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Öğe A nonspecific widespread involvement of encephalitis in a covid-19 patient(A. CARBONE Editore, 2022) Erok, Berrin; Atca, Ali ÖnderEncephalopathic symptoms including headache and altered mental status in hospitalized patients due to Covid-19 infection have been reported frequently in the recent literature. Moreover, neuroimaging correlation of some of these patients have been deonstrated with various forms of encephalitis. We aimed to describe the neuroimaging manifestations of an acute encephalitis with widespread involvement of deep white matter and deep gray matter areas that resolve following steroid treatment in a young male patient. We hope our case will add in the understanding of the range of neurological involvemnets related with Covid-19. More data about neuroimaging and neuropathological examinations are need to determine the neurotropism and particular types of involvements in the central nervous system.Öğe A rare presentation of retinoblastoma as a fungating orbital mass: A case report(Galenos Yayincilik, 2020) Kıbıcı, Kenan; Erok, Berrin; Akın, OnatRetinoblastoma (RBL) arises from the precursor cells of the retinal neuroepithelium. It is the most common primary malignant intraocular tumor in children. Primary orbital RBL is an extraocular disease detected clinically or radiologically at the time of diagnosis. It is a direct metastasis of an intraocular RBL. It very rarely presents as an exuberant fungating orbital mass, like in the present case, and is found in more advanced, untreated cases. Magnetic resonance imaging (MRI) is the preferred imaging modality for the evaluation of the tumor, vital orbital structures such as the optic nerve, and intracranial involvements. Computed tomography (CT) is useful in the evaluation of adjacent bony structures and calcifications. Herein, we report the case of a 3-year-old boy who presented to our clinic with a large, rapidly growing cauliflower-like mass protruding out of the left orbit and invading the surrounding soft tissues. MRI showed a10x8x7.5 cm(3) infiltrative heterogeneously enhancing left orbital mass with some necrotic and hemorrhagic components. Metastatic leptomeningeal enhancements were widespread in the intracranial region. CT revealed erosive destructive changes at the lateral orbital wall. Following left orbital enucleation, the diagnosis of RBL was made by histopathological examination, which showed sporadic Flexner-Wintersteiner type rosette formations. The patient underwent surgery and thereafter received radiotherapy and adjuvant chemotherapy. No recurrence was observed after 5 years. Although rare, orbital extension of RBL is one of the major contributors to mortality. Early diagnosis and detailed radiological evaluation are necessary to establish intracranial involvement and distant metastasis at the time of diagnosis.Öğe Analysis of clinical and radiological outcomes of posterior dynamic stabilization for direct repair of bilateral L5 pars ınterarticularis defect: dynamic assessment of pars fusion(2020) Kıbıcı, Kenan; Erok, BerrinTo evaluate the satisfactory clinical and radiological outcomes of posterior dynamic stabilization for the direct repair of bilateral L5 pars interarticularis defects and pars fusion. MATERIAL and METHODS: This is a retrospective evaluation of postoperative follow-up results of 13 patients with bilateral L5 pars interarticularis defects without spondylolisthesis. The patients underwent dynamic transpedicular stabilization between 2013 and 2018. Our surgical criteria included unilateral or bilateral L5 spondylolysis; excessive low back pain; low back pain accompanied by leg pain without neurological findings; symptoms lasting at least six months despite conservative treatments, age <50 years; and lack of significant adjacent disc degeneration. RESULTS: There were seven female and six male patients with a mean age of 38.9 years. All patients achieved satisfactory postoperative results during a mean follow-up period of 22 months. Preoperative visual analog scale score and Oswestry Disability Index value were 8.85 ± 0.69 and 54.46 ± 7.62, respectively, which decreased to 1.31 ± 0.48 and 9.85 ± 3.51, respectively, at the postoperative 24th month. In all patients, the bony fusion of the pars interarticularis at the stabilized segment was confirmed on the computed tomography scan at an average of 22 months postoperatively. CONCLUSION: The posterior dynamic system ensures that the spine moves within physiological limits and carries the load by sharing it with the spine. The advantages of direct pars repair using our technique are the restoration of the posterior structures’ normal anatomy, protection of the functional mobility segment, and early functional recovery without degeneration in the adjacent segment. Therefore, when there is no significant instability, patients with spondylolysis can be treated with posterior dynamic stabilization techniques with satisfactory clinical and radiological results.Öğe Changes in laboratory findings and early postoperative radiological evaluations following laparoscopic sleeve gastrectomy(2022) Akyol, Hüseyin; Erok, Berrin; Idrees, AbdulrahmanIntroduction: Obesity is an important public health problem with its related comorbidities associated with chronic inflammation. Secretion and continued release of inflammatory mediators such as tumor necrosis factor-alpha and interleukin-6 are caused by hypertrophic growth of adipose tissue and lead to chronic inflammation. In this study, we aimed to retrospectively evaluate the changes in the hematological and biochemical profiles and also to review complications established in post-operative radiological imaging studies following laparoscopic sleeve gastrectomy (LSG). Materials and Methods: The changes in the obesity-related biochemical and hematological parameters 6 months after LSG were retrospectively analyzed in 143 consecutive patients older than 18-year of age who underwent LSG. In addition, the findings of abdominal ultrasonography (US) examinations in all patients and computed tomography findings in patients who had been performed were retrospectively reviewed in terms of post-operative complications. Results: The decrease in body mass index (BMI) compared to the pre-operative BMI was statistically significant. Both inflammatory markers and glucose-lipid profiles showed improvement with a positive correlation parallel to the change in BMI. Neutrophil-lymphocyte ratio was found to be decreased significantly. However, no significant change was observed in PLR 6 months after LSG. Newly developed gallstones appeared in six of the patients when compared with their pre-operative abdominal US reports. None of the patients had gastric leak, perigastric collection, or hemorrhage. Conclusion: LSG is one of the most effective bariatric surgery methods in the treatment of obesity. We showed improvements in inflammatory markers in addition to glucose and lipid profiles with a positive correlation parallel to the changes in BMI.Öğe Chest CT imaging features of early phase covid-19 pneumonia(Carbone Editore, 2021) Erok, Berrin; Atca, Ali ÖnderIntroduction: COVID-19 (coronavirus disease 2019) is a viral infectious disease presenting with primarily pulmonary involvement. It is caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), a strain of coronavirus. A wide variety of chest computed tomography (CT) findings have been reported in patients with Covid-19 pneumonia. However, these CT features are not specific for Covid-19 and are similar to various other viral pneumonia, atypical pneumonia or organizing pneumonia of different etiologies. For differentiation of Covid-19 pneumonia, some more prevelant CT manifestations have been demonstrated in various studies comparing Covid-19 and non-Covid viral pneumonia. Materials and Methods: We aimed to present the initial chest CT findings observed in our patients with rRT-PCR test-confirmed COVID-19, from the March 15 to August 15, 2020 were presented. Results: As shown in previous reports, our experience has also showed that the most common and typical chest CT manifestations of Covid-19 are multifocal ground glass opacities (GGOs) with peripheral/subpleural distribution predominantly starting from middle&lower zones, with second most frequent is reticulation and consolidation. Based our experience, we have recognized that in Covid 19 pneumonia perilesional pulmonary vascular prominence, isolated nodular involvements and reversed halo sign are more prevelant when compared with non-Covid viral pneumonia. Conclusion: We believe that being familier with the common and typical CT features of Covid-19 pneumonia and the recognition of unusual findings will be helpful in the management of Covid-19 pneumonia.Öğe Chest CT imaging features of progressive phase covid-19 pneumonia and evolution of findings(Carbone Editore, 2021) Erok, Berrin; Atça, Ali Önder; Kıbıcı, KenanIntroduction: In the natural course of COVID-19 (coronavirus disease 2019) pneumonia, four stages have been described with aggrevation and extention of the lesions in the progressive stage and a more slower increase toward the maximum involvements in the peak stage before the absorption phase. A distinct pattern and time course of evolution is observed depending on the severity of the disease. Materials and methods: We aimed to present chest CT findings of advanced stage Covid-19 pneumonia observed in our patients with rRT-PCR test-confirmed COVID-19, from the March 15 to August 15 2020. Results: As the disease progress more central involvement of the lung with increased GGOs (with or withot reticulation) and consolidations occur and may be accompanied by development of organizing changes appearing usually as irregular, frequently linear consolidative opacities with possible bronchial changes. In addition, rarely encountered extraparenchymal findings and some atypical CT features unexpected to be identified in new coronavirus disease can be observed. In the survival patients this progressive period is followed by the absorption phase, which may or may not be accompanied by irreversible pulmonary changes like fibrosis or cystic formations. Conclusion: We believe that being familier with chest CT manifestations of advanced stage Covid-19 pneumonia and the changes throughout the disease process will be helpful in the management of Covid-19 pneumonia. Moreover, Covid-19 pneumonia can still be the concern in the presence of atypical findings either due to a coinfection/superinfection or as rarely occuring features with currently unknown mechanisms.Öğe COVID-19 Infection Manifesting with Lumbar Spondylodiscitis Complicating With Psoas Abscess without Pneumonia(Georg Thieme Verlag Kg, 2021) Erok, Berrin; Kibici, KenanExtrapulmonary manifestations of COVID-19 (Coronavirus disease 2019) are increasingly recognized. Secondary spinal infections are dangerous complications reported in a few cases in the literature. However, to our knowledge, there is no reported case of a severe spondylodiscitis (SD) complicated with a large psoas abscess in a COVID-19 patient. We would like to report a 43-year-old male patient living in central Anatolia and dealing with farming who presented to the hospital with a complaint of severe back pain. The patient who was given oral treatment with analgesic, anti-inflammatory, and myorelaxant agents was readmitted with increased complaints. His nasopharyngeal swab was positive for COVID-19 without pneumonia on chest computed tomography (CT). He spent the quarantine and treatment period at home but was admitted to our outpatient clinic with a wheelchair with increased complaints and right leg pain preventing daily activities. The control nasopharyngeal swab was negative for COVID-19 but further increase in C-reactive protein (CRP) (152,8 mg/L) and creatine kinase (CK) level (549 IU/L) were revealed. Lumbar magnetic resonance imaging (MRI) showed SD in the L3-L4 level along with right-sided prevertebral inflammatory soft tissue and a large right psoas muscle abscess. Pyogenic lumbar SD complicated with the right psoas abscess in the setting of COVID-19 was considered and antibacterial treatment was started following hospitalization. On the same day, percutaneous aspiration from the psoas abscess under CT guidance was performed and revealed no growth in the culture. After 3 weeks, follow-up MRI showed worsening of all the bone, soft tissue and disc findings. Myalgia is a common manifestation in viral infections, which was also demonstrated in COVID-19 patients, with possible increase in muscle enzymes. Secondary spinal infections and its soft-tissue complications should be considered in the management of COVID-19 patients with neuromuscular symptoms, and detailed neurological and neurosurgical evaluation should be performed in order to avoid progression and permanent damage.Öğe Decompression and neurolysis of the lateral femoral cutaneous nerve in the surgical treatment of meralgia paresthetica and the results(Georg Thieme Verlag Kg, 2021) Kıbıcı, Kenan; Erok, Berrin; Atça, Ali ÖnderMeralgia paresthetica (MP), also known as Bernhardt-Roth syndrome, is a peripheral neuropathy of the primary sensory lateral femoral cutaneous nerve (LFCN). Its diagnosis is challenging, because it can mimic other clinical conditions particularly associated with upper lumbar spine or pelvis. Patients present with pain and paresthesia over the anterolateral thigh. Diagnosis is usually based on clinical examination and is supported by sensory nerve conduction (SNC) studies. The initial treatment is always conservative. In limited number of patients who are refractory to conservative managements, surgical treatment via decompression/neurolysis or neurectomy is concerned. There is still no consensus on which surgical technique is the best and the first choice. We retrospectively analyzed the surgical outcomes of 12 nonobese patients who underwent decompression/neurolysis between the years 2013 and 2018. Bilateral SNC studies were performed in all cases which supported the diagnosis. We applied conservative treatments for 3 months in addition to the treatments previously applied in other centers. Surgery was recommended for the patients who were refractory to these treatments. Preoperative and postoperative pain levels during follow-up visits were evaluated with visual analogue scale (VAS). A retrospective analysis was performed on preoperative and postoperative 6th month VAS scores. The mean preoperative VAS value was 8.75 +/- 0.62 and the postoperative VAS value at the sixth month was 1.17 +/- 0.72. A significant reduction in the pain was shown (p < 0.05). Our surgical results showed that decompression/neurolysis of the LFCN should be concerned as the primary surgical approach to avoid negative outcomes of resection surgeries.Öğe Drop foot secondary to a peroneal intraneural ganglion connected to the superior tibiofibular joint: A case report(Georg Thieme Verlag Kg, 2021) Kıbıcı, Kenan; Erok, Berrin; Onat, AkınPeroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.Öğe Exploring the validity of ACDF with peek cages in sports activity patients with cervical spondylosis(2023) Erok, Berrin; Kıbıcı, Kenan; Atça, Ali ÖnderBackground The research aims to determine the outcomes of single or multilevel ACDF with polietereterketon (PEEK) cages in 152 patients (237 cages) with a focus on the cage instability in terms of migration and subsidence that may occur in the early postoperative period. Method 176 consecutive patients who had undergone single-or multilevel anterior cervical discectomy with PEEK cage for cervical syndolysis (CDDH) from January 2015 to January 2021 were retrospective evaluated.152 patients (237 PEEK cages) who were found to be suitable for the study criteria were included. Results Cage migration was observed in 15 cages in 12 patients without relevant clinical complaints. There was no case of superior migration of the cage into the superior end plate and no posterior or sideways migration. Subsidence was not detected in any cage, and functional radiological examination was present in all cases with maintained intervened disc distance height during the follow-ups. Discussion and conclusion: PEEK cages without anterior plate instrumentation and using postoperative neck collars in single -level and multilevel ACDF provide reliable and valid clinical and radiological results.Öğe Incomplete circle of willis: A possible triggering factor for migraine(2022) Erok, Berrin; Win, Nunu; Agolli, Elidor; Kıbıcı, Kenan; Atca, Ali ÖnderThe Circle of Willis (CoW) is an anastomotic arterial heptagon which is located at the inferior surface of the brain, within the interpedincular cistern. It is formed by the anteriorly located internal carotid arterial system and the posteriorly located vertebrobasilar arterial (BA) system and provides an important collateral pathway to maintain sufficient cerebral perfusion. However, based on the complexity of the embryological development, there are numerious individual anatomical variations.Öğe Ligamentum flavum hematoma associated with L5-S1 pars interarticularis defect: A case report and review of the literature(Georg Thieme Verlag Kg, 2021) Kıbıcı, Kenan; Erok, Berrin; Çolak, AhmetLigamentum flavum hematoma (LFH) is an extremely rare compressive epidural lesion of the spine. The clinical manifestations of LFH are similar to that caused by other more common pathologies of nerve root compression like disc herniation. In the diagnosis, magnetic resonance imaging (MRI) is very important but challenging due to the changing intensities of the hematoma in relation to the stages of the aging blood. Herein, we report a case of LFH compressing the spinal canal in a 60-year-old man with pars interarticularis defect. He presented with low back pain radiating to the left leg. The neurological examination was consistent with left S1 nerve root compression. The MRI revealed a left posterior epidural mass compressing the thecal sac and S1 nerve root at the left L5-S1 level near the pars interarticularis defect. After surgical removal of the lesion, histopathological examination confirmed the diagnosis of LFH. Following surgery, he recovered rapidly. LFH due to spinal instability is important in terms of the understanding of the pathophysiological mechanisms related with LFH.Öğe Mammography, ultrasonography and sonoelastography findings of granular cell tumor in accessory axillary breast(Aves, 2017) Yılmaz, Ebru; Yılmaz, Ayhan; Pehlivan, Esmehan; Erok, Berrin; Doğan, Sebahat Nacar; Yıldız, Hülya Kurt; Atça, Ali ÖnderThe main objective of breast imaging is to detect and differentiate benign lesions from malignant ones with higher accuracy rates. Recent studies have reported that sonoelastography (SE) is helpful for distinguishing benign and malignant solid breast masses and shows higher specificity than B-mode ultrasound (US) alone. Granular cell tumors are rare stromal tumors. While mammographically, they appear to be indistinctly marginated asymmetric density, sonographically the lesion generally shows acoustic shadowing and an irregular shape. In our case, in addition to mammography and US findings, we evaluated SE findings as well. The elasticity value and elasticity ratio showed similarity with malignant masses; therefore, we conclude that SE has no additional contribution to diagnosis of these lesions.Öğe Measurement of apparent diffusion coefficient in discrimination of benign and malignant axillary lymph nodes(Int Scientific Information Inc, 2019) Yılmaz, Ebru; Erok, Berrin; Atca, Ali ÖnderPurpose: We aimed to determine the contribution of the apparent diffusion coefficient (ADC) value in the detection of axillary lymph node metastasis. Material and methods: Breast magnetic resonance of 58 patients, performed in the radiology clinic of our hospital between 2015 and 2017 were examined retrospectively, and 43 lymph nodes in 43 patients were included in the study. They were evaluated morphologically on T1W and T2W sequences, and the lymph nodes showing rounded shape, focal or diffuse cortical thickness of more than 3 mm, and partial or total effacement of fatty hilum were included in the study. Subsequently, their ADC values were measured. Results: There were 43 lymph nodes, 20 of which were malignant and 23 of which were benign. While the mean ADC value of malignant axillary lymph nodes was 0.749 10(-3) min(2)/s (0.48-1.342), it was 0.982 10(-3) mm(2)/s (0.552-1.986) for benign lymph nodes. When the ADC cut-off value was taken as <= 0.753 x 10(-3) mm(2)/s, its discrimination power between benign and malignant axillary lymph nodes was as follows: sensitivity - 60%; specificity - 91.3%; accuracy - 76.7%; positive predictive value - 85.7%; and negative predictive value - 72.4%. Conclusions: There was no significant difference between mean ADC value of 12 lymphadenopathies (LAP) associated with inflammatory breast diseases (granulomatous mastitis and acute suppurative mastitis) and mean ADC value of metastatic lymph nodes. However, the ADC value of lymph nodes showing thickened cortex due to systemic inflammatory diseases was over 1, and there was a statistically significant difference when compared with metastatic lymph nodes.Öğe MRI appearance of COVID-19 pneumonia: An incidental finding(Fsg Communications Ltd, 2020) Atca, Ali Onder; Erok, Berrin; Kıbıcı, KenanCOVID-19 (coronavirus disease 2019) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first cases was reported in Wuhan, China on December 31st, 2019 and has rapidly spread globally.1 The main mode of transmission is person to person spread via respiratory droplets during close contact. Clinical symptoms are often nonspecific and include mainly fever and dry cough, which may be accompanied by dyspnea, fatigue, myalgia and headache.2 While most of the cases result in mild to moderate symptoms, some progress to severe pnemonia and acute respiratory distress syndrome (ARDS) leading to death. The gold standart method of diagnosis is real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) test on respiratory specimens, most frequently nasopharyngeal swabs.3,4 However, the sensitivity of the rRT-PCR test depends on specimen collection or viral burden at the time of sampling and the initial tests may be negative.5 Therefore, radiological imaging, particularly chest computerized tomography (CT) which is a very sensitive imaging modality, plays an important role in the diagnosis of COVID 19 pneumonia. On chest CT, the typical and the earliest finding is the unilateral or bilateral ground glass opacity (GGO) with peripheral distribution predominantly in the lower lobes. With the progression of the disease, extention of the GGOs with multilobar involvement, with or without associated consolidation and/or reticualtion (crazy paving patern) is seen.6 Considering the rapid spread of the infection, COVID-19 pnemonia can be encountered incidentally on any radiological imagings which are performed for other reasons. In our patient, COVID-19 pneumonia was recognised incidentally on contrast enhanced MRI of the abdomen. He was a 47 year old male with a known history of primary malignant disease, who underwent MRI in our outpatient clinic for the evaluation of any suspicious metastatic lesions. At the time of imaging, he had no clinical findings suggesting COVID 19 pneumonia and no history of close contact to a patient with positive COVID 19 test. A patchy inhomogenous peripheral pulmonary infiltration in the right lower lobe which was partially covered on multiple sequences was demonstrated. It was isointense on unenhanced T1w images and hyperintense on T2w images (figure1). There was no diffusion restriction (figure 2). Following intravenous contrast administration, the infiltration showed mild enhancement which is more prominent at the periphery of the lesion (Figure 3). Probably it corresponds to the reversed halo sign (atoll sign) shown on the targetted chest CT, which refers to complete or incomplete ring-like consolidation surrounding a GGO. It is a nonspecific pattern of organising pneumonia and has also been reported in patients with Covid-19. The mechanism of this sign is not clear. While some authers think that it depicts disease progression that make consolidation developed around GGO, others argue that it is related with absorption in the lesion leaving a decreased attenuation in the center. On the targetted chest CT, typical multifocal, patchy, peripherally located GGOs were demonstrated (figure 4). Diagnosis was confirmed by rRT-PCR test of an upper airway smear. Although MRI is not an effective imaging modality for the evaluation of pulmonary parenchyma due to the low proton content of the lungs and possible respiratory and cardiac pulsation artefacts, it has been shown to be an important imaging modality that can be used, particularly in the follow-up of patients who require dynamic imagings to avoid exposure to ionising radiation.7 To our knowledge, there are limited number of reports on the MRI findings of COVID-19 pnemonia. In a retrospective case study, Vasilev et al., concluded that MRI can be effectively used to detect COVID 19 pneumonia especially in young people and in the follow up imagings to avoid ionising radiation.8 Marcel et al., reported a case with COVID 19 pneumonia recognized incidentally on contrast enhanced MRI of the liver, similar to our patient.9 In conclusion, COVID 19 pneumonia can be incidentally established as peripherally located mild contrast enhancing consolidations on MRIs, for example MRI of the upper abdomen or thoracal spine. Therefore radiologists shoud be aware of suspicious findings of COVID 19 pneumonia in all radiological imaging modalities to allow early recognation of these asypmtomatic carriers and prevent further transmission of the infection.Öğe Neuroimaging fndings of posterior reversible encephalopathy syndrome (PRES) following haematopoietic stem cell transplantation in paediatric recipients(BMC, 2021) Atça, Ali Önder; Erok, Berrin; Aydoğdu, SelimeBackground: Haematopoietic stem cell transplantation (HSCT) is used worldwide in various malignant and nonmalignant childhood diseases, including haematologic, genetic, autoimmune and metabolic disorders, and is the only curative treatment for many of these illnesses. The survival rates of many childhood diseases have been increased due to HSCT treatment. However, associated complications are still important for management. Central nervous system (CNS) complications in paediatric HSCT recipients can be associated with high morbidity and signifcantly contribute to mortality. Posterior reversible encephalopathy syndrome (PRES) is one of the most common CNS complications in patients with neurological symptoms following HSCT. Magnetic resonance imaging (MRI) is the modality of choice and shows typical bilateral vasogenic oedema at the posterior parts of the cerebral hemispheres; however, various atypical imaging manifestations can also occur. In this study, we retrospectively examined CNS complications in our paediatric HSCT recipients with a focus on the typical and atypical neuroimaging manifestations of PRES following HSCT. Methods: We retrospectively reviewed the medical records of 300 consecutive paediatric HSCT recipients from January 2014 to November 2018. A total of 130 paediatric HSCT recipients who experienced neurological signs and symptoms and were evaluated with neuroimaging studies following HSCT were enrolled in the study. The timing of CNS complications was defned according to immune status, including the pre-engraftment period (<30days after HSCT), the early postengraftment period (30–100days after HSCT), and the late postengraftment period (>100days after HSCT), which were defned as phases 1, 2 and 3, respectively. Results: Overall, 130 paediatric HSCT recipients experienced neurological signs and symptoms and therefore underwent neuroimaging examinations. Among these 130 patients, CNS complications were present in 23 patients (17.6%, 23/130), including 13 (56.5%) females and 10 (43.5%) males with a median age of 8.0 years (range, 8months to 18.0 years). Among these 23 patients, 14 cases of PRES (60.9%), 5 (21.7%) cases of leukoencephalopathy, 3 cases of acute subdural haemorrhage (ASDH) (13%) and 1 (4.3%) case of fungal CNS infection were identifed by neuroimaging. On MRI, typical parietooccipital vasogenic oedema was present in 78.5% of the PRES cases (11/14). The following atypical neuroimaging manifestations were observed: isolated involvement of the bilateral frontal lobes in 1 case, isolated cerebellar vermis involvement in 1 case, and isolated basal ganglia involvement in 1 case. Restricted difusion associated with cytotoxic damage was demonstrated in 2 of 14 cases, one of which also showed subacute cytotoxic injury with ADC pseudonormalization. Conclusion: Paediatric HSCT recipients presenting with CNS signs and symptoms should be evaluated by neuroimaging studies for timely diagnosis and early management. PRES is the most common CNS complication and may present with atypical MRI manifestations, which should not dissuade a PRES diagnosis in appropriate clinical settings.Öğe Neurological complications encountered in imaging studies in association with COVID-19 - a single center analysis(Publishing Office of the University of Rzeszow, 2023) Erok, Berrin; Atca, Ali Önder; Önder, HakanIntroduction and aim. COVID-19 is a viral infectious disease, which was first reported in patients with unusual pneumonia in December 2019. However, as the pandemic progressed, extrapulmonary manifestations including various neurologic complications have been started to be increasingly reported. In this retrospective study, we tried to search the neurological complications seen in our patients with positive rRT-PCR test for COVID-19 and examine the underlying associated risk factors. Material and methods. We have retrospectively analyzed the neuroimaging studies performed in our patients with positive rRT-PCR test for COVID-19 between April, 2020 and August, 2021. Both computed tomography (CT) scans and magnetic resonance imagings (MRI) of brain, head & neck region and the spine were retrospectively evaluated for the presence of any complications in patients with positive rRT-PCR test for COVID-19. Results. There were 147 patients having neuroradiological imaging studies performed for various neurological symptoms. Among these patients we detected 10 acute neurologicalcomplications.The most common was acute ischemic stroke in 5 patients and intracranial hemorrhage in 3 patients, two of which were intraventricular hemorrhage. The other complications included a preasumed cytotoxic lesion of corpus callosum in a 18 year old girl and lumbar spondylodiscitis complicated with psoas abcess in a 47 year-old man. Conclusion. In COVID-19 patients severe neurological complications can occur even as a presenting manifestation. Early cytotoxic endothelial injury can be the underlying cause in these patients and should be further studied in larger series in terms of what the susceptibility factors in these patients.Öğe Posttraumatic arachnoid cyst rupture and delayed acute subdural hygroma(Publishing Office of the University of Rzeszow, 2021) Erok, Berrin; Kıbıcı, KenanIntroduction. Subdural hygromas (SDGs) are the accumulation of fluid in the subdural space. Arachnoid cysts (ACs) on the other hand are common cerebrospinal fluid (CSF) containing lesions of the central nervous system, located within the subarachnoid space. They are generally found incidentally on neuroimaging studies and remain asymptomatic throughout the life. Rupture into the subdural space resulting in subdural hygroma (SDG) is relatively rare. Aim. We aimed to show the importance of the radiological follow up in head trauma patients having large ACs. Description of the case. We report a case of a 69-year-old male patient with a known large Galassi type III AC, presented to our hospital with traumatic brain injuries and re-presented with acute posttraumatic SDG in association with AC rupture. Conclusion. This case emphasizes the importance of radiological follow up in head trauma patients having large ACs to reveal and appropriately manage traumatic subdural collections. © 2021 Authors. All rights reserved.Öğe Pulmonary cavitation in COVID-19 pneumonia; is it primary or secondary?(Fsg Communications Ltd, 2020) Erok, Berrin; Kıbıcı, Kenan; Atça, Ali ÖnderA wide variety of chest computed tomography (CT) findings have been reported in patients with Covid-19 pneumonia. Pulmonary cavitation, although reported in a few cases of Covid19 pneumonia in the literature, is an uncommon finding to be identified in viral pneumonia and is considered among atypical CT features of Covid-19. In an attempt to adress to this issue, We want to emphasize the possibility of secondary infections in Covid-19, presenting with pulmonary cavitations as in our patient demonstrating a large sized pulmonary cavity when he was in intensive care unit (ICU).With consideration of a superinfection, bronchoscopy was performed and revealed growth of Acinetobacter in bronchoalveolar lavage (BAL) culture. As a result, secondary infections are common particularly in severely ill Covid-19 patients with much greater frequency in ICU. In cases of cavitary lesions superinfection should always be considered and accurate targetted treatment according to susceptibility testing should be started immediatelly, for better clinical outcomes.Öğe Radiation-induced brachial plexopathy in breast cancer and the role of surgical treatment(Georg Thieme Verlag Kg, 2020) Kıbıcı, Kenan; Erok, Berrin; Atça, Ali ÖnderObjective We aimed to evaluate improvement in the pain, motor, and sensory functions after neurosurgical intervention, by objective methods in patients with radiation-induced brachial plexopathy (RIBP), as a complication of radiotherapy (RT). Materials and Methods In our study, 11 patients, who experienced grade 3 or 4 brachial plexopathy according to the LENT-SOMA (late effects of normal tissue-subjective, objective, management, analytic) side-effect index, as a complication of RT which was performed after being operated for breast cancer, were included. In the postoperative period pain, sensation, and motor function loss were followed. Results There was apparent regression in the pain. The mean visual analogue scale (VAS) value decreased to 4 from the preoperative VAS value of 9.4. However, no significant improvement was observed in either sensory and motor functions. Conclusion RIBP is a progressive disease in breast cancer patients after radiotherapy. Evaluation of the results of applied surgical treatments and changes in the results with time is important to direct the treatment. Neurolysis should only be considered when other treatment methods fail and should be considered as an irreversible and potentially permanent procedure.
