Split cord malformation in two sisters

WOS: 000179287900006PubMed ID: 12411715Split cord malformations (SCMs) are uncommon congenital spinal anomalies and are seen mostly in females. SCMs in siblings are extremely rare. We report two sisters with SCM. These 10- and 8-year-old girls were the first and second children, respectively, of nonconsanguineous parents. Both sisters had a hypertrichosis and pes cavus deformity. The first child had a type I SCM and the second a type II SCM. They had additional spinal lesions, with tethering of the spinal cord. They were operated on and showed an uneventful postoperative course. All reported siblings with SCM have been female. The present data are not sufficient to account for the sex predilection. Therefore, further data and knowledge are needed. (C) 2002 S. Karger AG, Base

Report of diffusion-weighted MRI in two cases with different cerebral hydatid disease

WOS: 000221495600016PubMed ID: 15164785Purpose: To present MRI findings in two cases of cerebral hydatid disease with an emphasis oil diffusion-weighted imaging (DWI) findings of Echinococcus granulosus (EG) versus Echinococcus alveolaris (EA). Results: EG lesions were isointense with cerebrospinal fluid in all sequences including DWI. On DWI, EA lesions remained hypointense on b=1000 s/mm(2) diffusion-weighted images. Apparent diffusion coefficient (ADC) values of EG and EA lesions were completely different from each other, 2.88+/-0.24x10(-3) s/mm(2) and 1.33+/-0.15x10(-3) s/mm(2), respectively. Conclusion: The ADC values Could not be used to discriminate from other differential diagnoses

Conventional and diffusion-weighted MR imaging of intracranial tuberculomas

WOS: 000179908900003PubMed ID: 12485250Intracranial tuberculoma is a rare form of central nervous system tuberculosis. We here report on conventional and diffusion-weighted cranial MR images of a non-immunocompromised patient with multiple intracranial tuberculomas, tuberculous lymphadenitis and pulmonary tuberculosis. Conventional MR imaging revealed multiple ring-enhancing mass lesions. At follow-up MR, appearances of both edema and number and size of nodules were decreased. Diffusion-weighted MR was normal and normal ADC values were found in this case of tuberculomas

DWI findings of periventricular ischemic changes in patients with leukoaraiosis

WOS: 000184800600006PubMed ID: 12821031In this report the diffusion-weighted imaging (DWI) findings and ADC values of leukoaraiosis (LA) and associated periventricular ischemic lesions were assessed. Seventy-eight patients with LA were examined with magnetic resonance imaging (MRI) and DWI. Twenty one patients (28%) were found to have focal acute white matter infarction on DWI which could not be detected and discriminated on the basis of MRI findings alone. LA and acute white matter infarction both showed hyperintensity on standard T2W MRI, whereas acute infarction revealed focal hyperintensity on DWI. Thirteen patients (16%) had chronic lacunar infarctions in the white matter. ADC values of LA, acute and chronic white matter infarctions were calculated and found to be significantly different from each other (P < 0.05). It is concluded that DWI is necessary in the detection of acute periventricular white matter infarction from LA. (C) 2003 Published by Elsevier Science Ltd

Evaluation of common vetch (Vicia sativa L.) as living mulch for ecological weed control in citrus orchards

Weeds are one of the most important problems in newly established orchards. Especially in organic orcharding, the importance of weed management is much more than conventional orcharding. Therefore, importance of alternative methods to chemical control of weeds is increasing. This study was conducted to quantify the effects of common vetch (Vicia sativa L.) as living mulch on weeds and evaluate the availability of common vetch in organic citrus production. The study was carried out in Mandarin orchard which was established specially for this research in research and implementation area of the Plant Protection Department of Çukurova University in Turkey, in a three-year-period. Living mulch and control plots were placed between rows in newly established mandarin orchard and plots were maintained at the same locations until the end of the experiment. In this study, effects of the living mulch application on density, cover proportion, biomass, dry weight and similarity index of weed species were investigated. Overall three-years results of the study were evaluated, living mulch application reduced weed density and cover proportion average of 42.8% and 45.9% respectively compare to control. Biomass and dry weight of weeds were also reduced by living mulch in all years of the experiment. The results indicate that living mulch application by common vetch is an important alternative weed suppression method for ecological weed management. ©2011 Academic Journals

A rare diagnosis in emergency department. Spontaneous spinal epidural hematoma

PubMed ID: 18774053We report a case of a 32-year-old man who presented to the emergency department (ED) with a sudden onset of paraplegia due to spontaneous spinal epidural hematoma. Although the patient had a poor neurological condition on presentation, he was successfully operated and discharged without any neurological sequel. Spontaneous spinal epidural hematoma is a rarely seen clinical entity, especially in the ED. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression is essential to prevent serious neurological deficits. A 32-year-old previously healthy man presented to the emergency department with a complaint of sudden onset of numbness and weakness of the lower extremity. He had been having back pain during 1 week before presentation, and it was gradually worsening. There was no medical history of any recent trauma or illness, and he was on no medication. On presentation, his vital signs were stable. He was in apparent distress because of back pain. Physical examination revealed paraplegia and bilateral lower extremity anesthesia below the T3 dermatome. Deep tendon reflexes were absent on both lower extremities. The rest of physical examination including peripheral pulses and anal sphincter tone was normal. Complete blood count, electrolytes, coagulation, and kidney and liver function tests were normal except that white blood cell count was 13 500/µL, creatine kinase was 447 U/L (range, 24-195 U/L), and myoglobin was 128 ng/mL (range, <70 ng/mL). Thoracic and abdominal contrast-enhanced computed tomography was performed with a suspicion of aortic dissection, and it revealed normal aortic anatomy. Afterward, he underwent spinal magnetic resonance imaging (MRI). Magnetic resonance imaging demonstrated spinal epidural hematoma at the level of C7-T3 causing spinal cord compression (Fig. 1). Intravenous pulse prednisolone (bolus of 30 mg/kg and maintenance of 5.4 mg/kg per hour) therapy was initiated, and he was admitted to the neurosurgery ward. He was successfully operated the following day and discharged without any neurological sequel after 5 days of admission. Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but important neurological emergency. The incidence is 0.1 patients per 100 000 populations [1]. It presents in all ages, and most cases occur after the fourth or fifth decade [2]. The common symptom is preceding neck or back pain, followed by sudden onset of neurological deficits [3]. The initial neck or back pain is sometimes vague and cannot be early diagnosed until the following cord compression and neurological deficits present. Although sensory and motor deficits are usually bilateral (paraplegia or quadriplegia), unilateral involvement (hemiparesis or hemiplegia) or Brown-Sequard syndrome is also reported [4-6]. Urine retention or loss of sphincter tone frequently accompanies. If the hematoma extends above the upper cervical vertebra, respiratory failure may be observed [6]. The etiopathogenesis of spinal epidural hematoma is not clear, although many predisposing factors including abnormality of coagulation (hemophilia), vascular malformation (eg, spinal dural arteriovenous fistula and hemangioma), some drugs (eg, anticoagulant therapy, therapeutic thrombolysis, aspirin, clopidogrel, and cocaine abuse), trauma (vertebral fractures, postsurgical bleeding, and missile injuries), and iatrogenic manipulations (spinal/epidural injections) are suggested [3,7-11]. The duration between onset of symptoms and inciting event varies from minutes to months [11,12]. Spontaneous spinal epidural hematoma is defined as spontaneous collection of blood in spinal epidural space without any obvious causes. Idiopathic cases account for approximately 40% to 60% of all spinal epidural hematoma [3,13]. Straining-associated events such as bending, dancing, swimming, sneezing, coughing, vomiting, micturition, or heavy lifting may play a role in the development of SSEH [3,14]. Liu and colleagues [3] reported that SSEH is generally located (96%) in the dorsal aspect of the spinal epidural space in cervical (30%), thoracic (35%), and cervicothoracic (22%) levels. They also demonstrated a worse prognosis associated with the bigger size of hematoma, shorter progressive intervals between the initial onset and emergence of the obviously neurological deficits (<12 hours), and a poor neurological condition on presentation [3]. Epidural venous plexus have been considered the source of hemorrhage for SSEH by many authors. The bleeding from rupture of valveless venous plexus in the epidural spaces is possibly secondary to abrupt change in venous pressure after blunt trauma or straining. In addition, the rapidly deteriorating neurological deficits after initial back pain and quick formation of the hematoma also suggested the arterial origin of SSEH [15,16]. Acute or progressive painful paraparesis and/or paraparesis with sphincter dysfunction is a well-known indication for an emergency MRI. Magnetic resonance imaging is the most useful method for diagnosis of SSEH. Magnetic resonance imaging can evaluate the location, extent, and compressive effects of hemorrhage. The hematomas usually appear as a shuttle-shaped image on sagittal section and a crescent-shaped image on transverse section dorsal to the spinal cord on MRI. In the hyperacute phase, MRI demonstrates an isointense lesion on T1-weighted images and hyperintense lesion on T2-weighted images. In the late or subacute phase, the hemorrhage demonstrates a hyperintense lesion on T1- and T2-weighted images [17]. Although some cases of spontaneous recovery have been reported, the most appropriate treatment of SSEH is surgical decompression [18]. Laminectomy and evacuation of the hematoma is the most effective method for rapid decompression of the spinal cord. The best favorable outcome can be achieved if surgical decompression is performed within 12 hours of symptom onset [19]. Therefore, operation should be considered as soon as possible, unless the neurological deficits resolve in the earlier period. Our patient had no history of any trauma, recent medication, or iatrogenic manipulations. His coagulation tests including prothrombin time, activated partial thromboplastin time, and platelet counts were normal. Therefore, in our case, spontaneous spinal epidural hematoma was considered. Spontaneous spinal epidural hematoma was diagnosed using MRI, and he was operated on immediately. Early diagnosis and treatment were the major factors that contributed to the complete recovery of our patient. Spinal epidural hematomas can cause dramatic neurological deficits, which can be successfully reversed if diagnosed and treated without delay. Emergency physicians should be aware of spinal epidural hematoma in patients presenting with back pain and new-onset neurological deficits, and MRI as an appropriate diagnostic modality should be performed immediately. © 2008 Elsevier Inc. All rights reserved