Cognitive performance in young and middle-aged adults with migraine: Investigating the correlation with white matter hyperintensities and psychological symptoms

Introduction This study aimed to evaluate the cognitive performance of migraine patients with (MwA) and without aura (MwoA) and investigate the correlation of white matter hyperintensities (WMHs) and psychological symptoms with their cognitive test scores. Material and methods Hundred migraine patients aged 20–55 years and 80 healthy volunteers with similar age, sex, and education level were enrolled. The total Montreal Cognitive Assessment (MoCA) scores were compared by age, sex, presence of aura, migraine duration, attack frequency, pain localization, presence and number of WMHs, and the scores of the Beck Depression Inventory and the Beck Anxiety Inventory (BAI). Results Forty-seven (47%) patients had MwA and 53 (53%) had MwoA. The performance of the MwA patients was significantly poorer than that of the MwoA patients and the healthy subjects on the MoCA scales. In particular, the results revealed lower scores in the subscales regarding visuospatial/executive functions, naming, memory, attention, and abstraction in MwA patients than in the MwoA patients. Compared to healthy controls, more number of migraine patients had WMHs. The presence and number of WMHs had no significant correlation with the MoCA scores of the migraine patients. There was a significant correlation of the BAI and BDI scores with the total MoCA scores considering all migraine patients. Conclusions This study suggested that MwA may be associated with low cognitive performance which was correlated with depression and anxiety but not with WMHs. Further, longitudinal studies for assessing the relationship between WMHs, cognitive functions, and migraine, and for establishing the causality are warranted

Extracranial and intracranial artery dissections: Experiences from a tertiary referral center

Background: Craniocervical artery dissection is an important cause of ischemic stroke especially in young and middle aged adults. In this study, we evaluated extracrainal and intracranial artery dissections in terms of etiologies, risk factors, stroke severity and functional outcomes. Methods: A total of 29 patients who were diagnosed with ischemic stroke due to extracranial or intracranial artery dissections were enrolled to this study. The ischemic stroke diagnosis was confirmed with diffusion weighted magnetic resonance imaging in all patients. Computed tomography angiography, magnetic resonance angiography and digital subtraction angiography were used to demonstrate the dissection. Demographic findings, risk factors and presence of trauma were evaluated. National Institute of Health Score Scale (NIHSS) was used for stroke severity assessment at disease onset. Functional outcomes were measured with Modified Rankin Scale (mRS) at the 3rd month. Results: Fifteen patients (51.72%) had carotid artery dissections while 12 patients (41.37%) had vertebral artery dissection (VAD), 1 (3.4%) had basilar artery dissection (BAD) and both VAD and BAD were seen in 1 patient (3.4%). Coagulopathy was detected in 12 patients (41.37%). Connective tissue disease was suspected in 3 patients (10.3%). In 6 patients, dissections occured after trauma. Nineteen patients (65.51%) presented with somatosensory deficits. The 3rd month mRS scores were in the range of 0-2 and no significant correlation was found in terms of risk factors, etiology and trauma history. Conclusion: Arterial dissection should be kept in mind for the clinical presentation of ischemic stroke in young adults. We think that better understanding of the risk factors, etiologies and clinical presentation of the dissections and early diagnosis-proper treatments might yield improved clinical outcomes

Bariatrik Cerrahi Sonrası Gelişen ve Guillain Barre Sendromu’nu Taklid Eden Poliradikülonöropati Olgusu

With the rising prevalence of morbid obesity, the numbers of bariatric surgical procedures are also increasing, thus resulting in more neurological complications to be recognized. Among these complications, the most well-defined are Wernicke's encephalopathy and peripheral neuropathies. Guillain Barre Syndrome (GBS) has been reported as a very rare complication of bariatric surgery and reported cases are mostly axonal types. An 18-year-old female patient applied to our outpatient clinic with complaints of pain and weakness in her arms and legs. She had bariatric surgery 3 months ago. The electrophysiological findings of the patient who had proximal muscle strength loss in the lower extremities were consistent with subacute anterior root anterior horn involvement in the L3-S1 innervated muscles. After the intravenous immunoglobulin therapy, the patient improved almost completely. We think that in neurological complications after bariatric surgery, nutritional deficiencies should be taken into consideration as well as inflammatory damage and these cases should be followed up and treated in a multidisciplinary manner in order to prevent permanent neurological damage

Clinical significance and prognostic value of serum autoantibody tests in multiple sclerosis

Introduction. It is known that multiple sclerosis (MS) often coexists with other autoimmune diseases. Hence, autoantibody (auto-Ab) tests may prove useful in the differential diagnosis of MS. The objectives of this study were to: (a) investigate the prevalence of auto-Ab positivity at the beginning of the MS diagnostic process; (b) assess whether Auto-Ab+ and Auto-Ab- patients differ in baseline clinical, laboratory, and radiological parameters; and (c) investigate the prognostic value during a two-year follow-up period. Material and methods. This retrospective study consisted of 450 patients aged between 18 and 55 years. All patients underwent a wide range of auto-Ab tests, anti-nuclear antibody (ANA) tests in particular. The expanded disability status scale (EDSS) scores of the patients were recorded at the time of diagnosis and at the end of a two-year follow-up period. Results. The mean age of the 212 patients, 148 (69.8%) female and 64 (30.2%) male, included in the study sample was 37 ± 10.83 years. The rate of relapsing cases was 84% (178). Oligoclonal band (OCB) was positive in 142 (86.6%) of the 164 tested cases. At least one of the auto-Ab tests was positive in 51 (24.1%) of the cases. ANA test was positive in 21 (9.9%) cases. There was no significant difference between patients with at least one positive auto-Ab test and without any positive auto-Ab test and between ANA-positive and ANA-negative patients in terms of age, gender, clinical features of MS, presence of brain stem lesion, presence of spinal lesion, OCB positivity, level of clinical improvement after the first pulse steroid treatment, family history, presence of comorbidity, presence of autoimmune disease, or EDSS scores recorded at the end of the two-year follow-up period (p > 0.05). Conclusions. Our study findings revealed that Auto-Ab positivity was more common in MS patients than in the general population. However, given their limited contribution to the diagnosis and differential diagnosis of MS with no effect on the prognostic process, auto-Ab tests should be requested only in the event of accompanying autoimmune disease symptoms, and in cases where the diagnosis of MS may be suspected

Vaccination in Individuals with Multiple Sclerosis – Part I

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections

Inflammatory markers are beneficial in the early stages of cerebral venous thrombosis

ABSTRACT Cerebral vein thrombosis (CVT) is a rare but serious cause of acute stroke. Inflammation is a hypothetical etiological factor in CVT. Objective: The aim of this study was to evaluate inflammatory marker levels in CVT patients and compare these with healthy individuals. Methods: This prospective case-control study was conducted with 36 newly-diagnosed CVT patients age- and sex-matched with 40 healthy individuals. The laboratory investigations included a serum hemogram, full biochemistry profiles, high sensitivity C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-HDL cholesterol ratio (MHR) values were calculated and compared between the patients and healthy participants. Results: The mean age was 41.4 ± 11.8 years for patients, and 39.3 ± 12.5 for controls. Lymphocyte, total bilirubin, indirect bilirubin, and HDL levels were significantly lower in CVT patients (p 0.05). Conclusions: We suggest that NLR, PLR, CRP, ESR, and bilirubin can be used in clinical practice for prediction of CVT in suspected patients as they are inexpensive parameters and widely available. However, further large-scale studies are required to confirm this relationship

INVESTIGATING DIFFERENT USER PROFILES OF E-GOVERNMENT SERVICES FOR TURKEY

INVESTIGATING DIFFERENT USER PROFILES OF E-GOVERNMENT SERVICES FOR TURKE