Central Nervous System Vasculitis Due to an Endemic Zoonosis in Turkey; Tularemia.

Tularemia is a bacterial zoonotic disease. The etiologic agent is francisella tularensis which is a gram negative coccobacillus. It is also an epidemic disease in some parts of Turkey. Clinical forms are ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory, and typhoidal forms. Neurological involvement is rare. It is usually presented with meningitis and encephalitis in literature. Our 42-year-old patient was suspected for demyelinating disease, ischemic cerebrovascular disease and vasculitis because of acute onset of neurological symptoms. She was diagnosed as tularemia during the investigation of her lymphadenitis. No etiologic risk factor was found for cerebrovascular disease, and demyelinating disease was excluded. Digital substraction angiography revealed the narrowing of the cerebral vessels. The lesions were partially regressed with the treatment. However, a new infarction developed with the interruption of treatment. All these findings suggested the diagnosis of central nervous system vasculitis due to francisella tularensis infection. Our case was important as it was the first vasculitic case due to tularemia in the literature.

68Ga PSMA PET/MR in the differentiation of low and high grade gliomas: Is 68Ga PSMA PET/MRI useful to detect brain gliomas?

BACKGROUND: Magnetic resonance imaging (MRI) is the most important imaging modality in the diagnosis and follow-up of glial brain tumors. OBJECTIVE: The aim of our study is to determine the correlation between tumor grade, determined with postoperative pathological examination, and standard uptake value (SUV), a semi-quantitative parameter, in patients who underwent imaging 68Ga-PSMA with using PET/MR. MATERIAL-METHOD: Thirty-five out of 38 patients' images whose pathology was consistent with glial tumor, 42 lesions from separate anatomic localizations or with higher activity uptake than the rest of the tumor were evaluated. SUV values measured on PET images and grade relationship were evaluated based on each lesion while mitosis, Ki-67 were evaluated for each patient. RESULTS: Grade, Ki-67, mitosis, necrosis and SUVmax/mean/peak were found statistically significant with moderate/high correlation. The parameter with the highest correlation coefficient was mitosis. (For SUVmax r = 0.64, p = 0). When Grade II and III were considered as the first group and IV as the second group, the cutoff values were found to be 2.3 for SUVmax, 0.21 for SUVmean and 0.63 for SUVpeak. In the diagnosis of HGG, PET's sensitivity is higher than MRI but no statistically difference was found between specificities. CONCLUSION: 68Ga PSMA PET imaging is found to be particularly useful in differentiating Grade IV glial tumors from other grades. This finding is thought to be important in the differentiation the relapse with postoperative tissue changes, which is an important problem in the follow-up.

Single-center experience with the Tigertriever device for the recanalization of large vessel occlusions in acute ischemic stroke.

BACKGROUND: Tigertriever (Rapid Medical, Yoqneam, Israel) is a new design of stent retriever. PURPOSE: To evaluate the feasibility, safety, and efficacy of the Tigertriever in patients with acute ischemic stroke who have undergone mechanical thrombectomy. MATERIALS AND METHODS: Two different techniques-namely, standard unsheathing (SUT) and repetitive inflation-deflation (RID) techniques, were used. Modified Thrombolysis in Cerebral Infarction (mTICI) scores of 2b and 3 were considered as successful recanalization. RESULTS: A total of 61 thrombectomy procedures with Tigertriever were retrospectively evaluated. The mean age of patients was 60.7 years and their National Institutes of Health Stroke Scale score was 14.7. Overall, the percentage of patients with a mTICI score of 0, 2b, and 3 was 24.6, 26.2, and 49.2, respectively. Successful recanalization and first-pass success rates were 75.4% and 37.7%, respectively. There were no statistical differences between the results of the SUT and RID techniques. No vessel rupture, dissection, or device detachment was observed. The number of patients with a good clinical outcome (modified Rankin Scale score 0-2) was 17 (27.9%). CONCLUSION: Our results showed that the Tigertriever device is safe and efficient for mechanical thrombectomy.

A rare aetiology of stroke; myxomatous aneurysm caused by atrial myxoma.

Atrial myxoma is a rare cause of stroke. In this report we present the case of a 52-year-old female patient who went to hospital suffering from a headache. Her neurological examination was normal except for a positive Babinski sign on the left. In the superolateral of the right, a Sylvian fissure consistent with a thrombosed aneurysm was detected using computerised tomography (CT). Diffusion MRI showed an acute infarction on the right MCA area. Transthorasic Echocardiography and ECG were normal. A -16×4 mm-sized fusiform perpendicular aneurysm on the M2 segment Sylvian curve of right MCA and a -6×4 mm-sized dissecting aneurysm on P3 segment of the left posterior cerebral artery (PCA) were observed in cerebral angiography. Transesophageal echocardiography (TEE) demonsrated a large mass with a suspected size of 2×2×1.5 cm on the left atrium. The mass was resected and on the eighth day after the operation, she had a temporary vision loss and hyperintensity on the T1 sequence was interpreted as laminary necrosis suspected on Cranial MRI. In follow up, she was stable with 300mg acetylsalicylic acid treatment. The main treatment is surgical resection in stroke caused by atrial myxoma.

Multifoci Bone Tuberculosis and Lymphadenitis in Mediastinum Mimics Malignancy on FDG-PET/CT: A Case Report.

UNLABELLED: Positron Emission Tomography with 2-deoxy-[F-18]-fluoro-D-glucose (FDG-PET) has become a reliable diagnostic tool in clinical practice similar to Magnetic Resonance (MR) imaging and Computed Tomography (CT). FDG-PET has especially been used to differentiate malignant from benign lesions, and for staging and follow- up malignant tumors. However, FDG-PET has some pitfalls in cancer screening and FDG tracer accumulates at sites of infection and inflammation. Bone tuberculosis may be confused with malignant tumors of bone and its metastases, and can accumulate focally increased FDG in active period. We present a 60-year-old woman with lytic bone lesions and mediastinal hypermetabolic foci, initially suspected to be malignant by means of FDG-PET and the other imaging modalities; however, bone biopsy confirmed the diagnosis of bone tuberculosis. CONFLICT OF INTEREST: None declared.