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Acute subdural hematomas caused by ruptured aneurysms: Experience from a single turkish center
(Turkish Neurosurgery, 2009) Koçak, Ayhan; Ateş, Özkan; Durak, Mehmet Akif; Alkan, Alpay; Çaylı, Süleyman; Saraç, Kaya
Öz: AMAÇ: Bir anevrizma ruptürü tipik olarak tomografide subaraknoid kanama ile ortaya çıkmasına rağmen kendiliğinden (travmasız) subdural kanama ile beraber görülebilir. Bu makalenin amacı, bu hayatı tehdit eden durumun klinik ve radyolojik özellikleriyle birlikte tanı ve tedavisindeki potansiyel tehlikeleri tartışmaktır. YÖNTEM ve GEREÇ: İnönü Üniversitesi Nöroşirürji Anabilimdalı (Turgut Özal Tıp Merkezi) 1999’dan bu yana intrakraniyal anevrizma tanısı ile tedavi edilen hastaların kayıtlarını prospektif olarak tutmaktadır. Bu veri tabanını kullanarak, tomografisinde akut subdural kanama ile gelen ruptüre anevrizma hastalarını tespit ettik. BULGULAR: Ocak 2000-Ocak 2009 tarihleri arasında radyolojik olarak dökümante edilmiş 687 hasta başvurdu. Bunların 11 (on bir) tanesinde akut travmatik olmayan subdural kanama mevcuttu. Akut subdural kanama-anevrizma rüptürü birlikteliği serimizde % 1,6 idi. SONUÇ: Subaraknoid kanamanın varlığı veya yokluğunda bile, tomografide görülen akut travmatik olmayan subdural kanama anevrizma ruptürü ile ilgili acil çalışmaları düşündürmelidir. CT anjiyografinin DSA’ya göre avantajları vardır ve akut olan bir travmatik olmayan subdural kanama olgularının tedavi planlaması, triyajı ve tanısında makul bir alternatif modalitedir.
Acute Subdural Hematomas Caused by Ruptured Aneurysms: Experience from a Single Turkish Center
(Turkish Neurosurgical Soc, 2009) Kocak, Ayhan; Ates, Ozkan; Durak, Akif; Alkan, Alpay; Cayli, Suleyman; Sarac, Kaya
AIM: Although an aneurysmal rupture typically presents on computed tomography (CT) imaging as only a subarachnoid hemorrhage (SAH), it may be associated with spontaneous (nontraumatic) subdural hemorrhage (sSDH). The purpose of this paper is to discuss the clinical and radiological characteristics, as well as a potentially dangerous situation in the diagnosis and the management of this life-threatening condition. MATERIAL and METHODS: The Department of Neurosurgery at Inonu University (Turgut Ozal Medical Center) (TOMC) maintains a prospective database of all patients treated for intracranial aneurysms since 1999. Using this database, we obtained patients with ruptured aneurysms who presented with sSDH on CT imaging. RESULTS: 687 patients with radiographically documented ruptured aneurysms were admitted from January 2000 through January 2009. Of these, eleven patients presented with sSDH. The incidence of aneurysmal rupture with sSDH is 1.6% in our series. CONCLUSION: Acute sSDH on cranial CT should be considered for an urgent workup of a ruptured aneurysm, even in the absence or presence of SAH finding. CT angiography has advantages over cerebral digital substraction angiography (DSA) and may be a reasonable alternative to latter modality in the diagnosis, triage, and treatment planning in patients with sSDH.
Adrenolökodistrofi: Tek voksel MR spektroskopi bulguları
(Tanısal ve Girişimsel Radyoloji (Yeni Adı: Dİagnostic & Intervent. Radiol), 2004) Alkan, Alpay; Kutlu, Ramazan; Aslan, Mehmet; Yakıncı, Cengiz
Öz: Adrenolökodistrofi (ALD), santral sinir sistemi ve adrenal kortekste çok uzun zincirli yağ asitlerinin birikimine bağlı olarak ortaya çıkan metabolik bir hastalıktır. Nöropatolojisinde serebral beyaz cevherde demyelinasyon, aksonal kayıp ve inflamasyonlu bölgelerde IgG ve sitokin birikimi bildirilmiştir [1-4]. Manyetik rezonans spektroskopi (MRS), değişik hastalıklarda hücresel düzeyde metabolit değişikliklerini gösterebilen bir görüntüleme yöntemidir [1,4-6]. Bu çalışmada, ALD’li bir olguda tutulum alanlarında ve normal görünen beyaz cevherde metabolit değişikliklerin olup olmadı ğının MRS ile ortaya konması amaçlanmıştır.
Advanced Magnetic Resonance Imaging Findings of Renal Hydatid Cyst
(2014) Erdem, Gülnur; Burulday, Veysel; Alkan, Alpay
Abstract: Hydatid Cyst, a serious health problem in the developing countries, is a zoonotic infection formed by echinococcus. Though liver or lung involvement is often, kidney involvement is rarely seen and represents for only 2 to 3 per cent of all cases of hydatid disease. An adult case referred who had multiple cysts in liver and large, solitary cyst in the kidney. We aimed to present magnetic resonance spectroscopy (MRS) and diffusion weighted magnetic resonance (DWI) findings of the hydatid cyst's. This is the first study that shows the MRS and DWI results of the renal hydatid disease. The mean ADC (apparent diffusion coefficient) value of the renal hydatid cyst was 2554x10-6 mm2/s on DWI and high signal intensity was detected compared with the renal parenchyma. MR spectroscopy at TE of 31 shows prominent alanine peak in addition to small amino acid peaks. Advanced MRI studies such as DWI and MRS can provide supplementary information both in the post-treatment period and in the diagnosis by bringing non-invasive approaches.
Atlanto axial subluxation associated with rubinstein taybi syndrome
(Eur J Radiol Extra, 2003) Sığırcı, Ahmet; Yakıncı, Mehmet Cengiz; Alkan, Alpay; Aslan, Mehmet; Sığırcı, Aykut; Kutlu, Ramazan
A case of atlanto-axial subluxation in a 5-year-old boy with Rubinstein /Taybi syndrome (RTS) is presented and the imaging findings are evaluated. To the best of our knowledge, atlanto-axial subluxation has not been reported in association with this syndrome
Bilateral Congenital Cystic Eye Posterior to the Lower Eyelid: Case Report
(Ortadogu Ad Pres & Publ Co, 2012) Doganay, Selim; Alkan, Alpay; Cankaya, Cem; Firat, Penbegul
One day after delivery, an infant boy was referred to our clinic with the complaint of bilateral inferior eyelid bluish discoloration and absence of globe in orbital space. External ocular examination showed no globe in orbital space but a mild bulging of the right and left lower eyelid with an area of bluish discoloration. There were no other ocular or non-ocular abnormalities. Systemic evaluation was normal. Magnetic resonance imaging (MRI) confirmed presence of bilateral cystic eye and absence of ocular structures in orbital space. MRI at age of 14 months showed enlargement of the left cystic eye. A clear fluid (5 cc) was aspirated from the cyst to restore the globe size within the lower eyelid. Biochemical analysis of cystic fluid revealed no abnormalities.
BILATERAL SEMINAL VESICLE AND UNILATERAL RENAL AGENESIS IN CASE WITH PRIMARY INFERTILISM
(Aves, 2007) Erdem, Glnur; Karakas, Hakki Muammer; Ugras, Murat; Alkan, Alpay; Altinok, Tayfun; Doganay, Selim
Introduction: Agenesia of the seminal vesicle is an uncommon cause of the male infertility. While unilateral agenesia of seminal vesicle is observed in 0.6-1% of male population, bilateral agenesia is extremely rare. These malformations may be associated with unilateral or bilateral agenesia of the vas deferens or unilateral renal agenesia. 70-80% of the cases with bilateral agenesia of the seminal vesicle have gene mutations related to cystic fibrosis. In his article we presented the ultrasonographic and magnetic resonance imaging findings of bilateral agenesia of the seminal vesicle and unilateral renal agenesia in primary infertile case who has not cystic fibrosis. Materials and Methods: Pelvic magnetic resonance imaging (MRI) and abdominal ultrasonography was utilized in 29 years old male patient with primary infertility. Results: Bilateral seminal vesicle agenesis was found in MRI. In spermiogram, neither live nor dead spermium was detected. Abdominal ultrasonography was yielded as unilateral renal agenesis and contralateral compensatris hypertrophy consecutively on left and right sides. Conclusion: Pelvic and transrectal ultrasonography gives valuable data on investigation of the etiology of primary infertility. Pelvic MRI is important to distinguish the hypoplasia and the agenesis of the seminal vesicle.
Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus
(Neuroradiology, 2005) Saraç, Kaya; Akıncı, Ayşehan; Alkan, Alpay; Aslan, Mehmet; Baysal, Tamer; Özcan, Abdulcemal
Abstract The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9±3.4 (8.2–19.4). The average number of keto-acidosis episodes was 1.9±2.2 (0–9) and the average number of daily insulin injections was 2.8±0.97 (2–4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover.
Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type1 diabetes mellitus
(NEURORADIOLOGY, 2005) Saraç, Kaya; Akıncı, Ayşehan; Alkan, Alpay; Aslan, Mehmet; Baysal, Tamer; Özcan, Abdulcemal
The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9±3.4 (8.2–19.4). The average number of keto-acidosis episodes was 1.9±2.2 (0–9) and the average number of daily insulin injections was 2.8±0.97 (2–4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover.
Brain MR spectroscopy in children with a history of rheumatic fever with a special emphasis on neuropsychiatric complications
(Eur J Radiol, 2004) Alkan, Alpay; Kutlu, Ramazan; Koçak, Gülendam; Sığırcı, Ahmet; Emul, Murat; Doğan, Selda; Aslan, Mehmet; Saraç, Kaya; Yakıncı, Mehmet Cengiz
Purpose: To investigate whether there are metabolite changes in basal ganglia of children with complete healing of rheumatic fever (RF), history of Syndenham chorea (SC) and obsessive compulsive-tic disorder (OCTD) developed after RF when compared with healthy controls and each other. Material and methods: A total of 49 children with history of RF and 31 healthy controls were included into the study. All patients and control group underwent a detailed neuropsychiatric evaluation. Children with the history of RF were classified into three groups as; group 1: with history of RF without neuropsychiatric complications (NCRF), group 2: only with history of SC (HSC), group 3: with HSC and OCTD (OCTD). After MR imaging, single voxel MR spectroscopy was performed in all subjects. Voxels (15 × 15 × 15 mm) were placed in basal ganglia. N-acetyl aspartate (NAA)/creatin (Cr), and choline (Cho)/Cr ratios were calculated. Results: OCTD were detected in 13 children with HSC. NAA/Cr ratio was found to be decreased in these children when compared with NCRF (n:29), HSC without OCTD (n:7) and control groups (n:31). No significant difference was found in metabolite ratios of children with HSC without OCTD when compared with NCRF and control groups. There were no significant differences in Cho/Cr ratio between patient and control groups. Conclusion: Although MR imaging findings was normal, MR spectroscopy findings (decreased NAA/Cr ratio) in our study support the neuronal loss in basal ganglia of children with OCTD and could indicate the development of permanent damage.
Brain Perfusion MRI Findings in Patients with Behcet's Disease
(Hindawi Publishing Corporation, 2012) Alkan, Alpay; Goktan, Asli; Karincaoglu, Yelda; Kamisli, Suat; Dogan, Metin; Oztanir, Namik; Turan, Nergiz
Objective. To search brain perfusion MRI (pMRI) changes in Behcet's disease (BD) with or without neurological involvement. Materials and Method. The pMRI were performed in 34 patients with BD and 16 healthy controls. Based on neurologic examination and post-contrast MRI, 12 patients were classified as Neuro-Behcet (group 1, NBD) and 22 patients as BD without neurological involvement (group 2). Mean transit time (MTT), time to peak (TTP), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) were obtained and compared to those of healthy control group (group 3). Results. There was a significant difference in the MTT and rCBF within the pons and parietal cortex in groups 1 and 2. rCBV increased in cerebral pedicle in group 1 compared with groups 2 and 3. In the temporal lobe white matter, prolonged MTT and decreased rCBF were found in groups 1 and 2. In the corpus striatum, internal capsule, and periventricular white matter, rCBF increased in group 1 compared with group 3 and decreased in groups 1 and 2. Conclusion. Brain pMRI is a very sensitive method to detect brain involvement in patients with BD and aids the clinical diagnosis of NBD, especially in patients with negative MRI findings.
A case of migrating intracranial bullet
(Appl Radiol, 2004) Kutlu, Ramazan; Koçak, Ayhan; Çaylı, Süleyman; Alkan, Alpay; Sığırcı, Ahmet; Saraç, Kaya
Case report malignant thigh hemangiopericytoma with thoracic wall metastasis
(İnönü Üniversitesi Tıp Fakültesi Dergisi, 2002) Altınok, M. Tayfun; Baysal, Tamer; Kutlu, Ramazan; Sığırcı, Ahmet; Alkan, Alpay; Soysal, Ömer; Mızrak, Bülent
A malignant soft tissue hemangiopericytoma metastatic to the thoracic wall in a 65 year old man is reported. Although the MRI of both the primary and metastatic foci revealed complementary finding of a network of fine vessels, only the histologic examination of the specimens confirmed the malignant features of the tumor. Both the primary and metastatic foci were totally resected. The patient is alive without local recurrence and metastasis for 10 months after the operation.
Case report: Malignant thigh hemangiopericytoma with thoracic wall metastasis
(2002) Altınok, M. Tayfun; Baysal, Tamer; Kutlu, Ramazan; Sığırcı, Ahmet; Alkan, Alpay; Soysal, Ömer; Mızrak, Bülent
65 yaşında erkek hastada toraks duvarına metastaz gösteren malign yumuşak doku hemanjioperisitioması rapor edildi. Primer ve metastatik odakların MRI incelemesinin ince damar ağını göstermesine rağmen sadece histolojik inceleme tümörün malign özelliklerini ortaya çıkardı. Primer ve metastatik odaklar tamamen çıkarıldı. Operasyondan 10 ay sonra lokal nüks veya metastaz yoktu.
Cerebral Venous Sinus Thrombosis After Spinal Anesthesia: Case Report
(Elsevier Science Bv, 2011) Yucel, Neslihan; Akgun, Feride Sinem; Tekin, Yusuf Kenan; Altinayar, Sibel; Alkan, Alpay
Cerebral venous sinus thrombosis is a rare clinical disorder which frequently shows up as prolonged headache unresponsive to standard therapies following spinal anesthesia. In this study, a 24 years old male presenting to our emergency department (ED) after many visits to other ED with headache which started following spinal anesthesia underwent fifteen days ago and being diagnosed with cerebral sinus venous thrombosis upon the evaluations is reported.
The cisternal segment of the abducens nerve in man three dimensional MR imaging
(Eur J Radiol, 2004) Alkan, Alpay; Sığırcı, Ahmet; Özveren, M. Faik; Kutlu, Ramazan; Altınok, Tayfun; Önal, Çağatay; Saraç, Kaya
Purpose: The goal of this study was to identify the abducens nerve in its cisternal segment by using three-dimensional turbo spin echo T2-weighted image (3DT2-TSE). The abducens nerve may arise from the medullopontine sulcus by one singular or two separated rootlets. Material and methods: We studied 285 patients (150 males, 135 females, age range: 9–72 years, mean age: 33.3 ± 14.4) referred to MR imaging of the inner ear, internal auditory canal and brainstem. All 3D T2-TSE studies were performed with a 1.5 T MR system. Imaging parameters used for 3DT2-TSE sequence were TR:4000, TE:150, and 0.70 mm slice thickness. A field of view of 160 mm and 256×256 matrix were used. The double rootlets of the abducens nerve and contralateral abducens nerves and their relationships with anatomical structures were searched in the subarachnoid space. Results: We identified 540 of 570 abducens nerves (94.7%) in its complete cisternal course with certainty. Seventy-two cases (25.2%) in the present study had double rootlets of the abducens nerve. In 59 of these cases (34 on the right side and 25 on the left) presented with unilateral double rootlets of the abducens. Thirteen cases presented with bilateral double rootlets of the abducens (4.5%). Conclusion: An abducens nerve arising by two separate rootlets is not a rare variation. The detection of this anatomical variation by preoperative MR imaging is important to avoid partial damage of the nerve during surgical procedures. The 3DT2-TSE as a noninvasive technique makes it possible to obtain extremely high-quality images of microstructures as cranial nerves and surrounding vessels in the cerebellopontine cistern. Therefore, preoperative MR imaging should be performed to detect anatomical variations of abducens nerve and to reduce the chance of operative injuries.
Çölyak gangliyon blokajı BT eşliğinde anterior yaklaşımın etkinliği
(Türk Tanısal ve Girişimsel Radyoloji Dergisi, 2003) Alkan, Alpay; Durak, Ahmet Candan; Özcan, Nevzat; Kutlu, Ramazan; Baysal, Tamer; Sığırcı, Ahmet
Şiddetli karın ağrısı nedeniyle narkotik analjezik kullanan abdominal maligniteli olgularda çölyak gangliyon blokajının etkinliği ve güvenliğinin araşl- tırılması. GEREÇ VE YÖNTEM Yaşlları 19 ile 75 arasında değişlen 27 hastaya 30 çölyak gangliyon blokaj işllemi yapıldı. Bilgisayarlı tomograşi eşlliğinde perkütan anterior yaklaşlımla 22 G’lik Chiba iğnesi çölyak gangliyon bölgesine yerleşltirilerek %98’lik alkol verildi. Üç olgumuzda işl- lem sonrası yetersiz cevap alınması nedeniyle ikinci kez işllem uygulandı. BULGULAR Yirmiyedi olgunun 24’ünde (%88.8) işllem sonrası ağrıda azalma oluşltu. Onüç olgumuzda ağrıda tam düzelme (%48,1) sağlanırken, 9’unda (%33,3) ağrı non-narkotik analjeziklerle kontrol altına alındı. ‹ki olgumuzda (%7,4) narkotik analjezik dozu azaltıldı. Üç olgumuzda (%11,1) ise işllem sonrası ağrı karakterinde değişliklik olmadı. ‹şllem sonrası dört olguda diyare (%14,8), altı olguda hipotansiyon (%22,2) ve bir olguda geçici hemiparezi saptandı. SONUÇ Bilgisayarlı tomograşi eşlliğinde anterior yaklaşlımla yapılan perkütan çölyak gangliyon blokajı, kolay uygulanabilirliği, güvenli ve komplikasyonlarının az olması, başları oranının yüksek ve maliyetinin düşlük olması gibi nedenlerle özellikle mide ve pankreas başlta olmak üzere abdominal malignansilere bağlı ağrıların erken dönemde kontrol altına alınması amacıyla tercih edilmelidir.
Çölyak gangliyon blokajı: BT eşliğinde perkütan anterior yaklaşımın etkinliği
(2003) Alkan, Alpay; Durak, Ahmet Candan; Özcan, Nevzat; Kutlu, Ramazan; Baysal, Tamer; Sığırcı, Ahmet
AMAÇ Şiddetli karın ağrısı nedeniyle narkotik analjezik kullanan abdominal maligniteli olgularda çölyak gangliyon blokajının etkinliği ve güvenliğinin araştırılması. GEREÇ VE YÖNTEM Yaşları 19 ile 75 arasında değişen 27 hastaya 30 çölyak gangliyon blokaj işlemi yapıldı. Bilgisayarlı tomografi eşliğinde perkütan anterior yaklaşımla 22 G'lik Chiba iğnesi çölyak gangliyon bölgesine yerleştirilerek %98'lik alkol verildi. Üç olgumuzda işlem sonrası yetersiz cevap alınması nedeniyle ikinci kez işlem uygulandı. Yirmiyedi olgunun 24'ünde (%88.8) işlem sonrası ağrıda azalma oluştu. Onüç olgumuzda ağrıda tam düzelme (%48,1) sağlanırken, 9'unda (%33,3) ağrı non-narkotik analjeziklerle kontrol altına alındı. İki olgumuzda (%7,4) narkotik analjezik dozu azaltıldı. Üç olgumuzda (%11,1) ise işlem sonrası ağrı karakterinde değişiklik olmadı. İşlem sonrası dört olguda diyare (%14,8), altı olguda hipotansiyon (%22,2) ve bir olguda geçici hemiparezi saptandı. SONUÇ Bilgisayarlı tomografi eşliğinde anterior yaklaşımla yapılan perkütan çölyak gangliyon blokajı, kolay uygulanabilirliği, güvenli ve komplikasyonlarının az olması, başarı oranının yüksek ve maliyetinin düşük olması gibi nedenlerle özellikle mide ve pankreas başta olmak üzere abdominal malignansilere bağlı ağrıların erken dönemde kontrol altına alınması amacıyla tercih edilmelidir.
Comparison of brain apparent diffusion coefficient value in naturally and assisted conceived newborns
(Taylor & Francis Ltd, 2012) Aslan, Mehmet; Dogan, Metin; Celik, Onder; Karsavuran, Nazan; Dogan, Derya Gumus; Botan, Edin; Alkan, Alpay
Background: Our aim was to assess the value of brain apparent diffusion coefficient (ADC) in Intra Cytoplasmic Sperm Injection (ICSI) and spontaneously conceived preterm singletons. Methods: Twenty ICSI-conceived preterm singletons and 20 gestational age matched spontaneously conceived preterm singletons were studied. All subjects underwent diffusion-weighted imaging (DWI). The main outcome measure was the brain ADC value in the in ICSI-conceived and naturally conceived newborns. Results: Children born after ICSI had an increased ADC value than the controls. The ADC values of ICSI-conceived singletons were higher than those of spontaneously conceived singletons at cerebellum, corpus striatum, frontal lobe, occipital lobe, and temporal lobe white matter. The mean Apgar score, birth weight, height, and head circumference of ICSI children were found to be similar to naturally conceived children. Conclusions: Measuring ADC value may be a promising marker in identifying neurological outcome of ICSI-conceived newborns.
Delayed myelination in a rhizomelic chondrodysplasia punctata case MR spectroscopy findings
(Magn Reson Imaging, 2003) Alkan, Alpay; Kutlu, Ramazan; Yakıncı, Mehmet Cengiz; Sığırcı, Ahmet; Aslan, Mehmet; Saraç, Kaya
Rhizomelic chondrodysplasia punctata is a member of genetic peroxisomal disorders. Delayed myelination, which is probably related to the inadequacy of plasmalogens biosynthesis, is an important feature of this disorder. Direct assessment of neuropathologic aspects of RCDP syndrome such as neuronal degeneration and delayed myelination is possible with MR spectroscopy. In this report, MR spectroscopy findings (decreased Cho/Cr and increased Ins-Gly/Cr ratios and increased levels of mobile lipids) of a rhizomelic chondrodysplasia punctata case supporting delayed myelination are presented. This is the second report of MR spectroscopy examination of the specific brain metabolic changes associated with rhizomelic chondrodysplasia punctata. © 2003 Elsevier Science Inc. All rights reserved.

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