Bal Arısı Sokması Sonrası Beyin Sapında Gelişen Akut İskemik İnme

Arı sokmaları, tüm böcek sokmaları içerisinde en sık olanıdır. Nörolojik etkilenme nadirdir. Ancak ensefalit, akut dissemine ensefalomiyelit, polinöropati ve ekstrapiramidal tutulum ortaya çıkabilmektedir. 79 yaşında erkek hasta sol hemiparezi ve dizartri yakınması ile başvurdu. 1 gün önce 10 tane bal arısı tarafından sokulduğu öğrenildi. Sol kol ve bacakta 4/5 kas gücü, ataksik yürüme ve dizartri bulunmaktaydı. Difüzyon ağırlıklı manyetik rezonans görüntülemede sağ ponsta akut iskemi ile uyumlu lezyon belirlendi. Asetilsalisilik asit 300 mg/gün vemetformin 1000 mg/gün başlandı. Arı sokması sonrası salgılanan kimyasal moleküller ile tromboza eğilim artmaktadır. Bu nedenle iskemik inme riski olan hastalar yakın takip edilmelidir. Gerekirse hastalar bu moleküllerin inaktivasyonunu sağlayan ilaçlar ile tedavi edilmelidir. Ancak hipotansiyon ve vazokonstriksiyon oluşturabilen antialerjik ilaçlar başlanmamalıdı

COVID-19 Pandemic and Neurocognitive Process: New Scenarios for Understanding and Treatment

COVID-19 disease was defined as a disease of primary respiratory system. However, symptoms associated with central nervous system were detected in approximately 2/3 of the hospitalized patients. The rate of ischemic cerebrovascular diseases is higher in central nervous system. In addition, hemorrhagic cerebrovascular diseases, encephalitis and/or encephalopathy are the other diseases. Complex pathogenesis was demonstrated in the central nervous system diseases associated with SARS-CoV-2. It was reported that SARS-CoV-2 virus could directly invade the central nervous system, especially via the olfactory nerves or the haematological pathway. As a result, endothelial cells, pericytes and/or neurons can be infected (direct pathway). Another mechanism is central nervous system deficit resulting from peripheral immune reactivation (indirect pathway). All these etiopathogenetic results support that COVID-19 disease is associated with cognitive dysfunction. Cerebral hypoperfusion associated with vascular endothelial structures is the main factor in the etiopathogenesis. It was reported that COVID-19 disease induced amyloid-β (Aβ) and α-synuclein phosphorylation. Besides, it was detected that this process was associated with tau and TDP-43 pathology. “Cognitive COVID-19” is a term that describes acute and long-term cognitive changes in people infected with SARS-CoV-2. Encephalopathy, delirium and cognitive disorders are most frequently detected. In this chapter, the clinical and etiopathogenetic processes of cognitive dysfunction after COVID-19 disease were evaluated. In addition, the disease, disease process and treatment were evaluated in general

Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Pramipexole

One of the most common causes of hyponatremia is inappropriate antidiuretic hormone release syndrome (SIADH). Serotonin reuptake inhibitors, tricyclic antidepressants, carbamazepine, amantadine and cytotoxic drugs can cause of hyponatremia as a result of SIADH. Pramipexole is a non-ergot dopamine agonist. It is frequently used for treatment of Parkinson disease and restless legs syndrome. Pramipexole-associated SIADH are rare in Parkinson disease. Also, pathogenetic mechanisms are uncertain. In our case, SIADH associated with pramipexole was presented in Parkinson disease. Clinical symptoms and hyponatremia occurred 12 days after the drug dose increase. Serum sodium level and clinical complaints returned to normal with drug dose reduction. SIADH-related hyponatremia occurs especially within the first 2-3 weeks after pramipexole treatment. Therefore, patients treated with pramipexole should be monitored more frequently for hyponatremia in the first weeks and dose increase

Evaluation of Epilepsy Knowledge, Epileptic Concern and Sleep Quality in Patients with Epilepsy

INTRODUCTION: About fifty million people have epilepsy in the world. This disease leads to concerns about occupational, social and marital in patients and their relatives. In addition, sleep disorders are more common in epileptic patients than normal. Disease-related concern and sleep disoder can affect negative the prognosis of disease. So, it is important to evaluate concern and sleep disorder. METHODS: Primary epilepsy patients were included between the ages of 18 and 85 who applied to the neurology clinic in 2016-2017. Demographic and clinical characteristics of the patients were evaluated. Epilepsy knowledge questionnaire and consisting of 16 questions, epilepsy concern scale consisting of 20 questions and Pittsburgh sleep quality tests were made. The results were evaluated with SPSS Windows 16 version. RESULTS: 49 (%48) female and 53 (%52) male patients included. The mean age was 31,86+-11,04. There were epileptic disease for 12,11+-12 years. 1,82+-1,02 different epilepsy medications were used. There were 2,06+-1,04 seizures in the last month. Epilepsy knowledge questionnaire was 10,56+-3,24; concern scale was 61,28+-6,82 and sleep quality test was 8,22+-3,27. Not relationship was found between disease-related concern and sleep quality (r: 0,12; p: 0,04). A low relation was found between the knowledge about the disease and concern (r: 0,35; p: 0,09). There was stronger relationship between seizure frequency and sleep disorder (r: 0,47; p: 0,04). DISCUSSION AND CONCLUSION: Patients had moderate knowledge but high level concern about epilepsy. Most of them had sleep disorder. So, disease-related concern and sleep disorder should also be evaluated during follow-up and treatment of patients

Sporadic Creutzfeldt-Jakob Disease in the Differential Diagnosis of Psychiatric Disorders: Two Case Reports

Creutzfeldt-Jakob disease (CJD) is a prion disease manifesting with signs of impaired conscious and mental state, cerebellar ataxia, myoclonus, and loss of vision. Since the disease progresses rapidly to death, it is important to distinguish it from other diseases. The exact diagnosis is made by postmortem histopathological analysis of the brain. The diagnosis of CJD is difficult because the clinical presentation varies between cases. In this paper, we present two cases of CJD. The first case was a 50-year-old male who was admitted with agitation, impaired consciousness and involuntary movements for three months. The second case was a 70-year-old male presented with forgetfulness, total loss of vision in the form of conversion disorder and ataxia. Diagnostic support was provided by magnetic resonance imaging (MRI) and electroencephalography (EEG). Increased cerebrospinal fluid concentration of 14.3.3 protein was determined. As a result, prion disease was considered in these cases due to rapid progression of the neuropsychiatric symptoms. Repeated EEG and MRI are useful for diagnosis in these patients. Although there is not effective treatment, diagnosis of the condition is very important in terms of preventive measures

The Relationship Between Structural Measurements of the Corpus Callosum and Disability in Patients with Multiple Sclerosis

Abstract Purpose: The corpus callosum (CC) is the largest commissural pathway connecting both cerebral cortices. Materials and Methods: Forty MS patients and 40 healthy controls were included in this research, which was planned as a prospective and case-control study. Disability was evaluated with the expanded disability rating scale. The number of attacks, disease duration, and MS disease subtype were determined. CC genu, truncus, splenium, and anterior-posterior diameters were measured in brain magnetic resonance imaging TSE/T1 sagittal sequence, and the corpus callosum index (CCI) was calculated using these measurements. The relationship of all these parameters with each other was examined. Results: There were 40 patients (29 females, 11 males) with a mean age of 36.47±11.14 years in the study. In the CC morphometric measurements of the patients, the genu (mean±SD) was 11.46±1.60, truncus (median, min-max) 5.29 (4.6-6.52), splenium 11.09±1.82, anterior-posterior diameter 65.20 (63.64-67.22) and CCI was determined as 0.43±0.05 millimeters. The anterior-posterior diameter was smaller in MS patients (p=0.022). A negative correlation was determined between CCI and disease duration, the number of attacks, and EDSS scores in MS patients (p<0.05; r=-0.319; r=-0.316; r=-0.349; respectively). In the severe disability group, CC splenium, AP diameter, and CCI were lower (p=0.007; p=0.020; p=0.046; respectively). Conclusion: In MS disease, the CC structure is affected, as in many central nervous system regions. The study results revealed that changes in the corpus callosum could be examined as a parameter in evaluating the disease process in MS patients. Keywords: Multiple sclerosis; corpus callosum; morphometry; disability

The impact of the COVID-19 lockdown on the quality of life in chronic neurological diseases: the results of a COVQoL-CND study

Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson's disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. Methods: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. Results: The mean age of a total of 577 patients was 49 +/- 17 (19-87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 +/- 11, 39 +/- 12, 38 +/- 10, 47 +/- 17, 61 +/- 12, and 60 +/- 15 years, respectively. The IES-R scores were found to be higher in the younger group, those with comorbid disease, contacted with CO-VID-19 patients, or diagnosed with COVID-19. In the group with a high IES-R score, the rate of DIT was found to be high. IES-R scores were negatively correlated with QoL. IES-R total scores were found highest in the CVD group and lowest in the PD group. The ratio of DIT was found highest in the PNP group and the lowest in the EP group. Contact with CO-VID-19 patients was high in the EP and HA group. Conclusions: The results of the COVQoL-CND study showed that lockdown causes posttraumatic stress and deterioration in the QoL in CND

Gerilim Tipi Baş Ağrısı Olan Hastalarda Uyku Bozuklukları, Depresyon ve İlişkili Faktörlerin Değerlendirilmesi

Amaç: Gerilim tipi baş ağrısı (GTB) etiyolojisinde uyku bozukluğu önemlidir. Ağrı, uykunun birçok safhasına etki ederek uyku kalitesini bozmaktadır. Ayrıca, psikojenik etmenler de uyku kalitesini etkilemektedir. Bu nedenle GTB de uyku kalitesi, depresyon ve gündüz uykululuk durumu incelenmiştir. Gereç ve Yöntem: Çalışmaya 50 GTB hastası ve 40 kontrol alındı. Ağrı sıklığı, süresi, şiddeti, analjezik miktarı ve tedaviye cevap sorgulandı. Ağrı şiddeti için Görsel Ağrı Skalası (VAS) kullanıldı. Hastalarda yaş, cinsiyet, medeni durum, yaşam ortamı, sigara ve alkol kullanımı, eğitim, maddi durum, kilo ve boy değerlendirildi. Pittsburgh Uyku Kalitesi İndeksi (PUKİ), Beck Depresyon Ölçeği (BDÖ) ve Epworth Uykululuk Ölçeği (EUÖ) uygulandı. PUKİ 0-5, 6-10 ve 10 üzeri olarak 3 gruba ayrıldı. Veriler SPSS Windows 16 sürümü ile değerlendirildi. Bulgular: Çalışmada 50 (42 kadın, 8 erkek) hasta vardı. Ortalama±SD sonuçlar: yaş 37,92±14,18; boy 162,2±7,91; kilo 69,96±15,2; PUKİ 12,26±6,05; BDÖ 31,12±15,43 ve EUÖ 9,34±4,80 idi. Uyku süresi, latansı ve bozukluğu, ilaç sayısı ve PUKİ hastalarda daha yüksekti (p<0,01). Uyku kalitesi, gündüz uykululuğu, BDÖ ve EUÖ puanları benzerdi (p>0,05). Hastaların sosyodemografik özellikleri, ağrı şiddeti, analjezik kullanımı ile uyku bozukluğu arasında ilişki yoktu (p>0,05). BDÖ ile uyku bozukluğu ve gündüz uykululuk durumu arasında pozitif korelasyon vardı (p<0,05; r=0,57; 0,52). Sonuç: GTB hastalarında uyku bozukluğu daha fazladır. Depresif durum arttıkça uyku bozukluğu ve gündüz uykululuğu artmaktadır. Bu nedenle bu hastalarda uyku bozukluğu ve depresyonun da sorgulanması önemlidir

Evaluation of Concealment of Illness and Sleep Disorder in Epilepsy

Objectives:The social stigma associated with epilepsy can be a major cause of concealment of illness. This behavior is associated with many neuropsychiatric disorders. Sleep is an important factor affecting epilepsy and seizures. The aim of this study was to evaluate concealment of illness, sleep disorders, and related factors in epilepsy.Methods:A total of 95 primary epilepsy patients who were referred to the neurology outpatient clinic were included in the study. The demographic and clinical characteristics of the patients were recorded. Concealment of illness was measured using a scale consisting of 17 questions, and the Pittsburgh Sleep Quality Index (PSQI), consisting of 24 questions, was also administered to assess sleep disorders.Results:There were 44 (46.3%) female and 51 (53.7%) male epilepsy patients in the study. The mean concealment score was 57.09±8.96 and the mean PSQI score was 8.12±3.09. Sleep latency was significantly prolonged, and sleep efficiency and daytime functions were impaired. Indications of a sleep disorder were greater in young people (p<0.05; r=0.50). There was a negative correlation between age and concealment of illness (p<0.05; r=0.65) and a positive correlation between concealment of illness and a sleep disorder (p<0.05; r=0.54).Conclusion: The concealment of illness had a negative effects on sleep quality in patients with epilepsy. Concealment and sleep disorders increased as age decreased; therefore, it is especially important to evaluate young epilepsy patients carefully

Morphometric Measurements of Corpus Callosum and Blood Parameters in Epilepsy Patients Treated with Monotherapy

Objectives:Corpus callosum (CC) is the largest commissural pathway that connects cerebral hemispheres. Structural changes have been reported in epilepsy. Therefore, in this study, the relationship between CC structure and blood parameters was evaluated in patients with epilepsy treated with monotherapy.Methods:In this study, 50 primary epilepsy patients treated with monotherapy and 40 healthy controls were included. Age, sex, antiepileptic drugs, duration of disease, type and frequency of seizures were questioned. Genu, truncus, splenium and anterior-posterior diameter of CC were measured in the TSE/T1 sagittal sequence of brain magnetic resonance imaging. The relationship between blood parameters, antiepileptic treatment and disease characteristics were evaluated.Results:Fifty patients (26 females, 24 males) were included in this study. The mean age was 34.46±13.02 years. Morphometric measurements of CC were genu was 11.12±1.69, truncus was 6.09±1.17, splenium was 10.39±1.93 and anterior-posterior was 69.08±5.19 millimeter (mm). Anterior-posterior diameter was smaller in patients with epilepsy (p=0.04). Female patients with epilepsy had smaller genu diameter (p=0.01). Splenium diameter was smaller in patients with longer disease duration (p=0.04). There was no difference between antiepileptic drug use and morphometric measurements (p>0.05). Urea and creatinine levels were higher in patients with epilepsy (p=0.00, 0.00). Vitamin D and ferritin levels were lower (p=0.01, 0.01). There was no correlation between blood values and morphometric measurements (p>0.05, r<0.25).Conclusion:Anterior-posterior diameter of CC is smaller in epilepsy. Especially in female patients, genu diameter is smaller. Splenium diameter is smaller in patients with a long duration of epilepsy. There is no correlation between blood parameters and CC diameters