Importance of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of the Treatment Efficacy in Multiple Sclerosis Patients with Acute Attacks.

BACKGROUND: We planned to investigate contribution of DWMR to the treatment efficacy with ADC values which were measured in acute and chronic plaque before and after MS treatment. ADC changes in normal appearing white matter (NAWM) in patients with MS and healthy volunteers were also evaluated in this study. MATERIAL/METHODS: 25 patients with MS and 30 healthy subjects with normal brain MR findings were included to our study. Contrast enhancement in plaque was evaluated as an acute, and non-contrast enhancement in plaque was evaluated as a chronic. Also, ADC measurements were performed using the same parameters in NAWM in plaque neighborhood and volunteers. Results were compared with appropriate statistical methods. RESULTS: ADC values in acute and chronic plaques were decreased after the treatment, and these reductions were statistically significant for acute plaqus in b500 and for chronic plaques in b500 and b1000. The mean ADC values were measured as 1.53±0.49×10(-3) and 1.43±0.58×10(-3) in acute plaques and 1.40±0.35×10(-3) and 1.34±0.36×10(-3) mm(2)/sec in chronic plaques before and after the treatment. CONCLUSIONS: We think that DWMR have important role due to quantitative measurement ability in the evaluation of the treatment efficacy of the MS patients with acute attack in addition to contrast-enhanced MR sequence.

The effectiveness of simple drainage technique in improvement of cerebral blood flow in patients with chronic subdural hemorrhage.

OBJECTIVE: In the present study, the clinical effectiveness of a surgical procedure in which no draining tubes are installed following simple burr hole drainage and saline irrigation is investigated. METHODS: 10 patients, having undergone operative intervention for unilateral chronic subdural hemorrhage, having a clinical grade of 2 and a hemorrhage thickness of 2 cm, were included in the study. The cerebral blood flow rates of middle cerebral artery were evaluated bilaterally with Doppler before and after the surgery. All the cases underwent the operation using the simple burr hole drainage technique without the drain and consequent saline irrigation. Statistical analysis was performed by Wilcoxon signed rank test (p<0.05). RESULTS: There was a pronounced decrease in the preoperative MCA blood flow in the hemisphere the hemorrhage had occurred (p=0.008). An increased PI value on the side of the hemorrhage drew our attention (p=0.005). Postoperative MCA blood flow measurements showed a statistically significant improvement (p=0.005). Furthermore, the PI value showed normalization (p<0.05). The paresis and the level of consciousness improved in all cases. CONCLUSION: Simple burr hole drainage technique is sufficient for the improvement of cerebral blood flow and clinical recovery in patients with chronic subdural hemorrhage.