Miller Fisher Sendromunun Alışılmadık Tekrarı: Sekiz Yılda Üç Kez

Miller Fisher Syndrome (MFS) is an acute, autoimmune polyneuropathy usually associated with a good prognosis which is clinically characterized by ataxia, ophtalmoplegia, and areflexia. MFS has a monophasic course, double recurrence can be seen in rare cases. But three attacks are very rare. In this article, we discussed a rare case of MFS and approach to the treatment that recurred 3 times within a period of 8 years. It is emphasized that MFS cases may occur a recurring pattern, and plasma exchange should be definitely tried as a therapeutic approach when clinical deterioration occurs under intravenous immunoglobulin (IVIg) therapyMiller Fisher Sendromu (MFS) akut, genellikle iyi prognoz ile ilişkili otoimmün bir polinöropati olup, klinik olarak ataksi, oftalmopleji ve arefleksi ile karakterizedir. MFS monofazik seyirlidir, ikinci tekrar nadir vakalarda görülmektedir. Ancak, üç atak oldukça nadirdir. Bu yazıda, sekiz yıllık periotta üç kez tekrarlayan nadir bir MFS olgusu ve tedaviye yaklaşım tartışılmıştır. MFS’lu olguların tekrarlayıcı bir patern gösterebileceği ve plazma değişiminin intravenöz immünglobulin (IVIg) tedavisi altında klinik kötüleşmesi olan hastalarda tedavi edici bir yaklaşım olarak denenebileceği vurgulanmıştı

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

Akut İskemik İnme Hastalarında Yeni Bir Markır: Monosit / HDL Oranı

Objective: Stroke is a major cause of global morbidity and mortality. Ischemic stroke is usually marked by cell death associated with inflammation and oxidative stress, and the role of inflammation in neurological diseases has become increasingly obvious. In our study, we studied the monocyte / HDL ratio (MHR) which can support the theory of inflammation in stroke and can be used in clinical practice. MHR can be used a prognostic marker in stroke patients base on this theory. Methods: Our study registered 91 acute ischemic stroke patients (47 females and 44 males) and 50 healthy controls. Results: MHR was elevated in the patient group and correlated with high-sensitivity C-reactive protein (hsCRP). MHR was higher in patients with high a National Institutes of Health Stroke Scale (NIHSS) than those with a low NIHSS (p=0.050) as well as in patients with a larger infarct area and in than those with a smaller area (p=0.050). The MHR correlated with both the clinical condition and infarct area in acute ischemic stroke patients, which underscores the value of MHR as a new marker. Conclusions: This cross-sectional study of 91 acute ischemic stroke patients indicates that inflammation markers and MHR are correlated with clinical status and even radiological parameters.Amaç: İnme, dünyada major bir morbidite ve mortalite sebebidir. İskemik inmede genellikle inflamasyon ve oksidatif strese bağlı hücre ölümü görülür. Nörolojik hastalıklarda inflamasyonun rolü giderek daha da belirginleşmektedir. Çalışmamızda inmede inflamasyon teorisini destekleyebilen ve klinik uygulamada kullanılabilecek monosit / HDL oranını (MHO) inceledik. Gereç ve Yöntem: Çalışmamızda 91 akut iskemik inme hastası (47 kadın ve 44 erkek) ve 50 sağlıklı kontrol kaydedildi. Bulgular: Hasta grubunda MHO yüksek idi ve yüksek duyarlılıkta C-reaktif protein (hsCRP) ile korele idi. MHO, Ulusal Sağlık Enstitüleri İnme Ölçeği (NIHSS) skoru yüksek olan hastalarda, düşük NIHSS'li (p = 0.050) olanların yanı sıra, ve de daha büyük bir infarkt alanı olanlarda daha küçük infarkt alanına sahip olanlara (p = 0.050) göre daha yüksekti. MHO, yeni bir belirteç olarak, akut iskemik inme hastalarında, hem klinik durum hem de infarkt alanı ile koreledir. Sonuç: 91 akut iskemik inme hastasının, bu cross-sectional çalışması, inflamasyon belirteçlerinin ve MHO'nin; klinik durum ve hatta radyolojik parametrelerle körele olduğunu göstermektedir

Effect of Smoking on Migraine Attack Frequency in Patients with Migraines

Purpose: Smoking and smoke inhalation are known to have negative effects on many diseases, primarily lung diseases. The aim of this study was to examine the effect of smoking on the frequency of migraine attacks in patients. Methods: A total of 82 migraine patients diagnosed in accordance with the revised diagnosis criteria of the International Headache Society were involved in this study. For each patient, we recorded demographic findings, smoking habits, disease duration, attack frequency, headache severity (determined with a visual analogue scale [VAS]), medicine and triggering factors. Those with a migraine attack frequency of less than three times a month were grouped as mild migraine, and those with a greater frequency were grouped as severe migraine. Those that smoked up to and including five cigarettes a day were grouped as mild smokers and those that smoked more than five per day were grouped as severe smokers. The Chi square test was used for parametric distribution. A p-value of< 0.05 was considered significant. Results: Among the 82 migraine patients involved in the study, 13 were male (15.9%) and 69 were female (84.1%). The mean age was 35.85 ± 9.90 years. Migraines with aura were seen in 38 patients (46.3%) and without aura in 44 patients (53.7%). Regarding smoking, 29 patients smoked (35.3%), while 53 did not smoke (64.6%). With patients who smoked, especially in females, the incidence of migraine attacks by 2 or more was higher than those who did not smoke. (57,5%) The mean number of attacks that patients had in a month was 5.45 ± 4.97 and the mean duration of the disease was 11.58 ± 8.43 years. VAS values were 5.85 ± 0.86. A significant relationship was found between smoking and migraine attack frequency in the smoking group (p = 0.002). Conclusion: Migraines are a chronic disease that negatively affects a patient’s quality of life. This study was undertaken to contribute to the relevant literature by showing the effect of smoking on attack frequency in migraines

Evaluation of pre- and post-transplant electroencephalographic examination in hematopoietic stem cell transplant patients = A transzplantáció előtti és utáni elektroencefalográfiás vizsgálatok értékelése haematopoeticus őssejttranszplantált betegeknél

Background and purpose – Haemato poietic stem cell transplantation (HSCT) is one of the most effective treatment methods for many malignant and non malignant diseases. In this study, we aimed to detect electroencephalographic (EEG) anomalies at an early stage in patients who underwent allogeneic and autologous HSCT and required the management of potentially life threatening non-convulsive seizures. Methods – The study was conducted with 53 patients. The age, gender, HSCT type (allogeneic or autologous), and treatment regimens applied before and after HSCT were recorded. All patients underwent EEG monitoring twice, once on the first day of hospitalization and again one week after conditioning regimens began and HSCT was performed. Results – When the pre transplant EEG findings were examined, 34 (64.2%) patients had normal EEGs and 19 (35.8%) had abnormal EEGs. After transplantation, 27 (50.9%) had normal EEG findings, 16 (30.2%) had a basic activity disorder, 6 (11.3%) had a focal anomaly, and 4 (7.5%) had a genera- lised anomaly. In the allogeneic group, the anomaly rate in post transplant EEGs was significantly higher than that in the autolo- gous group (p<0.05). Conclusion – It is important to consider the likelihood of epileptic seizures in the clinical follow up of HSCT patients. EEG monitoring is crucial for the early diagnosis and treatment of such non-convulsive clinical mani- festations. | Háttér és cél – A haematopoeticus őssejt- transzplantáció (HSCT) számos rosszindulatú és nem rosszindulatú betegség egyik leg hatékonyabb kezelési módszere. Ebben a vizsgálatban az volt a célunk, hogy korai stádiumban kimutassuk az elektroencefa lográfiás (EEG-) anomáliákat az allogén és autológ HSCT n átesett betegeknél, akiknél potenciálisan életveszélyes, nem konvulzív görcsrohamok kezelésére lehet szükség. Módszerek – A vizsgálatot 53 beteg bevo násával végeztük. Feljegyeztük a betegek életkorát, a nemüket, a HSCT típusát (allogén vagy autológ), valamint a HSCT előtt és után alkalmazott kezelési rendet. Minden beteg nél kétszer végeztünk EEG-monitorozást, egyszer a kórházi kezelés első napján, majd egy héttel a kondicionáló kezelések megkez dése és a HSCT elvégzése után. Eredmények – A transzplantáció előtti EEG-leleteket vizsgálva 34 (64,2%) betegnél volt normális az EEG, 19 (35,8%) betegnél pedig kóros. A transzplantációt követően 27 (50,9%) betegnél volt normális az EEG, 16 (30,2%) betegnél alaptevékenységi zavar, 6 (11,3%) betegnél fokális anomália, 4 (7,5%) betegnél pedig generalizált anomália volt megfigyelhető az EEG-n. Az allogén csoport ban a transzplantáció utáni EEG anomáliák aránya szignifikánsan magasabb volt, mint az autológ csoportban (p<0,05). Következtetés – Fontos figyelembe venni az epilepsziás rohamok lehetőségét a HSCT- kezelt betegek klinikai követése során. Az EEG monitorozás kulcsfontosságú az ilyen nem konvulzív klinikai megnyilvánulások korai diagnosztizálásában és kezelésében

Predictors of intensive care unit admission and mortality in patients with ischemic stroke: investigating the effects of a pulmonary rehabilitation program

Abstract Background The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. Methods This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. Results Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (p<0.001; r=0.440, r=0.432, r=0.339 and r=0.410, respectively). One and three months mortality- ICU admission had a statistically significant relationship with parenteral nutrition (p<0.001; r=0.346, r=0.300, respectively; r=0.294 and r=0.294, respectively). Similarly, there was also a statistically significant relationship between pneumonia onset and one- and three-month mortality- ICU admission (p<0.05; r=0.217, r=0.127, r=0.185 and r=0.185, respectively). A regression analysis showed that parenteral nutrition (odds ratio [OR] =13.434, 95% confidence interval [CI] =1.148–157.265, p=0.038) was a significant predictor of ICU admission. The relationship between pulmonary physiotherapy (PPT) and ICU admission- pneumonia onset at the end of three months was statistically significant (p=0.04 and p=0.043, respectively). Conclusion This study showed that PPT improved the prognosis of ischemic stroke patients. We believe that a pulmonary rehabilitation program, in addition to general stroke rehabilitation programs, can play a critical role in improving survival and functional outcomes. Trial registration NCT03195907 . Trial registration date: 21.06.2017 ‘Retrospectively registered’