Inferior Gluteal Nerve Injury Due to Intramuscular Injection

Aim: The purpose of this study was to determine the clinical features of the inferior glutealnerve (IGN) injury due to intramuscular (IM) injection.Material and Methods: Patients with clinical and electrodiagnostic features of the sciaticnerve (SN) and possible IGN injuries due to IM injection were included in this retrospectivestudy. The presence of an IGN injury was considered in patients with weakness in the gluteusmaximus (GM) muscle or in those who demonstrated needle electromyography (EMG)abnormality in the GM muscle.Results: There were 44 (95.6%) patients with an SN injury only, 1 (2.2%) patient with bothan SN and an IGN injury, and 1 (2.2%) patient with an IGN injury only. The complaints of thepatient with an IGN injury only occurred within hours to days after the IM injection; thispatient had no muscle weakness. The complaints of the patient with both IGN and SN injuriesoccurred minutes to hours after IM injection; this patient had mild weakness in the plantarflexion of the foot. In 40 of the patients with only an SN injury, complaints occurredimmediately after or within a few seconds following the IM injection, while complaintsoccurred within minutes to hours in the remaining 4 patients.Conclusion: Although rare when compared to SN injury, the IGN can be injured by IMinjection. Therefore, the GM muscle should be examined with needle EMG in patients withcomplaints associated with IM injection. Muscle weakness may not occur in nerve injuries dueto IM injections

Inferior Gluteal Nerve Injury Due to Intramuscular Injection

Aim: The purpose of this study was to determine the clinical features of the inferior glutealnerve (IGN) injury due to intramuscular (IM) injection.Material and Methods: Patients with clinical and electrodiagnostic features of the sciaticnerve (SN) and possible IGN injuries due to IM injection were included in this retrospectivestudy. The presence of an IGN injury was considered in patients with weakness in the gluteusmaximus (GM) muscle or in those who demonstrated needle electromyography (EMG)abnormality in the GM muscle.Results: There were 44 (95.6%) patients with an SN injury only, 1 (2.2%) patient with bothan SN and an IGN injury, and 1 (2.2%) patient with an IGN injury only. The complaints of thepatient with an IGN injury only occurred within hours to days after the IM injection; thispatient had no muscle weakness. The complaints of the patient with both IGN and SN injuriesoccurred minutes to hours after IM injection; this patient had mild weakness in the plantarflexion of the foot. In 40 of the patients with only an SN injury, complaints occurredimmediately after or within a few seconds following the IM injection, while complaintsoccurred within minutes to hours in the remaining 4 patients.Conclusion: Although rare when compared to SN injury, the IGN can be injured by IMinjection. Therefore, the GM muscle should be examined with needle EMG in patients withcomplaints associated with IM injection. Muscle weakness may not occur in nerve injuries dueto IM injections

A case with basilar artery thrombosis resulted in Locked-in syndrome in spite of endovascular treatment

Locked-in Sendrome is a clinical picture consist of quadriplegia, lower cranial nerve paralysis, and mutism with preservation of only vertical gaze and upper eyelid movement. Consciousness remains intact and the patient is able to communicate intentionally using eye blinking. The most common cause underlying the locked-in syndrome is thrombosis of the basilar artery. In this study, we reported a 49-years-old male with past medical history for cerebrovascular disease presented with acute basilar artery thrombosis, manifesting as reduced level of consciousness, weakness in all extremity dominated on the right side, speech impairment, horizontal gaze disorder and for reaching us of the last munite of endovascular intervention threshold, so it can perform only mechanical and intra-arterial thrombosis treatment method as an endovascular treatment modalities of acute stroke

A case of multiple cerebral fat embolism syndrome associated with femoral fracture after motorcycle accident

Fat embolism syndrome is a clinical condition which is caused by oil particles introduce into the systemic circulation and result in respiratory distress, altered consciousness and petechial rashes. The most common occurrence develops following the long bone fractures within 24-72 hours. The clinical picture may vary from mild respiratory distress to grave respiratory failure and coma.We aimed to present case of diagnosis and treatment process with fat embolism syndrome following femur fractures due to motorcycle acciden

The Influence of the Social Support on the Cognitive Functions of the Elderly Living in Old Age Asylums

OBJECTIVE: Although there has been a need for a systematic approach towards improving the care of the elderly in asylums, the related literature has been scarce throughout the world. In Turkey, the present knowledge about the cognitive functions of the elderly living in asylums is limited and the influence of social support on the cognitive functions is unknown. OBJECTIVES: The aim of this study was to investigate the influence of the social support of family, friends, and others (doctors, nurses, social care experts and so on) on the cognitive functions of the elderly living in two physically different asylums. METHODS: 136 elderly people living in two different asylums operating Social Services department were included in the study. The elderly people taking part in the study were administered the Standardized Minimal Test (MMT), The Scale For Depression In The Elderly, and Multi-Dimensional Social Support Scale in order to test the social support. RESULTS: The MMT scores were low and the depression scores were high in the elderly in Group I and a significant difference was observed between the groups (t=- 4.94, p<.001, t=3.78, p<.001 respectively). Those in Group II had higher scores in terms of the support of friends and others and the statistical difference between the groups was significant (t=-7.89, p<.001, t=-8.05, p<.001 respectively). The relation between the support of friend and MMT was positive (0.655, p<.001). A positive relation was also observed between the support of others and MMT (0.506, p<.001). A negative correlation was observed between the Depression Score and MMT (-0.518, p<.001). No difference was observed between the groups in terms of family support (t=-1.46, p=.14). CONCLUSION: The findings of this study indicate that there is a close relation between social support and cognitive functions. We feel that the improvements in the physical conditions in the asylums and the introduction of more effective psycho-social rehabilitation approaches will contribute greatly to the promotion of the cognitive functions of the elderl

The Importance of Cerebrospinal Fluid Cytology in Leptomeningeal Carcinomatosis Presenting with Intracranial Hypertension

Scientific Background: Leptomeningeal carcinomatosis (LMC) is one of the complications of systemic cancers with the most poor prognosis. Tumor cells in LMC disturb CSF circulation either by spreading into su-baracnoid space or directly infiltrating meninx and occasionaly causes intracranial hypertension (IH). Hydrocephalus can be established by ne-uroimaging methods in the most of patients with IH due to LMC. Me-ningeal contrast enhancements are also present in some patients. CSF cytology must be examined in patients with IH because of not to missing diagnosis of LMC. Material and method: Three patients presented with IH without findings of hydrocephalus in neuroimaging were diagnosed as LMC by CSF cytologic examination. IH and LMC were initial manifestations of breast carcinoma in the first patient. Our second patient was admitted with epileptic seizures and IH two years after the primary diagnosis of breast cancer. However, the fourth cytologic examination of CSF showed LMC by showing malignant cells. The last patient presented with IH was di- agnosed as gastric carcinoma one and a half month ago and LMC was diagnosed by both CSF cytology and cranial magnetic resonance imaging studies. Conclusions: LMC should be suspected in IH patients even in the absence of hydrocephaly and/or meningeal contrast enhancement in ne-uroimaging and CSF cytology must examined even if there is no history of cance

The Relationship Between Body Mass Index and Mononeuropathies

Aim: The study aimed to find out whether there is a relationship between the mononeuropathies of the median, ulnar, radial, peroneal, and sciatic nerves and body mass index (BMI). Material and Methods: Patients whose clinical and electrodiagnostic findings were compatible with carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow (UNE), radial neuropathy at the spiral groove (RNS), peroneal neuropathy at the fibular head (PNFH), and sciatic injury due to intramuscular injection (SNIII) were included in this retrospective cohort study. In addition, controls whose clinical and electrodiagnostic features were not compatible with mononeuropathy were included in the study. The BMI values of all participants were analyzed. Results: One hundred thirty-one CTS patients, 53 UNE patients, 6 RNS patients, 25 PNFH patients, 72 SNIII patients, and 53 controls were included in the study. The BMI of CTS patients was higher than the BMI of controls (p&lt;0.001), PNFH patients (p&lt;0.001), and SNIII patients (p&lt;0.001). The BMI of SNIII patients was lower than the BMI of controls (p&lt;0.001), CTS patients (p&lt;0.001), and UNE patients (p&lt;0.001). The BMI of PNFH patients was lower than that of CTS patients (p&lt;0.001) and UNE patients (p=0.004). No significant correlation was found between BMI values and electrodiagnostic classification of mononeuropathies in the groups. Conclusion: This study showed that high BMI is a risk factor for CTS and low BMI is a risk factor for SNIII. There may also be a relationship between BMI and PNFH, but this should be confirmed by further studies

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

Acute Stroke Management in Türkiye: Intravenous Tissue Plasminogen Activator and Thrombectomy NöroTek: Türkiye Neurology Single Day Study

Objective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neuro-interventional therapy in Türkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0–2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 ± 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 ± 6; hospital stay, 24 ± 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 ± 13 years; NIHSS: 14.1 ± 6.5; length of hospital stay, 33 ± 31 days), 19% in those who received combined treatment (age: 66 ± 14 years; NIHSS: 15.6 ± 5.4; length of hospital stay, 26 ± 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 ± 13 years; NIHSS: 7.6 ± 7.2; length of hospital stay, 21 ± 28 days). The symptom-to-door time was 87 ± 53 minutes in the IV treatment group and 200 ± 26 minutes in the neurointerventional group. The average door-to-needle time was 66 ± 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 ± 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0–2 was 41%, while the rate of mRS 0–1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0–2 was 31% and mRS 0–1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 ± 107 and 95 ± 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Türkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the “Directive on Health Services to be Provided to Patients with Acute Stroke.”. © Copyright 2023 by the Turkish Neurological Society / Turkish Journal of Neurology published by Galenos Publishing House