Skull Base Osteomyelitis Presenting with Facial Paralysis, Low Cranial Nerve Palsies and Bilateral Carotid Involvement: A Case Report

Skull base osteomyelitis (SBO) typically presents with severe otalgia and unilateral otorrhea in immune-compromised, particularly in elderly diabetic patients. Skull base osteomyelitis usually presents with external otitis but it can also occur as a complication of acute otitis media and mastoiditis. Complications of SBO are venous sinus thrombosis, meningitis, abscess, cranial neuropathies and carotid invasion with or without ischemic stroke. Here we report a case with SBO presenting with facial paralysis, lower cranial nerve palsies and bilateral carotid involvement which occurred following sore throat and bilateral otalgia

Improvement of fuel properties of biodiesel with bioadditive ethyl levulinate

Biodiesel has poor cold flow properties due to their high saturated fatty acid content. Ethyl levulinate is used as bio-based cold flow improver additive in biodiesel. In this work, both ethyl levulinate and biodiesel were synthesized in the laboratory. Ethyl levulinate was added to the biodiesel at different rates, i.e, 5, 10, 15, 20 (vol %). The effect of ethyl levulinate addition on density, kinematic viscosity, acid value, cloud point and pour point was determined and compared to the EN 14214 and ASTM D6751 specification. Consequently, ethyl levulinate appears acceptable as a cold flow improver for biodiesel fuel

Improvement of fuel properties of biodiesel with bioadditive ethyl levulinate

Biodiesel has poor cold flow properties due to their high saturated fatty acid content. Ethyl levulinate is used as bio-based cold flow improver additive in biodiesel. In this work, both ethyl levulinate and biodiesel were synthesized in the laboratory. Ethyl levulinate was added to the biodiesel at different rates, i.e, 5, 10, 15, 20 (vol \%). The effect of ethyl levulinate addition on density, kinematic viscosity, acid value, cloud point and pour point was determined and compared to the EN 14214 and ASTM D6751 specification. Consequently, ethyl levulinate appears acceptable as a cold flow improver for biodiesel fuel

Periodic electroclinical seizures following an ischemic stroke revealed by continuous-EEG

© 2021 The AuthorsBackground: Periodic EEG patterns are mostly associated with critical illnesses and acute disruptions of the central nervous system. Periodic or cyclic seizures are extremely rare phenomena, most of which are nonconvulsive, only reported in critically ill patients. Here we report a patient with periodic focal impaired awareness seizures following a minor stroke and address possible pathophysiological mechanisms. Case: A 49 years old male patient presented with periodic seizures, associated with an acute stroke in the left occipital and parietal regions. These focal seizures, recorded during long-term video-EEG monitoring in the scalp EEG, appeared every 9–11 min, and responded to iv valproic acid treatment but not to iv treatments of diazepam, phenytoin, and levetiracetam. Discussion: We believe that the blood–brain barrier disruption due to stroke, in conjunction with hyperglycemia and antiphospholipid antibodies have led to an imbalance of the surrounding tissue and sustained hyperexcitability to a point of pacemaker potentials. It is tempting to speculate that repetitive cycles of cortical spreading depression due to tissue injury have aided the periodicity of the seizures. Conclusion: Continuous EEG monitoring is crucial, not only to diagnose and appropriately treat accompanying subtle seizures but also to further understand the underlying intriguing pathophysiological processes like periodicity

The Contribution of Neuroimaging to Diagnosis in Idiopathic Intracranial Hypertension

Objective: Due to difficulties in diagnosis, the presence of patients with idiopathic intracranial hypertension (IIH) without papilledema has led to the addition of neuro-radiologic features, which are indicative of increased intracranial pressure, to new diagnostic criteria. In this study, it was aimed to investigate the inter-rater agreement regarding the evaluation of neuroimaging findings of patients diagnosed as having definite IIH and to detect their possible contribution to diagnosis

A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma

Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease

A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma

Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease

Glycoprotein Ib-alpha Kozak polymorphism in ischemic stroke

WOS: 000298667900010PubMed ID: 22196864Background: Recently, a T/C polymorphism in the Kozak sequence of glycoprotein Ib-alpha (GPIb-alpha) gene at position 25 from the initiator ATG codons, has been identified. The presence of -5C allele increases the surface expression of GPIb-IX-V complex in a gene dosage-dependent manner. It has been suggested that higher receptor levels might increase the adhesiveness of the platelets and confer risk for thrombosis. In this study, we aimed to investigate the association between GPIb-alpha Kozak polymorphism and ischemic stroke. Methods: We prospectively and consecutively recruited 231 patients (118 women and 113 men; mean age: 65 +/- 14.2 years) with first ever ischemic stroke admitted to Istanbul Faculty of Medicine Edip Aktin Stroke Unit between April 2007 and June 2009. Demographic features, risk factors, clinical, and etiological subtypes were analyzed. As the control group, 220 unrelated healthy subjects were included. Results: We found that 156 patients had TT, 70 patients had TC, and 5 patients had CC genotype. At least one copy of C allele carriers were overrepresented in the ischemic stroke group (32.5%) compared with controls (23%) [odds ratio (OR): 0.61; 95% confidence interval (CI): 0.40-0.93; P=0.03]. Among etiologic subtypes, the distribution of C allele carriers was the highest in patients with undetermined etiology (45%) and it was significantly higher than controls (OR: 0.36; 95% CI: 0.20-0.65; P=0.0008). In other subtypes, there was no association with Kozak -5C allele. Conclusion: In conclusion, these encouraging preliminary results show that GPIb-alpha T/C polymorphism might increase the risk of ischemic stroke, especially in those with undetermined etiology.Istanbul University Scientific Research [1476]This work was supported by Istanbul University Scientific Research Projects Unit (BAP - project number 1476)