Reversible Anorgasmia with Acetazolamide Treatment for Idiopathic Intracranial Hypertension

Dear Editor, Idiopathic intracranial hypertension (IHH) is a clinical disorder characterized by symptoms and signs of increased intracranial pressure without abnormal cerebrospinal fluid composition and structural parenchymal abnormalities (1,2). There is no related systemic disorder and its etiology is unknown yet. Patients usually present with headache, vomiting, visual loss, and diplopia. Bilateral papilledema is found in most cases as a neurological sign and acetazolamide is an effective drug for the treatment of IIH. Acetazolamide is a carbonic anhydrase inhibitor and has been used for many relatively common disorders such as congestive heart failure, some forms of epilepsy, glaucoma, IHH, and also for some rare diseases such as acute mountain sickness. Paresthesia, fatigue, taste alterations, vomiting, and polyuria are common side effects of the treatment with acetazolamide. Usually acetazolamide is well tolerated, and sometimes this treatment may be associated with anorgasmia and this effect is thought to be dose related. Organic impotence has been reported in glaucoma patient therapy with acetazolamide. In this paper, we report a case admitted to our hospital that developed anorgasmia during treatment with acetazolamide. The patient, a 25-year-old female was admitted to the neurology department of our university hospital due to presence of anorgasmia. Previously, the patient had applied to a center for headache, nausea and vomiting, and visual loss, which had persisted for the past three months. The patient was evaluated with brain magnetic resonance imaging, in addition to examination of the cerebrospinal fluid and the other possible reasons of headache. Other possible causes of bilateral papilledema were ruled out; therefore, she was diagnosed with IIH and was started with appropriate treatment at our center. The patient reported that she was taking acetazolamide for IIH treatment orally during the last 15 days with an onset dosage of 750 mg/day, increased to 1500 mg/day after the 7 th day of usage. She was not using antidepressants, antipsychotics, or any other medications. The patient reported that the anorgasmia appeared during the last 5 days of acetazolamide treatment (three days after the onset of 1500 mg/days dosage). Except for the bilateral papilledema and light visual loss, the physical, psychiatric, gynecological, and neurological examinations as well as the brain magnetic resonance imaging were normal. Routine blood and hormonal tests were also normal. When the acetazolamide was decreased to 1000 mg/day, the anorgasmia resolved within 7 days. Female orgasmic disorder is characterized by the persistent or recurrent delay in, or absence of orgasm following a normal sexual excitement phase. Anorgasmia is defined as failure to achieve orgasm (climax) during sexual intercourse. Anorgasmia has many causes, it is believed that approximately 90% of anorgasmia problems are related to psychological issues, and some cases may result from the use of certain drugs such as serotoninergic drugs including antidepressants (particularly selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors), antiepileptic, and antipsychotic drugs (3,4). The new onset of the patient' s complaints, the lack of any additional drug use, and the absence of previous similar complaints suggested that the present anorgasmia was due to acetazolamide. We believe that acetazolamide treatment produced a dose-related anorgasmia in our patient. To the best of our knowledge, no other case of acetazolamide induced reversible anorgasmia has been reported previously for a female patient. It is difficult to present the precise mechanism between acetazolamide and anorgasmia. Acetazolamide is an enzyme inhibitor that acts on carbonic anhydrase specifically and catalyzes the reversible reaction of hydration of carbon dioxide and dehydration of carbonic acid. Although the underlying neurochemical changes of anorgasmia are not fully understood, orgasm, in both sexes, is particularly controlled by noradrenergic activity. Serotonin and dopamine are also essentia

A Study of Cerebral Performance Categories Based on Initial Rhythm and Resuscitation Time Following In-Hospital Cardiac Arrest in a State Hospital in Turkey

Background: The cerebral performance category (CPC) score is widely used in research and quality assurance to assess neurologic outcome following cardiac arrest. However, little is known about the results of the CPC in Turkey. Objective: This study aimed to determine whether the CPC is associated with the initial rhythm and resuscitation time following resuscitation from in-hospital cardiac arrest. Methods: This study compared the CPCs (CPC 1-2 and CPC 3-4-5) of patients discharged from the hospital after surviving cardiopulmonary arrest (CPA) during a 2-year period between June 2013 and June 2015 (at discharge, and at 6th, 12th, 18th, and 24th months) based on the initial rhythm (asystole/pulseless electrical activity and ventricular fibrillation/pulseless ventricular tachycardia) and resuscitation time (0–14 min and 15–30 min) at the time of arrest. Results: No difference was found between CPC 1-2 and CPC 3-4-5 scores at discharge or at 6th, 12th, 18th, and 24th months in terms of the first rhythm and resuscitation time (P > 0.05). Conclusion: Patients discharged from the hospital following in-hospital cardiopulmonary resuscitation (CPR) were found to have no difference in 2-year CPC scores with respect to cardiac rhythms and resuscitation durations at the onset of resuscitation

Multiple Skleroz’lu Hastalarda Üst Ekstremite Ataksisinin Bilgisayar Analizi İle Değerlendirilmesi

Objective: Neurological and neurophysiologic disorders such as Multiple Sclerosis (MS) and disorders with disabilities need to be evaluated thoroughly and thoroughly. In MS we developed a new test (Multiple Sclerosis Ataxia Test) (MSAT) to evaluate the upper extremity coordination problem. This test provides a computer-based evaluation platform to fully assess the severity of the upper extremity coordination problem. Method: (MSAT) was tested on 23 patients (MS) with 18 MS in EDSS groups with different (Expanded Disability Status Scale) MS disease. The amount of deviation of the following patient by the spiral line pen on the tablet is given as a percentage. Since the same practices were applied in healthy group, dominant and non dominant hand were compared in MS and healthy group. Results The Ataxia Ratio Scale (UAQ) was compared with the upper extremity kinetic functions section. Findings: No statistically significant correlation was found between EDSS and patients' dominant hand (right h and). (p>0.05). There was no significant correlation between ICAR variance and dominant and non-dominant hand (p>0.05). There was a statistically significant difference between the two groups in the analysis of right hand comparison of patients and healthy subjects (p<0.05). Conclusion: MSAT evaluates upper extremity ataxia more objectively and can give information about the functional status of the patient before and after treatment. This method may have the same transformative effect on clinical evaluation and research in MS, as does standardized computerized tests in the field of education, which have a clear potential to accelerate progress in clinical evaluation and research

Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers

Background Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Objective Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Methods Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Results Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority (n=8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity

REM Uykusundaki Horizontal Hızlı Göz Hareketlerinin Hemisferik Asimetri İle İlişkisi

WOS:000412947000008Amaç: İnsanlarda REM uykusunda oluşan hızlı göz hareketlerinin (HGH) fonksiyonel önemi ve orijini tam anlaşılamamıştır. HGH'nin, REM uykusunda rüya görme ve merkezi sinir sistemi aktivasyonuyla eşzamanlı görülmesi ilginçtir. Bu çalışma; REM uykusunda oluşan horizontal hızlı göz hareketlerinin (HHGH) yöneliş-amplitüt-açısal değerlerini ölçmeyi, yaşla ilişkilerini, hızlı göz hareketlerinin temelindeki anatomik, fizyolojik mekanizmaları açıklamayı ve hemisferik asimetri kavramına katkı sağlamayı amaçlamaktadır. Yöntem: Yaşları 19-70 arasında değişen 25 denek bir gecelik spontan uyku esnasında standart prosedürler uygulanarak kayıtlandı. Bir gecelik REM periyodunda sağa ve sola HHGH dağılım analizi, HHGH açısal değerleri ve HHGH amplitüt ortalamaları karşılaştırıldı. Bulgular: Yapılan istatistiki değerlendirmeyle hemisferik bir asimetriyi gösterecek anlamlı bir sonuç elde edilmedi. Sonuç: REM uykusu, HGH ve rüya için dominant bir hemisfer göstermek mümkün gözükmemektedir. Çalışmaların bir kısmı sağ hemisfer bir kısmı sol hemisfer üstünlüğünü ortaya koymaya çalışırken diğer kısım ki (bizim çalışmamızda bunu desteklemekte) iki hemisferin koordineli çalıştığını savunmaktadırObjective: The origin and functional importance of rapid eye movements (REMs) during REM sleep in humans has not been completely understood. It is interesting that REMs occur simultaneously with dreaming during REM sleep and central nervous system activation. In the present study, we aimed to measure the directional properties (amplitude and angular values) of horizontal REMs (hREMs), determine their relationship with age, explain the anatomical and physiological basis of REMs, and contribute to the concept of hemispheric asymmetry. Method: Using standard procedures, 25 subjects (age range, 19-70 years) were recorded during one night of spontaneous sleep. hREM distribution analysis to the right and left, hREM angular values, and hREM amplitude means were compared during an REM period of one night. Result: Statistical analysis revealed no significant results that would indicate a hemispheric asymmetry. Conclusion: The findings suggested that no hemispheric dominance can be demonstrated for REM sleep, REMs, or dream. Although some studies have demonstrated the dominance of one hemisphere over the other, others have advocated (also supported by our study) that both hemispheres function in coordinatio

Cortical Blindness

Lateral genikülat cismin başlangıcı ile oksipital korteks arasındaki herhangi bir yerde oluşan bilateral retrokiazmal lezyonların yol açtığı tabloya kortikal körlük denir.When bilateral retrochiasmal lesions from the beginning of the lateral geniculate body to the occipital cortex are present, there is a cortical blindness