Diagnostic Contribution of Magnetic Resonance Imaging and Computerized Tomography in Patients with Unidentified Vertigo and Normal Neurologic Examination in Emergency Medicine.

Background: Vertigo and dizziness are common symptoms in patients presenting to emergency medicine (ED) clinics. Vertigo may be caused by peripheral or central origin. Routine imaging is not indicated; however, neuroimaging is increasing, and published studies have revealed a small number of positive findings on imaging modalities. Aims: The aim of this study was to investigate whether neurological imaging was necessary in patients classified as "unidentified vertigo," who were admitted to the emergency department with vertiginous complaints and not revealing typical peripheral vertigo findings and any neurological deficits. Materials and Methods: All patients with "dizzy symptoms" were included in the study. For patients who met the definition of "unidentified vertigo," experimental neurological imaging studies were done. Head computerized tomography (CT), magnetic resonance imaging (MRI) with gradient-echo sequences (GRE), and diffusion weighted images (DWI) were used for imaging. Patients who underwent neuroimaging in the ED were followed up for 6 months in Neurology and ENT clinics. Results: A total of 351 patients were included in the study. Experimental imaging was performed on 100 patients. CT detected a significant pathology associated with the vertigo complaint in only one patient. MRI results were similar to the CT results. MRI-GRE sequences showed some additional pathologies in 14 patients and 4 of them were thought to be related to vertiginous symptoms. None of the patients classified as "non-central causes of vertigo" in the neuroimaging group developed TIA or CVD during 6 months of follow-up. Conclusion: Head CT can be adequate to exclude life-threatening central pathology in "undifferentiated vertigo patients" and the addition of MRI did not add any diagnostic accuracy in ED management. Using the physical examination findings effectively to make a specific diagnosis may reduce misdiagnosis and improve resource utilization.

Unilateral nevoid telangiectasia accompanied by neurological disorders.

BACKGROUND: Unilateral nevoid telangiectasia (UNT) is a unique vascular dermatosis of ambiguous aetiology. OBJECTIVE: To investigate the role of neurological disorder in pathogenesis of the UNT. METHODS: We investigated eight consecutive patients with unilateral nevoid telangiectasia. Detailed dermatological and neurological examinations, and magnetic resonance imaging were performed on each patient. In case of presence of dysesthesia over the skin lesion, electroneuromyography was performed to determine any relationships between lesions and peripheral neuropathy. RESULTS: All the patients had hypoesthesia over the skin lesion. The cranial magnetic resonance imaging showed subcortical hamartomatous lesions in one patient and demyelinized plaques on the corpus of the caudate nucleus and the pontin area in another. Electroneuromyography evaluation was nonspecific. CONCLUSION: In our study, neurological disorders were associated with UNT. Thus, it can be speculated that neurological disorders might contribute to the development and/or progression of UNT. Patients with UNT should be encouraged for neurological investigation.

MR imaging findings in brachial plexopathy with thoracic outlet syndrome.

The BPL is a part of the peripheral nervous system. Many disease processes affect the BPL. In this article, on the basis of 60 patients, we reviewed MR imaging findings of subjects with brachial plexopathy. Different varieties of BPL lesions are discussed.

Correlation between age, body size and thyroid volume in an endemic area.

Ultrasound is a safe, non-invasive technique that provides a more precise and objective method of determining thyroid volume than inspection and palpation, particularly in areas of mild endemicity, and generally whenever goiters are small. Thyroid volume is also correlated with age, weight, height and body surface area (BSA) in non-iodine-deficient areas. Different authors prefer different parameters to assess thyroid gland volumes. In this study, thyroid volumes were determined using ultrasound in 605 school children aged 6-11 yr who had been living for at least 5 years in Antalya. The correlation between age, BSA, height, weight, BMI and thyroid volume was sought in this mild to moderate iodine-deficient area. Somatic development of our children was in the normal range. Thyroid volume was significantly correlated with age (r=0.41, p<0.001), height (r=0.33, p<0.001), weight (r=0.30, p<0.001), BSA (r=0.33, p<0.001), and BMI (r=0.13, p<0.001). The most significant correlation was found to be with age. The application of the International Council for Control of Iodine Deficiency Disorders (ICCIDD) and the World Health Organization (WHO) thyroid volume references to our subjects resulted in prevalence estimates of enlarged thyroid of 31% based on BSA and of 34% based on age. In conclusion, when thyroid volumes are to be compared with reference values, assessment of thyroid volumes based on age is the most reliable method, in the event of normal somatic development.

Baló's concentric sclerosis: clinical and radiologic features of five cases.

Baló's concentric sclerosis (BCS) is a rare demyelinating disease considered to be a variant of multiple sclerosis. Five BCS cases were diagnosed antemortem based on their typical concentric mass patterns on MR images and based on clinical and CSF findings. Histopathologic investigation was also performed in one case. Our case report supports the concept that BCS may be a self-limited disease that is not always fatal. Characteristic MR imaging findings may allow antemortem diagnosis of BCS when performed at the onset of the disease.

Thyroid hormone profile in children with goiter in an endemic goiter area.

The thyroid hormone profile was investigated in goitrous schoolchildren aged 6-11 years living in Antalya, an area with mild/ moderate iodine deficiency. With few exceptions, the serum levels of T4 and TSH were in the normal range in children with different grades of goiter. Compensatory elevated T3 levels were detected in 24% of the subjects. Thyroid hormones did not differ significantly with respect to the urinary iodine (UI) level. No correlations were found between thyroid volume, UI excretion level and thyroid hormones. It was concluded that thyroid hormones, except compensatory T3 elevation in some subjects, were not affected significantly in a mild/moderate iodine deficient area.

Anteroposterior diameter of the vertebral canal in cervical region: comparison of anatomical, computed tomographic, and plain film measurements.

The purpose was to compare the computed tomographic and plain film measurements with those of anatomical specimens to determine the antero-posterior diameter of the spinal canal in cervical region. Antero-posterior diameters of 75 cervical vertebral canals (15 sets of C3-C7) were measured anatomically at two different levels. Computed tomographic and plain film measurements were also obtained at the corresponding levels. Considering anatomical measurements as the gold standard, plain film and computed tomographic measurements were statistically compared. Interobserver and intraobserver differences were also evaluated. At the uppermost pedicle levels, there was no statistically significant difference between plain films and anatomical measurements, a good correlation. However, at lowermost pedicle level there was a statistically significant difference between plain films and anatomical measurements but not between tomographic and anatomical measurements. Our results suggest that plain films can accurately estimate cervical spinal canal mid-sagittal diameter at the uppermost pedicle level and be used as a first step examination for the evaluation of cervical spinal stenoses.

Dizygotic twins with schizencephaly and focal cortical dysplasia.

The case reports of 17-year-old female dizygotic twins are presented. One of the twins had bilateral closed-lip schizencephaly, and the other had focal cortical dysplasia. Septum pellucidum was absent in both cases. The cortical dysplasia in case 2 corresponded to the same hemispheric location with the right schizencephalic cleft in case 1. The combination of schizencephaly and focal cortical dysplasia in siblings or twins has not been previously reported.

Intraosseous lipoma of the frontal bone. A case report.

Intraosseous lipomas are among the most uncommon bone tumors. They arise most often in the appendicular skeleton. There are very few reported cases of intraosseous lipomas within the skull bones. We report a case of intraosseous lipoma of the frontal bone with conventional radiography and CT findings.

Fascioliasis: US, CT, and MRI findings with new observations.

BACKGROUND: The purpose of this study is to describe the ultrasonographic (US), computed tomographic (CT), and magnetic resonance imaging (MRI) findings in fascioliasis and to emphasize the impact of radiology in diagnosis. METHODS: Radiologic findings in 23 consecutive patients with fascioliasis were prospectively recorded. All patients had at least one US and CT examination, and 10 of them were studied by MRI. All diagnoses were confirmed by serologic methods. In the first three cases, initial diagnosis was reached by microscopic demonstration of the parasites' eggs in bile obtained by US-guided gallbladder aspiration. RESULTS: In the hepatic phase of fascioliasis, multiple, confluent, linear, tractlike, hypodense, nonenhancing hepatic lesions were detected by CT. On US, the parasites could be clearly identified in the gallbladder or common bile duct as floating and nonshadowing echogenic particles. MRI showed the lesions as hypo- or isointense on T1-weighted images and as hyperintense on T2-weighted images. CONCLUSIONS: CT findings in the hepatic phase and US findings in the biliary phase are characteristic of fascioliasis. Because clinical and laboratory findings of fascioliasis may easily be confused with several diseases, radiologists should be familiar with the specific radiologic findings of the disease to shorten the usual long-lasting diagnostic process.

Orbital Doppler sonography findings in cases of brain death.

In this study, we investigated the blood flow velocity changes in orbital arteries by using Doppler sonography in eight patients with brain death. Peak-systolic and end-diastolic velocities and resistive indices of the ophthalmic and central retinal arteries were evaluated. We observed the absence or reversal of end-diastolic blood flow in these arteries. To our knowledge, this finding has not been previously reported to be associated with brain death.

Thyroid gland volume and urinary iodine excretion in children 6-11 years old in an endemic area.

Goiter prevalence and urinary iodine excretion levels were assessed in 605 schoolchildren (301 males and 304 females), aged 6-11 years, living in the Antalya region, a well known endemic goiter area in Turkey. Goiter prevalence was evaluated by clinical examination and ultrasound of the thyroid gland. Urinary iodine levels were expressed as microg/g creatinine. Goiter by inspection and palpation was found in 35% (n = 212) of all subjects, in 37.5% (n = 114) of girls and 32.5% (n = 98) of boys. Iodine deficiency of moderate degree was detected from the point of goiter prevalence. With regard to the upper limits of reference thyroid volumes reported by WHO and ICCIDD, goiter by ultrasonography was found in 34% (n = 206) of all subjects, in 36.8% (n = 112) of girls and 31% (n = 94) of boys. Median iodine/creatinine ratios of all subjects, and goitrous and non-goitrous subjects, were 64.1+/-20.1, 62.8+/-21.8 and 64.9+/-19.1 microg/g, respectively. Urinary iodine excretion levels revealed mild iodine deficiency in the region. No significant correlation was observed between urinary iodine excretion levels and thyroid volumes (r = 0.12, p>0.05). Iodine deficiency of mild to moderate degree in schoolchildren aged 6-11 years was detected in Antalya. It was concluded that urgent measures must be undertaken to eradicate iodine deficiency in the region.

Subacute sclerosing panencephalitis: brain stem involvement in a peculiar pattern.

The most common pattern in subacute sclerosing panencephalitis, is in the cerebral hemisphere white matter on T2-weighted images with or without atrophy. Brain-stem lesions are rare. We report brain-stem involvement in two children with subacute sclerosing panencephalitis. A peculiar pattern, with involvement of the pons with extension to both middle cerebellar peduncles and substantia nigra but sparing the pontine tegmentum, is suggested.

MR imaging findings of recurrent tumoral calcinosis.

Tumoral calcinosis is an uncommon disorder and characterized by development of calcified masses within the soft tissues near the large joints. We present a recurrent tumoral calcinosis case with radiographic and magnetic resonance (MR) imaging findings.