Patients’ misperception regarding the difficulty of lumbar puncture

Aim: Lumbar puncture (LP) is a crucial method of diagnosis and treatment of neurological diseases. Despite its importance, the patients' refusal of the procedure leads to difficulties in diagnosis and treatment. One of the main reasons for patients’ refusal may be that LP is perceived to be more difficult than it actually is. Our aim was to investigate whether the patients had prejudices against the difficulty of LP treatment. Methods: Sixty-seven patients aged between 20 and 80 years were included in to the study. Immediately prior to the procedure, each patient was asked to rate the difficulty level of the operation with the Visual Analog Scale (VAS) as 0 very easy to 10 very difficult. The cause of the LP, pre-diagnosis, education status, age and sex, presence of complications and the title of the physician performing the LP were recorded. Results: A total of 20 patients refused the procedure (29.3%).  Of the 47 patients, who had the procedure performed, 21 were female and 26 were male. Twenty-seven LP were performed by first-year assistant and 21 were performed by second-year assistant. Patients' mean VAS scores before the LP were 7.9 ± 2.0 and were 4.1 ± 2.9 after the LP. Post-procedure VAS scores were significantly lower than pre-procedural VAS scores (p <0.001). The mean value of the VAS scores of the patients, whose LPs were performed by 1st year assistant, was 5.6±3.2 and the mean value of the VAS scores of the patients, whose LPs were performed by 2nd year assistant, was 3±2.2. There was a significant difference between two patient groups (p=0.004). Conclusions: The patient perception of the lumbar puncture is perceived to be worse than it actually is. Therefore, it is very important to provide sufficient information to the patients about the LP and to inform them about the necessity of the procedure

Five-year experience of neurosyphilis cases in a tertiary care hospital in Turkey

Aim: To evaluate retrospectively the cases of syphilis who applied to different clinics of our hospital in the last 5 years and to emphasize the importance of admission screening tests in the diagnosis of neurosyphilis which is a rare but serious form of syphilis. Methods: Sixty-one patients who admitted to different clinics of our hospital between 2013 and 2017 with different clinical manifestations and positive Venereal Disease Research Laboratory (VDRL) and Treponema pallidum microhemagglutination assay (TPHA) tests were recorded and analyzed retrospectively. Results: Both VDRL and TPHA tests were positive in 44 males with a mean age of 57.4 ± 18.4 years and 17 females with a mean age of 65.3 ± 19.1 years. It was found that of the 61 patients who were examined for differential diagnosis of syphilis, 36 (%59) of them were referred from neurology clinic, 15 (25%) from infectious diseases clinic, 7 (12%) from dermatology clinic and 3 (4%) from gynecology clinic.   The clinical presentation was venereal chancre in 15 cases, asymptomatic ischemic brain lesions in 17 cases, acute ischemic stroke in 13 cases, movement disorder in three cases, tabes dorsalis in two cases, tendinitis-arthritis in eight cases, Amyotrophic lateral sclerosis (ALS) in one case, Deep venous thrombosis (DVT) in one case, and pulmonary nodule in one case.  Conclusions: In conclusion, syphilis is often overlooked in the differential diagnosis in patient with neurological findings. Since neurosyphilis is an easily treatable disease, it should be considered in the differential diagnosis of patients presenting with neurological findings

EFFICACY OF INTRAVENOUS TIROFIBAN THERAPY IN LACUNAR STROKE PATIENTS

Background:  Lacunar ischemic infarcts are small-sized infarcts that develop as a result of occlusion of perforating arteries. Although its pathophysiology differs from other stroke types, there is no separate treatment option from non-cardioembolic strokes. Early neurological worsening in lacunar strokes is a common condition reported up to 41%. There is no effective treatment method to prevent or correct progression. Tirofiban is a reversible receptor antagonist of glycoprotein IIb/IIIa. There are cohort studies with small number of cases related to its use in ischemic stroke. We wanted to evaluate its effectiveness on the progression of lacunar stroke because it is a powerful antiplatelet agent. Objective: Tirofiban is a reversible receptor antagonist of glycoprotein IIb/IIIa. There are cohort studies with small number of cases related to its use in ischemic stroke. We wanted to evaluate its effectiveness on the progression of lacunar stroke because it is a powerful antiplatelet agent. Methods: The data of patients who were followed up in our clinic with the diagnosis of lacunar stroke between August 2020 and May 2022 and who received tirofiban treatment were evaluated retrospectively. Patients' ages, infarct localizations, NIHSS scores at admission, at the beginning and end of tirofiban treatment, and 3rd month mRS scores were recorded. Results: Fifteen patients, 11 male and 4 female, were included in the study. The mean age of the patients was 68.73±9.58 (range, 51-85). Tirofiban was started proactively in 2 patients, after progression in 13 patients. The NIHSS scores were 7.20±2.65 at the start of the infusion, and 4.80±3.93 after the infusion, and the decrease was statistically significant (P=0.010). Conclusion: These findings suggest that intravenous tirofiban therapy is a safe and effective treatment option to stop symptomatic fluctuations and shorten the duration of deficit in patients with progressive lacunar stroke

An old approach to a novel problem: effect of combined balance therapy on virtual reality induced motion sickness: a randomized, placebo controlled, double-blinded study

Abstract Background The objective of this study was to investigate the impact of a rehabilitation program aimed at addressing vestibular and proprioceptive deficits, which are believed to underlie the pathophysiology of motion sickness. Methods A total of 121 medical students with motion sickness participated in this study and were randomly divided into intervention (n = 60) and placebo control (n = 61) groups. The intervention group underwent combined balance, proprioception, and vestibular training three times a week for 4 weeks, while the control group received placebo training. The study assessed various measurements, including the Virtual reality sickness questionnaire (VRSQ), tolerance duration, enjoyment level measured by VAS, stability levels using Biodex, and balance with the Flamingo balance test (FBT). All measurements were conducted both at baseline and 4 weeks later. Results There was no significant difference in pre-test scores between the intervention and control groups, suggesting a similar baseline in both groups (p > 0.05). The results showed a significant improvement in VRSQ, tolerance duration, VAS, Biodex, and FBT scores in the intervention group (p < 0.05). While, the control group showed a significant increase only in VAS scores after 4 weeks of training (p < 0.05). A statistically significant improvement was found between the groups for VRSQ (p < 0.001), tolerance duration (p < 0.001), VAS (p < 0.001), Biodex (p = 0.015), and FBT scores (p < 0.05), in favor of the intervention group. Conclusions A combined balance training program for motion sickness proves to be effective in reducing motion sickness symptoms, enhancing user enjoyment, and extending the usage duration of virtual reality devices while improving balance and stability. In contrast, placebo training did not alter motion sickness levels. These findings offer valuable insights for expanding the usage of virtual reality, making it accessible to a broader population

Optical coherence tomography findings in Parkinson's disease

The aim of this study is to compare optical coherence tomography (OCT) findings of retinal thickness (RT) and retinal nerve fiber layer thickness (RNFLT) of idiopathic Parkinson's disease (IPD) patients to those of healthy subjects, and to investigate whether there is any relationship between the severity of the disease and the RNFLT values. This prospective study was included 25 IPD patients and 29 healthy controls. In the IPD group, the Hoehn and Yahr (H&Y), Unified Parkinson's Disease Rating Scale (UPDRS), and Mini-Mental State Exam (MMSE) were performed. Intraocular pressure (IOP), visual acuity (VA), spherical equivalent, axial length (AL), and central corneal thickness (CCT) were measured using OCT in both groups. The RT was measured in the central retinal (RTc), nasal (RTn), and temporal (RTt) segments. Nasal (RNFLTn), nasal superior (RNFLTns), nasal inferior (RNFLTni), temporal (RNFLTt), temporal superior (RNFLTts), and temporal inferior (RNFLTti) measurements were made and mean RTFLT was calculated (RNFLTg) for each individual. In the patient group, IOP and VA values were statistically significantly lower The RTn and RNFLTg were significantly thinner in the patient group. There was no statistically significant relationship between the severity of IPD and these findings. In our study, RNFLTg and RTn were found to be thinner in the IPD group, which may have caused lower VA scores. The effects of retinal dopamine depletion on RT and RNFLT, and lower IOP values in the non-glaucomatous IPD patients should be further investigated