Sciatic nerve injury following analgesic drug injection in rats: a histopathological examination

OBJECTIVE: Sciatic nerve neuropathy can be observed following intramuscular gluteal injections. The histopathological examination of sciatic nerve damage following intramuscular injection in the gluteal region for acute pain treatment is not feasible in humans due to the inability to dissect and examine the nerve tissue. To overcome this issue, we used a rat model for demonstrating damage to the sciatic nerve tissue after the application of commonly used drug injections. METHODS: We investigated possible damage following the intramuscular injection of diclofenac, lornoxicam, morphine, and pethidine in a rat model based on histopathological characteristics such as myelin degeneration, axon degeneration, epineurium degeneration, fibrosis, epineurium thickening, perineurium thickening, lymphocyte infiltration, vacuolization, and edema. RESULTS: All the analgesic drugs used in our study induced histopathological changes in the sciatic nerve. Anti-S100 positivity, showing nerve damage, was found to be the lowest in the group treated with diclofenac. Neurotoxic effects of diclofenac on the sciatic nerve were greater than those of the other drugs used in the study. Lornoxicam induced the least histopathological changes in the nerve. CONCLUSION: Diclofenac induced severe nerve damage not only after direct injection in the sciatic nerve but also after injection in the area around the nerve. Thus, we recommend restricting the use of intramuscular gluteal injections of diclofenac. Intramuscular use of morphine and pethidine should also be overviewed

The Role of Patent Foramen Ovale in Cryptogenic Stroke Kriptojenik İnmede Patent Foramen Ovalenin Rolü

INTRODUCTION Approximately 40% of ischemic strokes with no clearly definable etiology are classified as cryptogenic stroke (1). The etiology of some cryptogenic strokes may be an embolus from the venous system traversing from the right to left atrium into the systemic circulation through a patent foramen ovale (PFO), a phenomenon known as paradoxical embolism (2). The first description regarding the association of PFO with stroke was in a young woman with cerebral arterial embolism by Cohnheim et al. (3) in 1877. At autopsy series of general population, the prevalence of PFO is 20−26% (4). However, PFO prevalence in cryptogenic strokes changes between 40% and 55.7% (5). A PFO located between the septum primum and septum secundum leads to the passage of fetal blood from the right atrium to the left atrium. In 75% of PFO cases, thi

Use of game console for rehabilitation of parkinson's disease

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Background: Parkinson’s disease (PD) predisposes to falls due to postural instability and decreased coordination. Postural and coordination exercises could ameliorate the incoordination and decrease falls. Aims: In this study, we explored the efficiency of a game console as an adjunct to an exercise program in treating incoordination in patients with PD

Ultrasound-Guided combined greater occipital nerve block at the C2 level with trapezius trigger point injection and supraorbital-Supratrochlear nerve block: More effective on allodynia and disability in chronic migraine

Background: Chronic migraine (CM) patients with cutaneous allodynia (CA) show a poor response to treatment. Long-term studies have yet to be conducted to demonstrate the efficacy of blocks on CA. This study evaluated the improvement in allodynia and disability in CM treated with ultrasound (US)-guided blocks. Methods: In this prospective, non-randomized comparative study, 60 CM patients with CA were evaluated for the clinical effectiveness of the therapy using the numeric rating scale (NRS), headache impact test-6 (HIT-6), brush allodynia test, and allodynia symptom checklist (ASC-12). At the first visit, tenderness in the nerve or trapezius muscle was confirmed in the intervention group. US-guided greater occipital nerve block (GONB), GONB, and trapezius muscle injection (TPI), or GONB, TPI, and peripheral trigeminal nerve block (PTNB), respectively, were performed four times once a week for a month. Initial and third-month assessments were performed. Results: The ASC-12 scores decreased in the GONB+TPI+PTNB and GONB groups more than the GONB+TPI group (mean rank, respectively, 26.86, 27.40, 38.39; P = 0.018). The decrease in HIT-6 scores was greater in the GONB+TPI+PTNB group than in the GONB group (mean rank, respectively, 21.98, 39.95, P < 0.017) in the first month. In the third month, the GONB+TPI+PTNB group scored HIT-6 significantly lower than GONB and GONB+TPI (mean rank: 18.84, 38.73, 35.61; P < 0.001). Conclusions: GONB+TPI+PTNB was more successful in alleviating allodynia and disability

Multiple System Atrophy (MSA-C) Presenting with Cognitive Affective Cerebellar Syndrome and Psychosis

Besides its well-established motor functions, the modulatory role of cerebellum in the neural networks subserving cognition and emotion has been supported by several lines of evidence obtained from neuroanatomical investigations, functional neuroimaging and clinical research. Damage to cerebellar posterior lobe and vermis may lead to a cognitive affective cerebellar syndrome primarily comprising cognitive disorders characterized by executive dysfunctioning, language and visuospatial impairments in addition to disorders of affect and other psychiatric impairments. Cognitive and affective symptoms have often been reported in neurodegenerative cerebellar diseases while psychotic symptoms occur less frequently. In this article, we describe an extraordinary case of multiple system atrophy (MSA-C), who presented with cognitive affective cerebellar syndrome and psychotic symptoms before cerebellar ataxia was evident. The wide variety of symptoms observed in this case underlines the critical role of cerebellum in modulation of networks engaged in cognition, affect, thought and perception, and provides further evidence regarding the contribution of cerebellar dysfunction to several neuropsychiatric symptom

How does the use of antiplatelet and anticoagulants affect the success of mechanical thrombectomy in acute ischemic stroke cases? = Hogyan befolyásolja a thrombocytaaggregáció-gátlók és az antikoagulánsok használata a mechanikus thrombectomia sikerességét akut ischaemiás stroke esetén?

In this study, we wanted to investigate the effect of antiplatelet and anticoagulant use on the success of mechanical thrombectomy in acute ischemic stroke cases. 174 patients who were brought to the Stroke Center of Gaziantep University Şahinbey Research and Practice Hospital between January 2018 and February 2019 due to acute ischemic stroke and who underwent mechanical thrombectomy were retrospectively analyzed. The demographic characteristics, antiplatelet/anticoagulant use before the stroke and mTICI (modified-Throm­bolysis-In-Cerebral-Infarction) scores used for reperfusion in mechanical thrombectomy were evaluated. The findings were analyzed statistically (p<0.05). The mean age was 63.3 ± 13.5 in 174 patients who underwent mechanical thrombectomy. 23/174 (13.2%) patients were using anticoagulant therapy (warfarin-OAC or new generation oral anticoagulant-NOAC) and 28/174 (16.1%) were using antiplatelet therapy. A history of atrial fibrillation (AF) was significantly higher in patients receiving anticoagulant therapy before acute ischemic stroke (p=0.001). Patients with a history of hyper tension (HT), diabetes mellitus (DM) and coronary artery disease (CAD) before acute ischemic stroke were receiving antiplatelet therapy in higher rates (respectively; p=0.003, p=0.037, p=0.005). Successful recanalization (mTICI ≥ 2b) was higher in patients with a history of anticoagulant use and who underwent mechanical thrombectomy (p=0.025). Our study showed that the use of anti­platelet or anticoagulants before mechanical thrombec­tomy may have an indirect positive effect on the success of the procedure

The Relationship of Serum S100B Levels with Infarction Size and Clinical Outcome in Acute Ischemic Stroke Patients

ABSTRACT Introduction: S100B protein, which helps nerve development and differentiation, is produced by astrocytes and can be detected in peripheral circulation after brain damage. In this study, we aimed to investigate the relationship between the serum S100B protein level and the infarction volume and clinical outcome and also the early prognostic role of serum S100B protein in patients with ischemic stroke

Leptomeningeal enhancement as a sole magnetic resonance imaging finding of secondary central nervous system vasculitis: A case report

The main radiological findings of central nervous system (CNS) consist of multiple subcortical infarcts, parenchymal and leptomeningeal enhancement, petechial hemorrhages on MRI and multifocal caliber changes of the vessels on MRA and DSA. Solely or prominent leptomeningeal enhancement is rarely seen as an isolated manifestation of CNS. We report a case of intracerebral vasculitis secondary to inflammatory bowel disease (IBD) showing leptomeningeal enhancement as a unique finding in routine contrast-enhanced cranial MRI and aimed to emphasize the importance of these finding in diagnosing CNS

Bilateral hypertrophic olivary degeneration secondary to ischemia following endovascular treatment of cerebral aneurysm: A case report

Hypertrophic olivary degeneration (HOD) is a degenerative disorder of the inferior olivary nucleus (ION) that occurs after damage to the dentatorubroolivary pathway (DROP). Damage to the DROP causes hypertrophy and enlargement of the inferior olivary nuclei (ION) contrary to the atrophy observed in the other parts of central nervous system. Focal lesions that may lead to HOD include ischemia, hemorrhage, trauma, and cavernous hemangioma and it also may mimic diseases including tumors and demyelinating processes. We here in present our experience with a case of bilateral HOD, which was a result of a thromboembolic complication during endovascular aneurysm embolization