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Purpose The aim of this study is to evaluate the effect of noise produced by magnetic resonance imaging (MRI) device on hearing by using objective and subjective audiological assessments. Methods A total of 38 patients between the ages of 18 and 50 without hearing loss, and had performed MRI for brain, head, neck or cervical imaging were included in this prospective clinical study. Pure tone audiometry, speech audiometry, high frequency audiometry, transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emission (DPOAE) were performed before and after MRI. Results There was no statistically significant difference in TEOAE, pure tone audiogram, high frequency audiogram and speech audiogram thresholds. In DPOAE, the median value before and after MRI at the frequency of the left ear at 4.0 kHz was 13.6 (8.5–19.9) and 15.7 (8.9–20.7) SNR respectively (p > .05). The median value before MRI at the right ear 4.0 kHz frequency was 14.1 (9.1–20.5) SNR, whereas the median value after MRI was 13.2 (8.8–19.8 SNR (p = 0,03). There was no statistically significant difference in other frequencies in DPOAE. Conclusions This is the first objective study that examines the MRI noise on speech audiometry and otoacoustic emission together. However, the effect of MRI noise on hearing pathway is still doubt. Based on the difference at 4 kHz frequency on DPOAE; on-earphones may not sufficiently protect the patients from the MRI noise and this issue should deserve further research.

Objective: Urinary neutrophil gelatinase associated lipocalin (NGAL) is among novel markers assessed for early diagnosis of acute kidney injury. The effect of gadolinium-based con - trast media on urinary NGAL concentrations has not been studied before. The aim of our study was to compare the effect of iodinated contrast agents and gadolinium-based contrast media on renal function and on urinary NGAL levels in patients with normal renal function. Material and Methods: The study group consisted of 4 0 patients. They were selected among patients who would undergo computerized tomography (CT) (n=20) or magnetic resonance imaging (MRI) (n = 20) scan. Patients with diabetes, malignancy or infection were excluded. Blood samples were drawn before, and 2 and 48 h after the procedure. Urine samples were collected before and 2 h after the proce - dure for NGAL measurements. Levels of urinary NGAL and blood creatinine before and after the procedure were compared. Results: Urinary NGAL levels did not significantly change 2 h after the procedure compared to baseline value at CT (29 (4.1 - 499) vs. 26.7 (1 - 113) ng/ml, p=0.100) and at MRI (16 (6.7 - 169) vs. 15.7 (3.5- 112) ng/ml, p=0.313). Although creatinine levels at 48 h were higher compared to baseline levels, they did not increase up to 50% in the CT group. The serum cre - atinine did not change at any time point in the MRI group. Conclusion: Gadolinium or iodinated contrast agents did not significantly change urinary NGAL levels when used intravenously in pa - tients with normal renal function.

Spontaneous intracranial hypotension is characterized by postural headache that is generally associated with neck and/or back pain, radicular symptoms, nausea, and vomiting, and can sometimes be accompanied by cranial nerve symptoms. Although ocular manifestations are common, visual impairment due to optic nerve involvement is not commonly reported. Here, we report a case of a 34-year-old woman with postural headache and visual loss in the left eye associated with spontaneous intracranial hypotension. The orbital magnetic resonance imaging revealed increased intensity on T2-weighted images and on the pathologic contrast enhancement of the left optic nerve. Radionuclide cisternography showed bilateral cerebrospinal fluid leakage at the top of the thoracic region. To our knowledge, this is the first report documenting an association between optic neuropathy and spontaneous intracranial hypotension.

STUDY DESIGN Ligamentum flavum (LF) thickness was measured by using lumbar magnetic resonance imaging in patients with low back or leg pain. OBJECTIVE This study investigated whether LF thickening is due to hypertrophy or buckling related to disc degeneration and examined the correlations between the thickness of the LF and age, sex, body mass index (BMI), degree of pain, lumbar spinal stenosis (LSS), and disc herniation. SUMMARY OF BACKGROUND DATA "LF thickness" and "LF hypertrophy" are used interchangeably in the literature, although they are not necessarily the same thing. Thickness may increase by buckling without a change in the mass of the LF, and whether LF thickening is due to tissue hypertrophy or buckling remains controversial. METHODS The thickness of 896 LFs at the L2-L3, L3-L4, L4-L5, and L5-S1 levels of 224 (mean age, 47.8 ± 16.7 yrs) patients was measured prospectively on axial T1-weighed magnetic resonance images, obtained at the facet joint level. The presence of disc degeneration, spinal stenosis, and disc herniation was evaluated. RESULTS At all of the levels investigated, LF thickness was significantly greater in patients with grades IV to V degeneration compared with the patients with grades I to III degeneration (P < 0.05). LF thickness at all levels increased significantly with age (P < 0.05). Sex and the degree of pain were not correlated with the thickness of the LF. Patients with a BMI of 25 kg/m or greater had the thickest LF at the L3-L4 level (P < 0.01). LF thickness was significantly greater at the L2-L3, L3-L4, and L4-L5 levels in subjects with LSS and significantly greater at all levels in subjects with disc herniation (P < 0.05). CONCLUSION Thickening of the LF is correlated with disc degeneration, aging, BMI, LSS, spinal level, and disc herniation. The authors concluded that thickening of the LF is due to buckling of the LF into the spinal canal secondary to disc degeneration more than to LF hypertrophy. Sex and the degree of pain were not correlated with the thickness of the LF.

Background/aims: Spontaneous intestinal hematoma is a rare complication of anticoagulant therapy, and small bowel obstruction caused by intramural hematoma secondary to anticoagulant therapy is even rarer. The first symptom is usually abdominal pain, frequently accompanied by nausea and vomiting. A history of anticoagulant use with prolonged international normalized ratios in patients presenting with abdominal pain should alert physicians to search for this entity. Typical findings on abdominal computed tomography yield the diagnosis. Early diagnosis is crucial because most patients are treated non-operatively with a good outcome. Herein, we present the non-enhanced and enhanced computed tomography findings of two cases who were admitted to the emergency clinic with acute abdominal pain and diagnosed as spontaneous intramural ileal hematomas and partial small bowel obstruction secondary to intramural ileal hemorrhage.

Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors.We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECASor =50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal,50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal oror =25%, 25-49%, andor =50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded.ECAS70% in 42 patients and ECASor =70% in 141 patients. ICAS was found in 51 patients and ICASor =50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS.We found ICAS in 27.8% of the patients with ECAS50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

We report the results of a retrospective analysis of radiological and clinical findings in 45 cases of midbrain-hindbrain anomalies and review recent advances in embryology and molecular neurogenetics. Among 45 patients with midbrain-hindbrain malformations, 16 cases of molar tooth malformation, 12 of cerebellar hypoplasia, ten of posterior fossa cyst and cerebellar vermian hypoplasia, three of rhombencephalosynapsis, two of Fukuyama congenital muscular dystrophy and two cases of isolated cerebellar dysplasia were identified. Twenty-six patients presented with motor-mental retardation, which was the most common clinical finding. Eleven patients were born to consanguineous parents. The correct diagnosis of cerebellar malformation is important for determining prognosis, the risk of recurrence and the need for genetic counselling. Integrated classification of malformations based on morphology, embryology and molecular neurogenetics may be useful.

Summary Objective To determine if any difference exists between a set of nasal dimension measurements in choanal atresia patients and in a control group. Methods A retrospective study was undertaken to define the variation of values for a series of nasal dimension measurements through axial computed tomography in 9 patients with bilateral choanal atresia and compare the same dimensions with a control group 104 patients of similar gender and age distribution. The statistical significance of the differences in these dimensions was examined. Results Nine of 17 variables showed a significant difference between normal and choanal atresia group. The result showed that the growth of the nasal complex can be influenced by nasal obstruction. Conclusion These findings might serve in understanding the differential growth patterns of nasal structures in the face of the nasal breathing obstruction. Computed tomography is valuable in defining the exact anatomical extent of the disease and also in preoperative evaluation of the patient.

Idiopathic ventral spinal cord herniation is a rare cause of progressive myelopathy that demonstrates unique radiological features. We describe a case of thoracic spinal cord herniation through an anterior dural defect and discuss the characteristic findings on magnetic resonance imaging and computed tomographic myelography. A 36-year-old man presented to our clinic with progressive leg weakness and spasticity in both legs. Magnetic resonance imaging of the thoracic spinal canal demonstrated C-shaped anterior kinking of an atrophied spinal cord and enlarged dorsal subarachnoid space at the T5-T6 level. Computed tomographic myelography showed ventral herniation of the spinal cord and no evidence of an intradural spinal arachnoid cyst. Ventral spinal cord herniation is a commonly misdiagnosed entity. Knowledge of the characteristic imaging appearance of this treatable condition is important for proper diagnosis and treatment.

Background/aim: The aim of this study was to evaluate perfusion computed tomography (PCT) findings in patients with Alzheimer disease and to compare them with those of patients without dementia. Materials and methods: PCT was performed in 35 patients: 20 with Alzheimer disease (mean age, 69.7 +/- 5.5 years) and 15 control subjects (mean age, 67.5 +/- 3.5 years). Control subjects were elderly individuals with no cognitive problems who were admitted with headaches. All PCT examinations were performed on a 4-slice CT unit. The PCT analysis software program was used to calculate regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), regional time-to-peak (rTTP) values in the bilateral frontal, temporal, and occipital cortices, and bilateral lentiform nucleus. Results: rCBF values in the bilateral frontal and temporal cortices and bilateral lentiform nucleus were significantly lower in the patients with Alzheimer disease than in the control subjects. There were no significant differences in rCBV values between Alzheimer disease and the control group. rTTP values in all cortical areas and bilateral lentiform nucleus were significantly higher in the patients with Alzheimer disease than in the control subjects. Conclusion: PCT is a rapid and reliable imaging modality for evaluating brain perfusion in Alzheimer disease.

Spondylolisthesis is the forward displacement of a lumbar vertebra relative to the adjacent vertebra, occurs as result degeneration or surgery and is a special type of lumbar instability. There is no consensus about which radiologic modality or findings truly reflect the lumbar instability and the exact incidence after single level disk surgery is unknown.In this prospective study, we have included 90 patients who were operated by the same surgeon with single level disk herniation. We aimed at evaluating the post-operative lumbar spondylolisthesis, with flexion and extension lateral radiographs in addition to standard magnetic resonance imaging (MRI).We have seen spondylolisthesis in six of 90 cases with standing lateral flexion-extension radiographs, which were undefinable with MRI. Pain intensity and functional-economic rating scale (Prolo scale) were unremarkable.We have concluded that standing flexion-extension radiographs should be routinely combined in patients with failed back surgery syndrome and even if lumbar instability is clinically suspected, especially when conventional MR examination is normal. When the MR examination showed spondylolisthesis, standing flexion-extension radiographs could not give additional information.

Although nervous system involvement is common in thrombotic thrombocytopenic purpura ( TTP), abnormalities on computerized tomography, magnetic resonance imaging and electroencephalography are not encountered so frequently and if present, these abnormalities are often reversible. We describe a 39-year-old woman with recurring transient focal neurological findings found to have laboratory findings consistent with TTP. In cerebral diffusion weighted images ( DWI), diffuse cortical hyperintensity was noted in right frontal lobe, but the ADC (apparent diffusion coefficient) map was normal. Electroencephalography demonstrated lateralized slowing and repeated DWI showed diffuse cortical hyperintensity in the right hemisphere. SPECT showed luxury perfusion in the right hemisphere areas. The patient's condition resolved with plasmapheresis. Our patient illustrates that diffuse hemispheric involvement can be seen in DWI and EEG, and SPECT may show luxury perfusion after resolution of neurological findings in TTP cases. To our knowledge, this is the first TTP case in which the ADC map was normal.

The objective of this study was to present the etiology, clinical presentation, diagnosis, and management for 14 cases of gossypiboma [retained surgical sponge (RSS)] treated at a single center and to emphasize the importance of this potential complication. Data for 14 cases of RSS treated between January 1999 and December 2004 were retrospectively assessed. The details of preoperative evaluation, demographic features, and operative findings were recorded. Use of, and findings from, abdominal x-ray, ultrasonography, computed tomography, magnetic resonance imaging, and upper-gastrointestinal endoscopy were also noted. In all cases, the RSS was surgically removed. Thirteen of the 14 patients were symptomatic, and the most frequent finding was nonspecific abdominal pain and intestinal obstruction. Four patients required urgent surgery because the sponges were causing intestinal obstruction or intraabdominal sepsis. Based on history, physical examination findings, and diagnostic imaging, RSS was diagnosed preoperatively in five of the patients. Postoperative complications, including surgical site infection and evisceration, occurred in five cases. RSS can lead to significant medical and legal problems between the patient and the doctor. RSS may be incorrectly diagnosed preoperatively, which can lead to unnecessary invasive diagnostic procedures and operations. Strict measures must be taken to prevent this complication.

Objective : To evaluate the technical success and immediate complication rates of temporary internal jugular vein (IJV) haemodialysis catheter placement in normal and high-risk patients. Methods and materials: Two-hundred and twenty temporary internal jugular vein catheters inserted under ultrasound guidance in 172 patients were prospectively analyzed. Of 172 patients, 93 (54%) were males and 79 (46%) were females (age range, 18–83; mean, 56.0 years). Of 220 catheters, 171 (78%) were placed in patients who had a risk factor for catheter placement like patients with disorder of haemostasis, poor compliance, and previous multiple catheter insertion in the same IJV. Forty-seven (21.3%) procedures were performed on bed-side. A catheter was inserted in the right IJV in 178 procedures (80.9%) and left IJV in 42 procedures. Of 172 patients, 112 (65%) had only one catheter placement and the rest had had more than one catheter placement (range, 1–5). Results: Technical success was achieved in all patients (100%). Average number of puncture was 1.24 (range, 1–3). One hundred and eighty-three insertions (83.1%) were single-wall punctures, whereas 37 punctures were double wall punctures. Nine (4%) minor complications were encountered. Inadvertent carotid artery puncture without a sequel in four procedures (1.8%), oozing of blood around the catheter in three procedures (1.4%), a small hematoma in one procedure (0.4%), and puncture through the pleura in one procedure (0.4%) without development of pneumothorax. Oozing of blood was seen only in patients with disorder of haemostasis. Conclusion: Ultrasound-guided placement of internal jugular vein catheters is very safe with very high success rate and few complications. It can safely be performed in high-risk patients, like patients with disorders of haemostasis and patients with previous multiple catheter insertion in the same vein.

To determine the incidence of abnormal hepatic vein Doppler waveform in patients with diffuse fatty infiltration of the liver (FIL).In this prospective study, 40 patients with diffuse FIL and 50 normal healthy adults who served as control group underwent hepatic vein (HV) Doppler ultrasonography. The patients with the diagnosis of FIL were 23 men (57.5%) and 17 women aged 30-62 years (mean age +/- S.D., 42 +/- 12 years). Subjects in the control group were 27 men (54%) and 23 women aged 34-65 years (mean age +/- S.D., 45 +/- 14 years). The diagnosis of FIL was confirmed with computed tomography density measurements. The waveforms of HV were classified into three groups: regular triphasic waveform, biphasic waveform without a reverse flow, and monophasic or flat waveform. Etiological factors for FIL were diabetes mellitus (DM), hyperlipidemia and obesity (body mass index25). Serum lipid profile was obtained from all the patients with FIL.Seventeen of the 40 patients (43%) with FIL had an abnormal HV Doppler waveform, whereas only one of the 50 (2%) healthy subjects had an abnormal waveform. The difference in the distribution of normal Doppler waveform pattern between the patients and the control group was significant (P0.001). No differences were found in the behaviour of the hepatic vein Doppler waveform in relation to the different etiologic factors for FIL (P0.05). There was not any correlation between the degree of fat infiltration and the hepatic vein waveform pattern (P = 0.60).Patients with fatty liver has a high rate of an abnormal hepatic vein Doppler waveform pattern which can be biphasic or monophasic. We could not find a relation between the etiological factors for FIL and the occurrence of an abnormal HV Doppler waveform.

To determine the incidence of pericatheter sleeve formation, thrombus formation, and stenosis of the central veins in hemodialysis patients with temporary catheters.In this prospective study, 57 patients (40 males, 17 females) with temporary dialysis catheters had catheter venography by pulling back the catheter just before removal. Patient's age range was 25-87 years (mean age, 51 years). The venographic studies were evaluated for pericatheter sleeve formation, thrombus formation, and stenosis of the brachiocephalic vein (BCV) and the superior vena cava (SVC). The IJV could only be evaluated if there was adequate filling during contrast administration. In a subgroup of patients who had had only right IJV or only right SCV catheters, impact of these catheters on the central veins was compared.The catheter location was right internal jugular vein (IJV) in 26 cases, right subclavian vein (SCV) in 27 cases, left IJV in 1 case, and left SCV in 3 cases. Thirty-two patients (56%) had had only one temporary catheter and the rest had had more than one inserted. The mean dwell time for the catheters was 21 days (range 7-59 days). A pericatheter sleeve was detected on venography in 32 (56%) patients and thrombus formation was noted in 16 patients (28%). A total of 41 patients (72%) exhibited pericatheter sleeve and/or thrombus formation. While 19 of the 32 patients (59%) without previous catheterization had a sleeve around the catheter, only 13 (52%) of 25 patients who had had multiple catheters inserted had a sleeve (P0.005). Of the eight patients (14%) with BCV stenosis, two had50% stenosis. Only one patient (2%) had mild stenosis of the SVC. Three patients out of 15 (20%) who had diagnostic venography for the IJV had severe stenosis of the vein. Pericatheter sleeve formation was more frequent in women (P0.005). However, there were no statistical differences with respect to pericatheter sleeve formation, luminal filling defect and BCV stenosis when patients were grouped according to age, dwell time of the catheter, number of catheters inserted, and diameter of the SVC. Forty-two of the fifty-seven patients had had only right IJV (n =16) or right SCV (n = 26) catheters. There were no differences between these groups with respect to rates of pericatheter sleeve formation, thrombus formation, or BCV stenosis.This study showed that even short-term catheters result in significantly high rates of pericatheter sleeve and thrombus formation which are two of the important causes of catheter malfunction. The IJV route is known to be much safer than the SCV route with respect to stenosis formation in the vein in which the catheter is inserted; however, the result showed no differences between the two routes with respect to frequencies of pericatheter sleeve formation, thrombus formation, and BCV stenosis. These findings remind us again that we should avoid unnecessary catheter insertion even for short-term in these chronically ill patients.

Objective. Color Doppler ultrasonography is the most widespread diagnostic procedure in obstructive disease of the arteries supplying the brain. To our knowledge, there are only a few correlative color Doppler ultrasonographic and angiographic studies of the vertebral arteries, especially in patients who have flow-restrictive stenosis at the carotid bifurcation. The main purpose of this prospective study was to evaluate diameter, flow volume, and time-averaged mean velocities of angiographically verified normal vertebral arteries without collateral flow. The second purpose was to try to establish a threshold value for the flow volume of the vertebral artery. Methods. One hundred twenty patients referred for carotid angiography with a normal vertebrobasilar system and with no patent posterior communicating arteries were investigated with color Doppler ultrasonography. Luminal diameter, time-averaged mean velocity, peak systolic velocity, and flow volume values were calculated for each patient. The parameters were compared between sexes, in different age groups, in patients with carotid stenosis of 50% or less and greater than 50%, and in patients who had clinical signs of vertebrobasilar insufficiency versus those who had not. Results. We have found no significant difference in evaluated parameters with the degree of associated carotid stenosis or vertebrobasilar insufficiency. Diameter and flow volume values on the left side were higher than on the right side. Conclusions. We found similar flow volume values of vertebral arteries in both sexes and both groups of patients with carotid stenosis of 50% or less and greater than 50%. All parameters did not differ in patients with stenosis of 50% or less and greater than 50% and in patients with and without clinical signs of vertebrobasilar insufficiency.

Skull metastases of thyroid cancer is very rare. Follicular cancer is the second most common form of thyroid cancer and hematogenous spread to distant sites predominates in follicular cancer. Metastatic skull tumors from follicular thyroid carcinoma are hyperdense on CT when compared with brain parenchyma and show intense enhancement. They are osteolytic in nature, and hemispheric in shape. MR findings of skull metastases from follicular thyroid carcinoma have not been specifically described in the literature. In this report, we have described CT and MRI findings of solitary skull metastasis from follicular thyroid carcinoma in a 75-year-old woman.

We present the case of an 8-month-old infant who was admitted to our Neurosurgery Department with venous infarction related to sagittal sinus thrombosis. The infarction was radiologically detected 5 days after the baby had undergone surgery for acute subdural hematoma due to a closed head injury. Cerebrovascular venous thrombosis is a rare clinical entity that has multiple causes and variable presenting symptoms. There is no consensus on overall strategy concerning surgical, radiosurgical, or medical therapy (anti-coagulation, thrombolytic, and anti-edema treatment), and exactly how, when, or in which cases these should be applied. The treatment planning should be based on clinical findings, and should be modified according to the clinical course. In this case, the clinical and radiological findings regressed with symptomatic treatment alone.

Scalp layers are widely used in reconstructive procedures. The authors used prefabricated galeal flaps based on the superficial temporal or postauricular vessels for ear, cheek, mandible, and cranium reconstructions in three cases. In case 1, synchronous beard and ear reconstructions were accomplished by using the temporoparietal and retroauricular flaps. In case 2, a buccomandibular defect was reconstructed by transposing the supra-auricular and retroauricular galea with prefabricated bone and skin. In case 3, an epidural hematoma in the left frontoparietal area was evacuated after a circular craniectomy. The harvested bone was not put back on the defect area but buried between the periosteal and galeal layers because of brain edema. These layers were raised as an osteogaleoperiosteal flap and transposed onto the defect area after 7 weeks. When used with a prefabrication method, scalp layers offer versatile options for repairing composite defects of the head region. A galeal flap based on the posterior auricular vessels is practical and reliable in reconstructive procedures. The authors suggest that this flap is an option in cases in which the temporoparietal fascia artery or the superficial temporal artery is not available. Prefabrication of the harvested cranial bone inside the adjacent tissues offers several advantages in that a viable bone is provided at the end of the procedure, intervention at a distant area is avoided, the graft is placed on osteogenic tissue (periosteum) that is also transposed onto the defect, and sophisticated procedures such as microsurgical techniques are not needed.

Spontaneous intracranial hypotension is an important cause of new daily persistent headaches in young and middle-aged individuals. The diagnosis is made based on low cerebrospinal fluid pressure with characteristic findings upon brain and spinal magnetic resonance imaging (MRI). We present the case of a 15-year-old boy with spontaneous intracranial hypotension. Although his brain MRI was normal, his lumbar spinal MRI showed clustering of the nerve roots characteristic of arachnoiditis. Radionuclide cisternography revealed an epidural leak, which was treated with an epidural blood patch. The patient reached a near-full recovery within 24 h, and the lumbar spinal MRI findings mimicking arachnoiditis disappeared.

Retained surgical foreign objects (RFO) include surgical sponges, instruments, tools or devices that are left behind following a surgical procedure unintentionally. It can cause serious morbidity as well as even mortality. It is frequently misdiagnosed. It should be considered in the differential diagnosis of any postoperative case with unresolved or unusual problems. Risk factors for RFOs include emergency procedures, unplanned change in operation, and body mass index and are clarified as being more frequent approximately 1 in 700 emergent cases. Although human errors cannot be completely prevented, medical training and consistency to rules seem to reduce the incidence to a minimum. It is a legal issue and potentially dangerous medical error. The definition, types, incidence, risk factors, complications and prevention strategies from RFOs are reviewed, from the comprehensive series until the year 2014.

End-stage renal disease patients who have been on long-term hemodialysis tend to develop central nervous system complications. The most common neurologic complications in this patient group include white matter changes, cerebral atrophy, osmotic demyelination syndrome, dialysis encephalopathy, hypertensive encephalopathy, intracranial hemorrhage, infarct, sinus thrombosis, and infection. Clinical evaluation of these patients is somehow complicated and MRI is important before establishment of the therapy. The purpose of this article is to illustrate the range of MRI findings of neurologic complications in end-stage renal failure patients on hemodialysis with etiologic factors.

Contrast agents are associated with a number of adverse effects, including central nervous system effects. These agents are primarily filtered and excreted by the kidney. Contrast-associated encephalopathy is a rare complication. We report the case of a 55-year-old male on chronic hemodialysis who developed confusion and agitation after receiving ioversol during abdominal angiography. Although hemodialysis was performed his healing took 15 days. Patients with end-stage renal disease may be at an increased risk of adverse effects of contrast agents.

Solid-pseudopapillary tumour of the pancreas is a rare benign or low-grade malignant epithelial tumour; its association with pancreatic dorsal agenesis has been reported only once before. We present the radiological and histological findings of a case of pancreatic solid-pseudopapillary tumour associated with total pancreatic dorsal agenesis. A 49-year-old woman presented with abdominal pain radiating to the back for several months. Radiological findings showed absence of the dorsal pancreas and an 8 cm x 6 cm diameter tumour arising from the head of the pancreas. She underwent successful complete resection of the tumour. Histopathology revealed a diagnosis of solid-pseudopapillary tumour.

Study design: A case report of intradural disc hernia mimicking an intradural extramedullary spinal tumor lesion in radiological evaluation. Objective: To describe a lumbar intradural disc herniation with atypical radiological appearance and point out the role of contrast magnetic resonance imaging (MRI) of the lumbar spine. Setting: Turkey. Case report: A 58-year-old man with suspected lumbar intradural mass and neurological involvement received L5 total laminectomy. L5 total laminectomy was performed, and on inspection dura was swollen and immobile. A longitudinal incision was made in the dura and an intradural-free disc fragment was removed. The patient's postoperative period was uneventful and he had full recovery in 3 months. Conclusions: Lumbar intradural disc rupture must be considered in the differential diagnosis of mass lesions causing nerve root or cauda equina syndromes. Contrast-enhanced MRI scans are useful to differentiate a herniated disc from a disc space infection or tumor. This case demonstrates the role and the importance of contrast MRI in the diagnosis of intradural disc herniation.

A 21-year-old woman was admitted with right hemiparesis, bilateral papilledema, negative myoclonus of right upper extremity, and bilateral pyramidal findings. An MRI showed no venous flow in the inferior sagittal sinus. Lipoprotein a (Lp [a]) level was high and iron deficiency anemia (IDA) was found. The coexistence of IDA and Lp (a) in patients with cerebral venous thrombosis is a very rare condition in adult patients. These risk factors should be investigated in patients with cerebral venous thrombosis.

Guillain-Barré syndrome is a relatively common, acute, and rapidly progressive, inflammatory demyelinating polyneuropathy. The diagnosis is usually established on the basis of symptoms and signs, aided by cerebrospinal fluid findings and electrophysiologic criteria. Previously, radiologic examinations have been used only to rule out other spinal abnormalities. We report a case of systemic lupus erythematosus associated with Guillain-Barré syndrome with marked enhancement of nerve roots of the conus medullaris and cauda equina on MR imaging. These MR observations may help confirm the diagnosis of Guillain-Barré syndrome.

Metastatic pulmonary calcification characterized by diffuse calcium deposition in the lungs is known to occur in patients with chronic renal failure. We present a case of a 47-year-old man with chronic renal failure presented with dyspnea, high-resolution computed tomography of the chest revealed multiple, centrilobular, calcified nodules and patchy areas of ground-glass opacity throughout both lungs, consistent with metastatic pulmonary calcification. Calcification was also seen in the bronchi and trachea.

Small bowel phytobezoars are rare and are almost always obstructive. The literature contains few reports on the radiological findings for primary small bowel bezoars. There is also very little published on CT results with this lesion, but the features of the scan are characteristic. We present the CT findings in a patient with an obstructive small bowel phytobezoar, and emphasize the diagnostic value of CT.

Purpose Previous studies have suggested coronectomy as an alternative procedure to decrease the risk of inferior alveolar nerve (IAN) injury when there are high-risk findings observed on panoramic radiographs. However, the exact relation between the inferior alveolar canal and the roots is not obvious on 2-dimensional imaging. The aim of this study was to evaluate the success of coronectomy by comparing it with conventional extraction for the treatment of the patients who had clear IAN injury risks that were determined on 3 dimensions by computed tomography. Patients and Methods Two hundred and sixteen teeth of 124 patients were evaluated by computed tomography and 175 teeth of 120 patients were enrolled in the study. Teeth were divided into an extraction group (n = 87) and a coronectomy group (n = 88) according to the operations planned. Results The mean follow-up time of the study was 17.29 months. There were 2 patients in the extraction group who had moderate IAN injuries that resolved in 1 month. Also 1 case of dry socket was observed in the extraction group and 1 patient in the coronectomy group had minor infection 1 month postoperatively, which was treated with antibiotics and subgingival irrigations. There were 2 failed coronectomies and neither had any postoperative complications. No cases of lingual nerve injury were noted in this study. Conclusions Coronectomy appears to be a preferable alternative with a low incidence of complications and therefore a suggested technique for the treatment of impacted mandibular molars when there is a high risk of IAN injury.

Congenital infiltrating lipomatosis of the face (CILF) is a rare disorder, causing unilateral facial asymmetry characterized by enlargement of the cheek or chin. Hemimegalencephaly is a unique malformation characterized by enlargement of a cerebral hemisphere. The association of CILF and hemimegalencephaly has rarely been reported. We present a case of unilateral facial swelling in a 1.5-year-old boy in whom magnetic resonance imaging and computed tomography revealed CILF associated with unilateral megalencephaly.

Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely presents with predominant involvement of the brainstem and sparing of the supratentorial regions. In this study, the clinical and neuroimaging features of a 39-year-old woman with hypertensive encephalopathy and magnetic resonance imaging (MRI) findings localized to pons and bilateral middle cerebellar peduncles were described. Reversible posterior leukoencephalopathy syndrome associated with hypertension rarely shows isolated brainstem and cerebellum involvement, and it is important to be familiar with the lack of correlation between the severity of the radiological abnormality and the clinical status.

Moyamoya syndrome (MMS) is a progressive disorder. We report a 19-year-old boy with β-thalassemia who presented with a left hemiparesis. Brain MRI showed old middle cerebral artery and left frontal subcortical white matter infarcts. Brain magnetic resonance angiography and digital subtraction angiography revealed occlusion of the bilateral internal carotid arteries with a rich network of basal collateral vessels. To our knowledge this is the third report of β-thalassemia intermedia and MMS, and the first report of a patient in Turkey. It emphasizes the potential for cerebral infarct due to anemia, protein S and thrombocytosis.

Purpose To evaluate cranial findings in patients with neurologically symptomatic sickle cell disease (SCD). Materials and methods We studied 50 consecutive patients with SCD and neurologic symptoms. All patients underwent brain MR examinations: all 50 underwent classic MR imaging; 42, diffusion-weighted MR imaging; 10, MR angiography; four, MR venography; and three patients, digital subtraction angiography. Results Of the 50 SCD patients, 19 (38%) had normal MR findings, and 31 (62%) showed abnormalities on brain MR images. Of the 50 patients, 16 (32%) had ischemic lesions; two (4%), subarachnoid hemorrhage; one (2%), moya–moya pattern; one (2%), posterior reversible encephalopathy; one (2%), dural venous sinus thrombosis; 12 (24%), low marrow signal intensity and thickness of the diploic space; 12 (24%), cerebral atrophy; and two (4%), osteomyelitis. Twenty-seven patients (54%) presented with headache, which was the most common clinical finding. Conclusions The cranial involvement is one of the most devastating complications of SCD. Early and accurate diagnosis is important in the management of cranial complications of SCD.

Intracranial metastases represent 7% to 17% of all brain tumors. Metastases may appear before, after or synchronously with the primary tumor. Synchronous tumor presentation means that that metastasis is found within two months of primary tumor diagnosis. A 60-year-old man was seen 15 days after the acute onset of confusion and gait disturbance. Results of a neurologic examination revealed disorientation, dysarthria, and left-sided ataxia. Results of nonenhanced computed tomography scanning of the brain were unremarkable. Cerebral magnetic resonance imaging showed multiple miliary, round, small (maximum diameter, 1 cm) lesions located infra- and supratentorially. Gradient-echo magnetic resonance images of these lesions were compatible with hemorrhage and were more pronounced compared with other sequences. Hemorrhagic cerebral metastases were suspected, and the patient was examined for primary tumors. Chest computerized tomography revealed a tumor in the posterior, superior lobe of the right lung; a cervical lymph node biopsy suggested a metastatic carcinoma. Our case illustrates that magnetic resonance imaging findings of synchronous cerebral multiple metastases presenting with neurologic symptoms may be atypical while the results of cerebral computerized tomography are normal. Contrast-enhanced cerebral magnetic resonance imaging, especially gradient-echo magnetic resonance sequences, should always be considered for diagnosing hemorrhagic metastases in patients presenting neurologic findings with a known or unknown cancer.

In a retrospective study, we investigated and compared the angulation and the length of the styloid process between patients operated for Eagle's syndrome and a control group by means of lateral skull and Towne's radiographs. Thirty patients with 51 symptomatic elongated styloid processes underwent surgery. As a control group, patients with chronic otitis media and trauma were included in the study and none of them had symptoms characteristic of an elongated styloid process. The length, medial and anterior angulation of the styloid processes of the patient and the control groups were measured on lateral skull and Towne's radiographs. The mean length of the styloid process was 5 cm on the right and 5.2 cm on the left in the patient group, whereas they were 2.8 and 2.6 cm, respectively, in the control group. The mean degree of anterior angulation in the patient group was 33.6 degrees on the right, 36.7 degrees on the left, whereas these were 21.4 degrees and 18.5 degrees , respectively, in the control group. There was a significant difference between the two groups for length and anterior angulation (P = 0.001). The mean medial angulation was 14 degrees on the right and 18.1 degrees on the left in the patient group, whereas these were 15 degrees and 16.3 degrees in the control group, respectively, and there were no significant differences between the two groups. The anterior angulation and the length of the styloid process are responsible for the symptoms of Eagle's syndrome.

Most carcinoid tumors involve the gastrointestinal tract or respiratory system. Primary hepatic carcinoid tumor is a rare entity. A 46-year-old woman presented with abdominal pain, vomiting, and diarrhea. She was diagnosed with primary hepatic carcinoid tumor based on radiologic and laboratory findings, namely a mass in the fifth segment of the liver and markedly elevated levels of 5-hydroxyindole acetic acid in the urine. Histologic and immunohistochemical findings of the resected liver segment showed a malignant carcinoid tumor of the liver. This case is of interest because of the rarity of this neoplasm. This report describes the case and reviews the clinical features, radiologic findings, and treatment in previously reported cases.

Patients with carbon monoxide (CO) intoxication may show neurological signs such as headache, seizures, extrapyramidal findings, and coma. However, cortical blindness is rare in these cases. This study describes a woman exhibiting confusion and axial rigidity after CO intoxication. Ten days after intoxication, her pupils were isonormocoric and reactive to light. A fundoscopic examination was normal, but visual acuity was light-perception in both eyes. There were diffuse EEG slow waves. Magnetic resonance imaging (MRI) demonstrated bilateral hyperintensity in the basal ganglia. The P100 latencies of visual evoked potentials (VEP) were increased and dispersed. One year later, the patient's visual acuity was almost normal and VEPs showed mild dispersion in P100 latencies. The authors found this case of interest because cortical blindness due to CO intoxication is only rarely seen with a relatively good outcome.

Synovial sarcomas are most commonly localized in the extremities, especially the lower thigh and knee areas. Retroperitoneal synovial sarcoma is very rare. We describe the radiological and pathological findings of an adult retroperitoneal synovial sarcoma.

Angular pregnancy, a type of cornual pregnancy, is a rare obstetric complication that can be life-threatening. In this situation, the embryo is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament. Angular pregnancy must be distinguished from interstitial pregnancy, in which the embryo is implanted lateral to the round ligament. The report presented here describes a case of angular pregnancy that was diagnosed by endovaginal ultrasonography and magnetic resonance imaging. Laparoscopy can be useful for guiding dilatation and curettage in angular pregnancies, and may circumvent the need for invasive surgery or hysterectomy.

An unusual presentation of unilateral cerebellar abscesses due to neurobrucellosis observed in a patient is reported. He gave a history of fever, headache, vomiting and had unilateral cerebellar signs. The abscess was detected on magnetic resonance imaging (MRI) and analysis of cerebrospinal fluid revealed neurobrucellosis. Patient treated by only antibiotics therapy, evolving to complete clinical and radiological resolution, without neurosurgical intervention. We are presenting a case of cerebellar abscess due to neurobrucellosis diagnosed by MRI, treated medically, and had both radiologic and clinical follow-up. We also made a review of the literature concerning the cerebellar abscess due to neurobrucellosis.

Summary: We present two cases of subclavian steal syndrome from the ipsilateral vertebral artery (VA) to the subclavian artery (SCA), one with the left VA originating from the aortic arch and the other with the left VA originating very close to the origin of the SCA, proximal to the occluded segment. In both cases, angiographic demonstration of these anatomic variations and successful endovascular treatment are presented.

Purpose: The aim of this study was to assess the value of abdominal CT and MRI in determining the severity of cirrhosis secondary to hepatitis compared to Child-Pugh classification. Materials and methods: The study included 23 patients who were clinically and histologically diagnosed with chronic liver disease secondary to viral hepatitis. Each patient underwent dynamic abdominal CT imaging and MRI within the same week. CT and MRI findings were retrospectively reviewed. The same parameters were used from the CT and the MR images for each patient. The parameters included liver volume index (posterior segment of the right lobe, medial and lateral segments of the left lobe), spleen volume index, ascites, portosystemic collaterals, contour irregularities of the liver and confluent fibrosis within the liver. The findings were compared with the patients’ Child-Pugh grades. Multiple regression analysis was used for statistical analysis. Results: On MRI, liver volume index (P = 0.0001), and ascites (P = 0.009) were strongly correlated with Child-Pugh grades. With CT, only ascites was correlated with Child-Pugh grades (P = 0.002). Conclusion: This study indicates that liver volume index on MRI, and ascites on CT and MRI are good indicators of clinical severity of cirrhosis secondary to hepatitis. To show the effect of the other parameters, more research is needed with larger patient groups.