Browsing by Author "Unal, Ozkan"

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Atypical Virchow-Robin Spaces: Report of Seven Cases
(Ortadogu Ad Pres & Publ Co, 2010) Avcu, Serhat; Sayin, Refah; Unal, Ozkan; Cogen, Etem Emre; Tombul, Temel
The term "Virchow-Robin spaces" (VRS) refers to the extension of the subarachnoid space accompanying a vessel penetrating the cerebral cortex. In case of widening, they can be seen on magnetic resonance imaging as round, oval, or curvilinear well-defined cystic lesions with smooth margins, isointense to cerebrospinal fluid. Although dilated VRS are normal findings that may be seen at all ages, big and atypical forms are rare. Although they have associated mass effect, they should not be mistaken for neoplasm or other disease. We report seven patients whose ages were between 7 and 66 (mean: 35.8) years showing unilateral or bilateral cerebral intraparenchymal extensive cystic dilations corresponding to atypical VRS (two with Type-I and five with Type-II VRS), with clinical and radiological findings.
A Case of Adem Mimicking Cerebral Adrenoleukodystrophy Based on Supratentorial Mri Findings
(Aves, 2014) Beyazal, Mehmet; Unal, Ozkan; Yilmaz, Sanem; Bora, Aydin
A 9-year-old male admitted for syncope also had the complains of pain and numbness in his legs and frequent falling down. There was a history of upper respiratory tract infection 10 days before. On neurologic examination, paraparesia and fall a sleep were identified. On magnetic resonance imaging, the symetric signal increases were seen in biparieto-occipital white matter intented to corpus callosum at T2-weighted sequences and cytotoxic edema was seen at diffusion-weighted images. Heterogeneous contrast enhancement was seen on these areas. In addition, at the C7-Th5 vertebrae levels, spinal cord had diffuse increased signal intensity and contrast enhancement. Acute disseminated encephalomyelitis was thought based on clinical and radiological findings. Steroid therapy was started. Significant improvement was shown after treatment. On 2-year follow-up, there was no recurrence. In conclusion, it must be kept in mind that acute disseminated encephalomyelitis can rarely present with biparieto-occipital involvement which extends to corpus callosum and can mimic adrenoleukodystrophy. For the differential diagnosis butterfly glioma, tumefactive demyelinating lesions or multiple sclerosis should be considered.
A Case of Enchondromatosis Concomitant With Cerebral Hamartomas: Radiologic Findings
(Taylor & Francis inc, 2011) Avcu, Serhat; Cetin, Feray; Unal, Ozkan
Enchondromatosis is a congenital nonhereditary condition characterized by multiple symmetrically distributed intraosseous cartillaginous masses in the metaphyses and diaphyses of bones. We report a case of bilateral multiple enchondromas and cerebral hamartomas in an 11-year-old boy in whom x-rays displayed distortion and expansion of bilateral long tubuler bones, hands and feet, scapulas, pelvis, and occipital regions of the calvarium. In addition to osseous abnormalities, bilateral cerebral hamartomas were observed on cranial magnetic resonance imaging (MRI). To the best of our knowledge, this is the first case in the literature with enchondromatosis and cerebral hamartomas.
A Case of Primary Vertebral Osteosarcoma Metastasizing To Pancreas
(E S Burioni Ricerche Bibliografiche, 2009) Avcu, Serhat; Akdeniz, Huseyin; Arslan, Harun; Toprak, Nursen; Unal, Ozkan
Context Osteosarcoma is the most common malignant bone tumor in children and adolescents and possesses a high potential for metastasis. The most common sites of osteosarcomatous metastases are the lungs, pleurae, and bone; the pancreas being extremely rare. Case report We report the computed tomography findings of a rare case of pancreatic metastasis in a 14-year-old boy with primary vertebral osteosarcoma being followed-up for 6 years. On abdominal CT, a huge mass containing necrotic and calcified areas and causing bone destruction was seen between thoracic vertebra 7 and sacral vertebra 1 involving both the vertebrae and paravertebral soft-tissue. A large metastatic mass with an irregular contour was also visualized in the pancreatic head and peripancreatic region having tomographic findings similar to the vertebral mass. Tru-cut biopsy of the pancreatic mass confirmed the diagnosis of osteosarcoma metastasis. Conclusions Although extremely rare, osteosarcoma metastasis should be included in the differential diagnosis of pancreatic mass lesions, particularly in patients with a primary tumor.
Cine Phase-Contrast Mri Evaluation of Normal Aqueductal Cerebrospinal Fluid Flow According To Sex and Age
(Aves, 2009) Unal, Ozkan; Kartum, Alp; Avcu, Serhat; Etlik, Omer; Arslan, Halil; Bora, Aydin
PURPOSE The aim of this study was cerebrospinal flow quantification in the cerebral aqueduct using cine phase-contrast magnetic resonance imaging (MRI) technique in both sexes and five different age groups to provide normative data. MATERIALS AND METHODS Sixty subjects with no cerebral pathology were included in this study. Subjects were divided into five age groups: <= 14 years, 15-24 years, 25-34 years, 35-44 years, and >= 45 years. Phase, rephase, and magnitude images were acquired by 1.5 T MR unit at the level of cerebral aqueduct with spoiled gradient echo through-plane, which is a cine phase-contrast sequence. At this level, peak flow velocity (cm/s), average flow rate (cm/s), average flow (L/min), volumes in cranial and caudal directions (mL), and net volumes (mL) were studied. RESULTS There was a statistically significant difference in peak flow between the age group of <= 14 years and the older age groups. There were no statistically significant differences in average velocity, cranial and caudal volume, net volume, and average flow parameters among different age groups. Statistically significant differences were not detected in flow parameters between sexes. CONCLUSION When using cine-phase contrast MRI in the cerebral aqueduct, only the peak velocity showed a statistically significant difference between age groups; it was higher in subjects aged <= 14 years than those in older age groups. When performing age-dependent clinical studies including adolescents, this should be taken into consideration.
Clinical Outcome and Magnetic Resonance Imaging Findings in Infants With Hypoglycemia
(Sage Publications inc, 2011) Caksen, Huseyin; Guven, Ahmet Sami; Yilmaz, Cahide; Unal, Ozkan; Basaranoglu, Murat; Sal, Ertan; Kaya, Avni
The authors examined clinical outcome and cranial magnetic resonance imaging (MRI) findings in infants with hypoglycemia to determine the effects of hypoglycemia on the developing brain. A total of 110 infants with hypoglycemia were included in the study. Of the patients, 36 were females and 74 were males. The age of the infants was between 1 day and 22 months. Of the 110 infants, 47 were preterm neonates, 40 were term neonates, and 23 were older than 28 days. No difference in serum glucose level was noted between symptomatic and asymptomatic infants. The most common observed abnormal findings were hyperintense lesions, encephalomalacia, and cerebral atrophy. Abnormal MRI findings were found in 4% of preterm infants, in 32.5% of term infants, and in 43.5% of older infants. Abnormal MRI findings were statistically significantly more common in symptomatic infants than in asymptomatic infants. Of the infants, 45.5% of hypoglycemic infants had cerebral palsy and/or cerebral palsy plus epilepsy.
Coexistence of Neurofibromatosis Type-1, Left Internal Carotid Artery Hypoplasia and Left Phytisis Bulbi
(Galenos Publ House, 2011) Avcu, Serhat; Akdeniz, Huseyin; Unal, Ozkan; Arslan, Harun; Bora, Aydin
Congenital abnormalities of the internal carotid artery (ICA) are extremely rare and aplasia/hypoplasia of the ICA associated with other congenital malformations is uncommon. An 8-year-old male patient was admitted to our hospital for extreme nervousness, attention problems and hyperactivity. On MR examination, left phytisis bulbi, left frontal lobe atrophy, assymmetric dilataion in the left lateral ventricle and hamartomas in both globus pallidi, right thalamus, and bilateral cerebellar hemispheres posterior to the fourth ventricle were observed. Left ICA was observed as hypoplastic in the cervical and cranial MR-angiography. Left MCA and ACA could not be visualised. Left carotid canal hypoplasia and left sphenoidal bone dysplasia were detected on CT. As far as we know, only 4 cases with concomitancy of ICA hypoplasia-NF Type-1 have been reported up to the present. In our case, in addition, phytisis bulbi is accompanying this coexistence.
The Diagnostic Value of Diffusion-Weighted Magnetic Resonance Imaging in Soft Tissue Abscesses
(Elsevier Ireland Ltd, 2011) Unal, Ozkan; Koparan, Halil Ibrahim; Avcu, Serhat; Kalender, Ali Murat; Kisli, Erol
Purpose: To study the diagnostic value of diffusion-weighted imaging (DWI) in soft tissue abscesses. Materials and methods: Fifty patients were included in this study who were thought to have soft tissue abscess or cystic lesion as a result of clinical and radiological examinations. Localisations of the lesions were: 1 periorbital, 3 breast, 14 intraabdominal, and 32 intramuscular lesions. After other radiological examinations, DWI was performed. The signal intensity values of the lesions were evaluated qualitatively according to the hyperintensity on b-1000 DWI, using 1.5 T MR system. All of the lesions were aspirated after DWI, and detection of pus in the aspiration material was accepted as gold standard for the diagnosis of abscess. Results: In 38 of the 50 patients, hyperintensity was obtained on diffusion-weighted images. False-positive results were maintained in 2 of these patients, and true-positive results were maintained in 36 of them. In 11 of the 50 patients, hypointensity was visualised on diffusion-weighted images. False-negative results were maintained in 3 of these patients, and true-negative results were maintained in 8 of them. An abscess which was seen on post-contrast conventional MRI could not be seen on DWI, and this was regarded as false-negative. Conclusion: The sensitivity and specificity of diffusion-weighted images for detecting soft tissue abscesses were found to be 92% and 80%, respectively. DWI has a high diagnostic value in soft tissue abscesses, and is an important imaging modality that may be used for the differentiation of cysts and abscesses. (C) 2009 Elsevier Ireland Ltd. All rights reserved.
The Efficacy of One Molar Contrast Material in the Evaluation of Breast Lesions With Mr Imaging
(int Scientific information inc, 2015) Toprak, Nursen; Unal, Ozkan; Avcu, Serhat
Background: To investigate the efficacy of 1 molar (containing 1 mol/mL gadobutrol) contrast material in the differentiation of malignant and benign breast lesions with MRI. Material/Methods: Thirty-seven women (age range: 22-77 years, mean: 43.7 years) with 76 breast lesions were included in this study. Dynamic post-contrast images with 0.2 mL/kg gadobutrol (Gadovist) injection were obtained in all patients. Contrast-to-noise-ratio (CNR) of the lesions, as well as their contrast enhancement patterns (ring, heterogeneous, homogenous), and perilesional increased vascularity were studied. Results: Fifty-six benign and 20 malignant lesions were examined histopathologically. In malignant cases, heterogeneous and peripheral enhancements were most commonly determined, whereas homogeneous enhancement was most commonly determined in benign cases. CNR was 450% in malignant lesions, and 60% in benign lesions. Conclusions: Type II/III contrast-time curves, ring/heterogeneous enhancement, prominent increase in CNR, and perilesional vascularity increase are important findings determining malignancy, whereas Type I curves, homogenous enhancement, a slight increase in CNR, and absence of perilesional vascularity increase support findings of benign breast lesions. By increasing CNR and providing increased perilesional vascularity, Gadovist can help in the determination of malignant breast lesions.
Flow Volumes of Internal Jugular Veins Are Significantly Reduced in Patients With Cerebral Venous Sinus Thrombosis
(Bentham Science Publ Ltd, 2014) Ozen, Ozkan; Unal, Ozkan; Avcu, Serhat
The aim of this study was to investigate the flow volumes of the internal jugular veins (IJVs) in patients with cerebral venous sinus thrombosis (CVST) using Doppler ultrasonography (DUS) and to compare the findings with the control group. Forty patients diagnosed with CVST between 2008 and 2010 were included in the study. The patients diagnosed with a thrombosis via MRV and MRI underwent a bilateral examination of the IJVs by DUS. The patients were divided into three groups: Group I (n=29) unilateral total thrombosis; Group II (n=6) bilateral diffuse thrombosis; and Group III (n=5) unilateral partial thrombosis. The IJV flow volumes of each group were compared to that of the control group (n=20). In Group I, the average flow volume was 53 ml/min on the side of the thrombosis. In Group II, the mean volume of the right and left IJV was 265 ml/min, and in Group III, the mean volume on the side of the partial thrombosis was 160 ml/min. The flow volume on the thrombosed side in Group I and Group III and the mean of the total bilateral flow volume in Group II were significantly lower than that of the control group. IJV flow volumes in the CVST group were significantly lower compared to the control group. Reduced flow volumes of the IJV may be diagnostic for CVST or an additional parameter to be considered with the use of MRI.
Goldston Syndrome in a Fetus: Case Report and Literature Review
(Taylor & Francis inc, 2010) Avcu, Serhat; Akdeniz, Huseyin; Unal, Ozkan; Kurdoglu, Mertihan
We present a case of the Goldston syndrome which is the association of polycystic kidneys with Dandy-Walker malformation. The diagnosis was made by ultrasound in twenty second week of gestation. Obstetric ultrasound and fetal MRI studies showed hydrocephalus, agenesis of the cerebellar hemispheres, vermian hypoplasia, cystic dilatation of the 4(th) ventricle, enlargement of the posterior fossa, abdominal distension, and oligohydramnios.. The kidneys were symmetrically enlarged and multicystic. To our knowledge this is the third reported case of Goldston syndrome which was diagnosed during intrauterine life.
A High Grade Gliomatosis Cerebri Case Report; Mr, Diffusion Mr and Mr Spectroscopy Findings
(Turkish Neurological Soc, 2014) Beyazal, Mehmet; Unal, Ozkan; Yilmazer, Gokhan; Celiker, Fatma Beyazal; Tombul, Temel
Gliomatosis cerebri is a rare primary diffuse cerebral malignity. "It is characterized by the diffuse proliferation of neoplastic glial cells that involve more than two cerebral lobes. For a definitive diagnosis histopathological examination is required. Advanced magnetic resonance imaging techniques are very useful in the pretreatment diagnosis-staging and post-treatment follow-up. In this report a patient with gliomatozis cerebri was presented with magnetic resonance, diffusion weighted imaging and magnetic resonance spectroscopy findings. In addition, the importance and the role of magnetic resonance spectroscopy in the diagnosis and staging of gliomatosis cerebri is discussed.
Intracranial Lipomas - a Clinical Study
(Elsevier, 2006) Yilmaz, Nebi; Unal, Ozkan; Kiymaz, Nejmi; Yilmaz, Cahide; Etlik, Omer
Objective: This study aimed to investigate the localization of the lipoma, as well as associated intracranial and extracranial lesions in 14 patients immediately following hospital admission. The pathological findings from the neurological examinations of these patients are also investigated. Methods: Fourteen patients who were admitted to our clinic with a variety of symptoms and diagnosed with intracranial lipoma were included in the study. Problems presented upon admission, neurological findings, and other existing system abnormalities were evaluated. Localization of the lipomas and accompanying pathologies were determined by using computerised tomography and magnetic resonance imaging. Results: The most frequent reasons for admission of patients with intracranial lipomas were: headache 7 (50%), trauma 3 (21.5%), epilepsy 3 (21.5%) and one with symptoms due to the local mass effect of tumor (7%). Although the pericallosal region is accepted as the region where lipomas commonly occur, this study found the most frequent occurrence in the quadrigeminal cistern. Intracranial lipoma calcification was only evident in 1 of the 14 patients. In addition, contrary to the expectations, intracranial and extracranial lesions accompanying lipomas were rare. All patients received systematic treatment. Conclusion: This study showed that intracranial lipomas are more frequent in the quadrigeminal region of the brain; most are asymptomatic, generally caught incidentally; and accompanying intracranial and extracranial pathologies are less common than expected. (c) 2005 Elsevier B.V. All rights reserved.
Metastasis of Testicular Yolk Sac Tumor To Cauda Equina
(informa Healthcare, 2011) Unal, Ozkan; Beyazal, Mehmet; Avcu, Serhat; Akbayram, Sinan; Akgun, Cihangir
Primary germ cell tumors may spread to the lung, liver, brain, and bone hematogenously. However, spinal metastasis is extremely rare. A case with yolk sac tumor (YST) and cauda equina metastasis was presented in a 2-year-old boy. Two months prior to admisssion, he underwent left radical orchiectomy for testicular YST. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed spinal and cauda equina involvement. This is the first report of metastasis of testicular YST to cauda equina in a child.
Necrotizing Brucella Epididymoorchitis: Magnetic Resonance Imaging Findings
(Nobel Ilac, 2014) Beyazal, Mehmet; Ozkacmaz, Sercan; Unal, Ozkan; Yavuz, Alpaslan; Bora, Aydin
Brucella epididymoorchitis (BEO) had been reported up to 20% of patients with brucellosis. Althought it has a good response to spesific antibiotherapy, the delay in diagnosis and in treatment may result in necrosis and abscess formation. Ultrasonography is the basic imaging method for screening of scrotal diseases such as BEO. In literature, there are many studies which present sonographic and magnetic resonance imaging (MRI) features of scrotal and testicular lesions. However; there is no any sufficient publication in which the findings of BEO have been defined on MRI examination. In this report, we presented a patient who had unilateral necrotizian epididymoorchitis and testicular abscess resulted from brucellosis with MRI findings and we also discussed the contribution of MRI to the management of the disease.
Occuring Transverse Sinus Thrombosis Secondary To Chronic Otitis Media and Pseudotumor Cerebri: Case Report
(Duzce Univ, 2010) Okur, Mesut; Yilmaz, Cahide; Acar, Mehmet Nuri; Caksen, Huseyin; Kir, Faruk; Unal, Ozkan; Atas, Bulent
Transverse sinus thrombosis (TST), although not common as the former still, is a major complication of middle ear infection. In this study, with the diagnosis of middle ear infection for a period of 3 years followed outpatient and the developing transverse sinus thrombosis, 12 years old patient due to a rare case were presented. This case, therefore, children with chronic otitis media in terms of transverse sinus thrombosis and pseudotumor cerebri should be closely followed would like to emphasize.
Polysplenia Syndrome: a Rare Case Report With Computerized Tomography Findings
(Ortadogu Ad Pres & Publ Co, 2010) Avcu, Serhat; Arslan, Harun; Unal, Ozkan
Polysplenia syndrome is a congenital anomaly in which cardiac, vascular, and thoracic anomalies are seen together. The diagnosis is mostly made in the childhood with radiological examinations which are performed due to cardiac complaints. On direkt X-ray of our patient, dextrocardia was detected. On computed tomography scans, multiple spleens biggest with 5 cm diameter were seen in the left upper quadrant, and the tail of the pancreas was missing. Inferior vena cava was absent and the hepatic veins were directly opening into the right atrium. The azygos vein was dilated and draining into the left sided superior vena cava. The minor fissure was absent in the right lung and the bi-lobed right lung was evaluated as thoracic isomerism. Here we report a rare case of polysplenia syndrome in a seven years old male patient who admitted to our hospital with complaints of shortness of breath and difficulty during running and was diagnosed after physical and radiological examinations.
Radiological and Clinical Course of Pneumonia in Patients With Avian Influenza H5n1
(Elsevier Ireland Ltd, 2007) Bay, Ali; Etlik, Omer; Oner, A. Faik; Unal, Ozkan; Arslan, Halil; Bora, Aydin; Dogan, Murat
Introduction: We evaluated chest X-ray and clinical findings of patients with lower respiratory tract infection due to influenza H5N1 and presented the radiological findings and clinical course of the infection. Materials and methods: Between December 2005 and February 2006, eight hospitalized patients (median age 10, 5-15 years) with avian-flu were evaluated in this study. All patients were evaluated with chest X-ray and four of them with CT scan. Post mortem pathological characterization were also available for three of the patients. Results: A rapidly progressive pneumonia with high mortality rate was observed especially for cases with late admission. The major radiologic abnormalities were extensive pneumonic infiltration with segmental and multifocal distribution, mostly located in lower zones of the lung. No pleural effusion and hilar lymphadenopathy was noted. Conclusion: Avian flu may be presented as rapidly progressive pneumonia. The chest radiography has an important role in diagnosis and should be obtained daily because of rapid change of the findings that may necessitate prompt action. (c) 2006 Elsevier Ireland Ltd. All rights reserved.
A Rare Extradural Mass: Primary Cervical Spinal Melanoma With Radiologic Findings
(Journal Neurological Sciences, 2014) Beyazal, Mehmet; Unal, Ozkan; Kankaya, Duygu; Bora, Aydin; Gokalp, Abdulsemat
Melanocytic cells are normally found in the meninges of the central nervous system (CNS). Primary tumour derived from meningeal melanocytic cells is rare. In this case report, a patient with primary spinal malignant melanoma localized in the cervical region was presented. Clinical features of this case including the magnetic resonance imaging (MRI) findings were described and its differential diagnosis was discussed with the line of literature.
Solitary Paraganglioma of the Hypoglossal Nerve: a Case Report With Magnetic Resonance Imaging Findings
(int Scientific information, inc, 2013) Beyazal, Mehmet; Yavuz, Alpaslan; Unal, Ozkan; Cankaya, Hakan; Yilmaz, Deniz
Objective: Rare disease Background: Paragangliomas are rare neuroendocrine tumors originating in the neural crest. Only a few cases of hypoglossal paraganglioma have been reported in the published literature. The localization of hypoglossal paragangliomas close to the carotid artery precludes determination of tumor origin preoperatively. Case Report: A 58-year-old female patient was admitted due to neck pain. During physical examination, a significant mass could not be palpated in the upper left part of the neck, despite sensitivity during palpation. Atrophy and left deviation of the left half of the tongue was observed. MRI of the neck revealed a lesion located superior to the carotid bifurcation between the left internal carotid artery and external carotid artery. There was atrophy in the left half of the tongue. The neck mass displaced the left internal carotid artery anteriorly and medially. The operation was performed with left lateral cervical access. This lesion, which derived from the hypoglossal nerve, was excised. Following histopathological evaluation, the lesion was diagnosed as paraganglioma. Conclusions: Hypoglossal paraganglioma is quite rare and there are no established criteria for preoperative diagnosis. Hypoglossal paraganglioma must be considered to determine treatment options if a lateral neck mass and ipsilateral tongue atrophy are present at the level of the 12th cranial nerve tract.