Executive Functions, Intellectual Capacity, and Psychiatric Disorders in Adults with Type 1 Chiari Malformation.

OBJECTIVE: Contrary to popular belief, the cerebellum is involved not only in motor planning, balance, and coordination but also in cognitive processes. The present study aimed to investigate executive functions (EFs), intellectual capacity, and psychiatric disorders in adults with type 1 Chiari malformation, which is defined as a hindbrain anomaly that involves the cerebellum. METHODS: The study included 62 adults, with 29 in the CM group and 33 in the control group. EFs were evaluated using the Stroop test, number sequence learning test, and standardized mini-mental state examination (SMMSE). The intelligence quotient (IQ) was measured using the Kent EGY and Porteus maze tests, and psychiatric disorders were evaluated using the Structured Clinical Interview for DSM-5, Clinician Version (DSM-5-CV). RESULTS: The CM group took longer than the control to complete the Stroop test for each section (P < 0.005). Although the mean IQ scores of both groups were within the normal range, the CM group had a lower mean IQ score than the control group (P < 0.005). Although the mean SMMSE scores of both groups were within the normal range, the CM group had a lower mean SMMSE score than the control group (P < 0.005). The CM group had a higher rate of psychiatric comorbidities than the control group (P < 0.005). CONCLUSIONS: The study found that subjects with type 1 Chiari malformation performed worse in EFs than healthy controls and had a higher prevalence of psychiatric disorders.

Fourth Ventricle Dimensions Increase in Chiari Malformation Type 1.

AIM: To investigate whether fourth ventricle dimensions and tentorial angulation differ in a healthy control population in our evaluation of patients with CM-1 malformation using MRI. MATERIAL AND METHODS: The radiological and demographic data from 251 patients with CM-1 followed in our clinic between 2014 and 2019 were compared with data from 273 persons in a healthy control group. Fourth ventricle dimensions, amount of cerebellar tonsillar herniation, and tentorium twinning angle were measured. Statistical analysis was performed. RESULTS: The mean tentorial twinning angle, craniocaudal length, and anteroposterior length of the fourth ventricle were significantly greater than the mean of the same measurements in the healthy control group. In addition, in a subgroup analysis conducted according to treatment modalities of patients with CM-1, the length between the bilateral recesses of the fourth ventricle was found to be statistically significantly greater in the subgroup of patients who underwent surgery compared with those in the nonsurgical subgroup. CONCLUSION: Fourth ventricle enlargement is a radiographic finding in patients with CM-1. Studies evaluating clinical presentation, severity, and outcome after treatment will be useful in revealing the importance of this entity.

The executive functions, intellectual capacity, and psychiatric disorders in adolescents with Chiari malformation type 1.

PURPOSE: In the last two decades, the non-motor functions of the cerebellum have become the centre of attention for researchers. Anecdotal observations of cognitive and psychiatric manifestations of cerebellar lesions have increased this interest. We aimed to investigate the executive function (EF), intellectual capacity, and comorbid psychiatric disorders in adolescents with Chiari malformation type 1 (CM1), which is a pathological manifestation of posterior cranial fossa structures include the cerebellum. METHODS: The Chiari group consisted of ten adolescents aged 12-18 years old, and the control group consisted of 13 healthy adolescents with similar age and sex with patients. Stroop test (ST), trail making test (TMT), and Behaviour Rating Inventory of Executive Function-Parent form (BRIEF) were used to evaluate EF; Kent EGY and Porteus Maze Test was used to measuring the intelligence quotient (IQ), and a semi-structured interview was used to determine the psychiatric disorders. RESULTS: EF test scores were found comparable between the two groups. IQ scores of the Chiari group were found in the normal range, but significantly lower than controls. No significant difference was revealed in terms of comorbid psychiatric disorders between the two groups. CONCLUSION: In this study, we did not observe an impairing effect of CM1 on EF and intelligence. Also, we found that CM1 did not cause more psychiatric disorders compared to controls. Further studies need to support our findings in adolescents diagnosed with CM1.

[A Case of Meningitis Caused by Globicatella sanguinis in a Patient with a Lumbo-peritoneal Shunt]. / Lumbo-peritoneal Santli Hastada Globicatella sanguinis'e Bagli Menenjit Olgusu.

Globicatella sanguinis is catalase-negative, alpha-hemolytic, nonmotile, facultative anaerobic grampositive cocci, identified as a new species in 1992. Since the colony morphology in blood agar and microscopic appearance resembles streptococci, it is thought that some of the isolates previously identified in the Streptococcus viridans group were G.sanguinis species. G.sanguinis has been isolated from various clinical specimens, its species identification and antibiotic susceptibility have been tested since the year it was identified. Clinical specimens in which it is isolated include various mucosal surfaces, blood, urine, wound and cerebrospinal fluid. In this report, considering also the literature information, a case of G.sanguinis which is thought to cause meningitis was presented. Our case is a 39-year-old female patient with a lumboperitoneal shunt. The patient was admitted to the neurosurgery clinic with a headache and vision loss and was hospitalized in the service with a pre-diagnosis of pseudotumor cerebri. Neurological examination revealed no pathological findings. Eye examination revealed mild papillary edema, local retinal hemorrhage, and bilateral expansion in retinal vascularization. There was no pathologic findings in the brain magnetic resonance imaging. The colonies resembling alpha hemolytic streptococci were isolated from the cerebrospinal fluid taken upon the development of neck stiffness, fever, and tachycardia on the 10th day of hospitalization of the lumbo-peritoneal shunt administered patient. The identification of the isolate was determined in Bruker IVD MALDI Biotyper 2.3 (Bruker Daltonik GmbH, Bremen, Germany), available in our laboratory and it was identified as G.sanguinis (KJ680157.1) with a score of > 2. The definite identification of the isolate at the species level was made by 16S rDNA sequence analysis and it was determined that the bacterium was G.sanguinis with 100% similarity and coverage. The minimum inhibitory concentration (MIC) for some of the antibiotics was determined by the agar gradient method. The MIC values were found as; linezolid 0.50 µg/ml, vancomycin 0.75 µg/ ml, imipenem 0.75 µg/ml, meropenem 3 µg/ml, penicillin G 6 µg/ml and cefotaxime > 32 µg/ml. It is known that these rare isolates can be isolated in greater numbers along with the introduction of MALDITOF MS-based devices in many laboratories. Following greater numbers of isolation of this rare species of bacteria, our knowledge about its clinical significance, placement in the flora and antibiotic susceptibility will also be expanded.

Evaluation of the prevertebral soft tissue thickness by magnetic resonance imaging in patients with mild neck problem.

AIM: We encountered no study conducted on the evaluation of prevertebral soft tissue (PVST) thickness by magnetic resonance imaging (MRI) during our literature search. Measuring PVST thickness by MRI in the cervical region of adult cases was aimed in the present retrospective study. MATERIAL AND METHODS: For the intended purpose, a total of 136 patients, composed of both males and females, with ages ranging from 20 to 69 years, in whom no pathology in the cervical prevertebral region was revealed by MRI modality implemented for various reasons, were included in the study. RESULTS: The upper limit of normal for PVST thickness was measured in our study to be 10 mm, 7 mm and 20 mm at C1, C2-C3 and C6-C7 vertebral levels, respectively. The least variation in the measurements and standard deviations were obtained at C3-C4 vertebral levels. Upon making a comparison between the measured PVST thicknesses on the basis of gender, the measurements at C2,C4 and C7 were found to display significant difference, whereas that was not the case for the measurements obtained at the other levels. CONCLUSION: Progressively widespread use of MRI for the traumas inflicting the cervical region makes it obligatory to specify normal values for the thickness of PVST measured by MRI.

Mutation in MEOX1 gene causes a recessive Klippel-Feil syndrome subtype.

BACKGROUND: Klippel-Feil syndrome (KFS) is characterized by the developmental failure of the cervical spine and has two dominantly inherited subtypes. Affected individuals who are the children of a consanguineous marriage are extremely rare in the medical literature, but the gene responsible for this recessive trait subtype of KFS has recently been reported. RESULTS: We identified a family with the KFS phenotype in which their parents have a consanguineous marriage. Radiological examinations revealed that they carry fusion defects and numerical abnormalities in the cervical spine, scoliosis, malformations of the cranial base, and Sprengel's deformity. We applied whole genome linkage and whole-exome sequencing analysis to identify the chromosomal locus and gene mutated in this family. Whole genome linkage analysis revealed a significant linkage to chromosome 17q12-q33 with a LOD score of 4.2. Exome sequencing identified the G > A p.Q84X mutation in the MEOX1 gene, which is segregated based on pedigree status. Homozygous MEOX1 mutations have reportedly caused a similar phenotype in knockout mice. CONCLUSIONS: Here, we report a truncating mutation in the MEOX1 gene in a KFS family with an autosomal recessive trait. Together with another recently reported study and the knockout mouse model, our results suggest that mutations in MEOX1 cause a recessive KFS phenotype in humans.

Etanercept treatment enhances clinical and neuroelectrophysiological recovery in partial spinal cord injury.

PURPOSE: To investigate the effect of an anti-TNF-α agent (etanercept) on recovery processes in a partial spinal cord injury (SCI) model using clinical and electrophysiological tests. METHODS: Twenty-four New Zealand rabbits were divided into three groups: group 1 [SCI + 2 ml saline intramuscular (i.m.), n = 8], group 2 (SCI + 2.5 mg/kg etanercept, i.m., 2-4 h after SCI, n = 8) and group 3 (SCI + 2.5 mg/kg etanercept, i.m., 12-24 h after SCI, n = 8). Rabbits were evaluated before SCI, immediately after SCI, 1 week after, and 2 weeks after SCI, clinically by Tarlov scale and electrophysiologically by SEP. RESULTS: Tarlov scores of groups 2 and 3 were significantly better than group 1, 2 weeks after SCI. SEP recovery was significantly better in groups 2 and 3 than group 1, 2 weeks after SCI. CONCLUSIONS: These results show that blocking TNF-α mediated inflammation pathway by an anti-TNF-α agent enhances clinical and electrophysiological recovery processes in partial SCI model.

Effect of cervical spinal cord electrical stimulation on nitric oxide levels in brain and dermal tissues: an evaluation using by real-time nitric oxide measurement.

OBJECTIVE: Nitric oxide synthesized from L: -arginine via the nitric oxide synthase enzyme family is the main regulatory molecule in many physiological systems. The level of nitric oxide can now be measured in tissues by a direct real-time amperometric method. The effect of electrical stimulation of the upper cervical spine on the arteries that supply the brain and upper extremities has been established by experimental studies, and thus it has begun to be used in clinical practice to increase blood flow in the brain and the peripheral vascular system. The mechanism of this effect is still a subject of research. This is the first report of real-time nitric oxide measurement in living brain and dermal tissue during electrical stimulation of the upper cervical spine. METHODS: Using the amperometric method, nitric oxide levels in frontal subcortical and front foot skin were measured before, during and after electrical stimulation of the upper cervical spine in three groups of rabbits that received infusions of saline solution, 7-aminoguanidine or atropine. RESULTS: By electrical stimulation, tissue nitric oxide levels increased significantly and remained increased during stimulation in the brain and skin. The nitric oxide levels dropped back to normal value 1 min after stimulation was turned off. CONCLUSION: The results we obtained have showed that real-time nitric oxide could also be measured by an amperometric method in living tissues like brain. The effect of stimulation on nitric oxide levels of living tissues disappears immediately when the stimulation is turned off.

Biological understanding of the cardiovascular risk associated with major depression and panic disorder is important.

INTRODUCTION: Panic disorder (PD) and major depressive disorders (MDD) are serious mental disorders but the mechanisms underlying the pathophysiology are poorly understood. Nitric oxide (NO) is a gas considered to play an important role in mediating anxiety and stress response and is synthesised from nitric oxide synthase (NOS). The endothelial isoform (eNOS) has been found also in platelets. Homocysteine (Hcy) is an amino acid which naturally occurs in the human body. Elevated levels are linked to increased risk of cardiovascular, neurological and psychiatric diseases. In this study we aimed to evaluate NO, platelet aggregation and Hcy levels in PD and MDD patients. MATERIALS AND METHODS: Nineteen PD and 18 MDD patients participated in this study. NO levels were measured spectrophotometrically, platelet aggregation levels were measured in an aggregometer and Hcy levels were measured by HPLC. RESULTS: NO levels were significantly lower in patients with MDD and PD than in control subjects (P < 0.05). Hcy and platelet aggregation levels were significantly higher in patients with MDD and PD than in control subjects (P < 0.05). CONCLUSION: Further more detailed studies are needed to find out the effects of drugs on these parameters or to disclose the exact mechanism underlying the alteration of these parameters.

Monostotic fibrous dysplasia of the clivus: imaging findings.

Fibrous dysplasia (FD) is an uncommon benign disorder of unknown etiology. It most likely represents a disorder of normal bone development. The disease can involve any bone in the body. In the head and neck, the skull and facial bones are involved in 10-25% of cases of monostotic FD. Involvement of the clivus in monostotic FD is extremely unusual, and has rarely been reported previously. The diagnosis is based on radiological images. We retrospectively reviewed our database and identified three patients with the diagnosis of FD of the clivus. We reviewed the clinical and radiological findings of these patients in this paper.

eNOS G894T polymorphism and abdominal aortic aneurysms.

BACKGROUND: The genetic risk factors that contribute to the risk of developing abdominal aortic aneurysm (AAA) are poorly understood. We assessed the association of endothelial nitric oxide synthase (eNOS) gene polymorphism with AAA. METHODS: eNOS gene polymorphism of 61 patients with AAA and 62 control participants were analyzed by polymerase chain reaction (PCR)-restriction technique. RESULTS: eNOS G894 homozygote T/T genotype polymorphism and 894T allele frequency in patients with AAA were significantly higher than those of the control participants (P = .01, P = .03). Among patients with AAA, the eNOS G894 T/T polymorphism and 894T allele frequency were associated with larger AAAs. CONCLUSION: The current study, in a small group of participants, showed a relationship between eNOS G894T polymorphism and AAA.

Paraganglioma in pituitary fossa.

Paragangliomas are neuroendocrine tumors of paraganglionic tissue which are extremely rare in the sellar area. We present a case of sellar paraganglioma with parasellar and suprasellar extension in a 70-year-old man who presented with headache. CT demonstrated sellar mass with suprasellar and right parasellar extension. The lesion was removed subtotally via a trans-sphenoidal approach. Histopathological diagnosis was paraganglioma. Differential diagnosis between paragangliomas and unusual types of pituitary adenomas, especially null-cell adenomas, is made by presence of cell nests (Zellballen) in paraganglioma, lack of immunopositivity for pituitary hormones, cytoplasmic immunopositivity for chromogranin A and neuron-specific enolase, and immunonegativity for cytokeratin 19, cytokeratin 20 and endomysial antibody. In the case of a mass in the sellar region, paraganglioma, although rare, should be included in the differential diagnosis.

[Diffuse cerebrovascular air embolism on CT secondary to cardiopulmonary resuscitation]. / Kardiyopulmoner resüsitasyon sonrasi BT'de saptanan difüz serebrovasküler hava embolizmi.

Air embolism is known to be a complicating factor in several clinical settings, including thoracic, cardiovascular and neurosurgical operations, central line placement, penetrating thoracic and cranial trauma and haemodialysis. Computed tomography (CT) is useful for showing cerebral air embolism. However, CT demonstration of massive air in all of the major cerebral arteries is extremely rare. In this report, we present a 45-year-old woman with cerebrovascular pneumoangiogram on postmortem CT examination after an unsuccessful posttraumatic cardiopulmonary resuscitation and discuss the possible mechanisms of pneumoangiogram.

Intracarotid L-arginine reverses motor evoked potential changes in experimental cerebral vasospasm.

OBJECTIVE: To investigate motor evoked potentials during short term L-arginine infusion in cerebral vasospasm after experimental subarachnoid hemorrhage. METHODS: Three groups were designated for this study: control group, subarachnoid hemorrhage-saline infusion group, and subarachnoid hemorrhage-L-arginine infusion group. A subarachnoid hemorrhage was created by intracisternal injection of autologous blood in New Zealand rabbits. At the fourth day of subarachnoid hemorrhage, latency and amplitude of motor evoked potentials were recorded during intracarotid saline and L-arginine infusion, and compared with motor evoked potential parameters of the control group. RESULTS: Motor evoked potential latencies were increased, and amplitudes were decreased in all animals before saline and L-arginine infusion on the fourth day of subarachnoid hemorrhage. A decrease in latencies as well as an increase in motor evoked potential amplitudes was observed with short-term intracarotid L-arginine infusion. CONCLUSION: Intracarotid short term L-arginine infusion significantly improves motor evoked potential parameters after experimental subarachnoid hemorrhage.

Intracisternal versus intracarotid infusion of L-arginine in experimental cerebral vasospasm.

AIM: The effect of short term intracisternal and intracarotid L-arginine infusion on experimental cerebral acute phase vasospasm in a rabbit subarachnoid haemorrhage model is investigated, and the two groups compared. MATERIALS AND METHOD: Subarachnoid haemorrhage was produced by intracisternal injection of autologous blood in New Zealand rabbits. On the fourth day after subarachnoid haemorrhage, cerebral blood flow was monitored using transcranial Doppler ultrasonography during intracisternal and intracarotid saline and L-arginine infusions. RESULT: Cerebral blood flow measurements revealed resolution of vasospasm with short-term intracisternal and intracarotid L-arginine infusion. No significant difference was found between the effects of intracisternal and intracarotid L-arginine infusions, however intracarotid L-arginine infusion created a more potent vasodilatation towards the end of infusion. CONCLUSION: Both intracisternal and intracarotid short term L-arginine infusion significantly improve acute phase cerebral vasospasm after experimental subarachnoid haemorrhage. Intracarotid L-arginine infusion is more potent and safer as large amounts of intracisternal L-arginine may lead to overproduction of nitric oxide by inducible nitric oxide synthase with the production of free radicals.

A safe and effective method for treatment of chronic subdural haematoma.

OBJECTIVE: Burr-hole irrigation and burr-hole drainage without irrigation are the most popular methods for treatment of chronic subdural haematoma. It is not well known if irrigation is necessary or which method has a higher recurrence rate. We compared the recurrence rates of those two methods. MATERIALS AND METHODS: Forty-two patients were treated by burr-hole irrigation (irrigation group), whereas 38 patients were treated by burr-hole drainage (drainage group). Recurrence rate and its relation with sex, age, haematoma localization and aetiology were investigated in both groups. RESULTS: There was no significant difference between recurrence rates of the two groups. There was also no correlation between recurrence rate and age, sex, haematoma localization, or aetiology. CONCLUSIONS: There was no significant difference between recurrence rates of the two groups. Since the burr-hole drainage method is simpler to carry out, its use may be preferable.

Intracranial plasma cell-granuloma with extensive ossification.

Intracranial plasma-cell granuloma is non-neoplastic proliferation of plasma cells which occurs rarely. We present an unusual case of an 18-year-old female patient with extensively ossified intracranial plasma-cell granuloma. Computed Tomography (CT) and Magnetic Resonance Image (MRI) demonstrated a left frontoparietal mass with extensive calcification. The lesion was removed subtotally. Histopathological findings revealed diffuse inflammatory cells consisting mostly of reactive plasma cells, histiocytes and neutrophils, several lymphocytes, lymphoplasmacytic cells, a few eosinophils throughout the dura and adjacent brain. Widespread psammomatous and dystrophic calcifications, and very extensive ossification with trabecular bone formation were present within the lesion. In the case of an intracranial mass lesion with calcification, plasma-cell granuloma, although rare, should be included in the differential diagnosis.