Infection with COVID-19 is no longer a public emergency: But what about degenerative dementia?

Although no longer considered a public health threat, post-COVID cognitive syndrome continues to impact on a considerable proportion of individuals who were infected with COVID-19. Recent studies have also suggested that COVID may be represent a critical risk factor for the development of Alzheimer's disease (AD). We compared 17 COVID patients with 20 controls and evaluated the effects of COVID-19 on general cognitive performance, hippocampal volume, and connections using structural and seed-based connectivity analysis. We showed that COVID patients exhibited considerably worse cognitive functioning and increased hippocampal connectivity supported by the strong correlation between hippocampal connectivity and cognitive scores. Our findings of higher hippocampal connectivity with no observable hippocampal morphological changes even in mild COVID cases may be represent evidence of a prestructural compensatory mechanism for stimulating additional neuronal resources to combat cognitive dysfunction as recently shown for the prodromal stages of degenerative cognitive disorders. Our findings may be also important in light of recent data showing that other viral infections as well as COVID may constitute a critical risk factor for the development of AD. To our knowledge, this is the first study that investigated network differences in COVID patients, with a particular focus on compensatory hippocampal connectivity.

Relationships among retropalatal airway, pharyngeal length, and craniofacial structures determined by magnetic resonance imaging in patients with obstructive sleep apnea.

BACKGROUND: The integration of anatomical and nonanatomical parameters will improve our ability to predict the outcomes of OSA treatment. Currently, no standardized, quantitative classification of upper airway anatomical traits is available. The retropalatal (RP) airway is the most important area to consider when planning anatomical treatment. However, current evaluation methods feature qualitative conventional endoscopy. Here, we describe a quantitative magnetic resonance imaging (MRI) method used to classify RP airway patterns. METHODS: We recruited 117 males; 20 simple snorers and 97 patients with OSA. Lateral/anteroposterior ratios were calculated in three parallel planes and RP patterns were classified accordingly. Lateral wall soft tissue structures, skeletal dimensions representing those planes, pharyngeal lengths, and skeletal and vertical axis ratios were also measured. RESULTS: Both the cross-sectional area at the hard palate level and the RP lateral dimension were associated with OSA. OSA patients had longer pharynges than controls. The oblique pattern was associated with narrow lateral dimensions. The vertical pattern was associated with a narrow nasopharynx but a longer pharynx. The airway ratio at the hard palate level and the skeletal ratios of all three planes were negatively correlated with the vertical axis ratio and together explained 40.8% of the variance in the vertical axis ratio. CONCLUSIONS: The data suggest that anatomical imbalances between the craniofacial skeletal and soft tissue structures affect pharyngeal airway morphology in all three dimensions. The dimensions of the nasopharynx, the cross-sectional area at the hard palate level, and pharyngeal length were associated not only with the RP patterns but also with OSA severity. This study affords insights into upper airway anatomy and RP patterns and may help diagnose OSA patients and aid in the selection of an appropriate therapy.

High sensitivity C-reactive protein and cerebral white matter hyperintensities on magnetic resonance imaging in migraine patients.

BACKGROUND: Migraine is a common headache disorder that may be associated with vascular disease and cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scan. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that may predict subclinical atherosclerosis. However, the relation between migraine, vascular risks, and WMHs is unknown. We evaluated hs-CRP levels and the relation between hs-CRP level and WMHs in adult migraine patients. METHODS: This case-control study included 432 subjects (216 migraine patients [without aura, 143 patients; with aura, 73 patients]; 216 healthy control subjects without migraine; age range 18-50 y). Migraine diagnosis was determined according to the International Classification of Headache Disorders II diagnostic criteria. The migraine patients and control subjects had no known vascular risk factors, inflammatory disease, or comorbid disease. The presence and number of WMHs on MRI scans were determined, and serum hs-CRP levels were measured by latex-enhanced immunoturbidimetry. RESULTS: Mean hs-CRP level was significantly greater in migraine patients (1.94 ± 2.03 mg/L) than control subjects (0.82 ± 0.58 mg/L; P ≤ .0001). The mean number of WMHs per subject and the presence of WMHs was significantly greater in migraine patients (69 patients [31.9%]; 1.68 ± 3.12 mg/dL) than control subjects (21 subjects [9.7%]; 0.3 ± 1.3; P ≤ .001). However, there was no correlation between hs-CRP level and WMHs in migraine patients (r = 0.024; not significant). The presence of WMHs was increased 4.35-fold in migraine patients (odds ratio 4.35, P ≤ .001). CONCLUSIONS: High hs-CRP level may be a marker of the proinflammatory state in migraine patients. However, the absence of correlation between hs-CRP level and WMHs suggests that hs-CRP is not causally involved in the pathogenesis of WMHs in migraine patients. The WMHs were located mostly in the frontal lobe and subcortical area.

Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values.

The aim of this study was to retrospectively measure and compare pancreatic apparent diffusion coefficient (ADC) in patients with acute pancreatitis (AP) with aged matched controls who underwent diffusion weighted imaging (DWI). The institutional review board approved this retrospective Health Insurance Portability and Accountability Act compliant study with a waiver for informed consent. Pancreatic ADC values from 27 patients with a clinical diagnosis of AP and 38 normal age-matched controls evaluated with DWI (b = 0 and 800 mm(2)/s) were retrospectively and independently measured by two radiologists. The ADCs were compared between the groups and between each of the pancreatic segments in the normal group. Inter-observer reliability was calculated and receiver operating characteristic analysis was used to determine the sensitivity and specificity of DW imaging in the diagnosis of acute pancreatitis. P < 0.05 was considered statistically significant. The ICC for inter-observer reliability was 0.98 in the control and 0.97 in the AP group. The mean pancreatic ADC in the AP group (1.32 × 10(-3) mm(2)/s ± 0.13) was significantly lower than in the normal group (1.77 × 10(-3) mm(2)/s ± 0.32). There was no significant difference in mean ADCs between each of the pancreatic segments in the controls. A threshold ADC value of 1.62 × 10-3 mm(2)/s yielded a sensitivity of 93% and specificity of 87% for detecting acute pancreatitis for b values of 0 and 800 s/mm(2). Pancreatic ADCs are significantly lower in patients with AP than normal controls.

Evaluation of the relationship between L5-S1 spondylolysis and isthmic spondylolisthesis and lumbosacral-pelvic morphology by imaging via 2- and 3-dimensional reformatted computed tomography.

PURPOSE: The purpose of this study was to investigate the differences in the axial and coronal parameters of lumbosacropelvic morphology among a population with spondylolysis and healthy individuals by using 2- and 3-dimensional (3D) reformatted computed tomographic images. Moreover, this study aimed to evaluate the differences in sagittal geometry. MATERIALS AND METHODS: The stone protocol abdominal computed tomographic images of 386 patients were retrospectively analyzed. Thirty individuals who had spondylolysis at L5-S1 level were included in the study. Moreover, a control group of individuals free of spondylolysis and spondylolisthesis was formed, similar in age and sex to the study group. A number of linear and angular lumbosacral morphologic parameters were evaluated using 2D and 3D reformatted computed tomographic images. The data of the 2 groups were compared using a t test. RESULTS: There was an association between spondylolysis and decreased interpedicular angle and S1 vertebra interfacet index, increased distance between the iliac crest and L5 vertebral transverse process, decreased L5 pedicle width, and increased height of the iliac crest and decreased L5 vertebra sagittal index. The paravertebral muscle area was larger in the lysis group when compared with the healthy individuals. CONCLUSIONS: Multiple factors (eg, interpedicular angle, S1 vertebra interfacet index, the distance between the iliac crest and L5 vertebra transverse process, L5 pedicle width, height of the iliac crest and L5 vertebra sagittal index) in lumbosacropelvic morphology affect the defect development in pars interarticularis. In individuals with spondylolysis, paravertebral muscle hypertrophy develops as a secondary adaptive change.

Diffusion-weighted MR imaging of abdominopelvic abscesses.

This study was conducted to determine the incremental value of diffusion-weighted MR imaging (DW-MRI) over T2-weighted imaging diagnosing abdominopelvic abscesses and compare apparent diffusion coefficient (ADC) values of abscesses and non-infected ascites. In this IRB-approved, HIPAA-compliant study, two radiologists retrospectively compared T2-weighted, T2-weighted + DW-MRI and T2-weighted + contrast enhanced MR images of 58 patients (29 with abscess, 29 with ascites) who underwent abdominal MRI for abscess detection. Confidence and sensitivity was compared using McNemar's test. ADC of abscesses and ascites was compared by t test, and a receiver operating characteristic (ROC) curve was constructed. Detection of abscesses and confidence improved significantly when T2-weighted images were combined with DW-MRI (sensitivity: observer 1-100%, observer 2-96.6%) or contrast enhanced images (sensitivity: both observers-100%) compared to T2-weighted images alone (sensitivity: observer 1-65.5%, observer 2-72.4%). All abscesses showed restricted diffusion. Mean ADC of abscesses (observer 1-1.17 ± 0.42 × 10(-)³ mm²/s, observer 2-1.43 ± 0.48 × 10(-3) mm²/s) was lower than ascites (observer 1-3.57 ± 0.68 × 10(-3) mm²/s, observer 2-3.42 ± 0.67 × 10(-3) mm²/s) (p < 0.01). ROC analysis showed perfect discrimination of abscess from ascites with threshold ADC of 2.0 × 10(-3) mm²/s (Az value 1.0). DW-MRI is a valuable adjunct to T2-weighted images diagnosing abdominopelvic abscesses. ADC measurements may have the potential to differentiate abdominal abscesses from ascites.

Topological network mechanisms of clinical response to antidepressant treatment in drug-naive major depressive disorder.

AIM: There is rapidly increasing evidence that remission of MDD is associated with substantial changes in functional brain connectivity. These New data have provided a holistic view on the mechanism of antidepressants on multiple levels that goes beyond their conventional effects on neurotransmitters. METHOD: The study was approved by the Local Ethics Committee of Istanbul Medipol University (10840098-604.01.01-E.65129) and followed the Helsinki Declaration principles. In our study, we have evaluated the effect of six weeks of treatment with antidepressants (escitalopram and duloxetine), and tested the underlying brain functional connectivity through a Graph analysis approach in a well-defined first-episode, drug-naive, and non-comorbid population with MDD. RESULTS: Beyond indicating that there was a significant correlation between the antidepressant response and topological characteristics of the brain, our results suggested that global rather than regional network alterations may be implicated in the antidepressant effect. CONCLUSION: Despite the small-sample size and non-controlled study design, our study provides important and relevant clinical data regarding the underlying mechanisms of the antidepressants on topological dynamics in the human brain.

[Bilateral cerebellopontine angle lipoma in an asymptomatic patient: a case report]. / Asemptomatik hastada iki tarafli serebellopontin kösede lipom: Olgu sunumu.

We present here an asymptomatic case of a bilateral cerebello-pontine angle lipoma incidentally diagnosed by magnetic resonance imaging. Intracranial lipomas are rare and comprise just 0.1-1.5% of all intracranial tumors, and are mostly located in the corpus callosum. Cerebello-pontine angle (CPA) or internal acoustic canal (IAC) locations, on the other hand, are rather rare, and usually unilateral. Bilateral locations, as with the case presented here, were reported in only three cases in the literature. Cerebello-pontine angle and IAC lipomas typically infiltrate the neighboring cranial nerves (5, 7 and 8), causing progressive neurological deficits in 95% of cases. However, cases of bilateral CPA/IAC lipomas similar to this case are interesting because of their being asymptomatic.

Predictive value of leucocytosis in head trauma.

AIM: Head trauma is associated with an acute phase response which is characterized by leucocytosis due to increased levels of catecholamine and cortisol. Early edema formation following severe head injury may also be associated with microglia activation. Therefore, increased white blood cell (WBC) count after head trauma may be a predictive parameter of the severity of craniocerebral trauma. MATERIAL AND METHODS: We retrospectively studied 59 patients with severe, moderate and minor injury between February 2007 and March 2009. WBC counts of all patients were obtained within the first day of their admission. All patients were divided into separate groups according to their Glasgow Coma Scale (GCS) scores and hospital stay durations. Their CT progressions and Glasgow Outcome Scale (GOS) scores were also assessed. The relationship between these parameters and WBC counts were evaluated by statistical methods. RESULTS: There was a favorable correlation between WBC counts of the patients and GCS scores (pI0.01), hospital stay (p=0.006), CT progression (p < 0.01) and GOS scores (p < 0.01). CONCLUSION: AWBC count exceeding 17.5 x 106/l has a predictive value for poor GCS score, and long hospital stay. CT progression tends to be seen in patients with moderate and severe head injury.

STIR sequence for depiction of degenerative changes in posterior stabilizing elements in patients with lower back pain.

OBJECTIVE: The aims of this study were to investigate whether degenerative posterior paraspinal changes are a cause of lower back pain and to determine the age- and sex-related distribution of these changes on MR images acquired with a STIR sequence. SUBJECTS AND METHODS: The lumbar MRI findings of 372 patients (141 men, 231 women; mean age, 51.2 years) with nonradicular lower back pain and of 249 healthy persons acting as controls (126 men, 123 women; mean age, 49.3 years) were analyzed. The sagittal STIR sequence was used for all MRI examinations. Presence of interspinous ligament edema, facet joint effusion, neocysts, paraspinal muscle edema, subcutaneous edema, disk herniation, and disk degeneration was evaluated, and the incidence of each finding was determined. All findings were grouped according to age and sex. Chi-square, Fisher's exact, and independent-samples Student's t tests and Spearman's rank correlation analysis were used for statistical analysis. RESULTS: The incidences of facet joint effusion, interspinous ligament edema, neocyst formation, and paraspinal muscle edema were found to be statistically significantly higher in patients with lower back pain than in controls. The incidences of intervertebral disk degeneration, disk herniation, and subcutaneous edema in persons with and those without lower back pain were similar. Intervertebral disk degeneration, disk herniation, subcutaneous edema, and muscle edema were found to increase with age in both persons with and those without symptoms. CONCLUSION: Degenerative changes in the posterior paraspinal structures were found in a higher percentage of subjects with lower back pain than in controls. Use of a STIR sequence with homogeneous fat suppression facilitates visualization of these changes.

Adult polysplenic syndrome accompanied by aberrant right subclavian artery and hemangioma in a cleft spleen: a case report.

We present a case of adult polispleny syndrome accompanied by cleft spleen containing a cavernous hemangioma and an aberrant right subclavian artery. Patients with polysplenic syndrome are usually lost in childhood and rarely reach adulthood. The most frequently accompanying vascular abnormality is an interrupted inferior vena cava with azygous-hemiazygous continuation. Arterial vascular anomalies are rather rare, and there are several reports in the medical literature where cases of childhood polyspleny syndrome are accompanied by pulmonary arteriovenous fistulas or a main hepatic artery originating from the superior mesenteric artery. The case presented here seems to be the first report of adult polysplenic syndrome with an aberrant subclavian artery and a splenic cavernous hemangioma. The possible congenital vascular anomalies which eventually could accompany adult polysplenic syndrome cases are clinically important for the approach to the patient and planning of eventual vascular interventions.

Subpubic cartilaginous cyst: incidental finding detected by abdominopelvic computed tomography.

Subpubic cartilaginous cysts are rare cystic lesions that have been radiologically identified only in recent years, and the our understanding of the cautions to be observed in the diagnostic approach and the radiologic characteristics is still incomplete. The medical literature search revealed three reported cases of a subpubic cartilaginous cyst diagnosed histopathologically and one case that was suggested by radiological findings. Definitive diagnosis of all the cases was confirmed by excisional biopsy. This report discusses the radiological features and the important issues necessary in the diagnostic approach of subpubic cartilaginous cysts.

Multiple rice body formation accompanying the chronic nonspecific tenosynovitis of flexor tendons of the wrist.

Rice body formation is generally a rare disorder related to rheumatoid arthritis. It can also be observed in cases of systemic lupus erythematosus, seronegative arthritis, infectious arthritis (tuberculosis, atypical mycobacterial infection), nonspecific arthritis, and osteoarthritis. It is generally located within joints or bursae. Multiple rice bodies of tendon sheaths are rarely encountered. Rice body formation may also be encountered without underlying systemic disorders. We present a case of multiple rice body formation that accompanied chronic nonspecific tenosynovitis of the flexor tendons of the wrist.

[The relationship between MRI findings and duration of symptoms in transient osteoporosis of the hip]. / Geçici kalça osteoporozunda MRG bulgulari ile semptomlarin süresi arasindaki iliski.

OBJECTIVES: We investigated the relationship between magnetic resonance imaging (MRI) findings and duration of symptoms in patients with transient osteoporosis of the hip (TOH). METHODS: The study included nine patients (7 men, 2 women; mean age 45 years; range 31 to 54 years) with TOH, whose symptoms disappeared after conservative treatment. MRI scans of the patients were retrospectively and independently reviewed twice by two radiologists to assess the presence of a subchondral hypointense fracture line, to calculate the area of subchondral fracture, and to classify the extent of bone marrow edema into four groups as A, B, C, and D. Duration of symptoms before and after MRI was recorded and associations between symptom duration and MRI findings were assessed. RESULTS: The intraobserver and interobserver correlation coefficients showed an excellent agreement for both radiologists. A subchondral fracture was detected in seven patients; of whom, bone marrow edema corresponded to group B, C, and D in 2, 2, and 3 patients, and the mean fracture areas were 8.5 mm(2), 18.2 mm(2), and 29.7 mm(2), respectively. The mean symptom duration in these patients before MRI was 1.8 months (range 1 to 4 months), and relief of symptoms after MRI took 4, 5, and 6.6 months in groups B, C, and D, respectively. In the presence of a similar extent of bone marrow edema, the occurrence of subchondral fracture and increase in the fracture area were associated with delayed relief of symptoms. Subchondral fracture area was also correlated with the extent of bone marrow edema. Two patients without a subchondral fracture had bone marrow edema of group A and D, and the symptoms disappeared in one month and three months following MRI, respectively. CONCLUSION: Our results show that the extent of involvement of the proximal femur may vary in TOH, and that time to clinical improvement may be closely related to the presence and size of subchondral fracture, and the extent of bone marrow edema.

[A giant retropharyngeal lipoma showing no change in clinical presentation and size within a two-year follow-up: a case report]. / Iki yillik takipte kliniginde ve boyutunda degisiklik saptanmayan dev retrofarengeal lipom: Olgu sunumu.

Retropharyngeal tumors are rare. They typically originate from the neighboring anatomical structures or from the retropharyngeal space itself. Retropharyngeal lipomas are even rarer. A 75-year-old male patient presented with complaints of dyspnea, dysphagia, snoring, and obstructive sleep apnea. Computed tomography showed a giant mass measuring 125 x 81 x 27 mm in the retropharyngeal space, compressing the larynx, trachea, and esophagus, and extending to the thoracic inlet. The mass had regular margins, exhibited low attenuation, and was homogeneously hypodense. After intravenous contrast administration, there were thin septa formations within the lesion that did not show contrast enhancement. There was no invasion to the neighboring muscular structures. The lesion was considered a lipoma. Surgery was not performed due to the cardiovascular problems of the patient. During a two-year follow-up, there were no changes in the size and tissue characteristics of the mass, nor any mass-related clinical problems.

Acute spinal cord compression from an extraosseous vertebral hemangioma with hemorrhagic components: a case report.

OBJECTIVE: This case report presents a patient with acute compression myelopathy caused by acute hemorrhage of a thoracic vertebral hemangioma extending into the epidural space. CLINICAL FEATURES: A 22-year-old male patient experiencing back pain for 5 months presented to our medical facility complaining of sudden onset numbness and muscle weakness in the lower extremities. INTERVENTION AND OUTCOME: Magnetic resonance imaging of the thoracic spine revealed a T5-level mass involving predominantly the posterior vertebral elements, extending into the epidural area, and showing significant gadolinium enhancement. Hemorrhagic signal changes were noted within the epidural component of the mass. In addition, the epidural mass component was noted to significantly compress the spinal cord. The patient was referred for emergency surgery with the preliminary diagnosis of epidural vertebral hemangioma with hemorrhagic component; a decompression laminectomy was performed without preoperative angiography. The patient's complaints improved completely after surgery, and radiotherapy was instituted for the residual tumor tissue. CONCLUSION: The presence of acute or subacute myelopathic symptoms is usually suggestive for malignancy or metastasis. However, in young patients, vertebral hemangioma, causing acute hemorrhage, should be considered in the differential diagnosis. Decompression surgery should be done in such cases before neurological symptoms become irreversible.

[A case of rectus sheath hematoma]. / Rektus kilifi hematomu: Olgu sunumu.

Rectus sheath hematomas are uncommon and are being caused by the injuries of the epigastric vessels and the rectus muscle. They are usually located infraumblically and often misdiagnosed as inflammatory diseases or tumours of the abdomen. We present a 70-year-old woman who had complaints of severe abdominal pain on the left side, nausea and vomiting after heavy lifting. Rectus sheath hematoma was detected by abdominal ultrasonography and computerized tomography. The patient recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment. Computerized tomography must be chosen for definitive diagnosis. Ideal treatment is conservative.

[Incarceration of the left hepatic lobe in incisional hernia: a case report]. / Insizyonel hernide sol karaciger lobunun inkarserasyonu.

Incisional hernias are delayed complications of abdominal surgery and occur in 0.5-13.9 % of patients according to various reported series. The causative factors of incisional hernia are related to the condition of the patient, the main disease, surgical techniques and postoperative complications. The subcutaneous herniation of the left hepatic lobe through the abdominal wall is a rare condition. In this case report, we discuss an incarcerated incisional hernia associated with medial segment of the left hepatic lobe.

[Posttraumatic tension pneumocephalus causing herniation]. / Herniasyona neden olan posttravmatik tansiyon pnömosefalus.

A 12 year old boy was admitted to emergency service with loss of consciousness, convulsions and anisocoria of the right eye along the history of upper respiratory tract infection for the last four days. Two months ago he was hospitalized at the intensive care unite due to motorcycle accident with frontal fracture and minimal frontal pneumocephalus. He was treated for ten days and discharged without any neurological impairment. The last computerized tomography showed right frontal air of 5x5x7 cm. multiple airs in the ventricular system and in the upper central canal of the cervical region. The air was removed immediately through a right frontal burr-hole with a bedside procedure. The patient's neurological status rapidly improved and ten days after computerized tomography showed clearly resolution of the air. The presented case is an interesting example of post traumatic pneumocephalus due to herniation and widespread intracranial air. The situation can be explained with acute penetration of huge amount of air into the cranium through the frontobasal fracture and torn dura by strong Valsalva 's maneuver resulting from coughing and sneezing in the course of upper respiratory tract infection. We suggest close follow up, frequent control computerized tomography scans, preventive and effective treatment respiratory tract infections along 3-6 months in similar cases.