Possible role of endocannabinoids in olfactory and taste dysfunctions in Alzheimer's and Parkinson's patients and volumetric changes in the brain.

The purpose of this study is to determine the volumes of primary brain regions associated with smell and taste in Alzheimer's and Parkinson's patients and healthy controls using MR imaging and examine volumetric changes in comparison to smell/taste questionnaire and test results and endocannabinoid (EC) levels. The study included 15 AD patients with mild cognitive dysfunction scored as 18 ≤ MMSE ≤ 23, 15 PD patients with scores of 18 < MoCA < 26 and 18 ≤ MMSE ≤ 23, and 15 healthy controls. A taste and smell questionnaire was given to the participants, and their taste and smell statuses were examined using the Sniffin' Sticks smell identification test and Burghart Taste Strips. EC levels were analyzed in the blood serum samples of the participants using the ELISA method. The volumes of the left olfactory bulb (p = 0.001), left amygdala (p = 0.004), left hippocampus (p = 0.008), and bilateral insula (left p = 0.000, right p = 0.000) were significantly smaller in the Alzheimer's patients than the healthy controls. The volumes of the left olfactory bulb (p = 0.001) and left hippocampus (p = 0.009) were significantly smaller in the Parkinson's patients than the healthy controls. A significant correlation was determined between volume reduction in the left Rolandic operculum cortical region and taste dysfunction. EC levels were significantly higher in both AD (p = 0.000) and PD (p = 0.006) in comparison to the controls. Our results showed that volumetric changes occur in the brain regions associated with smell and taste in Alzheimer's and Parkinson's patients. It was observed that ECs played a role in these volumetric changes and the olfactory and taste dysfunctions of the patients.

Evaluation of dural venous sinuses and confluence of sinuses via MRI venography: anatomy, anatomic variations, and the classification of variations.

PURPOSE: We aimed to determine the anatomical variations more comprehensively particularly at the level of superior sagittal sinus (SSS), confluence of sinuses (CS), transverse sinuses (TS), straight sinuses (SS) and occipital sinuses (OS) with the help of the images obtained via MRI venography, and to contribute to the classification efforts. METHODS: In our retrospective study, we evaluated 211 patients who admitted to our hospital with various complaints and cerebral MRI venography has been performed. All investigations were performed by using 1.5-T MRIscanner (Achiva, Philips) with a VEN-3D -PCA MR venous angiography technique. Section thickness was 0.8 mm and axial plane was used. Other parameters were as follows: 17/7.1 (TR/TE), flip angle, 10.00, FOV, 220-mm, and matrix 244x140. RESULTS: We divided our cases into 3 types but we increased the number of subgroups. Type I was divided into 4 subgroups (Type IA, IB, IC, ID), Type II into 9 (Type IIA1, IIA2, IIB1, IIB2, IIC, IID1, IID2, IIE1, IIE2) and Type III into 2 (Type IIIA, IIIB). Type I constitutes a 26.06% of whole cases, and Type II 59.71%, Type III 14.21%. In our cases R-TS wasn't revealed in 10 cases (4.73%) whereas in 37 cases (17.53%) it was hypoplastic. L-TSwasn't shown in 26 cases (12.32%) and in 85 cases (49.09%) it was hypoplastic. R-Sig S wasn't revealed in 7 (3,31%) and was hypoplastic in 34 (16.11%) whereas L-Sig S wasn't present in 2 (0.94%) and hypoplastic in 72 (34.12%). Among these cases 14 had bilateral hypoplastic TS (6.63%). In cases with hypoplastic TS or Sig S, as an alternative pathway 30 patients had OS (14.21%). Two of these patients had double OS. CONCLUSION: Our wish is to contribute to the efforts of clarifying and classifying the intracranial venous structures and their anatomical variations. We hope our study enlightens a path in this field for future studies.

Radiological Imaging of Rare Intracranial Complications Secondary to Otitis Media and Mastoiditis.

Acute otitis media used to cause fatal results because of its intracranial complications before the introduction of potent and effective antibiotics. After the introduction of antibiotics, complications have started to be observed more frequently as a result of chronic otitis media and especially in children. Because clinical findings changed and became indistinct, the diagnosis of otitis and mastoiditis has been made occasionally with imaging findings only after complications occurred. Multidetector computed tomography and magnetic resonance imaging are efficient and sufficient methods in the rapid diagnosis and should be immediately referred methods.

Antronasal Polyp Extending to Orbital Fossa.

Sinonasal infections and nasal polyps can be taken as 2 components of a disease. Polyps due to chronic inflammations of nasal cavity and sinuses are not rare. They may present with various clinical signs and symptoms, while the secondary complications may cause serious problems. They are most commonly treated medically, although surgery is the therapy of choice in some conditions. The complications can be listed as mucocele formation, orbital inflammation, intracranial extension by erosion of the boney structures.

Congenital abnormalities of the ribs: evaluation with multidetector computed tomography.

OBJECTIVE: To evaluate congenital abnormalities of ribs using multidetector computed tomography. METHODS: The retrospective study was conducted at Mustafa Kemal University Research Hospital, Hatay, Turkey and comprised data of patients aged 1-45 years who attended the Radiology Department for computed tomography of the thorax between January 2010 and July 2013. Multiplanar reconstructions, maximum intensity projections, and 3-dimensional images were acquired to investigate numerical and structural abnormalities of the ribs of the patients who underwent multidetector computed tomography for a variety of indications. RESULTS: The study comprised 650 patients. Of them, 231(35.5%) were female and 419(64.5%) male. The overall mean age was 20.9± 5.1years. However, data of 90(13.8%) patients was excluded from cervical rib evaluation and of 120(18.5%) from lumbar rib evaluation as these regions were out of the section because of the positioning. Finally, 560(86.5%) patients were included in the cervical rib evaluations, and 530(81.5%) in the lumbar rib evaluations. All the 650(100%) patients were included in the thoracic rib evaluations. Numerical abnormalities were observed in cervical ribs in 19(3.6%), in thoracic ribs in 1(0.15%) and in lumbar ribs in 7(1.3%) cases. The structural abnormalities were bifid rib in 44(6.7%) and fused type in 17(2.6%) cases. CONCLUSIONS: Multidetector computed tomography enabled evaluation of the thoracic cage as a whole.

Aberrant Internal Carotid Artery in the Tympanic Cavity.

OBJECTIVES: Presence of aberrant internal carotid artery (ICA) in the tympanic cavity is a very rare case and therefore the diagnosis is a challenge. Here, the authors aimed to address the importance of the diagnosis since the intervention to the middle ear and implants is increasing in number and this condition may lead to life-threatening bleeding. METHODS: Between 2012 and 2016, among the patients referred to the authors' Radiology Department from the Department of Otolaringology for the evaluation of the temporal region for various indications, the authors reported this anomaly in 6 patients and multidetector computerized tomography of these 6 patients and magnetic resonance imaging of 2 were assessed in detail. RESULTS: The mean age of the 6 patients was 28.8 and aberrant ICA abnormality was observed in 2 patients bilaterally and 4 patients unilaterally on the right side. In 1 patient ICA was not totally regressed and observed as hypoplastic. In one of the patients, dehiscence was evident between ICA and the cochlea. Moreover, in 1 patient the contralateral ICA was not observed. CONCLUSION: Although rare, aberrant ICA is an abnormality that should be kept in mind by the clinicians and the radiologists, since it leads to abundant bleeding when undiagnosed before the surgical interventions.

Two cases with giant pseudo-aneurysm of vertebral artery secondary to shrapnel injury.

INTRODUCTION: Due to their locations, vertebral arteries (VA) are structures that are rarely injured after traumas. Formation of vertebral pseudo-aneurysm (PA) because of pieces of shrapnel is also rare. It causes clinical findings like cervical mass after the injury CASES PRESENTATION: Two Syrian 12- and 17-year-old male patients were admitted to the Department of Ear, Nose and Throat with the complaint of swelling in the left lower cervical region. In their USG examination which was ordered to investigate the cervical lesion, a lesion consistent with PA which shows a prominently thick wall structure due to circumferential thrombus formation and fibrotic tissue, chaotic flow, and ying-yang appearance in the centrally located cavity of the lesion in a color Doppler examination was detected. Later, multi-detector computed tomography angiography (MDCTA) was planned to demonstrate pseudo-aneurysms (PAs). CONCLUSION: Because there was no report on the development of giant pseudo-aneurysms secondary to shrapnel injury to date and because we thought these cases are demonstrative, we found the cases suitable for presenting as case reports.

The effect of width of facial canal in patients with idiopathic peripheral facial paralysis on the development of paralysis.

The aim of this prospective study is to investigate whether the possible stenosis due to anatomic variations of labyrinthine segment (LS), tympanic segment (TS) and mastoid segment (MS) of the facial canal in the temporal bone is a predisposing factor in the development of paralysis. 22 patients with idiopathic peripheral facial paralysis (IPFP) were included in the study. Multi-slice computed tomography (MSCT) with 64 detectors was used for temporal bone imaging of the patients. Reconstruction images in axial, coronal and sagittal planes were created in workstation computers from the captured images. The diameters and lengths of LS, TS and MS of the facial canal were measured. The mean values of LD, ND and SL of LS were 1.31 ± 0.39, 0.91 ± 0.27, 4.17 ± 0.48 in patient group and 1.26 ± 0.29, 0.95 ± 0.21, 4.60 ± 1.36 in control group, respectively. The mean values of LD, ND and SL of TS were 1.11 ± 0.22, 0.90 ± 0.14, 12.63 ± 1.47 in patient group and 1.17 ± 0.23, 0.85 ± 0.24, 12.10 ± 1.79 in control group, respectively. The mean values of LD, ND and SL of MS were 1.80 ± 0.30, 1.44 ± 0.29 vs. 14.3 ± 1.90 in patient group 1.74 ± 0.38, 1.40 ± 0.29, 14.15 ± 2.16 in control group, respectively. The measurements of the parameters of all three segments in patient group and control group were similar. Similar results between patient and control group were obtained in this study investigating the effect of stenosis in facial canal in the development of IPFP.

Pseudoaneurysm of the carotid arterial system.

Pseudoaneurysms of internal, external, and common carotid arteries are seen rarely. Blunt traumas caused by automobile accidents are the prior reasons to this. Central venous catheterization, ballistic trauma, cystic medial necrosis, fibromuscular dysplasia, atherosclerosis, and other inflammatory processes are some other potential reasons for pseudoaneurysm. In contrast to true aneurysms, it does not contain 3-layer structure with adventitia, media, and intima sublayers in its wall. The wall contains coagulum and fibrous capsules. Clinically, after trauma, it presents itself as swelling after days to weeks of damage to vascular walls. Because it causes morbidity and mortality when it is ruptured, It should be treated via surgical or vascular intervention.

Evaluation of the postnatal development of the sternum and sternal variations using multidetector CT.

PURPOSE: We aimed to evaluate the postnatal development and the maturation of the sternum and sternal variations using multidetector computed tomography (MDCT). Additionally, we aimed to examine the roles of gender and age in sternal development. MATERIALS AND METHODS: Two hundred and fifty patients who underwent thorax MDCT examinations were evaluated for sternal development and variations. Coronal curved planar reconstruction and maximum intensity projection images were used to better assess the ossification centers in the manubrium and the body of the sternum. Multiplanar images were used to accurately measure the thickness and the sagittal dimension of the manubrium, the sagittal dimension of the body, and the total sagittal dimension of the sternum in the sagittal plane. RESULTS: No significant differences in the manubrium measurements were observed between the genders. The thickness and sagittal dimension of the manubrium, sagittal dimension of the body, and total sagittal dimension of the sternum in the sagittal plane were significantly different between the age groups. We evaluated the ossification centers; shape and developmental variations in the manubrium and body; direction, calcification, and termination of the xiphoid process; developmental variations in the xiphoid process; and manubriosternal and sternoxiphoidal fusion. Significant variations were observed from person to person. CONCLUSION: The anatomy and the developmental properties of the sternum should be well understood in cases of potential chest and sternum injuries and in several surgical procedures. Therefore, knowledge of the development and the maturation of the sternum, and sternal variations and anomalies is important. We suggest that the postnatal development and the morphogenesis of the sternum can be adequately assessed using MDCT.

Magnetic resonance imaging findings of the abducens nerves in type 1 Duane's retraction syndrome.

PURPOSE: To investigate nervus abducens and extraocular mucles in patients with Type 1 Duane's retraction syndrome using high-definition magnetic resonance imaging. METHODS: The study included 10 patients with Type I Duane's retraction syndrome who underwent magnetic resonance imaging (MRI) of the brain and orbits. RESULTS: Overall, 10 cases were included in the study. There were seven women and three men. The mean age was 5.2 years (1-15 years). MRI of the abducens nerve was performed in all cases. Of the cases, the left eye was involved in eight cases, whereas the right eye was involved in two cases. There was no bilateral eye involvement. Among the 10 patients clinically diagnosed as Type 1 Duane's retraction syndrome, the abducens nerve could not be visualized in eight cases, whereas the nerve was hypoplastic in one case and bilateral abducens nerves were present in one case by MRI. The extraocular muscles were normal in all cases on T2 weighted coronal MRI of the orbits. CONCLUSION: Absence of abducens nerve and normal extraocular muscles was detected in patients with Type 1 Duane's retraction syndrome at the affected side.

Liver hydatid cyst leading to bilateral pulmonary artery embolism and bilateral multiple pulmonar echinococcosis via inferior vena cava: report of a case.

Hydatid disease (HD) is a worldwide parasitic disease. Echinococcosis may involve many organs but affect most commonly liver and lungs. The location of echinococcal cysts inside pulmonary artery is extremely rare. Radiologic findings range from purely cystic lesions to a completely solid appearance. Hydatid cysts (HC) can be solitary or multiple and varies size. Pulmonary artery embolism of HC can be symptomatic or asymptomatic. When symptomatic, we see the chest pain, dyspnea, cough, hemoptysis and sometimes acute cor pulmonale or sudden death secondary to massive giant pulmonary artery embolism of HC.

Our experience with the surgical management of paranasal sinus osteomas.

The aim of this work is to describe our experience with the management of osteomas of the fronto-ethmoidal region, and to evaluate the limits and possibilities of different approaches: endonasal endoscopic versus external surgical resection of symptomatic osteomas. A review of 26 patients with detected osteomas in tertiary health care center was accomplished. We analysed the 26 adult patients, which detected paranasal sinus (PNS) osteomas--patients who underwent paranasal sinus CT examinations almost exclusively for other reasons. We analysed the patient's symptoms, localization and size of osteomas, clinical and imaging signs, in relation to adjacent structures. Of the 26 cases, 16 located in the etmoid sinus, eight in the frontal sinus, of which two with orbital one with an ethmoid extension, and one isolated maxillary and sphenoid sinus were involved. We treated 11 patients with endoscopic (eight cases) and external surgical approaches (three cases). Besides this surgical excision; 15 cases were kept in follow up, because of asymptomatic nature of the PNS osteomas or patients lack of consent. While the extranasal approach is still a part of the treatment concept for removing osteomas; over the last years, in suitable cases, the endoscopically controlled endonasal approach has greatly gained importance due to the improved surgical equipment and experience.

Bilateral Abducens Paralysis Secondary to Compression of Abducens Nerve Roots by Vertebrobasilar Dolichoectasia.

Vertebrobasilar dolichoectasia is characterized by dilatation, tortuosity, and marked elongation of the vertebral and basilar arteries. Dolichoectatic arteries usually have thin arterial walls secondary to degeneration of the internal elastic lamina, reticular fibre deficiency, and smooth muscle atrophy. This anomaly is relatively uncommon and generally asymptomatic. Clinical manifestations of dolichoectasia result from the compression and displacement of adjacent structures, causing cranial nerve palsy, obstructive hydrocephalus, or ischaemic stroke. The authors present a case in which vertebrobasilar dolichoectasia led to the development of bilateral abducens nerve paralysis in a 9-year-old girl.

Bilateral pulmonary sequestration in the elderly adult.

Pulmonary sequestration (PS) is a rare malformation consisting of aberrant lung tissue which is not affiliated with the normal bronchial system and is fed by an aberrant artery that derives from systemic arteries. However, PS is usually seen unilaterally but, only rarely, it is bilateral. Most patients with PS are diagnosed because of symptoms due to pulmonary infection or cardiac disease, while a small portion of patients are asymptomatic and diagnosed incidentally. In this report, we present an extremely rare case of asymptomatic bilateral PS which was diagnosed at advanced age. To our knowledge, this case represents the oldest patient in the literature, and the second case that was diagnosed in a patient over the age of 50.

Lipoid proteinosis in the eastern Mediterranean region of Turkey.

BACKGROUND: Lipoid proteinosis (LP), also known as hyalinosis cutis et mucosae or Urbach-Wiethe disease, is a rare autosomal recessive genodermatosis. Hyalin-like material is deposited in multiple organs, including the skin, oral mucosa, larynx, and brain. Only about 300 cases have been reported in the literature so far. Occurrence of LP in siblings is also rare. The reasons for relatively large number of cases, the clinical features of the patients, and the association of LP with other clinical conditions are described in this article. AIMS: The aim of this study is to show that LP is not rare in Turkey and consanguineous marriage is still a social problem. METHODS: We included patients between the years of 2008-2011 with lesions resembling LP. Based on the findings of clinical and histological examination of all cases, a diagnosis of LP was made. RESULTS: We presented six different families with multiple family members suffered from LP. In total, we determined eight children and six adult patients. Three of eight children were from the same family (sisters), the other three children belonged to another family (brothers), two children were from another family (brother and sister), and the adult patients were from three different families. CONCLUSIONS: Patients with LP are likely to present first to a dermatologist because of the appearance of their skin; therefore, it is important that the dermatologic diagnosis is not to be missed. We described patients with LP and discuss the salient features of this disease.

Intrathoracic rib associated with pulmonary collapse in a pediatric patient.

The ribs are essential structures of the osseous thorax that provide certain significant information and aid interpretation of radiologic images in daily routine practice. Intrathoracic rib is a rare congenital anomaly that is usually discovered incidentally, but may cause in vain interventions in case of being unaware. We herein report an intrathoracic rib in a girl whose chest X-ray was strange enough to obtain a spiral computed tomography (CT) scanning for a definitive diagnosis afterwards.

Congenital agenesis of the left lung: a rare case.

Pulmonary agenesis is a rare congenital anomaly, the etiology of which is not clearly known. Other systemic comorbidities such as cardiovascular, gastrointestinal, musculoskeletal, and urogenital system anomalies can be observed in more than half of the patients. It is usually diagnosed during childhood. Diagnosis in adulthood is very rare. We present a case of pulmonary agenesis diagnosed in an adult.