Acute transverse myelitis at the conus medullaris level after rabies vaccination in a patient with Behçet's disease

Case report: A 25-year-old man with Behçet's disease was admitted because of weakness of the lower limbs and difficulty in urination. He had received a rabies vaccination 2 months previous because he had been bitten by a dog. Findings: Clinical and laboratory findings supported acute transverse myelitis. A hyperintense lesion and expansion at the level of conus medullaris was detected on spinal magnetic resonance imaging. Conclusion: Although neurologic involvement is one of the main causes of mortality and morbidity in Behçet's disease, the factors that aggravate the involvement of the nervous system are still unclear. Vaccination may have been the factor that had activated autoimmune mechanisms in this case. To our knowledge, involvement of the conus medullaris in Behçet's disease after rabies vaccination has not been reported.Indications:For prevention of rabies in a patient who was bitten by a dog. Coexisting diseases: Behcet's disease, relapsing aphthous stomatitis and genital ulcerations.Patients:One 25-year-old male patient.TypeofStudy:A case report describing acute transverse myelitis at the conus medullaris level after Rabipur vaccination in a patient with Behcet's disease.AdverseEffects:1 patient developed acute transverse myelitis at the conus medullaris characterized by weakness of lower limbs, urinary retention, severe backache, difficulty with urination and defecation, hypoesthesia below the level of L1, absence of lower extremities vibratory and position senses, absence of deep tendon reflexes in the lower extremities, detrusor atony, and atrophy and fasciculations of the left leg muscles.AuthorsConclusions:Involvement of the conus medullaris in Behcet's disease after rabies vaccination has not been reported previously in the literature. The possibility of an activating factor (eg, vaccination) other than infection has never been mentioned in Neuro-Behcet syndrome. Understanding the activating factors may be helpful for the prevention of neurological involvement and is important for planning follow up and understanding the prognosis. Further reports and investigations are needed.FreeText:Tests: cerebrospinal fluid (CSF) leukocyte and protein level; muscle strength using Medical Research Council grade scoring; spine magnetic resonance imaging (MRI); vibratory and position senses; and deep tendon reflexes. The active substance of the rabies vaccine was an inactivated rabies virus.Results:Two months after the administration of the rabies vaccine, the patient experienced weakness of lower limbs which was preceded by severe backache for 12 hours and urinary retention. The weakness progressively worsened, and he began experiencing difficulty with urination and defecation. Muscle strength score was 2/5 at proximal left lower limb, 1/5 at distal left lower limb, 3/-5 at proximal right lower limb, and 1/5 at distal right lower limb. Atrophy and fasciculations of the left leg muscles were noted. There was hypoesthesia below the level of lumbar 1 (L1), and lower extremities demonstrated absence of vibratory and position senses. Absence of deep tendon reflexes was noted in the lower extremities, and plantar responses were extensor bilaterally. CSF examination revealed 110 leukocytes/mm3 with no microorganisms and elevated protein level (114 mg/dL). Spine MRI showed hyperintense lesion and expansion at the level of the conus medullaris. The patient was treated with methylprednisolone, azathioprine, and physiotherapy. He also required intermittent catheterization for urinary retention. After a year, a complete resolution of symptoms was observed and spinal MRI became normal.DosageDuration:Dosage not stated; given on the day of the bite and on the 3rd and 7th days thereafter

Clinical and electrooculografical finding in patient with essential tremor

Çalışmamızda, Esansiyel tremor (ET) hastalarında göz hareketlerini elektrookülografi (EOG) ile kayıtlamak, patoloji saptanırsa; ET patofizyolojisinde özellikle son çalışmalarda üzerinde durulan serebellar disfonksiyon başta olmak üzere, beyin sapı, talamus ile yolaklarındaki disfonksiyonunun, bu yolaklardaki disfonksiyon sonucunda ortaya çıkabilen göz bulguları ile karşılaştırmak amaçlandı. Ocak 2008 ve Ekim 2008 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesi Nöroloji polikliniğine başvuran 36 ET'li hasta ile benzer cinsiyet ve yaşta 36 sağlıklı katılımcı çalışmaya alındı. Tüm katılımcıların EOG testlerinden sakkadik test, yavaş takip (trekking) testi, optokinetik test, gaze testi ve pozisyonel testti yapılarak öykü ve muayene bulgularıyla birlikte değerlendirildi. ET'li hasta ile kontrol grubu arasında, EOG testlerinde anlamlı bir farklılık saptanmadı. Bu durumda ET nin patogenesisinde öne sürülen serebellar hipotezi destekler veri elde edemediğimiz söylenebilir ancak bu durum hipotezi reddettirmez. Oküler bulgu çıkartmayacak düzeyde bir patoloji sözkonusu olabilir.The aims of the study were to record ocular movements of Essential tremor (ET) patients using electrooculography (EOG) and; if there are any pathological results, to compare them with the ocular manifestations of the recently investigated causes of ET such as brainstem, thalamus disfunction and especially cerebellar disfunction. Thirty six ET patients admitted to Pamukkale University Neurology department between January 2008 and October 2008 were recruited for the study and 36 healthy, age and sex matched subjects formed the control group. Saccadic, tracking, optokinetic, gaze and positional test results were obtained from the EOG tests of the each subject and evaluated together with the history and examination findings. There was not any significant difference between the ET patients and controls. Those results may not lead us to support cerebellar hypothesis in the pathogenesis of ET. On the other hand they can not discard the hypothesis

Two Case Report With Bilateral Thalamic Infarct

Bilateral thalamic infarction is a rare clinical condition. Thalamo-perforan arteries are arise from the same vascular territory in nearly one third of the cases and oclussion of it causes bilateral infacts. Clinical presentation can be altered mental status, decrease alertness, memory problems, mood disorders, cognitive problems and vertical gaze palsy. In this report we present two cases with different clinical status

Spontan Recanalization of Internal Carotis Artery Occlusion: A Case Report

There is not too much literature knowledge about spontaneous recanalization of the internal carotid artery (ICA) occlusions following and treatment. Here we presented a case who could have the opportunity of carotid artery stending treatment, where it is incidentally revealed that the occlusion of ICA is recanalized. The purpose of this case report is to emphasize the importance of ICA spontaneous recanalization

Association between cholesterols, homocysteine and silent brain infarcts

Background The aim of this study was to assess the relationship between total plasma homocysteine, cholesterol levels, vitamin B12, folate, thyroid hormones, urea, ferritin, uric acid, C-reactive protein, cardiovascular risk factors and silent brain infarct (SBI) in patients without any neurological disorder. Whether the factors of interest were associated with SBI is investigated. Methods One hundred and forty-two subjects with a mean age of 52.1 ± 13.1 years (21-87 years) without any history of stroke, transient ischaemic attack and neurological abnormality were enrolled in this cross-sectional study. The subjects underwent brain magnetic resonance imaging and blood chemistry determinations. Student's t-test was used to compare differences in means of laboratory results between the groups with and without SBI. The χ2-test was used for categorized variables. Multiple logistic regression analysis was used to determine the independent predictors of SBI. Results The group comprised 56 men and 86 women. SBI were found in 40 patients (28%). The low-density lipoprotein levels were significantly higher in the infarct group (P = 0.019), homocysteine concentrations were significantly higher in the men-infarct group (P = 0,029) and total cholesterol levels were significantly higher in the women-infarct group than the women non-infarct group (P = 0.006). Conclusion Serum low-density lipoprotein, total cholesterol and homocysteine levels were associated with SBI. © 2009 The Authors Journal compilation © 2009 Royal Australasian College of Physicians

Predictors of Symptomatic Hemorrhage After Endovascular Treatment for Anterior Circulation Occlusions: Turkish Endovascular Stroke Registry

We evaluated the predictive factors of symptomatic intracranial hemorrhage (SICH) in endovascular treatment of stroke. We included 975 ischemic stroke patients with anterior circulation occlusion. Patients that had hemorrhage and an increase of >= 4 points in their National Institutes of Health Stroke Scale (NIHSS) after the treatment were considered as SICH. The mean age of patients was 65.2 +/- 13.1 years and 469 (48.1%) were women. The median NIHSS was 16 (13-18) and Alberta Stroke Program Early CT 9 (8-10). In 420 patients (43.1%), modified Rankin Scale was favorable (0-2) and mortality was observed in 234 (24%) patients at the end of the third month. Patients with high diastolic blood pressure (P<.05) had significantly higher SICH. SICH was significantly higher in those with high NIHSS scores (P<.001), high blood glucose (P<.001), and leukocyte count at admission (P<.05). Diabetes mellitus (DM) (OR 1.90; P<.001), NIHSS (OR 1.07; P<.05), adjuvant intra-arterial thrombolytic therapy (IA-rtPA) (OR, 1.60; P<.05), and puncture-recanalization time (OR 1.01; P<.05) were independent factors of SICH. Higher baseline NIHSS score, longer procedure time, multiple thrombectomy maneuvers, administration of IA-rtPA, and the history of DM are independent predictors of SICH in anterior circulation occlusion

Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF

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