Yasar Karatas

Telmisartan ameliorates oxidative stress and subarachnoid haemorrhage-induced cerebral vasospasm

Objectives: Growing evidence suggests that oxidative stress is one of the factors contributing to subarachnoid haemorrhage (SAH)-induced cerebral vasospasm. SAH-induced cerebral vasospam alters thioredoxin (Trx) cycle enzymes and thioredoxin-interacting protein (TXNIP) as an important endogenous antioxidant system. In this study, we have explored the effects of telmisartan on the vascular morphological changes, endothelial apoptosis, tissue oxidative stress status and the level of Trx cycle enzymes/ TXNIP in a rabbit SAH model. Methods: Forty male New Zealand rabbits were randomly divided into five groups of eight rabbits each: control group, sham group, SAH group, SAH + vehicle group and SAH + telmisartan group. SAH was created by a single cisterna magna blood injection. SAH + telmisartan group received telmisartan treatment (5 mg/kg intraperitoneal, once daily) for 72 h. The brainstem tissue Trx1, Trx2, Trx reductase (TrxR), TrxR1and TXNIP levels were investigated. Total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA) levels and tumour necrosis factor alpha (TNF alpha) levels were investigated. Basilar artery segments were investigated for cross-sectional area, wall thickness measurements and endothelial apoptosis. Results: Telmisartan treatment restored the lowered level of Trx1, TrxR, TAS and the expression of TrxR1 seen in SAH. Telmisartan treatment also decreased TXNIP expression, TOS, MDA and TNF alpha levels. Morphological changes of cerebral vasospasm were attenuated after treatment. Endothelial apoptosis significantly reduced. Discussion: Treatment with telmisartan ameliorates oxidative stress and SAH-induced cerebral vasospasm in rabbits. These effects of telmisartan may be associated with downregulation of TXNIP and upregulation of Trx/TrxR.

Congenital carotid-jugular fistula in a child: a case report.

Congenital carotid–jugular (CJ) fistula of the neck is a very rare clinical entity that has various causes. The CJ fistulas are particularly prone to complications unlike other peripheral arteriovenous fistulas. The aim of this report is to present a case of a CJ fistula between the external carotid and the external jugular vein, which was successfully closed with detachable balloon by an endovascular approach. A 14-year-old child was admitted to our clinic with a pulsatile neck swelling. There was no previous history of trauma. A high-flow fistula between the external carotid and the external jugular vein was determined. The fistula was closed with detachable balloon by an endovascular approach. The postoperative angiogram demonstrated complete resolution of the fistula. Endovascular treatment of CJ fistulas with detachable balloons is a safe and less traumatic technique and may be an effective alternative to the open surgery in selected patients.

Ruptured spinal artery aneurysm associated with coarctation of the aorta.

A 55-year-old woman presented with unconsciousness and tetraparesis. Routine blood tests were normal. Computed tomography (CT) of the brain showed ventricular hematoma and associated mild hydrocephalus (Fig. 1). Urgent external ventricular drainage was performed. Craniocervical magnetic resonance imaging showed an intradural paramedullary lesion primarily consistent with an aneurysm at the C6 level. Diffuse spinal hematoma and aneurysm was also seen on CT (Fig. 2). Computed tomography angiography showed coarctation of the aorta (Fig. 3). Spinal angiography showed coarctation of aorta with a ruptured, 10-mm, dissecting spinal artery aneurysm (SAA). The aneurysm was occluded successfully with endovascular coiling (Fig. 4). Spinal artery aneurysms are very rare pathologies. Coarctation of the aorta is a well-recognized risk factor for SAA aneurysm formation.

Primary tumor of thoracic vertebra: chondrosarcoma

A 46-year-old man who had a prior history of lung mass operation presented with back pain. On suspicion of recurrence physician performed thorax and mediastinal magnetic resonance imaging with contrast. A lobulated mass with cystic necrotic components on the T9 left paravertebral space that extended into the spinal column through the left neural foramen (Figs. 1 and 2) was found. Postcontrast images showed the heterogenous capsular enhancement. There was also a pleuralbased mass on the left lung lower lobe superior segment. [F]fluorodeoxyglucose positron emission tomography-computed tomography was performed to investigate metastasis. On positron emission tomography images, hypermetabolic focus (standardized uptake value max: 3.80) was seen in the left lung concordant with magnetic resonance imaging. Furthermore, the mass at the vertebral corpus and transverse process could be seen as increased fluorodeoxyglucose uptake (standardized uptake value max: 6.17) (Fig. 3). The patient underwent neurologic examination and the result was normal. He was operated and T9 corpectomy and T8–T10 posterior fixation-fusion were performed. Pathologically, the tumor was diagnosed as low-grade chondrosarcoma.

A Case of Upper Thoracic Intradural-Extramedullary Multiple Meningiomas

Intradural spinal tumors are classified into extramedullary and intramedullary tumors. The most frequent intradural-extramedullary tumors are meningiomas and neurinomas. Meningiomas mostly occur in thoracic region and are generally located at the dorsal aspect. Multiplicity is a rare condition for spinal meningiomas, and multiple spinal meningiomas are usually associated with neurofibromatosis. In this report, we present a case of thoracic spinal multiple meningiomas which was located at the ventral aspect and not associated with neurofibromatosis.

New clues in the malignant progression of glioblastoma: can thioredoxin system play a role?

AIM To evaluate and compare the expression of thioredoxin reductase 1 (TrxR1) in primary and secondary glioblastoma samples. MATERIAL AND METHODS Surgically resected human glioblastoma samples from 40 patients who underwent surgery at our institution were extracted from their histopathological specimens and divided into three groups. Ten histopathologically regular cerebral tissue samples, acquired from the non-neoplastic portion of the specimens, were assigned as the control group. Twenty specimens that included tumoral tissue from each type of glioblastoma (WHO grade IV, primary and secondary) were assigned as the primary and secondary glioblastoma groups. TrxR1 expression was analyzed by using both quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunohistochemistry. Isocitrate dehydrogenase 1 (IDH1) mutation was analyzed by immunohistochemistry. Ki-67 proliferative index and apoptosis were also analyzed by immunohistochemistry. The differences between the groups were statistically compared and the correlation between these parameters was analyzed. RESULTS The expressions of TrxR1 and Ki-67 values were significantly higher in primary glioblastoma. IDH1 mutation was significantly higher in secondary glioblastoma. TrxR1 expression was found to be highly correlated with the Ki-67 index. The apoptotic index was similar between primary and secondary glioblastoma. CONCLUSION This study showed a high TrxR1 expression in primary glioblastoma which could indicate a role of the Trx system in promoting the malignant progression by some complex processes.

Dura Mater and Epidural Space

Tuberculosis (TB) remains as a major public health issue along the world especially in the underdeveloped and some developing countries. Central nervous system (CNS) TB has a wide spectrum of clinical manifestations depending on the phase of the infection and affected component of the nervous system. Dura mater has an invasion limiting ability due to its unique structure consisting of tenacious interlocking fibroblasts and collagen fibres that act as a firm barrier for infections. But also dura mater has a good blood supply that makes it a possible target for haematogenous spreading of invasive diseases. Isolated dural and epidural TB of the CNS is an extremely rare pathology that involves epidural abscess or tuberculoma and cranial pachymeningitis. In this section, we aimed to review the pathogenesis, imaging and treatment of this rare but potentially hazardous pathology.

A case of symptomatic synchronous cervical and cerebellar metastasis after resection of thoracal metastasis from temporal glioblastoma multiforme without any local recurrence

Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults and it is usually occurs between the age of 40 and 60 years. It is local invasive and recurrent tumor and hence that has a poor prognosis. However, recent advances in tumor surgery, irradiation and chemotherapeutic agent permit long survival and metastasis which is symptomatic. Previously studies reported spinal metastasis, but we report a first case of synchronous symptomatic cerebellar and cervical spinal metastasis after resection of symptomatic thoracic spinal metastasis from temporal GBM without any recurrence of excision areas.