Pituitary macroadenoma manifesting as an isolated third nerve palsy [İzole okulomotor paralizi ile prezente olan hipofiz makroadenomu]

Visual field defects, is the most common presenting sign of pituitary tumors. Acute painful third nerve palsy with pupillary involvement is a well known presenting symptom of a posterior communicating artery aneurysm. Oculomotor palsy with pupillary involvement is a relatively uncommon initial sign of a pituitary adenoma. This report describes a patient who presented with isolated oculomotor palsy with pupillary involvement which on neuroimaging was found to be due to a pituitary macroadenoma with cavernous sinus invasion. We suggest that differential diagnosis of painful oculomotor palsy must also include pituitary adenomas which rarely present with isolated third nerve palsy

POEMS syndrome: Case report [POEMS sendromu: Olgu sunumu]

Presented with characteristic polyneuropathy and multisystemic manifestations, POEMS syndrome is a rare plasma cell disorder. Vascular endothelial growth factor, secreted by plasmacytoma, is considered responsible for these symptoms. The first symptoms in this patient were arthralgia, distal sensory impairment ascending proximally and motor impairment of distal lower extremities. By immunoelectrophoresis, M protein in serum and urine was detected. In addition to polyneuropathy and monoclonal gammopathy, the patient presented with organomegaly, endocrine dysfunction and skin changes, and was diagnosed as POEMS syndrome. This rare syndrome should be included in the differential diagnosis of acquired neuropathies associated with multisystemic manifestations

Valproate-induced encephalopathy in three cases [Valproik Aside Bagli{dotless} Üç Ensefalopati Olgusu]

Valproic acid-induced encephalopathy is a serious complication of valproate, rarely observed, and can lead to death if early diagnosis is not made. It is clinically presented as mental status changes that range from drowsiness to lethargy and coma, focal or bilateral neurological deficits, seizure, vomiting, and marked electroencephalography (EEG) background slowing, with or without hyperammonemia. It can also be properly managed by discontinuation of the drug. We present three cases who developed vomiting, disturbance in consciousness, EEG-slowing, and elevated serum ammonia levels. In all cases, symptoms resolved after termination of valproate. Most notably, these side effects occurred in the presence of normal liver enzymes and normal valproate concentrations. Development of unconsciousness and associated EEG slow waves are observed rarely in VPA-induced encephalopathy, and this is discussed together with a review of the literature. Serum ammonia level is an important parameter in the early diagnosis of this rare adverse event. The clinical symptomatology and EEG findings have significant importance in the differential diagnosis when encephalopathy occurs without hyperammonemia and with normal or slight increase in serum ammonia level