Subclavian steal syndrome- a case report

Subklavian çalma sendromu, özellikle kolun hareketiyle vertebrobaziler sistem yetmezlik belirtilerinin ortaya çıktıgı nadir bir sendromdur.Bu nedenle subklavian çalma sendromu tespit edilen olgu sunulmustur.Subclavian steal syndrome is a rare syndrome with vertebrobasillar system insufficiency symptoms aggrevated especially with arm movements.We present a patient with this syndrome

Hot water epilepsy: a report of two cases

Hot water epilepsy is a rare reflex epilepsy which is characterized by complex partial seizures during a hot bath. It has a good prognosis and generally seen in male children, however it can be also seen in adults. Although the exact mechanism is still unknown, repeated hot water stimuli were shown to have a kindling phenomen effect. Our aim is to outline the clinical features of two patients with hot water epilepsy, seen at our clinic. Two male patients 23 and 35 years old, had complex partial seizures during bathing since their childhood. Neurological examinations, psychomotor development and cranial magnetic resonance images were found to be normal. In EEG examinations epileptic activity originated from temporal regions were observed in both patients. Our patients were under control with lamotrigine (300 mg/day; 200 mg/day) medication. In this report, we aimed to present this rare and commonly misdiagnosed reflex epilepsy

Bilateral abducens nerve palsy due to middle cerebral artery aneursym

We present a case of bilateral sixth nerve paralysis due to bilateral middle cerebral artery aneurysms.A46-yearold woman with severe headache, nausea and diplopia which had started six days before her admittance was found unconsious at home and admitted to our emergency unit. On neurological examination she was alert and had nuchal rigidity. There was no papil oedema but right subhyaloid hemorrhage in fundoscopy and bilateral abducens nerve paralysis. Although cranial magnetic resonance images (MRI) showed no neuropathology, cerebrospinal fluid (CSF) was xanthochromic. The emergency digital substraction angiography (DSA) demonstrated a 7mm at the right and 10mm at the left sacculer aneurysms of middle cerebral arteries. After successful clipping of aneursyms bilateral abducens nerve palsies resolved. Subarachnoid hemorrhage should be considered in differential diagnosis of abducens nerve paralysis.Bilateral orta serebral arter anevrizmasına baglı bilateral abdusens paralizisi olan bir olgumuzu nadir olması nedeniyle sunmayı uygun gördük. 46 yasında, kadın hasta altı gündür devam eden akut baslangıçlı, çok siddetli basagrısı, bulantı ve çift görme sikayetleri ile acil servisimize basvurdu. Nörolojik muayenesinde ense sertligi, fundoskopide papil ödem olmaksızın sagda subhyaloid hemoraji ve bilateral abdusens paralizisi saptandı. Kranial MR normal olmakla birlikte beyin omurilik sıvısı ksantokromik idi. Acil yapılan serebral DSA'da sagda 7mm, solda 10mm orta serebral anevrizmaya ait orta serebral arter sakkuler anevrizması görüldü. Anevrizmaların klipslenmesinden sonra 6. sinir paralizisinin geriledigi görüldü. Abdusens sinir paralizisi ayırıcı tanısında serebral anevrizmaya baglı subaraknoid hemoraji de düsünülmelidir

Anatomical variations of anterior circulation in the brains of patients with and without intracranial aneurysm

INTRODUCTION: Anatomic variations of cerebral arteries may influence the development of aneurysms. In this study our aim was to determine vascular anatomical variations of the anterior circulation of the brain in patients with and without cerebral aneurysms and also the relationship between vascular variations. METHODS: The cerebral digital subtraction angiography data of 438 patients were investigated retrospectively. Anatomical vascular variations of MCA and ACA-AcomA complex were investigated separately in patients with and without aneurysm. RESULTS: Most of our patients with cerebral aneurysms had SAH (n: 68, 80%). Although normal ACA AcomA complex and MCA vascular anatomy was less frequently seen in SAH, there was no statistical significance. ACA AcomA vascular anatomy was not significantly different between patients with and without cerebral aneurysm, however patients with cerebral aneurysm had statistically higher MCA vascular anatomical variations (p: 0.03). DISCUSSION AND CONCLUSION: ACA-AcomA vascular anatomy was not significantly different between patients with and without cerebral aneurysm. However MCA vascular anatomical variations were more commonly seen in patients with cerebral aneurysm. Variations of MCA may increase the risk of aneurysm formation and therefore have an important role in the planning of aneurysm treatment

Admission Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratio as a predictor of mortality in patients with Subarachnoid Hemorrhage

INTRODUCTION: Inflammation is associated with the pathogenesis of subarachnoid hemorrhage (SAH) which is a serious disease with high mortality. NLR and PLR as novel inflammatory markers may serve as predictors of clinical severity and mortality in patients with SAH. METHODS: Medical records of adult SAH patients who were admitted to our Neurology and Neurosurgery Departments were investigated. Clinical, neuroradiological, laboratory, and follow-up data were collected from electronic database. Admission complete blood count values including hemoglobin, leukocyte, neutrophil, platelet and mean platelet volume, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were also studied. Fisher score and mortality rates were also evaluated. RESULTS: : A total of 152 patients with a mean age of 52.94±17.04 (20-104) years, (94 (%61.8) females and 58 (38.2%) males) with SAH were included in the study. The patients were divided into two groups: aneurysmal (group 1, n: 99) and nonaneurysmal SAH (group 2, n: 53). In comparison of complete blood count parameters we found lower lymphocyte and higher neutrophil, NLR and PLR values in aneurysmal SAH patients who had also higher Fisher scores and mortality rate. There were also correlations between Fisher score and leukocyte, neutrophil, lymphocyte, NLR and PLR values. We also found that advanced age and higher NLR, PLR values are significantly related to mortality rates independent of presence of aneurysm. DISCUSSION AND CONCLUSION: Aneurysmal SAH patients had lower lymphocyte and higher neutrophil, NLR, PLR values with higher mortality rates and disease severity. Additionally advanced age and higher NLR, PLR values were significantly related to mortality rates independent of presence of aneurysm. We believe that NLR and PLR can be used as simple parameters to evaluate severity of SAH and short term mortality in clinical practice

Stevens–Johnson Syndrome Prevalence due to Antiepileptic Drug Therapy at Aydin Province University Medical Faculty Hospital

Objectives:This study aimed to determine the prevalence of Stevens–Johnson syndrome (SJS) due to anti-epileptic drug use among patients at Aydın province epilepsy clinic.Methods:The records of 2112 adult epileptic patients treated at outpatient clinics of Adnan Menderes University Hospital departments of neurology, pediatric neurology, and dermatology were studied retrospectively.Results:Two of 2112 epileptic patients who had used lamotrigine had a history of SJS.Conclusion:The prevalence of SJS due to antiepileptic drug therapy among patients at Aydın province epilepsy clinic was 0.021%

Multicentre evaluation of central nervous system infections due to Flavi and Phleboviruses in Turkey

Objectives: Flavi- and Phleboviruses associated with central nervous system (CNS) infections including West Nile Virus (WNV), Tick-borne Encephalitis Virus (TBEV) and Toscana Virus (TOSV) cause significant morbidity and mortality in humans. In this study, the impact of these agents have been investigated in CNS infections at referral hospitals in two provinces in Turkey, where circulation of these viruses have previously been recognized

The molecular basis and genotype-phenotype correlations of congenital adrenal hyperplasia (CAH) in Anatolian population

Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disorder due to presence of mutations in the genes involved in the metabolism of steroid hormones in adrenal gland. There are two main forms of CAH, classic form and non-classic form. While classic form stands for the severe form, the non-classic form stands for the moderate and more frequent form of CAH. The enzyme deficiencies such as 21-hydroxylase, 11-beta-hydroxylase, 3-beta-hydroxysteroid dehydrogenase, 17-alpha-hydroxylase deficiencies are associated with CAH. In this study, we aimed to investigate CYP21A2, CYP11B1, HSD3B2 genes which are associated with 21-hydroxylase, 11-beta-hydroxylase and 3-beta-hydroxysteroid dehydrogenase enzyme deficiencies, respectively, in 365 individuals by using Sanger sequencing method. We emphasized the classification of variants according their disease causing potential, and evaluated variants' frequencies including newly discovered novel variants. As a result, 32 variants of CYP21A2 including 10 novel variants, 9 variants of CYP11B1 including 3 novel variants and 6 variants of HSD3B2 including 4 novel variants were identified. The conclusions of our study showed that in Anatolia, discovery of novel variants is quite common on account of tremendous ratios of consanguineous marriages which increases the frequency of CAH. These results will contribute to the understanding of molecular pathology of the disease