Combination of cerebral demyelination and Graves disease in a case with Miller Fisher syndrome

A 44-year-old male patient with a diagnosis of Miller Fisher syndrome, Graves disease and central nervous system demyelination is presented. Clinical and laboratory findings supported the diagnosis of Miller Fisher syndrome. On T2-weighted sections of cranial magnetic resonance imaging, many ovoid-shaped, hyperintense lesions in bilateral deep white matter were detected. Magnetic resonance imaging spectroscopy demonstrated low N-acetylaspartate to creatine (NAA/Cr) ratio consistent with demyelination. Combined peripheral nervous system and central nervous system demyelinating processes are rare. In this Miller Fisher syndrome case, an immunological mechanism affecting both the peripheral nervous system and central nervous system with association of Graves disease is discussed in light of the relevant literature. A positive response to intravenous immunoglobulin G treatment was obtained

Benign-onset acute disseminated encephalomyelitis: A report on two cases

The signs and symptoms of acute disseminated encephalomyelitis are heterogeneous and dependent on the location and severity of the inflammatory process. The meningoencephalitic presentation may include meningism, impaired consciousness (occasionally leading to coma), seizures and confusion, or behavioral disturbances. Multifocal neurological features include a combination of optic neuritis, visual field defects, cranial neuropathy, sensorimotor impairment, ataxia, aphasia, and involuntary movements. One definition of acute disseminated encephalomyelitis is "an initial clinical event with a presumed inflammatory and demyelinating cause, with acute or sub-acute onset affecting multifocal areas of the central nervous system". Patients with acute disseminated encephalomyelitis frequently suffer from seizures, disturbances of consciousness, fever, and headaches, and occasionally there are focal signs and symptoms. Here, we report on two cases who presented with different symptoms, but the clinical findings that the patients showed were benign

ASCO classification in clinical practice

ASCO (Atherosclerosis, Small vessel disease, Cardiac source. Other cause) is a new of classification of ischemic cerebrovascular diseases. This classification categorizes the data of the patients according to all underlying diseases and allows the clinician to grade the severity of cause (Each of the four phenotypes can be graded 1, 2, or 3). It is suggested to use ASCO classification in large epidemiologic studies but this classification may be used in daily practice. In this study we aimed to analyze the clinical features of patients with ischemic stroke and to investigate results of ASCO classification of these patients and data of 35 patients with ischemic stroke is analyzed. Use of ASCO classification is discussed with the special example cases. Patients' etiology of stroke was classified according to ASCO as known, unknown, completely unknown and unclassifiable group. Percentile of the patients classified as "known" was 71.4% (n=25), "unknown" was 1 7.1% (n=6), "completely unknown" was 5.7% (n=2) and "unclassifiable group" was 5.7% (n=2). We think that the ASCO classification which is thought to be more useful in large epidemiologic studies may be used in clinical follow-up period of the stroke patients. Further studies, from different neurology centers and stroke units, are needed to expand our experiences about use of ASCO classification in clinical practice

Central nervous system infections and diagnostic brain biopsy: Two case reports

Cerebral biopsy is an invasive technique with limited, specific indications in view of the potential risk of complications. Brain biopsy, aside from the direct sampling of a suspected neoplasm, is often diagnostic in cases of granulomatous angiitis, some forms of encephalitis, subacute spongioform encephalopathy, and a number of other rare diseases. Two cases who had a central nervous system infection and had undergone diagnostic brain biopsy in our clinic will be discussed by reviewing the literature. Copyright © 2005 by Türkiye Klinikleri

The cognitive dysfunctions of multiple sclerosis: Do we face from the early terms?

Objectives: The diversity of physical and cognitive impairments seen in Multiple Sclerosis (MS), make it difficult to make the definition and classification of physical and cognitive disabilities and to identify the factors that influence neurorehabilitation programs and outcomes. In the view of the complexities of both Multiple Sclerosis (MS) and the rehabilitation process, this preliminary study's aim was to determine the cognitive dysfunctions by conducting on early term relapsing-remitting MS (RRMS) patients. Methodology: Cognitive performances of 27 early term RRMS patients and 27 individually s ex-age matched volunteer healthy controls (HC) were compared. Each patient underwent a complete clinical assessment, including depression, disability and comprehensive cognitive function [attention: Stroop tests, memory and perception: Wechsler Memory Scale-Revised (WMS-R) subtests]. Results: There were statistically significant differences between groups for all subtests of Stroop (p<0.05), WMS-Digit Span (p<0.05), WMS-Logical Memory (p<0.001) and WMS-Visual Reproduction (p<0.001). The significance remained while the depression's effect was controlled. There was a statistically significant difference between visual reproduction of immediate (WMS-VRI) and delayed (WMS-VRD) memory in RRMS patient group (p<0.05). In the light of results it was recorded that, deficient cognitive performance is predominantly apparent in early term RRMS patients. Conclusion: Cognitive assessment and rehabilitation must be in the context of multidisciplinary rehabilitation of RRMS patients from the early terms