Baş düşmesi ile prezente olan motor nöron hastalığı

Motor nöron hastalığı, yutma, yürüme, konuşma ve nefes alma gibi işlevlerden sorumlu olan istemli kasları innerve eden motor nöronların tutulumu ile karakterize progresif nörolojik bir hastalıktır. En sık görülen formu amyotrofik lateral sklerozdur. Nörolojik muayene bulguları üst ve alt motor nöron dejenerasyonunu gösterir. Hastalığın tanısı için spesifik bir biyolojik marker bulunmamaktadır. Klinik özellikler elektromiyografik bulgularla birleştirilerek tanı konur. Literatürde az sayıda atipik prezentasyonlu motor nöron hastalığı olgusu bulunmaktadır. Bu yazıda boyun kaslarında progresif güçsüzlükle başlayan atipik bir motor nöron olgusu sunulmuştur.Motor neuron diseases are a group of progressive neurological disorders that destroy motor neurons that control voluntary muscle activity such as swallowing, walking, speaking and breathing. The common form of motor neuron disease is amyotrophic lateral sclerosis. Neurological examination presents specific signs associated with upper and lower motor neuron degeneration. In the absence of any biological marker, the diagnosis of motor neuron disease is based on clinical features, combined with the results of electromyography. Some patients of motor neuron disease with atypical presentation have been reported in the literature. We presented here a case of motor neuron disease with atypical presentation who had progressive weakness of the neck muscles

Extracranial and intracranial artery dissections: Experiences from a tertiary referral center

Background: Craniocervical artery dissection is an important cause of ischemic stroke especially in young and middle aged adults. In this study, we evaluated extracrainal and intracranial artery dissections in terms of etiologies, risk factors, stroke severity and functional outcomes. Methods: A total of 29 patients who were diagnosed with ischemic stroke due to extracranial or intracranial artery dissections were enrolled to this study. The ischemic stroke diagnosis was confirmed with diffusion weighted magnetic resonance imaging in all patients. Computed tomography angiography, magnetic resonance angiography and digital subtraction angiography were used to demonstrate the dissection. Demographic findings, risk factors and presence of trauma were evaluated. National Institute of Health Score Scale (NIHSS) was used for stroke severity assessment at disease onset. Functional outcomes were measured with Modified Rankin Scale (mRS) at the 3rd month. Results: Fifteen patients (51.72%) had carotid artery dissections while 12 patients (41.37%) had vertebral artery dissection (VAD), 1 (3.4%) had basilar artery dissection (BAD) and both VAD and BAD were seen in 1 patient (3.4%). Coagulopathy was detected in 12 patients (41.37%). Connective tissue disease was suspected in 3 patients (10.3%). In 6 patients, dissections occured after trauma. Nineteen patients (65.51%) presented with somatosensory deficits. The 3rd month mRS scores were in the range of 0-2 and no significant correlation was found in terms of risk factors, etiology and trauma history. Conclusion: Arterial dissection should be kept in mind for the clinical presentation of ischemic stroke in young adults. We think that better understanding of the risk factors, etiologies and clinical presentation of the dissections and early diagnosis-proper treatments might yield improved clinical outcomes

The association of vertebrobasilar calcification with etiological subtypes, stroke recurrence and outcome in acute brainstem ischemic stroke

Arterial calcification (AC), a frequent finding on imaging studies, has been reported as a risk factor for ischemic stroke. However few studies have explored the association of AC with etiological subtypes and prognostic implications. The purpose of this study was to investigate the association of AC with demograhics, risk factors and etiological subtypes and to determine whether it predicts stroke recurrence and functional outcome in patients with acute brainstem ischemic stroke. We analyzed our database consisting of patients who were diagnosed as acute brainstem ischemic stroke admitted within 24hours of onset. Etiological classification of stroke was made based on The Trial of ORG in Acute Stroke Treatment (TOAST) Classification. AC in vertebral and basilar arteries were assessed from baseline brain CT. AC degree was categorized according to calcification along the circumference in the densest calcified segment of each vessel (0 point if no calcification in any of the CT slices, 1 point if calcification <50% of circumference and 2 points if calcification ≥50% of circumference). Three AC categories were defined according to the total AC score as follows: no AC (0 point), mild AC (1–2 points), severe AC (≥3 points). Recurrent stroke within the first 3 months of follow up and modified Rankin Score (mRS) at 3-month were reviewed. 42% of 188 patients had AC in at least of the vertebrobasilar arteries. Severe AC was related to age and the presence of diabetes mellitus and coronary artery disease. The prevalence of AC was significantly higher in large artery atherosclerosis subtype. The presence of AC was marginally associated with recurrent stroke but did not find to be related with functional outcome. Further studies with larger sample size are warranted to explore this topic

Idiopathic intracranial hypertension: Clinical, laboratory features and prognosis

Amaç: Bu çalışmada idyopatik intrakranyal hipertansiyon (İİH) olgularının klinik semptom ve bulguları, demografik özellikleri ve prognozları araştırıldı. Hastalar ve Yöntemler: Modifiye Dandy kriterlerine göre idyopatik intrakranyal hipertansiyon tanısı almış, on yıllık bir süredir izlenen 21 hasta (18 kadın, 3 erkek; ort. yaş 34.9; dağılım 16-50) çalışmaya alındı. Bütün hastaların başvuru yakınmaları, tıbbi öyküleri, hemogram, biyokimya ve görüntüleme incelemeleri, göz dibi bakıları kaydedilerek değerlendirildi. Bulgular: En sık gözlenen yakınma baş ağrısıydı (%85.7), bunu vizüel semptomlar (%47.6), tinnitus (%19.0) ve bulantı- kusma (%38.1) izliyordu. Hastaların 15'inde (%71.4) papilla ödemi, dördünde (%19.0) optik diskte nazal veya temporal siliklik saptandı, kalan iki hastada (%9.5) fundus muayenesi normaldi. Sekiz hastada (%38.1) beyin ödemi saptandı. Görsel uyandırılmış potansiyel kaydı yapılan 16 hastanı n dördünde (%25) P100 latansında uzama gözlendi. Ortalama sekiz aylık takip süresinin sonunda hastaların baş ağrısı ve vizüel semptomlarında belirgin düzelme oldu. Sonuç: Sonuç olarak, İİH genellikle benign karakterli bir tablodur ancak nadiren kalıcı görme kaybına da neden olabilir. Bu nedenle baş ağrısı, görme ve işitme bozukluğu yakınmalarıyla başvuran genç, kilolu kadın hastalarda İİH tanısı da akılda bulundurulmalıdır.Objectives: In this study, we evaluated the clinical symptoms and findings, demographic features and prognosis of patients with idiopathic intracranial hypertenson (IIH). Patients and Methods: Twenty-one patients (18 women, 3 men; mean age 34.9 years; range 16 to 50 years) who fulfilled the modified Dandy's diagnostic criteria for IIH and were followed in the last 10 years, were included in the study. The presenting complaints, medical history, laboratory data including blood count and routine biochemical assessments, imaging and ophtalmoscopic evaluation data were evaluated. Results: Headache was the primary symptom (85.7%) on admission. The other presenting symptoms were visual impairment (47.6%), tinnitus (19.0%), nausea-vomiting (38.1%). Papilledema was found in 15 patients (71.4%), nasal and temporal swollen of optic disc in 4 patients (19.0%). Two patients had normal fundus examination. Eight (38.1%) had brain edema. Four out of 16 patients who underwent visual evoked potential, had prolonged P100 latency. Headache and visual symptoms were improved within 8 months follow-up period. Conclusion: In conclusion, although idiopathic intracranial hypertenson has good prognosis, it may rarely cause permanent visual loss. For this reason, IIH should be considered in young and obese women presenting with headache, visual and auditive symptoms

Epileptic seizures following cerebrovascular disease

Amaç: Beyin damar hastalığı geçiren hastalarda epileptik nöbet sıklığı araştırıldı. Hastalar ve Yöntemler: Üç yıllık bir sürede beyin damar hastalığı ile başvuran 1273 hastanın verileri retrospektif olarak değerlendirildi. Çalışmaya beyin damar hastalığı sonrası epileptik nöbet geçiren 160 hasta (130 iskemik, 30 hemorajik) alındı. İnme risk faktörleri ile nöbet gelişimi arasındaki ilişki, nöbet tipleri, elektroensefalografi bulguları, nöbetlerin zamansal dağılımı, lezyon tipi ve lokalizasyonu değerlendirildi. Aynı dönemde kliniğimizde takip edilen beyin damar hastalığı olan 640 hasta da kontrol grubu olarak alındı. Bulgular: Üç yıl boyunca takip edilen beyin damar hastalarının ortalama bir aylık takip süresinde nöbet geçirme oranı %12.6 bulundu. Multivaryant analizle, iskemik beyin damar hastalığı olanlarda kortikal tutulum, enfeksiyon ve metabolik bozukluk varlığı; kanayıcı beyin damar hastalığı olanlarda ise kortikal lezyon ve enfeksiyon nöbet gelişimi için bağımsız risk faktörleri olarak saptandı. Total anterior sirkülasyon infarktı olan hastalarda nöbet gelişimi istatistiksel olarak anlamlı derecede yüksek bulundu. Sonuç: Kortikal lezyonlu ve anterior sirkülasyon lezyonlu hastalarda nöbet gelişim oranı daha yüksek bulundu ve nöbet geçiren hastaların mortalitesi yüksekti. Ayrıca beyin damar hastalığı sonrası gelişen nöbetlerin çoğu jeneralize tonik klonik tipteydi.Objectives: Evaluation of the frequency of epileptic convulsions in patients with cerebrovascular disease. Patients and Methods: The data of 1273 patients with cerebrovascular disease, admitted within three years, were evaluated retrospectively. 160 patients (130 ischemic, 30 haemorrhagic) with epileptic seizures, developing after cerebrovascular diseases were included in this study. The association between the risk factors of stroke and seizure development, types of seizures, electroencephalographic findings, time distribution of seizures, types and localisations of lesions were evaluated. 640 patients with cerebrovascular disease, admitted to our clinic at the same time period, were included as control subjects. Results: The ratio of epileptic convulsions within one month follow-up period was 12.6% for all patients during the three years follow-up. Multivariant analyses revealed that independent risk factors for convulsion were cortical localisation of lesions, infections and metabolic disturbances were in patients with ischemic cerebrovascular disease and cortical lesions and infections in patients with haemorrhagic cerebrovascular disease. The ratio of convulsion was significantly higher in patients with total anterior circulation ischemic lesion. Conclusion: Patients with cortical lesions and anterior circulation lesions had an increased risk for convulsions, and convulsions increased mortality. Most of the seizures in patients with cerebrovascular disease were of generalised tonic clonic type

Pethidine Induced Epileptic Seizure

In this presentation we report a case of seizures following the administration of pethidine

Migraine headaches among university students using id migraine test as a screening tool

<p>Abstract</p> <p>Background</p> <p>Migraine is a significant health problem, especially for the young people, due to its frequency and accompanying morbidity, causing disability and loss of performance. In this study, our aim was to determine the prevalence of migraine headaches among university students in Edirne, a Turkish city.</p> <p>Methods</p> <p>In this cross-sectional and descriptive study, study population was composed of students registered to Trakya University in the academic year of 2008-2009. Out of these, 3694 of them accepted to participate. Participants who had two or more headaches in the last 3 months formed the headache group. Afterwards, two preliminary questions were applied to the headache group and participants with at least one affirmative response were asked to perform the validated ID-Migraine™ test.</p> <p>Results</p> <p>The mean age of 3694 students participated in the study was 19.23 ± 1.84 (17-39 years), with adolescents:adult ratio being 2.5:1. 1613 students (43.7%) did have at least two headaches in the last three months. Migraine-type headache was detected in 266 subjects (7.2%) based on the ID-Migraine™ test. Of the migraine group, 72 were male (27.1%) and 194 were female (72.9%). There was no significant difference in migraine prevalence between adolescent and adult age groups.</p> <p>Conclusions</p> <p>With a prevalence similar to adults, primary care physicians should be aware of the probability of migraine headaches in university students in order to maintain a successful school performance.</p