Prevalence of carpal tunnel syndrome in cases with migraine and tension type headache

Background: Carpal Tunnel Syndrome (CTS) is the most frequent entrapment neuropathy; also Tension Type Headache (TTH) and migraine headache are the most common forms of headaches. The aim of this study is to determine whether there is a relationship between carpal tunnel syndrome and migraine and/or TTH, and if so, to determine the factors causing this relationship.  Methods: This study included 201 patients who were electro-physiologically diagnosed with idiopathic CTS and 100 controls. In addition to being examined for headaches, each patient’s Body Mass Index (BMI) was determined, and each was evaluated with Boston Questionnaire Form (BQF) and a Beck Depression Scale (BDS).  Results: The CTS group had significantly more patients with TTH and migraine headache than did the control group. In addition, the CTS group had a significantly higher frequency of headaches, and significantly higher BDS and BMI than did the controls. There were no significant differences in headache type and frequency of headache between those with mild CTS and those with mild-serious CTS. In addition, the Boston scores of CTS patients with headache were higher than those CTS patients without headache. Further, the monthly income levels of patients with CTS were lower than those of the control group.Conclusion: We found that primary headache is more frequent in CTS patients than in controls. This may be due to somato-autonomic reflexes and other common risk factors that can be seen in both CTS patients and those with headache, including obesity, depression and low level of income.

Nerve conduction studies in the early diagnosis of amyotrophic lateral sclerosis and the importance of split-hand phenomenon

Aim: The heterogeneity of the Amyotrophic Lateral Sclerosis (ALS) clinical phenotypes leads to difficulties in early diagnosis. The ‘split hand’ sign is defined as the thenar muscles that are more prominently affected by hypothenar. In this study, the results of the initial nerve conduction study of the patients were compared with those of the controls in order to increase the findings supporting early diagnosis. Material and Method: Seventy-five patients who were diagnosed with ALS in our clinic were included in the study. The initial ENMG findings of the patients were compared with those of 70 healthy controls: Distal motor latency (DML), the compound muscle action potential (CMAP) amplitude, velocity in the motor conduction of median, ulnar, peroneal and tibial nerves; distal latency, amplitude, velocity in sensorial conduction were evaluated. Ulnar/median DML and ulnar/median CMAP amplitude ratios were examined. Results: In ALS group, DMLs of the median, ulnar, peroneal, and tibial nerves were significantly longer, and CMAP amplitudes were significantly smaller than those of the controls. The sensory conductions of the median, ulnar, and sural nerves were not statistically different between the groups. The ulnar/median DML ratio of the patients was lower than the ratio of controls (0.73/0.80;p=0.003); while the ulnar/median CMAP amplitude ratio was greater (1.40/1.11; p=0.002). Conclusion: Prolonged DML and reduced amplitudes were observed in the motor nerve conduction of ALS patients in the early period. The results of the present study also support the presence of split-hand phenomenon even in early period of limb-onset ALS (both upper and lower). These findings suggest that nerve conduction studies and electrophysiologically detected split-hand sign are important clues for the early diagnosis of ALS in case of heterogeneous clinical phenotype

A Dyskinesia Case Induced by Pramipexole, Pregabalin and Gabapentin After Cardiopulmonary Resuscitation

Drug-induced dyskinesias can be seen occasionally in clinical practice. Here we present a 70-year-old patient who developed a noticeable dyskinesia after the use of pramipexole, gabapentin, pregabalin respectively for the restless legs syndrome. Prior to this condition, he had been hospitalized in intensive care unit for the myocardial infarction required cardiopulmonary resuscitation, and he had been discharged with no neurological deficits. The case presented here is a good example indicating the importance of being alert for drug-induced dyskinesias after hypoxic-ischemic encephalopathy, even though everything else seems righ

A Case of Sinus Venous Thrombosis Caused by Obstructive Sleep Apnea Syndrome

Obstrüktif uyku apne sendromu (OSAS) serebrovasküler sistemle ilişkili birçok komplikasyona yol açabilmektedir. Hipoksi, inflamasyon, oksidatif stres ve hiperkoagülabilite, serebrovasküler patolojinin gelişiminde rol oynayan patofizyolojik mekanizmalardır. Bu yazıda sinüs ven trombozu ile seyreden ve pozitif havayolu basıncı tedavisi ile semptomlarında düzelme izlenen 31 yaşında bir OSAS olgusu sunulmuştur.Obstructive sleep apnea syndrome (OSAS) can lead to many complications associated with cerebrovascular system. Pathophysiological mechanisms in the development of cerebrovascular pathology include hypoxia, inflammation, oxidative stress and hypercoagulability. Herein, we report a 31-year-old patient with OSAS which was associated with sinus venous thrombosis whose symptoms improved with positive airway pressure therapy