Sensitivities of conventional and new electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index

The purpose of this study is to evaluate prospectively the sensitivities of conventional and new electrophysiological techniques and to investigate their relationship with the body mass index (BMI) in a population of patients suspected of having carpal tunnel syndrome (CTS)

The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome

The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P < 0.01). At the end of follow-up period, the median sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment

Türkiye’de inme hastalarında atrial fibrilasyonun yönetimi: NöroTek çalışması gerçek hayat verileri

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.Amaç: Atrial fibrilasyon (AF) iskemik inmenin doğrudan önlenebilir en sık nedendir. Ülkemizde AF nedenli inme spektrumuna dair nöroloji kaynaklı geniş ölçekte bir veri bulunmamaktadır. NöroTek-Türkiye (TR) kapsamında akut inme algoritmalarının oluşturulmasına katkı yapması beklenen AF tespit edilen akut inme hastalarına dair hastane verisi toplanmıştır. Gereç ve Yöntem: 10 Mayıs 2018 Dünya İnme Farkındalık Günü’nde 30 sağlık bölgesine yer alan 87 nöroloji biriminde yatmakta olan 1.790 hasta prospektif olarak değerlendirilmiştir. Çalışmada yer alan toplam 929 hasta [859 akut iskemik inme, 70 geçici iskemik atak (GİA)] bu analize dahil edilmiştir. Bulgular: İskemik inme/GİA sebebiyle ile interne edilmiş hastalarda AF oranı %29,8 olup bunların %65’i bilinmekte olan, %5’i paroksismal ve %30’u yeni tanıdır. AF tanısı ile gelen hastalarda “etkin” tedavi [internasyonel normalizasyon oranı ≥2,0 varfarin veya rehber dozunda non-vitamin K antagonist oral antikoagülan (NOAK)] alanların oranı %25,3 olup, %42,5 olguda ya hiç ilaç kullanılmamakta ya da sadece antiplatelet kullanılmaktaydı. Düşük doz kullanım oranı 42 NOAK alırken inme geçirmiş olguda %50 idi. Taburcu edilirken antikoagülan %94,6 (düşük molekül ağırlıklı veya non-fraksiyone heparin %28,1; varfarin %32,5 ve NOAK %31) hastaya reçete edilmişti. NOAK ile taburcu edilen olguların %22’sinde doz düşük kategoride olup gelişte NOAK almakta olan olguların yarısı aynı ilaçla taburcu edilmiştir. Sonuç: NöroTekTR ülkemizde AF’nin akut inmedeki sıklığı yanı sıra sekonder proflaksi perspektifinde yönetiminin geliştirilebilecek yönlerini ortaya koydu. Türkiye’de hastanede yatan akut inme olgularının yaklaşık üçte birinde AF saptanmıştır. AF’si bilinen akut inme olgularının dörtte üçünde etkin antikoagülan tedavi kullanılmamaktaydı. AF’de inme sekonder proflaksisi kapsamında heparin, varfarin ve NOAK planlaması benzer sıklıkta (üçte bir) olup reçete edilen NOAK dozu dörtte bir olguda subterapötiktir. AF’ye bağlı inmenin önlenebilmesi non-medikal ve medikal eğitim gerekli görünmektedir

Audituar and visual evoked potentials in amateur boxers (BAEP, VEP)

Boks sporu ile uğraşanlarda tekrarlayıcı darbelerin kronik travmatik ansefalopatiye neden olabileceği bir çok araştırıcı tarafından bildirilmiştir. Kronik beyin zedelenmesinin hem kortikal, hemde subkortikal yapıları etkileyebileceği postmortem çalışmalarla gösterilmiştir. Boksörlerde beyin sapındaki duysal sistemler ve hemisferlerde çaprazlaşan nöral sistemlerin disfonksiyonunun anlaşılmasına yönelik çalışmalar sınırlı sayıdadır. Mevcut çalışmayla rastgele seçimle alınan amatör boksörlerdeki kronik travmatik ansefalopatinin klinik delilleri ve elektrofizyolojik yansıması araştırıldı. Çalışmaya alınan 52 olgunun yaş dağılımı 13-60 (ort:32.7±11.9) yıl arasında değişmekte olup 31'i aktif boksu bırakmış, 21 'i halen aktif olarak devam etmekteydi. Klinik nörolojik değerlendirmede 2 boksörde horizantal fiksasyonel nistagmus, 2'şinde göz kapalı yürümede güvensizlik, 1 'sinde psikotik reaksiyon, 3'ünde alkol alışkanlığı saptandı. %15.3 oranındaki izole bulgu ve semptomların nörolojik disfonksiyonun minör klinik göstergesi olduğu ve kronik travmatik ansefalopatiye işaret edebileceği düşünüldü. İzole muayene bozukluklarının tümünün aktif boksu bırakmış boksörlerde gözlenmesi ilginçtir. Bunların bir çoğu tahsil düzeyi düşük, şiddetli ve rastgele döğüşen boksörlerdir. Boks yaptıkları dönemde amatör boks kaidelerinin tam olarak uygulanmadığı vurgulanmalıdır. Aktif boksörlerden birisinde gözlenen psikiyatrik bozukluğun (% 1.9) boks yaptığı dönemde gelişmesi dolayısıyle bu spora bağlanabileceği sonucuna ulaşılmıştır. BAEP kayıtlamasıyla boksörlerin sol kulak 90 dB klik uyarımla elde olunan V. dalga latansının kontrollerle mukayesesinin anlamlı olduğu gözlendi. Bunun subkonküziv kafa darbelerinin kümülatif etkisiyle "inferior kollikulus"un etkilenmesinin elektrofizyolojik yansıması olabileceği düşünüldü. Diğer parametrelerde boksörlerle kontroller arasında istatistiki olarak önemli farklılık tespit edilemedi. Daha uzun latanslı VEP kayıtlamasıyla da istatistiksel olarak anlamlılık gözlenmedi. Bundan hareketle uyarılmış potansiyel kayıtlamalarının kronik travmatik ansefalopatiyi ortaya koymada yetersiz olduğu sonucuna ulaşıldı. Bununla birlikte boksörlerde uyarılmış potansiyellerle ilgili çalışmaların kısıtlı sayıdadır, daha fazla dökümante etmeye ihtiyaç vardır.AUDITUAR AND VISUAL EVOKED POTENTIALS IN AMATEUR BOXERS (BAEP, VEP) It has been reported by many researchers that repetitive impacts on boxers may cause chronic traumatic ancephelopathy. It has also been shown by post-mortem studies that chronic brain damage may affect both cortical and subcortical structures. There are limited number of studies on boxers that explain the dysfunction of the neural systems crossing hemispheres and sensorial systems placed on brain stem. The present study investigates the clinical evidences of the traumatological ancephalopathy and their electrophysological reflection on randomly chosen amateur boxers. Out of 52 objects with the age range of 16-60 (avg. 32.7+11.9), 31 have given up active boxing and 21 is currently active in boxing. On clinical evaluation of these objects, it's found that two has horizontal fixational nistagmus, two has insecurity in closed-eye walking, one has psychotic reaction and three has alcohol addiction. It has been thought that isolated findings and symptoms with a 15.3 % ratio are minor clinical indicators of neurological dysfunctions and may indicate chronic traumatic ancephelopathy. It is surprising to note that all of the isolated examination disorders have been observed on those who has given up active boxing. Most of these have low educational level and fight with much potent but random manner. It has to be recorded here that during the fighting period of these boxers, the rules of amateur boxing have not been applied. Physciatric disorder recorded on one of the active boxers (1.9 %) which developed during his boxing period may be due to this sport. The comparison of V.th wave latency obtained by 90 dB click evoke on the left ear of boxer on BAEP record with controls have been found to be meaningful. This is thought to be the electrophysiologic reflection of the cumulative effect of the subconcussive head traumas on the inferior colliculus. Statistically significant differences between boxers and controls could not have been obtained on other parameters. On VEP recordings with longer latency have also not shown any statistical importance. All these concluded that evoked potential recordings are not enough to recognise the chronic traumatic ancephalopathy, but the limited number of reported studies related to evoked potentials on boxers show that there is an intensive need to investigate these topics. 5

Diabetes mellitus presented by choreoathetoic involuntary movements as the first symptom: Case report

Koreoatetoz; kompleks, hiperkinetik, düzensiz, ani ve kısa süreli bir hareket bozukluğudur. Beraberinde bükülme şeklinde istemsiz hareketler de görülür. Herediter, immünolojik, metabolik, nörovasküler, enfeksiyona bağlı hastalıklar ve ilaç kullanımı bu duruma neden olabilmektedir. İleri yaşlarda özellikle vasküler hastalıklara bağlı olarak daha sık görülür. Metabolik nedenlere bağlı ise daha nadir görülür. Yetmiş üç yaşında erkek hasta, iki gündür sağ kolunu kontrol edememe şikayeti ile başvurdu. Özellikle yürürken belirginleşen sağ kolunda koreoatetoik hareketleri mevcuttu. Kan şekeri takip değerleri yüksekti. Amerikan Diyabet Birliği kriterlerine göre Tip 2 diabetes mellitus tanısı konuldu. Beyin manyetik rezonans görüntü-leme T1 sekansında solda daha belirgin olmak üzere kronik iskemik lezyonla uyumlu bilateral bazal ganglionlarda asimetrik hiperintensite saptandı. Subkutan insülin ile tedavi edildi. Koreoatetoik hareketleri 3. günden sonra azaldı ve 7. günde tamamen düzeldi. Bu durum putamen başta olmak üzere bazal ganglionlardaki etkilenmeler sonucu oluşur. Patofizyolojisinden GABA miktarıdaki azalma ve GABAerjik nöronların disfonksiyonu sorumlu tutulmaktadır. Bu nedenle akut gelişen koreoatetozda kan glukoz ve HbA1c değerlerinin saptanması önemlidir.Choreoathetosis is complex, hyperkinetic, irregular, sudden and short-term movement disorder. Involuntary twisting movements are also seen toget-her. Hereditary, immunologic, metabolic, neurovascular, infection diseases and drugs can cause this disease. It is more common in elderly people due to vascular diseases. It is more rare due to metabolic causes. A 73-year-old male patient presented with the complaint of was not being able to control the right arm for two days. There was choreoathetoid movements in his right arm, especially when he was walking. His blood glucose levels were high. Type 2 diabetes mellitus was diagnosed according to American Diabetes Association criteria. In brain magnetic resonance imaging, asymmetric hyperintensity was detected in the basal ganglia consistent with chronic ischemic lesions, more prominent on the left in T1 sequence. He was treated with subcutaneous insulin. Choreoathetoid movements declined after the third day and recovered on the 7th day. This is a consequence of the effects of basal ganglia, especially putamen. The reduction in the amount of GABA and dysfunction of GABAergic neurons are responsible from pathophy-siology. Therefore, it is important to detect blood glucose and HbA1c levels in acute developing choreoathetosis

The Effect of the Mobile Application on Students’ Achievement, Readiness and Technology Acceptance

The purpose of this study is to develop a mobile learning application for teaching vocabulary learning in order to support English as a foreign language education and to test its effectiveness. In this study, carried out in two phases, the multi-phase mixed method, which allows using qualitative and quantitative methods, was used. In the first phase (Phase 1), a Mobile-Assisted Language Learning (MALL) application was developed. At this phase, the study group consists of 14 students who have previously taken English courses in web-supported learning environments at a university. In accordance with the ADDIE model, a needs analysis was carried out first, the application was developed in the light of the results and in line with the opinions of the field experts, and the application was finalized with pilot studies. In the second phase of the study (Phase 2), the effectiveness of the mobile learning application was tested. For this purpose, the effects of MALL application on students' academic achievement, technology acceptance and technological readiness were examined. For this study, an experimental study lasting four weeks was conducted using a quasi-experimental design. In the experimental study, whose study group consisted of 61 students taking English courses at the same university; as pre-test and post-test, achievement tests and scales were administered to the experimental and control groups. According to the data obtained from the study, it was found that the mobile assisted language learning environment is more effective than the web supported learning environment in terms of students’ academic achievement; however, no significant difference was observed on students' acceptance levels and readiness. As a result of the research, it is recommended that MALL applications should be used to support language learning. Additionally, it is thought that this study can be a guide for researchers who want to conduct studies for developing mobile-assisted language learning applications

Akciğer Kanserinin Atipik Seyirli Multiple Beyin Metastazı

Brain metastases are the most common form of brain cancer. Patients with symptom and signsof brain metastasis may rarely present before the primary cancer causes any symptom and sign.Especially atypical multiple cranial lesions may be misinterpreted as hydatid cyst, TORCHinfection, sarcoidosis, human immunodeficiency virus (HIV), neurocysticercosis andtuberculosis according to its radiological appearance. A 54 year old male patient applied withheadache going on for one month, dizziness and nausea. Neurological examination was normal.In his cranial MRI there were multiple lesions consistent with parasitic infestation. The patientwas presented due to the appearance of his symptom and signs of multiple brain metastases ofa small cell lung cancer mimicking parasitic infestation radiologically, before any symptoms ofthe primary tumor arisedBeyin metastazları, en sık görülen beyin tümörleridir. Nadir olarak metastaza bağlı kliniknörolojik belirtiler primer tümöre ait belirtilerden önce ortaya çıkabilir. Atipik klinik seyir vemultipl beyin lezyonları olduğunda özellikle kist hidatik, TORCH, sarkoidoz, HIV, sistosarkozis,tüberküloz gibi hastalıklarla radyolojik olarak karışabilir. Ellidört yaşında erkek hasta 1 aydırdevam eden baş ağrısı, baş dönmesi ve bulantı şikâyetiyle müracaat etti, nörolojik muayenesinormaldi. Beyin kranial manyetik rezonans görüntüleme enfestasyona bağlı multiple beyinlezyonunu düşündürüyordu. Olgu küçük hücreli akciğer kanseri bulgularından önce multiplebeyin metastazı belirlenmesi, kranial MRI incelemesinin daha çok enfestasyonu düşündürmesi,multiple lezyonuna rağmen nörolojik muayenesinin normal olması gibi atipik özelliklerisebebiyle takdim edild

Atypical A Case Of Miller Fisher Syndrome

Miller fisher sendromu nadir görülen, oftalmopleji, ataksi ve arefleksi kliniği ile seyreden,Guillain-Bare sendromunun bir varyantıdır. Atipik seyreden, dipleji fasiyale ve kuadriparezigelişen bir Miller fisher sendromu olgusu sunuldu.Daha önce sistemik bir hastalığı olmayan, aniden çift görme ve göz kapaklarında düşme olanve akşamları şikayetleri daha belirgin hale gelen 19 yaşında erkek hastanın yapılan nörolojikmuayenesinde; bilateral total oftalmopleji, sol gözde daha belirgin her iki göz kapağında pitozistespit edildi. Pupiller izokorik, ışık refleksi, kornea refleksi ve göz dibi muayenesi normaldi.Derin tendon refleksleri tüm ekstremitelerde alınmıyordu, pozisyon ve vibrasyon kaybolmuşve yürüyüş esnasında özellikle dönüşlerde belirgin ataksi vardı. Yatışının üçüncü günü diplejifasiyale ve kuadriparezi gelişti. Beşinci günü bakılan beyin omurilik sıvısı tetkikindealbuminositolojik disosiasyon saptandı. Kranial magnetik rezonans görüntüleme normal,fizostigmin testi negatif olan ve elektronöromyografi incelemesinde ağır aksonal kayıplı duysalpolinöropati tesbit edilen hastaya miller fisher sendromu tanısı kondu. Beş gün boyunca 400mg/kg/ gün intravenöz immunglobulin tedavisi uygulandı. 20 gün sonra kısmı şifa ile taburcuedilen hastanın 3 ay sonraki kontrolünde tamamen düzeldiği gözlendi.Atipik seyreden dipleji fasiyale ve kuadriparezi gelişen klinik olarak Myastenia Gravisi (MG)düşündüren bir miller fisher sendromu olgusu sunuldu ve literatür ışığında tartışıldıMiller Fisher Syndrome is a rare variant of Guillain Barre Syndrome characterised withophtalmoplegia, ataxia and areflexia. We present a case with Miller Fisher Syndrome with anatypical course who developed facial diplegia and quadriparesis.19 years old male patient who had no history of systemic disease had developed diplopia, pitozisand his complaints were said to worsen at the nights. İn the neurological examination we foundbilateral ophtalmoplegia, bilateral pitosis more obvious in the left eyelid. Pupils were isocoricand pupillary light reflex, corneal reflex and examination of the fundus were found to be normal.Deep tendon reflexes could not be observed in all limbs. Position and vibration sense had beenlost and ataxia was obvious while walking especially turning around himself. In the third dayafter his admittance he developed facial diplegia and quadriparesis. In the cerebrospinal fluidin the 5 th day of the admittance we found albuminocytologic dissociation. Cranial MRI wasnormal and physostigmin test was negative and in electromyography we observed sensorypolyneuropathy with severe axonal degeneration and with these findings he had the diagnosisof Miller Fisher Syndrome. We administered intravenosus immunoglobulin treatment at thedose of 400 mg/kg/daily. He was discharged with partial remission at the 20 th day of admittanceand had full remission at his control at the 3 rd month of discharge.We presented a case with Miller Fisher Syndrome which is clinically similar to MyastheniaGravis with an atypical course having developed facial diplegia and quadriparesis and wasdicussed in the light of the literatur