Challenges in the clinical and radiological differential diagnosis of cerebrovascular events and malignant primary brain tumors: reports from a retrospective case series

AIM: To reveal difficulties in differential diagnosis of some cases of cerebrovascular events (CVEs) and malignant primary brain tumors (MBTs) even a multidiciplinary evaluation in grand rounds. MATERIAL and METHODS: This study retrospectively analyzed the patient archives from January 2017–December 2019. The records of 572 patients discussed in these meetings were examined. A total of 8 patients having a challenge in differential diagnosis were detected. RESULTS: This study has included 8 cases in which neurology−neurosurgery−neuroradiology clinicians have difficulty in differentiating CVE and MBT. In the present study, three patients were evaluated with a preliminary diagnosis of hemorrhagic CVE in the emergency room. Since degradation products of hemoglobin have prevented advanced imaging methods to diagnose in two patients, these patients have been followed closely. The correct diagnosis could be made through the scan performed during control follow-ups The preliminary diagnosis of seven patients was CVE, but they received the MBT diagnosis during the follow-up. One patient was thought to have MBT initially; however, he/she was diagnosed with CVE after an advanced examination and close follow-up. CONCLUSION: Despite developing medical imaging methods and diagnostic studies, there are still some difficulties in making differential diagnosis of CVEs and MBTs. In some patients, further examination and imaging methods may be needed such as magnetic resonance imaging-spectroscopy (MRI-S), perfusion magnetic resonance imaging (Per-MRI), digital substratioangiography (DSA). Despite all these neuroradiological examinations and multidiciplinary evaluation, distinction between CVE and MBT may be difficult, and medicolegal problems may be encountered

Assessment of the risk factors of congenital nasolacrimal duct obstruction in term newborns

Amaç: Çalışmamızın amacı, miadında doğan bebeklerde konjenital nazolakrimal kanal tıkanıklığı (NLKT) risk faktörlerinin değerlendirilmesidir. Gereç ve Yöntemler: Bu retrospektif ve kesitsel çalışmaya, Ocak 2010-Mayıs 2018 tarihleri arasında göz hastalıkları polikliniğine başvuran ve konjenital NLKT tanısı olan bebekler ve sağlıklı bebekler dâhil edildi. Çalışmaya dâhil edilen bebeklerin gestasyonel yaşı, doğum kilosu, doğum şekli ile annenin yaşı, daha önceki canlı doğum sayısı, gebelik sırasında ilaç kullanımı gerektiren sistemik enfeksiyon öyküsü ve sigara kullanımı hasta dosyalarından tarandı. Konjenital NLKT’si bulunan hastalar NLKT grubuna dâhil edilirken, hiçbir sağlık problemi olmayan bebekler ise kontrol grubuna alındı. Bulgular: Çalışmaya dâhil edilen 2060 bebekten konjenital NLKT tanısı olan 1030 bebek NLKT grubuna dâhil edilirken 1030 sağlıklı bebek kontrol grubuna dâhil edildi. Konjenital NLKT’nin sezaryen ile doğan bebeklerde istatistiksel anlamlı olarak daha sık olduğu tespit edildi (p<0,001). Bilateral konjenital NLKT’nin sezaryen ile doğan bebeklerde istatistiksel anlamlı olarak daha sık olduğu tespit edildi (p=0,035). Regresyon analizi sonucunda sezaryen ile doğumun konjenital NLKT riskini 1,4 kat artırdığı tespit edildi (p<0,001). Gestasyonel yaşın, doğum ağırlığının, anne yaşının, kardeş sayısının, sigara kullanımının, gebelik sırasında ilaç kullanımı gerektiren sistemik enfeksiyon hikâyesinin ve kardeşlerde konjenital NLKT hikâyesinin bu gelişimsel bozukluk için risk faktörü olmadığı tespit edildi (p>0,05). Sonuç: Çalışmamız, miadında doğan bebeklerde sezaryen ile doğumun, konjenital NLKT riskini artırdığını göstermiştir.Objective: To assess the risk factors of congenital nasolacrimal duct obstruction (NLDO) in term newborns. Material and Methods: This retrospective and cross-sectional study included healthy newborns and newborns that were diagnosed with NLDO between January 2010 and May 2018. Gestational age, birth weight, delivery methods, maternal age, maternal parity, history of systemic infection that required systemic drug use during pregnancy and history of smoking were noted. Patients with congenital NLDO formed the NLDO group and healthy newborns with no medical history formed the control group. Results: Present study included 2060 newborns. 1030 patients with congenital NLDO were included in the NLDO group and 1030 healthy newborns were included in the control group. Congenital NLDO was more frequent in babies born via cesarean section (p<0.001). Bilateral NLDO was also more frequent in babies born via cesarean section (p=0.035). Regression analysis revealed that congenital NLDO risk was 1.4- fold higher in patients born via cesarean section (p<0.001). Gestational age, birth weight, delivery methods, maternal age, maternal parity, smoking, history of systemic infection that required systemic drug use during pregnancy and history of congenital NLDO in siblings were not considered as risk factor for congenital NLDO (p>0.05). Conclusion: The present study showed that cesarean delivery increased the risk of congenital NLDO in term newborns

Penetrating transorbital intracranial foreign body

Yedi yaşında erkek çocuk, sol gözüne sanayi tipi dikiş makinesi iğnesinin batması şikayeti ile acil servise getirildi. Dikiş iğnesi sol orbitadan girerek sfenoid kemiği delmiş ve sol temporal lobun dura yaprakları içine uzanmaktaydı. Cerrahi tedavi uygulanan olguda ameliyat sonrası dönemde komplikasyon oluşmadı. Orbitadan girerek beyine kadar uzanan penetran yabancı cisimler intraserebral hematom, beyin apsesi, menenjit, beyin omurilik sıvısı (BOS) fistülü, proptosis, diplopi, orbital sellülit ve periorbital apse gibi komplikasyonlara neden olabilirler. Bu komplikasyonları önlemek için penetran transorbital uzanımlı yabancı cisimler cerrahi yaklaşımla çıkartılmalıdır.We report a seven year-old boy who suffered left orbital penetration of an industrial sewing machine needle. The needle passing through the left orbit and sphenoid bone at the posterior was extending into the layers of the dura of the left temporal lobe. In this patient, we preferred surgical approach and there was no complication after surgery. Penetrating intraorbital foreign materials with intracranial extension may lead to complications such as intracerebral hematoma, brain abscess, CSF fistula, proptosis of the eye, diplopia, orbital cellulitis and periorbital abscess. They have to be removed by surgical approach to prevent potential complications

FAHR SYNDROME - Three cases presenting with psychiatric signs

Fahr syndrome, a clinical entity that manifests with various signs and symptoms and has a familial predisposition is characterized by symmetric calcification of basal ganglia. It may present with neuropsychiatric, extrapyramidal and cerebellar symptoms. The etiology has not been defined yet. Three cases of Fahr syndrome; presenting with various clinical signs and psychiatric symptoms are reported in this article. The first case that occured following Brucella treatment and the other two occuring idiopathically are evaluated with a neuropsychiatric approach

A case of superior sagittal sinus thrombosis after closed head injury

Süperior sagittal sinüs trombozu (SSST) nadir görülen bir hastalıktır. Genellikle enfeksiyon, dehidratasyon ve hematolojik rahatsızlıklara bağlı gelişir. Travmaya bağlı gelişmesi son derece nadir bir durumdur. Bu yazıda kapalı kafa travması sonrası SSST saptanan 13 yaşında bir erkek çocuk hasta sunuldu. Görüntüleme incelemelerinde çökme kırığına bağlı gelişen SSST saptandı. Hastanın nörolojik muayenesi iki taraflı papil stazı dışında normal bulundu; hasta anti-ödem ve antikonvülzan ilaçlarla tedavi edildi. Sekiz ay sonraki kranyal manyetik rezonans venografide süperior sagittal sinüsün açık olduğu izlendi ve nörolojik muayene bulguları normal olarak değerlendirildi.Superior sagittal sinus thrombosis (SSST) is a rare entity, most often arising from infections, dehydration, and hematologic disorders. Development of this condition secondary to trauma is extremely rare. In this report, a 13-year-old boy who developed SSST following a closed head injury is presented. Imaging studies showed SSST caused by a depressed skull fracture. Neurologic examination of the patient was normal other than bilateral papillary stasis. He was treated with antiedematous and anticonvulsant drugs. Magnetic resonance venography obtained eight months after the diagnosis showed unoccluded superior sagittal sinus, neurologic examination findings were normal, as well

Anterior Servikal Omurga Cerrahisi Revizyonuna Ba��l� ÖZafagus Perforasyonu

Oesophageal perforation is a rare but potentially life threatening complication due to anterior cervical spine surgery (ACSS). In this report, we present a 55-year-old woman with a complication of oesophageal injury following an ACSS with a successful outcome.Özafagus perforasyonu nadir fakat anterior servikal omurga cerrahisine (ASOC) bağlı potansiyel olarak yaşamı tehdit eden bir komplikasyondur. Bu yazıda, ASOC sonrasında özafagus yaralanması komplikasyonu gelişen ve başarıyla tedavi edilen 55 yaşındaki bir kadın hastayı sunduk

Ateşli silah yaralanmasına bağlı spinal aksesuar sinir palsi: olgu sunumu

Spinal aksesuar sinir yaralanmalar› seyrek görülür ve ço¤unlukla iyatrojeniktir. A¤r›, ayn› taraf omuzun kald›r›lmas› nda güçlük ve kol abdüksiyonunda skapular kanatlanma, en s›kl›kla görülen klinik bulgulard›r. Ender rastlanan bir olgu olmas› nedeniyle, 20 yafl›nda, ateflli silaha ba¤l› penetran yaralanma sonras›nda spinal aksesuar sinir palsili bir erkek olgu sunuldu. Yaralanmadan üç ay sonra, sol kolunu omuz hizas›na kadar abdüksiyona getirdi¤inde a¤r› ve harekette k›s›tl›l›ktan flikayetçiydi. Fiziksel incelemesinde sol trapez kas› erimifl ve omuzu düflmüfl flekildeydi. Nörolojik incelemede sol trapez ve sternokleidomastoid kaslar›n›n motor fonksiyonlar› 3/5 idi; boyun, omuz ve kolda yayg›n dizestezi vard›. Mermi, klavikulan› n üzerinden girip, trapez kas›ndan ç›km›flt›. Radyolojik incelemeler normaldi fakat elektromiyelografi’de (EMG) nöropatik de¤ifliklikler saptand›. Cerrahi eksplorasyonda sinirin trasesi boyunca do¤al seyirini izledi¤i görüldü ve dekompresyon amaçl› eksternal nörolizis yap›ld›. Ameliyat sonras› sorunsuz geçti. Dizestezi ilerleyen günlerde kayboldu. Fizik tedavi de uygulanan hastan›n üç ay sonraki kontrol muayenesinde motor fonksiyonlar 4/5 idi ve EMG’de sol spinal aksesuar sinirde iyileflme saptand›.Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. As a seldom case, a 20 year-old male with spinal accessory nerve palsy after penetrating trauma by gunshot was reported. Three months after the injury, he was complaining about left arm pain in abduction to shoulder level and a decreased range of movement. On physical examination, wasting of the left trapezium with loss of nuchal ridge and drooping of the shoulder were found. On neurological examination of the left trapezius and sternomastoid muscles, motor function were 3/5 and wide dysesthesia on the neck, shoulder and arm was present. The bullet entered just above the clavicle and exited from trapezium. Radiological studies were normal, where electromyography (EMG) showed neuropathic changes. Surgical exploration showed the intact nerve lying on its natural course and we performed external neurolysis for decompression. The postoperative period was uneventful.Dysesthesia has diminished slowly. He was transferred to physical rehabilitation unit. In his clinical control after 3 months he had no dysesthesia and neurological examination of the left trapezius and sternomastoid muscles motor function were 4/5. EMG showed recovery in the left spinal accessory nerve

Longitudinal clival fractures: A report of three cases

Genellikle şiddetli kafa travmasına eşlik ettiği bildirilen klivus kırığı vertebrobaziler sistem, beyin sapı ve alt kraniyal sinir yaralanmalarına bağlı olarak yüksek mortaliteye sahiptir. Klivus kırığının tanısı erken dönemde yüksek mortalite oranı ve acil radyolojik tekniklerin yetersiz olmasından dolayı nadiren konur. Ancak, yüksek çözünürlükte kemik pencere bilgisayarlı tomografi görüntüleme ile günümüzde tanı kolaylaşmı ştır. Bu yazıda, hafif (bir olgu) ve şiddetli (iki olgu) kafa travması sonrası longitüdinal klivus kırığı saptanan üç hastadaki radyolojik ve klinik özellikler sunularak eşlik eden patolojiler ve prognoz açısından önemi, literatürdeki az sayıda bildirilen olgulardan da yararlanılarak tartışıldı.Fractures of the clivus are often associated with severe head trauma and have high mortality rates due to coexisting injury of the adjacent vessels, brain stem and lower cranial nerves. An early diagnosis is often not possible because of adherent problems, high mortality rate and inadequacy of emergency imaging. Diagnosis has recently become easier with high resolution bone window computed tomography studies. In this study, radiological and clinical findings of three patients with longitudinal clival fractures and severe head trauma have been presented and associated injuries and prognostic issues are discussed with reference to the limited number of similar cases in the English literature

The Effects of Adipose Tissue-Derived Mesenchymal Stem Cell Transplantation During the Acute and Subacute Phases Following Spinal Cord Injury

AIM: To investigate the effectiveness of rat adipose tissue-derived (rAT) mesenchymal stem cell (MSC) transplantation on the functional restoration and regeneration of spinal cord injury (SCI).MATERIAl and METhODS: Six of 48 Wistar albino rats were sacrificed to obtain MSCs, and the remaining rats were divided randomly into six groups. SCI was performed using the clip compression method. The control and transplantation groups were injected with physiological saline and a rAT-MSC suspension at the injury sites, respectively. Each animal was evaluated using the Basso, Beattie and Bresnahan (BBB) rating system and sacrificed at 28 days post-injury period (p.i.). The regeneration process was evaluated based on immunostaining against ?3-tubulin, BDNF, CNTF, and CNPase. RESulTS: rAT-MSC transplantation into the SCI site substantially improved the tissue regeneration and functional recovery (p &lt; 0.05). However, the rAT-MSC transplantation at 9 days p.i. was not more efficient on functional recovery than the transplantation immediately after injury. The expression of ?3-tubulin, BDNF and CNTF at the injury site indicated the potential for functional regeneration. COnCluSIOn: The adaptive nature of rat-MSCs enabled the remodulation and regeneration of the lesion site, decreasing the importance of transplantation time in the treatment of SC