Allogeneic mesenchymal stem cells may be a viable treatment modality in cerebral palsy

BACKGROUND

Cerebral palsy (CP) describes a group of disorders affecting movement, balance, and posture. Disturbances in motor functions constitute the main body of CP symptoms. These symptoms surface in early childhood and patients are affected for the rest of their lives. Currently, treatment involves various pharmacotherapies for different types of CP, including antiepileptics for epilepsy and Botox A for focal spasticity. However, none of these methods can provide full symptom relief. This has prompted researchers to look for new treatment modalities, one of which is mesenchymal stem cell therapy (MSCT). Despite being a promising tool and offering a wide array of possibilities, mesenchymal stem cells (MSCs) still need to be investigated for their efficacy and safety.

AIM

To analyze the efficacy and safety of MSCT in CP patients.

METHODS

Our sample consists of four CP patients who cannot stand or walk without external support. All of these cases received allogeneic MSCT six times as 1 × 106/kg intrathecally, intravenously, and intramuscularly using umbilical cord-derived MSCs (UC-MSC). We monitored and assessed the patients pre- and post-treatment using the Wee Functional Independence Measure (WeeFIM), Gross Motor Function Classification System (GMFCS), and Manual Ability Classification Scale (MACS) instruments. We utilized the Modified Ashworth Scale (MAS) to measure spasticity.

RESULTS

We found significant improvements in MAS scores after the intervention on both sides. Two months: Right χ2 = 4000, P = 0.046, left χ2 = 4000, P = 0.046; four months: Right χ2 = 4000, P = 0.046, left χ2 = 4000, P = 0.046; 12 months: Right χ2 = 4000, P = 0.046, left χ2 = 4000, P = 0.046. However, there was no significant difference in motor functions based on WeeFIM results (P > 0.05). GMFCS and MACS scores differed significantly at 12 months after the intervention (P = 0.046, P = 0.046). Finally, there was no significant change in cognitive functions (P > 0.05).

CONCLUSION

In light of our findings, we believe that UC-MSC therapy has a positive effect on spasticity, and it partially improves motor functions.

Effects of exosomes from mesenchymal stem cells on functional recovery of a patient with total radial nerve injury: A pilot study

BACKGROUND

Peripheral nerve injury can result in significant clinical complications that have uncertain prognoses. Currently, there is a lack of effective pharmacological interventions for nerve damage, despite the existence of several small compounds, peptides, hormones, and growth factors that have been suggested as potential enhancers of neuron regeneration. Despite the objective of achieving full functional restoration by surgical intervention, the persistent challenge of inadequate functional recovery remains a significant concern in the context of peripheral nerve injuries.

AIM

To examine the impact of exosomes on the process of functional recovery following a complete radial nerve damage.

METHODS

A male individual, aged 24, who is right-hand dominant and an immigrant, arrived with an injury caused by a knife assault. The cut is located on the left arm, specifically below the elbow. The neurological examination and electrodiagnostic testing reveal evidence of left radial nerve damage. The sural autograft was utilized for repair, followed by the application of 1 mL of mesenchymal stem cell-derived exosome, comprising 5 billion microvesicles. This exosome was split into four equal volumes of 0.25 mL each and delivered microsurgically to both the proximal and distal stumps using the subepineural pathway. The patient was subjected to a period of 180 d during which they had neurological examination and electrodiagnostic testing.

RESULTS

The duration of the patient's follow-up period was 180 d. An increasing Tinel's sign and sensory-motor recovery were detected even at the 10th wk following nerve grafting. Upon the conclusion of the 6-mo post-treatment period, an evaluation was conducted to measure the extent of improvement in motor and sensory functions of the nerve. This assessment was based on the British Medical Research Council scale and the Mackinnon-Dellon scale. The results indicated that the level of improvement in motor function was classified as M5, denoting an excellent outcome. Additionally, the level of improvement in sensory function was classified as S3+, indicating a good outcome. It is noteworthy that these assessments were conducted in the absence of physical therapy. At the 10th wk post-injury, despite the persistence of substantial axonal damage, the nerve exhibited indications of nerve re-innervation as evidenced by control electromyography (EMG). In contrast to the preceding. EMG analysis revealed a significant electrophysiological enhancement in the EMG conducted at the 6th-mo follow-up, indicating ongoing regeneration.

CONCLUSION

Enhanced comprehension of the neurobiological ramifications associated with peripheral nerve damage, as well as the experimental and therapy approaches delineated in this investigation, holds the potential to catalyze future clinical progress.

Feasibility of allogeneic mesenchymal stem cells in pediatric hypoxic-ischemic encephalopathy: Phase I study

BACKGROUND

Hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of death and long-term neurological impairment in the pediatric population. Despite a limited number of treatments to cure HIE, stem cell therapies appear to be a potential treatment option for brain injury resulting from HIE.

AIM

To investigate the efficacy and safety of stem cell-based therapies in pediatric patients with HIE.

METHODS

The study inclusion criteria were determined as the presence of substantial deficit and disability caused by HIE. Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs) were intrathecally (IT), intramuscularly (IM), and intravenously administered to participants at a dose of 1 × 10⁶/kg for each administration route twice monthly for 2 mo. In different follow-up durations, the effect of WJ-MSCs administration on HIE, the quality of life, prognosis of patients, and side effects were investigated, and patients were evaluated for neurological, cognitive functions, and spasticity using the Wee Functional Independence Measure (Wee FIM) Scale and Modified Ashworth (MA) Scale.

RESULTS

For all participants (n = 6), the mean duration of exposure to hypoxia was 39.17 + 18.82 min, the mean time interval after HIE was 21.83 ± 26.60 mo, the mean baseline Wee FIM scale score was 13.5 ± 0.55, and the mean baseline MA scale score was 35 ± 9.08. Three patients developed only early complications such as low-grade fever, mild headache associated with IT injection, and muscle pain associated with IM injection, all of which were transient and disappeared within 24 h. The treatment was evaluated to be safe and effective as demonstrated by magnetic resonance imaging examinations, electroencephalographies, laboratory tests, and neurological and functional scores of patients. Patients exhibited significant improvements in all neurological functions through a 12-mo follow-up. The mean Wee FIM scale score of participants increased from 13.5 ± 0.55 to 15.17 ± 1.6 points (mean ± SD) at 1 mo (z = - 1.826, P = 0.068) and to 23.5 ± 3.39 points at 12 mo (z = -2.207, P = 0.027) post-treatment. The percentage of patients who achieved an excellent functional improvement (Wee FIM scale total score = 126) increased from 10.71% (at baseline) to 12.03% at 1 mo and to 18.65% at 12 mo post-treatment.

CONCLUSION

Both the triple-route and multiple WJ-MSC implantations were safe and effective in pediatric patients with HIE with significant neurological and functional improvements. The results of this study support conducting further randomized, placebo-controlled studies on this treatment in the pediatric population.

Phase I study on the safety and preliminary efficacy of allogeneic mesenchymal stem cells in hypoxic-ischemic encephalopathy

BACKGROUND

Hypoxic-ischemic encephalopathy (HIE) is a leading cause of morbidity and mortality in the adult as well as in the neonate, with limited options for treatment and significant dysfunctionality.

AIM

To investigate the safety and preliminary efficacy of allogeneic mesenchymal stem cells (MSCs) in HIE patients.

METHODS

Patients who had HIE for at least 6 mo along with significant dysfunction and disability were included. All patients were given Wharton’s jelly-derived MSCs at 1 × 10⁶/kg intrathecally, intravenously, and intramuscularly twice a month for two months. The therapeutic effects and prognostic implications of MSCs were evaluated by multiple follow-ups. Functional independence measure (FIM), modified Ashworth, and Karnofsky scales were used to assess any side effects, neurological and cognitive functions, and overall outcomes.

RESULTS

The 8 subjects included in the study had a mean age of 33.25 ± 10.18 years. Mean HIE exposure and mean post-HIE durations were 45.63 ± 10.18 and 19.67 ± 29.04 mo, respectively. Mean FIM score was 18.38 ± 1.06, mean modified Ashworth score was 43.5 ± 4.63, and mean Karnofsky score was 20. For the first 24 h, 5 of the patients experienced a subfebrile state, accompanied by mild headaches due to intrathecally administration and muscle pain because of intramuscularly administration. Neurological and functional examinations, laboratory tests, electroencephalography, and magnetic resonance imaging were performed to assess safety of treatment. Mean FIM score increased by 20.88 ± 3.31 in the first month (P = 0.027) and by 31.38 ± 14.69 in 12 mo (P = 0.012). The rate of patients with an FIM score of 126 increased from 14.58% to 16.57% in the first month and 24.90% in 12 mo.

CONCLUSION

Multiple triple-route Wharton’s jelly-derived MSC administrations were found to be safe for HIE patients, indicating neurological and functional improvement. Based on the findings obtained here, further randomized and placebo research could be performed.

Asthma control affects school absence, achievement and quality of school life: a multicenter study

INTRODUCTION AND OBJECTIVES

Asthma may have a detrimental effect on school attendance and achievement. Friend relations, attendance to school activities, quality of life (QOL) of asthmatic children may be negatively affected. The aim of this study was to evaluate factors influencing school functioning for asthmatic school-age children.

MATERIALS AND METHODS

From January to May 2019, parents and school-age children who were followed by a diagnosis of asthma for more than one year, from seven pediatric allergy centers, were given a standard questionnaire including questions about child's disease, school performance, absenteeism, home-family-school conditions. A pediatric QOL questionnaire was filled out by children. For evaluating control in the previous year, children who had more than two exacerbations and/or had any exacerbations needing systemic corticosteroids in the previous year were defined as inadequate control. School absence over nine days was taken into account as this has been shown to bring a risk for successful school life.

RESULTS

507 patients were included. Asthma control status was found to be effective on school absence (p < 0.001), on school success (especially math scores) (p < 0.001), on friend relations (p = 0.033), QOL (p < 0.001), attendance to school activities (p < 0.001). Regular follow-up (p < 0.001), regular use of asthma medication (p = 0.014), tobacco smoke exposure (p < 0.001), heating with stove at home (p = 0.01) affected asthma control. School conditions such as crowdedness (p = 0.044), humidity of the class (p = 0.025), knowledge of teacher about child's asthma (p = 0.012) were effective on asthma control independent of home conditions and asthma treatment parameters.

CONCLUSION

School interventions are important to improve asthma management.

Diagnosis of atopic dermatitis in children: comparison of the Hanifin-Rajka and the United Kingdom Working Party criteria

BACKGROUND

Atopic dermatitis (AD) is the most common chronic skin disease in childhood. There is no definitive test for diagnosing AD. The Hanifin-Rajka criteria (HRC) and The United Kingdom Working Party criteria (UKC) are the most used in the literature. It is aimed to evaluate the clinical efficacy of HRC and UKC in pediatric age.

METHODS

Children diagnosed AD in the pediatric allergy clinic were enrolled. Patients with skin problems other than AD were involved as controls. All participants were evaluated for HRC and UKC at the time of diagnosis. Clinical diagnosis by the pediatric allergist was determined as the gold standard.

RESULTS

200 children with AD and 90 controls were enrolled in the study. Median (interquartile range, IQR) age of AD patients was 13.5 (7-36) months. There was no significant difference in age and sex between groups (p=0.11 and p=0.34, respectively). The HRC were superior to the UKC for sensitivity, negative predictive value, kappa and accuracy rate (94% vs. 72%, 84% vs. 60%, 0.68 vs. 0.56 and 87 vs. 78, respectively). On the other hand, specificity and positive predictive value of UKC were better than those of HRC (92% vs. 71% and 95% vs. 88%, respectively).

CONCLUSION

HRC seem to be better in diagnosing AD than UKC for young children. Further studies are needed to evaluate comparableness of HRC and UKC for AD in childhood in order to generate an international consensus for clinical trials.

Frequency and clinical features of pollen-food syndrome in children

BACKGROUND

Pollen-food syndrome (PFS) is an allergic reaction to fresh fruits, vegetables and/or nuts that can occur in patients who are allergic to pollen. The prevalence of PFS in children is not clearly known.

OBJECTIVE

The objective of this study was to determine the frequency and clinical features of PFS in pediatric patients with pollen-induced allergic rhinitis (AR).

METHOD

This study was conducted in the pediatric allergy outpatient clinic of our hospital. Pollen-induced seasonal AR patients who were evaluated for any symptoms appearing after consuming any fresh fruits and vegetables.

RESULTS

Six hundred and seventy-two pollen-sensitized patients were included in this study. The symptoms related to PFS were reported in 22 (3.3%) patients. The median age of the patients was 12.3 years and 59% (n=13) were female. Peach was the most common culprit (22%). There were isolated oropharyngeal symptoms in 20 (91%) patients and anaphylaxis in two (9%) patients with the suspected food. The multiple logistic regression analysis revealed that female gender, history of atopic dermatitis and allergic diseases in the family were the potential risk factors for PFS [Odds ratio 95%CI: 3.367 (1.344-8.435), 5.120 (1.935-13.550), 3.046 (1.239-7.492), respectively].

CONCLUSION

PFS can be seen in children who are followed up for pollen-induced AR. The symptoms of PFS are usually mild and transient. However, comprehensive evaluation of patients is important since serious systemic reactions such as anaphylaxis can also be observed.

Neuronal regeneration in injured rat spinal cord after human dental pulp derived neural crest stem cell transplantation

OBJECTIVE

This study aimed to analyze the effect of human Dental Pulp-Neural Crest Stem Cells (hDP-NCSCs) delivery on lesion site after spinal cord injury (SCI), and to observe the functional recovery after transplantation.

METHODS

Neural Crest Stem Cells (NCSCs) were isolated from human Dental Pulp (hDP). The experimental rat population was divided into four groups (n = 6/24). Their behavioral motility was scored regularly. After 4-weeks, rats were sacrificed, and their spinal cords were examined for Green Fluorescent Protein (GFP) labeled hDP-NCSCs by immunofluorescence (IF) staining.

RESULTS

In early post-injury (p.i) period, the ultrastructure of spinal cord tissue was preserved in Group 4. The majority of cells forming the ependymal region around the central canal were found to be hDP-NCSCs. While the grey-and-white-matter around the ependymal region was composed of e.g. GFP cells, with astrocytic-like appearance. The scores showed significant motor recovery in hind limb functions in Group 4. However, no obvious change was observed in other groups.

CONCLUSION

Cells e.g., mesenchymal (Vimentin+) which express GFP+ cells in the gray-and-white-matter around the ependymal region could indicate the potential to self-renewal and plasticity. Thus, transplantation of hDP-NCSCs might be an effective strategy to improve functional recovery following spinal cord trauma (Fig. 10, Ref. 32).

Wharton's Jelly-Derived Mesenchymal Stem Cell Transplantation in a Patient with Hypoxic-Ischemic Encephalopathy: A Pilot Study

Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs) have been introduced as a possible therapy in hypoxic-ischemic encephalopathy (HIE). We report a 16-year-old boy who was treated with WJ-MSCs in the course of HIE due to post-cardiopulmonary resuscitation. He received a long period of mechanical ventilation and tracheostomy with spastic quadriparesis. He underwent the intrathecal (1×10⁶/kg in 3 mL), intramuscular (1×10⁶/kg in 20 mL) and intravenous (1×10⁶/kg in 30 mL) administrations of WJ-MSCs for each application route (twice a month for 2 months). After stem cell infusions, progressive improvements were shown in his neurological examination, neuroradiological, and neurophysiological findings. To our best knowledge, this is a pioneer project to clinically study the neural repair effect of WJ-MSCs in a patient with HIE.

Radiofrequency Thermocoagulation of the Ganglion Impar for Coccydynia Management: Long-Term Effects

OBJECTIVE

To investigate the short- and long-term effects of ganglion impar radiofrequency thermocoagulation (RFT) treatment in patients with chronic coccydynia.

METHODS

We retrospectively analyzed the medical records of patients who underwent RFT of the ganglion impar between 2009 and 2011. Pain intensity visual numeric scale (VNS) scores and Euroqol 5D (EQ-5D) index scores were recorded pre-intervention and post-intervention at the first, sixth, and twelfth months. The differences between pre-procedural VNS scores and post-procedural VNS scores at the first, sixth, and twelfth months were evaluated. The success of the intervention was recorded as the percentage difference between the pre-intervention VNS scores and post-intervention VNS scores at the first, sixth, and twelfth months.

RESULTS

The mean age of the patients, including 11 females (55%) and 8 males (45%), was 48.7 ± 14.3 years. The average follow-up duration was 17.3 ± 2.9 months. Statistically significant differences were observed between the pre- and post-procedure VNS scores (P < 0.0001). Improvements in VNS scores were correlated with improvements in EQ-5D index scores. Mid-term (sixth month) and long-term (twelfth month) evaluations after the intervention revealed that 67.4% and 61.1% of the patients had successful outcomes, respectively.

CONCLUSION

Our data suggested that RFT of the ganglion impar in patients with chronic coccydynia resulted in effective outcomes, and patients who responded to RFT had significantly lower post-RFT pain scores.

The clinical factors associated with benefit finding of complementary medicine use in patients with back pain: A cross-sectional study with cluster analysis

BACKGROUND

Complementary and alternative medicine (CAM) use has been increasing.

OBJECTIVE

To identify the factors associated with perceived benefit from CAM methods in back problems.

METHODS

The study was conducted on patients who practiced any CAM methods due to complaints of back pain. Social-demographic properties, details of CAM methods employed were questioned. Severity of pain was measured by visual analog scale (VAS); benefits were evaluated by the Likert scale. Hierarchical cluster analysis was used to discover relationships among variables.

RESULTS

In total, 500 patients (265 female, 235 male) were included in the study. Mostly used methods were herbal therapy (32%), balneotherapy (31%), cupping (19.4%) and massage-manipulation (19.2%). Of patients, 355 (71%) were satisfied. The variables associated with benefit finding were female gender, age, chronicity and severity of pain, high educational level, upper middle income status, use as a result of recommendation, dissatisfaction with conventional methods, residence in an urban area, non-herbal method use, being married, and social insurance (p < 0.005).

CONCLUSION

The majority of patients using CAM perceived benefits; in particular, women living in urban areas, highly educated, aged more than 40, who suffer from severe chronic back pain, may be more inclined to go to CAM therapists.

Re-formation of acute parietal epidural hematoma following rapid spontaneous resolution in a multitraumatic child: a case report

Acute epidural hematomas resulting from traumatic brain injury remain among the most common causes of mortality and disability. In the literature, there are cases about the resolution and recurrence of spinal epidural hematomas. This case is characterized by the rapid disappearance and re-formation of an acute cranial epidural hematoma (EDH) associated with no overlying skull fracture. Various authors have reported resolution of EDHs managed conservatively, but rapid resolution and recurrence of cranial EDH was not reported before.

Sorafenib and lithium chloride combination treatment shows promising synergistic effects in human glioblastoma multiforme cells in vitro but midkine is not implicated

OBJECTIVES

The objectives of this study were to test the effects of the new combination treatment modality, sorafenib (SOR) and lithium chloride (LiCl) and to assess whether midkine (MK) protein has a role in any potential effects.

METHODS

Monolayer and spheroid cultures of T98G human glioblastoma multiforme (GBM) cells were treated with LiCl and SOR (inhibition concentration 50 value  =  100 μM), or their combination, or were left untreated (control). Cell proliferation and apoptotic indices, the mechanism of action, and the levels of apoptotic and anti-apoptotic proteins were evaluated in monolayer cultures and ultrastructure was evaluated by transmission electron microscopy (TEM) in spheroid cultures after for 72 hours.

RESULTS

All drug applications decreased cell numbers and increased the apoptotic index. The combination shows a synergistic effect. In the combination group, the decrease in cell numbers and the increase in the apoptotic index were significantly greater than with the individual drugs (P < 0.01). The combination treatment led to the greatest decreases in MRP-1 and p170 levels; but the greatest decreases in p-STAT-3, p-ERK (P < 0.05), p-AKT, p-GSK-3-beta (P < 0.01), EGFR (P < 0.01), NF-kappa-β levels were with SOR alone, followed by the combination. The decreases in MK levels in the SOR and combination groups were similar (P  =  0.06). Severe ultrastructural damage was more frequently observed in the combination group compared with the other groups.

CONCLUSIONS

These results suggest the possibility that the addition of LiCl to SOR could improve the prognosis in at least some patients who need both cancer and psychotherapy and indicate the need for further studies.

The relationship between gastro-oesophageal reflux disease and asthma during childhood

BACKGROUND

The relationship between GERD and asthma is complex. It is not yet clear whether GERD is an accompanying finding or a cause of asthma, or even if it is an aggravating factor. The aim of this study was to determine the frequency of asthma and allergic diseases in patients who underwent 24-h pH monitoring for a suspicion of GERD, including a comparison between subjects with and without GERD.

METHOD

Subjects who were evaluated by 24h ambulatory intraoesophageal pH monitoring were investigated for the presence of asthma and allergic disorders. All participants were subjected to a skin prick test and a complete blood count and serum levels of specific IgE.

RESULTS

A total of 204 subjects (49.5% male) with a mean age of 7.8±4.3 years were enrolled. A diagnosis of GERD was made in 78 (38.2%) subjects after 24h pH monitoring. The frequency of asthma in subjects with GERD was 20.5% compared to 25.4% in subjects without GERD (p=0.424). Subjects with GERD presenting with respiratory symptoms have higher incidence of asthma compared to subjects with GERD presenting with gastrointestinal symptoms (35.3% and 5.3% respectively; p=0.001).

CONCLUSION

Although, patients with and without GERD had comparable frequencies of asthma, our findings suggest that subjects who present with respiratory symptoms suggestive of GERD should also be evaluated for the presence of an underlying asthma.

Similar prevalence, different spectrum: IgE-mediated food allergy among Turkish adolescents

BACKGROUND

Scarcity of reliable data on food allergy prevalence exists in Turkey. We aimed to assess reported and confirmed IgE-mediated food allergy prevalence, and define the spectrum of allergenic food.

METHODS

We prospectively evaluated the ISAAC Phase II study population for food allergy. Participants that reported experiencing food allergy symptom in the last year and/or were skin prick test positive for a predefined list of food allergens, were interviewed via telephone, and those considered as having food allergy were invited to undergo clinical investigation, including challenge tests.

RESULTS

A total of 6963 questionnaires were available. Parental reported food allergy prevalence and skin prick sensitisation rate were 20.2 ± 0.9% and 5.9 ± 0.6%. According to the above-defined criteria, 1162 children (symptom positive n=909, skin prick test positive n=301, both positive n=48) were selected and 813 (70.0%) were interviewed via telephone. Out of 152 adolescents reporting a current complaint, 87 accepted clinical investigation. There were 12 food allergies diagnosed in nine adolescents, with food allergy prevalence of 0.16 ± 0.11%. The most common foods involved in allergic reactions were walnut (n=3) and beef meat (n=2), followed by hen's egg (n=1), peanut (n=1), spinach (n=1), kiwi (n=1), cheese (n=1), hazelnut (n=1) and peach (n=1).

CONCLUSIONS

While parental reported food allergy prevalence was within the range reported previously, confirmed IgE-mediated food allergy prevalence among adolescents was at least 0.16%, and the spectrum of foods involved in allergy differed from Western countries, implying environmental factors may play a role.

Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey

BACKGROUND

Food allergy, which becomes an important public health problem, can lead to important morbidity and mortality. Patients with food allergies are more likely to first present to their primary care physicians. We aimed to determine the knowledge of primary care physicians with regard to management of food allergies and anaphylaxis.

METHODS

Primary care physicians were surveyed via a questionnaire aimed to document their knowledge and attitudes about food allergy and anaphylaxis management.

RESULTS

A total of 297 participants completed questionnaires, 55.6% of which were female. Participating physicians had a mean of 17.0 ± 6.1 years of experience. Participants answered 47.2% of knowledge-based items correctly. Overall, participants fared poorly with regard to their knowledge on the treatment of food allergies and anaphylaxis. For example while 60.7% knew that a child can die from the milk allergy reaction, only 37.5% were aware that a child with IgE mediated milk allergies cannot eat yoghourts/cheese with milk. Besides, 53.1% of them chose epinephrine as their first treatment of choice in case of anaphylaxis, yet only 16.6% gave the correct answer about its dosage. Nearly a third of participants (36.7%) felt they were knowledgeable enough regarding the management of patients with food allergies, while 98.2% extended their request for future periodic educational meetings on allergic disorders.

CONCLUSION

Knowledge of food allergy and anaphylaxis among primary care physicians was unsatisfactory. Provision or periodic educational programmes should be aimed at improving the standard of practice as acknowledged by the participants.

The effect of oral contraceptives on current wheezing in young women

BACKGROUND

Emerging evidence suggests that sex steroid hormones may influence respiratory symptoms. The existing literature about the role of oral contraceptive pill (OCP) on respiratory disease is scarce and conflicting especially during the adolescent period. In this study, we aimed to investigate the effect of OCPs on current wheezing among adolescents and young adults.

METHODS

A questionnaire was administered face-to-face to adolescents and young women by a physician. The questionnaire included ISAAC survey-comprised questions on ever wheezing, current wheezing, allergic diseases, smoking history (active or passive), and family history of allergic diseases and questions on OCP usage status. The effect of OCPs on wheezing was evaluated by logistic regression analysis.

RESULTS

A total of 487 subjects aged between 11.3 and 25.6years participated in the study and 196 (40.2%) reported that they had used OCPs. 7.4% of the participants had physician-diagnosed asthma and 10.3% of them were active smokers. It was detected that OCPs were associated with increased risk for current wheezing (odds ratio, 2.36; 95% CI, 1.25-4.47 adjusted for asthma and current smoker) and this risk was related with the usage during the past year.

CONCLUSION

Young women taking oral contraceptives had a higher rate of current wheezing, suggesting that sex steroids may be of importance for respiratory health.

Dysfunctional segmental motion treated with dynamic stabilization in the lumbar spine

OBJECTIVE

To determine the suitability of the application of dynamic stabilization (DS) as a nonfusion technique to address dysfunctional segmental motion (DSM) in the lumbar spine.

METHODS

Over a 1-year period, 25 patients were treated with the same assessment and surgical protocol. Inclusion criteria were clinical presentation of DSM with or without stenosis. On preoperative and postoperative plain anteroposterior, lateral, and lateral flexion-extension radiographs, anterior and posterior disc height (DH); anteroposterior diameter of the disc; and global, segmental, apical segment, and below level lordotic angles (LAs) were measured.

RESULTS

The study included 9 women and 16 men with a mean age of 43.48 years ± 7.6. On average, patients had symptoms for 38.04 months ± 29.6, and mean follow-up was 12.36 months ± 3.46. The average height of anterior, posterior, and mean intervertebral discs increased significantly (P = 0.002, P = 0.003, and P < 0.0001). There were no significant differences between the preoperative and postoperative global, segmental, apical segment, and below segment LAs in flexion, extension, and neutral positions. At mid-term follow-up, no patients showed new signs of degeneration at the adjacent motion segment.

CONCLUSIONS

Overall, the limited radiologic data advocate DS as a nonfusion technique in the treatment of DSM in the lumbar spine. Long-term follow-up is essential, however, to investigate the long-term efficacy of DS in the surgical treatment of DSM.

Brucellar discitis as a cause of lumbar disc herniation: a case report

Brucellosis is an infectious disease spread by consumption of non-pasteurized milk products or through contact with infected animals. Spinal involvement is one of the most important complications and the lumbar area is the most frequently affected site. Among the neurological consequences, nerve root compression can be a result of epidural abscess, granuloma or discitis secondary to vertebral body involvement. In this case report we present a 50-year-old male patient with brucellar discitis without spondylitis which caused lumbar disc herniation. We want to emphasize that discitis should also be considered in differential diagnosis of nerve root compression in suspected cases.

Prevalence, burden, and risk factors of atopic eczema in schoolchildren aged 10-11 years: a national multicenter study

BACKGROUND

Little is known about the epidemiology of atopic eczema (AE), and studies from the Mediterranean region and the Middle East are limited.

OBJECTIVE

We investigated the frequency, burden, and risk factors of AE in a developing country.

METHODS

The International Study of Asthma and Allergies in Childhood Phase II questionnaire was used to survey a representative sample of 10 to 11-year-old children in Turkey. Children were examined by allergists, and parents completed standardized questionnaires.

RESULTS

Among 6755 children, the prevalence of having eczema during one's lifetime or currently was 17.1% and 8.1%, respectively. The prevalence of visits to the doctor, nocturnal awakening, school absenteeism, and drug usage was 36.3%, 56%, 9.7%, and 28.7%, respectively. Associated factors were current rhinoconjunctivitis (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.99-3.21), current wheezing (OR, 2.10; 95% CI, 1.58-2.79), family history of allergic disease (OR, 1.62; 95% CI, 1.21-2.18), low birth weight (OR, 1.79; 95% CI, 1.08-2.94), and exposure to animals in the first year of life (OR, 1.47; 95% CI, 1.06-2.03).

CONCLUSIONS

In a developing Mediterranean country, the prevalence of AE is comparable to that of developed countries in the same region and lower than that observed in developed countries elsewhere. The course of the disease and risk factors of AE probably differ in developing countries.

The effect of CD14 C159T polymorphism on in vitro IgE synthesis and cytokine production by PBMC from children with asthma

BACKGROUND

Even though the genotype at the promoter region of the CD14 molecule is known to affect the atopic phenotypes, the cellular and molecular basis of this association is largely unknown.

OBJECTIVE

To investigate the effect of lipopolysaccharide (LPS) on IgE production and cytokine profile by peripheral blood mononuclear cells (PBMC) obtained from asthmatic children with the TT and the CC genotypes at position -159 of the CD14 gene.

METHODS

Peripheral blood mononuclear cells from asthmatic children with alternative genotypes at CD14 C159T locus were stimulated with 2 and 200 ng/ml LPS in vitro. The IgE, IgG and, IgM response was determined by ELISA and Ig έ-germline, IgG, and IgM transcription by real-time PCR. A cluster of cytokines was measured by cytometric bead array.

RESULTS

Asthmatic children with the TT genotype but not those with the CC genotype responded with increased IgE synthesis and germline transcription to LPS stimulation. There were no genotype-related differences in IgG and IgM. TT but not the CC genotype was associated with significantly increased interleukin (IL)-4/IL-12 and IL-4/interferon-gamma (IFN-γ) ratios in the culture supernatant. There were no genotype-related differences in IL-1β, IL-7, IL-10, IL-13, IL-17A, granulocyte colony stimulating factor, granulocyte macrophage colony stimulating factor, monocyte chemotactic protein, and tumor necrosis factor alpha.

CONCLUSION

Peripheral blood mononuclear cells from asthmatic children with the TT genotype at position -159 of the CD14 gene make more IgE than those with the CC genotype following LPS stimulation because of increased germline transcription and have an augmented Th2 cytokine profile.

Analysis of proximal radial nerve injury in the arm

BACKGROUND

Radial nerve is the most frequently injured major nerve in the upper extremity. Proximal part of the radial nerve involvement can result from a humerus fracture, direct nerve trauma, compression and rarely from tumors.

OBJECTIVES

The aim of the study is to determine the clinical characteristics and electrodiagnostic findings in patients with proximal radial nerve injuries, and also the outcome of surgical treatment.

MATERIALS AND METHODS

The study subjects included 46 patients with radial nerve injuries seen between June 2000 and June 2008 at our hospital. The analysis included demographics, clinical features, etiology, pre-and postoperative EMNG (Electromyoneurography) findings.

RESULTS

Surgical decompression resulted in neurological improvement in patients with radial entrapment neuropathies. Good neurological recovery was observed from decompression of callus of old humeral fracture. The worst results were observed in the direct missile injuries of the radial nerve.

CONCLUSIONS

A detailed clinical and electrodiagnostic evaluation is of importance in patients with radial nerve injury to ensure an appropriate treatment. The choice of treatment, conservative or surgical, depends on the clinical presentation and the type of injury.

Analyses of clinical prognostic factors in operated traumatic acute subdural hematomas

BACKGROUND

Traumatic acute subdural hematoma is the most lethal of all head injuries.

METHODS

In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity.

RESULTS

Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%.

CONCLUSION

According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.

A new method of patient's head positioning in suboccipital retrosigmoid approach

BACKGROUND

The retrosigmoid approach is a common route to the cerebellopontine angle and lateral clivus. Patient's head positioning just before the operation is crucial to perform the procedure effectively and safely.

AIM

The aim of the study is to determine the positional angle of the head on preoperative axial sequences of the cranial magnetic resonance imaging (MRI).

MATERIALS AND METHODS

The angle between the line drawn along the petrous bone ventral to the internal auditory canal and the line drawn parallel to the dorsal face of the clivus on the axial view of MRI sequences was measured.

RESULTS

This method of patient positioning has resulted in minimal cerebellar retraction, less time in the preoperative preparation period and less postoperative headache and neck pain.

CONCLUSIONS

This method can provide quick and better exposure of the cerebellopontine angle. Preoperative measurement of positional angle on axial MRI sequences is a very simple and sufficient way to determine the angle of the head that is turned to the contralateral side.

Intramedullary lumbar lesion mimicking spinal cord tumor: a case of non-neoplastic intramedullary spinal cord lesion

Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed.

Extent and burden of allergic diseases in elementary schoolchildren: a national multicenter study

BACKGROUND

Scarcity of standardized, comparable data on allergic diseases in schoolchildren in Turkey requires further multicenter studies based on the use of objective tools in addition to parent-completed questionnaires to improve the validity and reliability of results.

METHODS

Using International Study of Asthma and Allergies in Children (ISAAC) Phase II tools, elementary schoolchildren aged 9 to 11 years were surveyed in 5 city centers in different regions of Turkey.

RESULTS

We surveyed 6963 children from 70 schools and found that 35% had had at least 1 symptom of allergic diseases in the past year. Based on parental reports, the overall prevalence rates for wheezing, rhinoconjunctivitis, and eczema in the past year were 15.8%, 23.5%, and 8.1%, respectively. The overall frequencies of atopy, flexural dermatitis, and bronchial hyperreactivity were 18.9%, 3.6%, and 24.2%, respectively. There were large variations in the prevalence of both symptoms and objective signs between study centers. Absence from school for at least 1 day was reported for 34.2% of children with a diagnosis of asthma or allergic rhinitis.

CONCLUSIONS

Approximately one third of elementary schoolchildren reported symptoms compatible with allergic diseases in the past year. The interregional differences in both symptoms and objective test results are possibly due to differences in environmental conditions. Unfortunately, serious problems are still encountered in the timely and proper diagnosis and treatment of allergic diseases.

Spinal accessory nerve palsy following gunshot injury: a case report

Injuries to the spinal accessory nerve are rare and mostly iatrogenic. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. As a seldom case, a 20 year-old male with spinal accessory nerve palsy after penetrating trauma by gunshot was reported. Three months after the injury, he was complaining about left arm pain in abduction to shoulder level and a decreased range of movement. On physical examination, wasting of the left trapezium with loss of nuchal ridge and drooping of the shoulder were found. On neurological examination of the left trapezius and sternomastoid muscles, motor function were 3/5 and wide dysesthesia on the neck, shoulder and arm was present. The bullet entered just above the clavicle and exited from trapezium. Radiological studies were normal, where electromyography (EMG) showed neuropathic changes. Surgical exploration showed the intact nerve lying on its natural course and we performed external neurolysis for decompression. The postoperative period was uneventful. Dysesthesia has diminished slowly. He was transferred to physical rehabilitation unit. In his clinical control after 3 months he had no dysesthesia and neurological examination of the left trapezius and sternomastoid muscles motor function were 4/5. EMG showed recovery in the left spinal accessory nerve.

Intermittent priapism in degenerative lumbar spinal stenosis: case report

BACKGROUND

Symptomatic lumbar spinal stenosis produces gradually progressive back and leg pain with standing and walking, relieved by sitting or lying. One of the uncommon symptoms is involuntary intermittent penile erection due to spinal canal stenosis. This symptom is very rare and often forgotten when history is taken.

METHODS

In this case report, a patient suffering from intermittent priapism due to degenerative spinal canal stenosis and spondylolisthesis is described. On admission his symptoms were intermittent neurogenic claudication and involuntary erection provoked by walking a short distance.

RESULTS

Bilateral laminectomy and posterior fusion was performed. His symptoms resolved over the first postoperative days.

CONCLUSION

Cauda equina compression due to LSS may rarely cause intermittent priapism. This rare symptom should not be forgotten when taking the patient's history and should also be kept in mind during follow-up.

Chronic subdural hematoma after endoscopic third ventriculostomy: case report

Endoscopic third ventriculostomy (ETV) is an effective and rather safe treatment for noncommunicating hydrocephalus secondary to aqueductal stenosis and other obstructive pathologies. It has become a popular alternative to ventricular shunts for noncommunicating hydrocephalus. Although it is a safe procedure, several complications related to this procedure have been reported in the literature. We report a rare case of a large chronic subdural hematoma (ChSDH) after ETV in a patient with aqueductal stenosis. A 42-year-old female patient presented with acute symptoms of obstructive hydrocephalus, headaches and blurring of consciousness. A computerized tomogram (CT) of the patient's brain revealed marked triventricular supratentorial hydrocephalus and an external ventricular drainage (EVD) was performed first. After this procedure, magnetic resonance imaging (MRI) demonstrated hydrocephalus secondary to aqueductal stenosis. ETV was performed and the EVD removed uneventfully. The patient was discharged home after a few days without any complications. She then presented with headaches 4 weeks following ETV. A CT demonstrated chronic subdural hematoma on the contralateral side. This was treated with burr-hole evacuation. Postoperatively, her headaches improved. During the follow-up period, she remains symptom-free and has radiographic evidence of a patent ventriculostomy. This case confirms chronic subdural hematoma formation is a possible complication following endoscopic third ventriculostomy.

Turkish physicians' perception of allergic rhinitis and its impact on asthma

BACKGROUND

The clinical association of rhinitis and asthma has been recognized for centuries, leading to a current definition of 'one airway, one disease'. Current findings indicate that the optimal treatment of rhinitis might improve coexisting asthma.

OBJECTIVES

To evaluate perception of the asthma-rhinitis association and to determine their capability in managing rhinitis.

METHODS

Participants of three national asthma meetings, in 2004, were asked to complete a questionnaire which, aside from demographic queries, elicited responses in order to reflect agreement or not with the given statements.

RESULTS

Of the 354 attendees, 220 (62%) responded to the questionnaire. Although over 80% reported good perception of the asthma-rhinitis association, only one-third were examining nasal mucosa of asthmatics, and over 70% believed sinus X-ray, blood eosinophil count, and determination of total serum IgE were required to diagnose allergic rhinitis. Between 20% and 40% of the physicians reported misuse of medications for rhinitis.

CONCLUSIONS

This survey documented that the asthma-rhinitis association is generally recognized by physicians treating asthma in Turkey. However, there are certain training needs in terms of attitude towards examinations and appropriate use of laboratories and medications for rhinitis. Improved understanding/management of rhinitis may contribute to asthma care as well as patient satisfaction and adherence to treatment.

Are risk factors of childhood asthma predicting disease persistence in early adulthood different in the developing world?

BACKGROUND

Predictive factors of childhood asthma for favorable prognosis may differ between populations where a variety of genetic and environmental factors are present.

OBJECTIVES

To document the factors predicting disease persistence in early adulthood in Turkey.

METHODS

An outpatient cohort (n = 115) with a mean follow-up duration of 11.4 +/- 0.2 years was evaluated. Complete remission was defined as no asthma symptoms, no use of controller medication, no airflow limitation and no airway hyper-responsiveness, and clinical remission as no symptoms and no use of controller medication, within the past year.

RESULTS

The mean ages during referral and at the final visit were 5.8 +/- 0.2 and 17.1 +/- 0.2 years, respectively. Thirty-one (27%) were in complete remission, and a further 30 (26%) in clinical remission. In multivariate logistic models, diminished airflow [forced expiratory volume in 1 s (FEV1) < 80% vs > or = 80%] at the initial lung function test predicted current diminished airflow (8.422; 2.202-32.206) (odds ratio; 95% confidence interval), and presence of obstructive pattern (FEV1/forced vital capacity (FVC) < 80% vs > or = 80%) predicted current obstructive pattern (29.333; 3.022-284.724). Furthermore, female gender appeared to predict persistence of asthma symptoms (3.330; 1.250-8.333) and absence of clinical remission (2.398; 1.038-5.254); eosinophilia predicted persistence of symptoms (4.271; 1.080-16.889) and presence of airway hyper-responsiveness (3.723; 1.129-12.278).

CONCLUSIONS

Diminished airflow, female gender and eosinophilia appear to predict an adverse outcome of childhood asthma, supporting the concept that variability may exist between populations.

[Penetrating transorbital intracranial foreign body]

We report a seven year-old boy who suffered left orbital penetration of an industrial sewing machine needle. The needle passing through the left orbit and sphenoid bone at the posterior was extending into the layers of the dura of the left temporal lobe. In this patient, we preferred surgical approach and there was no complication after surgery. Penetrating intraorbital foreign materials with intracranial extension may lead to complications such as intracerebral hematoma, brain abscess, CSF fistula, proptosis of the eye, diplopia, orbital cellulitis and periorbital abscess. They have to be removed by surgical approach to prevent potential complications.

ALOX5 promoter genotype, asthma severity and LTC production by eosinophils

BACKGROUND

The number of Sp1-Egr1 binding tandem repeats at the ALOX5 promoter influences gene transcription and may modify the response to anti-leukotriene treatment. The relationship of ALOX5 variants to asthma severity and leukotriene production by eosinophils is unknown.

OBJECTIVE

To characterize ALOX5 mRNA expression and cysteinyl-leukotriene production by eosinophils from individuals bearing ALOX5 promoter deletional variants and their association with the severity of childhood asthma.

METHODS

Eosinophils from adult asthmatics bearing only variant alleles (with other than five tandem repeats on both chromosomes, non5/non5) or no variant alleles (5/5) were cultured in vitro and ALOX5 expression and leukotriene secretion were measured. A total of 621 children with mild or moderate-severe asthma were genotyped at the ALOX5 core promoter.

RESULTS

Asthmatics with non5/non5 genotype expressed less ALOX5 mRNA and produced less LTC4 into culture supernatants than 5/5 individuals (6.4 +/- 2.0 and 20.0 +/- 5.0 pg/ml, n = 5; P < 0.05). More asthmatic children bearing non5/non5 genotype had moderate-severe asthma than children with the 5/5 genotype (5.3% vs. 1.4%, P = 0.008). Multivariate logistic regression identified ALOX5 promoter genotype as a significant predictor of disease severity (OR = 3.647, 95% CI: 1.146-11.608, P = 0.03). Consistent with these findings, children bearing the non5/non5 genotype had greater bronchomotor response to exercise as measured by the maximum fall after exercise and the area under the exercise curve (P < 0.05 for both).

CONCLUSION

Our results suggest that children who express the asthma phenotype despite having a genetic variant that impairs their ability to express ALOX5 have more severe disease and thus are more likely to have asthma symptoms.

The effect of polymorphisms at the CD14 promoter and the TLR4 gene on asthma phenotypes in Turkish children with asthma

BACKGROUND

Endotoxin, with its potential to enhance type 1 immunity, is a significant player in the hygiene hypothesis. The combined effects of the genetic variants of various molecules in the endotoxin response pathway on asthma related phenotypes are largely unknown.

OBJECTIVE

To investigate the effects of the genetic variants of CD14 and TLR4 genes on asthma phenotypes in a large number of asthmatic children.

METHODS

613 asthmatic children were genotyped at the CD14-C159T, TLR4-A896G and TLR4-C1196T loci. IgE, eosinophil numbers and FEV1 were compared in 327 children who were not on any controller medications and were symptom free. Multivariate logistic regression was used to determine the factors associated with total IgE.

RESULTS

Among children with atopic asthma, total IgE levels were significantly different among the three genotypes in the co-dominant model [CC: 435 kU/l (interquartile range: 146-820); CT: 361 (140-710); TT 204 (98-435), P = 0.035]. TT genotype was significantly and independently associated with lower IgE levels (OR: 0.5 95%; CI = 0.28-0.90, P = 0.021). Both TLR4-A896G and TLR4-C1196T polymorphisms were more frequent in the mild asthma group with atopy (P = 0.032, 0.018, respectively). The combined effects of the genetic variants in CD14 and TLR4 genes did not improve the observed associations.

CONCLUSION

Our study demonstrates that the CD14-C159T promoter variant influences total IgE levels and also indicates that the T allele has a more profound effect on total IgE in children with atopic asthma. Polymorphisms in the TLR4 gene may be associated with milder forms of disease in atopic asthmatics in the population studied.

Burden of rhinitis in children with asthma

Although the clinical association of allergic rhinitis and asthma has been recognized for centuries, in recent years the association appears to be stronger than was reported previously. However, data for children are less clear, and some studies indicate that results observed in developing countries may differ from those observed in Western populations. We therefore intended to document the association of rhinitis with pediatric asthma in terms of caregivers' perception, physician practice, and file records. Asthmatic children aged 3-16 years with at least 1-year follow-up in an allergy-asthma outpatient clinic were invited to participate in the study during a 10-month interval. In addition to a face-to-face questionnaire-based interview, file records were evaluated retrospectively to obtain information relating to asthma and rhinitis. Of 396 patients included in the study, 369 with consistent replies were included in the analyses. The mean age of the study group was 10.6 +/- 0.2 (mean +/- SEM) years, and a greater proportion of the respondents were male (63.7%), atopic (78.3%), and mildly asthmatic (50.7%). House dust mite and grass pollens were the most commonly sensitized allergens (50.7% and 46.9%, respectively). Although only 5.4% of our study population regarded themselves as rhinitic and 23.8% had been diagnosed with allergic rhinitis according to the file records, almost 57.7% of patients had required medications for rhinitis within the last year, and 68.8% had findings consistent with allergic rhinitis. Furthermore, 41.2% and 58.8% reported that their rhinitis symptoms caused a significant burden in their daily life and exacerbated their asthma, respectively, and almost 50% felt that their rhinitis had not been given significant consideration by their physician. In conclusion, although we report a large discrepancy between caregivers' perception of rhinitis, documentation in file records, and treatments for rhinitis, the allergic rhinitis prevalence determined in the survey and the medication use for rhinitis appeared to be in agreement. We recommend a greater effort be made to identify, label, and educate children with rhinitis and their families in asthma outpatient clinics.

[Trigeminal neuralgia and treatment options]

Trigeminal neuralgia is a painful condition of the face characterized by paroxysmal lancinating, shock-like pain confined to the somatosensory distribution of the trigeminal nerve. The etiology of most cases of trigeminal neuralgia has been suggested to be vascular compression of the central axons of the trigeminal nerve at the level of pontocerebellar region, so called hyperactive dysfunctional syndrome. Trigeminal neuralgia is the one of the most known pain syndromes. Several neurosurgical procedures have been developed for the treatment of idiopathic trigeminal neuralgia and in this review, idiopathic trigeminal neuralgia was discussed in aspect of different surgical modalities.

Management of childhood asthma: physicians' perspective in Turkey

Many attempts have been made to decrease asthma-related mortality and morbidity, including preparation and distribution of guidelines. However, several studies from different regions of the world have reported low asthma control among children as well as adults. A questionnaire-based study was performed involving a number of Turkish physicians taking care of pediatric asthmatics, and aimed to document asthma-related knowledge. Of 219 physicians, 126 (57%) completed the questionnaire. The majority were pediatricians (92%), with an average of 253 +/- 14.1 outpatients per week, and an asthmatic ratio of 15.8%. According to the self-reported knowledge, management of acute asthma received the highest (3.42 +/- 0.05) and chronic asthma the lowest scores (3.18 +/- 0.06). The study group further credited inhaled and oral steroids similarly for the treatment of exacerbations and reported infrequent usage of spirometry and oxygen saturation than physical finding to estimate attack severity. Although with regard to most subjects, physicians' opinions appeared to be in agreement with the guidelines, there were certain differences implying need for future educational training. Chronic management, reported as the least understood part of the guidelines, suggests requirement of new models for estimating chronic disease severity.

[A case of superior sagittal sinus thrombosis after closed head injury]

Superior sagittal sinus thrombosis (SSST) is a rare entity, most often arising from infections, dehydration, and hematologic disorders. Development of this condition secondary to trauma is extremely rare. In this report, a 13-year-old boy who developed SSST following a closed head injury is presented. Imaging studies showed SSST caused by a depressed skull fracture. Neurologic examination of the patient was normal other than bilateral papillary stasis. He was treated with antiedematous and anticonvulsant drugs. Magnetic resonance venography obtained eight months after the diagnosis showed unoccluded superior sagittal sinus, neurologic examination findings were normal, as well.