Normal Pressure Hydrocephalus Overshadowed by Traumatic and Degenerative Spinal Diseases: A New Assessment Proposal.

AIM: Normal pressure hydrocephalus (NPH) is a rare disorder among the elderly, characterized by gait disorder, dementia, and urinary incontinence. Considering the rareness of NPH and a lot of other pathologies, such as Parkinson's disease, lumbar spinal stenosis, and even aging cause similar symptoms, NPH is an underdiagnosed entity. However, the percentage of misdiagnosis is not given in the literature. MATERIAL AND METHODS: In this study, patients diagnosed with NPH were retrospectively screened between 2015 and May 2019 in our clinical database and Ste-P formula was applied. Example cases showed that some of the patients receive inaccurate medical and surgical treatments before being diagnosed with NPH. RESULTS: As a result of the study was seen that a few out of 29 patients confused dizziness with trunkal ataxia or imbalance due to gait abnormality. As the time between onset of complaints and diagnosis increased, the value approached "zero", and diagnosis became difficult. CONCLUSION: Every unnecessary operation carries serious risks that may threaten the life of the patient and decrease the quality of life. These surgeries and instrumentation materials used may also result to additional financial cost. Similarly, long-term use of Parkinson's and dementia medications has a serious economical burden on the insurance systems and is detrimental to the patient's health. Considering all these diagnoses and physiological conditions that can be easily confused with each other, we recommend in this article a new formula to reduce the possibility of misdiagnosis and treatment in patients with walking disorder.

Growth hormone-releasing pituitary microadenoma overshaded by a macroadenoma: a case of double pituitary adenomas and review of the literature.

OBJECTIVES: Double pituitary adenoma is a rare entity that can pose a significant challenge. The incidence of double or multiple pituitary adenomas is ∼1% in autopsy cases and 0.4-1.3% in surgical series. Its definition varies, including 'double adenomas' in the literature in contrast to 'multiple adenomas', which is more specific and suitable. While some authors require separating topographically unique tumours, others have used a looser definition of separate immunohistochemistry. CASE PRESENTATION: We presented the case of a 26-year-old patient with recurrent carpal tunnel syndrome symptoms, with double pituitary adenomas secreting growth hormone (GH) and thyroid-stimulating hormone (TSH). To date, 89 patients have been reported in the literature with symptomatic carpal tunnel syndrome, but only five had GH-TSH secretion. CONCLUSIONS: Double adenoma resection is of great importance for ensuring successful biochemical treatment. To ensure a successful operation, a careful preoperative 3T MRI examination is of great importance.

Unilateral isolated alar ligament rupture in an adult female patient.

Only seven cases of isolated unilateral rupture of the alar ligament had been previously reported. The authors report the first adult female case of this rare injury. The patient in their case, a 36-year-old female presented after a trauma due to falling, and at that moment, she had fainted due to a sudden pain between the neck and head. The radiological examinations [magnetic resonance imaging (MRI) and X-rays] had been interpreted as normal. She had a positive Alar ligament test at the right side, and a thin section craniovertebral junction computed tomography was obtained which revealed an asymmetrically left-sided odontoid process and a new MRI revealed a right-sided alar ligament rupture. Thus she underwent a bilateral greater occipital nerve block together with pulse radiofrequency and trigger point injection at splenius capitis, levator scapula, and trapezius followed by the application of a halo orthosis to be worn for 3 months. The patient was found to be pain-free in the follow-up examinations. With pure unilateral alar ligament rupture, the atlantooccipital joint is not disrupted and the craniovertebral junction is not destabilized. To date, only eight cases of isolated unilateral alar ligament rupture have been reported one of which was a 25 years old male; all of whom presented with marked neck pain and treated by external immobilization for 4 weeks to 4 months and our case is the first adult female patient.

The Correlation of SCL-90-R Anxiety, Depression, Somatization Subscale Scores with Chronic Low Back Pain.

AIM: To investigate the correlation of the Symptom Checklist-90-R (SCL-90-R) anxiety, depression, and somatization subscale scores with chronic low back pain (LBP). MATERIAL AND METHODS: Seventy-five patients who were admitted with the complaint of chronic LBP (patient group) and 75 healthy persons (control group) were evaluated. SCL-90-R anxiety, depression, and somatization subscale scores of patients having chronic LBP and healthy persons were measured. The mean values were paired and using two tailed t test they were statistically evaluated. RESULTS: The difference between SCL-90-R anxiety subscale subscores of patients having chronic LBP and healthy persons was not statistically significant (p > 0.05). The difference between SCL-90-R depression subscale subscores of patients having chronic LBP and healthy persons was not statistically significant (p > 0.05). The difference between SCL-90-R somatization subscale subscores of patients having chronic LBP and healthy persons was statistically significant (p < 0.05). CONCLUSION: SCL-90-R somatization subscale subscores are higher in patients with low back pain. The treatment of low back pain can be more successful when combined with the treatment of somatization.

Transoral screw and wire fixation for unstable anterior ½ atlas fracture.

STUDY DESIGN: Atlas fractures are evaluated according to the fracture type and ligamentous injury. External immobilization may result in fracture nonunion. OBJECTIVE: The ideal treatment method for non-stabilized atlas fractures is limited fixation without restricting the range of motion of the atlantoaxial and atlantooccipital joints. SUMMARY OF BACKGROUND DATA: Such a result can be established by using either anterior fixation or posterior lateral mass fixation. However, none of these techniques can fully address anterior 1/2 atlas fractures such as in this case. MATERIALS AND METHODS: A transoral technique in which bilateral screws were placed intralaminarly and connected with wire was used to reduce and stabilize an anterior 1/2 fracture of C1. RESULT: Radiological studies after the surgery showed good cervical alignment, no screw or wire failure and good reduction with fusion of anterior arcus of C1. CONCLUSIONS: Internal immobilization by this screw and wire osteosynthesis technique protects the mobility of the atlanto-occipital and atlantoaxial joints. The main advantage is that neither the twisted wires inserted under the anterior lamina, nor the laterally placed screw heads interfere with midline wound closure; unlike the plate/cage and rod systems used together with anterior screws. A computer navigation system with intraoperative 3D imaging facilities will be of benefit for safe placement of the screw, however we preferred a free-hand technique, as the starting point was at the fracture line along the trajectory of the routinely accessible anterior lamina.

Unilateral lag-screw technique for an isolated anterior 1/4 atlas fracture.

STUDY DESIGN: Fractures of the atlas are classified based on the fracture location and associated ligamentous injury. Among patients with atlas fractures treated using external immobilization, nonunion of the fracture could be seen. OBJECTIVE: Ideally, treatment strategy for an unstable atlas fracture would involve limited fixation to maintain the fracture fragments in a reduced position without restricting the range of motion (ROM) of the atlantoaxial and atlantooccipital joints. SUMMARY OF BACKGROUND DATA: Such a result can be established using either transoral limited internal fixation or limited posterior lateral mass fixation. However, due to high infection risk and technical difficulty, posterior approaches are preferred but none of these techniques can fully address anterior 1/4 atlas fractures such as in this case. MATERIALS AND METHODS: A novel open and direct technique in which a unilateral lag screw was placed to reduce and stabilize a progressively widening isolated right-sided anterior 1/4 single fracture of C1 that was initially treated with a rigid cervical collar is described. RESULTS: Radiological studies made after the surgery showed no implant failure, good cervical alignment, and good reduction with fusion of C1. CONCLUSIONS: It is suggested that isolated C1 fractures can be surgically reduced and immobilized using a lateral compression screw to allow union and maintain both C1-0 and C1-2 motions, and in our knowledge this is the first description of the use of a lag screw to achieve reduction of distracted anterior 1/4 fracture fragments of the C1 from a posterior approach. This technique has the potential to become a valuable adjunct to the surgeon's armamentarium, in our opinion, only for fractures with distracted or comminuted fragments whose alignment would not be expected to significantly change with classical lateral mass screw reduction.

Effects of cell phone radiation on lipid peroxidation, glutathione and nitric oxide levels in mouse brain during epileptic seizure.

The objective of the this study was to evaluate the effects of cellular phone radiation on oxidative stress parameters and oxide levels in mouse brain during pentylenetetrazole (PTZ) induced epileptic seizure. Eight weeks old mice were used in the study. Animals were distributed in the following groups: Group I: Control group treated with PTZ, Group II: 15min cellular phone radiation+PTZ treatment+30min cellular phone radiation, Group III: 30min cellular phone radiation+PTZ treatment+30min cellular phone radiation. The RF radiation was produced by a 900MHz cellular phone. Lipid peroxidation, which is the indicator of oxidative stress was quantified by measuring the formation of thiobarbituric acid reactive substances (TBARS). The glutathione (GSH) levels were determined by the Ellman method. Tissue total nitric oxide (NOx) levels were obtained using the Griess assay. Lipid peroxidation and NOx levels of brain tissue increased significantly in group II and III compared to group I. On the contrary, GSH levels were significantly lower in group II and III than group I. However, no statistically significant alterations in any of the endpoints were noted between group II and Group III. Overall, the experimental findings demonstrated that cellular phone radiation may increase the oxidative damage and NOx level during epileptic activity in mouse brain.

Pentylenetetrazol-induced seizures are not altered by pre- or post-drug exposure to a 50 Hz magnetic field.

PURPOSE: To investigate whether pre- and post-drug magnetic field (MF) exposure of 50 Hz, 0.2 mT has any significant effect on pentylenetetrazol (PTZ)-induced seizures in mice. MATERIAL AND METHODS: MF was generated by a pair of Helmholtz coils. Seizures were induced by PTZ injection intraperitoneally (i.p.) at a dose of 60 mg/kg. A total of 48 locally bred adult female mice 25-35 g in weight were used. Latency to seizure, total seizure duration, and mortality were recorded for each mouse. RESULTS: Neither pre- nor post-drug exposure to a 50 Hz, 0.2 mT MF was found to have any effect on PTZ-induced epileptic seizures or mortality rates in mice. CONCLUSION: The present study failed to provide any support for a therapeutic potential of a 50 Hz, 0.2 mT MF for epilepsy.

In vivo human brain biochemistry after aerobic exercise: preliminary report on functional magnetic resonance spectroscopy.

BACKGROUND: Our aim was to disclose whether the positive psychological changes observed after a single bout of aerobic exercise have a biochemical correlate that can be visualized by proton magnetic resonance spectroscopy (MRS) of the human brain. METHODS: Right-handed male volunteers underwent psychological testing and MRS of the frontal lobe of the left hemisphere, both before and after 20 minutes of jogging at about 70% of their maximal aerobic capacity. RESULTS: Although there was a significant decrease on the postexercise anxiety test scores (z = -2.201, P < .05), there was no significant difference between the preexercise and postexercise scores of positive and negative affect. Considering both "amplitude" and "area under the curve" values calculated for the peaks of metabolites N-acetylaspartate (NAA), creatine, and choline, none were found to be significantly changed (P > .05) after the exercise. CONCLUSION: This is, to our knowledge, the first study to report on a functional application of MRS to mood states. Because it offers the ability to directly measure metabolic changes in the brain during neuronal activation, "functional MRS" may be a potential new tool that may be used as an adjunct to functional magnetic resonance imaging.

Bilateral carpal tunnel syndrome associated to familial Mediterranean fever.

A unique case of bilateral severe carpal tunnel syndrome due to familial Mediterranean fever is reported. The syndrome was diagnosed by clinical examination and electrophysiological studies. Bilateral transverse carpal ligaments were released and the biopsy specimens revealed systemic type A amyloidosis. Up to our knowledge, the co-existence of bilateral carpal tunnel syndrome and familial Mediterranean fever has not been reported previously in the literature.

Proximally situated osseous septum in complex spina bifida. Case report.

In Type I split cord malformation (SCM) lesions, the osteocartilaginous spur and its dural sleeve are almost always located in the caudal extent of the median cleft. The authors present a case of lumbar myelomeningocele associated with a thoracic Type I SCM in which an osseous septum is uniquely situated in the proximal extent of the median cleft. Split cord malformations are cord-tethering lesions, which may be associated with a myelomeningocele that causes additional tethering, even in the opposite direction; therefore, both lesions should be treated. In view of this unique case, however, the surgical approach used for tethering lesions in such cases of complex spina bifida should perhaps be tailored. Whenever feasible, meticulous preoperative examination of a patient with spina bifida, including entire craniospinal magnetic resonance imaging followed with perioperative dynamic evaluation, is important for the effectiveness and safety of the surgery.

The immunohistochemical approach to determine the origin and possible function of the juxtaoral organ in dogs.

OBJECTIVE: In this study, we applied immuno- histochemical techniques on the functionally little known organ of Chievitz (juxtaoral organ [JOO]) in dogs to determine its origin and possible function. METHODS: The term abortive materials of 6 Doberman dogs were used for experimental procedures in July 2002 to June 2003 at Gazi University Faculty of Medicine, Ankara, Turkey, after routine light microscopic tissue preparation, the sections were stained with Masson's trichrome stain. In order to elucidate the function-related origin of the organ, we used epidermal growth factor (EGF-r), transforming growth factor (TGF-alpha) and nerve growth factor (NGF-beta) immunohistochemical stains. RESULTS: We observed a very strong and widespread immunoreactivity of EGF-r and TGF-alpha on simple squamous capsular cells. We detected nerve growth factor-beta positivity in granular form both in simple squamous capsular cells and in neighboring connective tissue. However, we did not detect EGF-r reactivity on parenchymal cells except a weak immunoreactivity on central ones. We noticed transforming growth factor-alpha in most of the parenchymal cells while we observed NGF-beta strongly in all the parenchymal cells. CONCLUSION: These results may point out that the JOO may be of mesothelial or epithelial origin. Having NGF-alpha positive granules and close relationship with blood vessels may imply a neurosecretory function. We believe that our study may add new perspectives to the function of the JOO.

Possible spontaneous "birth" of a hydatid cyst into the lateral ventricle.

INTRODUCTION: Intraventricular hydatid cyst is an extremely rare entity. We report a solitary hydatid cyst in a lateral ventricle. CASE REPORT: A 7-year-old girl had a free floating intraventricular cyst, diagnosed by computerized tomography examination inside the enlarged left lateral ventricle of an associated Dandy Walker malformation. The patient underwent surgery and the cyst was removed. CONCLUSION: To our knowledge, this is the first case report in which the natural developmental phases of an intraventricular hydatid cyst have been observed.

Sinonasal ossifying fibroma with fluid-fluid levels on MR images.

Ossifying fibroma is a rare benign neoplasm that usually affects mandibular and maxillary bones. In this report, we present a case of sinonasal ossifying fibroma with fluid-fluid levels and posterior extension toward the torus tubarius on MR images.

Common surgical pitfalls in the skull.

BACKGROUND: A detailed knowledge of the morphologic variations in the ossicles, foramina, and ridges of the skull vault and skull base is vital to performing safe radical surgery. METHODS: A surgical reminder of possible pitfalls was composed based on the incidences of most of the minor variations such as the supraorbital notch, frontal foramen, metopism, foramen caecum, parietal foramina, bony defects in the fossa occipitalis cerebellaris, Inca bone, foramen lacerum anterius, incomplete posterolateral wall of the foramen ovale, absence of the medial or posterior wall of the foramen spinosum, foramen innominatus, foramen meningoorbitale, bony dehiscence of the internal carotid canal, bony ridge or torus in the floor of the external auditory meatus, foramen of Huschke, precondylar tubercle, foramen hypoglossi, anterior condylar canal, hypoglossal bridging, divided articular surface of the occipital condyle, high jugular bulb, paramastoid process, atlanto-occipital assimilation, ossicle of Kerkring, delta or keyhole shaped bony defects in the anterior border of foramen magnum, foramen of Vesalius, posterior condylar canal, mastoid emissary foramen and occipital foramen in 200 skulls. CONCLUSION: Recognition of these structures and their possible variations will help in distinguishing normal from potentially abnormal structures during computed tomography and magnetic resonance imaging examinations, and in avoiding misinterpretations that lead to confusion during surgical interventions. Instrumentation near potential bone gaps may traumatize important neural or vascular structures.

Effects of vasoconstriction on the acute anterior pituitary hormonal response to head injury.

Since cerebral vasoconstriction alone may impair the hypothalamic and pituitary circulation, we planned to investigate whether the hormonal response to the vasoconstriction that may be induced by the head injury is a significant component of the general acute hormonal response to head injury. Although diffuse adrenocorticotropic hormone immunohistochemical staining of the adenohypophysis of rabbits was observed in the head trauma administered group, only mild positive staining was present in the Endothelin-1 administered group. However, decreased prolactin staining was found in both of the groups. It is postulated that trauma induced vasoconstriction may not be an important manipulating factor in the corticotrophic hormone response to injury, while it may be responsible for the decreased prolactin response.