Aynı hastada ikitaraflı karpal ve tarsal tünel sendromu : Olgu sunumu

Klinik muayene ve elektrofizyolojik çalışmalarla tanı konmuş, iki taraflı ciddi tarsal tünel sendromlu ve iki taraflı ciddi karpal tünel sendromlu, nadir bir vaka sunuyoruz. Kompresyon nöropatisi, özellikle iki taraflı veya multipl olduğunda sistemik bir hastalığa sekonder olabilir. Literatürde, bugüne kadar, aynı hastada iki taraflı tarsal tünel sendromu ve iki taraflı karpal tünel sendromu, sadece bir kaç vakada bildirilmiştir.We report, an unique case with co-existing bilateral severe tarsal tunnel syndrome (TTS) and bilateral severe carpal tunnel syndrome (CTS), which were diagnosed by clinical examination and electrophysiological studies. Compression neuropathy, especially when bilateral or multiple may be secondary to a systemic disease. To date, bilateral carpal and tarsal tunnel syndromes in the same patient have been reported only a few cases in the literature

Change in the dimensions of the lumbar area muscles after surgery: MRI analysis

Objective: This study aims to assess the change in the dimensions of the lumbar muscles in patients with chronic lower back pain using Magnetic Resonance Imaging (MRI) and to determine pre/post effects of surgery. Methods: We enrolled 28 individuals (13F/15M; age: 45.39±11.56 years) whose L2-S1 muscle measurements were obtained using MRI, before and at follow-up 6-12 months after surgery. The control group comprising 37 individuals (18F/19M; age: 34.41±10.72 years) who had no lumbar pathology but for whom retrospective archive images were available. In the axial MRI analysis, the cross-sections of m.multifidus, mm.erector spinae and m.psoas major on both sides were measured with the 'closed polygon' technique. Results: The L2-3 and L4-5 levels of the m.multifidus on the right side, the L2-3, L4-5 and L5-S1 levels of the m.multifidus and the L5-S1 levels of the mm. erector spinae on the left side cross-sectional areas were significantly lower than the control group (p<0.05). The right-side m.multifidus and the left-side mm.erector spinae sectional areas were significantly lower than the pre-surgery values at the L5-S1 levels (p<0.05). Conclusion: This study demonstrated that chronic lower back pain causes atrophy in the lumbar muscles and established the existence and continuity of atrophy after surgery

Carpal tunnel syndrome

Karpal tünel sendromu (KTS) en sık rastlanan tuzak nöropatidir. Median sinir, bilek düzeyinde, karpal tünel içerisinde kompresyona uğrar. Bu kompresyon sonucunda, kan-sinir bariyeri yıkılarak ödem, enflamasyon ve çevre yumuşak dokuda fibrozis gelişir. Sonraki evre sinirdeki myelin örtünün yıkımını takip eden akson hasarıdır. Karpal tünel sendromunun çoğu idiopatiktir. Diğer nedenler ise sistemik bozukluklar, lokal faktörler ve aşırı kullanım/çaba gerektiren faktörlerdir. Öykü, fizik muayene ve elektronöromiyografi tanı için gereklidir. Hastalar çoğunlukla radial taraftaki 3.5 parmakta uyuşma, karıncalanma ve ağrıdan yakınır. Tipik olarak hastalar gece uyuşuk bir el ile uyanırlar. Fizik muayenede, median sinir duysal alanında hipoestezi, provokatif testlerin pozitifliği ve tenar kaslarda güçsüzlük ve atrofi görülebilir. Sinir ileti hızı çalışmasındaki tipik bulgu, uzamış latansdır. Konservatif tedavi istirahat, non steroid antienflamatuvar ilaçlar, nötral pozisyon splintleri ve steriod enjeksiyonunu içerir. Cerrahi tedavi endikasyonları, konservatif tedavinin başarısızlığı veya ciddi KTS’dir. KTS, median sinirin bilekte tuzaklanması ile seyreden en sık fokal nöropati ve özellikle kadınlarda önkol ağrısının önde gelen etkenlerinden olması nedeniyle önemlidir.Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The median nevre is compressed within the carpal tunnel at the wrist. This compression result in disrupt of the blood-nerve barrier causing edema, inflamation and fibrosis of surrounding connective tissue. The next stage is a distruption of the myelin coverage of the nerve followed by damage to the axons. Most carpal tunnel syndromes are idiopathic. Other causes include systemic disorders, local factors and overuse/exertional factors. History, physical examination and electroneuromyography are essential for the diagnosis. Patients usually suffer from numbness, tingling and pain on palmar side in radial 3.5 fingers. Tipically patients are awakened at night by a numb hand. The physical examination may show hypesthesia in median nerve sensory distrubition, positive provocative tests and a weakness and atrophy of the thenar muscles. The typical finding in the nevre conduction velocity is a prolonged latency period. The conservative treatment for CTS include rest, non-steroidal anti-inflamatory drugs, neutral position splints, and steroid injection. The indications for surgical treatment are failure of conservative management or severe CTS. CTS is very important because of entrapment of the median nevre at the wrist is the most frequent focal neuropathy in humans and a common cause of pain in the forearm, particularly in women

Surgical management of the fourth ventricle arachnoid cysts

Aim: The arachnoid cysts are developmental masses that occur from the splitting or duplication of the arachnoid membrane. They may occur in different locations such as middle cranial fossa, retrocerebellar and convexity region, and they are usually asymptomatic. Arachnoid cysts are uncommon in association with intraventricular location especially fourth ventricle. In this study, we present six consecutive cases with arachnoid cyst in the fourth ventricle. Material and Methods: There were four female and two male patients. The average age of patients was 37 years ranging from2 to 65 years. These patients were periodically followed-up. The follow-up period ranged from minimum 2 to 6 years. Three patients were operated by a ventriculoperitoneal shunt and surgical excision was performed in two patients. Remaining two patients were followed up because they were asymptomatic. Results: Revision surgery was made due to shunt malfunction in a patient. The symptoms had been regressed in all patients. The arachnoid cysts were completely regressed after the operations in two patients. Conclusion: Most of arachnoid cysts which were small and asymptomatic did not require treatment. However, the size of an arachnoid cyst typically remained stable or increased over the time. An asymptomatic cyst may become symptomatic after minor head trauma. So, the asymptomatic patients with fourth ventricle arachnoid cyst should be under periodic follow up for obstructive hydrocephalus

Clinical and demographic characteristics of patients who were treated with kyphoplasty due to osteoporotic fracture

Amaç: Bu çalışmanın amacı, osteoporotik kırık nedeniyle kifoplasti uygulanan hastaların demografik ve klinik özelliklerini belirlemektir.Gereç ve Yöntem: Retrospektif olarak planlanan bu çalışmaya 2011-2014 tarihleri arasında osteoporotik kırık nedeniyle kifoplasti uygulanan 55 hasta dahil edildi. Hastalar yaşlarına göre; 65 yaş altı ve üstü olarak iki gruba, kırık bölgelerine göre; T10 ve üstü, T11-L1 arası ve L2 ve altı olarak üç gruba ayrılarak yaş ve cinsiyet dağılımları yapıldı. Ayrıca tüm hastaların istirahat ağrıları visual analog skala (VAS) kullanılarak; günlük yaşam aktiviteleri ise Oswetri Disabilite İndeksi (ODİ) kullanılarak tedavi öncesi ve tedavi sonrası 1. ayda karşılaştırıldı.Bulgular: Elli beş hastanın 17'si erkek (%30,9) ve 38'i kadın (%69,1) olup, ortalama yaşı 69,9±8,7 (50-88 yaş arası) yıldı. Altmış beş yaş üstü hastaların %90'ında kırık T11 ve altındaydı. Tüm hastaların %45,5'inde kırık T11-L1 (torakolomber bileşke) bölgesindeydi. Hastalar istirahat ağrıları ve fonksiyonel durumları yönünden değerlendirildiğinde tedavi öncesi VAS skoru 8,7±1,5 ve ODİ skoru 44,7±7,2 olup, kifoplasti sonrası 1. ayda VAS skoru 2,1±1,2 ve ODİ skorları 15,4±3,5 düzeyindeydi (p<0,05). Yedi (%12,7) hastada kifoplasti materyali disk aralığına kaçış ve 4 (%7,3) hastada beyin omurilik sıvısına sızıntı izlendi.Sonuç: Osteoporotik kırıklar 65 yaş üzeri hastaları etkilemektedir ve sıklıkla torakolomber bileşkede ve daha alt seviyelerde görülmektedir. Kifoplasti ağrı ve fonksiyonel durumu hızlı şekilde düzelten minimal invazif bir tedavi seçeneğidirObjective: The aim of this study is to determine the demographic and clinical characteristics of patients who underwent kyphoplasty due to osteoporotic fractures.Materials and Methods: This retrospective study included 55 patients who underwent kyphoplasty due to osteoporotic fracture between the years 2011 and 2014. The patients divided into two groups according to their ages (under/over 65 years), and divided into three groups according to fracture regions (T10 and above; between T11-L1; L2 and under). Thus the age and gender distributions of the patients were made. Resting pain scores of all patients were determined by using visual analog scale (VAS) and daily life activities by Oswetry Disability Index (ODI) before and in the first month of treatment.Results: Seventeen of the all patients were male (30.9%) and 38 were female (69.1%), with a mean age of 69.9±8.7 years (between 50-88 ages). 90% of the patients older than 65 years had fracture in T11 and below. In 45.5% of all patients, the fracture was in the T11L1 (thoracolomber junction) region. Resting VAS and ODI scores significantly improved from 8.7±1.5 to 2.1±1.2 and 44.7±7.2 to 15.4±3.5 respectively in the first month after kyphoplasty (p<0.05). Kyphoplasty material extravasated to the disc space in 7 (12.7%) patients and in 4 (7.3%) patients to cerebrospinal fluid.Conclusion: Osteoporotic fractures affect patients over 65 years of age and are frequently occur in the thoracolumbar junction and lower vertebras. Kyphoplasty is a minimally invasive treatment option to relieve pain and to improve functional statu

Vazospazmın indüklediği iskemiye bağlı spinal araknoidit ve spinal sinir köklerinin aksonal dejenerasyonu: Deneysel çalışma

Objective: Various reasons have been ascribed to arachnoiditis development, among which subarachnoid hemorrhage (SAH) may be an important factor in this process. In this experimental study, we investigated the effect of SAH on histopathological findings. The volumetric changes of the radicular arteries and the density of spinal nerve root axons of a SAH model on C4 roots in rabbits were measured. Materials and Methods: In this study, 18 rabbits were used. The animals were randomly divided into three groups: subarachnoid hemorrhage (SAH; n = 10), physiologic serum (SF; n = 4) and control (n = 4) groups. SAH was performed by injecting 0.5 cc of blood into cisterna magna taken from their auricular veins. Cervical spinal nerve roots at the C4 level were examined histopathologically. Results: Meningeal thickening and adhesions, reddish spinal cord and radices were detected macroscopically. Histopathologically, leptomeningeal adhesions, intimal lesions of radicular arteries and axonal injury were detected at the nerve radices. The mean radicular artery volume was found to be low on the arachnoiditis developing animals. The mean alive axon density of the C4 nerve root decreased and axonal degeneration was observed in the SAH group. Conclusion: Our study suggests that SAH may be an important etiologic factor in spinal arachnoiditis.Amaç: Araknoidit gelişiminde çeşitli nedenler suçlanmaktadır, subaraknoid kanama (SAK) da bu süreçte önemli bir öğe olabilir. Bu deneysel çalışmada (tavşan SAK modelinde) SAK'ın histopatolojik bulgular üzerine etkisini, radiküler arterlerin hacimsel değişikliklerini ve C4 spinal sinir kök aksonlarının dansitesini araştırdık. Materyal ve Metot: Bu çalışmada 18 tavşan kullanıldı. Tavşanlar rastgele üç gruba ayrıldı: subaraknoid kanama (SAK; n = 10), serum fizyolojik (SF; n = 4) ve kontrol (n = 4). SAK, kulak veninden alınan 0.5 ml kanın sisterna magnaya verilmesiyle oluşturuldu. C4 servikal spinal sinir kökleri histopatolojik olarak incelendi. Sonuçlar: Makroskopik olarak, meningeal kalınlaşma ve yapışıklıklar, kızılımsı spinal kord ve kökler saptandı. Histopatolojik olarak sinir köklerinde, leptomeningeal yapışıklıklar, radiküler arterlerde intimal lezyonlar ve aksonal hasar saptandı. SAK grubunda, radiküler arter ortalama hacmi araknoidit gelişen hayvanlarda düşük olarak bulundu. SAK grubunda, C4 kökünün ortalama canlı akson dansitesinde azalma ve aksonal harabiyet gözlendi. Yorum: Çalışmamızın sonuçlarına göre SAK, spinal araknoiditde önemli bir etyolojik etken olabilir

Primary nocardial vertebra osteomyelitis in an immunocompetent patient

Nokardiya türleri, immünsüpresif hastalarda vertebral osteomiyelitin nadir bir sebebidir ve literatürde bildirilmiş az sayıda olgu bulunmaktadır. Nokardiyoz genellikle akciğerlerden orijin alan, beyin gibi diğer organlara yayılma eğiliminde olan kronik bakteriyel bir infeksiyondur. Bu makalede pulmoner tutulumu olmayan, immünkompetan bir primer nokardiyal vertebra osteomiyeliti olgusu sunulmuştur. Olguda bir buçuk yıl önce başlayan bel ağrısı ve spinal hareketlerde kısıtlılık yakınmaları saptanmıştır. L2 vertebra, paraspinal bölge ve psoas kası içerisinde saptanan multiple apseleri cerrahi ve medikal tedaviye rağmen tekrarlamıştır. Operasyon bölgesindeki akıntıdan alınan materyalin kültüründe 3. günde Nocardia spp. izole edilmiştir. Tür tayini yapılamadığından trimetoprim sülfametoksazol, meropenem ve amikasin ile üçlü kombinasyon tedavisi başlanmıştır. Tedavinin 7. gününde operasyon bölgesindeki akıntı kesilmiştir. Hastada apselerin cerrahi drenajı, L2 vertebra korpusu eksizyonu ve uygun medikal tedavi sonrasında kontrol lomber vertebra MR’larında apse görülmemiştir. Bu olgu, tüberküloz ve brusellozun dışlandığı granülomatöz vertebral osteomyelit olgularında Nokardiya türlerinin de olası patojenlerden biri olabileceğini vurgulamak amacıyla paylaşılmıştır.Nocardia spp., is a rare cause of vertebral osteomyelitis in patients with immunosuppression and there are few cases have been reported in the literature. Nocardia infection is a chronic bacterial infection that usuall originates from the lungs which tends to spread to other organs such as the brain. A case of primary nocardial vertebral osteomyelit is with no history of immunosuppression and pulmoner involvement is presented in this article. She was complaining of back pain and limitati- on of spinal movement. Her complaints have been going on for 1.5 years. Multiple abscesses which were detected in the L2 vertebrae, paraspinal region and psoas muscle repeated despite surgical and medical treatment. Nocardia spp. was isolated on the third day. Because of subspecies of nocardia can not be determined, triple combination therapy with trimethoprim sulfa - methoxazole, meropenem and amikacin was started. Seventh day of treatment, discharge from operation region was stopped. After surgical drain age of the abscesses, excision of the L2 vertebral body and appropriate medical treatment, control lumbar spine MRI showed no abscess. This case was shared to highlight that Nocardia spp. should be one of the potential pathogen in the cases of granulomatous vertebral osteomyelitis in whom tuberculosis and brucellosis has been excluded

Delayed Seizure With Intracranial Sewing Needles

WOS: 000323219200008Penetrating head injuries are the main cause of intracranial foreign bodies. They can lead to complaints such as headaches and seizures at a later period. We report the case of a patient with sewing needles inserted within the parietal lobe. The primary complaint of the patient was epileptic seizures. The patient was treated with antiepileptic drugs. Surgical intervention was not considered. The removal of intracranial needles is still controversial in the literature. In our case, needles were not removed because the epileptic seizures were successfully treated with antiepileptic medication

An arachnoidal cystoperitoneal shunt catheter which protruded via anus and caused subdural empyema after colonic perforation : A rare complication

Ventriküloperitoneal (VP) ve kistoperitoneal (KP) şant uygulaması, beyin omurilik sıvısının periton boşluğuna akışını sağlayan ve hidrosefali tadavisinde yaygın olarak kullanılan cerrahi bir yöntemdir. Güvenli ve etkili bir yöntem olmalarına rağmen nadiren, kolon perforasyonunun da içinde yer aldığı çeşitli batın içi komplikasyonlara neden olabilirler. Şantın neden olduğu kolon perforasyonu, peritonit ve/veya assendan intrakranial enfeksiyonlar nedeniyle mortalite ve morbititesi yüksek olan, nadir bir komplikasyondur. Burada, kolon perforayonu sonrasında oluşan subdural abse nedeniyle hemiparazi sekeli gelişen bir çocuk hasta sunulmuştur.Ventriculoperitoneal (VP) and cystoperitoneal (CP) shunt insertion are common surgical treatment methods for hydrocephalus which allow the drainage of cerebrospinal fluid (CSF) into the peritoneal cavity. Although these procedures are safe and effective, they may lead to various intraabdominal complications including colonic perforation. Shunt related colonic perforations have high mortality and morbidity rate because of peritonitis and/or retrograde intracranial infections. We presented here a child who developed hemiparesis due to subdural abscess after colonic perforation