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

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

Prothrombin Gene Mutation as a Risk Factor in Young Ischemic Stroke: A Case Report

Stroke at young age is the stroke seen under the age of 45 years with the incidence range between 2.5 and 40/100.000. Stroke at young age is account for 4-10% of overall stroke cases. The majority of strokes in young adults are of ischemic origin. The causes of young ischemic strokes are different than those of advanced age and many analyses may be required to find out the underlying reason. These analyses include cerebral angiography, transesophageal echocardiography, tests to detect coagulation disorders, and investigation of collagen vascular diseases. Studies have most frequently focused on FV Leiden, MTHFR C677T and Prothrombin G20210A, which are among prothrombotic gene mutations in thrombophilia panel. Herein, a young female case with young ischemic stroke, in which heterozygote polymorphism of prothrombotic gene has been detected, was presented

Plasma And Cerebrospinal Fluid Homocysteine, Nitric Oxide And Malondialdehyde Levels In Acute Ischemic Stroke: Possible Role Of Free Radicals In The Development Of Brain Injury

Aim: Free radical mechanisms may play an important role in brain ischemia / reperfusion injury. The generation of reactive oxygen species by homocysteine (Hcy) or nitric oxide (NO) metabolism might be involved in the induction of lipid peroxidation, as indicated by malondialdehyde (MDA) formation. The purpose of this study was to investigate the behavior of Hcy, NO and MDA in plasma and cerebrospinal fluid (CSF) within 4 days after ischemic stroke onset. Methods: The levels of NO, Hcy and MDA were determined in plasma and CSF on the 3rd or 4th days after the onset of ischemic stroke in 29 patients (12 men and 17 women) and in 13 healthy controls (6 men and 7 women) of comparable age and gender. Results: The plasma MDA, NO and Hcy levels were significantly higher in the stroke patients, while mean MDA, NO and Hcy levels in CSF showed a significant increase in the cases as compared to controls (p<0.01). There were no gender-specific differences in the plasma or CSF MDA, NO and Hcy concentrations. A significant negative correlation was found between duration of diabetes with CSF NO (r=-0.63, p<0.001). The low Glasgow Coma Scale (GKS) was negatively correlated with lethal outcome, (r=-0.76, p<0.001), but it did not correlate significantly with any of the measured parameters. Conclusion: These data support that free radical mechanisms may play a role in the development of brain injury following ischemic stroke. It was suggested that the elevated Hcy may be an important risk factor for acute ischemic cerebral injury

Retrospective Evaluation of Carotid Artery Stenting Experience of a Third Stage Neurology Clinic

INTRODUCTION: In the protection of both primary and secondary ischemic stroke, the effectiveness and reliability of the placement of carotid artery stent (CAS) has been demonstrated. Our aim in this study is to demonstrate the reliability of the CAM procedure performed in the tertiary care neurology clinic and the clinical and radiological to evaluation the two-year results. METHODS: Twenty-seven patients who applied to our hospital between July 2015 and July 2016, were evaluated by our neurology clinic, decided on CAS and stenting were studied (average age 71.6 [58-85]). Patients with symptomatic onset of the carotid artery stenosis over 50% angiographically, asymptomatic and over 70% stenosis in the carotid artery were included. RESULTS: The operation success rate was 96.3% (a thrombus developed in the stent 2 hours after the operation in a single patient). No deaths or myocardial infarction occurred in any of these patients with CAS. No ischemic cerebrovascular event or transient ischemic attack occurred in any of the patients at 6 months follow-up. No restenosis was observed in any of the carotid doppler follow-ups performed in our clinic. DISCUSSION AND CONCLUSION: We believe that carotid artery stent placement performed by neurologists trained in endovascular surgery can be safely performed with low complication and high success rates in symptomatic or asymptomatic patients and that patients will be monitored in a more healthy manner