Acute Liver Ischemia Caused by Vasculitis Due to the Use of Synthetic Cannabinoids.

Teaching Point: Synthetic cannabinoids are drugs whose use has increased significantly in recent years and whose toxicological effects cannot be ignored. Chronic inflammatory processes such as vasculitis that may be caused by these substances pose serious health problems at all ages.

Nerve Root Compression Due to Contralateral Compensatory Hypertrophy: A Rare Case of Vertebral Artery Thrombosis.

In the patient who complained of dizziness, thrombus was observed in the right vertebral artery. Compression was detected in the nerve root due to compensatory hypertrophy in the left vertebral artery. In conclusion, in cases of unilateral vertebral artery thrombosis, should be aware of the pathologies that may develop in adjacent structures due to compensatory hypertrophy. Teaching Point: An occluded vertebral artery (VA) can cause contralateral VA hypertrophy, which can cause various pathologies including nerve root compression.

Brain metastasis from ovarian carcinoma: Analysis of eight cases from a single radiotherapy center.

OBJECTIVE: Brain metastasis from epithelial ovarian carcinoma (EOC) is rarely seen having rate of 1-3% with very poor prognosis. Studies on brain metastatic EOC is limited with low number of participants. An increasing trend in EOC related to brain metastasis has been reported recently confronting managing clinicians with new challenges. Therefore, more information on this issue is needed. We aimed to analyze a single radiotherapy center experience on EOC related brain metastases. MATERIALS AND METHODS: Data of all patients treated between January 1998 and December 2016 at a radiation center of a university hospital were reviewed retrospectively. Clinicopathological characteristics, treatment details and outcome were analyzed. RESULTS: We identified only ten cases with EOC related brain metastasis in our department during 18-year period. Two patients were excluded because of data unavailability and therefore our study was performed among 8 patients. The median time between EOC diagnosis and detection of brain metastasis was 19.8 months. Brain metastasis was multiple in majority (75%). Extracranial metastasis at the time of brain metastasis was 62.5%. All patients died in the follow-up. The median survival time after the diagnosis of brain metastasis was 4.5 months. The median overall survival (OS) after the diagnosis of EOC was 28.9 months. The interval between the initial diagnosis and brain metastasis was negatively correlated with survival after brain metastasis (B-OS) occurred as time interval (p = 0.047). Presence of extracranial metastasis at time of occurrence of brain metastasis and application of multimodal treatment after brain metastasis were positively correlated with B-OS time (p = 0.007, p = 0.046, respectively). CONCLUSION: Prognosis of brain metastasis from EOC remains poor. The factors associated with better B-OS were the longer time between initial diagnosis and brain metastasis, absence of extracranial disease at time of brain metastasis, and application of the multimodal treatment.

Electrophysiological, functional and histopathological assessments of high dose melatonin on regeneration after blunt sciatic nerve injury.

The aim of this study was to determine the curative effects of high-dose (100 mg/kg) melatonin on peripheral nerve injury. Forty male Wistar albino rats were randomized into four groups as sham, vehicle, melatonin, and ischemia and their right sciatic nerves were exposed. The process was terminated in the sham group. In the other groups, nerve injury was induced by clip compression. The vehicle group was intraperitoneally administered ethanol 0.1 cc (melatonin solvent), while the melatonin group was intraperitoneally administered a single dose of melatonin (100 mg/kg). Following the surgery, sciatic nerve functional index (SFI) was measured using walking track analysis on days 7, 14, and 21, and latency, amplitude, and muscle action potentials (MAP) field values were measured using electroneuromyography (ENMG) on day 21. Histopathologically, edema, axonal degeneration, myelin damage, and inflammatory response were evaluated in all groups. SFI values were noted to be statistically significantly different among the vehicle, melatonin, and ischemia groups, and the melatonin group showed a faster recovery. In the ENMG evaluations, higher amplitude and field values in the melatonin group indicated that melatonin accelerated peripheral nerve recovery. Histopathologically, although fibers with loss of myelin were identified in the melatonin group, the myelin sheath was preserved in general and the axonal structure was noted to be normal. A single injection of high-dose melatonin was found to preserve myelin sheath, prevent axonal loss, and accelerate functional recovery during the nerve regeneration in peripheral nerve injury.

The effects of barnidipine on an experimental ischemia reperfusion model of spinal cord injury and comparison with methyl prednisolone.

OBJECTIVE: Increased intracellular calcium concentration plays an important role in the secondary mechanism of spinal cord injury. In the presenting experimental study, we aimed to evaluate the healing effect of barnidipine, which has a high affinity for L-type calcium channels, on acute spinal cord injury and to compare its effects with those of methylprednisolone. METHODS: A total of 32 Spraque Dawley albino adult female rats were divided into 4 groups; group 1: sham-operated (n=8), group 2: only ischemia (n=6), group 3: barnidipine-treated (n=8), and group 4: methylprednisolone-treated (n=6). An ischemia-reperfusion model was created by clipping the abdominal aorta in the rats. Motor examination was performed 1 hour after the surgical procedure and before sacrification. Immediately following the second motor examination, rats were sacrificed and tissue samples were taken for histopathological examination and for testing of tissue malondialdehyde (MDA) levels. RESULTS: A significant correlation of motor examination was found between the sham-operated and barnidipine-treated groups and the sham-operated and only ischemia groups at the 1st and 24th hour (p<0.008). There was no significant difference between the only ischemia and barnidipine-treated groups and only ischemia and methylprednisolone-treated groups (p>0.008). Light microscopic examination of the sham-operated group revealed findings consistent with normal spinal cord structure. In group 2, 3, and 4, light microscopic examination revealed polymorphonuclear leukocyte infiltration and a small amount of axonal swelling. There was no significant correlation between the ischemia and barnidipine-treated groups and the barnidipine and methylprednisolone groups in terms of MDA levels (p>0.008). CONCLUSION: A single dose of barnidipine (10 mg/kg) and methylprednisolone are not effective and not sufficient to prevent spinal ischemia-reperfusion injury in rats.

Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases.

PURPOSE: Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue. METHODS: Cases of aortic injury during thoracic screw procedures were found using a MEDLINE search and analyzed together with 3 new cases that we present. RESULTS: Nineteen cases collected from the literature and 3 new cases were included in the study. In 7 of the cases, aortic impingement by the pedicle screw was detected during postoperative follow-up (day 1) radiologic examinations. In the other cases, time to presentation of aortic impingement ranged between 2 weeks and 60 months after fixation. The main indications for thoracic spinal fixation were post-traumatic vertebral fracture and kyphoscoliosis/scoliosis. Repair of the aortic damage ranged from primary repair to stent and tube graft placement by the thoracic endovascular aortic repair method. CONCLUSIONS: In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision.

A Right Middle Cerebral Artery Infarct After Frontal Eosinophilic Granuloma Resection in an 8-Year-Old Boy with Factor V Leiden.

Stroke in children is relatively uncommon. We describe an 8-year-old boy diagnosed with primary eosinophilic granuloma (EG) of the frontal bone. After excision of the EG, the postoperative course was eventful. The patient had an acute right middle cerebral artery (MCA) infarct and had been comatose with a diminished Glasgow Coma Scale (GCS) score of 5. Urgent decompressive hemicraniectomy with duraplasty was performed. The postoperative course after the second operation was uneventful. Hematological tests revealed a diagnosis of factor V Leiden. The patient was discharged with left hemiparesis and GCS of 15. To the best of our knowledge, no such clinical picture of MCA infarction after EG excision has been described before. Neurosurgeons should be aware of inherited thrombophilias, such as factor V Leiden, if the postoperative clinical course worsens because of cerebral artery thrombosis. Also, decompressive hemicraniectomy could be life saving and should be performed urgently without any hesitation.

May "Dubel" be a solution for pullout problem of the pedicle screws at osteoporotic spine?

AIM: To improve the strength of stabilization systems currently used in osteoporotic spinal fractures, essentially by increasing the fixation force of pedicle screws. MATERIAL AND METHODS: Six human cadaveric vertebrae were used. Bone mineral densities of the specimens were measured with Dual Energy X-ray Absorptiometry in order to assess the osteoporosis. All vertebrae were found to be severely osteoporotic. Standard pedicle screws were applied to left pedicles of vertebrae. Pedicle screws reinforced by fixing plugs "Dubel" were applied to right pedicles of vertebrae. Afterwards the vertebrae were embedded in acrylic casts to prevent possible fracture of the osteoporotic vertebrae and to obtain a correct vertical pull-out vector. The biomechanical pullout tests were performed with biomechanical testing machine. Pullout forces in each group were recorded and compared with Mann-Whitney U test. RESULTS: The pedicle screws strengthened by "Dubel" were found to be four times stronger than the standard pedicle screws, in the osteoporotic human cadaveric vertebrae. CONCLUSION: "Dubel"-augmented pedicle screws may contribute to developing better stabilization systems for osteoporotic thoracolumbar fractures needing surgery and in the revision of the previous fusion surgeries of the spine.

Coil embolization in 481 ruptured intracranial aneurysms: angiographic and clinical results.

PURPOSE: We aimed to report our 13-year experience with the embolization of ruptured cerebral aneurysms using detachable coils and postembolization angiographic and clinical results. MATERIALS AND METHODS: Between June 1998 and September 2011, 481 patients with ruptured aneurysms were referred for endovascular treatment with detachable coils at our center. The technical feasibility, procedural complications, morbidity, mortality, and initial angiographic and clinical results were evaluated. RESULTS: Endovascular treatment was successful in 95.6% of the patients. Postembolization angiography showed complete occlusion in 63.4%, a neck remnant in 30.8%, and incomplete occlusion in 5.8% of the aneurysms. A total of 331 patients were followed up. The overall angiographic results showed stable occlusion in 234 aneurysms (70.7%) and recurrence in 97 aneurysms (29.3%). During the follow-up period, stable angiographic occlusion was evident in 75% of the small, 61% of the large, and 38.5% of the giant aneurysms. Complications during the coiling procedure occurred in 75 procedures (15.6%). Ischemic complications were observed in 33 procedures (6.9%), and perforation of the aneurysm during the coiling occurred in 12 cases (2.5%). Five (41.7%) of 12 patients who had perforation during coiling died. The overall procedure-related morbidity and mortality were 5.6% and 2%, respectively. During the follow-up period, two patients (0.4%) had early rebleeding. None of the patients showed late rebleeding. In the follow-up, the retreatment rate was 12.6%. CONCLUSION: Our data confirm the feasibility, safety, and efficacy of endovascular coil embolization in patients with ruptured cerebral aneurysms.

Ossifying fibroma of the lumbar spine: case report.

Ossifying fibroma of the vertebra is a very rare condition. We report a 16-year-old boy with ossifying fibroma of the third lumbar vertebra. Neurological and laboratory examinations demonstrated normal findings. Low-back pain, in the absence of radicular pain, was the presenting symptom. Plain radiography and computerized tomography scanning revealed an osteolytic lesion. The tumor in the third lumbar vertebra was curetted and filled with bone allograft. The histopathological diagnosis was consistent with ossifying fibroma. There was no postoperative complication. The case is the second to be reported. The clinical and radiological aspects of this rare tumor are discussed with the pertinent literature.

Recurrent lumbar spinal intradural enterogenous cyst: a case report.

Enterogenous cysts mostly present in the cervical and thoracic region of the spinal canal and have only rarely been observed in the lumbar region. We report here a case of a recurrent enterogenous cyst in the lumbar spinal canal. A 24-year old woman presented with lower back and left radicular leg pain for 1 year. She had been operated on for mass lesion at the same level 10 years ago. Lumbar spine MRI showed a large intradural cyst at L2. Other congenital abnormalities were absent. The cyst was subtotally removed and the patient recovered well. Pathological examination revealed that the lesion was a typical enterogenous cyst.

The prognostic value of neuron-specific enolase in head trauma patients.

In recent years, in addition to neurological examination and neuroradiologic examinations, attempts have been made to assess the severity of post-traumatic brain injury and to obtain an early idea of patient prognosis using biochemical markers with a high degree of brain tissue specificity. One such enzyme is neuron-specific enolase (NSE). This study investigates the correlation between serum NSE levels, Glasgow Coma Score, and prognosis measured by Glasgow Outcome Scores in head trauma patients. This was a prospective study conducted with 80 trauma patients presenting to the Emergency Department. Patients were divided into four groups. The first group consisted of patients with general body trauma, but no head trauma. The second group had minor head trauma. The third group had moderate head trauma, and the fourth group had severe head trauma. The relationship between subjects' admission NSE levels and admission and discharge Glasgow Coma Scores (GCS) and Glasgow Outcome Scores (GOS) 1 month later was examined. A receiver operating characteristic (ROC) analysis was performed using a serum NSE cutoff level of 20.52 ng/mL and a GOS of 3 or less as the definition of poor neurologic outcome. There was a significant difference in the NSE levels between group 1 (general trauma) and group 3 (moderate head trauma). There was also a statistically significant difference in NSE levels between group 1 (general trauma) and group 4 (severe head trauma) (p < 0.05). There was a statistically significant inverse relationship between NSE levels and GOS as determined within groups 3 (moderate) and 4 (severe head trauma) (p < 0.05). When NSE levels were compared with admission GCS, it was found that GCS fell as NSE levels rose. There was no significant correlation between NSE and GCS within groups 3 (moderate) or 4 (severe). There was a statistically significant correlation within group 2 (mild) (p < 0.05). By ROC analysis, serum NSE was 87% sensitive and 82.1% specific in predicting poor neurologic outcome in the study patients. The area under the curve was 0.931. This study shows that initial serum NSE levels in moderate and severe head trauma patients correlate inversely with GOS 1 month later, but only within the moderate and severe head trauma groups. However, serum NSE was 87% sensitive and 82.1% specific in predicting poor neurologic outcome in all of the study patients. This derived cutoff value now needs to be prospectively validated.

Large orbital osteoma arising from orbital roof: Excision through an upper blepharoplasty incision.

Osteoma is the most common benign tumor of facial bony structure. Intraorbital extension is extremely rare. We report a case of intraorbital, pedicled osteoma originating from the left orbital roof. The patient's ophtalmological examination revealed; only light perception due to the severe amblyopia and posterior capsular opacification in the right eye, and complete visual acuity in the left. His left eye was proptotic and directed to downward lateral gaze position. Using upper blepharoplasty incision, the osteoma was completely excised. There were not any postoperative complications and all ocular symptoms in the left eye were resolved after 1 month.

Temporalis muscle metastasis of the uterine leiomyosarcoma: a case report.

Leiomyosarcomas are malignant tumors of smooth muscle origin. These tumors are very rare in the head and neck region. The majority of leiomyosarcomas of the head and neck arise in the paranasal sinuses, oral cavity, jaws and superficial soft tissues like the scalp. A mass was observed in the right temporoparietal region of the scalp of a 76-year-old female. Two years before presentation, the patient was operated for primary uterine leiomyosarcoma. Over the ensuing years, the mass substantially increased in size. Radiologic findings revealed a mixed density mass of the right temporalis muscle. Histologic and immunohistochemical examination of the tumor showed a malignant mesenchymal neoplasm consisting of spindle-shaped atypical mesenchymal cells with marked pleomorphism and central cigar shaped nuclei arranged in fascicles. We report a rare case of uterine leiomyosarcoma metastatic to the temporalis muscle, proven by histopathology.

Effects of clotrimazole on experimental spinal cord injury.

BACKGROUND: We examined a possible neuroprotective effect of clotrimazole on spinal cord clip compression injury. METHODS: Rivlin and Tator's acute extradural clip compression injury (CCI) model was used for producing SCI on 24 albino Wistar rats weighing 180-250 g. All rats were anesthetized with 30 mg/kg ketamine HCl intraperitoneally and were breathing spontaneously without tracheal intubation. Total laminectomy of T8-T12 was performed on all rats under operation microscope, and CCI was performed on all rats (expect those in group 1) with a 50-g closing force aneurysm clip for 1 min. Three hours later, all of the rats were killed with sodium pentobarbital. Spinal cords were excised for a length of 2 cm; 1 cm rostrally and caudally to the injury site and deep frozen at -76 degrees C for biochemical studies. RESULTS: Treatment with clotrimazole decreased MDA levels in rats with SCI with a statistically significant difference. CONCLUSIONS: To our knowledge, this the first study that shows the effects of clotrimazole on spinal cord clip compression injury. Clotrimazole was found to be effective on spinal cord clip compression injury, but further investigations are mandatory.

Ruptured chronic encapsulated intracerebral hematoma in infancy: review of the literature with a case report.

OBJECTIVES: We report a case of a 2-month-old boy with chronic encapsulated intracerebral hematoma (EICH) and discuss clinical, radiological and pathological features of the case. CONCLUSIONS: Chronic EICH in infants is extremely rare in the literature. Only two cases have been previously reported. One of the cases reported in the literature was supratentorial and the other was infratentorial.

Effects of citicoline on experimental spinal cord injury.

OBJECTIVE: To investigate the effects of citicoline on experimental spinal cord injury (SCI). BACKGROUND: Citicoline has been successfully used in clinical studies of head injury and cerebral infarction, but there is limited literature regarding its use in experimental SCI. STUDY DESIGN: Twenty adult Wistar rats were divided into four groups: sham, trauma, vehicle, and citicoline-treated. SCI was produced using a weight drop technique. Citicoline 300 mg/kg was given intraperitoneally, 5 minutes after the induction of trauma. The animals were sacrificed and 1 cm long samples of injured spinal cord were obtained at 48 hours post-SCI. Lipid peroxidation was estimated by the thiobarbituric acid test. Neurological examinations were performed using a previously described grading scale. RESULTS: Measures of lipid peroxidation and motor scores of the citicoline-treated group were significantly lower than those in the other injury groups. CONCLUSIONS: Citicoline attenuated lipid peroxidation after SCI and improved the motor scores. Further investigations will be required to determine the long-term effects of this drug on spinal cord injury.