Neurosarcoidosis: Report of a case with pituitary-hypothalamic involvement

Otuz sekiz yaşındaki bayan hasta başağrısı ve tüm vücutta yaygın kaşıntı şikayetleriyle kliniğimize başvurdu. Başağrısı etiyolojisine yönelik tetkikleri sırasında çekilen kraniyal manyetik rezonans görüntülemesinde hipotalamik şüpheli kitle lezyon görünümü ve leptomeningeal sarkoid odakları saptandı. Olguya klinik, laboratuvar bulguları ve radyolojik görüntüleri eşliğinde nörosarkoidoz tanısı konuldu. Hipotalamik kitle lezyonu görünümünde sarkoid odakları olan olgulara literatürde oldukça nadir rastlanmaktadır. Bu nedenle vasküler başağrısı etiyolojisine yönelik yapılan tetkikleri sırasında tesadüfi olarak saptadığımız, hipofiziyer-hipotalamik tutulumu olan, nadir görülen nörosarkoidoz olgusunu sunmayı ve sarkoidoz hastalığının tanı ile tedavi aşamalarını gözden geçirmeyi istedik.A 38-year-old female patient admitted to our clinics with headache and itching in whole body. In cranial magnetic resonance imaging performed for the investigation of headache, hypothalamic mass lesion and leptomeningeal sarcoid foci were detected. The diagnosis of neurosarcoidosis was made on the basis of clinical and laboratory findings and radiological imaging. Cases with sarcoid foci in the form of hypothalamic mass lesion are very rare in the medical literature. We, thus, aimed to present our very rare neurosarcoidosis case with pituitary-hypothalamic involvement, which we detected incidentally during the investigation of vascular headache and to review the diagnosis and treatment of sarcoidosis

A case of malignancy developing like cerebral vascular incident

Serebrovasküler hastalık kliniği olan olgularda malignite gibi kitle etkisi olan lezyonların ayırıcı tanısı için öncelikle bilgisayarlı beyin tomografisi çekilmesi gereklidir. Bilgisayarlı beyin tomografisi ile lezyon gösterilemez veya kuşkulu görünüm varsa manyetik rezonans görüntüleme yapılmalıdır. İnme kliniğiyle hastaneye yatırılan altmış dört yaşında erkek hastada ileri tetkikleri sonucunda evre IV skuamöz hücreli akciğer karsinomu tanısı kondu. Bu olgu sunumumuzla inme kliniğiyle acil servislere başvuran, ileri yaşta, risk faktörleri olan ve ilk değerlendirmelerinde kolaylıkla iskemik serebrovasküler olay tanısı alabilen hastaların, ayrıntılı olarak tetkik edildiklerinde inme kliniğinin altında yatan farklı patolojilerin de olabileceği gerçeğine dikkat çekmek istedik.In patients with clinical findings of cerebrovascular accident, computed tomography is initially necessary for the differential diagnosis of mass lesions such as malignancy. If the lesion cannot be demonstrated with computed tomography or if there is a suspicion, magnetic resonance imaging should be performed. The diagnosis of a stage IV squamous cell lung carcinoma was made with further investigation in a 64-year-old male patient who was hospitalized with stroke clinic. In this case report, we emphasize that various disorders may be the underlying pathology in elderly patients with risk factors who admit to the emergency room with the stroke clinics and may easily be diagnosed to have cerebrovascular incident at initial evaluation

The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey

Objective: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. Methods: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. Results: The mean age of 1358 patients was 35.92 ± 14.11 (range, 18–89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10–48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440–5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128–1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034–1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 – 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084–1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004–1.041]; p = 0.014), were determined as factors affecting quality of life. Significance: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy