Are We Aware of the Neurological Manifestations of Cytomegalovirus Infection in Immunocompetent Individuals?

BACKGROUND: While cytomegalovirus (CMV) infection usually causes disease in immunosuppressed individuals, it mostly progresses as an asymptomatic infection in healthy adults. However, very rarely, immunocompetent individuals may also suffer from encephalitis and stroke. METHODS: Nine patients who were admitted to the Neurology Clinic of Abant Izzet Baysal University Faculty of Medicine from 2016 to 2020 who had various neurological symptoms and were diagnosed with CMV infection were retrospectively analyzed. Symptoms, examination findings, laboratory results, radiologic imaging, and treatments were recorded and evaluated. RESULTS: Although severe infections because of CMV generally occur in newborns and immunosuppressed adults, it is estimated that the disease is more common in immunocompetent adults than known. This may be associated with unrecognized risks, in part because of immune dysfunction or comorbidities such as renal failure or diabetes mellitus. Also, CMV replication in arterial endothelial cells can restrict blood flow, inducing an atherosclerotic environment and causing stroke. Diagnosis is based on clinical suspicion and serology. Ganciclovir is administered for treatment. CONCLUSION: CMV infection should be considered in the differential diagnosis of patients presenting with neurological symptoms, even among immunocompetent individuals, because of the high possibility that patients can greatly benefit from antiviral treatment at the early stage.

Role of developmental venous anomalies in etiopathogenesis of demyelinating diseases.

OBJECTIVE: Multiple sclerosis (MS) is a demyelinating autoimmune disease of the central nervous system. T2W-hyperintense demyelinating lesions are detected in cranial magnetic resonance imaging (MRI). Developmental venous anomalies (DVAs) have frequently been detected in enhanced cranial MRI images, and are generally accepted as normal variants of venous development. The aim of the present study was to investigate whether there was an association between demyelinating diseases and venous anomalies. METHODS: One hundred five patients who were diagnosed as having MS in accordance with the McDonald diagnostic criteria, and 105 patients who were diagnosed as having vascular headache who had no lesions similar to MS were included in the present retrospective study. RESULTS: DVAs were detected in 31 of the study group and in 14 patients in the control group. A statistically significant higher rate of DVAs and abnormal signal increase in the neighboring tissue was detected in the study group (p = 0.004) (p = 0.006). The DVA was superficially localized in the RRMS, It was deeply located in RIS. CONCLUSION: Recent studies have emphasized the association of the central vein and the lesion severity of MS with the detection of the central collecting vein in MS lesions. In our study, DVAs, which are generally regarded as innocent developmental anomalies, and neighboring signal increase were found significantly higher in the MS group compared with the control group. The role of DVAs in the etiology of demyelinating lesions must be clarified through comprehensive future studies that use more advanced techniques.

Effect of Prone and Supine Positioning on Computed Tomography Urography Examination.

OBJECTIVES: The aim of this study is to evaluate the effects of performing computed tomography (CT) urogram in the prone position in terms of diagnosis. METHODS: CT urograms of 208 patients imaged randomly in the prone and supine positions were included in this study. A total of 199 patients and 370 collecting systems were examined in total. Axial raw data and reconstructed coronal thin and thick MIP images with a slice thickness of 5 mm were evaluated by 2 independent radiologists blinded to the initial diagnosis. Renal collecting system, ureters, and bladder were included in radiological evaluation. Anatomically, the renal collecting system was separated into 7 regions. Filling and dilatation of collecting systems were evaluated via images at urogram phase by scoring. RESULTS: Filling in lower pole infundibulum (p = 0.006), distal ureter (p = 0.006); and highly dilated lower pole calyx (p = 0.020), pelvis (p = 0.006), and bladder (p < 0.001) were determined to be better in images in the prone position compared to the supine position. There were no statistical differences in other regions. CONCLUSION: Better contrast material filling is achieved in dilated or non-dilated lower pole collecting system, dilated renal pelvis, non-dilated distal ureter of kidney, and in the bladder only by imaging the urogram phase in the prone position compared to the supine position. Additionally, presence of dilatation is a factor that could adversely affect filling. Studies in the future may investigate the contribution of prone positioning to CT urogram with larger series comparing it with other methods and modalities.

Vasculitis and neurobrucellosis: Evaluation of nine cases using radiologic findings.

Background: Brucellosis is an important multisystemic disease with many different clinical symptoms, and its early diagnosis and treatment are possible. Neurobrucellosis (NB) is a rare but serious finding of brucellosis. Brucella can be seen as meningitis and encephalopathy, and it can cause cranial nerve pathologies, vascular syndromes, myopathy, spinal diseases, and psychiatric disorders. In NB, vascular syndromes secondary to inflammation are rarely seen. Here, we present nine young patients with vascular and nonspecific neuropsychiatric findings who had NB as the etiology of stroke. Methods: Nine patients who were admitted to our Neurology Clinic between 2012 and 2017 for various reasons in whom brucellosis was found in the etiology were retrospectively studied. The patients' symptoms, physical examination, laboratory and radiographic findings, treatments, and treatment responses are discussed. Results: Of the nine patients who presented to our clinic in the 4-year period, five were female. The average age was 49 years. Five patients had small vessel vasculitis, three had great vessel vasculitis, and one had meningoencephalitis and pons abscess. Two patients had granuloma, and one had an aneurysm. Conclusions: We aimed to present our cases due to the fact that this disease should be kept in mind in the differential diagnosis of patients with stroke and similar neuropsychiatric findings.

Evaluation of the relationship between mandibular condyle cortication and chronologic age with cone beam computed tomography.

PURPOSE: The aim of the present study is to evaluate the relationship between mandibular condyle cortication and chronologic age and gender via cone-beam computed tomography (CBCT) and to investigate the effectiveness of using the condylar cortication as a new method of age estimation. METHODS: CBCT images from 433 subjects aged 8 to 31 years were included in this study. The right and left condyle cortication were assessed on the sagittal plane separately for each individual by the same investigator via a new method that describes the cortication of the condyle. Type I: There is no cortication on the condyle. Type II: The bone that is on the superior surface of the condyle is seen less density than the structures around the condyle. Type III: The surface of the condyle is seen similar or higher density than the surrounding cortical areas. RESULTS: The type of the condyle cortication in the right and left mandible was similar for almost each subject and there was no statistically significant different between them (p = 0.375). When we evaluated the results without including these patients for male, Type I cortication of the condyle was seen at 14.14 ±â€¯2.3 years, Type II cortication of the condyle was seen at 16.11 ±â€¯3.18 years and Type III cortication of the condyle was seen at 19.39 ±â€¯3.96 years. For the female, Type I cortication of the condyle was seen at 13.01 ±â€¯2.16 years, Type II cortication of the condyle was seen at 15.52 ±â€¯2.71 years and Type III cortication of the condyle was seen at 17.95 ±â€¯3.13 years. The minimum age of Type III cortication was 11 and 15 years old for male and female, respectively. However, there are subjects, who are 30 year old man and 31 year old female, have no cortication as much as similar or higher than the surrounding the cortical areas. CONCLUSION: This study is the first investigation of the relationship between condyle cortication and chronologic age with CBCT in the Turkish population. The type of cortication in the right and left condyle may be different for the same individual. Chronologic age increased as the stages of the cortication process from Type I to Type III in male and female individuals, and all the stages of the cortication in the mandibular condyle of male occur later time according to female.

Gorlin-Goltz syndrome.

Gorlin-Goltz syndrome is a rare multisystemic disease inherited in an autosomal dominant pattern. It is characterized by numerous basal cell carcinoma of the skin, jaw cysts, and skeletal anomalies such as frontal bossing, vertebral anomalies, palmoplantar pits, and falx cerebri calcification. There is a tendency to tumors including medullablastoma, fibroma, rabdomyoma, leiomyosarcoma etc.. The diagnosis is based on major and minor clinical and radiologic criteria. Early diagnosis and treatment are of utmost importance in reducing the severity of long-term sequelae of this syndrome. In this article, we present a 15-year-old boy who was admitted to our clinic with brown-black papules and plaques on his scalp and was thought to have Gorlin-Goltz syndrome. He had a history of medulloblastoma that was treated with surgical resection followed by cranial radiotherapy and unilateral retinoblastoma. We present this case, because association of Gorlin-Goltz syndrome and retinoblastoma has not been described previously in the literature and we aimed to draw attention to radiation-induced basal cell carcinomas.

Extra-medial thickness of carotid artery in patients with Behçet's disease: evaluation of atherosclerotic vessel wall changes with a novel carotid artery ultrasound index.

OBJECTIVES: Chronic inflammation and endothelial dysfunction are the characteristic features of Behçet's disease (BD). We researched carotid extra-medial thickness (cEMT), a novel ultrasound parameter for atherosclerotic vessel wall changes, and carotid intima media thickness (cIMT), a widely accepted marker of subclinical atherosclerosis, in patients with BD, and we evaluated the relationship between these two parameters. MATERIALS AND METHODS: In total, 31 patients with BD were matched to 26 control subjects based on age, gender, and major cardiovascular risk factors. Laboratory parameters, including lipid profile, were measured for both patients and controls. B-mode ultrasonography was used to assess the cEMT and cIMT. RESULTS: There was no significant difference in the cEMT values between the patients with BD and the control group (P = 0.90). cIMT in the BD group was significantly higher compared with the control group (P = 0.021). There was a significant positive correlation between cIMT and cEMT (r = 0.585, P = 0.001). Both cEMT and cIMT were positively correlated with age and the presence of arthritis. There was linear correlation with sedimentation, C-reactive protein, and cEMT. CONCLUSIONS: To the best of our knowledge, this is the first study to evaluate both cEMT and cIMT in BD. This study presents morphological evidence of subclinical atherosclerosis in terms of cIMT. Although there was no significant increment in cEMT, it has the potential to assess endothelial dysfunction in BD. Further studies are required to confirm this finding.

Mean platelet volume and D-dimer in patients with suspected deep venous thrombosis.

The aim of this retrospective study was to evaluate the diagnostic value of mean platelet volume (MPV) and D-dimer for acute deep venous thromboembolism (DVT). Two hundred and fifty six patients who presented to the emergency or cardiovascular surgery department with suspected lower limb DVT were retrospectively recruited. Plasma levels of MPV, platelet count, and D-dimer were obtained and duplex sonography examination was performed for all patients. Eighty four patients had acute DVT which was diagnosed by duplex ultrasonography. MPV was significantly higher in patients with DVT than in those without DVT (p < 0.01). The mean MPV was 7.97 ± 17.8 and 7.58 ± 0.87 fL in patients with DVT and without DVT, respectively (p < 0.01). D-dimer was significantly higher in patients with DVT (p < 0.01). For all the patients, a positive MPV when the cut-off value was 7.3 fL, had 69.7 % sensitivity and 43.9 % specificity. D-dimer (with a cut-off value of 0.5 µg/mL) had 82.9 % sensitivity and 32.7 % specificity. In case of combination of MPV and D-dimer, the specificity exceeded (65.9 %) despite the reduction in sensitivity (59.2 %). Elevated MPV was found to be associated with acute DVT and high levels of MPV might increase the specificity of D-dimer for exclusion of DVT.