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Ilhan Elmaci

Publications and source records attributed to Ilhan Elmaci.

10 recordsLinked to original sources
PubMed2006

Intracranial sewing needle in a man with seizure: a case of child abuse?

Physical abuse in infancy can cause persistent neurological deficits. Although intracranial foreign bodies are generally secondary to penetrating trauma or surgical procedures, rarely they also occur as a result of child abuse. A 32-year-old man presented with the complaint of generalized tonic clonic seizures to the Neurology Department of Marmara, University Hospital. Computerized tomography (CT) scan revealed a sewing needle located within the temporal lobe. The location and the position of the needle suggested that it must have been introduced in infancy through the lamdoid suture before the closure of it, as an unsuccessful deliberate homicide attempt or accidental injury.

Adult↗
PubMed2005

Expression of structural proteins and angiogenic factors in normal arterial and unruptured and ruptured aneurysm walls.

OBJECTIVE: To identify differences in the expression of certain structural proteins and angiogenic growth factors in vessel tissues that represent different phases of the process of intracranial aneurysm formation and rupture: normal vessel wall, intact (unruptured) aneurysm wall, and ruptured vessel wall. METHODS: The novel study design involved 10 pairs of specimens (ruptured and unruptured aneurysm wall) obtained perioperatively during clipping operations in 10 patients with multiple aneurysms. All surgeries were performed within 5 days of subarachnoid hemorrhage. As controls, five circle of Willis specimens were obtained from five cadavers. Sections of each of the 25 specimens were separately immunostained for five structural proteins (collagen Types III and IV, alpha-smooth muscle actin, fibronectin, and laminin) and three angiogenic factors (vascular endothelial growth factor, basic fibroblast growth factor, and transforming growth factor-alpha). Levels of expression for each protein and factor were graded, and the average grades for each tissue group were recorded and compared. RESULTS: Among the structural proteins studied, fibronectin specifically is densely expressed in ruptured aneurysms, which is graded as 2.0. However, its expression is less prominent both in nonaneurysmal vessel wall (Grade 1.0) and unruptured aneurysm vessel wall (Grade 1.1). Contrary to fibronectin, laminin is more intensely and regularly expressed in normal vessel wall (Grade 2.7) than in ruptured (Grade 1.1) and unruptured (Grade 1.0) aneurysmal specimens. Among the angiogenic growth factors studied, transforming growth factor-alpha shows a peculiar grading of staining, different from the other two angiogenic factors examined, so that it is more highly expressed in normal circle of Willis specimens (Grade 2.1) than in unruptured and ruptured aneurysm walls, graded as 0.5 and 0.6, respectively. CONCLUSION: Normal vessel wall, unruptured aneurysm wall, and ruptured aneurysm wall exhibit different levels and patterns of expression for the structural proteins and regulator growth factors investigated. If one accepts the premise that immunohistochemical study has its inherent methodological problems, these results suggest that the biological mediators of aneurysm formation in a vessel wall differ from those of the biological mediators of aneurysm rupture. There was a novel finding related to fibronectin and laminin: the results indicated that a rise in the fibronectin-to-laminin ratio in an unruptured aneurysm wall may contribute to rupture. A drop in transforming growth factor-alpha expression in a vessel wall may also contribute to aneurysm formation.

Actins↗
PubMed2003

Early-postoperative magnetic resonance imaging in glial tumors: prediction of tumor regrowth and recurrence.

OBJECTIVE: This study investigated the value of early-postoperative magnetic resonance (EPMR) imaging in the detection of residual glial tumor and investigated the role of EPMR for the prediction of tumor regrowth and recurrence. METHODS AND MATERIALS: We retrospectively analyzed pre- and post-operative magnetic resonance imaging results from 50 adult patients who underwent surgical treatment for supratentorial glial tumor. There were glioblastoma multiforme in 25 patients, astrocytoma (grades II and III) in 11 patients, oligodendroglioma (grades II and III) in 9 patients, and oligoastrocytoma (grades II and III) in 5 patients. EPMR imaging was performed within 24 h after surgery. EPMR findings were compared with the neurosurgeon's intraoperative estimation of gross tumor removal. Patterns of contrast enhancement at the resection site, in residual and developing tumor tissue and blood at the resection site were evaluated on EPMR and in follow-up studies. 'Residual tumor' was defined as contrast enhancing mass at the operative site on EPMR. 'Regrowth' was defined as contrast enhancing mass detected on follow-up in the same location as the primary tumor. 'Recurrence' was defined as appearance of a mass lesion in the brain parenchyma distant from the resection bed during follow-up. RESULTS: Nineteen patients showed no evidence of residual tumor, regrowth, or recurrence on EPMR or any of the later follow-up radiological examinations. EPMR identified 20 cases of residual tumor. Follow-up showed tumor regrowth in 10 patients, and tumor recurrence in 1 case. EPMR showed contrast enhancement of the resection bed in 45 of the 50 patients. Four of the 20 residual tumors showed a thick linear enhancement pattern, and the other 16 cases exhibited thick linear-nodular enhancement. No thin linear enhancement was observed in the residual tumor group. Nine of the 10-regrowth tumors showed a thick linear-nodular enhancement pattern, and one exhibited thin linear enhancement in EPMR. For predicting regrowth tumor EPMR sensitivity was 91%, specificity was 100%, positive predictive value 1; negative predictive value was 0.9375. CONCLUSION: EPMR, depending on the surgical site enhancement pattern, is a valuable means of demonstrating residual tumors, and can be used to predict possible regrowth after surgery.

Adult↗
PubMed2003

Totally thrombosed giant P2 aneurysm: a case report and review of literature.

The diagnosis and treatment of intracranial saccular giant aneurysms is still difficult despite developments in neuroradiology, neuroanesthesiology and micro-neurosurgery. These aneurysms are usually located on major intracranial arteries and are rarely on distal branches of these arteries. An extra-axial 4 x 5 cm mass lesion in the left mediobasal temporal region was detected on the CT and MRI examinations of a 37 year old male patient who was admitted to our institution with headache and slight right-sided hemiparesis lasting for 2 months. The lesion was avascular on angiography. Surgery proved that the lesion was a totally thrombosed giant aneurysm of the P2 segment of posterior cerebral artery (PCA). The P2 segment was clipped proximal to the aneurysm with pterional-transsylvian approach and the aneurysm was totally excised. Giant aneurysms of the P2 segment are rare and 15 cases have been reported in the literature. This report presents a rarely seen totally thrombosed giant P2 aneurysms and discusses the difficulties in diagnosis and treatment.

Adult↗
PubMed2002

Utility of transcranial Doppler ultrasonography in the diagnosis and follow-up of tuberculous meningitis-related vasculopathy.

INTRODUCTION: This prospective clinical study tested the hypothesis that transcranial Doppler ultrasonography (TCD) can be efficiently utilized in the diagnosis and management of tuberculous meningitis-related vasculopathy. PATIENTS AND METHODS: Twenty patients with tuberculous meningitis were assessed with serial TCD examinations. Blood flow velocity (Vm) and pulsatility index (PI) were measured, and findings were correlated with patient prognosis and with clinical and radiological findings. RESULTS AND CONCLUSIONS: The TCD data allowed us to distinguish three phases of tuberculous meningitis-related vasculopathy. In phase I vasculopathy TCD reveals increased Vm and normal to moderately decreased PI. In patients in this phase reversible ischemic deficits are seen clinically and radiologically. Phase II is associated with decreased Vm and decreased PI. At this stage patients reveal radiological and clinical signs related to proximally evolving vasculopathy in the basal main arteries. Phase III is characterized by almost absent blood flow in one or more basal arteries and, accordingly, by associated brain tissue infarction and permanent severe neurological deficit or fatal outcome.

Adolescent↗
PubMed2002

Dysembryoplastic neuroepithelial tumor of the midbrain tectum: a case report.

Dysembryoplastic neuroepithelial tumor (DNT) is a relatively new nosologic entity. First described in 1988, it is now included in the "neuronal and mixed neuronal-glial tumours" category in the revised 2000 World Health Organization (WHO) Classification of Tumours of the Nervous System. The collective experience of more than 300 reported cases indicates that, with only rare exceptions, DNTs are cerebral cortical lesions. At present, the actual incidence of extracortical DNT is unknown. We describe, the clinicopathologic features of the first tectal DNT. The patient was a 51-year-old man with a 2-month history of pulsatile headaches. On neurologic examination, the only abnormality was gait ataxia. Magnetic resonance imaging (MRI) demonstrated a midbrain tumor involving the tectum. It was hypointense on T1-weighted images and featured an iso- to hyperintense nodule at its center. The nodule showed enhancement upon contrast administration. No aqueductal obstruction or intraventricular extension of tumor was detected. The tumor was approached supratentorially and removed completely. The mucoid tumor was well demarcated from neural tissue. Histopathologically, it was a typical DNT, exhibiting a nodular pattern of growth with a "specific glioneuronal component." This case report documents the first DNT to arise in the midbrain tectum and focuses on the problem of diagnosing this uncommon tumor at extracortical sites.

Brain Stem Neoplasms↗
PubMed2002

Spinal hydatid disease.

STUDY DESIGN: Review article on spinal involvement of hydatid disease. OBJECTIVES: A better understanding of this rare but clinically challenging disease is intended. An overview of the epidemiology, pathogenesis, presentation and diagnosis of spinal hydatid disease is provided. Management problems and frequent pitfalls are discussed as well as current therapeutic options, results and outcome. METHODS: Thirty-seven reports of spinal hydatid disease published between 1964 and 2000 were reviewed. RESULTS: Most of the reported cases of spinal hydatid disease presented with spinal cord compression syndrome. Due to the relative rarity of the problem the diagnosis was frequently made during surgery. Surgical intervention by decompressive laminectomy was the most frequent first management. Reports of anterior procedures as well as spinal stabilization exist. Intraoperative prophylaxis to reduce spillage as well as pharmacotherapy were usually instituted. Results of surgery were generally reported to be poor. Progressive neurological and mechanical deterioration over the years was the most frequently reported disease course. Anecdotal reports of alternative management strategies exist. CONCLUSION: Spinal hydatid disease should be considered in the differential diagnosis of spinal cord compression syndrome in endemic countries and sought after with imaging and serology. Treatment is based on surgical decompression. Despite therapy the disease frequently relapses with progressive destruction of the vertebral column and neurological deterioration. Retention of spinal stability is the major long term concern. Overall outcome is poor with few reports of disease-free long term survival.

Echinococcosis↗
PubMed2002

Effect of surgery on tumor progression and malignant degeneration in hemispheric diffuse low-grade astrocytomas.

The aim of this study is to determine the impact of surgery on tumor progression and malignant degeneration in hemispheric diffuse astrocytoma WHO grade II. Twenty-eight patients who were operated or underwent stereotactic biopsy for hemispheric diffuse astrocytoma WHO grade II at Marmara University between January 1987 and January 1996, were prospectively reviewed for the presence of recurrence and histopathological dedifferentiation at their fourth years after the initial treatment. Twenty-two patients underwent surgical resection. Of this group, 7 patients had a total, 11 had a subtotal and 4 patients had a partial resection. Six patients underwent stereotactic biopsy. All patients, except for the ones in whom a radiological total surgical removal could be achieved, received postoperative radiotherapy. In the total surgical-removal group only one patient had recurrence, while no upgrade was noted. All of the patients in the partial resection and stereotactic biopsy groups recurred at a higher grade. Our results indicate that both tumor progression and histopathological dedifferentiation were less commonly seen when a total or subtotal resection could be achieved. So, surgery, as radical as possible, should be the choice of treatment in low-grade hemispheric astrocytomas.

Adolescent↗
PubMed2002

Infratentorial lateral supracerebellar approach for trochlear nerve schwannoma.

Schwannomas of the trochlear nerve are very rare. Only 25 cases without associated neurofibromatosis were reported in the literature, only 15 of which were surgically verified. We report an unusual case of a 31-year-old man who presented with isolated unilateral trochlear nerve palsy due to a left sided trochlear nerve schwannoma. The tumor was totally resected without additional morbidity using an infratentorial lateral supracerebellar approach.

Adult↗