Kluver-Bucy Syndrome Following Herpes Simplex Encephalitis

Kluver-Bucy syndrome (KBS) is characterized by visual agnosia, hypersexuality, emotional behavior changes, hyperorality, hypermetamorphosis, and cognitive dysfunction. The syndrome is often seen in pathologic states that destroy the anterior and medial temporal lobes, often bilaterally. Herpes simplex encephalitis (HSE) is the leading infectious cause of KBS owing to its frequent involvement of the temporal lobes. HSE is also the most common cause of KBS in general. In this paper, we present a rare case of KBS after HSE

Analys is of the Pat ients Who had Brain Dead Diag nosis in a Neurological Intensive Care Unit

Amaç: Ülkemizde kadavradan organ naklinin düşük olmasının önemli nedeni yoğun bakım ünitelerinde (YBÜ) çalışan klinisyenlerinbeyin ölümü (BÖ) tanısını koymaya odaklanmamasıdır. Bu çalışmada nöroloji yoğun bakım ünitesinde BÖ tanısı konulanvakaların incelenmesi planlanmıştır.Hastalar ve Yöntem: Bu çalışmada Bakırköy Ruh Sinir Hastalıkları Eğitim ve Araştırma Hastanesi nöroloji YBÜ’de bir yıl içinde BÖtanısı konmuş 23 erişkin vaka retrospektif olarak değerlendirilmiştir.Bulgular: Vakalarımızın %56.3’ü erkek olup, yaş ortalaması 6214 sene olarak bulunmuş, yatış tanıları iskemik inme (%52.2),intrakranial kanama (%39.2), sinüs trombozu (%4.3) ve hipoksik ensefalopati (%4.3) idi. YBÜ’ye alındıktan sonra BÖ tanısı konulmasınakadar geçen süre 27.5 (10.6-135) saat bulunmuştur. BÖ tanısını düşündüren klinik bulgular, beyin sapı arefleksisi,Glasgow koma skor düşüklüğü, spontan solunum kaybı ve poliüridir. BÖ tanısı 13 vakada YBÜ uzmanı ile anestezi ve reanimasyonuzmanı tarafından, 10 hastada ise nöroloji uzmanı tarafından ilk olarak düşünülüp tanı işlemlerine gidilmiştir. BÖ tanısı 15olguda apne testi ve nörolojik muayeneyle konulmuştur. Beş olguda apne testinin yapılamaması ve üç olguda tanıyı desteklemekiçin ek testler yardımıyla tanıya gidilmiştir. Vakaların %95.5’inde hipotansiyon, %78’inde diabetes insipidus ve %61.9’undahipotermi gelişmiş ve uygun tedavileri yapılmıştır. Olgularımızın %13’ü donör olmuştur.Sonuç: YBÜ’de vaka takibi yapan doktor ve hemşirelerin beyin ölümünü tanıma ve donör bakımı konusunda eğitimli olması ileBÖ tanısının konulması oranı ve bunun sonucunda kadavradan organ nakli sayısı artacaktır.Objectives: The main reason why we have insufficient organ donation from cadavers in our country is the lack of focus on braindeath (BD) by the clinicians working in the intensive care unit (ICU). The aim of this study was to analyze patients diagnosedwith BD in a neurological ICU.Patients and Methods: We retrospectively analyzed twenty-three patients who had been diagnosed within the year by BD inthe Neurological ICU of Bakirköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery.Results: The mean age was 6214 and 56.3% were male. The admission diagnoses were ischemic infarction (52.2%),intracerebral hemorrhage (39.2%), sinus thrombosis (4.3%) and hypoxic encephalopathy (4.3%). The time interval betweenICU admission and BD diagnosis was 27.5 hours. The signs leading to BD were brainstem areflexia, decreased Glasgow comascore, loss of spontaneous breath and polyuria which were noticed first by the neurologists in 10 subjects and by the intensivecare specialists and anaesthesiologists in 13 subjects. BD decisions in 15 patients were given by apnea testing and neurologicexamination. Further tests were conducted in five patients because of inability to perform apnea tests whereas neurologistsordered additional tests in three patients. The rates of hypotension, diabetes insipidus and hypothermia were 95.5%, 78% and61.9%, respectively, and they were managed properly. Organ donation rate was 13%.Conclusion: The doctors and nurses working in an ICU should be trained on how to recognize BD and to manage potential organdonors. This will improve BD diagnosis and increase organ donations

Our experience of spinal dural arteriovenous fistula: 4 case reports

Spinal dural arteriovenous fistula, which is caused by the low flow shunts between dural arteries and the perimedullary venous system shows progressive myelopathy signs. It is usually found in the thoracic region. It is vital to accurately make differential diagnosis since the disease may cause irreversible injury. In this case report we aimed to discuss four cases of spinal arteriovenous fistula that showed different outcomes

Pre-hospital Obstacles in Thrombolytic Therapy and Suggested Solutions

INTRODUCTION: Acute ischemic stroke is frequently encountered in emergency neurology clinics. Especially when administered within 3 hours of symptom onset, thrombolytic therapy is important in reducing ischemic injury and neurological disability. In this study, we aimed to investigate the demographic and clinical characteristics according to application time, to identify situations which pose an obstacle to thrombolytic therapy and to review the thrombolytic therapy results in patients diagnosed with acute ischemic stroke. METHODS: The patients diagnosed with acute ischemic stroke were evaluated and their age, gender, complaints, risk factors, previous history of stroke, with whom they live, how they arrived at the hospital and their application time information were recorded. Those who were admitted within 3 hours of symptom onset were assessed as early, those admitted after 3 hours were assessed as late admission. Then the rate of thrombolytic therapy, final results and the clinical status in early admission patients and the reasons for delay in late admission patients were discussed. RESULTS: Among 361 acute ischemic stroke patients, the mean age was 66±14,1. 111 patients were admitted within 3 hours of symptom onset, 246 patients were admitted after three hours. Patients arriving to emergency room with 112 Ambulance Service were admitted earlier than those brought in by family, and this difference was statistically significant. The most common causes of time loss in late admissions were the patients being referred from other centers and the unawareness of family about the importance of the disease. There were 13 patients treated with thrombolytic therapy, and complications occurred in one patient. DISCUSSION AND CONCLUSION: Thrombolytic therapy is important in acute ischemic stroke for suitable patients.Our study suggested that the most important factors in spreading of performing the thrombolytic therapy are informing the public about stroke and taking on the more active role in transporting patients of 112 ambulance services

Health-Related Quality of Life in Patients with Epilepsy

Objectives:This study aimed to evaluate health-related quality of life in patients with epilepsy and to investigate the role of sociodemographic attributes and clinical features.Methods:Two hundred five patients diagnosed with epilepsy and under the follow-up of epilepsy outpatient clinics of our tertiary center were enrolled. Gender, age, age of epilepsy onset, disease duration, seizure type, epilepsy etiology, frequency of seizures, anti-seizure drugs, electroencephalography, and magnetic resonance imaging findings were noted. The Short Form-36, valid and reliable in our country, was used to assess health-related quality of life. The Short Form-36 physical and mental scores were calculated.Results:All Short Form-36 subscores of patients were low when compared to the normative data of our country. Some physical and mental health scores of women with epilepsy were lower than the scores of men with epilepsy. All Short Form-36 subscores of patients under polytherapy were lower than the ones under monotherapy. Some quality of life scores were negatively correlated with disease duration; yet the range of age, age of epilepsy onset, seizure type, etiology of epilepsy, cranial magnetic resonance imaging, and electroencephalography findings were not significantly correlated with Short Form-36 scores.This study revealed that health-related quality of life of patients with epilepsy was lower than that of healthy individuals. It should be noted that Conclusions:women with epilepsy, patients with longer disease duration, patients suffering from frequent seizures, and the ones under polytherapy could have a lower quality of life. Patients with epilepsy should be supported in means of quality of life and modifiable factors

Gastrostomy in hospitalized patients with acute stroke: "NoroTek" Turkey point prevalence study subgroup analysis

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin’s scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.Amaç: Akut nörovasküler hastalıklarda nütrisyonel durum ve disfaji değerlendirmesi ve enteral beslenme kararı önemli prognoz belirleyicilerindendir. Gereç ve Yöntem: NöroTek, 10 Mayıs 2018’de (Dünya İnme Farkındalık Günü) Türkiye’nin tüm sağlık alt bölgelerine yayılmış 87 hastanenin katılımıyla gerçekleştirilen bir nokta prevalans çalışmasıdır. Hastanede yatan ve bu alt çalışma için toplanan verisi tam olan toplam 972 nörovasküler hasta (kadın: %53, yaş: 69±14 yıl; 845’i akut iskemik inme; 119’u intraserebral hematom ve 8’i post-resüsitasyon ensefalopatisi) analiz edildi. Bulgular: Gastrostomi iskemik inmeli hastaların %10,7, intraserebral kanamalıların %10,1 ve post-resusitasyon ensefalopatisi olanların %50’sine uygulanmıştır. Perkütan endoskopik gastrostomi (PEG) gereksiniminin bağımsız belirleyicileri, iskemik inme grubunda kabul NIHSS [exp (β): 1,09, %95 güven aralığı (GA): 1,05-1,14, puan başına] ile hem iskemik hem de hemorajik inmelerde mekanik ventilasyon uygulanmış olmasıdır [iskemik için: exp (β): 6,18, %95 GA: 3,16- 12,09] ve hemorajik inme için: [exp (β): 26,48, 95% GA: 1,36-515,8]. İnme olgularında PEG uygulaması hastane içi mortalite için bağımsız belirleyici değildi [exp (β): 1,731, 95% GA: 0,785-3,829]. Ancak, PEG uygulanmış olması taburculuk esnasında iyi prognoza (modifiye Rankin skoru 0-2) sahip olabilme için anlamlı bir negatif etmen olarak bulundu [exp (β): 0,032, %95 GA: 0,004-0,251]. Hastanede yatan nörovasküler hastaların yaklaşık üçte ikisinde malnütrisyon ve yutma bozukluğu açısından değerlendirme yapılmıştı. Nutrisyonel status değerlendirmesinin %69’u ve disfaji değerlendirmesinin %76’sı ilk 48 saat içinde gerçekleştirilmişti. Tüple enteral nütrisyon uygulama oranı %39’du. Beslenme tüplerinin %83,5’i ilk 2 gün içinde yerleştirilirken beslenme tüpü olan hastaların %28’ine daha sonra PEG açılmıştı. Sonuç: NöroTek çalışması ile Türkiye’de hastanede yatan akut inme hastalarında nutrisyonel uygulamaların temel kalite ölçütlerine ilişkin ilk güvenilir ve büyük ölçekli veri sağlanmıştır. Ekonomik olması ve doğruluğu açısından nokta yaygınlık yönteminin bu tip verilerin temini için daha fazla kullanılması mantıklıdır