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Öğe Acute thrombosis of inferior vena cava in a pregnant woman presenting with sciatica: A case report(SPRINGER, 2005) Gormus, N; Ustun, ME; Paksoy, Y; Ogun, TC; Solak, HA 20-year-old pregnant woman was admitted to our department with symptoms of deep venous thrombosis in the left lower extremity and excessive lumbar pain. Low-molecular-weight heparin was administered. She recovered with this treatement, however, severe lumbar pain continued. A lumbar magnetic resonance imageg showed dilated epidural veins compressing the roots and acute thrombosis of the inferior vena cava extending to renal veins. During the same period she had acute deep venous thrombosis in her right leg. An urgent venous thrombectomy was performed. Sciatica and deep venous thrombosis resolved after the operation. Low-molecular-weight heparin was administered until the end of her pregnancy.Öğe Bilateral mesial temporal sclerosis and kernicterus(LIPPINCOTT WILLIAMS & WILKINS, 2004) Paksoy, Y; Koc, H; Genc, BOTwo children with mental retardation, choreoathetosis, dystonia, and muscle rigidity are reported. They had a history of severe hyperbilirubinemia after birth as a result of Rh iso immunization. The history and clinical picture suggested the diagnosis of kernicterus. The magnetic resonance imaging examination showed a bilateral signal intensity increase in the globus pallidus on T2-weighted images. Additionally, our patients showed symmetric bilateral hyperintensity and volume loss in the hippocampus, which is known to be another characteristic area of bilirubin deposition in kernicterus.Öğe Distress triggered cervical root compression pain by looped vertebral artery(NEUROL SOC INDIA, 2005) Kalkan, E; Paksoy, Y; Reisli, R; Topatan, HI[Abstract not Available]Öğe Echinococcus caused hydatid disease and host protective antigenic properties for vaccination(MEDIMOND S R L, 2005) Arslan, A; Arikoglu, H; Baykan, M; Paksoy, Y; Odev, K[Abstract not Available]Öğe Epidural venous plexus enlargements presenting with radiculopathy and back pain in patients with inferior vena cava obstruction or occlusion(LIPPINCOTT WILLIAMS & WILKINS, 2004) Paksoy, Y; Gormus, NStudy Design. In the last 2 years, we have examined 9640 patients experiencing back pain or sciatica, using MRI. There were 13 (0.13%) patients who had radicular symptoms that clinically mimicked lumbar disc herniation or spinal stenosis. All of these patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural and paravertebral venous system, causing nerve root compression. Objective. To illustrate the imaging characteristics of 13 patients with epidural engorged veins due to inferior vena cava obstruction or occlusion causing sciatica and low back pain. Summary of the Background Data. Abnormalities or pathological changes of epidural venous network may give rise to symptoms similar to or mimicking lumbar disc herniation or spinal stenosis. Multiple lumbar epidural varices can cause nerve root and thecal sac compression. Lumbar epidural varices have been infrequently described in the literature. To date, the cause of anterior epidural venous enlargement has been poorly understood, and both congenital and acquired causes have been proposed. This report describes enlarged epidural veins in patients with inferior vena caval thrombosis or obstruction presenting with radicular syndromes. Methods. The authors have seen 13 patients with radicular symptoms. All of the patients had inferior vena caval obstruction or occlusion that caused engorgement in the epidural veins, causing nerve root compression. The ages of these patients ranged from 20 to 53 ( mean, 30) years. All of the patients were examined with color Doppler ultrasonography and magnetic resonance scanner. Results. Ten of 13 patients had inferior vena cava thrombosis located just under the renal vein orifices. In two patients, there was compression to inferior vena cava due to parity. In the remaining patient, a huge intra-abdominal mass was observed, and this mass was causing inferior vena cava obstruction and invasion. Enlargements of epidural venous plexus were demonstrated in all of these cases. All of the patients presented with the acute onset of low back pain followed shortly thereafter by acute radicular symptoms. The compression to inferior vena cava could not be treated in one patient because of intra-abdominal malignancy. The remaining 12 patients with inferior vena cava obstruction or occlusion experienced complete resolution of symptoms after treatment or delivery. Conclusion. The authors believe that epidural venous engorgement should be considered when the symptoms of patients with deep venous and inferior vena cava thrombosis are accompanied by radicular and/or back pain, because pathologic processes compressing a nerve root can cause pain.Öğe Klippel-Feil syndrome associated with persistent trigeminal artery(LIPPINCOTT WILLIAMS & WILKINS, 2004) Paksoy, Y; Seker, M; Kalkan, EStudy Design. In the present report, radiologic findings of the patient with the Klippel-Feil syndrome associated with persistent trigeminal artery are reviewed. In same case, there was also spina bifida occulta, cervical spondylosis, atlanto-occipital assimilation, bilateral cervical ribs, and lack of flow signal in the C4 segment of contralateral vertebral artery. The persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. It should be considered that they might be related with the insufficiency or dysfunction of the embryologic developmental process. Objectives. To draw attention to this rare presentation of Klippel-Feil syndrome associated with persistent trigeminal artery. Summary of Background Data. Klippel-Feil syndrome is a congenital spinal malformation characterized by the failure in segmentation of 2 or more cervical vertebrae. Although the anomaly is defined by its skeletal component, Klippel-Feil Syndrome may also be associated with developmental defects in many other organ systems including the inner ear, spinal cord, heart, and genitourinary tract. The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are persistent fetal anastomoses between the carotid and vertebrobasilar circulations. The authors report the association of a persistent trigeminal artery with the Klippel-Feil syndrome. Methods. Radiologic findings of a case of Klippel-Feil syndrome associated with persistent trigeminal artery are described. Results. There was vertebral fusion, spina bifida occulta, bilateral cervical ribs, atlanto-occipital assimilation, and cervical spondylosis. Magnetic resonance angiography showed the persistent trigeminal artery between the left internal carotid and basilar artery, but there was no sign of flow in the C4 segment of right vertebral artery. Conclusions. It should be kept in mind that a persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. Because of this reason, this type of case should prompt a search for the other related anomalies, and magnetic resonance angiography can be used as a noninvasive diagnostic technique in the persistent trigeminal artery determination.Öğe Percutaneous treatment of liver hydatid cysts: Comparison of direct injection of albendazole and hypertonic saline solution(AMER ROENTGEN RAY SOC, 2005) Paksoy, Y; Odev, K; Sahin, M; Arslan, A; Koc, OOBJECTIVE. The purpose of this study was to compare the effect of intracystic injection of albendazole and hypertonic saline in patients with liver hydatid disease. MATERIALS AND METHODS. Fifty-nine patients with a total of 109 hydatid cysts were treated percutaneously. In all cases, local anesthesia was applied. Twenty percent hypertonic saline was used in 31 patients (40 cysts, group 1) as the scolicidal agent, and albendazole solution was used in 28 patients (69 cysts, group 2). The PAIR (percutaneous puncture, aspiration, injection, reaspiration) method was applied in group 1. In group 2, we used a different procedure that could be called the PAI (percutaneous aspiration and injection) method. After this procedure, routine sonography and CT examinations were conducted. The results of both groups were compared. RESULTS. Follow-up examinations showed that liver hydatids expanded approximately to their original size after a significant reduction during the first month. In the follow-up period, fluid contents totally disappeared; thickening and irregularities were also observed in the cyst walls and a solid, hyperechogenic, heterogeneous pseudotumor appearance representing a degenerated membrane was seen in all patients. Hypertonic saline solution inactivated the scolices from the beginning of the treatment. However, scolices were inactive in the cysts aspirated 1 month after the procedure in group 2. A significant correlation was noted between elapsed time after the treatment and the cyst size using Wilcoxon's signed rank test (P = 0.000). No difference was seen between two groups in the amount of cyst size reduction using the Mann-Whitney test (p = 0.521). CONCLUSION. In addition to its oral use, albendazole may be injected intracystically as we did in our study. It sterilizes the cyst cavity and affects scolices as well.Öğe Retrograde flow in the left inferior petrosal sinus and blood steal of the cavernous sinus associated with central vein stenosis: MR angiographic findings(AMER SOC NEURORADIOLOGY, 2003) Paksoy, Y; Genc, BO; Genc, EBACKGROUND AND PURPOSE: We attempted to identify the cause of abnormal venous flow seen during arterial MR angiography in the inferior petrosal sinus by use of in three female patients (aged 51, 48, and 70 years, respectively). METHODS: Arterial 3D time-of-flight MR angiography was performed with a tilted optimized nonsaturating excitation pulse sequence (TR/TE, 31/7; flip angle, 20 degrees; section thickness, 65 mm; effective thickness, 1 mm; number of sections, 1 to 2); no magnetization transfer pulse sequence was used. Contrast-enhanced 3D MR angiography of the neck was performed with a 3D fast low-angle shot pulse sequence (TR/TE, 4.6/1.8; flip angle, 40 to 45 degrees; section thickness, 80 mm; intersection gap, 1.5 mm; acquisition matrix, 180 x 256; acquisition time, 27 s) on a system with a whole-body coil. RESULTS: In all three patients, 3D time-of-flight MR angiography revealed abnormal vascular signal originating from the left cavernous sinus, continuing through the inferior petrosal sinus, and ending in the proximal internal jugular vein at the jugular bulb level. Abnormal vascular signal at the jugular bulb, sluggish flow and flow-related enhancement in the left internal jugular vein, and signal void in the contralateral jugular vein were noted. Contrast-enhanced delayed-phase MR angiography showed stenosis in the left brachiocephalic vein in all patients. CONCLUSION: High signal intensity noted at the inferior petrosal sinus resulted from retrograde flow. Retrograde flow was due to blood stealing from the internal jugular vein toward the cavernous sinus because of venous stenosis in the brachiocephalic vein.Öğe Three-dimensional contrast-enhanced magnetic resonance angiography (3-D CE-MRA) in the evaluation of hemodialysis access complications, and the condition of central veins in patients who are candidates for hemodialysis access(WICHTIG EDITORE, 2004) Paksoy, Y; Gormus, N; Tercan, MABackground: Arteriovenous (AV) fistulas are crucial in Patients requiring long-term hemodialysis (HD). Dysfunctions of these fistulas are the most common causes of recurrent hospitalizations. This study aimed to evaluate the feasibility, safety and usefulness of contrast-enhanced magnetic resonance angiography (CE-MRA) in the evaluation of HD fistulas complications, and the condition of the central veins before HD access. Methods: This study comprised 30 consecutive patients (15 females, 15 males; age range 25-66 yrs, mean +/- SD 51.2 +/- 9.9 yrs). Of 30 patients, 26 had native AV fistulas and the remaining four patients, who had a history of previous subclavian vein catheterization, were candidates for HD fistulas. Nine patients had a radiocephalic fistula, 15 had a brachiobasilic fistula, one had a saphenous vein graft, and one had brachiobasilic vein transposition. To observe the fistula complications in these cases, three-dimensional (3-D) CE-MRA using gadolinium was performed. Results: The results were considered normal in three patients (10%), who were candidates for AV fistula construction; one patient had central vein occlusion due to previous catheterization. Thirteen patients (43.3%) had venous stenosis or occlusion; three of them (10%) had low CE arteries distal to fistula region, leading to ischemic complications, and six (20%) had stenosis at the fistula region. Seven patients (23.3%) had venous pseudoaneurysms, whereas two of them had both pseudoaneurysms and fistula region stenosis, and one had both venous stenosis and pseudoaneurysm. There were no adverse or allergic-like reactions or heat and taste sensations observed in our series. Conclusions: 3-D CE-MRA is a useful, safe and a practical imaging modality in complicated fistula diagnosis with fewer complications and side-effects in comparison to fistulography.
