Tolosa-Hunt Syndrome: A Report of Two Cases

Tolosa-Hunt syndrome (THS) is a painful ophthalmoplegia, characterized by cryptogenic granulomatous inflammation of the cavernous sinus and/or superior orbital fissure. Glucocorticoid treatment is used for both diagnostic and therapeutic purposes. According to the Headache classification subcommittee of international headache society criteria, magnetic resonance imaging (MRI) or biopsy is necessary for demonstration of the granulomatous inflammation. Here, we present two cases of THS with clinical and MRI findings

Epileptic Seizure as First Presenting Symptom of Multiple Sclerosis: A Case Report

While epileptic seizures are seen in the course of multiple sclerosis, they are rarely the first symptom. The first epileptic seizure of a 26-yearold woman with multiple sclerosis is described in the present report. The patient presented to the emergency department with generalized tonic-clonic seizure. Neurologic examination was normal except for right-sided hemiparesis and hyperactive deep tendon reflexes. Cranial MRI revealed periventricular, multiple millimetric lesions and a 45x27-mm, semi-ring-enhanced, cortical, T2/FLAIR, hyperintense lesion in the centrum semiovale. IgG index was high, and oligoclonal band was positive in cerebrospinal fluid examination. Electroencephalography showed prominent fronto-temporal activity on the left side and sharp wave paroxysms. Multiple sclerosis was diagnosed, and pulse corticosteroid therapy was initiated. Due to recurrent seizures, antiepileptic drug was added to treatment; seizures were controlled with monotherapy. It is known that patients with multiple sclerosis experience seizures. Multiple sclerosis should be considered in the differential diagnosis of young patients presenting with seizures

Increased serum citrullinated histone H3 levels in COVID-19 patients with acute ischemic stroke = Akut ischaemiás stroke-ban szenvedő Covid-19-betegek körében megnő a szérum citrullinált hiszton H3-szintje

Prevalence of acute ische­mic stroke (AIS) is increased in patients with coronavirus disease 2019 (COVID-19). A proposed hypothesis is increased virus-induced propensity to hypercoagulation resulting in arterial thrombosis. Our aim was to provide evidence regarding the involvement of neutrophil extracellular trap (NET) formation (NETosis) in COVID-19 related AIS. Twenty-six consecutively enrolled COVID-19+ pneumonia patients with AIS, 32 COVID-19+ pneumonia patients without AIS and 24 AIS patients without COVID-19 infection were included to the study. Clinical characteristics of recruited patients were collected. Serum levels of citrullinated histone H3 (H3Cit; a factor of NETosis), IL-8 and C5a (mediators associated with NETosis) were measured by ELISA (enzyme-linked immunosorbent assay). H3Cit levels were significantly higher in COVID-19+ AIS patients, whereas all study groups showed comparable IL-8 and C5a levels. There were no significant differences among etiological subgroups of AIS patients with or without COVID-19. AIS patients with COVID-19 showed relatively increased white blood cell, lymphocyte, neutrophil, D-dimer, C-reactive protein and procalcitonin levels than control groups. H3Cit levels did not correlate with clinical/prognostic features and inflammation parameters. H3Cit and IL-8 levels were correlated in COVID-19 patients without stroke but not in COVID-19 positive or negative AIS patients. Increased levels of inflammation parameters and H3Cit in COVID-19 related AIS suggest that NETosis may cause susceptibility to arterial thrombosis. However, H3Cit levels do not correlate with clinical severity measures and inflammation parameters diminishing the prognostic biomarker value of NETosis factors. Moreover, the link between IL-8 and NETosis appears to be abolished in AIS

Leucine-Rich Glioma-Inactivated Protein 1 Antibody-Positive Polyradiculopathy Associated with Epstein-Barr Virus Infection

Epstein-Barr virus (EBV) has been associated with a plethora of neurological manifestations including polyneuropathy and polyradiculopathy. A 27-year-old man with a recent upper respiratory system infection presented with difficulty in walking. His neurological examination revealed reduced muscle strength in both proximal and distal lower limb muscles without sensory and autonomic signs. Needle electromyography showed abnormal spontaneous activity and reduced recruitment of motor units in muscles innervated by multiple lumbo-sacral roots. Cerebrospinal examination showed increased protein levels with normal cell counts. While spinal MRI was normal, whole-body CT and PET examination showed disseminated lymph node enlargement. Anti-EBV viral capsid antigen and anti-nuclear antigen IgG but not IgM was positive, whereas EBV PCR was negative in blood. Analysis of inguinal lymph node biopsy showed reactive lymphoid hyperplasia and EBV DNA. Leucine-rich glioma-inactivated protein 1 (LGI1) antibody was found in serum but not in CSF. All clinical, imaging, and electrophysiological findings improved following steroid and intravenous immunoglobulin treatment. These findings suggested the acute involvement of lumbo-sacral spinal roots and/or motor neurons. Purely motor polyradiculopathy has been reported in both EBV-positive and LGI1 antibody-positive patients, and EBV infection is known to precede different autoimmunemanifestations. Whether EBV infection may trigger LGI1 autoimmunity and cause involvement of spinal motor roots and/or motor neurons needs to be further studied

The status of the neurology education from resident’s perspective: a national survey in turkey

Objective: In Turkey, a national program is governed by National Board of Medical Specialties (BMS), Commision of Syllabus Creation and Standardization to improve and standardize residency training. In the present study, we aimed to assess neurology residency training programs and working conditions in Turkey based on a national survey among residents. Materials and Methods: All neurology residents were invited to complete a 39-question survey via e-mail, which contained a link to the online questionnaire form. Data on the residents' working conditions, education and research activities were collected. Results: Out of 450 neurology residents, 136 (30.2%) completed the survey. Hundred nineteen (88%) of these residents reported working >8 h per day and 116 (85%) reported they were on night duty >3 d per month. Overall, 82% of the residents were not satisfied with the educational program in their department. Half of the residents reported that their institution did not have a structured education program. Eventhough, 70% reported that they contributed to clinical or basic research conducted at their clinics only 35% of them noted that they received sufficient academic supervision. Finally, 126 (94%) of the residents reported that the pay-for-performance healthcare system negatively affected their training. Conclusion: The main reasons of dissatisfaction with neurology training in Turkey seem to be the insufficiency in educational programing, nonstandardized working hours and the pay-for-performance healthcare system. The present findings can help standardize and improve neurology training program founded by National Board of Medical Specialties (BMS)

Effects of robotic rehabilitation on recovery of hand functions in acute stroke: A preliminary randomized controlled study

Objective The aim of this study was to investigate the effects of EMG-driven robotic rehabilitation on hand motor functions and daily living activities of patients with acute ischemic stroke. Materials & Method A preliminary randomized-controlled, single-blind trial rectuited twenty-four patients with acute ischemic stroke ( .05 for all). Conclusion In this preliminary study, improvement in motor functions, daily living activities and force were found in both groups. However, addition of the EMG-driven robotic treatment to the neurophysiological rehabilitation program did not provide an additional benefit to the clinical outcomes in 3 weeks in acute stroke patients.Rehab Robotic Compan