Sakral tarlov kistine bağlı anejakülasyon: Olgu sunumu

Persistent or recurrent difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation was defined as inhibited ejaculation or anejaculation that causes personal distress. Efferent innervation of ejaculation is somatic through the parasympathetic sacral outflow, originates at S2–S4. Anejaculation has neurogenic and nonneurogenic causes. Tarlov cysts occur on the extradural components of sacral or coccygeal nerve roots. Large Tarlov cysts may cause symptoms related to local compression and subsequently may affect the ejaculation. This study reports a case of anejaculation due to sacral Tarlov cyst.Seksuel uyariyi takiben orgazmin olusmasinda kalici veya gecici zorluk, gecikme ya da orgazmin gerceklesmemesi inhibe edilmis ejakulasyon ya da anejakulasyon olarak tanimlanir. Ejakulasyonun efferent stimulasyonu S2 – S4 den orijin alan parasempatik liflerle saglanir. Anejakulasyonun norojenik ve norojenik olmayan sebepleri vardir. Tarlov kistleri sacral ve koksigeal sinir koklerinin ekstradural komponentlerinden orijin alir. Genis Tarlov kistleri lokal kompresyona bagli semptomlara neden olabilir ve ejakulasyonu etkileyebilir. Bu calismada sacral Tarlov kistine bagli gelisen anejakulasyon vakasi sunulmustur

Bilateral striopallidodentate calcinosis associated with carea-like findings and epilepsy

Bilateral striatopallidodentat kalsinozisle (BSPDK) nadir görülen, çeşitli semptomların bir arada gö- rülebildiği ve bazal ganglionlar, serebellum ve serebral beyaz cevherde kalsiyum ve diğer minerallerin birikmesi ile karakterize bir hastalıktır. Genellikle idyopatik olarak görülmekle birlikte hipoparatiroidizm ve hipokalsemi birlikteliği, en sık görülen sekonder BSPDK nedenidir. Bu çalışmada hipoparatiroidizme bağlı olarak BSPDK saptanan ve hipokalsemi tablosunun düzeltilmesi ile klinik olarak belirgin iyileşme gösteren bir vaka sunulacaktırBilateral striopallidodental calcinosis (BSPDC) is a rare disease characterized by various symptoms and deposition of calcium and other minerals in the basal ganglia, cerebellum and cerebral white matter. It is generally an idiopathic disease. Beside this, hypoparathyroidism and accompanying hypocalcemia are the most frequent secondary BSPDC causes. In this article we report a BSPDC case related to hypoparathyroidism who has a significant clinical improvement related to the improvement of hypocalcemia

Bilateral striopallidodentate calcinosis associated with carea-like findings and epilepsy

Bilateral striatopallidodentat kalsinozisle (BSPDK) nadir görülen, çeşitli semptomların bir arada gö- rülebildiği ve bazal ganglionlar, serebellum ve serebral beyaz cevherde kalsiyum ve diğer minerallerin birikmesi ile karakterize bir hastalıktır. Genellikle idyopatik olarak görülmekle birlikte hipoparatiroidizm ve hipokalsemi birlikteliği, en sık görülen sekonder BSPDK nedenidir. Bu çalışmada hipoparatiroidizme bağlı olarak BSPDK saptanan ve hipokalsemi tablosunun düzeltilmesi ile klinik olarak belirgin iyileşme gösteren bir vaka sunulacaktırBilateral striopallidodental calcinosis (BSPDC) is a rare disease characterized by various symptoms and deposition of calcium and other minerals in the basal ganglia, cerebellum and cerebral white matter. It is generally an idiopathic disease. Beside this, hypoparathyroidism and accompanying hypocalcemia are the most frequent secondary BSPDC causes. In this article we report a BSPDC case related to hypoparathyroidism who has a significant clinical improvement related to the improvement of hypocalcemia

A year's retrospective evaluation of patients hospitalized with the diagnosis of ischemic stroke at Kocatepe University Medicine Faculty Neurology Clinic

OBJECTIVE: The aim of this study is to describe the etiological, demographical and clinical features and determine the risk factors of acute ischemic stroke patients, who were hospitalized and treated at Afyon Kocatepe University (AKU) Medical School Neurology Department within a year. METHODS: The stroke subtypes of 104 acute ischemic stroke patients hospitalized at AKU Medical School Neurology Department within a year were classified according to TOAST (Trial of Org 10172 Stroke Treatment) retrospectively. The distribution of risk factors based on gender was evaluated. RESULTS: Of the 104 stroke patients, 49 (47.1%) were males, 55 (52.9%) were females. The age range of the patients was between 23 and 92 and the mean age was 66.79 ± 15.05 years. Stroke was present in the carotid artery perfusion area in 84 patients (80.8%) and in the vertebro-basilar perfusion region in 20 (19.2%) patients. Hypertension, which was found in 61patients (58.7%), was at the top of the risk factors. The difference was statistically significant based on the hypertension, when the risk factors were assessed according to gender. The etiological classification based on the TOAST criteria was as follows: ischemic stroke resulting from small artery disease in 32 (30.8%), cardioembolic stroke in 27 (26%), and great artery atherosclerosis in 22 (21.2%) patients. The etiological factors of 5 (4.8%) patients were rare causes and in 18 (17.3%) no etiology could be found despite the investigation. CONCLUSION: The most important risk factors of ischemic stroke, which is a common entity in the elderly, are hypertension and diabetes mellitus. The strokes caused by small artery diseases are the most common type based on the classification of TOAST criteria. There is limited number of studies evaluating the stroke epidemiology in our country; therefore further studies are needed to assess this issue

Sakral tarlov kistine bağlı anejakülasyon: Olgu sunumu

Persistent or recurrent difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation was defined as inhibited ejaculation or anejaculation that causes personal distress. Efferent innervation of ejaculation is somatic through the parasympathetic sacral outflow, originates at S2–S4. Anejaculation has neurogenic and nonneurogenic causes. Tarlov cysts occur on the extradural components of sacral or coccygeal nerve roots. Large Tarlov cysts may cause symptoms related to local compression and subsequently may affect the ejaculation. This study reports a case of anejaculation due to sacral Tarlov cyst.Seksuel uyariyi takiben orgazmin olusmasinda kalici veya gecici zorluk, gecikme ya da orgazmin gerceklesmemesi inhibe edilmis ejakulasyon ya da anejakulasyon olarak tanimlanir. Ejakulasyonun efferent stimulasyonu S2 – S4 den orijin alan parasempatik liflerle saglanir. Anejakulasyonun norojenik ve norojenik olmayan sebepleri vardir. Tarlov kistleri sacral ve koksigeal sinir koklerinin ekstradural komponentlerinden orijin alir. Genis Tarlov kistleri lokal kompresyona bagli semptomlara neden olabilir ve ejakulasyonu etkileyebilir. Bu calismada sacral Tarlov kistine bagli gelisen anejakulasyon vakasi sunulmustur

Evaluation of Time in Therapeutic Range in Patients with Cerebrovascular Disease Receiving Treatment with Warfarin

Objective: The efficacy of warfarin therapy correlates with the Time in Therapeutic Range (TTR). This study aimed to investigate the efficacy and target achievement rates in patients using warfarin who were followed up in stroke outpatient clinics.Methods: In this study, 103 patients who had been under warfarin treatment were retrospectively evaluated. Duration and indications for warfarin use, thrombotic or hemorrhagic complications were recorded. Target INR value was 3.0-3.5 in patients with mechanical valves and 2.0-3.0 in those using warfarin for other indications.Results: In this study, 103 patients with a mean age of 67.14±14.19, 47 men and 56 women, were included. Indications for warfarin use, respectively, were non-valvular atrial fibrillation (AF) in 61.6% of the patients, akinetic/hypokinetic segment on echocardiography (ECHO) in 12.62%, thrombophilia in 8.74%, metallic prosthetic valve in 3.88%, frequent transient ischemic attacks in 6.79%, a hypokinetic segment on ECHO with atrial fibrillation in 5.82% and vertebral artery dissection in 0.87%. 46.8% of the patients were determined to be in good control, with a mean TTR of 64.09%; also, TTR was 100% in 36.8% of them. Minor/major hemorrhagic event was noted in 10 patients (9.70%), two of whom had an intracerebral hemorrhage.Conclusion: The mean TTR value detected in this study is considerably higher than the rate reported in our country. Findings of this study suggest that close monitoring is paramount of importance and vital in patients with stroke. Regular monitoring of stroke patients using warfarin will be beneficial in terms of informing patients, providing optimal anticoagulation and preventing complications

The Effects of a Postural Balance Training Program on Balance, Gait and Health-Related Quality of Life in Patients with Essential Tremor

Objective: Although the effectiveness of postural balance training on balance and gait impairment has been proven as an effective treatment approach in several patient and healthy populations, its effectiveness in patients with essential tremor (ET) is yet unknown. The aim was to examine the effects of postural balance training program on balance and gait performance, and health-related quality of life in patients with ET. Materials and Methods: This uncontrolled clinical study included patients with ET. The outcome measures were the Postural Stability Test, Limits of Stability Test, Fall Risk Test, Activities-Specific Balance Confidence scale, Dynamic Gait Index, and Short Form-36. The assessments were performed before and after the training program. The participants underwent an 8-week balance training designed to improve their ability to integrate multisensory inputs and postural control using a computerized balance assessment and training device. Results: In total, 24 patients with ET participated in the study. The compliance rate was 87.5%. There were significant improvements in all outcome measures of balance and gait performance, balance confidence, fall risk, and health-related quality of life (except the mental component, p>0.05) between baseline and 8 weeks (p<0.05). Conclusion: Our results suggest that the balance training program is a feasible method that may have positive effects on balance performance and confidence, gait performance, and health-related quality of life in patients with E

Morphological aspect on surgical approach to the cases with carpal tunnel syndrome

Amaç: Bu çalışma Karpal Tünel Sendromu (KTS) olan hastalara güvenli cerrahi yaklaşım şansı tanınabilmesi için bölgedeki karmaşık anatomik yapılanmanın anlaşılması amacıyla planlanmıştır. Materyal-Metod: Eylül 2002- Aralık 2008 tarihleri arasında Afyon Kocatepe Üniversitesi Tıp Fakültesi Nöroloji, Nöroşirürji ve Acil Servis’e el bileğinde ağrı, uyuşukluk yakınması ile başvuran ve Nöroşirurji polikliniğine sevk edilerek Karpal Tünel Sendromu (KTS) tanısı cerrahi tedavi uygulanan 21 olgunun sonuçları retrospektif olarak arşiv taraması yoluyla değerlendirildi. Bulgular: Tamamı kadın olan olguların 6’sı bilateral, 8’i sağ ve 7’si sol tarafta karpal tünel sendromu tanısı konularak opere edilmişti. Yaş ortalaması 54,8 olan olguların izleme süresi ortalama 42,1 ay olarak belirlendi. Olguların izlemi vizüel ağrı skalası (VAS) kullanılarak yapıldı. Preoperatif VAS skorları 9,5 olarak saptandı. Sağ karpal tünel tanısı ile opere edilen 1 olgu dışında nüks görülmedi (%4,8). Yirmibir olgunun 2’si dışında postoperatif dö- nemde ağrı yakınması tama yakın geçti. Postoperatif VAS skorları ortalama 3,4 olarak bulundu. Sonuç: Anatomik oryantasyon noktalarına bağlı kalınarak yapılan cerrahi girişimlerde gerek olgu memnuniyetinin yüksek, gerekse de nüks oranının daha düşük olması karpal tünel sendromu olgularında güvenli cerrahi yapılabileceğini düşündürmektedir.Background: This study is planned to explain the sophisticated anatomic structure of the region at carpal tunnel syndrome to give a chance for safe surgical approach. Material-method: 21 operated cases who admitted to Neurosurgery clinic by the same neurosurgeon from Afyon Kocatepe University School of Medicine NeurologyNeurosurgery and Emergency Departments with elbow pain and numbness between September 2002 to December 2008 with carpal tunnel syndrome were evaluated, retrospectively. Results: 6 bilateral, 8 right and 7 left side purely female cases with carpal tunnel syndrome were operated by the same neurosurgeon. The mean age was 54.8 and the follow-up period was 42.14 months. Visual pain scale (VPS) was used for evaluating the cases. Preoperative mean score was 9.5. Only one recurrence was obtained who was operated from right side (rate=4.76%). The complaints of the cases were improved postoperatively except 2 of the 21 cases. The mean of the postoperative VPS score was 3.4. Conclusion: We thought that the surgery which was done hold to anatomic landmarks, could provide higher case satisfaction and lower recurrent rates with a safe surgery at carpal tunnel syndrome

Morphological aspect on surgical approach to the cases with carpal tunnel syndrome

Amaç: Bu çalışma Karpal Tünel Sendromu (KTS) olan hastalara güvenli cerrahi yaklaşım şansı tanınabilmesi için bölgedeki karmaşık anatomik yapılanmanın anlaşılması amacıyla planlanmıştır. Materyal-Metod: Eylül 2002- Aralık 2008 tarihleri arasında Afyon Kocatepe Üniversitesi Tıp Fakültesi Nöroloji, Nöroşirürji ve Acil Servis’e el bileğinde ağrı, uyuşukluk yakınması ile başvuran ve Nöroşirurji polikliniğine sevk edilerek Karpal Tünel Sendromu (KTS) tanısı cerrahi tedavi uygulanan 21 olgunun sonuçları retrospektif olarak arşiv taraması yoluyla değerlendirildi. Bulgular: Tamamı kadın olan olguların 6’sı bilateral, 8’i sağ ve 7’si sol tarafta karpal tünel sendromu tanısı konularak opere edilmişti. Yaş ortalaması 54,8 olan olguların izleme süresi ortalama 42,1 ay olarak belirlendi. Olguların izlemi vizüel ağrı skalası (VAS) kullanılarak yapıldı. Preoperatif VAS skorları 9,5 olarak saptandı. Sağ karpal tünel tanısı ile opere edilen 1 olgu dışında nüks görülmedi (%4,8). Yirmibir olgunun 2’si dışında postoperatif dö- nemde ağrı yakınması tama yakın geçti. Postoperatif VAS skorları ortalama 3,4 olarak bulundu. Sonuç: Anatomik oryantasyon noktalarına bağlı kalınarak yapılan cerrahi girişimlerde gerek olgu memnuniyetinin yüksek, gerekse de nüks oranının daha düşük olması karpal tünel sendromu olgularında güvenli cerrahi yapılabileceğini düşündürmektedir.Background: This study is planned to explain the sophisticated anatomic structure of the region at carpal tunnel syndrome to give a chance for safe surgical approach. Material-method: 21 operated cases who admitted to Neurosurgery clinic by the same neurosurgeon from Afyon Kocatepe University School of Medicine NeurologyNeurosurgery and Emergency Departments with elbow pain and numbness between September 2002 to December 2008 with carpal tunnel syndrome were evaluated, retrospectively. Results: 6 bilateral, 8 right and 7 left side purely female cases with carpal tunnel syndrome were operated by the same neurosurgeon. The mean age was 54.8 and the follow-up period was 42.14 months. Visual pain scale (VPS) was used for evaluating the cases. Preoperative mean score was 9.5. Only one recurrence was obtained who was operated from right side (rate=4.76%). The complaints of the cases were improved postoperatively except 2 of the 21 cases. The mean of the postoperative VPS score was 3.4. Conclusion: We thought that the surgery which was done hold to anatomic landmarks, could provide higher case satisfaction and lower recurrent rates with a safe surgery at carpal tunnel syndrome