CT and Angiography in a Patient with Three Intracranial Giant Aneurysms

A patient with multiple giant aneurysms all located in the circle of Willis was treated conservatively. Literature pertaining to neuroradiologic features, especially dealing with the CT appearance of this entity, is scrutinized.

Osteoid osteoma in the thorasic spine

Osteoid osteoma is a benign skeletal neoplasm composed of osteoid and woven bone. The majority of the lesions arise in the cortex of long bones. Osteoid osteoma of the spine is a rare primary spine tumor and those located at the thoracal spine are even rarer. The usual treatment involves complete resection, including the nidus, or alternatively radiofrequency percutaneous ablation is performed. The authors present a 32-year-old female with an unusual localization of the osteoid osteoma in the thoracal spine where imaging modalities were not conclusive for the diagnosis. The T1 vertebra lesion was successfully resected via a posterior approach with T1 laminectomy, including right side C7 and T1 foraminotomies, and vertebroplasty were performed. Histopathology reported the lesion as an osteoid osteoma.

Predictive value of leucocytosis in head trauma

AIM

Head trauma is associated with an acute phase response which is characterized by leucocytosis due to increased levels of catecholamine and cortisol. Early edema formation following severe head injury may also be associated with microglia activation. Therefore, increased white blood cell (WBC) count after head trauma may be a predictive parameter of the severity of craniocerebral trauma.

MATERIAL AND METHODS

We retrospectively studied 59 patients with severe, moderate and minor injury between February 2007 and March 2009. WBC counts of all patients were obtained within the first day of their admission. All patients were divided into separate groups according to their Glasgow Coma Scale (GCS) scores and hospital stay durations. Their CT progressions and Glasgow Outcome Scale (GOS) scores were also assessed. The relationship between these parameters and WBC counts were evaluated by statistical methods.

RESULTS

There was a favorable correlation between WBC counts of the patients and GCS scores (pI0.01), hospital stay (p=0.006), CT progression (p < 0.01) and GOS scores (p < 0.01).

CONCLUSION

AWBC count exceeding 17.5 x 106/l has a predictive value for poor GCS score, and long hospital stay. CT progression tends to be seen in patients with moderate and severe head injury.

Her-2/neu gene amplification in paraffin-embedded tissue sections of meningioma patients

AIM

Meningiomas arise from the meningoendothelial cells and are one of the most common tumors of the central nervous system. The HER-2/neu gene is located on the 17q11.2-q12 chromosome region and encodes an epidermal growth factor receptor. HER- 2/neu gene amplification and/or over expression have been studied most widely in breast carcinomas. Previous studies have shown the importance of HER-2/neu gene amplification on the prognosis of meningioma cases. In this study, we aimed to detect HER-2/neu gene copy number in archive materials of 55 meningioma patients by fluorescent in situ hybridization (FISH).

MATERIAL AND METHODS

The patients included in the study had undergone surgery in the neurosurgery department of our hospital between 1999 and 2002. Tissue samples were classified histologically according to WHO 2007 guidelines. Interphase FISH was performed on 3 to 4microm thick paraffin embedded tissue sections for the detection of HER- 2/neu gene amplification status.

RESULTS

We found HER-2/neu gene amplification in 7 (12.73%) patients. Another 2 patients had only one signal for the HER-2/neu region. We confirmed this finding by a second hybridization with the chromosome 17p13.1 (p53) probe.

CONCLUSION

According to our results, HER-2/neu amplification could be regarded as an additional genetic factor playing role in meningioma pathogenesis together with known chromosomal abnormalities.

Nogo-A inhibitory peptide (NEP1-40) increases pan-cadherin expression following mild cortical contusion injury in rats

BACKGROUND

Nogo-A is a myelin-associated neurite outgrowth inhibitory protein that limits elongation of central nerve fibers, neuronal regeneration and plasticity. We investigated the effect of delivering an inhibitory peptide that neutralizes Nogo-A on neuronal recovery following mild cortical contusion injury.

METHODS

41 rats were allocated into the control and NEP1-40 treatment groups. PBS was applied following trauma over the parietal cortex after opening the dura in the control group. NEP1-40 solution was immediately applied following trauma after opening the dura in the treatment group. Each group was further divided into 3 subgroups and sacrificed on the third, eighth, and 21st days after injury. The brains were removed for analysis.

RESULTS

Immunohistochemical staining of the injured cortex for pan-cadherin revealed a significant increase in staining in the NEP 1-40 treatment group at the 8th and 21st days after injury. Electron microscopic evaluation revealed better cytoarchitectural preservation in the axons of the animals treated with NEP 1-40.

CONCLUSION

We observed improved preservation of injured neurons after topical application of NEP 1-40 following mild cortical injury. Pan-cadherin expression may correlate with the recovery of neurons and axonal bodies. Electron microscopical findings confirmed better preservation of neuronal structures after NEP1-40 treatment. Pan-cadherin is a good marker for neuronal recovery after cortical injury.

Tentorium schwannoma mimicking meningioma: an unusual location

A 60-year-old female was admitted to our clinic complaining of a long-lasting headache. Cranial magnetic resonance imagining examination of the patient revealed a 22x24 mm extra-axial, well-demarcated, mass lesion based on the left tentorium. The patient underwent a craniotomy and the tumor was totally excised with the adjacent tentorium. The histopathological examination of the tumor complied with the diagnosis of schwannoma. The rest of the clinical course was uneventful and the patient was released from the hospital without any neurological deficit. Intracranial schwannomas can rarely originate from atypical dural locations and radiological techniques are not always helpful in distinguishing tentorial schwannoma from tentorial meningioma. We presented a patient with a tentorium schwannoma mimicking meningioma and discussed the current literature.

Meningoencephalocele formation after nasal septoplasty and management of this complication

OBJECTIVE

Patients undergoing nasal septoplasty can face many complications. Some of these complications are rare but their results are life threatening. Being aware of this complication could prevent further problems such as enlargement of the bone and dural defect, herniation of the meninges and brain tissue through the defect by pulsation of the brain and ascending infection. With early diagnosis, a less aggressive method could be used to treat this complication.

CASE DESCRIPTION

A 50-year-old woman was admitted our hospital with the complaint of loss of consciousness. Her Glasgow coma score was 7 on admission. She had no lateralizing signs, but had nuchal rigidity. Blood pressure was 200/110mm Hg, the respiratory pattern was apneic, complete blood count revealed 12000 leucocytes/mm3 and arterial blood gases showed respiratory acidosis and other biochemical parameters were within normal limits. Computerized cranial tomography (CCT) showed diffuse brain edema without evidence of other signs. Lumbar puncture was performed revealing purulent and highly viscous cerebrospinal fluid (CSF).

CONCLUSION

Late diagnosis and late repair of arachnoidodural tearing could lead to life-threatening complications, and cases with meningitis and larger defects may require more extensive surgery instead of transnasal endoscopic repair.

Intraventricular dysembryoplastic neuroepithelial tumor: case report

OBJECTIVE

The most common localization of dysembryoplastic neuroepithelial tumors (DNTs) is the supratentorial cortex, often in the temporal lobe. However, intraventricular localization of a DNT is extremely rare.

CLINICAL PRESENTATION

A 30-year-old woman presented with a 1-year history of epileptic seizures. The seizures had not been controlled despite standard doses of antiepileptics.

INTERVENTION

Neuroimaging results demonstrated a lesion located in the occipital horn of the right lateral ventricle. The lesion was totally removed. Based on histopathological and immunohistochemical evaluation, a DNT was diagnosed. Over the course of the next 8 months, the patient's epileptic seizures were under control. The most recent neuroimaging examinations revealed neither residual nor recurrent tumor.

CONCLUSION

Because DNTs are surgically curable and neither radiotherapy nor chemotherapy is required after surgery, recognition of an intraventricular DNT in this location is extremely important.

The accuracy and diagnostic yield of computerized tomography guided stereotactic biopsy in brain lesions

OBJECTIVES

Radiological imaging techniques provide early detection of neurological diseases but they do not always provide an adequate and reliable diagnosis. With the help of stereotactic biopsy techniques, it is possible to access brain lesions safely and with high precision. We described the surgical method used in our clinic and discussed our results with the help of the current literature.

METHODS

Ninety-four patients underwent computerized tomography-guided stereotactic brain biopsy in our clinic. Anatomical locations, diagnostic yield and accuracy of the procedure, morbidity and mortality rates were analyzed.

RESULTS

A total of 100 stereotactic surgery procedures were performed on 94 patients. The localizations of the lesions were 13.83% frontal, 21.27% temporal, 27.66% parietal, 4.25% occipital, 4.25% multiple, 27.66% deep seated and 1.06% suprasellar. The histopathological diagnoses were 61.71% neuro-epithelial tumors, 8.51% metastases and 10.64% infectious lesions. Diagnostic yield was 86.16% and the accuracy was 90% in our series.

CONCLUSION

Computerized tomography-guided stereotactic brain biopsy is a reliable and safe method. Main diagnostic problems in SBB are tissue heterogeneity, insufficient material and sampling error. These problems can be minimized by careful correlation of clinical, radiological and histopathological findings by an experienced team and by using modern technologies.

Multiple cerebral hydatid cysts

A case of 19 years old female patient with 24 large primary cerebral hydatid cysts, in different localisations is presented. Cysts were removed unruptured by five separate operations in 6 months. The patient was observed to be in good health 1 year after the last operation. This case is the first case presented that contains such high number of cysts to our knowledge. The importance of MRI examination in localizing the cysts and designing the operative plan is emphasized. Interestingly, albendazole, which is an antiparasitic drug, was reported to be ineffective by infectious disease department of our hospital, because of large diameter of the cysts, in this case.

Tarsal tunnel syndrome in a patient on long-term peritoneal dialysis: case report

Tarsal tunnel syndrome (TTS) is defined as the entrapment of the posterior tibial nerve in the tarsal tunnel of the ankle. The etiologies of tarsal tunnel syndrome are mainly the presence of a ganglion, osseous prominence with tarsal bone coalition, trauma, varicose veins, neurinoma, hypertrophy of the flexor retinaculum, or systemic disease (rheumatoid arthritis, ankylosing spondylitis). However, no specific cause can be identified in some cases. Patients with chronic renal failure tend to develop peripheral nerve entrapment and carpal tunnel syndrome is the best-known peripheral entrapment neuropathy among them. Contrary to carpal tunnel syndrome, tarsal tunnel syndrome is observed less frequently in chronic renal failure patients. The common presenting symptoms of TTS are paresthesias and/or pain in the plantar side of the foot. Motor symptoms are rarely detected. Diagnosis is made primarily by electroneuromyographic studies and physical examination. Surgery is the treatment of choice and the outcome is generally favourable. In this report, we present a patient with tarsal tunnel syndrome complicating peritoneal dialysis.

Extraaxial chloroma of the cerebellopontine angle: case report

A chloroma or granulocytic sarcoma is an extramedullary leukemia. It can be encountered at any anatomical location, but until now only three cases have been reported in the cerebellopontine angle. We present an 8-year old patient with an extraaxial chloroma of the cerebellopontine angle to highlight this very rare and malignant pathology in the differential diagnosis of cerebellopontine angle tumors. The presented case, being the fourth chloroma in the cerebellopontine angle, occurred in the absence of relapse which is very unusual for these lesions. Chloroma should be remembered as a very rare and a malignant pathology in the differential diagnosis of pediatric cerebellopontine angle tumors.

Intraoperative monitoring of a patient with craniovertebral junction meningioma

Intraoperative monitoring is considered as a useful tool to prevent neurological damage during different neurosurgical procedures. Somatosensory evoked potentials (SEP) allow simultaneous assessment of several cortical and sub cortical centers. In this case presentation, we report intraoperative monitoring of an elderly patient with craniovertebral junction meningioma. Tibial SEP responses were elicited by stimulation of the tibial nerve; the recordings were visually analyzed for the presence of the main peaks P40-N50, peak to peak amplitudes, peak latencies and compared to baseline recordings throughout the procedure. During decompression from the medial aspect of the medulla SEP responses were lost for a brief period of time. Surgeons achieved total tumor removal and the patient left the operating room without any neurological deficit.

Cavernous hemangioma of temporalis muscle: report of a case and review of the literature

Hemangiomas are tumors of vascular origin comprising approximately 7% of all benign tumors. Intramuscular hemangioma is a rare condition and hemangiomas of the head and neck make up less than 15% of intramuscular hemangiomas. Temporalis muscle is an uncommon location for intramuscular hemangioma and seldom reported in the literature. Radiological methods are generally insufficient for the correct diagnosis and surgery is the treatment of choice to exclude malignancy and for adequate treatment of these lesions. A 37-year-old male was admitted with a slowly growing painless mass in his right temporal fossa. The lesion was surgically excised and histopathology confirmed the diagnosis of cavernous hemangioma. Diagnosis and treatment modalities for temporalis muscle hemangiomas are discussed.

Treatment differences in cases with venous angioma

Venous angiomas were found to be the most common cerebral vascular malformations, composing 63% of such lesions in two autopsy series. Annual bleeding risk associated with venous angiomas is about 0.22 % per year. Venous angiomas are generally silent lesions because of their dynamic features, and are low flow and low pressure vascular structures draining normal brain tissue. An angioma rarely causes symptoms such as bleeding, seizure, hemifacial spasm, trigeminal neuralgia, aqueduct compression, nonhemorrhagic infarction and thrombosis of the draining vein. Even if it should bleed, the lesion can be managed conservatively in asymptomatic or mildly symptomatic patients. In this paper we report two venous angioma cases. The first patient bled twice in a short period of time and the angioma was located at the posterior fossa next to the left lateral recess. The second patient recently suffered a cerebral stroke that was located in the vicinity of the right caudate nucleus and not associated with the venous angioma that was located next to the left caudate nucleus. This patient had been under warfarin sodium treatment for 14 years due to his previous coronary artery bypass surgery, but unknowingly there was a venous angioma located next to the caudate nucleus.

Chromosome 1p36 and 22qter deletions in paraffin block sections of intracranial meningiomas

Meningiomas are the most frequent benign tumors of the intracranial cavity. The classification and underlying pathogenetic mechanisms have been reported to be investigated by both pathological and genetic methods. In this study, we aimed to detect 1p36 and 22qter deletions by fluorescence in situ hybridization (FISH) in archival materials of 50 intracranial meningioma patients. The clinical material consisted of paraffin-embedded tissue sections from 50 patients who were surgically treated and had histopathologic diagnosis of an intracranial meningioma. We observed 1p36 deletion in 23/50 (46%) and 22qter deletion in 33/50 (66%) patients. In addition, we observed 22qter deletion in 26/36 (72.2%) patients with meningothelial meningioma. This finding implies that 22qter deletion might play an important role in the pathogenesis of meningothelial meningioma. On the other hand, no alterations were documented in the frequency of these chromosomal alterations according to the grade of meningiomas, suggesting that malignant progression of these tumors depends on other, more relevant, genetic changes.

Correlation between histological grade and MIB-1 and p53 immunoreactivity in meningiomas

OBJECTIVE

Meningiomas for the most part are slow-growing benign tumors, but complete removal can be difficult and recurrence is an issue. The aim of this study was to re-evaluate tumors diagnosed as meningioma previously in our hospital, according to the latest World Health Organization classification. We also examined the relationships among parameters such as brain invasion, histological grade and Ki-67 and p53 expression in these tumors.

MATERIALS AND METHODS

Meningioma biopsy specimens numbering 60 (48 grade I, 11 grade II, and 1 grade III tumors) were examined immunohistochemically using monoclonal antibodies for Ki-67 (MIB-1) and p53 protein. The MIB-1 labeling index (LI) for each tumor was calculated as a percentage based on the number of stained cells per total cells counted. The level of p53 expression in each sample was semiquantatively evaluated as < 1%, 1 - 10%, 10 - 70%, or > 70%. Any value > 1% was accepted as presence of p53 expression.

RESULTS

Of the 60 meningiomas, 7 (11.7%) exhibited brain invasion. The mean MIB-1 LI values for the grade I and grade II tumors were 1.1% and 2.3%, respectively. The corresponding levels of p53 protein expression in these groups were 54.1% and 72.7%. The MIB-1 LI and the level of p53 expression in the one grade III meningioma were 6.7% and 10 - 70%, respectively. Histological grade was significantly correlated with MIB-1 LI and with p53 expression (p < 0.01 for both). Brain invasion was not correlated with histological grade, MIB-1 LI, or p53 expression.

CONCLUSION

The results indicate that MIB-1 LI and p53 protein expression are good indicators of histological grade in meningioma and may be particularly valuable for distinguishing borderline atypical meningiomas. The number of cases was limited, but the findings also suggest that brain invasion is a prognostic parameter independent of grade, MIB-1 LI and p53 expression.

[Acute paraplegia caused by hypertensive spinal epidural haematoma]

The hypertension is an uncommon cause in acute spinal epidural haematomas. The severe motor disability and need to emergency treatment to avoid the permanent neurological impairments underline its importance. Seventy-five year old male, admitted with acute paraplegia, numbness in the lower extremities and urinary incontinence for 4 hours. The neurological examination showed complete paraplegia, numbness from the below of thoracal 9 dermatomes, and loss of all sensory motor reflexes including anal reflexes. The blood pressure was 210/120 mm Hg on his admission. Thoracolomber magnetic resonance examinations detected an acute epidural haematoma, which was compressing to the cord. The patient underwent emergent laminectomy involving T 9 to L 2 and clots were removed with microsurgical technique. The patient was mobilized on the 3. and discharged from the hospital on the 7. postoperative day without neurological impairment. Although majority of the spontaneous spinal epidural haematomas is a recognized idiopathic condition, hypertension is much more commonly seen etiological factor than estimated. Early diagnosis, surgical decompression of the spinal cord and high dose corticosteroids might result in complete recovery.

Chordoid meningioma: Rare variant of meningioma

Chordoid meningioma is a rare variant of meningioma that bears a striking histological resemblance to chordoma and has greater likelihood of recurrence. Although most meningiomas occur in the intracranial, orbital and intravertebral cavities, rare meningiomas have been reported in extracranial organs; thus, it is important to be able to distinguish them from other neoplasms that have similar histology but different biological behavior and therapies. A case of chordoid meningioma in a 48-year-old woman who did not have Castleman's syndrome is described in the present report. The patient presented with a mass in her left frontoparietal region, and had been suffering from headaches for many years. Magnetic resonance imaging of the brain demonstrated an expansive lytic lesion in the squamous portion of the left temporal bone. The lesion extended in both directions. Histological examination of the surgical specimen revealed a tumor composed of cords and nests of eosinophilic vacuolated cells embedded in a myxoid matrix. A typical meningiomatous pattern was observed focally, and positive staining of the tumor cells for vimentin and epithelial membrane antigen confirmed the diagnosis of chordoid meningioma.

Spontaneous corynebacterium discitis in a patient with chronic renal failure

STUDY DESIGN

Case report describing spontaneous Corynebacterium diptheria discitis in a patient with chronic renal failure.

OBJECTIVES

To describe this very rare form of discitis and the results of surgical and antibiotic therapy.

SETTING

University Department of Neurosurgery, Turkey.

CASE REPORT

A 55-year-old man with chronic renal failure presented with acute low-back pain. Lumbar magnetic resonance imaging (MRI) suggested discitis and osteomyelitis at the L5-S1 level. The L5-S1 disc was operated upon and the discectomy material was sent for pathological and microbiological analysis.

RESULTS

Pathological examination revealed infection and bacterial culture grew C. diptheria. The patient was prescribed combination antibiotic therapy with vancomycin, a third-generation cephalosporin, and rifampicin. Clinical status improved after 8 weeks of therapy. Lumbar MRI revealed remission of the discitis and osteomyelitis after 10 months of follow-up.

CONCLUSION

Chronic renal failure patients with low-back pain should be investigated for spinal infection. These individuals are prone to low-grade infection in the form of discitis or osteomyelitis. Corynebacterium subspecies rarely cause spontaneous discitis. This case is interesting because of the unusual causal organism and the occurrence of discitis in the setting of chronic renal failure.

The value of expanded polytetrafluoroethylene in preventing early re-ossification after craniosynostosis surgery: an experimental animal study in the rat

BACKGROUND

Early re-ossification at the suturectomy site after craniosynostosis surgery remains an important problem. Many surgical methods have been used to address this, including placement of various types of absorbable and non-absorbable material between the bone edges at the site. This experimental study investigated the value of expanded polytetrafluoroethylene (ePTFE) membrane as a barrier to calvarial reclosure after craniosynostosis surgery in rats.

METHOD

Thirty-five 2-week-old Sprague-Dawley rats were divided into two groups. In Group A (n = 17), ePTFE membranes were placed in the defect formed by a left coronal suturectomy. The Group B rats (n = 18) underwent left coronal suturectomy only. Animals were sacrificed at 1, 2 and 4 months postoperatively. In each case, the skull was removed and the operative site was examined for fibrosis, new bone formation, bone bridging, neovascularization and inflammatory response.

FINDINGS

The two groups were similar with respect to neovascularization and new bone formation. By the end of the fourth postoperative month, 50% of the Group B specimens showed fibrosis and 50% showed bridging between the bone edges at the suturectomy site. In contrast, at the same stage in Group A, only 16.6% of the specimens exhibited a small amount of fibrosis, and none showed bone bridging between the edges.

INTERPRETATION

Expanded PTFE is one of the most inert materials used in surgery. The study showed that inserting ePTFE membrane as a barrier between the bone edges at the suturectomy site prevents early re-ossification after craniosynostosis surgery in rats.

Spontaneous resolution of lumbar vertebral eosinophilic granuloma

Eosinophilic granuloma (EG) is a rare disease but is more common in adults than children. It's often self-limiting. Spinal involvement is rare. It is the localized and most benign form of Langerhans' cell histiocytosis (previously known as histiocytosis X), characterised by lytic lesions in one or more bones. Spontaneous resolution of vertebral body lesions is very rare. In this case, the patient had one EG in a cervical vertebra and a similar lesion in a lumbar vertebra. This case is important because it featured a symptomatic lesion in the cervical spine accompanied by an asymptomatic lesion in a lumbar vertebra. We treated the cervical lesion by surgical fusion and followed the lumbar lesion up conservatively, with the patient in a corset. After 8 years of follow-up, control MRI showed that the lumbar lesion had spontaneously resolved.

Magnetic resonance image findings and surgical considerations in T1-2 disc herniation

OBJECTIVE

To report a case of disc herniation at T1-2.

CLINICAL PRESENTATION

A 57-year-old man presented with hand weakness, Horner's syndrome, and pain radiating along the medial aspect of one upper extremity. Magnetic resonance imaging demonstrated extruded T1-2 disc herniation with upward herniation of a sequestrated fragment.

INTERVENTION

An anterior approach was used to excise the disc, that was compressing the spinal cord and the T1 nerve root. All the patient's symptoms resolved completely, including Horner's syndrome.

CONCLUSION

Anterior discectomy may be the simplest and most effective method for disc excision and relief of spinal cord and T1 nerve root compression.

The structure of a neurosurgical manuscript

Preparing publishable manuscripts is an important aspect of professional life in research or clinical neurosurgery, especially for those in academic circles. Scientific writing skills can be developed through a long process of training and experience, starting with the residency program. The first step in developing a manuscript is to focus on a subject or problem that might be of significant interest to colleagues in the field. Next, the prospective writer must do a detailed survey of the relevant literature, the results of which will help him or her decide whether to actually write about the topic. Since the primary goal is to get the manuscript published, the writer should bear a specific journal in mind and write in accordance with the guidelines of that publication. He or she must also consider general ethics and scientific rules during the writing process. Learning how to assess and use scientific sources, how to relate the collected information to the manuscript, and how to write in good scientific form are all important aspects of neurosurgical training.

[Posttraumatic tension pneumocephalus causing herniation]

A 12 year old boy was admitted to emergency service with loss of consciousness, convulsions and anisocoria of the right eye along the history of upper respiratory tract infection for the last four days. Two months ago he was hospitalized at the intensive care unite due to motorcycle accident with frontal fracture and minimal frontal pneumocephalus. He was treated for ten days and discharged without any neurological impairment. The last computerized tomography showed right frontal air of 5x5x7 cm. multiple airs in the ventricular system and in the upper central canal of the cervical region. The air was removed immediately through a right frontal burr-hole with a bedside procedure. The patient's neurological status rapidly improved and ten days after computerized tomography showed clearly resolution of the air. The presented case is an interesting example of post traumatic pneumocephalus due to herniation and widespread intracranial air. The situation can be explained with acute penetration of huge amount of air into the cranium through the frontobasal fracture and torn dura by strong Valsalva 's maneuver resulting from coughing and sneezing in the course of upper respiratory tract infection. We suggest close follow up, frequent control computerized tomography scans, preventive and effective treatment respiratory tract infections along 3-6 months in similar cases.

Cerebral hydatid disease CT and MR findings

In this study, we reviewed the computed tomography (CT, n=9) and magnetic resonance (MR, n=5) imaging findings of 11 patients with pathologically confirmed cerebral hydatid disease. Among our patients, there were 10 cases of Echinococcus granulosus and 1 case of Echinococcus multilocularis. Common CT and MR imaging findings of E. granulosus lesions were well-defined, smooth thin-walled, spherical, homogeneous cystic lesions with no contrast enhancement, no calcification, and no surrounding edema. E. multilocularis lesions showed calcified round, solid pattern with definite margins, contrast enhancement, and surrounding edema.

Quadruplets hydatid cysts in brain ventricles: a case report

An 18-year-old male patient with a hepatic hydatic cyst was admitted with cephalgia and gait disturbances. Radiological examination showed a cystic lesion in his liver and four cystic masses, 2-8 mm in diameter, in the right lateral brain ventricle. All cysts were removed without rupture by way of a right transparietal-transventricular approach, using an ellipsoid forceps designed by ourselves. Albendazole was given postoperatively. Postoperative outcome was excellent in this case except for transient left hemiparesis. To our knowledge, this is the first case of four hydatid cysts in the lateral brain ventricle.

MRI of neurologic complications in end-stage renal failure patients on hemodialysis: pictorial review

End-stage renal disease patients who have been on long-term hemodialysis tend to develop central nervous system complications. The most common neurologic complications in this patient group include white matter changes, cerebral atrophy, osmotic demyelination syndrome, dialysis encephalopathy, hypertensive encephalopathy, intracranial hemorrhage, infarct, sinus thrombosis, and infection. Clinical evaluation of these patients is somehow complicated and MRI is important before establishment of the therapy. The purpose of this article is to illustrate the range of MRI findings of neurologic complications in end-stage renal failure patients on hemodialysis with etiologic factors.

Pachymeningitis and optic neuritis in rheumatoid arthritis: successful treatment with cyclophosphamide

Pachymeningitis is a rare complication of rheumatoid arthritis. The case of a 52-year-old male rheumatoid arthritis patient with pachymeningitis and optic neuritis who was successfully treated with intravenous cyclophosphamide is described.

Central nervous system hydatidosis in Turkey: a cooperative study and literature survey analysis of 458 cases

OBJECT

Hydatidosis is both a medical and an economic problem in Turkey. The aim of this study was to analyze central nervous system (CNS) involvement in this disease, the related problems the disease causes, and its diagnostic and therapeutic aspects.

METHODS

The authors conducted an extensive literature survey of the subject, in which papers published by Turkish authors in international and domestic journals were carefully analyzed. In addition, the authors conducted a cooperative study in which data were gathered from 47 neurosurgery departments across the country. The purpose was to determine the current status of the disease in Turkey; thus, each unit was questioned about their experience over the past 5 years. Contrary to common belief, the incidence of hydatidosis has not decreased significantly in Turkey. However, computerized tomography and magnetic resonance imaging have tremendously increased diagnostic specificity. Incidences of morbidity and mortality have improved over time, according to the results of the cooperative study, although these changes are not statistically significant. This may be attributed to experience that has been gained and to more frequent use of chemotherapy, as reflected by the cooperative study data. The two statistically significant findings of that study were expanded use of chemotherapy in the management of hydatidosis, and a higher rate of extraneural involvement in the disease. The cooperative study revealed that chemotherapy was being used more often and that there was a wider range of indications for this treatment than previously reported. The higher rate of extraneural involvement was predictable because lesions in the CNS are typically secondary in this disease. With regard to the studies' findings on cases of spinal hydatid cysts, the authors found that administration of chemotherapeutic drugs was the only statistically significant parameter (t = 3.78, p < 0.05), with the rate of chemotherapy higher in the cooperative study.

CONCLUSIONS

Morbidity, mortality, and recurrence rates of hydatidosis uncovered by the cooperative study and the literature survey were not statistically significant.

Giant posterior fossa teratoma

In this study we report a rare case of a giant midline posterior fossa teratoma; its clinical presentation, radiological appearance, treatment and outcome, with an extensive review of the literature.

Akinetic mutism after fourth ventricle choroid plexus papilloma: treatment with a dopamine agonist

BACKGROUND

Akinetic mutism is a behavioral state wherein a patient seems to be awake but does not move or speak. Several patients are reported to have developed mutism after posterior fossa surgery. We present a patient who developed akinetic mutism after total excision of a choroid plexus papilloma of the fourth ventricle, and who was treated with bromocriptine.

CASE DESCRIPTION

An 18-year-old woman was admitted with akinetic mutism, which had developed 6 days after posterior fossa surgery. She had had no neurologic deficit in the first 5 days after surgery and could communicate with her family. Despite antioedematous therapy and daily lumbar punctures to drain cerebrospinal fluid, there was no clinical improvement after she entered the akinetic mute state. Brain magnetic resonance revealed ventriculomegaly; brain single photon emission computed tomography revealed bilateral reduction of perfusion in the frontal region. Because daily lumbar drainage did not result in clinical improvement, shunt placement was not considered. Bromocriptine therapy was begun at a dose of 2x2.5 mg; 24 hours later, the patient started to speak and move her upper extremities. Further improvement occurred over the following week when the dose was increased to 3x2.5 mg. Bromocriptine was replaced with a placebo to determine whether the neurologic improvement was caused by the medicine. The patient's neurologic status deteriorated progressively; therefore, bromocriptine was restarted and she was discharged from the hospital. During the 6 months of follow-up, the patient has remained in good health.

CONCLUSIONS

The etiology of akinetic mutism is not clear. Monoaminergic pathways, particularly dopaminergic cell groups, are most probably involved in this syndrome, because bromocriptine has a dramatic effect on these patients, as demonstrated in our case.

Intracranial meningiomas. Analysis of 344 surgically treated cases

The authors present 344 (230 females, 114 males) surgical cases of intracranial meningioma. A total of 370 interventions (344 primary procedures, 10 reexplorations for neurologic deterioration, 16 operations for recurrence) were made. Mean follow-up was 38 months. The overall evaluation revealed that 306 (88.95%) patients were completely normal or in a better condition than before operation. 18 (5.23%) were in a worse condition after operation and 20 (5.81%) died. Results suggested that complications and mortality were mostly related to localization and large volume; we also still have problems with aggressive and malignant meningiomas.

Cerebral Dermabacter hominis abscess

Dermabacter species are commonly isolated from the skin and other body sites but rarely show pathogenicity in humans. A case of Dermabacter hominis cerebral abscess is reported which presented as a contrast-enhancing intracranial mass in a renal transplant patient.

Interesting radiologic findings in suprasellar mass lesions. Report of three cases

The authors report three quite rare lesions of the sellar/parasellar region. They are namely; pituitary abscess, cystic macroadenoma and osteochondroma. In none of the cases, the preoperative diagnostic priority was not same as the final histopathologic diagnosis. The radiologic findings of these pathologies are discussed with emphasis on differential diagnosis.

Melperone treatment in an organic delusional syndrome induced by hyperprolactinemia: a case report

A young female with organic delusional syndrome induced by hyperprolactinemia was admitted to the Psychiatry Clinic of Ankara Social Security Hospital. The most striking characteristic of her history was either worsening of the endocrinologic clinical outcome under conventional neuroleptic treatment or worsening of clinical psychiatric outcome under bromocriptine therapy. A new atypical neuroleptic, melperone, suggested to minimally affect plasma prolactin levels, was started. Her psychotic complaints significantly subsided and she was devoid of any symptomatological change regarding her endocrinological status. These results were discussed.

An unusual dumbbell form of cavernous hemangioma of the cervical spine

Cavernous hemangiomas are vascular malformations of the central nervous system that may rarely affect the epidural space of the spine. We report a case of an epidural cavernous hemangioma which was originating from the left C8 nerve root and extending anteriorly to the apex of the left lung.

Management of problematic intracranial hydatid cysts

The authors report four patients with intracranial hydatic cysts. One patient had a pontine lesion which was punctured and aspirated and the cyst wall removed with a satisfactory outcome. The second patient had multiple cysts which was comparable to meningeomatosis. She had a rapidly deteriorating neurologic condition which proved to be fatal in spite of two consecutive surgical interventions. The third patient had nine lesions although only six were evident on the MRI. All of the cysts were removed, while two cysts ruptured. Multiple paracardial cysts of this patient were surgically removed shortly after the craniotomy. The last patient, again with multiple intracranial hydatid cysts had safe, total removal of all cysts. The first postoperative control CT raised the possibility of recurrence since the CT was highly suggestive of a hydatid cyst. However, this was not confirmed in the follow-up CT examination. Problems and the solutions of management are discussed.

MRI findings and encouraging fluconazole treatment results of intracranial Cladosporium trichoides infection

The authors report on a 31-year-old male patient harboring multiple intracranial mass lesions which proved histologically to be due to infection with Cladosporium trichoides upon removal of one of the lesions. Aggressive antifungal chemotherapy with fluconazole (400 mg/d for 3 months) in combination with surgery resulted in good clinical and radiologic outcome which prompted us to report this case.

Purification and characterization of human meningioma M2-type pyruvate kinase

The M2-type pyruvate kinase was purified from human meningioma by ammonium sulfate precipitation, followed by ion exchange and affinity chromatography. The specific activity of the purified enzyme was 33.4 U/mg with a yield of 6.5%. The enzyme gave a single band with 63,000 +/- 2000 Da upon SDS polyacrylamide gel electrophoresis. On cellulose acetate electrophoresis zymograms, the purified enzyme (M2) showed a single band, while crude extracts gave two broad bands corresponding to pyruvate kinase isozymes. The pI value of purified enzyme was found to be 6.9. With phosphoenol pyruvate as substrate the purified enzyme showed sigmoidal kinetics, while in the presence of 0.6 mM fructose 1,6-diphosphate as modulator it gave a hyperbolic saturation curve with a Km value of 0.53 mM.

Regulation of M2-type pyruvate kinase from human meningioma by allosteric effectors fructose 1,6 diphosphate and L-alanine

In the present study the mechanism of action of M2-type pyruvate kinase from human meningioma in the simultaneous presence of fructose 1,6 diphosphate and L-alanine was investigated. Purified pyruvate kinase from human meningioma was allosterically inhibited by L-alanine with respect to substrates phosphoenolpyruvate and ADP. The inhibitory effects of L-alanine was partially removed by fructose 1,6 diphosphate. The purified enzyme was slightly susceptible to ATP inhibition.

CT and angiography in a patient with three intracranial giant aneurysms

A patient with multiple giant aneurysms all located in the circle of Willis was treated conservatively. Literature pertaining to neuroradiologic features, especially dealing with the CT appearance of this entity, is scrutinized.