Transient Gyral Enhancement After Epileptic Seizure in a Patient with CREST Syndrome

WOS: 000419248500012Limited scleroderma, also termed CREST syndrome (calcinosis cutis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia), is a form of scleroderma which is an autoimmune connective tissue disease. Neurological involvement is less common than other system involvements in scleroderma. Epileptic seizure is a rare neurological complication. Gyral enhancement is not an expected finding during disease. Gyral enhancement is contrast enhancement of superficial brain parenchyma and it usually occurs as a result of vascular, inflammatory, infectious and neoplastic processes. A-sixty-seven-year old female patient, who was diagnosed as CREST syndrome for three years was admitted to our hospital. She had an epileptic seizure three days ago and behavioral changes after the seizure. There was not epilepsy diagnosis in her medical history. In neurological examination; she was apathic and deep tendon reflexes were hyperactive, Hoffman's and Babinski reflexes were positive on the right side of her body. In laboratory studies; anti-nuclear antibody was positive at 1/1000 and anti-centromere antibody was positive. On contrast-enhanced cranial magnetic resonance imaging (MRI); gyral enhancement was observed in the left parieto-occipital region. Cerebrospinal fluid tests were within normal limits. Electroencephalography demonstrated diffuse cerebral dysfunction. We administrated antiepileptic drug to the patient during hospitalization. On the follow up, apathy and restriction of the cooperation were improved. Epileptic seizure did not recur. After ten days, in the control cranial MRI, gyral enhancement was reduced significantly. Neurological involvement in CREST syndrome is rare and epileptic seizures have been appeared in a limited number in the literature. Inflammatory and vascular processes can cause gyral enhancement, but also it must be kept in mind that gyral enhancement can be observed transiently after epileptic seizure

Original Article - T2-weighted MRI in Parkinson’s disease; Substantia nigra pars compacta hypointensity correlates with the clinical scores

Background: Iron accumulation in substantia nigra pars compacta (SNpc) and related intensity and volumetric changes in patients with idiopathic Parkinson’s disease (PD) has been reported previously. There are only a few studies evaluating the relation between neuroradiological findings and clinical scores, with contradictory results. Aims: In this study we aimed to measure the iron-rich brain areas of PD patients and healthy subjects with T2-weighted magnetic resonance imaging (MRI) and to evaluate the relation between the clinical scores of PD patients and these imaging results. Methods and Materials: T2-weighted MRI findings were studied in 20 patients with PD and 16 healthy controls. The width of SNpc, putamen volume, and the intensity of the basal ganglia were measured. Unified Parkinson’s Disease Rating Scale (UPDRS) was used for evaluating the clinical status. Statistical Analyses: Mann Whitney U test for group comparisons, Wilcoxon sign rank test for comparisons within the patient group, and Spearman’s rank correlation coefficient for analyses of correlations were used. Results: Mean SNpc and dentate nucleus intensities were lower in PD patients than healthy subjects. Mean SNpc width and putamen volumes were lower in patients. Decrease in the intensity of mean SNpc correlated with high UPDRS and rigidity scores. Conclusion: The results of our study reflect the increase in iron accumulation and oxidative stress in the SNpc in Parkinson’s disease. The decrease in the intensity of SNpc correlates with poor clinical scores

FREQUENCY AND TYPES OF HEADACHES IN PATIENTS WITH METABOLIC SYNDROME

WOS: 000384632700005PubMed: 29638097Background - Metabolic Syndrome (MetS) and headaches are common public health problems in whole world. The relationship between headaches and the MetS isn't understood clearly. Purpose - The aim of this study is to determine the prevalence and types of headaches, and evaluate the relationship between headache characteristics and clinical and laboratory parameters analyzed in patients diagnosed with MetS. Materials and methods Of the patients diagnosed with MetS in Endocrinology outpatient clinics between July 2011 and July 2012, 202 patients were included in the study. Hemoglobin, fasting blood glucose (FBG), total cholesterol, triglyceride, HDL and LDL cholesterol, thyroid function tests and HbA(1C) values of all patients were recorded. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all patients. The headache severity was assessed by Visual Analog Scale (VAS). Results - The prevalence of headache in patients with MetS was found to be 61.4%. The incidence of headache was higher in female patients (F: 86.4%, M: 13.6%). The distribution of the subtypes of headaches was as follows: Episodic Tension-TypeHeadaches (ETTH) 24.8%, Episodic Migraine 14.4%, Chronic Tension Type Headaches (CTTH) 11.3%, Episodic Tension-TypeHeadaches (ETTH) and Episodic Migraine 7.9%, and other types of headaches (Cervicogenic Headache and Cluster Headache) 3%. No statistically significant relationship was found between headache and non-headache groups in terms of body mass index, waist circumference, and the laboratory-parameters (p>0.05). The mean BDI and BAI scores were higher in the headache group (p<0.001 and p<0.001). No significant difference was found between the mean MIDAS scores in the subtypes of headaches (p=0.35). In the headache group, there was a significant relationship only between triglyceride levels and attack frequency, duration and severity. Conclusion - Prevalence of headache in patients with MetS was 61.4%. The incidence of subtypes of headaches was similar to those in the general population. A relationship was found between triglyceride levels and attack frequency and severity. The result may be important to draw attention to the evaluation of triglyceride levels for reducing the frequency and severity of attacks in patients with headaches

Peripheral nervous system involvement in patients with Behcet disease

WOS: 000248132400010PubMed: 17622917Background: Central nervous system involvement in Behcet disease (BD) has been well documented, but studies evaluating peripheral nervous system involvement are relatively uncommon. Objective: The aim of this study is to evaluate the frequency and characteristics of peripheral nervous system involvement in BD. Methods: Sixty-nine BD patients (36 women, 33 men) followed by neurology and dermatology outpatient clinics between October 1999 and October 2004 were enrolled into study. A careful history was taken and physical and neurologic examinations were done. All other medical causes that may be related to peripheral nervous system involvement were studied. All patients underwent nerve conduction studies using standard electrophysiologic procedures. Results: Peripheral nervous system involvement was detected in 13 patients. There was no sign and symptom related to peripheral nervous system involvement in these patients. Causes other than BD were found in 5 patients with polyneuropathy. Asymptomatic delay in conduction velocities of the median nerves was detected in 3 patients. In 5 patients with clinically evident peripheral nerve involvement due to BD, 3 had sensorimotor and 2 had sensory axonal neuropathies. Conclusion: Axonal type polyneuropathy may be seen in BD patients. Peripheral involvement may be detected by electrophysiological examinations in asymptomatic BD patients