Discriminant analysis using MRI asymmetry indices and cognitive scores of women with temporal lobe epilepsy or schizophrenia.

PURPOSE: This study aims to assess the diagnostic power of brain asymmetry indices and neuropsychological tests for differentiating mesial temporal lobe epilepsy (MTLE) and schizophrenia (SCZ). METHODS: We studied a total of 39 women including 13 MTLE, 13 SCZ, and 13 healthy individuals (HC). A neuropsychological test battery (NPT) was administered and scored by an experienced neuropsychologist, and NeuroQuant (CorTechs Labs Inc., San Diego, California) software was used to calculate brain asymmetry indices (ASI) for 71 different anatomical regions of all participants based on their 3D T1 MR imaging scans. RESULTS: Asymmetry indices measured from 10 regions showed statistically significant differences between the three groups. In this study, a multi-class linear discriminant analysis (LDA) model was built based on a total of fifteen variables composed of the most five significantly informative NPT scores and ten significant asymmetry indices, and the model achieved an accuracy of 87.2%. In pairwise classification, the accuracy for distinguishing MTLE from either SCZ or HC was 94.8%, while the accuracy for distinguishing SCZ from either MTLE or HC was 92.3%. CONCLUSION: The ability to differentiate MTLE from SCZ using neuroradiological and neuropsychological biomarkers, even within a limited patient cohort, could make a substantial contribution to research in larger patient groups using different machine learning techniques.

Assessment the neurodegenaration process of post-geniculate optic pathway in thalamic tumors using optical coherence tomography: Post-geniculate optic pathway in thalamic tumors.

PURPOSE: To investigate the effect of thalamic tumors related to post-geniculate optic pathway and those of microsurgical removal on neurodegeneration process of visual pathway using OCT. METHODS: This cross-sectional study included 30 eyes of 15 patients with thalamic tumors and data compiled from 45 eyes of 45 healthy participants. The analysis of variables was divided into ipsilateral and contralateral eye depends on the laterality of brain tumors. The data gained at baseline, postoperative 3rd and postoperative 6th month period was analyzed in One-Way Repeated Measures ANOVA. RESULTS: The mean superior quadrant retinal nerve fiber layer (RNFL) thickness of ipsilateral eye was significantly thicker (p = 0.02), while inferior hemifield ganglion cell-inner plexiform layer (GC-IPL) thickness of contralateral eye was significantly higher compared to control groups (p = 0.02). Significant negative correlations were found between the mean preop. mean deviation (MD) and tumor volume and time interval between initial diagnosis and surgery (r = - 0.730, p = 0.002 and r = - 0.680, p = 0.005, respectively) in the ipsilateral eye. In repeated measure analysis, there was no unfavourable effect of thalamic microsurgery on peripapillary average RNFL thickness on both ipsilateral and contralateral eyes (Ipsilateral eye; f (1.5,21.7) 0.76 p = 0.51 and contralateral eye; f (1.4,20.4) 0.42 p = 0.59). CONCLUSION: This study suggests that thalamic tumors affecting post-geniculate optic pathway may lead to significant increase in RNFL and GC-IPL thicknesses and changes in VF parameters. Timely intervention in thalamic tumors may prevent irreversible loss of retinal axons secondary to neurodegeneration process.

Changes in the peripapillary and subfoveal choroidal vascularity index after transsphenoidal surgery for pituitary macroadenoma.

PURPOSE: To investigate the changes in peripapillary and subfoveal choroidal vascular indexes (CVI) before and after pituitary macroadenoma surgery by using a binarization method. METHOD: In this cross-sectional study, we examined 17 eyes in 9 patients with pituitary macroadenomas who had undergone transsphenoidal pituitary surgery due to chiasmal compression. We also compiled data from 17of in 17 healthy subjects. ImageJ 1.51 software processing (National Institutes of Health, Bethesda, Maryland, USA) was used for binarization of optical coherence tomography scans. The CVI was computed as the ratio of luminal area to total choroidal areal. The CVI, OCT and VF parameters were analyzed in One-Way Repeated Measures ANOVA to determine significant changes in measurements during the postoperative course. RESULTS: The mean peripapillary inferior and temporal quadrant CVIs were significantly lower in the eyes of patients with pituitary macroadenoma compared to controls (46.0 ± 0.03 versus. 42.8 ± 0.04, p = 0.02; 45.8 ± 0.03 Versus. 42.3 ± 0.04, p = 0.02). In repeated measure analysis, there was a significant effect of transsphenoidal microscobic pituitary surgery on peripapillary inferior quadrant CVI and BCVA, F(1.3, 21.5) = 6.62, p = 0.01 and F (1.8, 29.7) = 7.8, p < 0.005, respectively. CONCLUSION: This study suggests that PMa with chiasmal compression may lead to significant changes in the peripapillary CVI. Pituitary surgery had a favorable significant effect on peripapillary choroidal vascular network and BCVA. Furthermore, optical coherence tomography is a helpful technique for quantifying the alterations of peripapillary CVI during the preoperative and postoperative course.

Prognostic factors in progressive high-grade glial tumors treated with systemic approach: A single center experience.

PURPOSE: Malignant high-grade gliomas are the most common and aggressive type of primary brain tumor, and the prognosis is generally extremely poor. In this retrospective study, we analyzed the outcome of systemic treatment in recurrent high-grade glioma patients and the impact of prognostic factors on survivals. METHODS: Data from 114 patients with recurrent high-grade glioma who received systemic treatment and followed in our clinic between 2012 and 2018 were retrospectively analyzed. Eastern Cooperative Oncology Group (ECOG) performance status, age, gender, histology, type of surgical resection, side effects after systemic treatment (deep vein thrombosis, hypertension, proteinuria), IDH1 and alpha thalassemia/mental retardation syndrome X-linked (ATRX) mutation status were investigated as prognostic factors for progression-free survival and overall survival. RESULTS: At the time of diagnosis, the median age was 48 (17-77) and 68% of the patients were male. Most common pathologic subtype was glioblastoma multiforme (68%). Median follow-up duration was 9.1 months (1-68 months). Median progression-free survival and overall survival were 6.2 months and 8 months, respectively. In multivariate analysis, ECOG PS, deep venous thrombosis and the presence of ATRX and IDH1 mutation were found to be independent prognostic factors for progression-free survival (p < 0.05) and, ECOG PS, the presence of ATRX and IDH1 mutation for overall survival (p < 0.05). CONCLUSION: Our study is real life data and the median progression-free survival and overall survival rates are similar to the literature. We have found ECOG PS, presence of ATRX and IDH1 mutation to be independent prognostic factors for both progression-free survival and overall survival.

Transient Splenial Lesion of the Corpus Callosum Related to Migraine with Aura in a Pediatric Patient.

BACKGROUND: Transient splenial lesions of the corpus callosum are rare radiological findings first described in association with epilepsy, antiepileptic drugs and viral encephalitis. However, subsequently more cases were described associated with diverse clinical conditions. CASE REPORT: We describe a 13-year-old girl suffering from migraine with aura presenting with headache, right-sided hemiparesis and encephalopathy. Brain magnetic resonance imaging revealed an ovoid lesion in the splenium of the corpus callosum. The patient's neurological symptoms resolved within 3 days without therapy and the lesion disappeared in follow up magnetic resonance images obtained 3 weeks after the onset of the symptoms. RESULTS: Migraine with aura was considered to be the cause of the lesion. To our knowledge the present case is the first report of a pediatric patient with a diagnosis of migraine with aura presenting with hemiparesis and encephalopathy. CONCLUSIONS: A diagnosis of transient lesion of the corpus callosum should be suspected in patients with migraine with aura presenting with hemiparesis and encephalopathy. A mild course and a good prognosis might be expected in the presence of a splenial lesion of the corpus callosum.

Gómez-López-Hernández Syndrome: A Rare Cause of Bilateral Nonscarring Alopecia.

Gómez-López-Hernández syndrome is a rare neurocutaneous disorder characterized by the triad of rhombencephalosynapsis, parietal alopecia, and trigeminal anesthesia. We report a 16-year-old girl with bilateral parietotemporal alopecia in whom cranial magnetic resonance imaging revealed rhombencephalosynapsis, suggesting a diagnosis of Gómez-López-Hernández syndrome. Neurologic examination and neuroimaging may be warranted in select patients with parietal alopecia to exclude this uncommon entity.

Coexistence of aplasia cutis and nevus psiloliparus--report of a novel case.

Nevus psiloliparus is a type of mesodermal nevus of the scalp classically seen with encephalocraniocutaneous lipomatosis. The close association between nevus psiloliparus and aplasia cutis congenita is called didymosis aplasticopsilolipara. Although typically associated with neurologic, ocular, and skeletal findings, didymosis aplasticopsilolipara can be seen without the context of encephalocraniocutaneous lipomatosis.

The short appendix vermiformis as a risk factor for colorectal cancer.

The human appendix vermiformis is regarded as an evolutionarily vestigial organ, although it has presumptive immune system functions and appears to support beneficial bacterial gut flora, both of which could influence cancer progression. A review of the comparative anatomy of the mammalian appendix reveals a significantly longer appendix in herbivores than in carnivorous animals. The lengthier appendix vermiformis in herbivores has been associated with the presence of cellulose-digesting bacteria that colonize the structure. In light of recent studies that have reported the digestion of small amounts of cellulose in humans and the preventive effects of a vegetarian diet on colon cancer, we conducted a retrospective study of abdominal CT scans of 60 colon cancer patients and 60 healthy people to investigate a possible relationship between colon cancer and appendix vermiformis length. The mean length of the appendix in cancer patients [65.178 mm ± 13.46 (SD)] was shorter than that in the healthy control group [101.99 mm ± 16.58 (SD)] and the difference was statistically significant (P < 0.001). Statistical analysis demonstrated that the ages of the cancer patient group and the control group did not differ significantly (P = 0.534). The results of the present study indicate that the appendix is not merely a vestigial structure or regressed lymphoid tissue, but rather an organ that could be critical in the development of colon cancer, whether as a result of congenital or acquired appendicular factors.

Six Years Follow-Up of an 11-Year-Old Girl with Anti-HMGCR Myopathy.

Anti-HMGCR myopathy is decribed as an immune-mediated necrotizing myopathy which is characterised by subacute, progressive proximal muscle weakness and elevated creatine kinase (CK) level. In pediatric population, anti-HMGCR myopathy has been reported solely as small case reports, albeit rare. Although treatment consensus has not yet been established, proper treatment with several immunomodulators to include IVIg can show remarkable improvement. We report an 11-year-old-girl diagnosed with anti-HMGCR myopathy with 6 years of follow-up.

Microsurgical management of midbrain gliomas: surgical results and long-term outcome in a large, single-surgeon, consecutive series.

OBJECTIVE: The authors report on a large, consecutive, single-surgeon series of patients undergoing microsurgical removal of midbrain gliomas. Emphasis is put on surgical indications, technique, and results as well as long-term oncological follow-up. METHODS: A retrospective analysis was performed of prospectively collected data from a consecutive series of patients undergoing microneurosurgery for midbrain gliomas from March 2006 through June 2022 at the authors' institution. According to the growth pattern and location of the lesion in the midbrain (tegmentum, central mesencephalic structures, and tectum), one of the following approaches was chosen: transsylvian (TS), extreme anterior interhemispheric transcallosal (eAIT), posterior interhemispheric transtentorial subsplenial (PITS), paramedian supracerebellar transtentorial (PST), perimedian supracerebellar (PeS), perimedian contralateral supracerebellar (PeCS), and transuvulotonsillar fissure (TUTF). Clinical and radiological data were gathered according to a standard protocol and reported according to common descriptive statistics. The main outcomes were rate of gross-total resection; extent of resection; occurrence of any complications; variation in Karnofsky Performance Status score at discharge, 3 months, and last follow-up; progression-free survival (PFS); and overall survival (OS). RESULTS: Fifty-four patients (28 of them pediatric) met the inclusion criteria (6 with high-grade and 48 with low-grade gliomas [LGGs]). Twenty-two tumors were in the tegmentum, 7 in the central mesencephalic structures, and 25 in the tectum. In no instance did the glioma originate in the cerebral peduncle. TS was performed in 2 patients, eAIT in 6, PITS in 23, PST in 16, PeS in 4, PeCS in 1, and TUTF in 2 patients. Gross-total resection was achieved in 39 patients (72%). The average extent of resection was 98.0% (median 100%, range 82%-100%). There were no deaths due to surgery. Nine patients experienced transient and 2 patients experienced permanent new neurological deficits. At a mean follow-up of 72 months (median 62, range 3-193 months), 49 of the 54 patients were still alive. All patients with LGGs (48/54) were alive with no decrease in their KPS score, whereas 42 showed improvement compared with their preoperative status. CONCLUSIONS: Microneurosurgical removal of midbrain gliomas is feasible with good surgical results and long-term clinical outcomes, particularly in patients with LGGs. As such, microneurosurgery should be considered as the first therapeutic option. Adequate microsurgical technique and anesthesiological management, along with an accurate preoperative understanding of the tumor's exact topographic origin and growth pattern, is crucial for a good surgical outcome.

Pentoxifylline and Vitamin E Can Restrict Radiation Necrosis via Vascular Pathways, Experimental Study in an Animal Model.

OBJECTIVE: Radiation necrosis (RN) is a long-term side effect of Gamma Knife stereotactic radiosurgery that may require surgical intervention. Pentoxifylline and vitamin E have previously been shown to be effective in the treatment of RN in the published literature, but there are no data on the prophylactic use of these molecules or, more importantly, whether prophylaxis is required. METHODS: The iatrogenic RN model included 50 Sprague-Dawley rats of both sexes. There were 7 treatment subgroups established. Gamma-Plan 8.32 was used to plan after magnetic resonance scans were performed in a specially designed frame. The injection doses used in the treatment groups were vitamin E (30 mg/kg/day in a single dose) and pentoxifylline (50 mg/kg/day in 2 doses). Control magnetic resonance scans were performed at the end of a 16-week treatment, and the subjects were decapitated for pathological evaluations. RESULTS: The intensity of hypoxia - inducible factor 1α immunoreactivity is statistically significantly lower in the therapeutic vitamin E, prophylactic pentoxifylline and vitamin E, and therapeutic pentoxifylline and vitamin E groups than in the other groups. Similarly, the intensity of vascular endothelial growth factor immunoreactivity was reduced in the therapeutic vitamin E and prophylactic pentoxifylline and vitamin E treatment modality groups. When compared with other groups, the therapeutic pentoxifylline group had significantly fewer vascular endothelial growth factor-immunoreactive cells in the perinecrotic area, with an accompanying decreased contrast enhancement pattern. CONCLUSIONS: Both vitamin E and pentoxifylline are effective for the treatment and/or restriction of RN, either alone or in combination. The use of these molecules as a preventive measure did not outperform the therapeutic treatment.

Microsurgical and fiber tract anatomy of the interthalamic adhesion.

OBJECTIVE: The authors of this study aimed to define the microanatomy of the interthalamic adhesion (ITA) using microfiber dissection, magnetic resonance (MR) tractography, and histological analysis. METHODS: Sagittal, coronal, and axial MR images from 160 healthy individuals 2-82 years of age were examined. The relationships between age range and ITA morphology as well as between gender and ITA morphology were evaluated statistically. Among these 160 individuals, 100 who had undergone MR tractography were examined. In this group, the presence of fiber tracts in the ITA and the relationship with ITA morphological types were examined. Thirty formalin-fixed human cadaveric brains were also examined endoscopically, and 6 hemispheres were dissected from the medial to lateral and superior to inferior directions under the microscope. Sections taken from one of the brains with an ITA type 2 with both thalami were examined histologically. Anti-neurofilament antibody was used in the histological examination. RESULTS: Four morphological types of ITA were observed. Type 1 had an adhesion/adherent appearance, type 2 had a bridge/commissure appearance, type 3 showed no adhesion, and type 4 had a double bridge. Tractographic examination revealed that 28% had no fiber tract transition in the ITA, 21% had a significant transition, and 51% had an indistinct transition. Statistically, the presence of the ITA was significantly higher in the pediatric (age) and female (gender) groups. In specimens with ITAs of a bridge/commissure appearance (type 2), fiber tracts showed clear transitions between thalami. In type 1 (adherent/adhesive appearance), fiber tracts were observed within the ITA, but a reciprocal transition was unclear. Dissection showed that these fiber tracts in the ITA reach the nucleus accumbens, caudate nucleus, and frontoorbital region anteriorly and the lateral habenula and posterior commissure posteriorly. Some fibers also joined the ansa peduncularis. In histological studies, axonal fibers moving in the ITA were observed with anti-neurofilament antibody staining. CONCLUSIONS: This is the first study to demonstrate fiber tracts of the ITA through fiber dissection and transillumination techniques as well as radiological and histological study. Statistical data were obtained by comparing the morphological group with age and gender groups. The anatomy of this structure, which has been neglected for many years, was reexamined. This study showed that the ITA has fibers connecting different parts of the brain, in contrast to previous studies suggesting that it was a simple massa.

Presence of axial spondyloarthritis associated sacroiliitis and structural changes on MR enterography: A direct comparison with sacroiliac joint MRI.

INTRODUCTION: To investigate the acute inflammatory and structural changes of sacroiliitis as auxiliary findings on magnetic resonance enterography (MRE) and their presence on closely timed conventional magnetic resonance imaging of the sacroiliac joint (SI joint MRI). MATERIALS AND METHODS: We screened axial spondyloarthritis patients for the simultaneous presence of MREs and SI joint MRIs. Two blinded radiologists evaluated SI joint MRIs and MREs on two separate occasions. We used the Assessment of SpondyloArthritis International Society (ASAS)/Outcome Measures in Rheumatology Network (OMERACT) definitions for SI joint MRI. We implemented previously published standard definitions for osteitis, erosion, sclerosis, and fatty infiltration of SI joint in MREs that contain T1w and T1w post-gadolinium sequences. RESULTS: SI joint MRI and MRE images were present in 43 patients. The median time between the two modalities was 14 (0-89) days. Twelve patients had ASAS-defined positive SI joint MRI. Radiologist-1 and radiologist-2 detected osteitis on MRE in nine and eight out of these 12 patients, respectively. The two radiologists detected ankylosis and fatty metaplasia with a complete agreement and sclerosis with an almost perfect agreement. Both radiologists agreed on erosions on SI joint MRI in the same 10 cases. Radiologists did not identify acute inflammatory or structural changes on MRE in patients with a negative SI joint MRI for these lesions. CONCLUSION: Along with intestinal findings, additional reporting of acute inflammatory and structural changes of the SI joint on a MRE is valuable and may alert physicians to the presence of previously not diagnosed axial spondyloarthritis.

Neurodevelopmental Findings and Epilepsy in Malformations of Cortical Development.

AIM: The purpose of this study is to classify the malformations of cortical development in children according to the embryological formation, localization, and neurodevelopmental findings. Seizure/epilepsy and electrophysiological findings have also been compared. MATERIAL AND METHODS: Seventy-five children (age: 1 month-16.5 years; 56% male) followed with the diagnosis of malformation of cortical development, in Marmara University Pendik Research and Educational Hospital Department of Pediatric Neurology, were included in the study. Their epilepsy characteristics, electroencephalogram (EEG) findings, and prognosis were reported. Neurodevelopmental characteristics were evaluated by the Bayley Scales of Infant and Toddler Development (Bayley-III) for the ages of 0-42 months (n = 30); the Denver Developmental Screening Test-II (DDST-II) for ages 42 months-6 years (n = 11); and the Wechsler Intelligence Scales for Children (WISC-R), used for children 6 years and older (n = 34). RESULTS: The patients were classified as 44% premigrational (14.6% microcephaly, 24% tuberous sclerosis, 2.7% focal cortical dysplasia, 1.3% hemimegalencephaly, and 1.3% diffuse cortical dysgenesis); 17.3% migrational (14.6% lissencephaly, 2.7% heterotopia); and 38.6% postmigrational (14.6% schizencephaly, 24% polymicrogyria) developmentally. According to involved area, the classification was 34.7% hemispheric/multilobar, 33.3% diffuse, and 32% focal. Seventy-five percent of the patients had a history of epilepsy, and 92% were resistant to treatment. The seizures started before the age of 12 months in diffuse malformations, and epileptic encephalopathy was more common in microcephaly with a rate of 80% and lissencephaly with a rate of 54.5% in the first EEGs. Ninety-five percent of patients had at least one level of neurodevelopmental delay detected by DDST/Bayley-III; this was more common in patients with accompanying epilepsy (P < .05). As seen more commonly in patients with diffuse pathologies and intractable frequent seizures, mental retardation was detected by WISC-R in 64.5% of patients (P < .05). CONCLUSION: In cases with cortical developmental malformation, epilepsy/EEG features and neurodevelopmental prognosis can be predicted depending on the developmental process and type and extent of involvement. Patients should be followed up closely with EEG.

Acute flaccid myelitis outbreak through 2016-2018: A multicenter experience from Turkey.

AIM: We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis. METHODS: The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed. RESULTS: Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5-6.9 years). Most of the patients were admitted in 2018 (n = 27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3-7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n = 5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis. CONCLUSION: The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition.

Quantification of acromioclavicular reduction parameters after the Weaver-Dunn procedure.

BACKGROUND: The combination of the reconstruction of the coracoclavicular ligaments with the resection arthroplasty of the distal end of the clavicle is a commonly used technique in acromioclavicular separations. HYPOTHESIS: The purpose of the current study was to quantify the reduction parameters using 3-D CT and to analyze their effects on clinical outcomes. STUDY DESIGN: Case series. METHODS: The patients with chronic symptoms after acromioclavicular dislocation (type III) were treated with reconstruction of the coracoclavicular ligaments. The average follow-up was 69.5 months. The patient group consisted of 21 men and 8 women. The initial treatment at the time of injury was nonoperative in 26 of 29 patients. CT was used to document anteroposterior (APD), craniocaudal (CCD) and mediolateral (MLD) acromioclavicular reduction parameters. Constant Shoulder scoring system was used. RESULTS: The mean preoperative Constant score was 56.62 +/- 18.63 points while the postoperative score was 89.93 +/- 10.79 points. The mean APD was 9.2 mm, the mean CCD was 1.1 mm and the mean MLD was 8.4 mm. There was no correlation between the APD, MLD and the Constant Scores. However, an inverse correlation between the CCD and the postoperative Constant Scores was found. CONCLUSIONS: CCD plays an important role on the postoperative function. If the CCD is larger, the Constant score is lower. CLINICAL RELEVANCE: The reduction loss is a distinctive parameter of the functional outcome, even when the reconstructed coracoclavicular ligament is intact. Secure fixation may be achieved with techniques preserving CCD.

The clinical utility of 99mTc-HMPAO SPECT in Fahr's disease.

Fahr's disease is a rare neurodegenerative syndrome, characterized by massive symmetrical intracerebral calcifications of the basal ganglia, dentate nuclei of the cerebellum, and the adjacent parenchyma. Computerized tomography (CT) is considerably more sensitive to detect these intracranial calcifications than other imaging modalities. The clinical, CT scan, and 99(m)Tc-D,L-hexamethylpropylene amine oxime (99(m)Tc-HMPAO) brain perfusion single-photon emission computerized tomography (SPECT) findings in a 42-year-old woman with Fahr's disease are reported, and the clinical utility of 99(m)Tc-HMPAO SPECT findings in Fahr's disease is discussed in this article. In conclusion, 99(m)Tc-HMPAO brain perfusion SPECT seems to be useful in the clinical approach to Fahr's disease, and may provide more specific and clinically relevant information when compared with anatomical imaging.

Neuroimaging and clinical findings in a case of linear scleroderma en coup de sabre.

Linear scleroderma "en coup de sabre" is a subset of localized scleroderma with band-like sclerotic lesions typically involving the frontoparietal regions of the scalp. En coup de sabre and Parry-Romberg syndrome are variants of linear morphea on the head and neck that can be associated with neurologic manifestations. On imaging, patients may have lesions in the cerebrum ipsilateral to the scalp abnormality. We present a case of an 8-year-old girl with a left frontoparietal "en coup de sabre" scalp lesion and describe the neuroimaging findings of frontoparietal white matter lesion discovered incidentally on routine magnetic resonance imaging. The patient had no neurologic symptoms given the lesion identified.

Risk of hemorrhage in ischemic stroke and its relationship with cerebral microbleeds.

OBJECTIVES: Stroke is an important public health problem in most countries. Therefore, the treatment of stroke and its complications is important. Intracerebral hemorrhage is one of the complications of ischemic stroke. This study aimed to investigate the risk of hemorrhage in patients with acute ischemic stroke and prospectively study its relationship with cerebral microbleeds (MBs) using susceptibility-weighted imaging (SWI) that is a magnetic resonance imaging (MRI) sequence. PATIENTS AND METHODS: Patients with acute ischemic stroke were included. Those who underwent treatment with tissue plasminogen activator were excluded. The patients were analyzed according to their risk factors for stroke and their relationship with intracerebral hemorrhage. RESULTS: A total of 148 patients were included. Of these, 41 (28%) had hemorrhages in the ischemic area. The mean waist circumferences, left atrium diameter, and heart rate in these patients were higher than those in patients without hemorrhage. MBs were detected in 66 patients (44.6%) using SWI, and there was no significant relationship with the presence of hemorrhage. Intracerebral hemorrhages were significantly associated with the volume and localization of infarcts. CONCLUSION: Intracerebral hemorrhage in patients with acute ischemic stroke within the first 7 days after stroke onset was related to their waist circumference as well as the volume and localization of the infarct. However, there was no relationship found between the risk of hemorrhage and MBs using SWI.

The effectiveness of ultrasonography and ultrasonographic elastography in the diagnosis of carpal tunnel syndrome and evaluation of treatment response after steroid injection.

PURPOSE: To evaluate if there is a place for ultrasonography (US) and ultrasonographic elastography (UE) in the diagnosis and follow up of carpal tunnel syndrome treatment. MATERIALS AND METHODS: The study was performed on 25 patients (study group) and 17 healthy volunteers (control group). Measured US and UE criteria were median nerve area (MNA), proximal median nerve area (pMNA), difference between MNA and pMNA (dMNA) and strain values of carpal tunnel content (CTC) and median nerve (MN). Patients in the study group were also evaluated using the Boston questionnaire, Visual Analogue Scale (VAS) and nerve conduction studies. Thirty-three wrists in 23 patients received steroid injections on the same day. Patients were re-evaluated 6 weeks after steroid injection. To establish a cut off value for MNA, ROC Curve analysis was used. RESULTS: Mean MNA and dMNA values in the control group were significantly lower than in the study group (7.33 ± 1.31 vs. 15.44 ± 5.10; p=<0.05 and 1.58 ± 0.75 vs. 8.91 ± 4.93; p = 0.00 respectively). Median nerve and CTC strain indices were significantly higher in the control group (p = 0.00 and p = 0.036). Decrease in MNA and dMNA values after treatment was meaningful (p = 0.00). While there was no significant change in MN elasticity, mean CTC strain index of the study group (4.680 ± 1.664) decreased significantly after treatment (3.621 ± 1.054 p = 0.002). This decrease in the CTC index was more pronounced in patients who benefited from treatment (p = 0.001). CONCLUSION: US and UE can be useful in the diagnosis of CTS and its response to treatment, if used together with clinical and electroneurophysiological tests.