İzole oküler semptomlarla başvuran hastaların tanısal değerlendirilmesinde tek lif elektromiyografisinin yeri

Amaç: Pitoz ve diplopi gibi oküler semptomlar acil servislere, oftalmoloji ve nöroloji kliniklerine sık başvuru nedeni olmaktadır. Bu olguların birçoğuna oküler miyasteni gravis (OMG) ön tanısı ile tek lif elektromiyografisi (TLEMG) istenmektedir. Bu çalışmada, oküler belirtilerle başvuran hastaların değerlendirilmesinde konsantrik iğne elektrodu (KİE) ile TLEMG incelemesinin klinik yararlılığını araştırmak amaçlanmıştır.Gereç ve yöntem: Son 3 yıl içerisinde izole oküler semptomlarla başvuran ve OMG ön tanısı ile KİE-TLEMG/jitter analizi için laboratuvarımıza yönlendirilen hastaların klinik ve elektrofizyolojik verileri retrospektif olarak incelendi. Bulgular: Toplam 122 (78 kadın, 44 erkek) hastanın %62,3’sinde izlemde miyasteni dışı nedenler saptandı. Yüzde 37,7’si OMG tanısı aldı. Pitoz ve diplopinin birlikte görülmesi, diurnal fluktuasyon ve alternan patern OMG grubunda anlamlı fazla görüldü (p<0,001). Frontalis kasından KİE-jitter analizinin OMG tanısında duyarlılığı %80,4, özgüllüğü %90,8, pozitif prediktif değeri %84,1ve negatif prediktif değeri %88,5 olarak hesaplandı. Sonuç: Bu çalışma, KİE-jitter analizinin OMG’deki tanısal yararlılığını literatürle uyumlu olarak doğrulamakla birlikte klinik pratikte OMG ön tanısının uygunsuz fazla konulduğuna ve TLEMG incelemesinin sıklıkla gereksiz istendiğine dikkati çekmektedir. --------------------Objective: Ptosis and diplopia are frequent presentation symptoms in the emergency rooms, ophthalmology and neurology clinics. Most of these cases are referred for single fiber electromyographic (SFEMG) to confirm or rule out ocular myasthenia gravis (OMG). The aim of this study is to investigate the clinical utility of SFEMG/jitter analysis with concentric needle electrode (CNE) in the assessment of patients with ocular symptoms and signs.Material and methods: The clinical and electrophysiological data of patients with isolated ocular symptoms, who were referred for CNE-jitter analysis to our laboratory for the last 3 years, were retrospectively reviewed.Results: A total of 122 cases (78 female, 44 male) were included in the study. In retrospective review of the follow-up charts, 62.3% of them were found to have non-myasthenic disorders. Only 37.7% of the patients had the final diagnosis of OMG. The presence of both ptosis and diplopia, diurnal fluctuation and alternating patern were likely to be indicative of OMG (p<0,001). CNE-jitter analysis in the frontalis muscle was found to have a sensitivity of 80.4%, specificity of 90.8%, positive predictive value of 84.1%, and negative predictive value of 88.5% in the diagnosis of OMG.Conclusion: This study confirms the favorable diagnostic accuracy of CNE-jitter analysis in OMG, in concordance with the literature. However, it draws attention to the overutilization of SFEMG and frequent misdiagnosis/overestimation of OMG in clinical practice

Postcoital Internal Carotid Artery Dissection Presenting as Isolated Painful Horner Syndrome: A Case Report

Postcoital artery dissection is a rare condition. Here we report a 40-year-old male patient with painful Horner syndrome related to postcoital internal carotid artery (ICA) dissection. In neurologic examination of the patient, semiptosis, enophthalmus, and myosis were observed on the left side. There were no carotid bruits. On T1-weighted and fat-suppressed cranial MRI, hyperintensity consistent with intramural hematoma was observed within cervical and temporal petrous segments of left ICA. On cervical and cranial MRA, marked decrease in the calibration of C1 and C2 segments of the left ICA was remarkable. The patient was diagnosed as left ICA dissection and anticoagulant therapy was initiated. A prominent improvement was noted in clinical findings during two months of followup period

Acute flaccid myelitis outbreak through 2016-2018: A multicenter experience from Turkey

Aim: We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis. Methods: The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed. Results: Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5–6.9 years). Most of the patients were admitted in 2018 (n = 27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3–7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n = 5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis. Conclusion: The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition