A case of cerebral amyloid angiopathy associated with cerebral venous thrombosis

Cerebral amyloid angiopathy is a clinical picture which is commonly seen in elderly and progressing with the deposition of amyloid in the cerebral arteries without systemic amyloidosis. We report the first case in the literature, a 71 year-old patient having an association of cerebral vein thrombosis and cerebral amyloid angiopathy presenting with recurrent cerebral hemorrhages. The cause-and-result relationship of this association of cerebral vein thrombosis and cerebral amyloid angiopathy should be investigated

The Limbic Degradation of Aging Brain: A Quantitative Analysis with Diffusion Tensor Imaging

WOS: 000335020000001PubMed ID: 24977184Introduction. The limbic system primarily responsible for our emotional life and memories is known to undergo degradation with aging and diffusion tensor imaging (DTI) is capable of revealing thewhite matter integrity. Theaimof this study is to investigate agerelated changes of quantitative diffusivity parameters and fiber characteristics on limbic system in healthy volunteers. Methods. 31 healthy subjects aged 25-70 years were examined at 1,5 TMR. Quantitative fiber tracking was performed of fornix, cingulum, and the parahippocampal gyrus. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) measurements of bilateral hippocampus, amygdala, fornix, cingulum, and parahippocampal gyrus were obtained as related components. Results. The FA values of left hippocampus, bilateral parahippocampal gyrus, and fornix showed negative correlations with aging. The ADC values of right amygdala and left cingulum interestingly showed negative relation and the left hippocampus represented positive relation with age. The cingulum showed no correlation. The significant relative changes per decade of age were found in the cingulum and parahippocampal gyrus FA measurements. Conclusion. Our approach shows that aging affects hippocampus, parahippocampus, and fornix significantly but not cingulum. These findings reveal age-related changes of limbic system in normal population that may contribute to future DTI studies

“Thickened” ligamentum flavum caused by laminectomy

Objective The purpose of this study was to evaluate the effect of a laminectomy on the adjacent ligamentum flavum (LF) by measuring LF thickness using magnetic resonance imaging (MRI). Materials and methods A total of 78 patients (31 man, 47 woman) with laminectomy were included in our study. After determination of laminectomy level, measurements were done from the thickest parts of the bilateral LF at the upper level of the laminectomy where bilateral facet joints were evident at the slice. Results Ipsilateral ligamentum flavum with laminectomy was significantly thicker than the contralateral ligamentum flavum with laminectomy. Conclusion Laminectomy cause thickening of ligamentum flavum. Therefore we assume that it should kept in mind that LFH may develop at the adjacent level to the laminectomy and careful clinical and radiological assessments’ should be done to exclude LFH in cases who complain about the recurrence of complaints during the post-operative period after laminectomy

Comparative Lateralizing Ability of Multimodality MRI in Temporal Lobe Epilepsy.

Purpose. The objective is to compare lateralizing ability of three quantitative MR (qMRI) modalities to depict changes of hippocampal architecture with clinical entities in temporal lobe epilepsy. Methods. We evaluated 14 patients with clinical and EEG proven diagnosis of unilateral TLE and 15 healthy volunteers. T1-weighted 3D dataset for volumetry, single-voxel 1H MR spectroscopy (MRS), and diffusion tensor imaging (DTI) were performed for bilateral hippocampi of all subjects. Results. Individual volumetric measurements provided accurate lateralization in 85% of the patients, spectroscopy in 57%, and DTI in 57%. Higher lateralization ratios were acquired combining volumetry-spectroscopy (85%), spectroscopy-DTI (85%), and volumetry-DTI (100%). Significantly decreased NAA/(Cho+Cr) ratios (p = 0.002) and increased FA (p = 0.001) values were obtained in ipsilateral to epileptogenic hippocampus. Duration of epilepsy and FA values showed a significant negative correlation (p = 0.016, r = -0.847). The history of febrile convulsion associated with ipsilateral increased ADC values (p = 0.015, r = 0.851) and reduced NAA/(Cho+Cr) ratios (p = 0.047, r = -761). Conclusion. Volumetry, MRS, and DTI studies provide complementary information of hippocampal pathology. For lateralization of epileptogenic focus and preoperative examination, volumetry-DTI combination may be indicative of diagnostic accuracy

Successful Vaginal Delivery in Spite of a Large Pelvic Neurofibroma

Neurofibromatosis (NF) is an autosomal dominant genetic disorder and pregnancy in a patient with NF is associated with very poor perinatal outcome and life-threatening complications. In addition, the growth of pelvic tumors during pregnancy can be caused to dystocia and delivery is accomplished by cesarean section. We presented a case with a large pelvic nerve tumor not causing any dystocia or obstruction to the labor, allowing vaginal delivery A 26 year old primigravida, diagnosed NF, had a large neurofibroma (about 8x9 cm diameter size) in pelvis infront of the sacrum. No significant change was detected in NF lesions. After an uneventfully antenatal follow-up, the patient gave a birth with vaginal delivery at term, even had a pelvic mass almost equal to the size of the fetal head causing no birth dystocia. If not otherwise fetally or maternally indicated, initiation of labor and the course of labor should be observed and vaginal delivery should be attempted for the pregnant has a pelvic neurofibroma, before a decision for cesarean section is made

Listeria Meningoencephalitis in Immunocompetent Person Complicated with Hydrocephalus

Listeria monocytogenes is a common cause of central nervous system infection, especially in immunosuppressed patients, infants, and the elderly and in pregnancy; it is uncommon in individuals with immunocompetent status. In this case report, we aimed to present the case of an immunocompetent 45-year-old patient who presented with meningoencephalitis due to Listeria, which was complicated with hydrocephalus

Comparative Lateralizing Ability of Multimodality MRI in Temporal Lobe Epilepsy

Purpose. The objective is to compare lateralizing ability of three quantitative MR (qMRI) modalities to depict changes of hippocampal architecture with clinical entities in temporal lobe epilepsy. Methods. We evaluated 14 patients with clinical and EEG proven diagnosis of unilateral TLE and 15 healthy volunteers. T1-weighted 3D dataset for volumetry, single-voxel (HMR)-H-1 spectroscopy (MRS), and diffusion tensor imaging (DTI) were performed for bilateral hippocampi of all subjects. Results. Individual volumetric measurements provided accurate lateralization in 85\% of the patients, spectroscopy in 57\%, and DTI in 57\%. Higher lateralization ratios were acquired combining volumetry-spectroscopy (85\%), spectroscopy-DTI (85\%), and volumetry-DTI (100\%). Significantly decreased NAA/(Cho+Cr)ratios (p = 0.002) and increased FA (p = 0.001) values were obtained in ipsilateral to epileptogenic hippocampus. Duration of epilepsy and FA values showed a significant negative correlation (p = 0.016,r = -0.847). The history of febrile convulsion associated with ipsilateral increased ADC values (p = 0.015,r = 0.851) and reduced NAA/(Cho+Cr) ratios (p = 0.047,r = -761). Conclusion. Volumetry, MRS, and DTI studies provide complementary information of hippocampal pathology. For lateralization of epileptogenic focus and preoperative examination, volumetry-DTI combination may be indicative of diagnostic accuracy

Evaluation of local carotid stiffness and inflammatory biomarkers in stable angina pectoris

Introduction: Arterial stiffness (AS) is a well-accepted and reliable predictor of atherosclerotic diseases. Inflammation plays an important role in the development of AS. Aim : To evaluate local carotid stiffness (CS) together with fibrinogen and high-sensitivity C-reactive protein (hsCRP) levels in stable angina pectoris (SAP) patients. Material and methods : The study consisted of 353 consecutive patients with SAP. All underwent coronary angiography (CAG) after the evaluation of local CS parameters and carotid intima-media thickness (IMT) from both common carotid arteries by a real-time echo-tracking system. Baseline inflammatory biomarkers, serum hsCRP and fibrinogen levels were measured. Based on CAG findings, the patients were classified into 4 groups: control subjects with normal coronary arteries (group 1, n = 86), single-vessel disease (group 2, n = 104), double-vessel disease (group 3, n = 95) and triple-vessel disease (group 4, n = 68). Results : The mean carotid pulse wave velocity (PWV) in patients with angiographically confirmed coronary artery disease (CAD) was significantly higher than that in patients with normal coronary arteries (7.82 ±1.76 vs. 6.51 ±0.85 cm/s, p = 0.001). The mean carotid IMT was detected to be significantly higher in group 4 patients compared to those in group 1 (p < 0.001) and group 2 (p = 0.001). Significant correlations were observed between both inflammatory biomarkers and the number of diseased vessels and carotid PWV. Using multi-variate analysis, carotid stiffness, carotid IMT, hsCRP and fibrinogen were independently associated with the presence and extent of CAD. Conclusions : Local CS, carotid IMT, hsCRP and fibrinogen levels are significant predictors of atherosclerotic burden and they may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CAD