Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks.

OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

Can Cochlear Nerve Size Assessment With Magnetic Resonance Enhance the Understanding of Idiopathic Sudden Sensorineural Hearing Loss?

BACKGROUND AND OBJECTIVES: Idiopathic sudden sensorineural hearing loss (ISSHL) is a rapid loss of hearing, exceeding 30 dB in at least 3 consecutive frequencies within 3 days, without any identifiable cause despite thorough investigations. Currently, the etiology and pathogenesis of ISSHL have not been fully elucidated. This study aimed to assess the size of the cochlear nerve in patients with ISSHL and explore its relationship with pretreatment audiograms and treatment response. Subjects and. METHODS: A total of 125 patients (59 [47.2%] women; mean age 47.7±13.8 years [minimum-maximum: 21-76]) and 60 healthy participants (27 [45%] women; mean age 45.7±16.8 years [minimum-maximum: 20-76]) as a control group were included in this study. The size of the cochlear nerve was assessed on the affected side, compared to the control group, as well as on the unaffected side. Pretreatment and posttreatment audiological values were also analyzed. RESULTS: The cross-sectional area (CSA), vertical diameter (VD), and horizontal diameter (HD) of the CN were found to be smaller on the affected side of ISSHL patients compared to the control group (p<0.01; p=0.04; p=0.02, respectively). In the study group (affected side of ISSHL patients), there were no significant differences in VD, HD, and CSA values between pretreatment audiogram types (p=0.23; p=0.53; p=0.39, respectively), and initial hearing levels (p=0.16; p=0.22; p=0.23, respectively). Furthermore, there were no significant differences in VD, HD, and CSA values between the recovery groups according to Furuhashi criteria (p=0.18; p=0.37; p=0.27, respectively). CONCLUSIONS: The size of the CN may be a risk factor for ISSHL, but it does not affect the type of audiogram curves and was not prognostic in terms of treatment response.

Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

A 10-year retrospective analysis of intimate partner violence patients in the emergency department.

BACKGROUND: Intimate partner violence (IPV) is an important human rights problem faced by one in three women worldwide. The aim of this study is to evaluate the demographic, trauma, and radiological characteristics of patients admitted to a tertiary emer-gency department due to IPV. METHODS: Sociodemographic characteristics (age, gender, education level, and marital status), trauma characteristics (severity, type, and location), radiological imaging findings (radiography, computed tomography, and magnetic resonance imaging) of patients diagnosed with IPV were evaluated. RESULTS: In the study, 1225 patients were evaluated, and 98.7% of them were women (mean age 35 [IQR: 17] years). Of the pa-tients, 63.1% were high school and university graduates. The rate of married women was 74.6%. No relationship was found between gender, age, educational status, and marital status (p>0.05). Most of the traumas were minor (85.4%) and blunt (81.9%) trauma, and the most common types of trauma were kicking (49.9%) and punching (47.3%). It was found that the most frequently affected areas of the patients were the head and neck (76.7%), and the frequency of pelvic trauma was high in male patients (p<0.05). The most com-mon bone fracture was nasal (40.5%) followed by ulna fractures (14.5%). The left-sided diaphyseal fractures were the most common in patients exposed to IPV. In our study, the frequency of mortality was 12.9%, and it was found to be significantly higher in males (p<0.05). CONCLUSION: Female patients are more frequently exposed to IPV. Specific injury characteristics can be detected in patients diagnosed with IPV and old fractures detected in these patients should alert the clinician about IPV.

Radiographic findings of Desbuquois dysplasia.

Desbuquois dysplasia is an autosomal recessive chondrodysplasia characterized by severe micromelic dwarfism, joint laxity, progressive scoliosis, and advanced carpotarsal ossification. Two different types of Desbuquois dysplasia have been identified according to the presence (Type 1) or absence (Type 2) of characteristic hand abnormalities including bifid distal thumb phalanx, an extra ossification center distal to the second metacarpal, and interphalangeal joint dislocations. Further, Kim et al have described a milder variant of Desbuquois dysplasia characterized by short stature and hands with short metacarpals, elongated proximal and distal phalanges, and extremely advanced carpal ossification. Here, we present a 19-year-old male patient with Kim variant of Desbuquois dysplasia. He displays almost all of the characteristic skeletal findings of Desbuquois dysplasia along with the characteristic hand features described by Kim et al. This patient is unique in that he also presents sagittal femoral bowing, a radiographic finding that accompanies various skeletal dysplasias but has never been reported in a patient with Desbuquois dysplasia to date.

Urethral Recurrence of Urothelial Carcinoma of the Bladder Following Radical Cystectomy: An Unusual Imaging Pattern.

Residual urethra is a common site of recurrence in patients undergoing radical cystectomy with urinary diversion for bladder cancer. Urethral recurrence (UR) clinically manifests as a penile mass or a bloody or purulent penile discharge at a median of 13 months after surgery. And on imaging studies, it characteristically appears as a focal intraluminal mass, urethral wall thickening, or an infiltrating mass arising from the urethra. We, herein, present an unusual case of UR manifesting as a large cyst in the penile root 4 years after radical cystectomy with urinary diversion for muscle-invasive bladder cancer. Further, a complex cystic mass developed in the same location 2 years after the excision of the cystic UR. This case shows that the imaging spectrum of UR after radical cystectomy may be wider and may include cystic and complex patterns.

Primary hydatid cyst in the adductor magnus muscle.

Human hydatid cyst is a zoonotic disease caused by the larvae of the Echinococcus species, most commonly the Echinococcus granulosus. Although hydatid cyst can cause disease almost anywhere in the human body, it most commonly affects the liver and lungs. Primary musculoskeletal hydatid involvement is a very rare occurrence even in endemic regions. Musculoskeletal hydatid disease shows no pathognomonic clinical signs and symptoms. And the contribution of serology to the diagnosis is negligible due to the high rate of false-negative results. Therefore, radiological imaging studies have a critical role in the diagnosis of the disease. To the best of our knowledge, there are only a few case reports of primary hydatid involvement of the adductor magnus muscle in the current literature. Here we present a 55-year-old female patient with primary hydatid cyst in the adductor magnus muscle and discuss the case in terms of imaging.

The concordance of optic nerve sheath diameter measurements with the clinical course in children with traumatic head injury.

BACKGROUND: Intracranial pressure (ICP) monitoring is of profound importance concerning prognosis and treatment among children with traumatic brain injury (TBI). Measurements of the optic nerve sheath diameter (ONSD) are one of the methods recommended for ICP monitoring. In this study, we aimed to evaluate the correlation of ONSD change in brain computed tomography (CT) with pediatric Glasgow Coma Score (pGCS) in the follow-up of pediatric cases with TBI, and also to evaluate the usability of the ONSD, which is the indicator of ICP. METHODS: The data of 921 pediatric patients who were admitted to the emergency department with head injury between January 2016 and January 2018 were retrospectively evaluated in this study. Age, gender, trauma type, brain CT finding, pGCS, type of intracranial hemorrhage (ICH), and isolated skull fracture (ISF) were investigated. The patients were evaluated in three groups based on CT findings: (i) patients with parenchymal brain injury, (ii) patients with ISF, and (iii) patients with normal brain CT results. The measurements of ONSD were performed using CT. Whether the ONSD measurement results of the patients were compatible with the clinical data was investigated. RESULTS: The median age of the patients was 36 months (interquartile range [IQR] = 64) and 64.2% were male. The ONSD values and pGCSs of the patients with parenchymal injury were found to be significantly higher than patients with ISF and normal brain CT findings (p<0.05). The pGCSs showed a significant negative correlation with the first and second measurement results of ONSD (p<0.05). In groups undergoing control brain CT, ONSD levels in the second brain CT were found to be significantly high (p<0.05). CONCLUSION: In the clinical follow-up, ONSD measurements are reliable and significant parameters when evaluated with brain CT findings and pGCSs. We think that repeated ONSD measurements will be useful in determining possible adverse effects of secondary injury, as well as in determining the severity of the trauma during admission.

Incidentally Discovered Thyroid Nodules by Routine Magnetic Resonance Imaging of the Cervical Spine: Incidence and Clinical Significance.

OBJECTIVE: The aim of our study was to present the prevalence of thyroid nodules we incidentally discovered by routine Magnetic Resonance Imaging (MRI) of the cervical spine, to evaluate their clinical significance, and to discuss the current clinical approach to incidental thyroid nodules. METHODS: We retrospectively evaluated the cervical spinal MRI studies of 512 patients. Thyroid glands were evaluated for morphologic and signal characteristics and examined for the presence of nodule(s). The nodules with a maximum diameter of 5 mm or more were taken into analysis. RESULTS: Of 512 MRI studies, 254 revealed incidental thyroid nodule(s) (49.6%). The mean maximum nodule diameter was 7.48±2.92 mm. Thirty-eight of 254 incidental thyroid nodules were radiologically reported, 35 reported nodules were evaluated by US, and 22 were further analyzed by fine needle aspiration cytology. The final diagnosis of 11 aspirated nodules was an adenomatous nodule, whereas 3 were papillary thyroid carcinoma. One of the patients with papillary thyroid carcinoma was a 32-year-old man with a nodule with a maximum diameter of 7 mm. CONCLUSION: Incidental thyroid nodule is a frequent non-spinal lesion detected by routine cervical spinal MRI. The 3-tiered system which is recommended in the clinical approach to incidental thyroid nodules may miss some clinically significant thyroid nodules. We suggest the criteria of this system to be re-evaluated and modified if necessary. In addition, we would like to emphasize the need for a guideline for radiologists for reporting incidental thyroid nodules on MRI on the basis of a standard clinical approach.

Association of upper limb meromelia, proximal focal femoral deficiency, fibular hemimelia, and intermetatarsal coalition in a young adult male.

Meromelia refers to the partial absence of at least 1 limb and is also referred to as "terminal transverse hemimelia." It can occur in either isolation or with other congenital malformations. There are very few publications in the literature that report meromelia cases accompanied by other congenital anomalies. Proximal focal femoral deficiency is another rare congenital skeletal abnormality and is characterized by the underdevelopment of the proximal part of the femur and shortening of the entire lower extremity. A case of upper limb meromelia accompanied by proximal focal femoral deficiency and fibular hemimelia in a neonate has previously been reported. However, to our knowledge, the association of upper limb meromelia with intermetatarsal coalition has never been reported to date. Here, we present an adult patient showing an unusual association of multiple rare congenital skeletal abnormalities including meromelia, proximal focal femoral deficiency, fibular hemimelia, and intermetatarsal coalition.

An unusual association of ulnar hemimelia with mesoaxial synostotic syndactyly.

Ulnar hemimelia, also referred to as post-axial longitudinal deficiency of the upper limb, is a very rare skeletal anomaly characterized by the partial or complete absence of the ulna. The majority of the reported cases are sporadic and more common in males. The disorder is mostly unilateral, right-sided and incomplete. A slight shortening of the forearm, radial bowing and ulnar-sided hand drift are the anomalies which often accompany ulnar hemimelia. Ulnar hemimelia may also be seen in association with complex wrist and hand anomalies. The absence of post-axial metacarpal and digital bones are frequent findings in patients with this rare disorder. Cases with additional digital abnormalities such as post-axial syndactyly and camptodactyly are also present in the literature. However, a case of ulnar hemimelia in association with mesoaxial synostotic syndactyly has never been reported to date.

Unusually delayed manifestation of a hallux osteoid osteoma: A case report.

INTRODUCTION: Osteoid osteomas are benign osteoblastic bone tumors mostly seen in patients in the second or third decade of life, and they most frequently involve the femur and tibia. Hallux osteoid osteoma is an extremely rare occurrence with only 14 reported cases to date. PRESENTATION OF CASE: A 46-year-old woman with a right hallux pain for the last 18 months was admitted. Her foot radiographs showed a small sclerotic focus on the distal phalanx and degenerative changes in the interphalangeal joint of the hallux. The complaints of the patient were attributed to osteoarthritis involving the interphalangeal joint and non-steroidal anti-inflammatory drugs were administered; however, the patient's condition did not improve, and hallux osteoid osteoma could not be correctly diagnosed until a CT scan was performed. DISCUSSION: We present a case of hallux osteoid osteoma in which the diagnosis was delayed greatly due to the unusuality of the lesion location, the advanced age of the patient, and the uncertainty of the clinical and radiographic appearance. CONCLUSION: Although rare, osteoid osteoma may occur in the hallux. Even if the patient age, pain pattern, and radiographic findings do not exactly meet the classical definitions for osteoid osteoma, this tumor should always be included in the differential diagnosis list in patients presenting with foot pain.

Primary gluteal subcutaneous hydatid cyst.

Hydatid disease is a parasitic zoonosis caused by Echinococcus granulosus larvae. While it can affect almost any part of the human body, liver and lung are the two organs where the disease is most frequently detected. Subcutaneous hydatid cyst, which mostly develops secondary to iatrogenic spillage of cyst contents into incision area during a visceral hydatid cyst surgery, accounts for only 1.5 % of all cases of hydatid cyst. With only a limited number of reported cases, primary involvement of subcutaneous tissue by hydatid cyst is a much more rare occurrence as compared with the secondary form. Subcutaneous hydatid cysts tend to involve trunk and limb roots, and mostly present as a slowly-growing, painless, mobile mass with a normal overlying skin. To our knowledge, only a few cases of primary subcutaneous hydatid cyst in the gluteal region have been reported to date. Here, we present a 72-year-old farmer who presented with a painless lump in the gluteal region and diagnosed as having primary subcutaneous hydatid cyst.

Isolated unilateral proximal focal femoral deficiency presenting in a young woman.

Proximal focal femoral deficiency (PFFD) is a rare congenital skeletal abnormality characterised by the partial absence of the proximal femoral segment with shortening of the entire lower extremity. It typically presents as a shortened thigh, which is flexed, externally rotated and abducted. Some other skeletal anomalies, especially fibular hemimelia, usually accompany the disorder. The diagnosis of PFFD is made in early childhood and based mainly on conventional radiography. However, the radiographic appearance of the disease evolves as the child grows. In addition, treatment procedures applied to the child affect the radiographic presentation of the disease in adulthood. Almost all cases of PFFD reported to date are in young children and in the current literature, there is a paucity of radiographic images of PFFD in mature skeleton. The aim of this case report is to present the radiographic appearance of PFFD in an adult patient and to increase awareness among radiologists about this disease.

Atypical cleft hand with complex syndactyly: An unusual form of hand oligodactyly.

Hand oligodactyly refers to a developmental defect which results in the presence of less than 5 digits on a hand. It presents as a component of 4 main categories of congenital upper limb malformations. Herein, we present a 50-year-old man with an unusual form of hand oligodactyly which is characterized by atypical cleft hand accompanied by complex syndactyly between the thumb and the index finger. Accurate characterization of hand oligodacticity can sometimes be challenging due to unusual phenotypic appearances accompanying the abnormality. Radiological evaluation is of great importance for correct identification and classification of such complex hand anomalies, and the treatment should be highly individualized in these patients.

Chondromalacia Patella among Military Recruits with Anterior Knee Pain: Prevalence and Association with Patellofemoral Malalignment.

BACKGROUND: The aim of this study was to investigate the frequency of chondromalacia patella (CMP) and to evaluate its relation with trochlear morphometric and patellofemoral alignment measurements as well as with edema in superolateral region of Hoffa's fat pad (SHFP) in military recruits with anterior knee pain (AKP). MATERIALS AND METHODS: Knee magnetic resonance imaging examinations of 288 military recruits with AKP were retrospectively evaluated. Patellar cartilage lesions were graded using modified Noyes system. Quantitative measurements of trochlear morphology (sulcus angle, trochlear sulcus depth, and lateral trochlear inclination [LTI]) and patellofemoral alignment (patellar translation [PT], lateral patellofemoral angle (LPA), Insall-Salvati index, and tibial tuberosity-trochlear groove distance) were made. The SHFP region was assessed for the presence of edema. Mean values of measurements in knees with and without CMP and in knees with early and advanced stage CMP were compared. RESULTS: We found CMP in 169 (58.7%) patients. Patients with CMP demonstrated a significantly greater sulcus angle (P = 0.012), smaller LTI (P = 0.004), greater PT (P = 0.01), smaller LPA (P = 0.036), greater Insall-Salvati ratio (P = 0.034), and higher incidence of SHFP edema (P = 0.001) compared to those without CMP. While none of the measurements were associated with the severity of cartilage damage, the incidence of SHFP edema was significantly correlated with the severity of CMP (P = 0.001). CONCLUSION: CMP is a common disorder among military recruits with AKP. Patellofemoral malalignment is an important contributory factor in the development of CMP, and the presence of edema in SHFP may be a strong indicator of underlying severe CMP in this population.

Ovotesticular Disorder of Sex Development: An Unusual Presentation.

Disorder of sex development is an inclusive term that refers to any problem where the genital organ is atypical in relation to chromosomes or gonads. Ovotesticular disorder of sex development, which is formerly known as "true hermaphroditism," is the most rare form among all disorders of sex development in humans. It is characterized by the simultaneous presence of both ovarian and testicular tissues in the same individual and characteristically presents with ambiguous genitalia in neonates or infants. Herein, we present an unusual case of a 19-year-old individual with phenotypically nearly normal male genitalia who presented with the complaint of bilateral breast enlargement.

A rare case of isolated congenital unilateral brachymetatarsia presenting in a young adult male.

Congenital brachymetatarsia is a rare skeletal anomaly which is characterized by the abnormal length reduction of one or more metatarsal bones. It occurs as the result of the early closure of the growth plate. While the majority of the reported cases are idiopathic, it can also be seen in association with various genetic conditions or syndromes. Brachymetatarsia most commonly involves the fourth metatarsal followed by the first metatarsal. This rare disorder is mostly bilateral and reported almost exclusively in females. Herein, we present a rare case of congenital unilateral brachymetatarsia which was incidentally detected in a young adult male.

Upper Limb Meromelia with Oligodactyly and Brachymesophalangy of the Foot: An Unusual Association.

Meromelia is a rare skeletal abnormality characterized by the partial absence of at least one limb. Several mechanisms have been postulated to explain the etiopathogenesis of the disorder. Most of the cases of meromelia are reported to be sporadic. It can occur either in isolation or with other congenital malformations. VACTERL association, gastroschisis, atrial septal defect, proximal femoral focal deficiency, and fibular hemimelia are the congenital abnormalities reported to be in association with meromelia. However, no other congenital abnormalities in association with meromelia have been recorded to date. We herein present an unusual case of bilateral upper limb meromelia accompanied by unilateral oligodactyly and brachymesophalangy of the foot.