Przeglądanie według Autor "Erok, Berrin"

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A benign entity – cerebral multinodular and vacuolating neuronal tumor
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2022) Kış, Naciye; Erok, Berrin; Kılıç, Harun; Önder, Hakan
Introduction and aim. Multinodular and vacuolating neuronal tumor (MVNT) of the cerebrum is a rare benign, mixed glial/ neuronal lesion which has been included in the recent (2016) World Health Organization (WHO) Classification of the central nervous system tumors.Most of the reported cases are remarkable with adult onset seizure in the literature.They can also be found incidentally in nonepilepsy patients with or without headache We aimed to present this unique entity with its typical magnetic resonance imaging (MRI) features. Description of the case. A 21-year old man presented with complaint of headache that increased in frequency within the last few months.No relevant seizure or any other signs of note.He was diagnosed with MVNT by imaging andstarted to be followed- up.The repeat MRI 6 months later showed no interval changes. Conclusion. Clinicians should be aware of that it is a do not touch lesion in asymptomatic patients with no need for biopsy or surgery and follow up imaging is sufficient when presented with the typical MRI manifestations. Surgical resection may be required for seizure control and was reported in few cases with no tumoral regrowth in the literature.
A long clinical course with late distant metastases from follicular thyroid carcinoma
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Erok, Berrin; Harmancı, Kemal; Aksaray, Ferdi; Unlu, Nazmi Uğur; Aydın, Seckin
Introduction. Follicular thyroid carcinoma (FTC) accounts for 10-20% of the differentiated thyroid carcinomas (DTCs), and it is the second most common thyroid malignancy after papillary thyroid carcinoma (PTC). FTC is typically more common in women and in older age group than PTC. Unlike PTC, FTC metastases late to the lymph nodes, with only up to 10-20% of the patients having nodal metastases at the time of diagnosis.On the other hand, distant metastasis via hematogenous spread is more likely in patients with FTC due to the invasion of blood vessels. Prognosis depends on the extent of the distant metastasis which drop 10-year survival significantly. Aim. Although DTCs have usually favorable prognosis, metastatic disease in these patients has a long clinical course. Cranial imaging in these patients should be performed during the follow-up after the treatment of FTC with thyroidectomy and RAI. Description of the case. We report a case of late onset but catastrophic hematogenous distant metastases beginning 8 years after the diagnosis & treatment of FTC and becommimg widespread during the following 10 years with a long clinical course in a 60 year old female patient. Conclusion. In the RAI refractory metastatic lesions SRS and surgical resections should be conserned as the first management approach to improve survival.
An aggressive locoregional orbital rhabdomyosarcoma and Li Fraumeni syndrome
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Erok, Berrin; Kıbıcı, Kenan
Introduction. Rhabdomyosarcoma (RMS) is the most common pediatric soft tissue sarcoma with 10 % of the cases occuring in the orbit. Patients often present with a rapidly developing proptosis and globe displacement. Aim. We aimed to present a very rare presentation of orbital RMS, with a giant exophytic orbital mass, a very rare presentation occuring in more advanced cases. Description of the case. A 3-year old girl presented to our hospital with a rapidly enlarging tissue like ulcerative mass. Her past medical history was remarkable with the diagnosis of embryonal rhabdomyosarcoma (RMS) and treatment with chemoradiotherapy at the age of 15 months. On magnetic resonance imaging (MRI), there was a giant heterogenously enhancing mass filling the right orbit and extending to the intracranial region. Li Fraumeni syndrome (LFS) was considered due to her sister death from neuroblastoma at an early age. Cytogenetic analysis revealed mutations of p53 gene, which supported our consideration. Conclusion. RMS is a highly malignant tumor which usually occurs sporadiacally. However, some rare syndromes are associated with increased incidence of RMS, such as LFS.
Basal ganglia calcifications is not inconsequential in pediatric cases
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Erok, Berrin; Tatar, Sertaç; Uzunhan, Tuğçe Aksu; Bezen, Diğdem; Önder, Hakan
Introduction. Basal ganglia calcification (BGC) in pediatric population is rare and is considered as a pathological finding. Various causes may be responsible for BGC including hypoparathyroidism, various infectious, toxicities or hereditary disorders. Aim. We aimed to present a 8 year old boy presented with generalized seizure and bilateral small amount of globus pallidum calcifications on neuroimaging studies leading to the diagnosis of idiopathic hypoparathyroidism, which is a treatable cause of seizure. Description of the case. A 8-year-old boy presented to our emergency department with generalized seizure for the first time in his life. There was no history of previous head trauma and his family history was unremarkable. Neurological examination revealed no pathological findings. Radiological imaging studies revealed only bilateral small amount of globus pallidus calcifications. He was referred to the pediatric endocrinology department for further evaluation of the hypocalcemic convulsion, where laboratory investigations revealed idiopathic hypoparathyroidism as the cause of hypocalcemic convulsion with exclusion of the other causes. Conclusion. Even a small amount of BGC in pediatric patients may be the sign of primary hypoparathyroidism and should be evaluated with serum electrolyte levels for early diagnosis and for the prevention of multisystemic complications of hypoparathyroidism.
Contiguous diploic veins and ıntraosseous arachnoid granulations: can they function more than necessary?
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Erok, Berrin; Önder, Hakan
Contribution of diffusion weighted MRI to the differential diagnosis of renal masses
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2022) Kış, Naciye; Düzkalır, Hanife Gülden; Ağaçlı, Mehmet Oğuzhan; Erok, Berrin; Kılıçoğlu, Zeynep Gamze
Introduction and aim. We aimed to assess the usefulness of diffusion weighted imaging (DWI) and apparent diffusion coefficients (ADCs) for characterizing renal masses. Material and method. In this retrospective study we measured the ADC values of renal masses at b=0, b=500 and b=1000. Measurements were made by placing a circular region of interest with a diameter of 1 cm.ADC values from normal renal parenchyma were taken to define the ADC and to compare with the ADC values of the lesions. Results. A total of 72 lesions of 54 patients were included.40 of the masses were benign and 32 were malignant. The ADC values of benign lesions at both b values were significantly higher than malignant lesions. We found the lowest values in angiomyolipomas (AMLs) and oncocytomas and the highest values in Bosniac type I cysts. Similarities was found between the ADC values of some AMLs and the RCCs. In terms of statistical results, the inclusion of AMLs in the analysis did not significantly affect the difference between malignant and benign lesions. Conclusion. In our study, the ADC values of benign renal masses were higher than those of normal renal parenchyme, which is higher than those of malignant renal masses.The lowest ADC values were observed in AMLs and oncocytomas.
Diffusion weighted imaging in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Kış, Naciye; Erok, Berrin
Introduction. Renal cell carcinoma (RCC) is the most common malignant renal tumor in adults accounting for 80-90% of primary malignant adult renal neoplasms. RCC represents a very heterogenous groups of tumors with a number of distinct histological varieties, of which the major 3 subtypes are clear cell RCC (70-80%), papillary RCC (13-20%), and chromophobe RCC (5%). Imaging features are varied from solid and relatively homogenous appearance to markedly heterogenous appearance with cystic changes, hemorrhage and necrosis. The use of diffusion weighted imaging (DWI) for RCC subtyping and also for differentiation of high grade and low grade tumors has been showed to be useful in many studies in the literature. Aim. In this study, we aimed to determine the comparative contribution of DWI in differentiation of the clear cell RCC from the major non-clear cell RCC subtypes at standard high b-value (1000 s/mm2) versus low b-value (500 s/mm2). In addition, we also aimed to assess the diagnostic performance of DWI for differentiating high grade clear cell RCC from low grade clear cell RCC based on Fuhrman grades in our patients. Material and methods. 62 cases with a prediagnosis of RCC according to MRI findings including DWI sequence with histological verification and subtyping of renal cortical tumor following a total or partial nephrectomy were included in the study. Results. Among 62 cases, 46 were male and 16 were female, with mean age of 59.5 ± 15.7. Pathological diagnoses of 62 cases were as follows, clear cell RCC, (44) papillary cell RCC (14) and chromophobe cell RCC (4). They were divided into two groups as clear cell RCC group (44 cases) and non-clear cell RCC group (18 cases). There was no statistically significant difference between the mean ADC values of clear cell and non-clear cell groups at b-value of 1000 s/mm2 (p>0.05). However, the mean ADC level for clear cell RCC group at b-value of 500 s/mm2 were significantly higher than for non-clear cell RCC group (p<0.05). When a value of 0.99x10-3 mm2/s was set as cut-off for ADC at b-factor of 500 s/mm2, differentiation was achieved with a high sensitivity (91%) and specificity (56%). Regarding the diagnostic performance of DWI for differentiating high from low Fuhrman grades clear cell RCCs, there was no statistically significant difference between the ADC values of Grade I-II clear cell RCC cases and Grade III-IV clear cell RCC cases at b-factor of 1000 s/mm2 (p>0.05). However, ADC values for grade III-IV group was statistically significantly lower than ADC values for Grade I-II group at b-factor of 500 s/mm2 level. Conclusion. ADC measurements at moderate b-value of 500 s/mm2 were more sensitive in subtyping and grading of RCC cases. This technique can be used in clinical practice as a fast and additional sequence in abdominal MRI.
IgG4 related orbital/ophtalmic disease in COVID-19 after improving from critical pneumonia
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2022) Erok, Berrin; Mansuroğlu, İlknur; Keklikoğlu, Taha Oğuz; Önder, Hakan
Mirror aneurysm of ICA terminus associated with adult polycystic kidney disease
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Erok, Berrin; Win, Nu Nu; Can, Orçun; Çizmeli, Muzaffer Olcay
Introduction. Bilatereal saccular cerebral aneurysms (SCAs) that developed symmetrically on the same named vessels are defined as mirror aneurysms and account for a small subset of multiple cerebral aneurysms. The internal carotid artery (ICA) bifurcation is a rare location for mirror aneurysms. Aim. We aimed to present the importance of risk status assessment for SCAs and screening in all ADPKD patients for timely detection and managementof SCAs before catastrophic complications occur Description of the case. We present mirror aneurysms of bilateral ICA bifurcation that appear like a couple of dancing men on coronal computed tomography angiography (CTA) images, which were successfully treated with single stage coil embolization in a 45 year old female patient with medical history of autosomal dominant policystic kidney disease (ADPKD). Conclusion. SCAs are more frequent in patients with ADPKD than in general population and also these aneurysms are more likely to rupture at earlier ages. Mirror aneurysms of ICA terminus can be treated effectively and safely by single stage coil embolization.
Neurological complications encountered in imaging studies in association with COVID-19 – a single center analysis
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2022) Erok, Berrin; Atca, Ali Önder; Önder, Hakan
Introduction and aim. COVID-19 is a viral infectious disease, which was first reported in patients with unusual pneumonia in December 2019. However, as the pandemic progressed, extrapulmonary manifestations including various neurologic complications have been started to be increasingly reported. In this retrospective study, we tried to search the neurological complications seen in our patients with positive rRT-PCR test for COVID-19 and examine the underlying associated risk factors. Material and methods. We have retrospectively analyzed the neuroimaging studies performed in our patients with positive rRT-PCR test for COVID-19 between April, 2020 and August, 2021. Both computed tomography (CT) scans and magnetic resonance imagings (MRI) of brain, head & neck region and the spine were retrospectively evaluated for the presence of any complications in patients with positive rRT-PCR test for COVID-19. Results. There were 147 patients having neuroradiological imaging studies performed for various neurological symptoms. Among these patients we detected 10 acute neurologicalcomplications.The most common was acute ischemic stroke in 5 patients and intracranial hemorrhage in 3 patients, two of which were intraventricular hemorrhage. The other complications included a preasumed cytotoxic lesion of corpus callosum in a 18 year old girl and lumbar spondylodiscitis complicated with psoas abcess in a 47 year-old man. Conclusion. In COVID-19 patients severe neurological complications can occur even as a presenting manifestation. Early cytotoxic endothelial injury can be the underlying cause in these patients and should be further studied in larger series in terms of what the susceptibility factors in these patients.
Non-ketotic hyperglycemia and diabetic striatopathy – a rare presentation with hemichorea-hemiballismus
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2022) Erok, Berrin; Keklikoğlu, Taha Oğuz; Kış, Naciye; Önder, Hakan
Introduction and aim. Non-ketotic hyperglycemia (NKHG), also known as hyperosmolar hyperglycemic state (HHS) is a serious metabolic complication of diabetes mellitus (DM).The mortality rate can be up to 20% and this is much more higher than that of diabetic ketoacidosis (DKA). It is usually precipitated by an event such as pulmonary/urinary infection, myocardial infarction (MI) or stroke. In this state of metabolic derangements, central nervous system (CNS) manifestations including altered mental status with or without focal neurological deficits are prominent clinical presentations. On the other hand, HHS may also be complicated with various other CNS events. Herein, a quite rare presentation of HHS with hemichorea ‒ hemiballismus in a 71 year old female patient with type 2 DM is presented. Description of the case. A 71-year-old female patient type 2 DM presented to our emergency department with progressive involuntary movements on the right upper and lower extremities accompanied by semiconsciousness during the last 24 hours. On neurological examination, cranial nerves and cerebellar signs were found to be normal, as the deep tendon reflexes. However, involuntary non-rhythmic writhing movements at rest were present on her right sided extremities. The fingerstick evaluation showed marked hyperglycemia (HG). The laboratory findings were characterized with high blood glucose level without obvious acidosis compatible with HHS. In urine analysis, glucosuria without significant ketonuria was detected. On head CT, subtle hyperdensity was noted in the left neostriatal regions without any mass effect or perilesional edema, compatible with left sided diabetic striatopathy (DS). Conclusion. Diabetic striatopathy is a quite rare presentation of HHS with hemichorea – hemiballismus. The characteristic computed tomograhy (CT) findings of associated striatopathy should be differentiated from vascular lesions that may also present with unilateral findings in the course of HHS and should not be overlooked in diabetic patients to recognise the ongoing HHS before the coma precedes.
Pericallosal berry aneurysm associated with azygous anterior cerebral artery – a case report
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Erok, Berrin; Win, Nu Nu; Tatar, Sertaç
Introduction. Azygos anterior cerebral artery is a rare variant of the anterior segment of the circle of Willis caused by an unusual fusion of the normally paired A2 segments of the anterior cerebral artery (ACA). Despite its rare occurrence, it is associated with various vascular and structural cerebral abnormalities, particularly berry aneurysms. Aim. We aimed to present a case of a 41-year-old female patient who presented to our neurology department with complaints of headache. Description of the case. She had a positive paternal history of aneurysmal subarachnoid hemorrhage. Magnetic resonance angiography (MRA) of her brain revealed an azygos ACA (bifurcating into two pericallosal arteries) which was associated with a saccular aneurysm at its bifurcation point. She was referred to the interventional radiology department for preventive endovascular treatment. Conclusion. Azygos ACA carries a high risk of aneurysm development and its occlusion can potentially compromise blood supply to both cerebral hemispheres. It is therefore crucial for clinicians to be aware of its significance and to report its presence in angiographic studies.
Posttraumatic arachnoid cyst rupturę and delayed acute subdural hygroma
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Erok, Berrin; Kıbıcı, Kenan
Introduction. Subdural hygromas (SDGs) are the accumulation of fluid in the subdural space. Arachnoid cysts (ACs) on the other hand are common cerebrospinal fluid (CSF) containing lesions of the central nervous system, located within the subarachnoid space. They are generally found incidentally on neuroimaging studies and remain asymptomatic throughout the life. Rupture into the subdural space resulting in subdural hygroma (SDG) is relatively rare. Aim. We aimed to show the importance of the radiological follow up in head trauma patients having large ACs. Description of the case. We report a case of a 69-year-old male patient with a known large Galassi type III AC, presented to our hospital with traumatic brain injuries and re-presented with acute posttraumatic SDG in association with AC rupture. Conclusion. This case emphasizes the importance of radiological follow up in head trauma patients having large ACs to reveal and appropriately manage traumatic subdural collections.
The use of medial clavicular epiphysis ossification stages for bone age determination
(Wydawnictwo Uniwersytetu Rzeszowskiego, 2021) Win, Nu Nu; Erok, Berrin
Introduction. Bone age determination is a radiological method investigating the compatibility of ossification processes of bones with chronological ages. Aim. We aimed to investigate the use of CT staging of the medial clavicular epiphyseal ossification in bone age determination in Turkish adolescents and young adults. Material and methods. Chest CT exams of 2018 patients between 11 and 35 years of age were retrospectively evaluated for epiphyseal ossification stages of the bilateral medial clavicles (4036 clavicles) on both axial&coronal images and compared with the sex and chronologic age of the individuals in Turkey. Results. For stage 2,3 and 4 the ages of women were greater than men and it was statistically significant. For an individual classified as stage 4,it can be said with certainty that he or she has already reached the age of 18.There was no statistically significant difference between left&right sides and between the axial&coronal images.In addition, it was found that the medial clavicular head epiphyses showed a lot of variation. Conclusion. CT evaluation of the medial clavicular epiphysis ossification stages is helpful in determination of the individuals over the age of 18. Regardless of the sex, the stage 4 can be used as a criterion to make the prediction that an individual is older than 18 years.