1H-magnetic resonance spectroscopy in first episode and chronic schizophrenia patients

Background/aim: The aim of this study was to compare metabolite levels of the dorsolateral prefrontal cortex (DLPFC), anterior cingulate gyrus (ACG), thalamus, and hippocampus in patients with chronic schizophrenia (CSPs) and first psychotic episode patients (FEPs) by the use of magnetic resonance spectroscopy (MRS). Materials and methods: Thirty CSPs, 20 FEPs, and 30 healthy subjects participated in this study. N-Acetylaspartate (NAA), creatine, choline (Cho), and myoinositol levels of the DLPFC, ACG, thalamus, and hippocampus were measured by 1H-MRS. Results: It was determined that the NAA/Cho ratio was lower in both the FEPs and CSPs than the healthy controls in the DLPFC. DLPFC Cho levels were also higher in CSPs than healthy controls. NAA levels in CSPs were significantly lower than in the control group in the hippocampus. There was no significant difference in neurometabolite levels and ratios in the ACG and thalamus between the groups. Conclusion: This study supports neuronal dysfunction or loss of neuronal integrity in the DLPFC and hippocampus in CSPs. FEPs showed less neuronal dysfunction in the DLPFC, but not in the hippocampus. Our results suggest that schizophrenic patients show brain metabolic changes with the onset of the disorder in the DLPFC; these changes could be more apparent in the hippocampus as the disease progresses to chronic stages. © TÜBİTAK

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Intra-abdominal spilled gallstones simulating peritoneal metastasis: CT and MR imaging features (2008: 1b).

Laparoscopic cholecystectomy has rapidly become the preferred treatment for symptomatic cholecystolithiasis. However, the procedure is associated with a number of complications, one of which is the spillage of gallstones into the peritoneal cavity. Unretrieved gallstones may cause a wide variety of complications such as abscess, adhesion and small-bowel obstruction, or they may remain asymptomatic and harmless. In the latter case, spilled gallstones in the peritoneal spaces may cause diagnostic difficulty or mimic peritoneal metastasis. We present the computed tomography (CT) and magnetic resonance (MR) imaging features of intra-abdominal gallstone spillage in a case with head and neck neoplasm. Awareness of radiologic features of dropped intraperitoneal gallstones is necessary as they may be mistaken for peritoneal metastases

Wallenberg Syndrome following neck cracking: a case report.

Cracking the neck is an age-old practice in contravention of its dangerous affects. One of these affects is Brain stem strokes and in this report we describe a patient with Wallenberg syndrome due to neck cracking who is the one of the rare cases in the literature

1H-magnetic resonance spectroscopy in first episode and chronic schizophrenia patients.

BACKGROUND/AIM: The aim of this study was to compare metabolite levels of the dorsolateral prefrontal cortex (DLPFC), anterior cingulate gyrus (ACG), thalamus, and hippocampus in patients with chronic schizophrenia (CSPs) and first psychotic episode patients (FEPs) by the use of magnetic resonance spectroscopy (MRS). MATERIALS AND METHODS: Thirty CSPs, 20 FEPs, and 30 healthy subjects participated in this study. N-Acetylaspartate (NAA), creatine, choline (Cho), and myoinositol levels of the DLPFC, ACG, thalamus, and hippocampus were measured by 1H-MRS. RESULTS: It was determined that the NAA/Cho ratio was lower in both the FEPs and CSPs than the healthy controls in the DLPFC. DLPFC Cho levels were also higher in CSPs than healthy controls. NAA levels in CSPs were significantly lower than in the control group in the hippocampus. There was no significant difference in neurometabolite levels and ratios in the ACG and thalamus between the groups. CONCLUSION: This study supports neuronal dysfunction or loss of neuronal integrity in the DLPFC and hippocampus in CSPs. FEPs showed less neuronal dysfunction in the DLPFC, but not in the hippocampus. Our results suggest that schizophrenic patients show brain metabolic changes with the onset of the disorder in the DLPFC; these changes could be more apparent in the hippocampus as the disease progresses to chronic stages

Sinus cut-off sign: a helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion.

The objective of our study was to describe the "sinus cut-off" sign at CT in the diagnosis of diaphragmatic rupture in patients with blunt abdominal trauma complicated with pleural effusion, and evaluate its utility in an experimental model. Between January 2004 and March 2005, we observed an unusual interruption of costophrenic sinus at CT in three patients with blunt abdominal trauma accompanied with pleural effusion. This observation prompted us to evaluate the utility of this sign in an experimental model. Laparotomically, we created 2 cm diapragmatic lacerations at each hemidiaphragm in two rabbits and pushed up the abdominal viscera with omentum through the defect. To simulate hemothorax, we also injected 5-10 mL of diluted contrast material into the pleural space. Using a dual-slice helical CT scanner, limited thoracoabdominal CT examination was performed before and after injection of intrapleural contrast material. The images were analyzed for the presence of CT signs for diaphragmatic injury. The left posterior costophrenic sulcus was interrupted in all of the three patients with left pleural effusion. While it was associated with other findings of diaphragmatic injury, the "sinus cut-off sign" was the sole finding in one patient. The sinus cut-off sign was observed on the CT scans of 100% of the rabbits with a left and right sided diaphragmatic rupture. The "sinus cut-off sign" is useful and can increase the CT detection of acute diaphragmatic injury associated with pleural effusion

Association between cholesterols, homocysteine and silent brain infarcts.

BACKGROUND: The aim of this study was to assess the relationship between total plasma homocysteine, cholesterol levels, vitamin B(12), folate, thyroid hormones, urea, ferritin, uric acid, C-reactive protein, cardiovascular risk factors and silent brain infarct (SBI) in patients without any neurological disorder. Whether the factors of interest were associated with SBI is investigated. METHODS: One hundred and forty-two subjects with a mean age of 52.1 +/- 13.1 years (21-87 years) without any history of stroke, transient ischaemic attack and neurological abnormality were enrolled in this cross-sectional study. The subjects underwent brain magnetic resonance imaging and blood chemistry determinations. Student's t-test was used to compare differences in means of laboratory results between the groups with and without SBI. The chi(2)-test was used for categorized variables. Multiple logistic regression analysis was used to determine the independent predictors of SBI. RESULTS: The group comprised 56 men and 86 women. SBI were found in 40 patients (28%). The low-density lipoprotein levels were significantly higher in the infarct group (P = 0.019), homocysteine concentrations were significantly higher in the men-infarct group (P = 0,029) and total cholesterol levels were significantly higher in the women-infarct group than the women non-infarct group (P = 0.006). CONCLUSION: Serum low-density lipoprotein, total cholesterol and homocysteine levels were associated with SBI

Cerebral lateral ventricular asymmetry on CT: how much asymmetry is representing pathology?

PURPOSE: The purpose of this study was to evaluate the association of asymmetric lateral ventricle (ALV) with clinical and structural pathologies and assess its clinical importance. MATERIALS AND METHODS: We analyzed 170 consecutive ALV cases on computed tomography (CT) and 170 control group patients with normal head CT. Patients who had apparent etiologic causes for ALV were excluded. The differential diagnosis of ALV and unilateral hydrocephalus (UH) was made by using three different ventricle-brain ratios (VBRs). The measurements of the ALV were made at the frontal horn level. Patients with asymmetry were divided into three subgroups including mild, moderate and severe groups to eloborate the grade of the ventricular asymmetry. Additional CT findings including septal deviation, diffuse enlargement, atrophy and the densities of constant sites were also recorded systematically for each patient. Clinical and handedness data were collected and analyzed. RESULTS: The prevalence of ALV in the study population was 6.1%. Headache was the most common reason for head CT examination and was significantly more common in the asymmetry group (61.7% in group A, 42.9% in group B, P = 0.001). Transient ischemic attack, focal neurologic findings, vertigo, ataxia, visual and hearing disturbances were similar in both groups (P > 0.5). There was no difference in smoking and alcohol habits in both patient groups. Ten (5.8%) patients in group A and 16 (9.4%) patients in group B had neuropsychiatric disorders, which did not achieve statistical significance. In group A patients, the larger ventricle was more common in the left side than in the right (left = 70.0%, right = 30.0%). Group A consisted of 57.0% mild (grade 1, n = 97), 26.5% moderate (grade II, n = 45) and 16.5% severe (grade III, n = 28) patients. There was no significant correlation between handedness and ALV. The density of different brain sites was found close similar on both sides in ALV and control group (P > 0.5). Choroidal cystic or solid neoplasm or periventricular dysplasia was detected in six ALV patients in group A (3.5%), on their additional MR examinations. CONCLUSION: The physician should not overlook an ALV finding on unenhanced CT, particularly in cases with severe degree of asymmetry or diffuse ventricular enlargement, and search for possible accompanying disorders

Neurochemical metabolites in the medial prefrontal cortex in bipolar disorder: A proton magnetic resonance spectroscopy study.

The aim of this study was to investigate proton magnetic resonance spectroscopy metabolite values in the medial prefrontal cortex of individuals with euthymic bipolar disorder. The subjects consisted of 15 patients with euthymic bipolar disorder type I and 15 healthy controls. We performed proton magnetic resonance spectroscopy of the bilateral medial prefrontal cortex and measured levels of N-acetyl aspartate, choline and creatine. Levels of these three metabolites in the medial prefrontal cortex were found to be lower in patients with bipolar disorder compared with healthy controls. A positive correlation was found between illness duration and choline levels in the right medial prefrontal cortex. Our study suggests that during the euthymic period, there are abnormalities in cellular energy and membrane phospholipid metabolism in the medial prefrontal cortex, and that this may impair neuronal activity and integrity

Diffusion-weighted MR imaging of viral encephalitis.

INTRODUCTION: The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) in the diagnosis of viral encephalitis and its relationship with the stage of the illness. METHODS: We performed conventional magnetic resonance imaging (MRI) including T1-W, T2-W and fluid attenuated inversion recovery (FLAIR) sequences and DWI in 18 patients with viral encephalitis diagnosed on the basis of laboratory, clinical and radiologic findings. Based on the qualitative and quantitative comparison of the conventional MRI and DWI, the patients were divided into three groups. Apparent diffusion coefficient (ADC) values of the involved and contralateral normal brain tissues were computed and compared for each group. The degree of correlation between the time (TI) from the onset of neurologic symptoms to the MR examination and ADC values was determined. RESULTS: In group I (n=11) DWI was superior to conventional MRI in detecting the encephalitic involved sites and in depicting the borders of the encephalitic lesions. In group II (n=4) DWI was similar to conventional MRI. In group III (n=3) conventional MRI was superior to DWI. Mean ADC values of affected versus contralateral normal brain tissues were 0.458+/-0.161 x 10(-3) versus 0.86+/-0.08 x 10(-3) in group I, 0.670+/-0.142 x 10(-3) versus 0.93+/-0.07 x 10(-3) in group II, and 1.413+/-0.211 x 10(-3) versus 1.05+/-0.06 x 10(-3) in group III. Patients in group I had significantly lower ADC values than those in group II, while patients in group III had the highest ADC values (P<0.05). The ADC values were significantly lower in the affected sites than in the unaffected sites of patients in groups I and II, but were significantly higher in the affected sites than in the unaffected sites of patients in group III (P<0.05). There was an excellent correlation between ADC values and duration of the disease (r=0.874, P=0.01). CONCLUSION: DWI is superior to other conventional diagnostic MR sequences in the detection of early viral encephalitic lesions and depiction of the lesion borders and, in combination with other sequences, DWI may contribute to the determination of the disease phase