We describe the magnetic resonance imaging (MRI) findings in two patients admitted to our institution with neuropsychiatric symptoms and severe abdominal pain diagnosed as acute intermittent porphyria (AIP). MRI revealed multiple lesions which regressed following treatment. We suggest reversible cerebral vasospasm underlies the MRI abnormalities and the cerebral symptoms in porphyria.

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It is very important to make accurate and early diagnosis to reduce both the rate of negative laparotomy and the morbidity and mortality associated with acute appendicitis. Numerous scoring systems have been described in the diagnosis of acute appendicitis. We aimed to determine the accuracy rates of these scoring systems in the diagnosis of acute appendicitis by applying Alvarado, Eskelinen, and Ohmann clinical scoring systems to patients who underwent appendectomy.

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In recent studies about pediatric patients with multiple sclerosis (MS) and variants, early treatment with immunomodulating drugs has shown beneficial effects. 1,2 We report a child who developed encephalopathy during interferon beta-1a (IFN␤-1a) treatment which was initiated after 2 optic neuritis (ON) attacks.Case report. An 11-year-old girl was admitted to our clinic with acute blurred vision and pain in the left eye without any history of previous infection or vaccination. The neurologic examination was unremarkable except for papillitis and decreased visual acuity in the left eye. She had visual acuity of counting fingers from 50 cm distance. Enlargement of blind spot and centrocecal scotoma on the left eye were found. Orbital MRI revealed hyperintensity on T2-weighted and proton density images and contrast enhancement on left optic nerve (figure, A and B). Cranial MRI was normal. Decreased visual evoked potentials (VEP) amplitude and prolongation of P100 latency on the left side were observed. She was diagnosed with ON and IV methylprednisolone (IVMP) was initiated 1 g/d (20 -30 mg/kg/d) for 5 days. Her vision partially improved. Three days later, she redeteriorated with pain. IVMP (1 g/d) was given for 3 days followed by 3 weeks weaning course of oral methylprednisolone (MP). Her vision totally recovered in 1 month. Two months later, she was readmitted with right ON. Orbital MRI and VEP examination were compatible with right ON. Cranial MRI was still normal. Serum FANA and CSF oligoclonal bands were negative. After treatment with 1 g/d IVMP for 3 days, we initiated IFN␤-1a 15 mcg/wk and escalated to 30 mcg/wk within 1 month. At the second month of therapy, she developed subfebrile fever (37°C), generalized tonicclonic seizure, and left hemiparesis. Cranial MRI demonstrated right parieto-occipital, corticalsubcortical white matter isohyperintensity on T2weighted and proton images, with gadolinium enhancement (figure, C and D). EEG showed 5-6 Hz theta activity and 2.5-3 Hz slow-wave paroxysm activity located on the posterior region of the right

A 66-year-old woman was admitted to the emergency department with a complaint of severe abdominal pain, nausea, and vomiting. She had a history of previous appendectomy 36 years ago. The abdominal examination revealed moderate distension and rebound tenderness. The white cell count revealed a leukocytosis (35.500/mm 3 ). Abdominal computerized tomography (CT) revealed segmental intestinal dilatation. At laparotomy, a twisted jejunoileal segment 50 cm in length was twisted around a tight adhesion band starting from the appendocecal peritoneum to the small bowel mesentery. Segmental jejunoileal resection and primary end-to-end anastomosis was performed. The patient was discharged uneventfully on the nineth day of admission.A 48-year-old woman was admitted to the emergency department with severe abdominal colicky pain. She had a history of previous appendectomy due to perforated appendicitis 18 years ago. Abdominal examination revealed extreme distention and rebound tenderness. She had a leukocytosis of 18.400/mm 3 . Abdominal CT showed diffuse intraabdominal fluid accumulation. Laparotomy was performed and an approximately 30 cm ileal volvulus was discovered around an adhesive band beginning from underneath the appendectomy incision to the small bowel mesenteric root (Figure 1). Small bowel volvulus secondary to post appendectomy adhesion bandApendektomi sonras› geliflen adezyon band›na ba¤l› incebarsak volvulusu F Fi ig gu ur re e 1 1. . Laparotomy showed a twisted small bowel segment and compressed by adhesive band.