Conventional and contrast-enhanced MR angiographic techniques for the interpretation of cerebral aneurysms and vascular malformations

Bu makalede, intrakranyal anevrizma ve arteryovenöz malformasyon, kavernöz anjiyom ve venöz anomaliler gibi intrakranyal vasküler malformasyonların konvansiyonel ve kontrastlı manyetik rezonans anjiyografi teknikleriyle tanınması ve bu tekniklerin belirtilen durumlarda avantaj ve dezavantajları değerlendirildi.In this review, we evaluated identification of intracranial aneurysms and intracranial vascular malformations such as arteriovenous malformations and cavernous angiomas and venous anomalies by conventional and contrast magnetic resonance angiography, together with the merits and demerits of these techniques

Lumbar opening pressure and radiologic scoring in idiopathic intracranial hypertension : is there any correlation?

Background: To investigate correlation between lumbar opening pressure (LOP) and radiological scores based on cranial MRI and contrast-enhanced MR venography in patients with idiopathic intracranial hypertension (IIH). Material/Methods: Patients with IIH who underwent brain MRI and contrast-enhanced MR venography before measurement of LOP between 2010-2014 were evaluated retrospectively. Three experienced radiologists (blinded to LOP values) evaluated a total of 51 patients. They reached a consensus on the presence or absence of 6 radiological findings identified in the literature as characteristic for IIH: empty sella, perioptic dilation, optical tortuosity, flattening of the posterior globe, swelling of the optic disc, and bilateral transverse sinus stenosis. The radiological score was obtained by giving 1 point for the presence of each finding, with the highest possible score of 6 points. The correlation between the calculated radiological scores and LOP was evaluated. Results: There was no significant correlation between LOP and radiological scores (r=0.095; p=0.525, Spearman's rank coefficient). Similarly, no significant correlation was detected between LOP and each of the radiological findings (partial empty sella [p=0.137], perioptic dilation [p=0.265], optical tortuosity [p=0.948], flattening of the posterior globe [p=0.491], swelling of the optic disc [p=0.881], and bilateral dural sinus stenosis [p=0.837], Mann-Whitney U test). Conclusions: There was no significant correlation between LOP and reliable radiological features of IIH

Hepatic encephalopathy and atypical cortical involvement in cranial MRI: Case report

Hepatik ensefalopati karaciğer fonksiyon bozukluğuna bağlı olarak hastalarda nöropsikiyatrik belirtilerin gelişimi ile karakterizedir. Siroz, portal hipertansiyon veya porto-sistemik şantlar ve akut karaciğer yetmezliği durumlarında gelişebilir. Hafif mental durum bozukluklarından derin komaya kadar değişen geniş bir klinik tablo ile ortaya çıkabilir. Manyetik rezonans görüntüleme (MRG) başta olmak üzere nöro-görüntüleme teknikleri hepatik ensefalopati tanısında kullanılabilir. Sağlıklı bireylerde kolayca metabolize edilebilen maddelerin birikimine bağlı olarak özellikle T1 ağırlıklı MRG'de iki yanlı globus pallidus yapılarında sinyal artışı izlenir. Hepatik ensefalopatide kortikal tutulum oldukça nadir bildirilmiştir. Bu yazıda kortikal ve subkortikal yapıların tutulumu ile seyreden bir hepatik ensefalopati olgusu sunulmuştur.Hepatic encephalopathy is characterized by neuropsychiatric abnormalities occurring in patients with liver dysfunction. It most commonly occurs in association with cirrhosis, portal hypertension, portal-systemic shunts and acute liver failure. Clinical features of hepatic encephalopathy varies between mild cognitive impairment to deep coma. Several neuroimaging techniques, especially magnetic resonance imaging (MRI), may eventually be useful for the diagnosis of hepatic encephalopathy. Cranial MRI may demonstrate high signal intensity in the bilateral globus pallidum on T1-weighted images. Cortical involvement due to hepatic encephalopathy is rarely reported in the literature. We presented here a case of hepatic encephalopathy with cortical and subcortical involvement

Subdural and Cerebellar Hematomas Which Developed after Spinal Surgery: A Case Report and Review of the Literature

Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2 mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings

Efficacy of Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography (3D CE-MRA) in the Diagnosis of Thoracic Outlet Syndrome

Objective: The purpose of this study is to evaluate the effect of various upper extremity positions (adduction-abduction) on vascular structures in contrast-enhanced three-dimensional MR angiographic studies performed in patients with thoracic outlet syndrome.Materials and Methods: Twenty-two consecutive patients with clinical symptoms of neurovascular thoracic outlet syndrome were examined by 1.0 T MR unit. Examinations were studied by three-dimensional contrast-enhanced MR angiography with the arms positioned in abduction and adduction in the same patients. Results: In twenty-one of 44 subclavian arteries, impingement or stenosis with different degrees were found. Majority of lesions were localized in the costoclavicular region. Venous phase sequences of contrast-enhanced MR angiography showed compression of the subclavian vein in the 17 areas.Conclusion: Thoracic outlet syndrome remains controversial in both diagnosis and treatment, particulary in patients with no muscle atrophy, hand ischemia findings or venous stasis symptoms. Three-dimensional contrast-enhanced MR angiography is noninvasive and requires neither ionizing radiation nor administration of iodinated contrast material- and may be used to diagnose early compression findings and stenosis of the subclavian vessels

Ad dress for Cor res pon den ce/Ya z›fl ma Ad re si: A Rare Cause of Headache and Increased Intracranial Pressure: Primary Leptomeningeal Melanomatosis Sum mary Özet

Primary leptomeningeal melanomatosis is a rare central nervous system neoplasm originating from leptomeningeal melanocytes. The cases can be presented with focal neurologic deficit, seizure, neuropsychiatric symptoms or increased intracranial pressure symptoms along with encephalitis or meningitis. Diagnosis can be made upon imaging studies, cytopathologic examination of cerebrospinal fluid and biopsy. Biopsy can return false negative since the leptomeningeal involvement is not diffuse. In this study, a case is presented who admitted to hospital with leptomenengitis symptoms such as headache, fever and altered state of consciousness and developed additional neurologic signs after months. First biopsy came out as normal while the second one did as positive. This case has been found worth presenting since this is a tumor of rare existence and the diagnosis was made upon the second biopsy. (Turkish Journal of Neurology 2014; 20:138-140) Key Words: Primary leptomeningeal melanoma, headache, increased intracranial pressure, leptomenengitis Conflict of interest: The authors reported no conflict of interest related to this article. Primer leptomeningeal melanomatozis, leptomeningeal melanositlerden kaynaklanan merkezi sinir sisteminin oldukça nadir görülen bir neoplazmıdır. Ensefalit yada menenjit yanında fokal nörolojik defisit, nöbet, nöropsikiyatrik semptomlar veya kafa içi basınç artışı semptomları ile presente olabilmektedirler. Tanı, görüntüleme teknikleri, beyin omurilik sıvısının sitopatolojik incelemesi ve biyopsi ile konulabilmektedir. Leptomeningial tutulum diffüz olmadığı için biyopsi yanlış negatif çıkabilir. Bu çalışmada baş ağrısı, ateş ve bilinç bulanıklığı gibi genel leptomenenjit kliniği ile baş vuran ve aylar sonra nörolojik ek belirtiler eklenen bir hasta sunuldu. İlk biyopsi normal olarak yorumlanmış ve ikinci biyopsi pozitif olarak saptanmıştır. Oldukça nadir rastlanan bir tümör olduğu ve ikinci biyopsi ile tanı konulabildiği için bu olgu sunulmaya değer görülmüştür. (Türk Nöroloji Dergisi 2014; 20:138-140) Anah tar Ke li me ler: Primer leptomeningeal melanoma, baş ağrısı, intrakranial basınç artışı, leptomenenjit Çıkar çatışması: Yazarlar bu makale ile ilgili olarak herhangi bir çıkar çatışması bildirmemişlerdir