Acute median nerve palsy due to hemorrhaged schwannoma: case report

Schwannomas are common, benign nerve tumors originating from the sheath of peripheral nerves. In this article, a 54 year old woman suffered from sudden onset motor and sensory deficit at her first radial three fingers on her right hand. Radiological investigations were normal. Electromyography diagnosed a median nerve entrapment neuropathy and urgent surgery was performed. Interestingly, a hemorrhaged mass was detected in the median nevre at the proximal end of the carpal ligament and was resected totally. Histopathological diagnosis was Schwannoma. The patient maintained a healthy status for five years

COVID-19 Hastalarında Myalji Sıklığı ve Kreatin Kinaz Düzeyleri ile İlişkisi

Aim: Many studies have showed that myalgia is a common onset symptom in coronavirus disease 2019 (COVID-19). This study aimed to determine the frequency of muscle pain in patients followed with COVID-19 diagnosis, and to investigate the relationship between muscle pain and creatine kinase (CK), pH, lactate and lactate dehydrogenase (LDH) levels. Material and Methods: One hundred ten patients diagnosed with COVID-19 in our hospital were included retrospectively in this study. Presence of myalgia at the time of admission and on the 14th day of control were investigated. The first admission laboratory findings, 3rd day CK values and 14th day control CK values of all patients were recorded retrospectively from their files. Results: The study included 110 patients diagnosed with COVID-19. Fifty patients (45.5%) had muscle pain at the time of admission, and it was one of the most common musculoskeletal complaints. High CK results were obtained in 48 (43.6%) of the 110 patients at the time of admission. Thirty-two (66.7%) of 48 patients with high CK had muscle pain (p<0.001). In the patients with muscle pain, the CK levels observed on 1 st, 3rd, and 14th day of the disease were found to be significantly higher than in those without muscle pain (p<0.001, p=0.003, p=0.029). No significant relationship was found between complaints of muscle pain and lactate, pH, and LDH values. Conclusion: Since some patients may only present with musculoskeletal symptoms such as myalgia, it is important that clinicians consider COVID-19 in patients presenting with myalgia and high CK levels.Amaç: Birçok çalışma miyaljinin koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19)’da sık görülen bir başlangıç semptomu olduğunu göstermiştir. Bu çalışmada COVID-19 tanısıyla takip edilen hastalarda kas ağrısı sıklığının belirlenmesi ve kas ağrısı ile kreatin kinaz (creatine kinase, CK), pH, laktat ve laktat dehidrogenaz (LDH) düzeyleri arasındaki ilişkisinin araştırılması amaçlandı. Gereç ve Yöntemler: Bu çalışmaya hastanemizde COVID-19 tanısı almış olan 110 hasta geriye dönük olarak dahil edildi. Başvuru sırasında ve 14. gün kontrolde miyalji yakınması olup olmadığı incelendi. Tüm hastaların ilk başvurudaki laboratuvar bulguları, 3. gün CK değerleri ve 14. gün kontrolündeki CK değerleri dosyalarından geriye dönük olarak kaydedildi. Bulgular: COVID-19 tanısı almış 110 hasta çalışmaya alındı. Elli hastada (%45,5) başvuru anında kas ağrısı vardı ve en sık görülen kas iskelet sistemi şikâyetlerinden biriydi. Yüz on hastanın 48'inde (%43,6) başvuru anında CK yüksekliği saptandı. CK yüksekliği saptanan 48 hastanın 32'sinde (%66,7) kas ağrısı vardı (p<0,001). Kas ağrısı olan hastalarda 1., 3. ve 14. günde bakılan CK düzeyleri kas ağrısı şikayeti olmayanlara göre anlamlı derecede yüksek bulundu (p<0,001; p=0,003; p=0,029). Kas ağrısı yakınması ile laktat, pH ve LDH değerleri arasında anlamlı ilişki bulunmadı. Sonuç: Başvuru sırasında yalnızca miyalji gibi kas iskelet sistem semptomları bulunan hastalar olabileceğinden, miyalji ile başvuran ve CK yüksekliği saptanan hastalarda COVID-19’un akılda tutulması önem arz etmektedir

Sakarya İli SARS-CoV-2 Olgularında İnme Sıklığının Araştırılması

Aim: The aim of this study is to identify the frequency of stroke among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cases in Sakarya city, to find out the clinical characteristics of patients diagnosed with stroke and to contribute to the national database. Material and Methods: This retrospective study was carried out with 783 cases diagnosed with SARS-CoV-2 between April-June 2020 at the pandemic hospital in Sakarya city. Patients were compared in terms of age, National Institute of Health Stroke Scale (NIHSS), risk factors, radiological findings, inpatient treatment, intubation, and mortality rates. Results: Out of 26 cases of ischemic stroke, 11 (42.3%) were male and 15 (57.7%) were female. In terms of infarction localization, the cause was medial cerebral artery (MCA) in 4 (15.4%) patients, top of the basilar in 2 (7.7%) patients, basilar artery in 1 (3.8%) patient, lacunar in 9 (34.6%) patients and anterior system in 10 (38.5%) patients. There was no significant difference in terms of D-dimer and C-reactive protein (CRP) levels according to disease severity (both p=0.262). Three (0.38%) patients presented with stroke findings and were diagnosed with SARS-CoV-2. Cryptogenic stroke was detected in 8 (30.8%) of the SARS-CoV-2 cases. Stroke frequency was calculated as 3.3% among the SARS-CoV-2 cases in Sakarya city. Conclusion: This is the first study to identify the frequency of stroke among SARS-CoV-2 patients in Sakarya city and Turkey. Our study is important as it shows that preventing or treating ischemic stroke in SARS-CoV-2 cases contributes greatly to the reduction of mortality.Amaç: Bu çalışmanın amacı Sakarya ilindeki şiddetli akut solunum yolu sendromu koronavirüsü 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) olgularında inme sıklığını tespit etmek, inme tanısı almış olan hastaların klinik özelliklerini ortaya koyabilmek ve ulusal veri tabanına katkıda bulunmaktır. Gereç ve Yöntemler: Bu çalışma, Sakarya ilindeki pandemi hastanesinde Nisan-Haziran 2020 tarihleri arasında SARS-CoV-2 tanısı alan 783 olgu ile geriye dönük olarak yürütüldü. Hastalar, yaş, Ulusal Sağlık Enstitüleri İnme Skalası (National Institute of Health Stroke Scale, NIHSS), risk faktörleri, radyolojik bulgular, yatarak tedavi, entübe olma durumları ve mortalite oranları bakımından karşılaştırıldı. Bulgular: Yirmi altı iskemik inmeli olgunun 11 (%42,3)’i erkek ve 15 (%57,7)’i kadın idi. Enfarkt lokalizasyonu bakımından 26 hastanın 4 (%15,4)’ü orta serebral arter (medial cerebral artery, MCA), 2 (%7,7)’si baziller tepe, 1 (%3,8)’i baziller arter, 9 (%34,6)’u laküner, 10 (%38,5)’u arka sistemden kaynaklanmaktaydı. D-Dimer ve C-reaktif protein (C-reactive protein, CRP) düzeyleri bakımından hastalık şiddetine göre anlamlı bir farklılık yoktu (her iki p=0,262). Üç (%0,38) hasta inme bulgusuyla gelip SARS-CoV-2 tanısı almıştı. SARS-CoV-2 olgularının 8 (%30,8)’inde kriptojenik inme tespit edildi. Sakarya ilinde SARS-CoV-2 olgularında inme sıklığı %3,3 olarak hesaplandı. Sonuç: Bu çalışma SARS-CoV-2 hastalarında inme sıklığını tespit etmeye yönelik Sakarya ilinde ve Türkiye’de yapılmış ilk çalışmadır. Çalışmamız, SARS-CoV-2 olgularında iskemik inmenin önlenebilmesi ve tedavi edilebilmesinin mortalitenin azalmasına belirgin katkı sunduğunu göstermesi bakımından önemlidir

Phenotypic and Genotypic Analysis of Hereditary Ataxia Patients in Sakarya City, Turkey

Conclusion: Hereditary ataxias are rare neurodegenerative disorders. Large genetic pool, ethnic and local differences complicate diagnosing even further. Our study contributes to the literature by reflecting phenotypic and genotypic characteristics of hereditary SCA patients in our region and reporting rare hereditary ataxia genotypes

Sensitivities of conventional and new electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index

The purpose of this study is to evaluate prospectively the sensitivities of conventional and new electrophysiological techniques and to investigate their relationship with the body mass index (BMI) in a population of patients suspected of having carpal tunnel syndrome (CTS)

Demographic, Clinical and Electrophysiological Characteristics of the Hereditary Neuropathy Patients in Sakarya

Amaç Herediter nöropatiler; periferik sinir sisteminde, demyelinizasyon ve/veya akson kaybına yol açan, ilerleyici bir hastalık grubudur. Herediter nöropatiler genellikle aileselolmakla birlikte, sporadik olgular da nadiren görülebilir. Çalışmamızda Sakarya ilindeki herediter nöropatili olguların, demografik, klinik ve elektrofizyolojik özellikleriaraştırılmıştır. ( Sakarya Tıp Dergisi 2019, 9(1):120-124 )Gereç veYöntemBu çalışmaya, merkezimize 2011-2016 yılları arasında başvuran, herediter sensorimotor nöropati (HSMN) tanısı alan 26 hasta dahil edildi. Bu hastalara ait veriler; yaş,cinsiyet, hastalık başlangıç yaşı, başvuru yakınmaları, akraba evliliği, klinik ve elektrofizyolojik bulgular, ailesel ve genetik özellikler açısından retrospektif olarak incelendi.Bulgular Kliniğimizde takip edilen 26 hastanın 13’ü (%50) erkekti. Yaş ortalaması 41±12,29 iken hastalık bulgularının başlangıç yaş ortalaması 23,26±13,7 idi. Elektrofizyolojikincelemeler, 9 hastada aksonal, 12 hastada demiyelinizan ve 5 hastada mikst formda bir hasarı göstermekteydi. Genetik incelemelerde, 5 hastada heterezigot PMP 22delesyon ve 2 hastada PMP 22 duplikasyonu tespit edildi. Böylece, 5 hasta Charcot Marie Tooth (CMT)-1A, 2 hasta herediter basınca duyarlı polinöropati (HNPP) tanısıalırken, diğer 19 hasta ise tiplendirilemeyen herediter nöropati olarak değerlendirildi.Sonuç Son yıllarda moleküler biyoloji alanındaki yeni gelişmeler şimdiye kadar pek çok sınıflandırılamamış herediter nöropati tipinin tanınmasına yönelik önemli kazanımlarsağlamıştır. Çalışmamızda, Türkiye’de genotip değerlendirmesi yapılabilen demiyelinizan tip olguların Sakarya ilindeki fenotipik özellikleri değerlendirilmiş ve literatürle kıyaslanmıştır.Objective Hereditary neuropathies are a group of progressive disease that leads to demyelination and / or loss of axons in the peripheral nervous system. Although hereditary neuropathies frequently occurs in familial form, sporadic cases are rarely seen. In our study, demographic, clinical, and electrophysiological characteristics of hereditary neuropathy patients in Sakarya province were investigated. ( Sakarya Med J 2019, 9(1):120-124 ) Materials and Methods Totally 26 registered patients who were diagnosed as hereditary sensorimotor neuropathy (HSMN) between 2011 and 2016 were recruited for this study. The data of these patients were analyzed retrospectively in terms of age, gender, age at symptoms onset, referral complaints, consanguineous marriage, clinical and electrophysiological findings, familial and genetic features. Results Of the 26 patients followed up in our clinic, 13 (50%) were male. The mean age of the patients was 41±12,29, while the mean age of the symptoms onset was 23,26±13,7. Electrophysiological examinations showed axonal neuropathy in 9, demyelinating neuropathy in 12, and mixed neuropathy in 5 cases. Genetic studies revealed heterozygous PMP 22 deletion in 5 cases and PMP 22 duplication in 2 cases. Therefore, 5 cases were diagnosed as Charcot Marie Tooth (CMT)-1A, 2 cases were diagnosed as hereditary pressure sensitive polyneuropathy (HNPP), while other 19 cases were evaluated as unclassified hereditary neuropathy. Conclusion Recent advances in the field of molecular biology have provided significant development in recognition of many unclassified types of hereditary neuropathies. In our study, the phenotypic characteristics of demyelinating type cases which can be genotyped in Turkey of Sakarya province was evaluated and compared with the literature.

The Frequency of Fabry Disease in Acute Stroke Patients with Renal Insufficiency in Sakarya Province

Aim: This study aimed to investigate the frequency, clinical and genetic characteristics, and therapeutic options associated with Fabry disease (FD) in individuals with acute stroke and concomitant renal insufficiency. Material and Methods: An FD screening was performed on adult patients with renal dysfunction who were admitted to the neurology clinic due to acute stroke between 2015 and 2021. Screening was performed by a leukocyte α-galactosidase A (α-Gal A) enzyme activity assay using dried blood spot (DBS) samples from male patients. In cases where the enzyme activity was less than 2.5 nmol/ml/h, genetic analysis was performed. Female patients underwent direct genetic analysis. Results: Renal dysfunction was detected in 39 ischemic stroke patients and 5 hemorrhagic stroke patients out of a total of 401 cases. The enzyme level was found low in only one of the male patients. The c.680G>A (p.R227Q) mutation was observed in this male patient and a female patient. In the later stages of the study, it was realized with the help of pedigree analysis that these two cases were first-degree relatives. The same mutation was also detected in 13 first-degree and 2 second-degree relatives. The frequency of FD in our study group, which included patients with cerebral and renal involvement regardless of consanguinity, was 4.54%. Conclusion: Rapid detection of FD cases can be achieved by screening individuals presenting with multiple end-organ damages. To the best of our knowledge, this study highlights the underemphasized association between renal involvement and stroke in FD

Role of carotid body for neuronal protection in experimental subarachnoid haemorrhage

Objective: Carotid bodies are known as main arterialchemoregulatory units. Despite well known that carotidbodies have an important role in cerebral circulation andblood pH regulation, their roles has not been investigatedin subarachnoid haemorrhage. We investigated whetherthere is neuroprotective effect of neuron density of carotidbodies on the brain in subarachnoid haemorrhage.Methods: Twenty hybrid rabbits were studied. Four ofthem were used as reference group (n=4) and the remainingwas obliged to subarachnoid haemorrhage by injectingautologous blood into their cisterna magna (n=16)and sacrificed after one month. All carotid bodies andbrains examined histopathologically using by stereologicmethods. The relationship between the neuronal densityof carotid body and degenerated neuron density of thehippocampus were compared statistically.Results: Five rabbits with subarachnoid haemorrhagedead during the follow-up time (n=5). The average neuronaldensity of carotid body was 4500±500 cells/mm3and of hippocampus 170.000±17.000 cell/mm3 in normalrabbit family. The degenerated neuron density ofthe hippocampus was 20.000±3.000 cells/mm3 in rabbitswith have high neuron density of carotid body and was65.000±8.000 cells/mm3 in rabbits with low neuron densityof carotid body. The differences between the neuronaldensity of carotid body and the degenerated neuron numbersof the hippocampus were significant.Conclusion: The neuron density of carotid body mayplay an important role on the protection of brain in subarachnoidhaemorrhage.Key words: Subarachnoid haemorrhage, carotid body,hippocampus, neurodegeneration, cerebral ischemi

Autosomal Recessive Parkinson's Disease with Early-Onset in a Turkish Family

Parkinson disease is a progressive, neurodegenerative disease with an increasing incidence of age. It is thought that genetic factors in etiology may be the underlying cause together with environmental factors. Sporadic cases are seen in 85 %, familial forms in 10-15 %, and single gene inheritance in 5 %. In this article, we present a patient with early-onset Parkinson disease who had family history but negative genetic analyses. Genetic mutations of autosomal recessive early-onset parkinsonism are more frequently evaluated in clinical practice and are directed to be analyzed more frequently in a selected group of patients

Vascular mechanism of axonal degeneration in peripheral nerves in hemiplegic sides after cerebral hemorrhage: An experimental study

<p>Abstract</p> <p>Background</p> <p>Though retrograde neuronal death and vascular insufficiency have been well established in plegics following intracerebral hemorrhage, the effects of plegia on arterial nervorums of peripheral nerves have not been reported. In this study, the histopathological effects of the intracerebral hemorrhage on the dorsal root ganglions and sciatic nerves via affecting the arterial nervorums were investigated.</p> <p>Methods</p> <p>This study was conducted on 13 male hybrid rabbits. Three animals were taken as control group and did not undergo surgery. The remaining 10 subjects were anesthetized and were injected with 0.50 ml of autologous blood into their right sensory-motor region. All rabbits were followed-up for two months and then sacrificed. Endothelial cell numbers and volume values were estimated a three dimensionally created standardized arterial nervorums model of lumbar 3. Neuron numbers of dorsal root ganglions, and axon numbers in the lumbar 3 nerve root and volume values of arterial nervorums were examined histopathologically. The results were analyzed by using a Mann-Whitney-U test.</p> <p>Results</p> <p>Left hemiplegia developed in 8 animals. On the hemiplegic side, degenerative vascular changes and volume reduction in the arterial nervorums of the sciatic nerves, neuronal injury in the dorsal root ganglions, and axonal injury in the lumbar 3 were detected. Statistical analyses showed a significant correlation between the normal or nonplegic sides and plegic sides in terms of the neurodegeneration in the dorsal root ganglions (p < 0.005), axonal degeneration in the lumbar 3 nerve roots (p < 0.005), endothelial cell degeneration in the arterial nervorums (p < 0.001), and volume reduction in the arterial nervorums (p < 0.001).</p> <p>Conclusion</p> <p>Intracerebral hemorrhage resulted in neurodegeneration in the dorsal root ganglion and axonolysis in the sciatic nerves, endothelial injury, and volume reduction of the arterial nervorums in the sciatic nerves. The interruption of the neural network connection in the walls of the arterial nervorums in the sciatic nerves may be responsible for circulation disorders of the arterial nervorums, and arterial nervorums degeneration could result in sciatic nerves injury.</p