Sinir İletim Çalışmaları ve Elektromiyografiye Genel Bakış

Çeviri Editörleri Doç. Dr. Burcu Örmeci, Prof. Dr. A. Emre Öge Bölüm I-Sinir İletim Çalışmaları ve Elektromiyografiye Genel Bakış Şevki Şahin 1. Sinir İletim Çalışmaları ve Elektromiyografiye Yaklaşım 2. Anatomi ve Nörofizyoloji BÖLÜM VIII- Elektronik ve Enstrümantasyon Şevki Şahin 39. Elektrodiagnostik Araştırmalar için Temel Elektrik Elektronik Bilgis

Are cerebrospinal fluid protein levels and plasma neutrophil/lymphocyte ratio associated with prognosis of Guillain Barré syndrome?

Guillain Barré syndrome (GBS) is a post-infectious acute autoimmune polyradiculopathy. Cerebrospinal fluid (CSF) total protein level and plasma neutrophil/ lymphocyte ratio (NLR) are related with autoimmune response. We aimed to reach a prognostic indicator for GBS by using electrophysiological findings, protein level of CSF, and plasma NLR based on Medical Research Council (MRC) sum score data. Cases who met diagnostic criteria of GBS and followed at least six months were enrolled in the study. Nerve conduction study (NCS) and lumbar puncture were performed one week after symptom onset. Routine CSF findings and complete blood count were recorded. Plasma NLR was calculated as the ratio of neutrophil cell count to lymphocyte cell count. All patients received intravenous immunoglobulin. MRC sum scores were calculated on administration time (1st) and six months later (2nd) for evaluation of recovery. Mean values of baseline CSF protein level, NCS parameters and NLR were compared with mean scores of MRC1st and MRC2nd. Increased CSF protein levels showed negative correlation with MRC2nd scores but no correlation with NCS. Increased NLR levels were positively correlated with age, MRC2nd scores and NCS. Facial diplegia was observed in 42% of patients. A positive correlation was found between high level of NLR and MRC1st, and there was no relationship with MRC2nd. Regression analyses showed that only CSF protein level was an independent factor on both MRC1st and MRC2nd. A positive association was found between baseline data included young age high plasma NLR, low level of CSF protein and good prognosis in our study. Also a positive correlation was found between high level of NLR and baseline disability in GBS cases with facial diplegia. Calculation of NLR is an easy and inexpensive method. On the other hand it may be influenced by age and immunotherapy. Our results showed that CSF protein level is still a liable parameter for prognosis. NLR could be a candidate prognostic marker of GBS cases. Further investigations including more cases are needed

Kronik İnflamatuar Demiyelinizan Polinöropati Hastalarında Yaşam Kalitesini Etkileyen Parametreler

Kronik inflamatuar demyelinizan nöropati (KIDP), immün ilişkili nöropatidir. İlerleyici güç kaybı, duysal bozukluklarla seyreder. Fizik güçsüzlük, ağrı, yorgunluk, depresyon, sosyal ilişkiler yaşam kalitesini olumsuz etkiler. AMAÇ: Bu çalışmada Hastanemiz Nöroloji Kliniğinde KIDP tanısıyla izlenen hastaların yaşam kalitesi araştırılmıştır. YÖNTEM: Hastalara Medical Research Council (MRC), Dünya Sağlık Örgütü Yaşam Kalitesi Ölçeği – Kısa Form (WHOQOL – Bref), Dört soru nöropatik ağrı anketi (DN4) uygulanmıştır. MRC total skor 40, düşük skorlar daha düşük kas gücünü gösterir. WHOQOL – Bref, 5 alt bölümden (Genel sağlık- Fiziksel sağlık-Psikolojik sağlık- Sosyal ilişkiler-Çevresel sağlık) oluşur. Bölümler % olarak puanlanmıştır. Yüksek skorlar daha iyi yaşam kalitesini gösterir. DN4, toplam puan 10, yüksek skorlar nöropatik yakınmaların fazlalığını gösterir. SONUÇ: Çalışma grubu 62 hasta [yaş ort: 62.5±15 yıl, kadın/erkek: 29/33, beden kitle indeksi (BMI): 27.5±4.9, HbA1c: 7.1±1.5] oluşmaktadır. DN4 ortalaması 5.5±2.6, MRC skoru 53±5.8, WHOQOL –Bref genel sağlık ortalaması % 41±20, fiziksel sağlık 48±17, psikolojik sağlık 60±17, sosyal sağlık 57±22, çevresel sağlık 68±18 olarak saptandı. Korelasyon analizinde HBa1c ile DN4 arasında pozitif(F=0.465 p=0.04); DN4 ile psikolojik sağlık arasında negatif (F=- 0.244 p 0.04) , MRC ile psikolojik sağlık (F 0.474 p 0.006) ve , çevresel sağlık arasında (F 0.551 p=0.001) arasında pozitif korelasyon saptandı. Regresyon analizinde genel sağlık ve çevresel sağlık alanına DN4 ve MRC skor; sosyal ilişkiler alanına DN4 ve BMI etki eden faktörler olarak saptanmıştır. YORUM: Çalışmamızda en fazla etkilenen parametreler genel sağlık algısı ve fiziksel sağlıktı. Kısa Form 36 (SF-36) ile yapılan çalışmalarda da fiziksel sağlık etkilenmesi ön plandadır. Fiziksel zaaf ve nöropatik semptomlar özellikle psikolojik sağlığı olumsuz etkilemektedir

Eye-related visual hallucinations: Consider ‘Charles Bonnet syndrome’

The Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association

Cerebral blood flow changes in patients with probable medication-overuse headache

Transcranial Doppler (TCD) is a non-invasive method for measuring blood flow velocity (BFV), and a marker of vessel diameter. In this study, intracranial BFV was investigated, by means of TCD, in patients suffering from probable medication-overuse headache (PMOH). Twenty-three female patients with probable ergotamine-overuse headache (PEOH), 23 female patients with probable analgesic-overuse headache (PAOH), and 15 healthy female controls participated in the study. The mean BFVs of the bilateral middle and anterior cerebral arteries (MCA and ACA) and basilar artery (BA) were measured by TCD. The mean BFVs of the BA and MCA were found to be significantly increased in the PEOH group when compared with those of the PAOH and control groups (p0.05). The mean BFV of all the vessels in the PAOH group was found to be lower than that of the control group but no statistical significance was found (p>0.05). Our results show that ergotamine increases BFV via vasoconstriction, especially of the BA and MCA. We also suggest that 5HT1B/1D receptors are mainly localized in the BA and MCA, and that analgesic overuse results in a functional disorder of neuronal receptor and neurovascular reflexes and may cause a reduction of intracerebral vessel tone, leading to vasodilatatio

Hanging-induced burst suppression pattern in EEG

Lethal suspension (hanging) is one of the most common methods of attempting suicide. Spinal fractures, cognitive and motor deficits as well as epileptic seizures can be detected after unsuccessful hanging attempts. Introduced here is the case of a 25-year-old man exemplifying the clinical observations stated hereafter, who was conveyed to our emergency room after having survived attempted suicide by hanging, with his post-anoxic burst-suppression electroencephalography (BS-EEG) pattern and clinical diagnoses in the post-comatose stage. The patient′s state of consciousness was gradually improved over a period of time. His neuropsychiatric assessment proved that memory deficit, a slight lack of attention and minor executive dysfunction was observed a month after the patient was discharged. Although the BS-EEG pattern indicates severe brain dysfunction, it is a poor prognostic factor; rarely, patients survive with minor cognitive deficits and can perform their normal daily activities

Fas, Fas Ligand, and Vitamin D Receptor FokI Gene Polymorphisms in Patients with Type 1 Diabetes Mellitus in the Aegean Region of Turkey

WOS: 000309957500005PubMed ID: 22946667Objective: Several gene polymorphisms have been reported to be associated with the risk of developing type 1 diabetes. Among them, the human leukocyte antigen locus is the strongest genetic determinant. To identify additional genetic markers, we aimed to evaluate the relationship between the Fas, Fas ligand (FasL), and vitamin D receptor (VDR) FokI gene polymorphisms and the susceptibility to type 1 diabetes in the Aegean region of Turkey. Materials and Methods: Eighty-five patients with type 1 diabetes and 80 healthy controls were included in this study. The Fas -670A/G, FasL -843C/T, and VDR FokI gene polymorphisms were evaluated using the polymerase chain reaction-restriction fragment length polymorphism method. Results: The evaluation of the Fas genotype and the gene allele frequency did not show statistically significant differences between the patient and control group. Distribution of the FasL genotype differed significantly between patients and controls. The distribution of the VDR FokI genotype and allele frequencies differed significantly between the patients and controls. Individuals with type 1 diabetes presented less commonly with the FokI f allele. Conclusions: Our findings suggest that the FasL -843C/T and VDR FokI gene polymorphisms are associated with type 1 diabetes in the Agean region of Turkey; however, the Fas -670A/G gene polymorphism is not

Nine Years with Munchausen Syndrome: A Case of Psychogenic Dystonia

Background: Munchausen syndrome presenting with psychogenic dystonia is a rare condition. Phenomenology Shown: A psychogenic dystonia case presenting with an acute onset of retrocollis, lower limb dystonia and bizarre gait was diagnosed as Munchausen syndrome. Educational Value: Recognizing psychogenic dystonia avoids unnecessary investigations and provides successful treatment.</p