Nowadays, there are some ideas that direct graphy is unnecessary for the evaluation of patients with head trauma. But, computerized tomography (CT) is less sensitive in detection of calvarial skull fractures than plain radiographs. We report a case who was admitted to hospital after fall and skull fracture was not detected with CT. Neurologic examination of the patient was normal when he was referred to our emergency department with complaints of headache, nausea, and vomiting. Plain radiograph showed right frontal lineer fracture so the patient was hospitalized. All cases who apply with head trauma are routinely evaluated with direct cranial graphy in our clinic because of legal conditions and the probability that transverse fractures may not be detected with CT.

The occurrence of Tuberculous psoas abscess as the presenting manifestation of tuberculosis, without evidence of active infection elsewhere is rare. We report a case of bilateral psoas abscess that was diagnosed with computed tomography in a patient who presented with low back and abdominal pain. The treatment was made with radiologically-guided percutaneous drainage followed by antituberculous drugs. As the onset of symptoms is frequently insidious and the clinical presentation is vague the diagnosis requires recognition of this disease by the physician first.

Ozet Tuberkuloz psoas absesinin vucudun baflka bir bolgesinde aktif enfeksiyon bulgusu olmaks›z›n tubekulozun ilk bulgusu olarak ortaya c›k- mas› nadirdir. Bu olgu sunumunda bel ve kar›n ar›s› nedeniyle araflt›r›l›rken bilgisayarl› tomografi (BT) ile bilateral psoas absesi tan›s› ko- nulan ve bilgisayarl› tomografi eflliinde perkutan abse drenaj›n› takiben antituberkuloz ilaclarla tedavi edilen bir olgu sunulmufltur. Semp- tomlar s›kl›kla sinsice ortaya c›kt›¤› ve klinik bulgular muphem olduu icin psoas absesinin tan›s›nda ilk onemli ad›m klinik olarak hastal›k- tan fluphelenmektir. Anahtar kelimeler: Bilgisayarl› tomografi, psoas absesi, tuberkuloz Cerrahpafla T›p Derg 2010; 41: 20-22 Abstract The occurrence of Tuberculous psoas abscess as the presenting manifestation of tuberculosis, without evidence of active infection elsewhere is rare. We report a case of bilateral psoas abscess that was diagnosed with computed tomography in a patient who presented with low back and abdominal pain. The treatment was made with radiologically-guided percutaneous drainage followed by antituberculous drugs. As the onset of symptoms is frequently insidious and the clinical presentation is vague the diagnosis requires recognition of this disease by the physi- cian first.

A two years old boy presented with a transanal protrusion of the ventriculoperitoneal (VP) shunt catheter. A VP shunt was inserted when the boy was six-month-old for congenital hydrocephalus. He was active and neurologically normal, with no signs of meningitis and peritoneal irritation. During laparotomy, the tube was seen entering the sigmoid colon, so the tube was cut at the point where it entered the sigmoid colon. The distal end of the protruding tube was pulled out from the anus. The sigmoid colon was repaired, and a delayed shunt revision was completed. The patient was discharged without abdominal and neurological deterioration.

We report a 10-year-old girl with an isolated traumatic intraventricular hemorrhage following a traffic accident, who had a good prognosis. Her neurological examination upon arrival was normal and she had no complaint other than headache and vomiting. Computed tomography on admission showed a hemorrhage in the lateral and fourth ventricles. She had a Glasgow Coma Score of 15, and she was thus given only antiepileptic drugs for prophylaxis and followed. Computed tomography that was repeated 5 days after admission showed no blood and all ventricles were of normal size. There was no vascular pathology on magnetic resonance imaging and magnetic resonance angiography. The patient remains well 5 months after her accident. Intraventricular hemorrhage does not always have a poor prognosis.

Numerous problems have been described during the aneurysm surgery. In this report, severe arachnoidal scarring (that is named as armored arachnoiditis) that made clipping of anterior communicating (ACom) aneurysm impossible in our case of study is presented. A case with recurrent hemorrhage is hospitalized in our institution. Initial diagnosis was meningitis in a local hospital. The patient was operated after recurrent intraventricular hemorrhage in late phase due to unavailability of endovascular options at our institution. At surgery, surprisingly all of the cisterns were obliterated and no cleavage plane was found. Every effort for taking CSF was unsuccessful. The corticectomy of gyrus rectus did not solve the problem. Neither aneurysm nor proximal and distal controls could be exposed in spite of any dissection techniques used. We felt that any further attempts to dissect aneurysm and ACom complex would result in a catastrophic injury and rupture. Since, the armored arachnoiditis could not be detected before the surgery, patients should be treated by endovascular techniques following the surgery in the presence of this type of arachnoiditis. In this report, the pertinent literature related to perioperative complications of aneurysm surgery is shortly reviewed. (Archives of Neuropsychiatry 2011; 48: 207-10)

Hypertrophy of the ligamentum flavum (LF) can reduce the diameter of the spinal canal posteriorly. Such stenosis may significantly compress the dural sac and nerve roots, resulting in symptoms, even without a bulging anulus fibrosus or herniated nucleus pulposus. We conducted an anatomical study to determine the influence of age and gender on the thickness of the LF at the lower lumbar levels using magnetic resonance imaging (MRI). The thickness of 1,280 ligaments was determined at the L4-L5 and L5-S1 levels from MRIs. We screened 320 patients (152 males [47.5%] and 168 females [52.5%]) between 21 and 82 years of age. There were no significant differences in LF thickness with respect to gender (P > 0.05). Age was not correlated with the thicknesses of the LF. The left LF at the L4-L5 and L5-S1 levels was significantly thicker than on the right side (P < 0.05). Furthermore, the LF thicknesses at L5-S1 bilaterally were significantly greater than on the corresponding sides at L4-L5 (P < 0.05). The LF is an important anatomical structure, which might cause low back or leg pain. Therefore, the thickness of the LF should be measured and evaluated carefully in the case of spinal stenosis.

4 Aim: Diabetes mellitus is a chronic metabolic disease that is associated with peripheral microvascular complications and an increased risk of neurological events. Following closed head injury, diabetic rats suffer greater neurological dysfunction, associated with further lipid peroxidation than normal rats. The mechanistic factors in diabetes which cause neurological dysfunction are not clear, but disruption of the blood-brain barri- er (BBB) may be one reason. We experimentally investigated alterations in the BBB after traumatic brain injury in streptozotocin-induced diabetic rats. Methods: Thirty-two adult male Sprague-Dawley rats were divided randomly and evenly into four groups as trauma only, diabetes only, diabetes plus trauma, and sham-operated control. Diabetes was induced by a sing- le injection of streptozotocin. Diabetic rats were exposed to trauma 4 weeks after streptozotocin injection to allow development of chronic diabetes. Permeability to Evans blue dye (EBD) was evaluated to assess the BBB integrity following trauma. Brains perfused with EBD were divided into six anatomically distinct brain regions (cortex, hippocampus, corpus striatum, midbrain, thalamus, and cerebellum), and EBD extravasation was quantified using spectrophotometric methods 60 min after injury. Results: Spectrophotometric measurements of EBD revealed that BBB permeability was increased signifi- cantly in the cerebellum and corpus striatum in the diabetes plus trauma group compared with the trauma only and control groups. Conclusion: The disruption of the BBB caused by traumatic brain injury is more severe in diabetics than normal subjects, and also region specific with cerebellum and corpus striatum appearing to be most susceptib- le to trauma-induced microvascular damage in diabetics.

Low back pain (LBP) among nurses has been a well-known occupational health problem. This cross-sectional Study is designed to investigate the rate of LBP in nurses working in different departments and to evaluate the relationship between psychologic factors and LBP. The general aspects of LBP were evaluated with Oswestry Low Back Pain and Disability Questionnaire and a 10 cm Visual analog scale among 118 nurses. Psychologic state was evaluated with Beck Depression Inventory and Brier Symptom Inventory. Student t test ror independent samples and chi(2) test Were used in univariate analysis. One-way analysis of variance was used to compare the parametric variables of 3 groups of nurses. The mean number or pain attacks was significantly higher among nurses working in Emergency/Intensive Care Unit (mean: 5.4) than those ill Surgery department (mean 4.6) and in Internal Medicine Department (mean: 2.2), respectively, (P = 0.031). The mean Beck Depression Inventory score of subjects with pain (mean: 9.8) was significantly higher than those without pain (mean: 5.6, P <= 0.002). The mean Brief Symptom Inventory scores of depression, somatization, and hostility were significantly higher in Subjects with pain than in subjects without pain (P = 0.002; P = 0.000; P = 0.012, respectively). The Subjects with back pain showed statistically significant higher rates of mild mood disturbance and depression (P = 0.027). Further studies about file causes and associations of LBP among nurses are needed as the preventive measures call be undertaken.

We report two cases with primary autoimmune hypothyroidism and an ectopic thyroid gland causing pituitary enlargement mimicking pituitary macroadenoma. One of the cases presented with complaints of headache and short stature and the other case with a complaint of menorrhagia. In both cases, the pituitary mass and symptoms resolved with levothyroxine replacement. Normal menses resumed. However, pituitary dynamic tests revealed persistent growth hormone and gonadotropin deficiency in one case and growth hormone deficiency in the other. To our knowledge, this is the first report in an adolescent of hypogonadotropic hypogonadism, growth hormone deficiency, and menorrhagia associated with pituitary hyperplasia secondary to primary hypothyroidism. The recognition of the association between reversible pituitary hyperplasia and primary hypothyroidism might eliminate unnecessary surgery.

We report a 13-year-old girl with a hydatid cyst located in the posterior fossa. The pre-operative diagnosis was a cerebellar tumour; the cyst was operated on using puncture, aspiration, irrigation and resection. Sixteen months post-operatively, the patient is in a good health. A hydatid cyst must always be considered in the differential diagnosis of cystic lesions of the cranium, especially for those children living in rural areas.

Objective: Pott's puffy tumour (PPT) is a rare entity that is characterised by a subperiosteal abscess associated with frontal bone osteomyelitis. Case: We report a case where a frontal periosteal abscess was successfully treated with simple surgical abscess drainage, followed by prolonged broad-spectrum antibiotic therapy. Conclusion: The treatment goal is early diagnosis and aggressive therapy to prevent severe complications like meningitis, subdural empyema, and brain abscess.

This study examined the preventive effects of the local application of mitomycin C (MMC), 5-fluorouracil (5-FU), and cyclosporine A (CsA) in minimizing spinal epidural fibrosis in a rat laminectomy model. Thirty-two 2-year-old male Wistar albino rats, each weighing 400 +/- 50 g, were divided into four equal groups: sham, MMC, 5-FU, and CsA. Each rat underwent laminectomy at the L5-L6 lumbar level. Cotton pads (4 x 4 mm2) soaked with MMC (0.5 mg/ml), 5-FU (5 ml/mg), or CsA (5 mg/ml) were placed on the exposed dura for 5 min. Thirty days after surgery, the rats were killed and the epidural fibrosis, fibroblast density, inflammatory cell density, and arachnoid fibrosis were quantified. The epidural and arachnoid fibroses were reduced significantly in the treatment groups compared to the sham group. Fibroblast cell density and inflammatory cell density were decreased significantly in the MMC and 5-FU groups, but were similar in the sham and CsA groups. The decreased rate of epidural fibrosis was promising. Further studies in humans are needed to determine the short- and long-term complications of the agents used here.

The treatment of patients with spontaneous intracerebellar hematoma (SIH) still remains controversial. Computerized tomography (CT) offers early and accurate diagnosis of SIH, the size and location of SIH can be precisely defined. The main prognostic factors affecting the outcome are the clinical state of the patient on admission, the size and localization of the hematoma, compression of brain-stem, and the presence of intraventricular hematoma and hydrocephalus. In this report, a 62 year old female patient with a giant cerebellar hematoma who was treated medically was presented.

The large myelomeningocele defects that cannot be closed reliably by simple skin undermining require a close cooperation between the neurosurgeon and the plastic surgeon. In this study, a 3-year review was undertaken of nine consecutive patients with a myelomeningocele defect treated in our hospital. The aim of the study was to analyze the size, location of myelomeningocele defects, features of the surrounding tissue, and type and results of the reconstruction method for skin closure. Of the nine patients, five were repaired within the first 48 h of life, two within the 1st month of life, and two were repaired within the 1st year of life. Of the nine patients, seven (78%) underwent repair with direct skin approximation by the Neurosurgical Service. For three patients (33%) with large lumbosacral meningomyelocele defects, including one patient who had failed direct skin approximation, the Plastic Surgery Service achieved the skin closure by bilateral paralumbar fasciocutaneous rotational flaps. Minimal area in the patients referred to the Plastic Surgery Service was 24 cm2 (range 24–48 cm2); patients having 18 cm2 or less skin defect were not referred for closure. In conclusion, fasciocutaneous rotational flaps provided tension-free, durable, innervated and well-vascularized skin coverage over the dural repair in all three referred patients, without using skin graft. Since myelomeningocele defects vary in size, shape, and location, no single procedure applies to all. Therefore, other reconstruction methods involving skin grafts, fasciocutaneous flaps, and musculocutaneous flaps are reviewed in this report.

A woman had burning pruritus on both arms and thenar regions for 1 year. The location of pruritus was consistent with C5-C6 dermatomes. Brachioradial pruritus caused by spinal cord tumor was diagnosed. Although cases of brachioradial pruritus were reported in cervical osteoarthritis and cervical rib previously, to our knowledge, our patient is the first reported case of brachioradial pruritus caused by a tumor.