Small fiber neuropathy associated with hyperlipidemia: utility of cutaneous silent periods and autonomic tests

Background. Established electrophysiological methods have limited clinical utility in the diagnosis of small fiber neuropathy.Thecutaneous silent period (CSP) may be useful as a method for the evaluation of smaller and unmyelinated fiber dysfunctions.Hyperlipidemia is a very rare cause of small fiber neuropathy. In this study, hyperlipidemia and small fiber neuropathy insymptomatic patients with normal nerve conduction studies were evaluated with autonomic tests and cutaneous silent periods.Methods. Twenty-five patients with clinically suspected small fiber neuropathy and 23 healthy volunteerswere included. CSP latencyand duration, as well as CSP latency difference of the upper and lower extremities, were examined. Two tests were used to assess theautonomic nervous system, namely, the R-R interval variation test in basal and profound breath conditions and the sympatheticskin response. Results. Twenty-five patients with clinically suspected small fiber neuropathy and normal nerve conduction studieswere compared with 23 controls. In the upper extremities, patients had prolonged CSP latencies (?? = 0.034) and shortened CSPdurations (?? = 0.039), whereas in the lower extremities, patients had shortened CSP durations (?? = 0.001). The expiration-toinspirationratios were also reduced in patients groups. There was no significant difference between sympathetic skin responselatencies and amplitude of the case and control groups. Conclusion. Our findings indicate that CSP may become a useful techniquefor the assessment of small fiber neuropathy in hyperlipidemic patients

The management of neurological disease during the COVID-19 pandemia

In this current pandemic period, neurological disorders are the most devastating disease group among all disease groups considered which created the highest health burden for patients, their relatives, and healthcare workers which keeps increasing with aging world population. COVID-19 directly invades lungs, it also involves the nervous system. However, it is too early to know whether COVID-19 will have long-term impacts on patients with neurologic disease. The COVID-19 pandemic has changed people’s daily routines, and it all happened in a short period. Neurologists are affected negatively by the COVID-19 pandemic in a few key ways, including: a reduced ability on admission or transfer of critically ill neurologic patients. During these exceptional times,a huge need arose for neurologists in the frontline and expected to be aware of and conscious for diagnosing neurological complications of COVID-19. In this process, the use of telemedicine (teleneurology) in the field of neurology is a significant approach to evaluate patients. Telemedicine has been used as a platform for rehabilitation,neurological examinations,neuropsychologyand other specialty services. Management of neurological diseases such as Parkinson disease, multiple sclerosis, intracranial infections, epilepsy, dementia, headache, neuromuscular diseases, and stroke had been affected in this process. In this review article, the main goal is to discuss how the diagnosis, proper management of people with existing neurological disease during pandemia period

An unusual case of subclinical peripheral neuropathy and cervical spondylosis in atopic myelitis

Many cases of atopic myelitis have been reported in Japan; however very few were described in western countries. An 82-yearold woman with a past medical history of atopic dermatitis and asthma presented with progressive paresthesia (tingling) of both hands and tetraparesis. Before the onset of neurological symptoms, she complained of ichthyosis of both legs for 5 weeks.Magnetic resonance imaging demonstratedmultisegmental degenerative arthritis, degenerative disc disease, and abnormal spinal cord signal intensity over several cervical segments, suggesting the diagnosis of myelitis. Total serum IgE level was elevated. Nerve conduction studies revealed asymmetric axonal sensorimotor neuropathy. The cerebrospinal fluid specimen showed lymphocytic pleocytosis and elevated protein level. Based on clinical, imaging, and laboratory findings, atopic myelitis was diagnosed. The diagnosis of atopic myelitis should be considered in myelopathy patients with history of atopy and elevated serum IgE levels

Epilepsi tanısıyla takip edilen hastada atrioventriküler blok

[No Abstract Available

Ovarian reserve assesment in patients withmultiple sclerosis

Annual Meeting of the American-Society-for-Reproductive-Medicine (ASRM 2010)American Society for Reproductive Medicin

Latencies to first interictal epileptiform discharges in different seizure types during video-EEG monitoring

Purpose: Interictal epileptiform discharges (IEDs) have high diagnostic value concerning patients with epilepsy and the instances of obtaining IEDs increase with longer recording times. However, the merit of a single, extended electroencephalography (EEG) recording in detecting IEDs has not been substantiated. We aimed to determine the optimal duration of an EEG required to diagnose epilepsy in different seizure types. Methods: Overall, 84 patients—29 with generalised onset epilepsy and 55 with focal onset epilepsy—were evaluated. Long-term video electroencephalographic monitoring (VEM) was analysed to find the first definite IED besides assessing the first seizure and latency. Results: The median latency of the first IED (12 min, ranging from 1 to 440 min vs. 55 min, ranging from 2 to 7500 min; p= 0.014) and the median duration of a VEM recording (2 d, ranging from 1 to 10 d vs. 3 d, ranging from 1 to 10 d; p= 0.012) were found significantly lower in the generalised epilepsy group compared with that in the focal epilepsy group. Conclusions: Generalised onset epilepsy showed a significantly shorter latency to IED and VEM duration compared with focal onset epilepsy. In our data set, all the patients with generalised onset epilepsy had interictal IED within 10 h, but the patients with focal onset epilepsy required monitoring for three days to obtain IED

Karpal tünel sendromunun klinik şiddetiyle elektrofizyolojik bulgular değişiyor mu?

Amaç: Klinik olarak orta ve şiddetli karpal tünel sendromu (KTS) olan gruplar arasındaki elektrofizyolojik (EMG) farklılıkları değerlendirmek. Hastalar ve Metod: KTS’si olan 226 hastada retrospektif olarak 385 el EMG çalışmaları ile değerlendirildi. Italyan KTS çalışma grubunun modifiye edilen kriterlerine gore klinik tutulumları orta ve şiddetli olarak ikiye ayrıldı. Sinir iletim çalışmaları da yine aynı grubun modifiye edilmiş kriterlerine gore orta ve şiddetli olarak klasifiye edildi. Iğne EMG bulguları da analiz edildi. Bulgular: Klinik ve elektrofizyolojik evreleme arasında iyi koralasyon saptandı (p 0.01). Klinik olarak orta ve şiddetli gruplar arasında nörofizyolojik tutulumun şiddeti arasında önemli fark izlenmedi (p0.07). Bununla birlikte iğne EMG anormalliği (p0.01) ve uzamış median F dalga latansı (p0.01) klinik olarak şiddetli grupta anlamlıydı. Ulnar sinir duyu iletim anormallikleri sadece orta derecede etkilenmiş grupta izlendi. Sonuçlar: Bu sonuçlar göstermektedir ki elektrofizyolojik değerlendirme patolojiyi yansıtan oldukça duyarlı yöntem olup klinik tutulumun şiddetinden bağımsızdır.Aims: To assess the electromyographic (EMG) differences between groups with clinically mild and severe carpal tunnel syndrome (CTS) Patients and Methods: The charts of 226 CTS patients were retrospectively reviewed and a total of 385 hands that underwent EMG studies were identified. These hands were assigned to mild and severe groups according to the severity of the clinical involvement, as defined by the modified criteria of the Italian CTS study group. Nerve conduction studies in these hands were also classified as mild and severe according to the modified criteria of the same group. Needle EMG findings were also analysed. Results: A good correlation between the clinical and electrophysiological staging of the CTS was demonstrated (p<0.01). The severity of the neurophysiological involvement showed no significant change between the clinically mild and severely affected groups (p0.07). However, needle EMG abnormalities (p<0.01) and prolonged median nerve F-wave latencies (p<0.01) were more commonly encountered among the hands showing a severe clinical involvement. Ulnar sensory nerve conduction abnormalities were only observed in the mildly affected group. Conclusion: These results indicate that the electrophysiological investigation, being a highly sensitive procedure, reflects the pathology, independent of the severity of the clinical involvement

Acute bilateral paramedian thalamic and mesencephalic infarcts due to occlusion of the Percheron artery: a case report

The thalamus and midbrain mesencephalon have a complex blood supply with a great number of feedingarteries. The blood build up of thalamus is being provided by four arteries originating from the vertebrobasilarsystem and posterior communicating artery. The paramedian thalamic artery is derived from the posteriorcerebral artery proximal P1 segment. The infarcts of arterial constitute approximately 35% of all thalamicinfarcts. However, bilateral infarctions of this region are very infrequent. Percheron artery originates from thefirst branch of the posterior cerebral artery and gives bilateral medial thalamic perforating branches. Wedescribed a patient of a 88-year-old woman with acute bilateral thalamic and midbrain infarcts due to occlusionof Percheron artery demonstrated on magnetic resonance imaging

Benign tremulous Parkinson's disease

Objective : To analyze the long-term outcomes of patients presenting with pure parkinsonian tremor and to determine whether or not such patients develop the other features of Parkinson's disease (PD) eventually. Methods and materials : Two hundred fifty-one patients with PD followed at our referral center were examined regularly. In this study, we evaluated the long-term follow lip of the the patients with parkinsonian tremor without bradykinesia or rigidity. Results : The mean disease duration was 5 Years, (range : 2-10 yrs.) at the last follow-up visit. This final group included 7 female and 16 male patients with a mean age of 66.6 +/- 10.8 years. Four groups of patients were identified. First group consisted of 15 patients presenting with rest tremor most prominently in one upper limb and/or contra-lateral upper limb. In the second group, there were 3 patients who had parkinsonian tremor with greatest severity in one lower limb and ipsilateral upper limb. Group 3 comprised 2 patients who had parkinsonian tremor in only one lower limb. The fourth group comprised 3 patients with isolated jaw tremor. Conclusions : Some patients with pure parkinsonian tremor may remain without bradykinesia or rigidity for a long time, which may be considered a benign form of, Parkinson's disease

Comparing short-term memory, working memory and executive functions among patients with relapsing remitting multiple sclerosis and healthy individuals

Objective: The intrinsic connectivity networks mostly affected in Alzheimer’s disease (AD) are the default mode (DMN) and salience networks (SN). The capacity of the functional connectivity (FC) changes in these networks in differentiating subjective cognitive impairment (SCI), earliest stage of cognitive decline along the AD continuum, from objectively diagnosed mild cognitive impairment (MCI) is not yet shown. Therefore, we investigated FC changes in DMN and SN among SCI, MCI and AD dementia (ADD) groups. Methods: Resting-state fMRI data of 88 participants (21 ADD, 34 MCI, 33 SCI) were collected with 3T MRI scanner. FC of 11 regions of interest (ROI) corresponding to DMN and SN nodes were analysed using CONN-toolbox (https://web.conn-toolbox.org/). Cluster level significance threshold in the F test among the 3 groups was set at p(FWE-corr) <0.0045 (Bonferroni corrected according to number of ROIs). For ROIs with significant difference in the F test, t-tests were performed between pairs of groups, and results with p(FWE-corr) <0.017 were reported. Results: In ADD compared to both MCI and SCI, FC of posterior cingulate cortex node of DMN with temporal and occipital cortices, FC of anterior cingulate cortex (ACC) node of SN with right insula and temporal cortices and FC of right and left anterior insula nodes of SN with ACC significantly decreased. Additionally, for ADD vs MCI comparison, FC of left anterior insula node of SN with the right insula, and for ADD vs SCI comparison, FC of the right and left anterior insula nodes of SN with the supplementary motor area were reduced. Conclusion: The findings reveal that the FC changes of DMN and SN in AD continuum occur in the advanced stages of the disease with no distinctive change between SCI and MCI stages