Adli Belge İncelemesinde Yazıcı Krampının Değerlendirilmesi

El yazısı ve imzalar üzerinde, değişiklik yaratan, çok sayıda faktör bulunmaktadır. Bunlar arasında, yazının yazıldığı vücut pozisyonu, yazı yazılan yüzey, yazı enstrümanı, yazı yazan kişinin o anki ruhsal durumu, kullanılan ilaçlar, alkol, uyutucu-uyuşturucu-uyarıcı maddeler, fiziksel-ruhsal hastalıklar ve yaşlanma sayılabilir. Yazıcı krampı, el yazısı ve imzalar üzerinde, önemli derecede değişiklik yaratabilen bir hastalık olmakla birlikte, yazı incelemelerinde sıklıkla göz ardı edilebilen bir hastalıktır. Bu hastalık, fokal distoniler içerisinde, üst ekstremiteleri en sık olarak tutan distoni tipi olup, el yazısını süratli ve ciddi bir biçimde değiştirmektedir. Çalışmamızda, yazıcı krampı bulunan 38 hastanın, el yazısı örnekleri adli tıbbi yönden değerlendirilmiştir. Bu amaçla, ön tanıları yazıcı krampı ya da yazıcı krampı + yazıcı tre- moru olan hastalar incelenmiştir. İncelenen 38 hastanın 5' i kadın olup, yaşları 24 ile 80 arasında değişmektedir. Hastaların, ortalama hastalık süreleri, 3.3 yıl olarak belirlenmiştir. Yapılan yazı incelemelerinde 20 hastanın, yazmaya normal başladığı, ancak birkaç cümle yazdıktan sonra yazının bozulduğu, 18 hastanın yazısının ise, yazmaya başlandığı ilk andan itibaren bozuk olduğu ve yazdıkça daha da bozulduğu, 6 hastanın yazısının ise püeril karekterde bulunduğu tespit edilmiştir. Sonuç olarak, ele geçen bulgular, adli belge incelemesinin genel prensipleri yönünden değerlendirilmiş ve bu tip hastalıklarda, hatalı sonuçlara varılmasının önlenmesi yönünden yapılabilecekler ışığında tartışılmıştır. Anahtar Kelimeler: Yazıcı krampı, adli belge incelemesi, adli tıp, el yazıs

Comparisons of Akathisia and Restless Legs Syndrome: An Electrophysiologic Study

Objective: There are clinical similarities between akathisia and restless legs syndrome (RLS). Thus, we aimed to investigate the functional changes of the brainstem and its rostral connections in akathisia in comparison with RLS. Materials and Methods: Seven patients with akathisia were included in the study. We also included a group of patients with RLS (n=14), and a control group was formed including healthy volunteers (n=39). Blink reflex (BR), auditory startle reflex (ASR), and somatosensory startle (SSS) reflexes were studied in all participants. Onset latency, probability of response, amplitude, pattern and duration of responses were compared between the 3 groups. Results: Mean onset latencies of bilateral R2 and R2c were longer in the akathisia group compared with patients with RLS and healthy individuals. The mean latencies of responses after auditory stimulation were similar among the groups. The total ASR probability was higher in the akathisia and RLS groups compared with healthy subjects and this difference showed borderline significance (p=0.047). Duration of responses after auditory stimulation was longer in the akathisia group. Presence and latency of SSS were similar among the three groups. Conclusion: Longer-onset latencies and the higher probability of ASR in the akathisia group suggest that there is a hypodopaminergic state in this group. On the other hand, the longer latencies of R2-BR in patients akathisia suggest a delayed transmission in its pathway, indirectly showing involvement of serotoninergic pathways in the absence of a structural lesion. Thus, in akathisia, there are findings suggestive of serotoninergic involvement, differing from RLS, whereas findings attributed to dopaminergic deficits were quite similar to patients with RLS

Posterior Auricular Muscle Response: Observations in Brainstem Lesions

Objective: Posterior auricular muscle response (PAMR) is a myogenic potential recorded over PAM after auditory stimulation. Its circuit is formed by cochlear and facial nerves with the generator in the brainstem. Here, we investigated whether the addition of a PAMR examination would add additional use in determining or localizing isolated brainstem lesions given that the importance of blink reflex (BR) in determining or localizing brainstem lesions is known. Our hypothesis was that examination of both reflexes would increase clinical utility. Materials and Methods: We included 34 patients with isolated brainstem lesions (multiple sclerosis, ischemic stroke and cerebellopontine angle schwannoma) and 41 healthy subjects. PAMRs were recorded over the PAM after auditory stimulation. BR was elicited by the electrical stimulation of the supraorbital nerve. Results: PAMR was present in 82.9% of healthy subjects, whereas the presence was quite low in the patient group (38.2%, p=0.001). The mean latency of PAMR was delayed in patients compared with healthy subjects (p=0.001). BR was obtained in all healthy subjects, whereas prolonged latencies or absence of BR was observed in the patient group. There were no differences according to the different etiologies or localization. Conclusion: Although the presence of PAMR is quite high, its absence does not always indicate a pathology. However, prolonged latencies almost always suggest an involvement of the PAMR pathway. Likewise, absent PAMR with an abnormal BR provides information for the involvement of brainstem facial nucleus or the proximal part of the facial nerve