Obstructive Sleep Apne Syndrome and Neurology

Obstrüktif Uyku Apne Sendromu (OUAS) nörolojik hastalar arasında sık görülen ciddi bir durumdur. OUAS’ın etyolojisinde, ayırıcı tanısında ve sonuçlarında nörolojik hastalıklar bulunmaktadır. OUAS’ın nörolojik hastalıklarla birlikteliği daima dikkat çekmiştir. OUAS birçok nörolojik semptomu içinde barındıran bir sendromdur. OUAS tanınmaz ve tedavi edilmezse, birçok nörolojik hastalığa sebep olabilir , potansiyel olarak birbirlerini daha da kötüleştirebilirler ve sonuçta ölüme yol açabilir. Bu derlemede, nörolojik hastalıklarla OUAS ilişkisi ele alınmıştır.Obstructive Sleep Apnea Syndrome (OSAS) is a common condition in neurological patients. Neurological diseases are present in the etiology, differential diagnosis and outcomes of OSAS. The association of OSAS with neurological diseases has always attracted attention. OSAS is a syndrome that contains many neurological symptoms. If OSAS is unrecognized and untreated, it can lead to many neurological diseases, potentially worsening each other and ultimately leading to death. In this review, the relation between OSAS and neurological diseases has been mentioned

Comorbid fibromyalgia in migraine patients: clinical significance and impact on daily life

Hamamci, Mehmet/0000-0001-7100-3952WOS: 000473488300001PubMed: 31221031Objective: Herein, we aimed to investigate the impact of FM in migraine patients and the specific features and discriminations of this group of migraineurs with FM according to patients without FM. Methods: 102 consecutive migraine patients among 18-50 years old who accepted to involve in the study were included. All patients were asked to complete the following self-report questionnaires for the assessment of pain-related disability, migraine-related disability, anxiety, depression, sleep disturbance and quality of life. All statistical analyses were performed using the SPSS statistics 20 program. Results: 92% of the patients were diagnosed with episodic migraine, whereas 8% of them was diagnosed with chronic migraine (CM). Comorbid FM which was detected to present in 30.3% of the patients. FM was more frequent in CM patients and in migraine patients with aura. The analyses comparing FM (+) and FM (-) migraineurs revealed that headache frequency, migraine disease duration, headache impact test, MIDAS scores were significantly higher in FM (+) migraineurs. Furthermore, the vitality and role-emotional domains of the SF-36 resulted in worse scores in the group of FM (+) migraineurs. Conclusion: The results of our study may suggest the presence of FM as a clinical sign of a more severe migraine. However, the long-term prospective studies including these group of patients are needed to understand the prognostic impact and importance of the comorbid FM in migraine

Acute Ischemic Stroke in a Patient with Multiple Sclerosis Presenting with Left Hemiplegia and Dysarthria

Multipl Sklerozda, santral sinir sistemindeki kronik inflamasyonun indüklediği endotelial disfonksiyon ve buna bağlı ateroskleroz serebrovasküler hastalık riskini artırır. Multipl Skleroz (sekonder progressif) ve hipertansiyon (regüle) tanıları olup EDSS skoru 6 olan 54 yaşındaki bayan hasta intravenöz yüksek doz pulse steroid tedavisi sonrası sol tarafında ani güç kaybı, konuşma ve yutma bozukluğu ile getirildi. Acil servisteki difüzyon MR’da mezensefalon ile pons sağ kesiminde, serebellar hemisferlerde difüzyon kısıtlaması gösteren akut enfarkt alanları izlendi. İnme etiyolojisine yönelik yapılan karotisvertebral doopler ultrasonografi ve transtorasik ekokardiografi normaldi. Ritm holterde, aritmi izlenmedi. Rutin laboratuar tetkikleri, tromboz ve vaskülit markerlerinde patoloji saptanmadı. Olguda inme nedeni olarak Multipl Skleroz ve immobilite düşünüldü. Multipl Skleroz hastalarında yeni gelişen nörolojik disfonksiyon durumunda atak dışı neden, inme olasılığı da her zaman akılda tutulmalıdır.Endothelial dysfunction induced by chronic inflammation in the central nervous system and associated atherosclerosis increases the risk of cerebrovascular disease in Multiple Sclerosis. A 54 years-old woman with multiple sclerosis (secondary progressive), hypertension (regular) and EDSS score 6 was brought with sudden loss of power on her left side as well as speech and swallowing disturbances after high dose intravenous pulse steroid therapy. Acute infarcts with diffusion restriction were observed in mesencephalon, cerebellar hemispheres and right side of pons in diffusion MR which was requested in the emergency department. Carotid-vertebral Doppler ultrasonography and transthoracic echocardiography performed to investigate etiology of stroke were normal. Arrhythmia was not observed in rhythm Holter evaluation. Routine laboratory tests, thrombosis and vasculitis markers were found to be normal. Multiple Sclerosis and immobility were considered as the cause of stroke for this patient. The possibility of stroke and a non-attack pathology should always be kept in mind when Multiple Sclerosis patients admit with a new onset neurological dysfunction

Is there a relationship between basilar artery tortuosity and vertigo?

alpua, murat/0000-0002-0951-5962WOS: 000460832100018PubMed: 30771568Objective: The aim of this study was to investigate the relationship between basilar artery (BA) tortuosity, hypogenesis/agenesis of the vertebral artery (VA), and vertigo, with the use of magnetic resonance imaging (MRI). Patients and methods: This case-control study included patients admitted to the outpatient clinics, who were aged 18-80 years, without any known systemic diseases. All patients were evaluated with a 1.5-tesla MRI system. BA Tortuosity, VA agenesis, and VA asymmetry were noted. BA diameter (central) and length (longitudinal) were measured. Results: A total of 154 vertigo patients (46 M, 108 F; mean age of 48.95 +/- 17.3 years) and 346 control subjects (112 M, 234 F; mean age of 45.12 +/- 17.0 years) were included. The mean age of the vertigo patients was significantly higher than that of the control group (48.95 vs 45.12 years) (p = 0.021). The rate of BA tortuosity was higher in patients with vertigo (p = 0.030). When the participants were divided into two groups according to median age ( = 45 years) there was no statistically significant difference between the groups in terms of VA asymmetry (p = 0.070) and hypogenesis/agenesis (p = 0.577). There was a statistically significant difference between the groups in respect of BA tortuosity (p = 0.033), BA diameter (p < 0.001), and BA length (p < 0.001). When the study populations were divided into two groups according to the presence of vascular tortuosity, the mean age, BA diameter, and BA length values were higher in the tortuosity ( + ) group (all p < 0.001). Conclusion: These results demonstrated that vertigo and BA tortuosity rates seem to increase with age. Likewise, BA diameter and length increased with age, although there was no significant relationship with vertigo. Patients with tortuosity were significantly older, and had higher rates of VA asymmetry/agenesis, and increased BA diameter compared to subjects without tortuosity

Retrospectif Analysis of 1545 Patients: Neuroimaging in Headache

WOS: 000505071500012Objective: Neuroradiological imaging is also used to differentiate between primary and secondary headaches. The aim of this study was to evaluate retrospectively the significant abnormal neuroradiological imaging results and rates in the primary headache group. In addition, it was also planned to analysis the results of all headaches with imaging and discuss the imaging in the headache with the literature. Methods: Medical records of headache patients of the neurology outpatient clinic at the tertiary care center were reviewed. Patients who required brain imaging and did not have any disease that could cause pathology in imaging were included. Neuroradiological images were grouped as brain computed tomography (CT), brain magnetic resonance imaging (MRI) and others. Results were normal, significant abnormal findings and others. Results: Total 1545 patients were included. Primary headache 992, secondary headache 91, painful cranial neuropathies and other headaches were observed in 462 patients. Significant abnormal radiological findings were found to be 4.3% in primary headache, 14.3% in secondary headache, and 6.6% in painful cranial neuropathy and other headaches. Significant findings in primary headache were Arnold Chiari Malformation, sinus thrombosis, intracranial mass, choroid plexus xanthogranuloma, hydrocephalus, vascular malformation. Conclusion: In this series, the rate of significant findings in neuroradiological imaging in primary headache is low. Secondary headaches require neuroimaging because of the presence of underlying life-threatening causes, although the rate of abnormal neuroradiological imaging is low. History, examination, and red flags in headache may lead to imaging, but patient and physician concerns may also increase imaging rates

Evaluation of the Optic Nerve by Strain and Shear Wave Elastography in Patients With Migraine

INAL, MIKAIL/0000-0003-0642-7913; Sahan, Mehmet Hamdi/0000-0001-8976-6157WOS: 000465075300004PubMed: 30578566Objectives To investigate the optic nerve's elastic properties using shear wave and strain elastography in patients with migraine compared to healthy individuals. Methods The migraine group consisted of 30 patients (16 with visual auras and 14 without auras) who had previously had a diagnosis of migraine. These were age and sex matched with healthy participants to form the control group. The findings from shear wave and strain elastography in the groups were compared. The elastographic examination was performed with a 6-15-MHz multifrequency linear array transducer. Results The evaluation involved 30 patients with migraine (3 male and 27 female), whose mean age +/- SD was 34.63 +/- 10 years, and 30 healthy participants (3 males, 27 females), whose mean age was 36.4 +/- 10.5 years. In strain elasticity patterns, a statistically insignificant hardening of the optic nerve in the patients with migraine was observed (P = .052). Analysis of the shear wave elastic modulus values (9.8 +/- 3.34 and 12.3 +/- 5.25 kPa; P = .03) revealed that differences between the healthy participants and patients with migraine were statistically significant. The results for elasticity patterns and the shear modulus suggested that the differences between migraines with and without visual auras were insignificant (P > .05). A positive correlation was discovered between the duration of the disease and the shear modulus in the patients with migraine (r = 0.496; P < .01). Conclusions Histopathologic changes in the optic nerve may be seen in patients with migraine due to possible fibrotic changes. Elastographic techniques can be useful diagnostic tools for investigating these changes.Kirikkale University Scientific Research Projects and Coordination Unit [2018/036]This work was supported by Kirikkale University Scientific Research Projects and Coordination Unit with the project number 2018/036

Evaluation of the optic nerve using strain and shear wave elastography in patients with multiple sclerosis and healthy subjects

INAL, MIKAIL/0000-0003-0642-7913WOS: 000393176900006PubMed: 28180195Aims: Our aim was to evaluate the elasticity features of the optic nerve using strain (SE) and shear wave elastography (SWE) in multiple sclerosis (MS) patients in comparison with healthy subjects. Material and methods: One hundred and seven optic nerves from 54 MS patients and 118 optic nerves from 59 healthy subjects were examined prospectively by SE and SWE. Optic nerves were divided into three types in accordance to the elasticity designs, as follows: type 1 predominantly blue (hardest tissue); type 2 predominantly blue/green (hard tissue); and type 3 predominantly green (intermediate tissue). Quantitative measurements of optic nerve hardness with SWE were analyzed in kilopascals. Results: Elastographic images from healthy volunteers showed mostly type 3 optic nerves (61.9%); type 2 was also found (38.1%), but type 1 was not observed. Elastographic examination of MS patients showed mostly type 2 optic nerves (88%), while some type 1 (4.6%) and type 3 optic nerves (6.5%) were rarely observed. There was a statistically significant difference in terms of elasticity patterns between patients and healthy volunteers (p<0.001). Statistically significant differences were observed between patients and healthy volunteers in the analysis of SWE values (10.381 +/- 3.48 kPa and 33.87 +/- 11.64 p< 0.001). The receiver operating characteristic curve analysis was perfect (0.993; 95% confidence interval [CI]=0.971-0.999), and a cut-off value of 18.3 kPa shear had very high sensitivity and specificity for the patient group. No significant differences were observed between patients with and without previous optic neuritis. Conclusion: SE and SWE examination findings concerning the optic nerve in MS patients demonstrated remarkable differences according to the healthy group

Endothelial and Autonomic Functions in Patients with Migraine

WOS: 000515122500025PubMed: 31603510Objective It has been shown that patients with migraine have endothelial dysfunction. Migraine patients with aura, especially, have more clinical manifestations of autonomic nervous system dysfunction. We aimed to evaluate the endothelial and autonomic functions in migraine patients during both migraine headache attack and headache-free periods. Design This was a cross-sectional, randomized study. Subjects and Methods A total of 130 participants (67 male and 63 female patients, minimum age = 19 years, maximum age = 71 years, mean age = 38.812.2years) were enrolled into the study. For the statistical evaluation of data, we classified the participants of the study as follows: group 1: headache (+) aura (+); group 2: headache (+) aura (-); group 3: headache (-) aura (+); group 4: headache (-) aura (-). Noninvasive evaluation of endothelial function was performed by flow-mediated dilation (FMD) and pulse wave analysis methods. Heart rate variability measurements were used for noninvasive evaluation of autonomic functions. Results Group 1 had a higher FMD ratio than the control group, group 3, or group 4 (P<0.001, P<0.001, and P=0.003, respectively). Group 4 had lower FMD ratio levels than the other migraine groups and or the control group (P<0.001). Group 3 had the highest high-frequency (HF) power levels among all migraine groups (P<0.001). Group 2 had higher low-frequency/HF ratio values than other migraineurs (P<0.001). Conclusions We concluded that endothelial dysfunction and headache are closely related. Additionally, higher parasympathetic tonus might be associated with the presence of aura