Tortuous occipital emissary vein combined with dural venous sinus stenosis in contrast-enhanced MRV for evaluation of idiopathic intracranial hypertension.

PURPOSE: Venous outflow impediment is increasingly recognized in idiopathic intracranial hypertension (IIH). We aim to search for the value of tortuous occipital emissary vein (OEV) in IIH by integrating measurable transverse sinus (TS) stenosis in contrast-enhanced MR venography (CE-MRV). METHODS: Twenty-one IIH patients were evaluated with CE-MRV. Each patient had high LP opening pressure (> 25 cm.H2O), and presented papilledema. Age- and sex-matched 21 control subjects who underwent cranial CE-MRV were selected. The OEV and the following features: intraosseous diameter of more than 3 mm, twisted course, and continuous with prominent sub-occipital extracranial veins were named tortuous OEV. TS stenosis was measured by utilizing the coronal T1-VIBE series to calculate quantitative metrics such as TS max./min.. The tortuous OEV and TS max./min. were registered to create a bivariate logistic regression model to assess the performance of tortuous OEV for IIH when accompanied by TS stenosis. RESULTS: Six (29%) tortuous OEVs were observed in the IIH group, while no tortuous OEV was identified in the control group (p = 0.021). The mean TSmax./min. was 2.48 ± 1.19 in patients with IIH and 1.23 ± 0.33 in the control group (p < 0.001). According to regression analysis, tortuous OEV is not predictive of IIH (p = 0.999), while the higher TSmax./min. (> 1.69) is predictive of IIH (p = 0.022, OR: 8.9; %95 CI; 1.4-59.0) when accompanied together. CONCLUSION: Tortuous occipital emissary vein is more frequently seen in patients with IIH. However, the tortuous appearance alone does not predict idiopathic intracranial hypertension unless associated with measurable transverse sinus narrowing in CE-MRV.

Investigation of the effects of Gamma Knife radiosurgery on optic pathways using diffusion tensor MRI within the first year after treatment.

PURPOSE: To investigate the radiation-induced effects of Gamma Knife radiosurgery (GKRS) for sellar-parasellar tumors on optic pathways using DTI parameters within the first year after treatment. METHODS: Twenty-five patients with sellar-parasellar tumors underwent MRI before and 3 months after GKRS, including T1WI, DTI, T2WI. Moreover, 21 patients underwent follow-up DTI 6-8 months after radiosurgery. ROIs were set on optic nerves, optic radiations, and control localizations; DTI parameters for each were calculated. Pre- and post-radiosurgery differences in DTI values were statistically compared and assessed with respect to tumor size changes. RESULTS: Following GKRS, DTI parameters, notably ADC, FA, and RD, showed statistically significant changes in optic nerves and anterior optic radiations. DTI changes were more significant in the group of cases with tumor shrinkage. In this group, DTI of the anterior optic radiations further deteriorated 3 months post-GKRS, whereas acute changes in DTI parameters of the optic nerves resolved within 6-8 months. DTI of central and posterior optic radiations did not differ significantly following radiosurgery; 6-8 months after radiosurgery, visual function was stable in 14 (56%) patients and improved in 11 (44%), showing no correlation with tumor size changes or DTI parameters. CONCLUSION: White Matter (WM) injury in the optic pathways can be induced by Gamma Knife radiosurgery targeted to sellar and parasellar tumors. Following GKRS, microstructural abnormalities occurred in the optic radiations as well as the optic nerves within the first post-treatment year. Our findings could support modifications to radiosurgical treatment strategies to minimize the risk of permanent WM injury.

Comparative evaluation of brain perfusion with ASL and DSC MRI following intracranial vascular flow diverter stent replacement.

PURPOSE: The objective of this study was to asses brain perfusion parameters and ischemic changes following treatment of aneurysm with flow diverters with two different perfusion MRI technique (Arterial spin labeling and DSC MRI), and to compare the results and effectiveness of these two methods. METHODS: The prospective data was collected from patients with aneurysm who treated with flow diverters. MR examinations, including diffusion-weighted imaging (DWI), ASL, and DSC perfusion MRI, were conducted before and after treatment within the first week and at 6 months. Perfusion parameters of territory area and contralateral side were measured and analyzed by statistically. The relationships between ASL and DSC parameters were analyzed by using Sperman's correlation analysis. RESULTS: A total of 14 cases of aneurysms in 11 patients treated successfully with endovascular flow diverter stent placement. Pretreatment and post treatment (within first week and 6 months) MRI images were evaluated. Asymptomatic randomly distributed millimetric restricted diffusion foci were observed in 8 of all patients. There was no statistically difference between pre and post treatment perfusion parameters (p > 0.05). A statistically significant correlation was found between variable ASL CBF, and the variables of DSC CBF and TTP. CONCLUSIONS: Notwithstanding the fact that flow diverters change flow dynamics in aneurysm sac, there is no any perfusion abnormality in the territory area. Asymptomatic randomly distributed diffusion restricted foci in the both cerebral hemisphere can be observed. ASL and DSC MRI are effective for evaluation of brain perfusion.

DWI-based MR thermometry: could it discriminate Alzheimer's disease from mild cognitive impairment and healthy subjects?

PURPOSE: The aim of this study is to compare lateral ventricular cerebrospinal fluid (CSF) temperature of the patients with Alzheimer's disease (AD), mild cognitive impairment (MCI), and healthy subjects (HS) using diffusion-weighted imaging (DWI)-based magnetic resonance (MR) thermometry. METHODS: Seventy-two patients (37 AD, 19 MCI, 16 HS) who underwent 3-T MR examination from September 2018 to August 2019 were included in this study. Smoking habits, education level, disease duration, and comorbidity status were recorded. Patients were assessed using Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) score. Brain temperatures were measured using DWI-based MR thermometry. Group comparisons of brain temperature were performed using the Pearson chi-square, Mann-Whitney, and Kruskal-Wallis tests. Further analysis was performed using the post hoc Bonferroni test. Receiver operating characteristic (ROC) analysis was also used. RESULTS: A CDR score of 0.5, 1, and 2 was 2 (5.4%), 14 (37.8%), and 21 (56.8%) in AD, respectively. The median MMSE score had significant differences among groups and also in pairwise comparisons. The median CSF temperature (°C) values showed statistically significant difference among groups (HS: 38.5 °C, MCI: 38.17 °C, AD: 38.0 °C). The post hoc Mann-Whitney U test indicated a significant difference between AD patients and HS (p = 0.009). There were no significant CSF temperature differences in other pairwise comparisons. CONCLUSION: Lower CSF temperatures were observed in AD patients than in HS, probably due to decreased brain metabolism in AD. DWI-based MR thermometry as a noninvasive imaging method enabling the measurement of CSF temperatures may contribute to the diagnosis of AD.

Dynamic contrast-enhanced magnetic resonance imaging for evaluating early response to radiosurgery in patients with vestibular schwannoma.

PURPOSE: This study aimed to use dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate early treatment response in vestibular schwannoma (VS) patients after radiosurgery. METHODS: Twenty-four VS patients who underwent gamma knife radiosurgery were prospectively followed up for at least four years. DCE-MRI sequences, in addition to standard MRI protocol, were obtained prior to radiosurgery, at 3 and 6 months. Conventionally, treatment responses based on tumor volume changes were classified as regression or stable (RS), transient tumor enlargement (TTE), and continuous tumor enlargement (CTE). DCE-MRI parameters, such as Ktrans, Kep and Ve, were compared according to follow-up periods and between groups. The diagnostic performance was tested using receiver operating characteristic (ROC) curves. RESULTS: Changes in tumor volume were as follows at the last 48 months of follow-up: RS in 11 patients (45.8%), TTE in 10 patients (41.7%), and CTE in three patients (12.5%). The median time required to distinguish TTE from CTE using conventional MRI was 12 months (range 9-18). The Ktrans and Ve were significantly decreased in patients with RS and TTE at 3 and 6 months, but did not differ significantly in patients with CTE. There were no significant differences in Ktrans and Ve between patients with RS and TTE at 3 and 6 months. Both Ktrans and Ve demonstrated high diagnostic performance in evaluating early treatment response to radiosurgery in patients with VS. CONCLUSION: DCE-MRI may aid in the monitoring and early prediction of treatment response in patients with VS following radiosurgery.

Congenital defects of glycosylation: Novel presentations with mainly neurological involvement and variable dysmorphic features.

The pathophysiology of congenital defects of glycosylation (CDG) is complex and the diagnosis has been a challenge because of the overlapping clinical signs and symptoms as well as a large number of disorders. Isoelectric focusing of transferrin has been used as a screening method but has limitations. Individual enzyme or molecular genetic tests have been difficult to perform. In this study, we aimed to describe CDG patients who were referred to from different departments either without a preliminary diagnosis or suspected to have a genetic disorder other than CDG. The patients were diagnosed mainly with a 450 gene next-generation DNA sequencing panel for inborn errors of metabolism, which also included 25 genes for CDG. A total of 862 patients were investigated with the panel, whereby homozygous (10) or compound heterozygous (4) mutations were found in a total of 14 (1.6%) patients. A total of 13 different mutations were discovered, 10 of them being novel. Interestingly, none of the patients was suspected to have a CDG before referral. This report expands the clinical/laboratory findings in patients with CDG and stresses on the fact that CDG should be in the differential list for pediatric patients presented with nonspecific dysmorphic features and neurological delays/regression. Also, next-generation DNA sequencing with panel approach was noticed to have a significant diagnostic potential in patients presented with nonspecific neurologic and dysmorphic findings.

Correlation of language lateralization with resting state hippocampal connectivity in temporal lobe epilepsy patients

Background/aim: The main purpose of this study is to evaluate the resting state hippocampal connectivity with language areas and to correlate them with laterality index calculations on single subject basis, hence to present hippocampal lateralization for language with rs-fMRI. Materials and methods: Task based and rs-fMRI data were gathered from a total of 45 subjects in 3T scanner. BrainVoyager QX, SPM, and CONN softwares were used for data analysis. LI score of each subject was calculated and converted into normalized LI score (nLI). Intrahemispheric rs-connectivity analysis was performed between hippocampus and Broca's regions on both sides. Correlation between these variables was measured with SPSS software. Results: Right-TLE patients were found to have highest whereas left-TLE group were found to have lowest mean LI scores. Regarding hippocampal-lingual networks; left intrahemispheric connectivity values showed strong positive correlation with nLI values in left, right-TLE patients and healthy controls (P = 0.035, 0.014, 0.047). There were no significant correlation between right intrahemispheric connectivity values and nLI scores in all groups. Conclusions: This study seems to depict the existence of resting state hippocampal-lingual functional network which correlates well with lateralization of language function in the left hemisphere in both temporal lobe epilepsy patients and healthy controls.

Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.

OBJECTIVES: This study aims to compare two single-step arthroscopic techniques, microfracture and cell-free scaffold implantation, in the treatment of talar osteochondral lesions (OCLs) clinically and radiologically. PATIENTS AND METHODS: This retrospective study included 62 patients (35 males, 27 females; mean age 41±13 years; range, 15 to 65 years) diagnosed with talar OCLs between March 2007 and January 2015. Patients who were followed-up with a minimum of 24 months with lesions larger than 1 cm2 were included. Pre- and postoperative clinical evaluations were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and radiological evaluations according to the magnetic resonance observation of cartilage repair tissue (MOCART) scale. RESULTS: Patients were divided into microfracture (n=22) and scaffold (n=40) groups. The mean follow-up duration was 36.1±14.9 months. The mean preoperative AOFAS score increased from 60.6±13.9 to 82.1±11.8 in the microfracture group (p<0.001) and from 53.8±13.6 to 89.4±9.9 in the scaffold group (p<0.001). The scaffold group had superior results than the microfracture group clinically (p=0.011). Clinical results were superior in younger patients (<45 years) (p=0.018), male patients (p=0.020), and traumatic lesions (p=0.014). There was no significant difference between the two techniques according to the total MOCART scores (p=0.199). However, the scaffold technique was more successful in terms of lesion border and effusion subgoups of MOCART scale. CONCLUSION: Both single-step arthroscopic techniques are effective and safe in the treatment of talar OCLs. The scaffold technique showed superior clinical results than the microfracture technique in short-term follow-up. Age, trauma history and gender significantly affected the treatment outcomes. The scaffold technique can be considered as a safe and good alternative particularly in the treatment of large lesions.

The effectiveness of RENAL nephrometry score in ablated renal tumors via radiofrequency ablation or cryoablation

Background/aim: This study aimed to evaluate the clinical efficacy of radiofrequency ablation (RFA) and cryotherapy and to scrutinize the therapeutic success of the RENAL (radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, and location) nephrometry score in terms of possible complications and the predictive status of oncological results. Materials and methods: Forty-five patients with biopsy-proven renal cell carcinomas (32 males, 13 females) treated with RFA and cryotherapy were included. Patients were 22­90 years old (average: 59.2 years). Statistical analyses were performed using SPSS for Windows. Results: A total of 79 lesions with dimensions varying between 0.9 and 4.5 cm (average: 2.2 cm) were ablated. Complete ablation was achieved for 72 (91.1%) lesions. Six repeat RFA sessions were applied for 4 (5%) lesions with residue/recurrence. The average RENAL nephrometry scores of lesions that underwent complete ablation and those that developed residue/recurrence were 6.3 and 7.7, respectively. The average recurrence-free survival time was 34.8 months (range: 3­55 months), while it was 44.6 months (range: 6­55 months) for cryotherapy and 28.6 months (range: 3­50 months) for RFA. Conclusion: Ablative therapies are minimally invasive and effective methods for treating small renal tumors. RENAL nephrometry scoring is a valuable system for standardizing renal tumors and evaluating the success of ablative therapies, possible complications, and oncological results.

The relationship between patellofemoral arthritis and fat tissue volume, body mass index and popliteal artery intima-media thickness through 3T knee MRI

Background/aim: Evaluating the relationship of patellar chondromalacia with obesity, infrapatellar fat pad (IFP) volume and popliteal artery intima-media thickness (IMT). Materials and methods: A total of203 patients with different degree of patellar chondromalacia (103 male, 100 female) and 52 control subjects (19 male, 33 female) were included and grouped according to sex, age, body surface area (BSA), body mass index (BMI) and patellar chondromalacia classification. All measurements were completed with 3T magnetic resonance imaging (MRI). Articular cartilage and IFP volume were measured in saggital plane using double echo steady state (DESS) and DIXON sequences, respectively. Patellar cartilage damage was graded using modified outerbridge classification, and the relations among cartilage volume and BMI, BSA, IFP, IMT were statistically assessed. Results: Popliteal artery IMT showed an independent association with the prevalence of cartilage defects and IFP volumes (P ˂ 0.001). There was an association between BMI and IFP volumes (P ˂ 0.001). However, no differences were observed between IFP volume and different chondromalacia groups. When IFP measurements were corrected using individual BMI and BSA values, a positive correlation was found between control and advanced chondromalacia groups (P ˂ 0.001). Conclusion: This study demonstrates the relationship among obesity, IMT and chondromalacia and highlights this potential circle to develop effective treatments and inhibit the progression of chondromalacia.

Treatment-related alterations of imaging findings in osteoid osteoma after percutaneous radiofrequency ablation.

OBJECTIVES: We aimed to report the long-term outcomes of osteoid osteoma patients and to determine CT and dynamic contrast-enhanced MR imaging characteristics of radiofrequency ablation (RFA) treatment related changes of osteoid osteoma between follow-up periods. MATERIALS AND METHODS: Thirty patients (seven female, 23 male) who underwent CT-guided RFA of osteoid osteoma were included. Follow-up imaging examinations were divided into two subgroups; first (1-3 months) and second (> 6 months) periods. Nidus size, calcification, cortical thickening, maximum signal intensity (SImax), time of SImax (Tmax), slope of signal intensity-time (SIT) curves were noted. CT and dynamic MR imaging findings were compared between follow-up periods. RESULTS: Clinical success rate was 100%. The mean of OO nidi size was 5.85 ± 1.98 mm before treatment. There was a significant difference for OO nidi sizes between pretreatment and second follow-up period examinations (p = 0.002). SImax and slope of SIT curves of all patients (100%) showed decrease on follow-up MRIs. There was a significant decrease for SImax values between pretreatment and second follow-up period. There was a significant decrease for slope of SIT curves between pretreatment and both follow-up periods. CONCLUSIONS: RFA is an effective and safe treatment choice for osteoid osteomas. On follow-up imaging, slope of SIT curve and Tmax have the most important positive predictive value for long-term outcomes and single dynamic contrast-enhanced MRI within first 3 months after treatment may be sufficient for symptom-free patients.

Do subscapularis tears really result in superior humeral migration?

OBJECTIVES: The aim of this study was to analyse the effect of subscapularis tear on superior humeral excursion (SHE) and acromiohumeral distance (AHD). The hypothesis was that subscapularis tears do not result in superior humeral excursion. METHODS: Patients who underwent shoulder arthroscopy between August of 2011 and 2015 were reevaluated. Those with isolated Bankart lesion were used as control group and included in the Group 1, isolated full-thickness supraspinatus tear in the Group 2, isolated subscapularis tear in the Group 3, and combined subscapularis and supraspinatus tear in the Group 4. The mean SHE and AHD measurements on magnetic resonance imaging of these groups were compared to reveal any difference in superior humeral migration (SHM). RESULTS: There were 30 patients in each group. The mean age of Group 1 (26.44 ± 8.34) was younger than the other 3 groups. The mean AHD and SHE were higher in Group 1 and 3 (Mean AHD: 12.89 ± 2.24 and 12.28 ± 1.9, respectively. Mean SHE: -3.2 ± 0.99 and -2.78 ± 0.64, respectively) than Group 2 and 4 (Mean AHD: 6.2 ± 1.78 and 6.16 ± 1.52, respectively. Mean SHE: 0.72 ± 0.65 and 1.24 ± 0.63, respectively). The AHD and SHE were strongly correlated with each other (Pearson correlation coefficient = 0.184). The inter-observer and intra-observer correlation of the measurements of SHE on MRI were excellent with intraclass correlation coefficient of 0.95 and 0.94, respectively. CONCLUSION: Subscapularis tears do not lead to SHM and subacromial impingement. However, superior rotator cuff tears can still lead to SHM and subacromial impingement even when subscapularis tendon is intact. LEVEL OF EVIDENCE: Level III, diagnostic study.

Single-Step Arthroscopic Repair With Cell-Free Polymer-Based Scaffold in Osteochondral Lesions of the Talus: Clinical and Radiological Results.

PURPOSE: To report the clinical and radiological results of patients with talar osteochondral lesions who were treated by microfracture and cell-free scaffold implantation in a single-step arthroscopic surgery. METHODS: Forty patients, treated with a single-step arthroscopic surgery, were evaluated in this single-center-based retrospective study. Patients with degenerative arthritis (n = 1), history of ankle fracture (n = 1), kissing lesions (n = 1), lower extremity deformity (n = 1), and lesions <1.5 cm2 (n = 4) were excluded. Oversized (>10 mm depth) bone cysts were additionally treated with bone graft. Patients were evaluated clinically, using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological assessment was performed with magnetic resonance imaging, using the magnetic resonance observation of cartilage repair tissue (MOCART) score. RESULTS: Thirty-two patients with a mean age of 38 ± 12 years were evaluated. The mean defect size was 2.5 ± 0.8 cm2 and the mean defect volume was 2.4 ± 1.9 cm3. The mean preoperative AOFAS score was 52.8 ± 13.9 and increased to 87.1 ± 11.1 postoperatively at the mean follow-up of 33.8 ± 14.0 months (P = .0001). A total of 84.4% of patients had good to excellent clinical scores. Clinical scores had no significant relation with age, lesion size, depth, or body mass index. The mean MOCART score was 64.2 ± 12.0. There was no significant correlation between the total MOCART and AOFAS scores (P = .123). A significant relation was found between the defect filling (the subgroup of the MOCART score) and the clinical outcomes (P = .0001, rho = 0.731). CONCLUSIONS: The arthroscopic scaffold implantation technique is a single-step, safe, and effective method for the treatment of talar osteochondral lesions with satisfactory clinical and radiological outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Intrathecal Contrast-Enhanced Magnetic Resonance Imaging-Related Brain Signal Changes: Residual Gadolinium Deposition?

OBJECTIVES: There have been recent studies evaluating brain magnetic resonance imaging changes in patients with normal renal function, after intravenous administration of gadolinium-based contrast agents (GBCAs). Their findings were supported by histological evidence as well and brought a new vision concerning what needs to be learned to provide better patient care. In this report, we aim to present brain magnetic resonance imaging changes after intrathecal administration of a linear ionic agent (gadopentetate dimeglumine). MATERIALS AND METHODS: We evaluated hyperintensities in the deep nuclei of the brain in 6 patients with normal renal function after intrathecal administration of a linear ionic GBCA, without other confounding intravenous GBCA administrations. For visual analysis, T1 signal hyperintensity of the globus pallidus (GP), putamen, pons, and dentate nucleus (DN) were scored on a 4-point scale. For quantitative analysis, using the unenhanced T1-weighted images oval regions of interests were placed within the DN, central pons, GP, and thalamus on different image slice positions. RESULTS: On visual analysis, 5 patients had T1 signal hyperintensity of the DN and GP, whereas the DN/pons signal intensity and the GP/thalamus signal intensity were found to be increased in all 6. CONCLUSIONS: This observation not only adds to our fund of knowledge concerning biodistribution and pharmacokinetics of those agents, but also raises the question of a possible association with the glymphatic pathway.

Lesser tuberosity cysts and their relationship with subscapularis tears and subcoracoid impingement.

BACKGROUND: We aimed to evaluate cysts in the lesser tuberosity of humeral head seen on magnetic resonance imaging (MRI) and their relationship with subcoracoid impingement and subscapularis tears evident on arthroscopic surgery videos. Our hypothesis was that the cysts would be more frequent with subscapularis tears and in the case of subcoracoid impingement. METHODS: Patients who underwent shoulder arthroscopy between January 2010 and January 2016 were retrieved to evaluate subscapularis tears on surgery videos and lesser tuberosity cysts (LTC), coracohumeral distances (CHD) on both sagittal oblique and transverse sections of MRI retrospectively. There were 137 patients meeting the study criteria with subscapularis tear evident on surgery video and having preoperatively studied magnetic resonance images. All the tears were classified according to the Lafosse's system. The control group was constituted with 121 patients who underwent shoulder arthroscopy and were diagnosed with no subscapularis tear. Then, any statistically significant relationship between these parameters was investigated by the use of statistics software. RESULTS: The mean age (57), gender distribution (female for 67.1%), and involved shoulder (right for 62.8%) rate of the groups were statistically similar. The existence rate of LTC was 55.5% and 19% for the study and control groups, respectively (P = .000). The study group was then evaluated in two groups regarding the existence of a cyst in the lesser tuberosity. There was no statistical difference between these two groups in terms of coracohumeral distances and tear type (P > .05). The study group was also divided into two depending on the transverse section CHD whether it was under 7 mm or not. There was still no statistical difference between these subgroups in terms of a cyst existence (P > .05). The supraspinatus tear rate and age distribution was also not differing in patients with and without LTC. CONCLUSIONS: The LTCs were significantly associated with subscapularis tears, and could be used as an indicator in the interpretation of MRI scans. However, there was no relationship between the subcoracoid impingement and LTCs.

Outcomes of resective surgery in children and adolescents with focal lesional epilepsy: The experience of a tertiary epilepsy center.

OBJECTIVE: This study aimed to investigate the efficacy of resective surgery in children with focal lesional epilepsy by evaluating the predictive value of pre- and postsurgical factors in terms of seizure freedom. METHODS: This study included 61 children aged between 2 and 18years who were admitted to the pediatric video-EEG unit for presurgical workup. Each patient was evaluated with a detailed history, video-EEG, neuroimaging, and postsurgical outcomes according to Engel classification to predict postsurgical seizure freedom. All the possible factors including history, etiology, presurgical evaluation, surgical procedures, and postsurgical results were analyzed for their predictive value for postoperative seizure freedom. RESULTS: Of the 61 patients, 75% were diagnosed as having temporal lobe epilepsy (TLE), and 25% were diagnosed with extra-TLE. Two years after the surgery, 78.6% were seizure-free, of which 89% had TLE, and 50% had extra-TLE (p<0.05). Patients were more likely to have a favorable outcome for seizure freedom if they had rare seizure frequency, focal EEG findings, and focal seizures; had a temporal epileptogenic zone; or had TLE and hippocampal sclerosis. On the other hand, patients were more likely to have unfavorable results for seizure freedom if they had younger age of seizure onset, frequent seizures before the surgery, a frontal or multilobar epileptogenic zone, secondarily generalized seizures, extra-TLE with frontal lobe surgery, or focal cortical dysplasia. SIGNIFICANCE: Resective surgery is one of the most effective treatment methods in children with intractable epilepsy. A history of young age of seizure onset, frequent seizures before surgery, secondarily generalized seizures, a multilobar epileptogenic zone, frontal lobe surgery, and focal cortical dysplasia (FCD) are the most important predictive factors indicating that a patient would continue having seizures after surgery. On the other hand, focal seizure semiologies, temporal lobe localization, and hippocampal sclerosis indicate that a patient would have better results in terms of seizure freedom.

Intracranial Hemangiopericytoma in a Child: A Case Report with Magnetic Resonance Spectroscopy Findings.

Hemangiopericytoma is a hypervascular soft tissue sarcoma with a predilection for the extremities. It has two clinical types according to the age of presentation: Infantile hemangiopericytoma ( < 1 years) and adult type hemangiopericytoma ( > 1 years). The intracranial location is very rare and accounts for only 0.4-1% of all primary brain tumors, with only 10% detected in the pediatric age group. The differential diagnosis of this rare tumor from other extra-axial masses plays an important role in proper treatment planning. There are few case reports in adult patients indicating that magnetic resonance spectroscopy (MRS) can play a role in the differential diagnosis. Here, we present imaging findings of this rare tumor, including MRS at 3.0T of an intracranial hemangiopericytoma in a 4.5 year old boy.

Macrodystrophia lipomatosa of the foot: A case report.

Macrodystrophia lipomatosa is a sporadic, nonhereditary developmental anomaly and a rare form of congenital localized gigantism. It is characterized by the proliferation of all the mesenchymal elements of a digit or digits, and a disproportionate increase of fibroadipose tissue involving the nerve sheath, muscle, periosteum and bone marrow. In the present study, a 9-month-old boy was referred to Gazi University Hospital (Ankara, Turkey) with congenital unilateral enlargement of the right forefoot, particularly involving the second and third toes. X-ray and magnetic resonance imaging (MRI) scans were performed in order to assess the skeletal structures. The present study described the characteristic imaging features, with an emphasis on the MRI findings, of this rare congenital form of gigantism.

Assessment of 3D T2-weighted high-sampling-efficiency technique (SPACE) for detection of cerebellar tonsillar motion: new useful sign for Chiari I malformation.

OBJECTIVE: To describe tonsillar blackout sign (TBS) on three-dimensional (3D)-SPACE, evaluate its performance in identifying Chiari malformation (CM1) as diagnostic marker, and investigate its role in differentiation of symptomatic and asymptomatic CM1. METHODS: One-hundred fifty-six patients were divided into two groups based on caudal displacement of cerebellar tonsils: CM1 (Group I) and non-CM1 (Group II). Group I was subclassified as symptomatic and asymptomatic by a neurosurgeon. Two radiologists evaluated TBS and cerebrospinal fluid flow abnormality. RESULTS: All subjects presenting TBS had CM1. Difference in presence of TBS between Group I and Group II was highly significant (P<.001).Grading of TBS in symptomatic patients was significantly higher than that in asymptomatic patients (P<.001). CONCLUSION: TBS is highly suggestive of CM1 and potentially useful in differentiation of symptomatic and asymptomatic CM1.

Brain abscess caused by Nocardia cyriacigeorgica in two patients with multiple myeloma: novel agents, new spectrum of infections.

OBJECTIVE AND IMPORTANCE: Introduction of high-dose chemotherapy and the novel agents including bortezomib, Lenalidomide, and Thalidomide has provided a significant progress in the treatment of multiple myeloma (MM) with an increase in median overall survival up to 6-8 years. However, the advances in myeloma treatment comes at a price with new spectrum of treatment-related infectious complications which should be taken into consideration while treating these patients. CLINICAL PRESENTATION: We report here two patients with Ig G λ MM presenting with intracerebral mass lesions in the abscence of constitutional symptoms that would suggest an infectious etiology. Both patients had severe hypogammaglobulinemia and lymphopenia, which was attributed to treatment regimens including bortezomib. Intervention The surgical intervention-revealed abscess in both cases caused by Nocardia cyriacigeorgica, a relatively new pathogen which rarely causes infections in humans and also an unexpected pathogen in myeloma patients. CONCLUSION: Although every aspect of immune system is known to be affected in MM, humoral immune deficiency is the hallmark of the inherent immune defect in this disease. Introduction of the novel agents, bortezomib in particular seems to have changed the characteristics of the immune dysfunction and the spectrum of the opportunistic infections by causing qualitative and quantitative changes in cellular immunity. The new spectrum of infectious agents might not be limited to hepatitis B and herpes zoster. Monitoring lymphopenia and administration of prophylactic antimicrobial agents accordingly could be considered in patients treated with bortezomib.