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1
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Contiguous diploic veins and ıntraosseous arachnoid granulations: can they function more than necessary?

100%
Erok B., Önder H.
European Journal of Clinical and Experimental Medicine
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2021
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issue 4
359-361
2
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Non-ketotic hyperglycemia and diabetic striatopathy – a rare presentation with hemichorea-hemiballismus

81%
Erok B., Keklikoğlu T. O., Kış N., Önder H.
European Journal of Clinical and Experimental Medicine
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2022
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issue 1
122-125
EN
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.
3
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A benign entity – cerebral multinodular and vacuolating neuronal tumor

81%
Kış N., Erok B., Kılıç H., Önder H.
European Journal of Clinical and Experimental Medicine
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2022
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issue 1
126-128
EN
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.
4
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Neurological complications encountered in imaging studies in association with COVID-19 – a single center analysis

81%
Erok B., Önder Atca A., Önder H.
European Journal of Clinical and Experimental Medicine
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2022
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issue 1
5-10
EN
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.
5
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Basal ganglia calcifications is not inconsequential in pediatric cases

71%
Erok B., Tatar S., Uzunhan T. A., Bezen D., Önder H.
European Journal of Clinical and Experimental Medicine
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2021
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issue 3
267-269
EN
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.
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