BACKGROUND Traumatic and ischemic injuries of the spinal cord are effective in the development of neurological dysfunction of tissue damage caused by primary and secondary mechanisms. Free radical changes are effective in the development of early ischemia and progressive tissue ischemia is the main cause of secondary damage. Delaying ischemia is the basis of treatment. In this study, we aimed to demonstrate the presence of neuroprotective effects of alpha-lipoic acid in comparison with methylprednisolone. METHODS 50 Sprague Dawley rats were divided into 5 groups (n = 10) and spinal cord trauma was created by the method, described by Rivlin and Tator. Group 1: Laminectomy group, Group 2: Laminectomy + spinal cord injury (SCI), Group 3: Laminectomy + SCI + alpha-lipoic acid (ALA) (100 mg / kg), Group 4: Laminectomy + SCl + Methyl-prednisolone (30 mg / kg), Group 5: Laminectomy + SCl + ALA + Methyl-prednisolone. RESULTS AND DISCUSSION Rats with spinal cord injury were found to be paraplegic. There was no significant change in motor function between the groups. When the antioxidant values were compared in the groups, there was a statistically significant difference between Group 2 and Group 3. Oxygen radicals decreased significantly between ALA and Methylprednisolone. The most striking difference was between the monotherapy group and the combined treatment group. CONCLUSION Our results showed that alpha lipoic acid given after spinal cord trauma in rats decreases anti-oxidant formation. KEY WORDS Alpha-lipoic acid, Methyl-prednisolone, Oxygen radicals, Spinal cord injury.

AIM:Posterior epidural migration of a sequestered lumbar intervertebral disc fragment (PEMSLIDF) is an extremely rare condition published so far only as case reports or small case series (ranging between 2 to 8 cases). Diagnosing this condition is often challenging and the diagnosis is usually made intraoperatively. The affected patients usually suffer cauda equina syndrome (CES). In the present study, we aimed to discuss the clinical and radiological findings, types and features of surgical therapies, and outcomes of 9 patients with PEMSLIDF.MATERIAL AND METHODS:This study included 9 (0.36%) patients with PEMSLIDF among 2470 patients who underwent lumbar disc hernia surgery between August 2002 and September 2012. The preoperative clinical and radiological properties of the patients were evaluated. The postoperative outcomes were assessed using neurological examination, radiological imaging, visual analog scale (VAS) and modified Odom criteria.RESULTS:As far as we know, this study is the largest case series examining the characteristics of PEMSLIDF. Seven (77.8%) of our patients were male and 2 (22.2%) were female and they had a mean age of 49.5 years (range 28-70 years). The mean duration from symptom onset to hospital admission was 7.4 days. Seven patients had CES. All patients underwent sequestrectomy and discectomy via posterior microsurgery. The patient outcomes were evaluated by the Modified Odom criteria and the outcome was excellent in two (22.2%) patients, good in 4 (44.5%), fair in 2 (22.2%), and poor in 1 (11.1%).CONCLUSION:The entire free fragment can usually be excised via the posterior microsurgery technique. Early surgical treatment is of great importance to prevent more serious neurological deficits.

Objective: Brain is involved in 1-2% of hydatid cyst infections. A cranial location is rare. In this study, we aimed to assess clinical findings, radiological investigations, and treatment modalities of cases with intracranial hydatid cyst. Materials and Method: The present study included 26 patients operated for cerebral hydatid cyst disease between January 1990 and October 2012. Results: Seventeen patients were male and 9 were female. The mean age of the study population was 20.3 years (range 7-50 years). Headache and nausea were the most common clinical symptoms. The lesions were demonstrated by computed tomography (CT) and magnetic resonance imaging (MRI) as large, smooth, thin walled, spherical-shaped, cystic homogenous lesions with the same density as cerebro spinal fluid, which showed no edema or contrast uptake. Two patients were complicated or infected cysts with perifocal edema and contrast uptake. In 20 patients, the cysts were removed completely with Dowlings technique, by rectifying cysts without rupturing. Eleven patients with ruptured cysts during operation, recurrent or systemic hydatid cyst were treated medically. Conclusion: Medical therapy appears effective in hydatid cyst disease. Cerebral hydatid cysts should be excised totally without rupturing them. Preoperative imaging techniques are central to surgical planning. Intracranial hydatid cyst should be remembered when CT or MRI shows a cystic lesion, especially in countries where hydatid cyst is endemic.

OBJECTIVE:An animal model of laminectomy in rats was used to study scar tissue formation around the spinal cord. Bevacizumab (BV) [a recombinant, humanized, monoclonal antibody targeting vascular endothelial growth factor], 5-Fluorouracil (5-FU) and BV+5-FU was tested in this system for its ability to decrease fibrous tissue formation.MATERIALS AND METHODS:Twenty-eight Sprague Dawley rats were used in this sudy. Rats were divided into four groups; a control group, a BV group, a 5-FU group and a BV+5-FU group. L1-2 laminectomies were performed on the rats. The medicated groups were treated with topical drug administration. After 6 weeks, the rats were sacrified and histologic sections prepared from the spines were examined and graded by a pathologist. Epidural fibrosis and fibroblast density were evaluated under light microscope.RESULTS:BV (Avastin: Genentech, San Francisco, CA, USA) significantly reduced the density of the scar tissue undermining the laminas (p < 0.005). Monotherapy with 5-FU did not change the scar formation in the back (p = 0.317). Combination of 5-FU and BV was more effective on reducing the epidural fibrosis after laminectomy on rats (p < 0.001).CONCLUSIONS:Bevacizumab reduced the spinal epidural fibrosis significantly that developed in rats after laminectomy and 5-Fluorouracil combination had a synergic effect. Further investigations under the light of these findings may help to reduce epidural fibrosis formation after laminectomy.

We report the case of a 37-year old male patient was wounded at the face bay a gunshot. There was a single entrance wound, was detected at the right maxilla in the inspection. Cervical plain X rays a bullet was seen, between the axis and the occipital bone. It is very rare for an upper cervical injury not causing any neurological deficits at all. The aim of this case report is to prevent a case with a gunshot causing a clivus fracture by advancing to the adjacent dens between the occipital bone and the axis.

Aim: We aimed to determine the effects of rt-PA and enoxaparin on post laminectomy epidural fibrosis and to compare the effects of these two medications with hyaluronic acid and urokinase in an experimental model of spinal epidural fibrosis. Method: Forty Spraque-Dawley rats were anaesthetized by intraperitoneal anesthesia (ketamin 8 mg/100 g) and randomly allocated to five groups. All groups were underwent L1-2 total laminectomies. Topical medications were applied to group 2-5 right after the laminectomy space. Hence, in group 1 (G1=control) only laminectomy was constituted, in group 2 (G2) laminectomy + topical Urokinase, in group 3 (G3) laminectomy + topical rt-PA, in group 4 (G4) laminectomy + topical enoxaparin and in group 5 laminectomy + topical Hyaluronic acid (G5) application were performed. The potentials of local urokinase, rt-PA, hyaluronic acid and enoxaparin in preventing the production of epidural fibrosis were assessed. Result: In inter group comparison, G1-G2, G1-G3, G1-G4, G1-G5 groups differed from each other for total scar score, middle scar score and deep scar score (p<0.05). However, G2-G3, G2-G4, G2-G5, G3-G4, G3-G5 and G4-G5 were not different from each other. Conclusion: In rats, the topical thrombolysis with fibrinolitic agents is safe and efficacious in preventing of post laminectomy epidural fibrosis. Thrombolytic therapy with topical hyaluronic acid, rt-PA, urokinase and enoxaparin may come to play an important role in the prevention of post operative spinal epidural fibrosis and arachnoiditis. Based on the results we found that rt-PA and enoxaparine inhibit the formation of epidural scar adhesions and arachnoiditis compared with control group.

Elevated serum neuron-specific enolase levels are correlated with brain cell damage. Low scores according to Glasgow Coma Scale are also considered as serious poor prognostic factor. The aims of the study were to investigate whether there is a correlation between the two measurements in patients with traumatic brain injury and whether serum neuron-specific enolase levels have potential as a screening test to predict outcome. A total of 169 consecutive patients with traumatic brain injury admitted to our clinic between 2002 and 2005 are included in this study. Those patients, who had any major health problem before trauma, were excluded from the study. However, patients with isolated head injury were included in the study. Serial serum neuron-specific enolase concentrations taken at the first 2, 24, and 48 h after traumatic brain injury were analyzed. A computed tomography was performed on each patient on admission. Their Glasgow Coma Scale scores were recorded serially. The relationship between Glasgow Coma Scale scores and the serum neuron-specific enolase levels were assessed by statistical methods. There was a significant negative correlation between the serum neuron-specific enolase levels and Glasgow Coma Scale scores. The levels of neuron-specific enolase were significantly higher in the patients who died in 30 days after trauma and whose scores were lower than or equal to 8 points in Glasgow Coma Scale. Although there are several serious limitations of the use of neuron-specific enolase as a biomarker in traumatic brain injury (i.e., hypoperfusion, extracranial trauma, bleeding, liver, or kidney damage also increase the level of neuron-specific enolase), its concentrations may be useful as a practical and helpful screening test to identify neurotrauma patients who are at increased risk and may provide supplementary estimation with radiological and clinical findings.

We have presented a patient with brucellar spondylodiscitis who developed paraparezi secondary to spinal cord compression, and responded well to the medical treatment.A 55 year-old male farmer presented with a 7-day history headache, urinary retention, weakness in his lower extremities and a 3-month history of back pain. Blood brucella Wright antibody titer was 1/160 and Rose Bengal test was positive.Our case did not need a surgical intervention and gave a good response to medical treatment and rehabilitation. Thus, we suggest that in cased with brucella spondylitis, medical treatment should be considered at first, even in cases with spinal cord compression due to prevertebral abscess.

The aim of this study was to present a unique case of intramedullary brucellar granuloma (IBG) and to discuss the diagnosis and management. To our knowledge, only one case of thoracic IBG has been reported previously, and our case is the first in cervical spine. A 35-year-old female patient was admitted with headache, pain and weakness in her four extremities. She had no gastrointestinal symptoms and fever. She had been diagnosed with Brucella meningitis 3 months ago and a triple therapy of doxycyclin, rifampicin and trimetoprim/sulfametoxazol (TMP/SMZ) had been started. Medical history revealed that she had ingested raw cheese and taken her medication improperly. Loss of strength was detected in her four extremities, which led us to assume the formation of a mass lesion at cervical level. Therefore, we performed a magnetic resonance imaging scan and found enhancement of an intramedullary mass lesion at cervical 1-2 level. Diagnosis of neurobrucellosis was confirmed by titer of >1/160 Brucella antibodies both in blood and cerebrospinal fluid. Based on these findings, brucellar granuloma of cervical spine was diagnosed and a combination therapy of doxycyclin, TMP/SMZ and rifampicin was administered for additional 6 months. At the ninth month of treatment, the patient recovered both radiologically and clinically. Our case is unique, in terms of cervical IBG formation. The excellent response to antimicrobial therapy in our patient suggests that, a trial of medical treatment for 6 months may be effective in such cases.

SUMMARY In this study, of 3462 cases admitted with cranial trauma between 1992 and 2000. The 115 cases that were diagnosed as extradural haematoma (EDH), were analyzed to obtain the outcome of extradural hematomas. Each patient was evaluated retrospectively in terms of age, sex, and models of injury, localization of the haematoma, origins of bleeding, neurological findings and diagnostic investigations. The outcomes for each patient were retrieved and analyzed, and the chi–square test was used in the statistical analyses. Of all the patients in this group, 88 (76%) were male and 27 (24%) were female, of the patients, 70% were between 10-40 years old. The outcomes showed a significant correlation with Glasgow Coma Scale score, pupillary sizes, and pyramidal signs (p <0.05).The radiologic findings of the the size hematoma, the degree of the brain shift, significantly correlated with outcome (p < 0.05). Factors such as coma, pupil alterations, volume of haematoma, presence of pyramidal signs, midline shift, and lucid interval the existence of local motor findings are risk factors for the outcome in patients with EDH.

We report the case of a 20-year-old man with a gunshot injury as an example of spontaneous migration of a metallic foreign body within the brain. Computed tomography (CT) showed the bullet in the left temporoparietal region. At 10 days follow-up, CT revealed that the bullet had migrated posteriorly, due to the effect of gravity, lodging in the occipital lobe. Although there are a few literature reports of spontaneous migration of a bullet within the brain, this case was unique as the patient was fully conscious without any neurological deficit.

Objectifs. – Évaluer les résultats de la rééducation sur l’évolution des fonctions motrices et de l’état fonctionnel au cours du traitement de la tuberculose vertébrale.

Background: The blood supply to tissues is reduced as a result of arterial occlusions. Angiogenesis, collateral circulation and reverse flow mechanisms go into operation to restore a continued adequate supply of blood. Ca++ channels undertake the major part of this function. As a result of the increasing tension on the arterial walls, vascular autonomy is affected, and ischemia and even necrosis are observed. Method: Adult 100 male hybrid rabbits were used in this study. The bilateral carotid arteries were ligated at the carotid bifurcation. The rabbits were divided into 2 main groups: treatment and control, and then both groups were further divided into 5 subgroups consisting of 10 rabbits each. The rabbits were sacrificed between the first day and the end of 8 weeks for histopathological examination of the basilar artery in two groups. Results: In control groups, after 24 hours of the occlusion partial swelling and minor endothelial damage were observed in histopathological sections of the basilar artery. Luminal flattening started to decrease, and expanding of the diameter continued. The increase in the diameters of the basilar artery was higher in animals treated by nimodipine, and that difference was statistically significant (P=0,000). Conclusion: This study revealed that the intimal and medial alterations arising from the increased blood flow rate in the basilar artery might be lessened and even partially prevented by the use of nimodipine.

Vasospasm is an important cause of morbidity and/or mortality with a subarachnoid haemorrhage (SAH). The roles of lipid peroxidation in a vasospasm caused by a SAH remain to be investigated. The effect of an intracisternal administration of alphatochopherol on a cerebral vasospasm was investigated in an experimental model. The authors assessed whether the administration of alphatochopherol reduced the vasospasm. By means of an intracisternal blood injection model, a SAH was induced in 30 rats, which were randomly divided into three groups, as follows: group I (G1), without a SAH and drug, group II (G2), a SAH alone, group III (G3), a SAH and alphatochopherol. Following the withdrawal of cerebrospinal fluid (CSF), a fresh unheparinized arterial blood was injected into the cisterna magna to induce a SAH. In G3, 20 U (0.4ml) alphatochopherol was intracisternally injected forty-five hours after induction of the SAH. All rats were sacrificed 72 hours after the induction. The basilar artery, with surrounding tissue, was removed from the cranium. The cross-sectional diameter of the lumen and vessel wall of the rat basilar artery was assessed from a planimetric analysis, and changes compared with G1 and G2. The reduction in the luminal cross-sectional diameter of the vessels exposed to subarachnoid blood was found to be 29.01 % (p=0.001). The group treated with alphatochopherol had a 9% reduction (p=0.004). The role of lipid peroxidation on a vasospasm caused by SAH is well known to be critical. Data from the present study indicated that antioxidant therapy, with topical alphatochopherol, may be promising on a vasospasm caused by a SAH.

The current study is based on a retrospective investigation of firearm deaths in Diyarbakir, which were autopsied by the Diyarbakir Branch of the Council of Forensic Medicine during the 6- year period. Four hundred-forty four deaths were investigated from January 1996 through December 2001, including homicide (296 cases, 66.7%), suicide (120 cases, 27%) and accidental shootings (28 cases, 6.3%). The age range of all firearm deaths in the study period was 5 to 75 years with a median age of 29.8 years. The majority were in the groups aged 16-25 years (38.7%). In the homicide group, 248 subjects (83.8%) were male, and 48 (16.2%) were female. The 31.1% of the homicide victims were in the group aged at 20-30 years. Of the 120 suicide victims, 56 (46.7%) were in the group aged 16-20 years. The head was by far the favoured site, accounting for 82 (68.3%) deaths: entry wounds in the right temple accounted for 72 of these. Twenty-eight cases were accidental shootings and 18 of them were male (64.3%). Twelve of the 28 accidental victims (42.9%) were in the group aged 0-10 years. The eight cases were due to their own accidental shootings, and the remaining 20 cases were shot by others. Our findings show that the contributing factors for increasing death by firearm are terrorists' activities, traditional habits of obtaining and using guns and blood feuds.

STUDY DESIGN:A randomized-controlled experimental study was conducted to investigate the effectiveness of recombinant tissue plasminogen activator (rt-PA) on postlaminectomy epidural fibrosis in rats.SETTING:Diyarbakir, Turkey.METHODS:In a rat model, allowing objective histopathological quantification, the postoperative epidural scar formation was investigated and the potential of local rt-PA in preventing the production of epidural fibrosis was assessed. Rats were randomly allocated to local rt-PA (12 rats) or control (12 rats).RESULTS:Findings suggest a beneficial effect of rt-PA in decreasing the epidural fibrosis following laminectomy when compared with control groups for all investigated parameters such as intermuscular scar (P=0.04), middle scar (P=0.001), deep scar (P=0.001) and dural adhesion (P=0.01) except new bone formation. The presence of arachnoiditis was less in treatment group (P=0.01).CONCLUSION:In rats, the topical thrombolysis with rt-PA is safe and efficacious in preventing postlaminectomy epidural fibrosis. This Thrombolytic therapy with rt-PA after spine surgery may come to play an important role in the prevention of epidural fibrosis and arachnoiditis.

We report on an 18-year-old girl with the coexistence of an epidermoid cyst in the cerebellopontine angle (CPA) with a pituitary adenoma. The clinical course and histopathological characteristics were reviewed. The patient presented with headache, vision loss and amenorea. Computerised tomographic (CT) scan and magnetic resonance imaging (MRI) examinations demonstrated a solid sellar lesion with supra-sellar extension. There was another mass lesion in the CPA with prepontine extension. The tumours were removed surgically. Histopathological examination revealed an epidermoid cyst in the prepontine area and a pituitary adenoma in the sellar region. This has been the second case to be reported in the literature with the coexistence of an epidermoid cyst and a pituitary adenoma.

Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The aims of this study are to review our experience of hydrocephalus in childhood TBM and to evaluate the effect of the timing of ventriculoperitoneal shunting (VPS) on the final outcome. In this study, 156 patients with TBM and hydrocephalus were reviewed retrospectively between 1990 and 2000. Patients’ ages ranged from 6 months to 15 years, with a mean age of 4.1 years. There were 85 boys, and the male-to-female ratio was 1.19:1.0. Sixty-two percent of the children were younger than 6 years old. VPS was performed 2 days after the diagnosis in 100 patients, and in the remaining 56 patients, 3 weeks after the diagnosis. The average follow-up period was 8.5 months. Good recovery or minor sequelae was seen in 82 patients (52.6%), and 51 died (12.3%). The timing of the VPS procedure and cerebral complications had an effect on the final outcome. Early VPS gave a better outcome in mild and moderate hydrocephalus (p = 0.040). This study has shown that early surgical procedure for mild/moderate hydrocephalus has a positive effect on the morbidity and mortality of hydrocephalus in childhood TBM (p = 0.014, p = 0.040, respectively). In severe hydrocephalus, there was a tendency for early shunting to have a positive effect on morbidity, although this did not reach statistical significance.

Objective: To determine the presence of intraforaminal synovial cysts resulting in nerve root compression. Methods: A 26 year old man presenting with left leg pain was admitted. He had no motor, sensory, or reflex changes. Magnetic resonance imaging (MRI) and MRI-myelography showed an intra and extra foraminal, extradural, cystic lesion at L4 vertebra on the left side. Results: At surgery there was a cystic mass pressing on the nerve root, and no connection or communication with the dural structures could be found. Conclusion: Synovial cysts are uncommon extradural degenerative lesions. Intraspinal synovial cysts occur most often at the L4-5 level, but they have been reported in all areas of the spine except the intraforaminal region and the sacrum. Spinal Cord (2001) 39 , 399–401.