second report of MR spectroscopy examination of the specific brain metabolic changes associated with rhizomelic chondrodysplasia punctata.

Subacute sclerosing panencephalitis: Relationship between clinical stage and diffusion‐weighted imaging findings

To investigate the relationship between clinical stages and apparent diffusion coefficient (ADC) changes in the brain of patients with subacute sclerosing panencephalitis (SSPE).

Renal Interlobar Artery Parameters with Duplex Doppler Sonography and Correlations with Age, Plasma Renin, and Aldosterone Levels in Healthy Children

OBJECTIVE The objectives of this study were to compare and make correlations between age and Doppler parameters of the interlobar arteries, including synchronously obtained plasma renin and aldosterone levels and to obtain new normative data regarding acceleration time in healthy children from neonates to 16 years. SUBJECTS AND METHODS One hundred sixty-nine healthy children (72 girls and 97 boys) were classified into four groups: group 1 (< 1 year; n = 34), group 2 (range, 1-6 years; n = 48), group 3 (range, 6-12 years; n = 50), and group 4 (range, 12-16 years; n = 37). Blood samples from the renin and aldosterone were collected in the morning after bed rest and fasting. The resistive index (RI), pulsatility index (PI), and the acceleration time of the renal interlobar arteries with duplex Doppler sonography, including both kidney longitudinal lengths with grayscale sonography, were evaluated. One-way analysis of variance with the least significant difference post-hoc test and Pearsons correlation test were used to compare the differences between groups and to make correlations, respectively. An independent-sample t test was used to evaluate the differences between all parameters based on sex and to compare the left and right kidney longitudinal lengths in each group. RESULTS The RI, PI, and acceleration time were statistically significant in between-group comparisons. Only in group 4 was acceleration time not statistically significant compared with groups 2 and 3. Plasma renin levels were significantly higher in group 1 compared with groups 2 (p < 0.03) and 4 (p < 0.0001); in group 2 compared with group 4 (p < 0.05); and in group 3 compared with group 4 (p < 0.01). The plasma aldosterone levels were significantly higher only in group 1 compared with groups 2 (p < 0.001), 3 (p < 0.008), and 4 (p < 0.0001). The RI correlated linearly with the PI, plasma renin levels, and aldosterone levels and correlated inversely with acceleration time. Age had a negative correlation with the RI, PI, plasma renin levels, and aldosterone levels and correlated positively with acceleration time. There were no statistically significant differences between all parameters based on sex and no significant difference found between the right and left kidney longitudinal lengths in each group. CONCLUSION The RI in children up to 54 months old is higher than in adults. Therefore, the adult mean renal RI criterion of 0.70 should be applicable to children 54 months old and older. We showed that the age dependency of the RI was directly related to that of plasma renin and aldosterone levels in healthy children in whom Doppler parameters and blood analysis were evaluated synchronously.

Proton MR spectroscopy features of normal appearing white matter in neurofibromatosis type 1

To determine whether differences exist between neurofibromatosis type 1 (NF1) patients with or without focal lesions and healthy normal volunteers in the metabolite ratios of normal appearing white matter, 27 patients with NF1 (with parenchymal lesion, MR positive, n: 17; without parenchymal lesions, MR negative, n: 10) and 20 healthy volunteers underwent MRI and short TE (31 ms) proton MR spectroscopy (MRS). In 17 patients with parenchymal lesions, 61 focal lesions were detected by MRI. MRS was performed from normal appearing frontal and posterior parietal white matter (FWM and PWM) in NF1 and from control groups. NAA/Cr, Cho/Cr and MI/Cr ratios were calculated. Significant increase in Cho/Cr and MI/Cr ratios were found in FWM and PWM in MR negative and positive groups when compared to control group. NAA/Cr ratio in MR positive group was significantly decreased in FWM compared to control group. There were no significant differences between FWM and PWM in all metabolite ratios of MR negative group. MI/Cr ratio in MR positive group was significantly elevated in PWM compared to FWM. Metabolite changes detected by MRS could indicate demyelination and gliosis in normal appearing white matter in all NF1 patients, and additionally neuroaxonal damage in the FWM of NF1 patients with focal lesions. For that reason, in the clinical evaluation and follow-up of these patients MRS features of normal appearing white matter should be considered in addition to focal lesions.

Pyridoxine-Dependent Seizures: Magnetic Resonance Spectroscopy Findings:

Pyridoxine-dependent seizures are an extremely rare genetic disorder. Early diagnosis and treatment are important for the prevention of permanent brain damage. Elevated levels of glutamate and decreased levels of γ-aminobutyric acid (GABA) in the frontal and parietal cortices are among the characteristic features of this disorder. These metabolic abnormalities eventually lead to seizures and neuronal loss. In this case report, we present magnetic resonance spectroscopy findings of a 9-year-old girl with pyridoxine-dependent seizures with mental retardation. The N-acetyl-aspartate-to-creatine ratio was found to be decreased in the frontal and parieto-occipital cortices, which could indicate neuronal loss. Magnetic resonance spectroscopy could be a useful tool in the neuroimaging evaluation for assessment of parenchymal changes despite a normal-appearing brain magnetic resonance image in patients with pyridoxine-dependent seizures. (J Child Neurol 2004;19:75—78).

Brain MR spectroscopy in children with a history of rheumatic fever with a special emphasis on neuropsychiatric complications

PURPOSE To investigate whether there are metabolite changes in basal ganglia of children with complete healing of rheumatic fever (RF), history of Syndenham chorea (SC) and obsessive compulsive-tic disorder (OCTD) developed after RF when compared with healthy controls and each other. MATERIAL AND METHODS A total of 49 children with history of RF and 31 healthy controls were included into the study. All patients and control group underwent a detailed neuropsychiatric evaluation. Children with the history of RF were classified into three groups as; group 1: with history of RF without neuropsychiatric complications (NCRF), group 2: only with history of SC (HSC), group 3: with HSC and OCTD (OCTD). After MR imaging, single voxel MR spectroscopy was performed in all subjects. Voxels (15 x 15 x 15 mm) were placed in basal ganglia. N-acetyl aspartate (NAA)/creatin (Cr), and choline (Cho)/Cr ratios were calculated. RESULTS OCTD were detected in 13 children with HSC. NAA/Cr ratio was found to be decreased in these children when compared with NCRF (n:29), HSC without OCTD (n:7) and control groups (n:31). No significant difference was found in metabolite ratios of children with HSC without OCTD when compared with NCRF and control groups. There were no significant differences in Cho/Cr ratio between patient and control groups. CONCLUSION Although MR imaging findings was normal, MR spectroscopy findings (decreased NAA/Cr ratio) in our study support the neuronal loss in basal ganglia of children with OCTD and could indicate the development of permanent damage.

Duplicate origin of left vertebral artery with thrombosis at the origin: Color Doppler sonography and CT angiography findings

We describe a rare case of vertebral artery duplication in a patient with vertigo, weakness, and nausea. A color Doppler examination revealed a duplicate origin of the left vertebral artery and a hyperechoic thrombus at the origin of 1 of the duplicated arteries. CT angiography of the lower neck area demonstrated duplicated vertebral arteries on the left side. MR angiography of the vertebrobasilar system did not show duplication, indicating that the duplicated vertebral arteries fused at a level higher than C2.