Hereditary neuropathy with liability to pressure palsies case which is presenting as distal symmetric polyneuropathy

Basınç felçleri ile beraber olan herediter nöropati (HNPP), heterojen bir fenotipe sahiptir. HNPP’de karekteristik olarak minör travmaları takiben ortaya çıkan tekrar eden mononöropatiler oluşur. Klinik bulguların bir kısmının Charcot-Marie-Tooth (CMT) hastalığıyla çakışması nedeniyle, HNPP hastaları yanlışlıkla CMT tanısı alabilir. HNPP ve CMT hastalıklarının her ikisinde de demyelinizan nöropati izlenmekle beraber, elektro fizyolojik ve patolojik bulguları oldukça farklıdır. Biz bu bildiride, dört ekstremiteyi etkileyen periferik nöropatisi olan ve CMT bulguları izlenen 22 yaşında bir HNPP olgusunu sunuyoruz.Hereditary neuropathy with liability to pressure palsies (HNPP) phenotypes are heterogeneous. HNPP is characterised by recurrent mononeuropathies following minor trauma. Mild overlap of clinical features with Charcot-Marie-Tooth (CMT) disease may lead patients with HNPP to be misdiagnosed as having CMT. HNPP and CMT are both demyelinating neuropathies, however, their pathological, and electrophysiological features are quite distinct. We describe the HNPP case of a 22 year-old man who presented with peripheral polyneuropathy affecting the four limbs and overlap of features with CMT disease

Hereditary neuropathy with liability to pressure palsies case which is presenting as distal symmetric polyneuropathy

Basınç felçleri ile beraber olan herediter nöropati (HNPP), heterojen bir fenotipe sahiptir. HNPP’de karekteristik olarak minör travmaları takiben ortaya çıkan tekrar eden mononöropatiler oluşur. Klinik bulguların bir kısmının Charcot-Marie-Tooth (CMT) hastalığıyla çakışması nedeniyle, HNPP hastaları yanlışlıkla CMT tanısı alabilir. HNPP ve CMT hastalıklarının her ikisinde de demyelinizan nöropati izlenmekle beraber, elektro fizyolojik ve patolojik bulguları oldukça farklıdır. Biz bu bildiride, dört ekstremiteyi etkileyen periferik nöropatisi olan ve CMT bulguları izlenen 22 yaşında bir HNPP olgusunu sunuyoruz.Hereditary neuropathy with liability to pressure palsies (HNPP) phenotypes are heterogeneous. HNPP is characterised by recurrent mononeuropathies following minor trauma. Mild overlap of clinical features with Charcot-Marie-Tooth (CMT) disease may lead patients with HNPP to be misdiagnosed as having CMT. HNPP and CMT are both demyelinating neuropathies, however, their pathological, and electrophysiological features are quite distinct. We describe the HNPP case of a 22 year-old man who presented with peripheral polyneuropathy affecting the four limbs and overlap of features with CMT disease

Acetylsalycylic Acid Resistance and Risk Factors in Acute Ischemic Stroke Patients

OBJECTIVE: The aim of the study was to investigate prevalence of acetylsalicylic acid (ASA) resistance in acute ischemic stroke patients by using Platelet Function Analyzer (PFA) 100 test and to determine the effect of risk factors that may be responsible for ASA resistance. METHODS: Fifty acute ischemic stroke patients (mean age: 66.32±12.983 years, 34 male) were given 300 mg/day aspirin for at least 10 days and all risk factors were investigated for a correlation to ASA resistance by using PFA 100 test. These factors were; age, gender, hemoglobin(Hgb), hematocrit(Htc), platelet (plt) total cholesterol, von Willebrand Factor (vWF) levels, hypertension(HT), diabetes mellitus(DM), coronary artery disease(CAD), smoking and previous cerebrovascular disease (CVD). In PFA-100 system, a collagen/epinephrine (C/EPI) closure time in the range of 85-157 sec. and a collagen/ADP closure time of 65-125sec. were considered normal. Maximal test duration was 300 s. C/EPI closure time is sensitive for ASA resistance. Subjects with duration shorter than 300 s. were accepted as ASA-resistant or non-responder. RESULTS: ASA resistance was apparent in 32% of the study group. vWF levels were higher in ASA resistant patients group. All risk factors were compared in ASA sensitive and resistant group. vWF levels and mean age were higher in ischemic stroke ASA non responder group, but not statistically significant. CONCLUSION: In 50 acute ischemic patient aspirin resistance rate was 32%, this means aspirin was pharmacologically non effective in those. Clinical outcome for aspirin non responders may be revealed through the follow up at least six months

Lacosamide-Induced Visual Hallucinations and Psychosis: a Case Report and Literature Review

Lacosamide (LCM) has both frequent side effects, such as headache, diplopia, and nausea, and rare side effects such as depression, mood changes, and confusion. This article presents a case of possible LCM-induced psychosis and reviews the literature. A 22-year-old woman presented to the Emergency Department in Status Epilepticus. The seizure was treated with intravenous midazolam and valproic acid. However, she developed cardiopulmonary arrest and was resuscitated successfully. She was intubated and admitted to the intensive care unit. She had first been diagnosed with epilepsy 15 years earlier and had been seizure-free for 3 years. She had undergone a sleeve gastrectomy 1 year earlier. She was extubated the day after admission. LCM 200 mg/day was added to the treatment because of generalized seizures beginning in the right arm. Her seizures were controlled on the 4th hospital day. However, after starting LCM, she developed agitation, visual hallucinations with a sexual content, and intellectual delusions. Therefore, the LCM was discontinued and her psychosis resolved completely 4 days later. On the 12th hospital day, she was discharged. LCM blocks sodium channels and can act as a mood stabilizer and sedative. However, our patient developed psychosis with LCM treatment. This is the first reported case of LCM-induced psychosis in Turkey. Visual hallucinations and psychosis may develop immediately after starting LCM therapy. Clinical recovery can be achieved by discontinuing the drug

Thrombotic thrombocytopenic purpura and ischemic stroke: A case report

Thrombotic Thrombocytopenic Purpura (TTP) characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurological changes, renal failure, and fever is a life threatening, multisystem disease. The first was defined by Moskowitz in 1924. Thrombosis of small arterioles, venules and capillaries lead to cerebral micro-infarct. There are many neurological symptoms such as headache, seizures, changes in consciousness and mental, focal neurological changes. A case which was observed that neurological complications while the patient was monitoring with diagnose of TTP is presented

Demographic/Clinical Characteristics And Midas Scores Of 103 Consecutive Migraine Patients

OBJECTIVE: Migraine as an heterogenous disease and may cause important functional disability in professional and social life. In this study our goal was to examine the characteristics that affect the disability in migraine patients who have different demographic and clinical characeristics, by using migraine disability assesment scale (MIDAS). METHODS: One hundred and three consecutive migraine patients who have admitted to out-patient neurology clinic were included in this study. After definition of their migraine type, patients ' demographic and clinical characteristics and MIDAS scores were recorded.Relation between demographic/social characteristics and MIDAS scores was evaluated on statistical basis RESULTS: There were 86 female and 17 male patients. Mean patient age was 37.3±9.81 (15-70). Twenty patient had migraine with aura, 82 had migraine without aura, one had basilar migraine. MIDAS score was 1 in 8 patients, 2 in 5 patients, 3 in 21 patients and 4 in 69 patients. Mean headache intensity was 8.60±1.38 (4-10). CONCLUSION: Statistical analysis showed a significant positive correlation between headache intensity and disability. However the relation between demographics, migraine type, migraine attack duration or frequency and disability score was insignificant. According to our results, in our society the only characteristic that affects disability score was intensity of headach

Electrophysiologic Findings and Pain in Carpal Tunnel Syndrome

OBJECTIVE: Carpal tunnel syndrome (CTS) is defined as median nerve entrapment within the carpal tunnel at the wrist. Pain and paresthesia are the most common presenting symptoms of the patients. In this study, our aim was to identify the association between intensity of presenting symptoms and electrophysiologic findings in patients referred to the electrophysiology laboratory with prediagnosis of CTS. METHODS: Sixty-two consecutive patients who were referred to the electrophysiology laboratory with the diagnosis of CTS were enrolled in the study. The intensity of pain was determined by visual analog scale, the findings of Tinel-Phalen tests were assessed, and clinico-demographic findings were recorded. Nerve conduction studies were performed bilaterally in median and ulnar nerves. The severity of CTS was determined with electrophysiologic evaluation, and the association between electrophysiologic findings and symptoms were analyzed statistically. RESULTS: Sixty-two (57 female, 5 male) patients were examined in the study. CTS was bilateral in 53 patients and unilateral in 9 patients (total 115 hands). Mean pain score was 5.78 ± 3.50. In 28 hands with a clinical diagnosis of CTS, no electrophysiologic CTS findings were found, whereas in 32 hands mild, in 41 hands moderate and in 14 hands severe findings were obtained. CONCLUSION: According to our study, there was no statistically significant association between severity of symptoms and severity of electrophysiologic findings in CT

Development of Insulin Resistance in Patients with Epilepsy During Valproate and Carbamazepine Monotherapy

Objectives:This study investigated the development of insulin resistance (IR) secondary to the use of valproic acid (VPA) and carbamazepine (CBZ), which are highly effective and frequently used antiepileptic drugs.Methods:This cross-sectional prospective cohort study included 111 participants aged 15 to 64 years. Patients diagnosed with epilepsy were divided into 2 groups: those using VPA (n=45) and those using CBZ (n=35). Those groups were compared to healthy control group (n=31). Preprandial blood glucose, insulin, C-peptide levels were examined, and IR was calculated. Anthropometric measurements were taken.Results:A significant relationship was identified between VPA or CBZ use and development of IR (p<0.05). C-peptide level was significantly higher in patients who used antiepileptic drugs than in control group (p<0.05). Average body mass index (BMI) was not different between groups.Conclusion:In patients under antiepileptic treatment, neuroendocrine dysfunction, such as insulin metabolism disorders, can develop in addition to common side effects. Thus, symptoms should be followed up carefully and patients should be evaluated in terms of side effects both before starting and during treatment

Cost of Inpatient Treatment of Patients with Status Epilepticus in Turkey

Objectives:Status epilepticus (SE) is a neurological emergency with high mortality. As there are no data on the cost of treatment of SE in this country, the aim of this study was to investigate and analyze these costs.Methods:Patients who were hospitalized in the neurology intensive care unit between January and August 2018 were retrospectively evaluated. Demographic data, SE type, etiological factors, antiepileptic drugs used, duration of hospitalization, total cost of hospitalization, and the cost of medication(s) were recorded.Results:The records of 15 patients (male/female: 4/11) with a mean age of 46.73 years were examined. Seven patients had no previous history of epilepsy and their first seizure was SE-like. The seizures were classified as primary generalized convulsive (n=5), focal onset generalized convulsive (n=6), focal motor (n=1), and non-convulsive (n=3) SE. Medication mismatch (n=4), systemic infection (n=4), previous stroke (n=2), acute stroke (n=3), metabolic causes (n=1), and iatrogenic causes (n=1) were found in the seizure etiology. Two patients died during followup. The mean length of time of hospitalization in the neurology service and intensive care unit was 5.7 and 13.2 days, respectively. The mean total cost of the treatment per patient was TL 22,202.86 and the mean drug cost was TL 4,630.73.Conclusion:The presence of an acute central nervous system etiology and advanced age of the patient are 2 important factors that significantly increased the cost. More comprehensive data are needed to investigate the risk factors that contribute to the cost of larger patient numbers in our country