Cerebellar Infarction in Childhood: Delayed-Onset Complication of Mild Head Trauma

How to Cite This Article: Oz II, Bozay Oz E, Şerifoğlu I, Kaya N, Erdem O. Cerebellar Infarction in Childhood: Delayed-Onset Complication of Mild Head Trauma. Iran J Child Neurol. Summer 2016; 10(3):82-85.Objective Cerebellar ischemic infarction is a rare complication of minor head trauma. Vertebral artery dissection, vasospasm or systemic hypo perfusion can cause infarct. However, underlying causes of the ischemic infarct cannot be explained in nearly half of cases. The accurate diagnosis is essential to ensure appropriate treatment. Here we report a five yr old boy patient of cerebellar infraction after minor head trauma, admitted to emergency serves of Bulent Ecevit University, Turkey in 2013. We aimed to remind minor head trauma that causes cerebellar infarction during childhood, and to review the important points of the diagnosis, which should be keep in mind. ReferencesSchutzman SA, Greenes DS. Pediatric minor head trauma. Ann Emerg Med 2001;37(1):65-74.Shaffer L, Rich PM, Pohl KR, Ganesan V. Can mild head injury cause ischaemic stroke? Arch Dis Child 2003;88(3):267-9.Lin JJ, Lin KL, Chou ML, Wong AM, Wang HS. Cerebellar infarction in the territory of the superior cerebellar artery in children. Pediatr Neurol 2007;37(6):435-7.Matsumoto H, Kohno K. Posttraumatic cerebral infarction due to progressive occlusion of the internal carotid artery after minor head injury in childhood: a case report. Childs Nerv Syst 2011;27(7):1169-75.Williams LS, Garg BP, Cohen M, Fleck JD, Biller J. Subtypes of ischemic stroke in children and young adults. Neurology 1997;49(6):1541-5.Kieslich M, Fiedler A, Heller C, Kreuz W, Jacobi G. Minor head injury as cause and co-factor in the aetiology of stroke in childhood: a report of eight cases. J Neurol Neurosurg Psychiatry 2002;73(1):13-6.O’Brien NF, Reuter-Rice KE, Khanna S, Peterson BM, Quinto KB. Vasospasm in children with traumatic brain injury. Intensive Care Med 2010;36(4):680-7.Barkovich A, Schwartz E. Brain and Spine Injuries in Infancy and Childhood. In: Barkovich A, Raybaud C, editors. Pediatric Neuroimaging. 5th ed. Philidelphia, PA: Lippincott Williams & Wilkins; 2012. p. 335-8.Lansberg MG, Albers GW, Beaulieu C, Marks MP. Comparison of diffusion-weighted MRI and CT in acute stroke. Neurol 2000;54(8):1557-61. 

Diffusion-weighted imaging in the head and neck region: usefulness of apparent diffusion coefficient values for characterization of lesions

PURPOSEWe aimed to evaluate the role of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging for head and neck lesion characterization in daily routine, in comparison with histopathological results.METHODSNinety consecutive patients who underwent magnetic resonance imaging (MRI) at a university hospital for diagnosis of neck lesions were included in this prospective study. Diffusion-weighted echo-planar MRI was performed on a 1.5 T unit with b factor of 0 and 1000 s/mm2 and ADC maps were generated. ADC values were measured for benign and malignant whole lesions seen in daily practice.RESULTSThe median ADC value of the malignant tumors and benign lesions were 0.72×10-3 mm2/s, (range, 0.39–1.51×10-3 mm2/s) and 1.17×10-3 mm2/s, (range, 0.52–2.38×10-3 mm2/s), respectively, with a significant difference between them (P < 0.001). A cutoff ADC value of 0.98×10-3 mm2/s was used to distinguish between benign and malignant lesions, yielding 85.3% sensitivity and 78.6% specificity. The median ADC value of lymphomas (0.44×10-3 mm2/s; range, 0.39–0.58×10-3 mm2/s) was significantly smaller (P < 0.001) than that of squamous cell carcinomas (median ADC value 0.72×10-3 mm2/s; range, 0.65–1.06×10-3 mm2/s). There was no significant difference between median ADC values of inflammatory (1.13×10-3 mm2/s; range, 0.85–2.38×10-3 mm2/s) and noninflammatory benign lesions (1.26×10-3 mm2/s; range, 0.52–2.33×10-3 mm2/s).CONCLUSIONDiffusion-weighted imaging and the ADC values can be used to differentiate and characterize benign and malignant head and neck lesions

The role of computed tomography in the evaluation of small bowel obstruction

Tıpta Uzmanlık TeziBu çalışma prospektif olarak planlanmış olup kliniği ve ayakta direkt batın grafisi bulguları ile ince barsak obstrüksiyonu düşünülerek bilgisayarlı tomografi çekilen hastaları kapsamaktadır. Bilgisayarlı tomografinin rolü ince barsak obstrüksiyonunun tanısı yanında obstrüksiyon seviyesinin tespiti, altta yatan nedenlerin ortaya konması ve varsa komplikasyonlarının saptanmasıdır. Çalışma kapsamına 21 kadın (%44,7), 26 erkek (%55,3) toplam 47 hasta dâhil edilmiş olup, olguların yaş ortalaması 60,91 (SS±18,15), yaş ortanca değeri 62'dir. Olgular, General Electric Hi Speed NX/i sys 8.10 dual dedektörlü spiral bilgisayarlı tomografi cihazı ile intravenöz kontrast verilerek incelendi. Bilgisayarlı tomografi değerlendirmelerinde ince barsak obstrüksiyonu tanısında dikkate aldığımız parametreler: mezenterik yağlı doku heterojenitesi, ince barsak feçes işareti, geçiş zonu izlenmesi, ince barsakta intramural hava ve batında asittir. Çalışmamızda bilgisayarlı tomografide geçiş zonu, mezenterik yağlı doku heterojenitesi ve intramural hava görülmesinin ince barsak obstrüksiyonu tanısında anlamlı olduğu saptanmıştır. Bilgisayarlı tomografi görüntülerinde geçiş zonu izlenmesinin ince barsak obstrüksiyonu tanısındaki duyarlılığı %97,4, özgüllüğü %44,4'tür. Mezenterik yağlı doku heterojenitesinin bilgisayarlı tomgrafi kesitlerinde görülmesinin obstrüksiyon tanısındaki duyarlılığı %89,5, özgüllüğü %66,7'dir. İntramural hava imajları bulgusunun bilgisayarlı tomografi görüntülerinde izlenmesinin ince barsak obstrüksiyonu tanısındaki duyarlılığı %81,6, özgüllüğü %66,7'dir. Yaptığımız değerlendirmede bilgisayarlı tomografi kesitlerinde ince barsak feçes işareti ve asit varlığının ince barsak obstrüksiyonu tanısında tek başlarına istatistiksel değeri yoktur. Ancak incelediğimiz bilgisayarlı tomografi parametrelerinden en az iki veya daha fazlasının birlikte olmasını ince barsak obstrüksiyonu tanısında istatistiksel anlamlı olarak saptadık. Bilgisayarlı tomografi parametrelerinin birlikte olması durumunda duyarlılık %97,4'e yükselmektedir Sonuç olarak, ince barsak obstrüksiyonu düşünülen hastaların tanısı ve tedavi planlamasında bilgisayarlı tomografi etkili ve değeri yüksek bir görüntüleme yöntemidir.In this prospective study we included the patients who undergone computed tomography examination due to suspicion of small bowel obstruction after erect abdominal radiographic signs and with their clinical features. Beside the diagnosis the role of the computed tomography also include to detect the obstruction level and complications if exist. Being 21 (44,7%) of them female and 26 (55,3%) of them male, 47 patients at total included in this study, their mean age was 60,91 (SS±18,15) median age value was 62. They were all studied with spiral computed tomography scanner (General Electric Hi Speed NX/i sys 8.10 with 2 detectors) and all given intravenous contrast media. Heterogeneity at the mesenteric fatty tissue, small bowel faeces sign, presence of transition zone, intramural air bubbles and intraperitoneal ascites are the parameters we used at the diagnosis of small bowel obstruction. In this study presence of heterogeneity at the mesenteric fatty tissue, presence of transition zone and intramural air bubbles are found statistically significant at the diagnosis of small bowel obstruction. Sensitivity of the presence of transition zone at computed tomography images in the diagnosis of small bowel obstruction is 97,4 % and the specificity is 44,4 %. Sensitivity of presence of heterogeneity at the mesenteric fatty tissue at computed tomography images is 89,5% and the specificity is 66,7%. Sensitivity of presence of intramural air bubbles at computed tomography images is 81,6% and the specificity is 66,7%. Presence of small bowel faeces sign or intraperitoneal ascites alone has no statistical value in the diagnosis of small bowel obstruction. But at the same time the presence of two or more of the parameters we studied is found statistically significant; in these instances the sensitivity is increased up to 97,4%. As a result, computed tomography is effective and highly valuable imaging modality in the diagnosis and treatment planning in patients with small bowel obstruction

Imaging of central nervous system tumors

Çoğu santral sinir sistemi (SSS) tümörlerinin ve tümör olmayan lezyonların oldukçabenzer görünümler sergilemesinden dolayı rutin Manyetik Rezonans Görüntüleme(MRG) sekanslarının özgüllükleri bunları ayırmada yetersizdir. SSS tümörlerinin ayırıcıtanısında anahtar unsurlar, lezyonun lokalizasyonu (intra- veya extra-aksiyel, infraveyasupra-tentoriyal) ile birlikte hastanın yaşıdır. Multiparametrik MRG tekniklerini(Spektroskopi, Difüzyon Ağırlıklı Görüntüleme, Difüzyon Tensor Görüntüleme, PerfüzyonAğırlıklı Görüntüleme, Fonksiyonel MRG), tümörün mikroskobik ve fonksiyoneldavranışına ilişkin (hücresel yoğunluk, neo-vaskularizasyon, kapiller sızıntıve metabolitler gibi) bilgiler sunar. İleri multiparametrik görüntüleme teknikleri SSStümörü olan hastaların teşhisi, yönetimi ve takibinde kesin ve güvenilir invaziv olmayanbir yöntem sunar.Many Central Nerve System (CNS) tumors and even non–tumoral lesions may showa very similar imaging appearance; therefore, routine Magnetic Resonance Imaging(MRI) are lack of specificity to differentiate these lesions. The key points in the differentialdiagnosis of CNS tumors are the location of the lesion (intra- or extra-axial,infra- or extra-tentorial) and the age of the patient. Multiparametric MRI techniques(Spectroscopy, Diffusion Weighted Imaging, Diffusion Tensor Imaging, PerfusionWeighted Imaging, Functional MRI) reveal the information about the microscopicand functional behaviors of the tumor (cellular density, neo-vascularization, capillaryleakage and metabolites, etc). Advanced multiparametric imaging tools support thediagnosis, management and follow-up of patients with CNS tumors as an accurateand reliable noninvasive technique

Magnetic resonance imaging findings in spinal hemangioblastoma case

Oz, Ibrahim/0000-0002-5014-4972; Serifoglu, Ismail/0000-0001-5643-739XWOS: 000386368700005PubMed: 26892370A 70-year-old man presented to the neurosurgeryclinic with low back pain. Four years previously, thepatient had undergone surgery for cerebellar hemangioblas-toma. T2-weighted magnetic resonance images of thethoracolumbar spinal region showed expansion withheterogeneous hyperintense signal changes. Irregularlydilated cystic cavities were also seen at this level (Fig. 1,Middle, Right)

Changes in renal Doppler ultrasonographic parameters in patients managed with rigid ureteroscopy

Background: There has been no study evaluating the intrarenal hemodynamic changes after ureteroscopy in the published literature. Purpose: To determine preoperative and postoperative intrarenal vascular parameters such as resistive index (RI), pulsatility index (PI), peak systolic velocity (PSV), end-diastolic velocity (EDV), measure changes on these values (DRI, DPI, DPSV, DEDV) after ureteroscopy (URS) and compare the outcomes with the results of normal contralateral kidneys, and finally investigate possible parameters that would affect renal vascular resistance changes. Material and Methods: We prospectively studied 47 patients who underwent rigid URS. Preoperative grayscale and Doppler ultrasonography (CDUS) measurements were obtained 24 h before URS. Similarly, postoperative CDUS measurements were done 24 h after the operation. The degree of hydronephrosis and location of stones in the obstructed kidneys, diameters of both kidneys, and thickness of renal parenchyma were evaluated with gray-scale US followed by CDUS with calculation of the intrarenal RI, PI, PSV, and EDV values for each kidney. Results: For the operated kidneys, statistically significant P values were noticed when RI and PI values were considered (P, 0.001). DRI and DPI of the operated kidneys were also significantly greater than the values for non-operated kidneys (P, 0.001). However, it was not the case for DPSV and DEDV values. In Spearman correlation coefficient analysis, DRI was found to be correlated with the parameters: “operative time” and “irrigation fluid volume”. No significant relation was documented between DRI and the other parameters: age, gender, side of ureteroscopy, stone location, and degree of hydronephrosis. Conclusion: Significant changes in RI and PI values in patients treated with URS reveal that URS can cause a significant increase in renal vascular resistance. With the increase in operative time and irrigation fluid volume used during the operation, RI seems to be significantly increased

Role of Preoperative Sonography in Predicting Conversion From Laparoscopic Cholecystectomy to Open Surgery

Tosun, Alptekin/0000-0003-1783-9171WOS: 000349177800002PubMed: 25579475Background: Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methods: This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. Results: Scoring significantly predicted failure in laparoscopic approach (AUC = 0.758,P = 0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score >1.95 was a risk factor for failure in laparoscopic approach [odds ratio = 7.1(95% CI,2-24.9, P=0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p = 0.002). Negative predictive value of 128/132 = 97%. Mean score of whole study population was 1.28 (range 0-8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p 0.05). Sex of subjects did not affect the success of surgery (p>0.05). Conclusion: The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports. (C) 2014 Elsevier Ireland Ltd. All rights reserved

İnvajine Meckel Divertikülü: Bir Genç Kızda Tekrarlayan Karın Ağrısının Nadir Bir Nedeni

Meckel divertikülünün invajnasyonu, ergen ve erişkinlerde karın ağrısının çok nadir bir nedenidir. İntussepsiyonun klasik klinik bulguları olan karın ağrısı, ele gelen bir sosis şeklinde kitle ve kanlı dışkı seyrek görülür. Tanıda, ultrasonografi ve bilgisayarlı tomografini önemli bir yere sahiptir ve hedef işareti ya da sosis görünümü ile karakteristik bulgular görülür. Bu yazıda, tekrarlayan karın ağrısına neden invajine Meckel divertikülü olgusu sunulmaktadır.The invagination of Meckel's diverticulum is a very rare cause of abdominal pain in adolescents and adults. The classic clinical triad of the intussusception consisting abdominal pain, a palpable sausage-shaped mass, and bloody stools is seen infrequently. At the diagnosis, ultrasonography and computed tomography has a significant role with characteristic findings that include the “target” sign and sausage- shaped appearance. In this paper, we report a case of invagination of Meckel’s diverticulum which causes recurrent abdominal pain in a young adolescent

Dumbbell Shaped Transforaminal Paravertebral Meningioma

Dambıl tümörler iki veya daha fazla spinal alanı tutan tümörlerdir. Dambıl tümörlerin büyük kısmını schwannomlar oluşturur. Spinal menenjiomların dambıl tümor olarak prezente olması oldukça nadirdir. Spinal dambıl tümör şeklinde prezente olan menenjiomların görüntüleme yöntemleri ile ayırıcı tanısının yapılması hem cerrahi öncesi doğru tedavi planlaması, hem de cerrahi sonrası olası rekürensleri engelleme açısından önemlidir.Dumbbell tumors are tumors of two or more regions of the spinal column. The majority of the dumbbell tumors are schwannomas. The presentation of spinal meningiomas as a dumbbell tumors are very rare. The diagnosis of Dumbbell-shaped meningiomas with imaging methods is important for preoperative accurate treatment planning and to prevent its postsurgical recurrences