Introduction: Acute ischemic stroke is an important cause of mortality in childhood with variable long term neurological sequelae. This study presents long term follow up outcome data of our center which is a tertiary clinic with a well-organized pediatric stroke team. Method: Medical records of patients diagnosed at pediatric age (28 days-18 years) with acute ischemic stroke between years 2011-2018 in Marmara University Pediatric Neurology Clinic were retrospectively evaluated. Patients whose initial medical intervention was performed by Marmara University Pediatric Emergency unit and had been followed by our clinic for at least 5 years after initial diagnoses were included in this study. The modified Rankin Scale(mRS) and Pediatric Stroke Outcome Measure Short Neuro Exam (PSE-SEN) were performed to all of the patients in addition to final neurological examination. Results: The mean first ischemic stroke age of 32 patients (20 male,62,5%) included in the study was 77,39±61,93 months. First stroke age was grouped as early (≤60 months; n=16) and late (>61 months, n=16). The median time passed from initial symptom to emergency room admission was 15,5 (1-720) hours. The mean follow-up interval of the study group was 85,44±20,52 months and the mean age of the group at the time of the study (present age) was 162,62±64,4 months. Affected vascular territory did not have any significant effect on long-term clinical outcomes (p=0,550). Late stroke age group (>61 months) had a significantly higher rate of normal functional long-term outcome(p=0.023). The younger age group (≤60 months) had longer hospital admission time (24 h vs 9 h). PSOM scores were helpful to detect some mild cognitive and language dysfunctions that did not interfere with daily life. Conclusion: Pediatric Stroke Outcome Measure Short Neuro Exam (PSE-SEN) is helpful to catch mild neurocognitive sequela that can be missed with neurological examination. Considering the fact that time after first symptom is critical for early intervention in acute ischemic stroke patients, stroke teams should be settled in all centrally located medical centers with easy transportation opportunities.

Radiographic progression in Ankylosing spondylitis (AS) is driven by mechanical strain. A well-balanced spine provides a favorable weight distribution across the entheses. Pelvic parameters are useful in assessing the shape of the spine. The present study aimed to prospectively investigate the predictive value of pelvic parameters for radiographic progression in AS. This non-interventional, observational, and prospective study enrolled AS patients fulfilling the modified New York criteria (mNY) currently under follow-up in the MARS (MARmara Spondyloarthritis) outpatient clinics. The primary objective was to investigate the relationship between the baseline pelvic parameters and radiographic progression in the spine. Two trained radiologists (EB, OB) independently assessed the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS). An orthopedic surgeon (AHA) and a radiologist (EB) derived the pelvic parameters. Patients with no bridging or bamboo spine were included in the final analysis. Risk assessment for radiographic progression, defined as a two-unit increase in mSASSS or developing a new syndesmophyte every two years, was done using uni- and multivariate logistic regression analyses. Radiographs of 69 AS patients were analyzed. The median (IQR 25–75) prospective follow-up was 47.7 (34.6–52.8) months. Only 33.3

Background and Objectives: The shape of the spine is critical in maintaining posture on the vertical axis, and the morphology of the pelvis affects the distribution and dynamics of mechanical stress along the spine. Pelvis and spine angulations, called spinopelvic parameters, vary individually, hence, the site of mechanical load in individuals. Particular types of spino-pelvic parameters are associated with different types of degenerative diseases. However, whether baseline pelvic parameters affect the location of new bone formation and the degree of radiographic damage in patients with SpA is not known. This study aimed to prospectively investigate the effect of pelvic parameters on syndesmophyte formation and radiographic damage in the spine in a heterogeneous group of SpA patients. Methods: Radiographic SpA (r-SpA) patients currently under follow-up in the MARS (MARmara Spondyloarthritis) outpatient clinic were included. Two readers independently scored the radiographs according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), and two readers calculated the spinopelvic parameters. The average scores were used. The relationship between pelvic parameters and radiographic progression was investigated using logistic regression analyses adjusted for potential confounders. Interactions were tested. Results: Sixty-nine patients completed the prospective follow-up period, with a median (IQR 25-75) follow-up period of 47.7 (34.6-52.8) months. Of these patients, 40 (58%) were male, and 39/68 (58.2%) were HLA*B27 positive, 38 (55.1%) were under treatment with biological therapies during the follow-up period. Radiographic progression developed in 23 (33.3%) of 69 patients. The mean (SD) mSASSS and the mean (SD) the number of syndesmophytes of these patients, respectively: at the time of enrolment were: 8.5 (4.6), 2.1 (1.8); after two years of follow-up were: 11.1 (4.28), 2.6 (1.9); at the end of the study were: 14.5 (4.7), 5 (2.7). Patients with radiographic progression statistically significantly had a higher baseline mSASSS (p<0.001), syndesmophyte count (p<0.001), PT measurement (p=0.037), and SS/PI (p=0.034) ratio than those without. No statistically significant difference existed between those with and without radiographic progression in gender, smoking, BMI, HLA*B27 positivity, and receiving biological treatment rates (Table 1). When PI, SS, and LL, were compared, PI was lower, and SS was higher in those with radiographic progression than those without. However, the difference between both parameters did not reach statistical significance. Nevertheless, the SS/PI ratio was statistically significantly higher in those with radiographic progression (in groups with and without radiographic progression, respectively; mean (SD): 0.78 (0.13) and 0.71 (0.15); p=0.034). Multivariate logistic regression analysis revealed that SS with an OR of 1.14 (95%CI: 1-1.31 p=0.043) and PI with an OR of 0.9 (95%CI: 0.82-0.996, p=0.041) were significant risk factors that are independent of the effects of previously reported risk factors or new bone formation. Conclusion: The SS/PI ratio is significantly higher in patients with radiographic progression. The baseline SS/PI ratio is correlated with the progression of mSASSS per unit time under follow-up, and the PI itself has a negative correlation with the progression in the lumbar spine. These correlations are more emphasized in the male sex and increase with age. In this model of new bone formation, information on HLA*B27, obesity, uveitis, smoking, and treatment had no additional contribution. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.

Assessment of breast development by physical examination can be difficult in the early stages and in overweight girls. To investigate ultrasonography (US) for evaluation of early breast development. In a prospective study, 125 girls (age 7.1 ± 1.5 years) with breast development before 8 years underwent US breast staging, breast volume, and elastography, in addition to clinical/hormonal evaluation for precocious puberty. Accuracy of US for determining breast development and predicting progression to central precocious puberty was investigated. Physical examination revealed glandular breast enlargement in 100 and predominantly lipomastia in 25. Breast US in the former confirmed glandular breast development in 92 (group 1, physical examination and US positive), but not in 8 (group 2, physical examination positive, US negative). Comparison of the two groups demonstrated lower Tanner and US staging, bone age/chronological age, basal luteinizing hormone (LH), breast volume, and uterine volume in group 2. In the 25 lipomastia patients, US demonstrated no breast tissue in 19 (group 3, physical examination and US negative), but US stage ≥ II in 6 (group 4, physical examination negative, US positive) without differences in clinical parameters. After follow-up of 19.8 ± 4.2 months, 46/125 subjects were diagnosed with precocious puberty. US stage, total breast volume, and shear-wave speeds were significantly higher in these 46 patients. Multivariate analyses demonstrated breast volume > 3.4 cc had odds ratio of 11.0, sensitivity of 62

Objective: Aim of this study is investigation of the risk of vertebral artery injury on the dominant and non-dominant vertebral artery sides at the craniocervical junction on cadavers . Methods: A total of five cadavers and 10 vertebral arteries injected with red latex were studied. Dissection was performed on all of the cadavers. The study also involved CT scans obtained from all of the cadaver specimens. Distance of C1 lateral mass medial wall to the V3 segment of the vertebral artery, distance of C1 lateral mass lateral wall to the V3 segment of the vertebral artery, distance of C2 pedicle medial wall to the V3 segment of the vertebral artery, and distance of C2 pedicle lateral wall to the V3 segment of the vertebral artery were measured and statistically analyzed. Results: There was no statistically significant difference between anatomical measurements on cadavers and on CT scan measurements. The data in the study demonstrated that the non-dominant (hypoplastic) vertebral artery follows a much closer course to the pedicle and the lateral mass, compared to the dominant artery. Conclusion: In conclusion, it has been shown that the vertebral artery may be easily injured during surgical procedures due to the anatomical proximity of the pedicle and lateral mass and the screws’ entry points being much closer on the non-dominant side.

OBJECTIVE: A novel posteriolateral surgical approach is described that will provide safe access to intradural and extradural lesions located in the anterior part of the spinal cord (SC) at the C1-2 level and to the odontoid in single session. METHODS: A total of five cadavers and two dry C1 vertebrae were used in this study. The study involved obtaining computed tomography magnetic resonance imaging scans and magnetic resonance imaging of all cadaver groups before and after the procedures. Group 1: Control; Group 2: Unilateral C1 posterior arch was removed, the inferomedial part of C1 lateral mass was removed, and access the anterior and lateral aspects of the SC. Group 3: In addition, odontoid was removed, Group 4: In addition, - nilateral C1C2 screw was placed. Group 5: In addition, bilateral C1 -C2 screw was placed. RESULTS: The median distance from the midpoint of C1 posterior tubercle to vertebral groove which was removed in groups is 21.4 +/- 2.88 mm. The average width of C1 lateral mass was 13.4 +/- 2.4 mm. After the lateral mass was drilled, its width decreased to 10,2 mm. This area was sufficient to open a surgical corridor and reach the anterior of SC and odontoid. After the procedure, no instability was found in group 2 without instrumentation on computed tomography and magnetic resonance imaging scans. CONCLUSIONS: It is possible to access the anterior C1C2 via a posterolateral paramass approach by drilling 20% - 30% of the lateral mass, providing an open pathway for easy intervention in C1C2 intradural lesions. It is also possible to perform odontoid resection using this approach.

Background To investigate the imaging findings and clinical features of multinodular and vacuolating neuronal tumor (MVNT). Methods We retrospectively sought for cases that have suspicious imaging findings for MVNT through the hospital information system. The patients’ demographics and clinical symptoms were extracted. All available images were re-examined. Results Headache was the most common complaint ( n = 7). Other complaints included seizure, stroke-like symptoms and numbness. Conventional MRI revealed that all lesions consisted of tiny, sharply marginated, round or ovoid nodules following the gyral contour. These nodules were hyperintense on T2 and FLAIR WI, hypointense on T1 WI. All lesions were characterized by a lack of enhancement and diffusion restriction. Mass effect and peripheral edema were not observed. MVNT presented as an incidental finding in one case who complained gynecomastia and had pituitary adenoma on pituitary MRI. All lesions were supratentorial—mostly on the right side (10/11)—and located in subcortical white matter. Follow-up MRI was available for 11 patients with a mean of 14.8 months (3–40 months). No change in lesion size and morphology was observed in these follow-up images. Conclusions Radiological and clinical follow-up data suggest MVNT may exhibit indolent behavior. If asymptomatic, patients can be followed by imaging alone. Surgery should be considered for symptomatic patients.

British Journal of Hospital MedicineVol. 29, No. 3 Images in MedicineOrbital and dural involvement in multiple myelomaOmer Faruk Sımıtcıoglu, Erhan Bıyıklı, Yesim Alahdab, Hatip AdınOmer Faruk SımıtcıogluCorrespondence to: Omer Faruk Sımıtcıoglu; E-mail Address: [email protected]Department of Radiology, Faculty of Medicine, Marmara University, Istanbul, TurkeySearch for more papers by this author, Erhan BıyıklıDepartment of Radiology, Faculty of Medicine, Marmara University, Istanbul, TurkeySearch for more papers by this author, Yesim AlahdabDepartment of Gastroenterology, Faculty of Medicine, Marmara University, Istanbul, TurkeySearch for more papers by this author, Hatip AdınDepartment of Gastroenterology, Faculty of Medicine, Marmara University, Istanbul, TurkeySearch for more papers by this authorOmer Faruk Sımıtcıoglu; Erhan Bıyıklı; Yesim Alahdab; Hatip AdınPublished Online:29 Mar 2023https://doi.org/10.12968/hmed.2022.0383AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 March 2023Volume 29Issue 3ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 29 March 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedPDF download

Cervical radiculopathy and spinal cord indentation caused by vertebral artery loop formation is a rare entity. We report here an 85-year-old woman had a four-year history of neck pain and left arm weakness. Radiologic evaluation showed vertebral artery loop formation compressing the adjacent nerve root and spinal cord. Accurate radiologic diagnosis of this condition is crucial to reduce unexpected surgical complications.

Objective: To evaluate the value of coeliac artery (CA) and superior mesenteric artery (SMA) origin levels as an anatomic marker in the detection of lumbosacral transitional vertebrae (LSTV) and vertebral enumeration. Patients and Methods: Institutional review board approval was obtained. Routine lumbar magnetic resonance (MR) imaging that included sagittal cervicothoracic scout images in 972 cases were evaluated retrospectively. Six segments were created in the vertebral column with 7 lines. CA and SMA ostiums were localized in these segments. Results: Coeliac artery and SMA levels were detected more caudally in lumbarized S1 and more cranially in sacralized L5 cases compared to non-LSTV cases. Conclusion: Coeliac artery and SMA origin levels are not confidential in consequence of wide variability.

Introduction Pilocytic astrocytoma of the cerebellopontine angle (CPA) is uncommon, and its spread to the cerebrospinal fluid (CSF) at the time of diagnosis has not been reported in the literature. Case Presentation We report the case of a 33-year-old man with multifocal pilocytic astrocytoma diagnosed by magnetic resonance imaging (MRI) and confirmed by histopathological examination, and present the radiological and histopathological findings. Conclusion In the case herein reported, we observed spread of the pilocytic astrocytoma of the CPA to the CSF at the initial diagnosis, and early detection by MRI is very important regarding the treatment modality and prognosis.

The diagnosis of brain death is primarily clinical. Sometimes ancillary tests are needed. This study compared sensitivity and interobserver agreement of the 10-, 7- and 4-point CT angiography scoring systems for the diagnosis of brain death in children. CT angiography examinations of 50 pediatric patients with a clinical diagnosis of brain death were evaluated according to 10-, 7- and 4-point scoring systems. Images were evaluated by two radiologists who considered the vessel opacification first in the arterial phase (A0–V50) and then in the venous phase (A0–V50). We evaluated interobserver agreement for the assessment of vessel opacification and diagnosis of brain death. We compared the differences among brain death diagnoses between children with craniotomy–craniectomy defects, open fontanelles and preserved bone integrity. We subdivided children into two groups according to age: ≤ 2 years and > 2 years. We calculated sensitivities according to age groups. Using the clinical exam as the reference standard, we found sensitivities for 10-, 7- and 4-point scoring systems to be 70

Background: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most common thermal ablation methods. Studies evaluating the effectiveness of these techniques have been carried out in recent years. Objectives: Evaluation of local therapeutic effectiveness of imaging guided percutaneous thermal ablation methods, short-middle term radiologic and clinical outcomes and to compare the effectiveness of treatment between two MWA and RFA methods. Patients and Methods: We retrospectively browsed clinical-radiologic-pathologic-demographic parameters of patients who had undergone RF or MW treatment due to HCC between January 2012 and January 2015. Twelve females (30%) and 28 males (70%) who had at least 6 months follow-up were included. We evaluated the risk factors which we considered to affect the prognosis by means of Log-Rank (Mantel-Cox) analysis. Complications rates, ablative effectiveness, local progression free and disease free survival rates for 6 months and 1 year periods were calculated by Kaplan Meier test for each group separately. The results of two groups were compared by chi-square test. Results: 6-month, 1-year and 2-year survival rates for thermal ablation were 84.6%, 78.7% and 65% for general; 76.3%, 55.2%, 33% for disease free and 78.9%, 76.2%, 37.3% for local progression free respectively. Size and number of lesions were the only parameters that effective for all type of survival rates. In addition, Child-Pugh classification, AFP (alpha-fetoprotein) level and gender were found to affect just; general, disease free and local progression free survival rates respectively. No statistically significant difference was found in complication, ablative effectiveness, 6 month and 1 year general, disease free and progression free survival rates between RF and MW separately. Conclusion: RF and MW ablation methods have similar complication rates, tumor ablation efficiency and survival rates for treatment in HCC patients.