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Venogenic erectile dysfunction is an important problem. Embolization of draining veins through penile deep dorsal vein is an effective alternative endovascular treatment procedure. We report a 27-year-old male with venogenic erectile dysfunction who developed pulmonary embolism after penile deep dorsal vein embolization with n-butyl-2-cyanoacrylate (NBCA) and lipiodol mixture. Although it is uncommon, due to inherent possible complications of liquid embolic material n-butyl-2-cyanoacrylate and lipid soluble contrast material lipiodol, symptomatic pulmonary embolism could be seen after deep dorsal vein embolization if the amount of lipiodol is increased and repeat injection is performed without performing a control venogram.

Pyridoxine-dependent seizures are an extremely rare genetic disorder. Early diagnosis and treatment are important for the prevention of permanent brain damage. Elevated levels of glutamate and decreased levels of γ-aminobutyric acid (GABA) in the frontal and parietal cortices are among the characteristic features of this disorder. These metabolic abnormalities eventually lead to seizures and neuronal loss. In this case report, we present magnetic resonance spectroscopy findings of a 9-year-old girl with pyridoxine-dependent seizures with mental retardation. The N-acetyl-aspartate-to-creatine ratio was found to be decreased in the frontal and parieto-occipital cortices, which could indicate neuronal loss. Magnetic resonance spectroscopy could be a useful tool in the neuroimaging evaluation for assessment of parenchymal changes despite a normal-appearing brain magnetic resonance image in patients with pyridoxine-dependent seizures. ( J Child Neurol 2004;19:75—78).

A 45-year-old woman presented with an extremely rare metastatic fibrosarcoma of the brain manifesting as persistent headache. She had undergone surgery for a fibrosarcoma of the soft tissue of the thigh 2 months earlier. She had a history of previous surgery and radiotherapy for this tumor. She was somnolent with papilledema and left hemiparesis. Magnetic resonance imaging of the brain revealed a right frontal lesion with mass effect and heterogeneous enhancement. Computed tomography and scintigraphy showed multiple metastatic lesions of the lung. Right frontal craniotomy was performed for gross total removal of the yellowish-white tumor. Histological examination showed signs of epithelioid transformation based on positive staining for epithelial membrane antigen compared to the primary tumor. Postoperatively the patient was alert and the left hemiparesis improved. She refused radiotherapy or chemotherapy. Follow-up computed tomography showed multiple intracranial metastases. She died 5 months after the surgery.

To determine whether differences exist between neurofibromatosis type 1 (NF1) patients with or without focal lesions and healthy normal volunteers in the metabolite ratios of normal appearing white matter, 27 patients with NF1 (with parenchymal lesion, MR positive, n: 17; without parenchymal lesions, MR negative, n: 10) and 20 healthy volunteers underwent MRI and short TE (31 ms) proton MR spectroscopy (MRS). In 17 patients with parenchymal lesions, 61 focal lesions were detected by MRI. MRS was performed from normal appearing frontal and posterior parietal white matter (FWM and PWM) in NF1 and from control groups. NAA/Cr, Cho/Cr and MI/Cr ratios were calculated. Significant increase in Cho/Cr and MI/Cr ratios were found in FWM and PWM in MR negative and positive groups when compared to control group. NAA/Cr ratio in MR positive group was significantly decreased in FWM compared to control group. There were no significant differences between FWM and PWM in all metabolite ratios of MR negative group. MI/Cr ratio in MR positive group was significantly elevated in PWM compared to FWM. Metabolite changes detected by MRS could indicate demyelination and gliosis in normal appearing white matter in all NF1 patients, and additionally neuroaxonal damage in the FWM of NF1 patients with focal lesions. For that reason, in the clinical evaluation and follow-up of these patients MRS features of normal appearing white matter should be considered in addition to focal lesions.

A case of atlanto-axial subluxation in a 5-year-old boy with Rubinstein-Taybi syndrome (RTS) is presented and the imaging findings are evaluated. To the best of our knowledge, atlanto-axial subluxation has not been reported in association with this syndrome. © 2003 Elsevier Ireland Ltd. All rights reserved.

Multiseptate gallbladder is a very rare congenital malformation of the gallbladder. We present the magnetic resonance imaging, ultrasonography and magnetic resonance cholangiography appearance of a multiseptate gallbladder in a 9-year-old boy. To our knowledge, this is the first description of the magnetic resonance imaging and magnetic resonance cholangiography appearance of a multiseptate gallbladder.

We report a case of pseudoaneurysm following mumps infection in the left internal jugular vein with sonography and Doppler ultrasound findings. The diagnosis was confirmed during surgical exploration. To the best of our knowledge, this is the first case report of an internal jugular vein false aneurysm in the literature.

En-plaque tuberculoma is a rare manifestation of CNS tuber- culosis and presents as a solitary, fo- cal, caseous plaque-like lesion. It is difficult to differentiate en-plaque like meningeal tuberculoma from true primary or secondary meningeal neoplasia. Good response to antitu- berculosis treatment in a patient with tuberculosis history and typical MR findings confirm the diagnosis. We present the follow-up MR imaging findings of a case in which an en- plaque tuberculoma on tentorium was diagnosed during pregnancy in a patient with a history of tuberculosis. To the best of our knowledge, en- plaque tuberculomas of tentorium during pregnancy have not been re- ported before.

Purpose: To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm. Case Report: An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated. Conclusions: Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.

Background: Although there are a few reports describing abscess formation in endometriotic foci no report of abscess formation arising de novo within adenomyosis appears in the literature. Preoperative diagnosis of adenomyosis is frequently difficult because of non-specific signs and symptoms. Synchronous pelvic pathologies such as leiomyoma, endometrial polyp, endometrial hyperplasia, as well as endometrial cancer may cause differential diagnostic problems. Case: A 54-year-old postmenopausal woman complaining of inguinal pain, nightsweats and hot flashes is presented. Radiologic examinations of the pelvis revealed a 95 × 85 mm leiomyoma-like lesion including a 53 × 43 mmcystic space and 9 × 6 mmpapillary formation within the uterus raising clinical suspicion of malignancy. A total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed accompanied by a frozen section diagnosis. The frozen section revealed an abscess formation arising in a focus of adenomyosis. The postoperative period of the patient was uneventful. Conclusion : The present case, to our knowledge, is the first report representing abscess formation in adenomyosis. Abscess arising within adenomyosis can strongly raise the suspicion of endometrial cancer, particularly if the patient is postmenopausal. If endometrial cancer cannot be ruled out with definitive histopathological diagnosis in the preoperative period, a frozen section becomes mandatory during surgical intervention.

Aim The purpose of our study was to determine whether the administration of contrast material affects the results of MR Spectroscopy (MRS) in different intraaxial brain tumors. Materials and methods Thirty-three patients (median range 46.72 ± 2.95, range 9–77) with intraaxial brain tumors underwent MRS before and 5 min after intravenous administration of gadolinium based contrast material at the standard dose of 0.1 mmol/kg (Gadodiamide or Gd-DOTA). Metabolite ratios (N-acetyl aspartate (NAA)/Creatine (Cr), Choline (Cho)/Cr, and NAA/Cho) were calculated. Results There was no significant difference between the pre and postcontrast MRS spectra as regards to NAA/Cr (p:0.4), Cho/Cr (p:0.2), and NAA/Cho (p:0.2) ratios obtained from the intraaxial brain tumors. Conclusion Contrast material administration did not change the metabolite ratios of MRS. Contrast administration would be useful in guiding voxel localization in MRS evaluation of intraaxial brain tumors.

Purpose The purpose of our study was to evaluate the relationship between the splenoportal hemodynamics in patients with cirrhosis and the stage of the disease. Methods Patients with cirrhosis were grouped according to modified Child-Pugh scoring into stages A, B, and C of cirrhosis. A control group of healthy volunteers was included. After gastroenterologic clinical and laboratory examinations, all participants underwent a splenoportal Doppler sonographic evaluation in which the vessels' diameter, area, and blood flow velocity were measured and blood flow rate and the congestion index in the splenoportal venous system were calculated. Results Seventy-five patients with cirrhosis (25 women and 50 men) were enrolled; the control group consisted of 30 healthy volunteers (15 women and 15 men) with no liver disease. The mean age (± standard deviation) of the patients was 54.4 ± 14.8 years (range, 13–80 years) and of the control subjects was 47.3 ± 14.5 years (range, 18–72 years). No significant differences in vessel diameter, blood flow velocity, and blood flow rate were found in the main and left portal veins between the study group and the control group. In the right portal vein, we found decreases in the vessel diameter, blood flow velocity, and blood flow rate, and in the splenic vein, we found increases in vessel diameter and blood flow rate. The congestion index was increased in the main portal and splenic veins but was unchanged in the left portal vein. Conclusions Although our data indicate that there is no difference in Doppler sonographic parameters of the main portal vein according to Child-Pugh scores, the hemodynamic differences between the left and right branches of the portal vein may be clinically useful in patients with cirrhosis. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30: 537–543, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10114

The purpose of this article was to review the anatomy of the cavernous sinus (CS), illustrate numerous lesions that can affect the CS, and emphasize the imaging characteristics for each lesion to further refine the differential diagnoses. The CS, notwithstanding its small size, contains a complicated and crucial network that consists of the carotid artery, the venous plexus, and cranial nerves. The wide-ranging types of pathologies that can involve the CS can be roughly classified as tumoral, congenital, infectious/inflammatory/granulomatous, and vascular. Conditions that affect the CS usually lead to symptoms that are similar to each other; thus, for diagnosis, imaging procedures are required. Radiological evaluations are also required to detect pre- and postoperative CS invasion. Magnetic resonance imaging, which can be supplemented with thin-section contrast-enhanced sequences, is the preferred imaging technique for evaluating the CS. For correct diagnosis of CS lesions and accurate evaluations of CS invasions, it is essential to carefully analyze the anatomical structures within the CS and to acquire precise knowledge about the imaging features of CS lesions, which may frequently overlap.

OBJECTIVES To evaluate bone-healing effects of local simvastatin application to critical size defects (CSDs) in the experimental diabetes mellitus (DM) rat model. MATERIALS AND METHODS A total of 35 male Sprague-Dawley rats with an average weight of 350 g and aged 3 months were used in this study. The rats were divided into five groups of seven animals each: passive control (group A), active control (group B), 0.5 mg simvastatin (group C), 1.0 mg simvastatin (group D), and 1.5 mg simvastatin (group E). Streptozotocin was used to induce Type 1 diabetes in all rats. Eight mm CSDs were created under anesthesia in each rat calvarium. CSDs were left empty in group A. Defects in group B were grafted alone with a gelatin sponge mixed with normal saline. Defects in the experimental groups (groups A, B, and C) were grafted with gelatin sponge mixed saline solutions contain 0.5, 1.0, 1.5 mg simvastatin. Rats were sacrificed after 1 month, and the defects were prepared for radiologic and histomorphometric assessment of regenerated bone. RESULTS None of the specimens exhibited complete closure of new bone across the 8-mm defect. A correlation between computed tomography and histomorphometric analysis was not determined. Both amount of volume and area of regenerated bone were found higher in the experimental groups than in the control groups. However, these values were not found statistically significant degree (P < 0.05) for each groups. The density of regenerated bone in the region of interest was higher in the control groups in contrast to in the experimental groups. However, statistical significance was just found between groups C and A and between groups C and B (P < 0.05). CONCLUSION The local simvastatin application enhanced healing of the bone defects in the diabetic rat model CSDs.

During the follow-up of recurrent pneumonia in a 9-month-old girl, rhinorrhea with discharge of a positional and intermittent nature was discovered. Radiological assessment was requested to detect any skull base openings and cerebrospinal fluid (CSF) leakage. T2-weighted MR cisternography showed bilateral inner ear dysplasia, communication of the internal auditory canal with the vestibule, and effusion in the right middle ear. Intrathecal contrast-enhanced MR cisternography revealed a CSF fistula from the right internal auditory canal to the Eustachian tube. The patient was operated upon on the right side, and the presence of a CSF leak near the oval window was confirmed. No adverse effects were seen during the short-term and long-term follow-up. Diagnosing this case required special attention, careful examination, and relevant investigations to find the site of CSF leakage in this patient with bilateral inner ear dysplasia.

Objective: We examined brain diffusion changes of patients with acromegaly. We searched whether there are differences in apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values between remission and nonremission patients with acromegaly and investigated any effect of time of hormone exposure on diffusion metrics. Methods: The values of FA and ADC were calculated in a total of 35 patients with acromegaly and 28 control subjects. Patients were subdivided into remission and non-remission groups. We looked at brain FA and ADC differences among the groups and looked for any relation between the diffusion changes and time of hormone exposure among the patients with acromegaly. Results: We found decreased FA and increased ADC values in some of the growth hormone responsive areas. There were no significant brain diffusion changes between remission and non-remission groups. The most affected areas were the hypothalamus, parietal white matter and pre-motor cortex in patients with acromegaly. In terms of hormone exposure time among the patients with acromegaly, there was no effect of disease duration on brain microstructural changes. Conclusion: All patients with acromegaly showed increased brain diffusion with no relation to disease duration and treatment status. We suggested that in patients with acromegaly, brain damage had already occurred in the subclinical period before symptom onset. Advances in knowledge: This study contributes to the understanding of the mechanisms in acromegaly.

Glutaric aciduria type-1 (GA-1) is a disorder of amino acid metabolism. The usual clinical-onset is an acute encephalopathic crisis in early childhood. There are only a few cases diagnosed in older age groups. MRI features of the disease are well defined. However, there are limited number of studies concerning advanced neuroimaging findings. We present DWI and MRS findings of an 11 year-old GA-1 patient admitted with an encephalopathic crisis. Diffusion restrictions in bilateral basal ganglia, corpus callosum and periventricular deep white matter were observed. In left occipital periventricular white matter and left basal ganglia, mild increased Cho/Cr and MI/Cr ratios and decreased NAA/Cr ratio were detected. Also inverted double lactate peak (TE: 135 ms) was present at 1.33 ppm in the left basal ganglia. In addition to these findings, a peak at 1.56 ppm above the baseline was seen on both short and long echo-time MRS in left occipital lobe deep white matter which may show accumulation of degradation products of amino acids in the GCDH enzyme deficiency.

To evaluate neurochemical alterations in Heschl's gyri and determine the most affected side in case of unilateral acoustic neuroma using magnetic resonance spectroscopy (MRS).Fifteen patients with unilateral acoustic neuroma were studied. Following routine cranial MRI sequences, MRS of Heschl's gyri on tumor and nontumor sides was obtained. MRS metabolite values of both Heschl's gyri were statistically compared.The values of N-acetylaspartate (NAA) and Cr on nontumor side Heschl's gyrus (HG) were significantly lower than that on tumor side.We found nontumor side HG more affected with lower NAA and Cr values, suggesting neuronal damage and decreased energy metabolism compared to the tumoral side.

Purpose.We investigated diffusion alterations in specific regions of the brain in morbid obese, obese, and nonobese OSA patients and searched whether there is a correlation between BMI and ADC values.Materials and Methods.DWIs of 65 patients with OSA were evaluated. The patients were classified according to BMI as morbid obese (n=16), obese (n=27), and nonobese (control,n=22) groups. ADC measurements were performed from 24 different regions of the brain in each patient. The relationship of BMI with ADC values was searched.Results.The ADC values in hypothalamus, insular cortex, parietal cortex, caudate nucleus, frontal white matter, and posterior limb of internal capsule were all increased in obese patients (n=43) compared to control group. The ADC values of midbrain, hypothalamus, orbitofrontal cortex, and parietal cortex were significantly increased in morbid obese compared to obese patients. In obese patients, the degree of BMI was positively correlated with ADC values of orbitofrontal cortex, parietal cortex, and hypothalamus.Conclusion.We observed increasing brain vasogenic edema with increasing BMI, suggesting that the main reason of brain diffusion alteration in patients with OSA could be obesity related.

Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.

Digital Photography X -- 3 February 2014 through 5 February 2014 -- 105377 Objectives: To evaluate the usefulness of power Doppler vocal fremitus (PDVF) breast sonography for differentiation of hamartomas from other breast (malign or benign) masses. Material and methods: Two hundred and six breast masses in 180 women were evaluated. The breast lesions were scanned first by mammography (MG), then by ultrasonography (US) with PDVF imaging. Finally, biopsy was performed on lesions suspicious for malignancy (n=172). We used PDVF imaging to evaluate whether the Power acoustic Doppler artifact existed in all breast lesions. Results: Pathology results of 172 biopsied lesions showed that 83 were malign and 89 masses were benign. Totally 39 breast hamartomas were diagnosed radiologically (n=25) or histopathologically (n=14). All hamartomas (n=39) produced the power acoustic Doppler artifact as the surrounding tissue at the same depth in PDVF imaging. On the other hand, none of the malign or benign lesions, apart from hamartomas, evidenced a similar vibrational artifact as the surrounding tissue at the same depth in the PDVF imaging. Conclusion: PDVF imaging during breast sonography is an invaluable technique in the identification of breast hamartomas from other benign or malign breast masses.

OZET Bu arastirma ile , Isparta ili ortaogretim kurumlarinda gorev yapan tarih ogretmenlerinin tarih ve tarih dersine dair (tarihsel) ogrenme ve dusunce gelisimi ile ilgili goruslerinin belirlenmesi amaclanmistir. Ayrica,bu arastirma ile orta ogretim okulu tarih konularinin ogretiminde elestirel ve yaratici dusuncenin gelistirilip kullanilmasi, elestirel ve yaratici dusuncenin onundeki engeller, elestirel ve yaratici dusunme yontem ve teknikleri, ogretmenlerin elestirel ve yaratici dusunceyi harekete geciren etkinlikleri kullanma sikliklari, gerekceleri ve konu ile ilgili dusunceleri tespit edilmistir. Anahtar Kelimeler: Tarih, Tarih Ogretimi, Yaratici Tarih ogretimi

Reversible corpus callosum splenial (CCS) lesions are rare findings and usually detected incidentally. We presented a case of 15-year-old boy with a diagnoses of nephrotic syndrome. He was referred for neuropsychiatric symptoms following dose reduction on steroid treatment. Brain magnetic resonance imaging (MRI) revealed a focal lesion in the CCS, hyperintense on T2 and FLAIR and hypointense on T1 images with diffusion restriction on apparent diffusion coefficient map. Follow-up MRI 3 weeks later showed complete resolution of the lesion. It was probably result of focal intramyelinic edema due to excytotoxic mechanisms and/or arginine-vasopressin release.

Portosystemic collaterals are the natural consequence of portal hypertension. These collaterals can occur anywhere in the gastrointestinal tract. Apart from the usual sites, they can develop in some unusual and rare locations. In this report, imaging findings of an unusual venous collateral pathway between spleen and left subclavian vein in a 30-year-old female patient with cirrhosis and portal hypertension are presented.

Hallermann-Streiff syndrome is a rare clinical entity with unknown etiology characterized by a birdlike face, microphthalmia, a beaked nose, hypotrichosis, and proportional small stature. We present a 4-year-old boy in whom magnetic resonance imaging showed complete agenesis of the corpus callosum, which has not been presented in the literature. ( J Child Neurol 2005;20:691—693).

Transfusion-associated graft-versus-host disease (TAGvHD) is in most cases refractory to immunosuppressive therapy and fatal because of severe bone marrow aplasia. Mucormycosis is a rare invasive fungal infection, but it has clinical importance because of its often delayed diagnosis and high mortality. Invasive mucomycosis is frequently associated with diabetes mellitus, neutropenia, severe immunodeficiencies following steroid therapy, organ transplantation, cytotoxic chemotherapy, and AIDS. We present a case of lethal rhino-orbito-cerebral mucormycosis after TA-GvHD in an initially healthy patient.

A 46-year-old woman with Gaucher’s disease (GD) consulted our clinic for abdominopelvic magnetic resonance imaging (MRI), as physical examination had revealed hepatosplenomegaly. Upper abdominal MRI showed massive hepatosplenomegaly and innumerable hypointense splenic nodules on T1-weighted images. Diffusion-weighted MRI (DW-MRI) and magnetic resonance spectroscopy (MRS) were performed to liver parenchyma and splenic nodules. MRS revealed lactate, lipid, acetate, and alanine peaks in splenic nodules, and choline, creatine, lipid, myo-inositol-glycine, and lactate peaks in the liver parenchyma. The DW-MRI showed diffusion restriction in splenic nodules. It was concluded that MRI is a reliable method for the diagnosis and follow up of GD. Coupling DW-MRI and MRS allows quantitative evaluation, thereby increasing the efficacy of the method. This is the first report in the literature presenting advanced abdominal MRI findings in GD.

Pheochromocytoma is a rare cause of hypertension in children. Hypertension is one of the common reasons of posterior reversible encephalopathy. Intracerebral hemorrhage is a serious and unexpected complication of hypertensive encephalopathy due to pheochromocytoma, and very rarely seen in the childhood. Intracerebral hemorrhages should be searched if there are hypertensive reversible signal changes on the brain. Susceptibility weighted imaging (SWI) is a more sensitive method than conventional MRI when demonstrating cerebral microhemorrhagic foci. This is the first report of SWI findings on intracerebral hemorrhages in basal ganglia, brain stem and periventricular white matter due to hypertensive encephalopathy in a child with pheochromocytoma.

Background Refractory status epilepticus is a prolongation of status epilepticus despite anticonvulsant therapy with two or three medications in proper doses; it is defined as malignant status epilepticus if it takes weeks or months. Intravenous immunoglobulin, high-dose steroids, magnesium infusion, pyridoxine, hypothermia, ketogenic diet, electroconvulsive therapy, and surgical therapy are the other treatment options for status epilepticus. Patient Our 5-year-old male patient was hospitalized at our pediatric intensive care unit because of status epilepticus secondary to meningoencephalitis. No response could be obtained with many medical and nonmedical therapies in our patient, who developed malignant status epilepticus with unknown etiology. Therapeutic plasma exchange was applied as convulsions continued. Result Ours is the first child for whom therapeutic plasma exchange was successfully applied because of malignant refractory status epilepticus secondary to meningoencephalitis. Conclusion Therapeutic plasma exchange may be a treatment option for children with refractory status epilepticus following presumed meningoencephalitis.

We presented MRI and DWI findings of a 12-year-old boy with primary carnitine deficiency, manifested with hypoglycemic hypoketotic encephalopathy.Magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) were performed to the patient.In our case, T2 hyperintensity and diffusion restriction were noted bilaterally in the corona radiate, cerebral white matter, deep white matter of cerebellum, ascending (inferior cerebellar peduncle) and descending tracts (corticospinal and corticobulbar tracts) of brainstem.MRI and DWI are helpful in the diagnosis, therapy planning and follow up of encephalopathic cases with carnitine deficiency.

Nonketotic hyperglycemia has been described as a metabolic cause of Hemiballism-hemichorea (HB-HC), especially in elderly patients with poorly controlled diabetes. Pathophysiology is not known yet. MRI features tend to be hyperintense in the putamen on T1-weighted images. We present conventional MRI with diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI) features of two cases with nonketotic hyperglycemia. T1 hyperintensity without diffusion restriction on DWI and minimal putaminal hypointensity without phase shift on SWI were compatible with either pathological mineralization or petechial microhemorrhage or protein denaturation. In the type 2 diabetic patients with HC-HB, conventional MRI together with SWI and DWI will guide to clinician to plan treatment approach.

Compartment syndrome occurs when the pressure inside a closed fascial compartment increases to a level that compromises the blood supply to the structures. Untreated compartment syndrome commonly leads to muscle necrosis, limb amputation, and, if it is severe, which is seen in large compartments, renal failure and death may occur. We discussed MRI findings of crural compartment syndrome based on the case series.

Megalencephalic leukoencephalopathy with subcortical cysts MLC) is a rarediseasefirst describedbyvanderKnaap, et al. in1995 1]. The classic phenotype is characterized by early onset macroephaly and delayed-onset neurological deterioration. Patients evelop macrocephaly during the first year of life. After sevral years, there is evidence of slow neurological deterioration, ncluding gradual onset of cerebellar ataxia, spasticity, seizures, nd sometimes extrapyramidal findings; and usually late onset of ild cognitive decline. Several genotypic and phenotypic variaions have been described [2]. An atypical improving phenotype as a similar initial presentation without mental or motor regresion, followed by an improving clinical course:motor and cognitive unctions improve or normalize. Some patientswith the latter pheotype have intellectual disability that is stable with or without utism [2]. MLC is more commonly reported in communities having conanguineous marriages and in people of Indian descent from the grawal community [2]. It is an autosomal recessive disorder most ften due tomutations inMLCI gene,which are observed in approxmately 75% of patients with MLC, which is known as classic

The incidence of pisiform fracture is very low, and generally it is associated with other carpal or distal radial injuries. We present the case of an acute isolated pisiform fracture suspected on plain films and diagnosed on magnetic resonance imaging (MRI). MRI revealed a fracture line within the pisiform bone and helped to exclude additional fractures and soft-tissue injuries. Immobilization in a short arm cast was applied for 4 weeks, and the patient had good clinical response.

Background: Our aim was to assess the value of brain apparent diffusion coefficient (ADC) in Intra Cytoplasmic Sperm Injection (ICSI) and spontaneously conceived preterm singletons. Methods: Twenty ICSI-conceived preterm singletons and 20 gestational age matched spontaneously conceived preterm singletons were studied. All subjects underwent diffusion-weighted imaging (DWI). The main outcome measure was the brain ADC value in the in ICSI-conceived and naturally conceived newborns. Results: Children born after ICSI had an increased ADC value than the controls. The ADC values of ICSI-conceived singletons were higher than those of spontaneously conceived singletons at cerebellum, corpus striatum, frontal lobe, occipital lobe, and temporal lobe white matter. The mean Apgar score, birth weight, height, and head circumference of ICSI children were found to be similar to naturally conceived children. Conclusions: Measuring ADC value may be a promising marker in identifying neurological outcome of ICSI-conceived newborns.

Background: Obstructive sleep apnoea syndrome (OSAS) is a disorder characterized by repeated apnoeic episodes during sleep. Neurocognitive changes secondary to OSAS are likely to occur due to hypoxia in certain brain locations. Advances in magnetic resonance imaging technology, such as diffusion-weighted imaging (DWI), enable non-invasive and accurate identification of OSAS-induced changes. Objective: We aimed to use DWI to investigate changes in the brain secondary to hypoxia in OSAS. Methods: Eighty-eight patients underwent polysomnography and were classified as non-OSAS, mild-moderate OSAS and severe OSAS sufferers. DWI was used to evaluate 14 areas of the brain, and apparent diffusion coefficients (ADCs) were calculated. We investigated whether there were differences in the ADC values in specific areas of the brain between the non-OSAS and OSAS patients. Results: We measured the ADC values of the 68 newly diagnosed OSAS patients (21 mild, 15 moderate and 32 severe) and of 20 healthy controls. There were significant increases in the ADC values in the hippocampus, amygdala and putamen in OSAS patients. Compared to the non-OSAS subjects, the ADC values of the putamen in severe OSAS patients, those of the hippocampus in moderate or severe OSAS patients and those of the amygdala in moderate OSAS patients were significantly increased. A negative correlation between the lowest oxygen saturation during sleep and the ADC values of the hippocampus and amygdala was found. Conclusions: Increased ADC levels in the hippocampus, amygdala and putamen in OSAS patients indicate hypoxia and likely cause vasogenic oedema in specific regions of the brain.

Background: Virchow-Robin (VR) spaces are the fluid-filled perivascular spaces adjacent the brain vessels. The signal intensities of the VR spaces are very similar to those of cerebrospinal fluid (CSF). VR spaces should be distinguished various pathologic conditions, including lacunar infarctions, cystic periventricular leukomalacia, cryptococcosis, cystic neoplasms and neuroepithelial cysts. Case presentation: 32-year-old female with 6 month history of worsening severe headaches. The clinical examination and laboratory findings were congruent with hypothyroidism. MR imaging revealed multiloculated, thin-walled, “soap bubble” like lesions cystic lesions involving anterior part of left cingulated gyrus. Cystic lesions showed the same signal intensity characterstics with CSF. There was no any mass effect, enhancement, peripheral edema and no restriction in diffusion-weighted images. After 10 month follow-up there was no any change in size or in MRI features. Conclusion: Knowledge of the signal intensity characteristics, locations of VR spaces and absence of any change in follow up prevents unnecessary biopsy.

To evaluate metabolite changes in the visual cortex of diabetic patients with nonproliferative or proliferative diabetic retinopathy by Magnetic Resonance Spectroscopy (MRS).15 normal subjects (group 1), 15 patients with diabetes who did not have diabetic retinopathy (group 2), 15 patients with nonproliferative diabetic retinopathy (NPDR) (group 3), and 15 patients with proliferative diabetic retinopathy (PDR) (group 4) were included in the study. Furthermore, diabetic patients were divided into two groups according to HbA1c levels (Group A: 20 patients, HbA1c8%; Group B: 20 patients, HbA1c8%). In all cases' left visual cortex, amounts of N-acetyl-aspartate (NAA), choline (Cho), and creatine (Cr) were measured by MRS. NAA/Cr, Cho/Cr, and NAA/Cho ratios were calculated. Furthermore, all cases' complete blood count (CBC) and biochemical parameters were evaluated.There was no statistically significant difference for NAA/Cr, Cho/Cr, and NAA/Cho ratios between groups 1, 2, 3, and 4 (P0.05). However there was a statistically significant difference for NAA/Cr and NAA/Cho ratios between groups A and B (P0.05). There was no statistically significant difference for Cho/Cr ratio between groups A and B (P0.05).Although NAA/Cr and NAA/Cho ratios decrease in the visual cortex while diabetic retinopathy progresses, these decreases are not statistically significant. While HbA1c levels increase, the NAA concentration decreases in the visual cortex which indicates neuronal loss. The metabolite changes in the visual cortex are associated with acute events rather than chronic.

Hypoglycemia manifests as hemiparesis, mimicking stroke. Diffusion-weighted MRI (DWI) is a useful method to detect early brain injury in acute ischemia, but is less well known in hypoglycemia-induced hemiparesis [1–3]. Brain changes due to hypoglycemia are reversible, but irreversible changes can occur if not treated promptly. In the literature, there are limited reports about DWI features of transient hypoglycemia in which diffusion correction is shown starting from 12 h to 2 or 3 days following correction of hypoglycemia. We presented a case of hypoglycemic encephalopathy in which diffusion restriction almost rapidly resolved in 2 h following glucose infusion, probably due to the patient's young age.

Cutaneous anthrax, caused by Bacillus anthracis contacting the skin, is the most common form of human anthrax. Recent studies implicate the presence of additional, possibly toxin-related subtle changes, even in patients without neurological or radiological findings. In this study, the presence of subtle changes in cutaneous anthrax was investigated at the metabolite level using magnetic resonance spectroscopy. Study subjects were consisted of 10 patients with cutaneous anthrax without co-morbid disease and/or neurological findings, and 13 healthy controls. There were no statistical differences in age and gender between two groups. The diagnosis of cutaneous anthrax was based on medical history, presence of a typical cutaneous lesion, large gram positive bacilli on gram staining and/or positive culture for B. anthracis from cutaneous samples. Brain magnetic resonance imaging examination consisted of conventional imaging and single-voxel magnetic resonance spectroscopy. Magnetic resonance spectroscopy was performed by using point-resolved spectroscopy sequence (TR: 2000 ms, TE: 136 ms, 128 averages). Voxels of 20 mm x 20 mm x 20 mm were placed in normal-appearing parietal white matter to detect metabolite levels. Cerebral metabolite peaks were measured in normal appearing parietal white matter. N-acetyl aspartate/creatine and choline/creatine ratios were calculated using standard analytical procedures. Patients and controls were not statistically different regarding parietal white matter N-acetyl aspartate/creatine ratios (p = 0.902), a finding that implicates the conservation of neuronal and axonal integrity and neuronal functions. However, choline/creatine ratios were significantly higher in patient groups (p = 0.001), a finding implicating an increased membrane turnover. In conclusion, these two findings point to a possibly anthrax toxins-related subtle inflammatory reaction of the central nervous system at the cellular level. (C) 2012 Elsevier Ltd. All rights reserved.

Objective. To search brain perfusion MRI (pMRI) changes in Behcet’s disease (BD) with or without neurological involvement.Materials and Method. The pMRI were performed in 34 patients with BD and 16 healthy controls. Based on neurologic examination and post-contrast MRI, 12 patients were classified as Neuro-Behcet (group 1, NBD) and 22 patients as BD without neurological involvement (group 2). Mean transit time (MTT), time to peak (TTP), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) were obtained and compared to those of healthy control group (group 3).Results. There was a significant difference in the MTT and rCBF within the pons and parietal cortex in groups 1 and 2. rCBV increased in cerebral pedicle in group 1 compared with groups 2 and 3. In the temporal lobe white matter, prolonged MTT and decreased rCBF were found in groups 1 and 2. In the corpus striatum, internal capsule, and periventricular white matter, rCBF increased in group 1 compared with group 3 and decreased in groups 1 and 2.Conclusion. Brain pMRI is a very sensitive method to detect brain involvement in patients with BD and aids the clinical diagnosis of NBD, especially in patients with negative MRI findings.

Timetabling problems are well known NP-hard constraint satisfaction problems, and real-world cases often have complicated and challenging structures. For such problems, we present a new hybrid method, Interleaved Constructive Memetic Algorithm (ICMA) that interleaves memetic algorithms with constructive methods. ICMA works using an active subset of all the events. Starting with a few events, in multiple construction stages ICMA increases the active set to eventually include all of them. At each stage, a memetic algorithm (MA) is applied to improve the current partial solution before the next construction step. We also describe a real-world course timetabling problem, the Preparation School Timetabling Problem (PSTP), which is of particular interest because it has a highly hierarchical structure arising from various organisational requirements. An important advantage of ICMA is that both the constructive heuristics and MA can be tailored to exploit such hierarchical structures. We give empirical results showing that ICMA performs better than the corresponding conventional MA on the PSTP. © 2011 Elsevier Ltd. All rights reserved. Engineering and Physical Sciences Research Council: EP/F033214/1

Glutaric aciduria type I is an uncommon inborn error of metabolism. It is a serious disease, often with a fatal outcome. Magnetic resonance imaging findings and the clinical course of monozygotic twin females with glutaric aciduria type I who were admitted with acute encephalopathic crisis symptoms 3 days after immunization for poliovirus are presented in this report. Magnetic resonance imaging findings revealed hyperintensity in the putamen, head of the left caudate nucleus, and globus pallidus, periventricular white matter (on T(2)-weighted images), arachnoid cysts in bilateral temporal regions, and enlargement of the sylvian fissures. Glutaric aciduria type I should be included in the differential diagnosis of patients with acute encephalopathic crisis occurring shortly after poliovirus immunization. Typical magnetic resonance findings guide urinary organic acid analysis in these patients.

MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings.

Maple syrup urine disease (MSUD) is caused by a genetic defect of branched-chain amino acids, which include leucine, isoleucine and valine. We report diffusion-weighted imaging (DWI) findings in a newborn child with MSUD who presented with acute metabolic encephalopathic crisis. DWI (b = 1,000 s/mm(2)) showed high signal localized within the myelinated white matter (WM) areas including the cerebellar white matter, pons, bulbus, cerebral peduncles, lentiform nucleus, posterior limbs of the internal capsules, corona radiata and bilateral perirolandic cortex. The apparent diffusion coefficient values of these regions were markedly low in the affected areas. The presence of these findings was considered cytotoxic or intramyelinic edema evidenced by restricted water diffusion. In conclusion, our findings suggest that during the acute phase and early encephalopathic crisis stage of MSUD, DWI can demonstrate the involvement of myelinated WM in newborns.

The aim of this study was to assess the shape differences of the corpus callosum (CC) in patients with Behçet's disease using statistical shape analysis (SSA). Additionally, an attempt was made to investigate the changes in CC size according to disease duration. Twenty-five adults with clinically diagnosed Behçet's disease and 25 age- and gender-matched controls were examined by high-resolution structural magnetic resonance imaging. The data obtained from the coordinate of landmarks were analyzed with Euclidean distance matrix analysis and a thin-plate spline analysis. SSA and growth curve models were performed to investigate group differences and to fit the curves. A significant difference was determined between CC shape of Behçet patients and controls (P = 0.006). Based on the analysis, a decrease occurred in the CC size of the Behçet patients as the duration of disease increased. Maximum deformations were determined in the landmarks of interior notch of the splenium, inferior tip of the splenium, posterior-most point of the CC, and topmost point of the CC. Similarly, the landmark of anterior-most point of the CC was identified as having the minimum deformation. Behçet patients had significantly different CC shapes from control subjects. The results suggest that SSA is a promising tool for distinguishing Behçet patients from normal subjects, and that it can give useful information to assist clinicians. Additionally, SSA might be applied to detect shape differences in anatomical structures that are affected by a broad range of neurological diseases.

Neuroimaging constitutes an important component in the diagnosis of the underlying infectious agents in central nervous system (CNS) infections. Despite the recent advances in neuroimaging evaluation, the diagnosis of unclear infectious CNS diseases remains a challenge. Conventional magnetic resonance imaging (MRI) is used in routine practice to identify abnormal areas involved in CNS infections. More recent MRI techniques, such as diffusion-weighted imaging (DWI), provide additional helpful information in the assessment of CNS infectious lesions compared with conventional MRI. This pictorial essay summarizes the clinical role of DWI in the demonstration of CNS infections including meningitis, encephalitis and pyogenic infections, and determination of the lesions compared with conventional MRI on the basis of physiopathologic phases of the infections.