Profile Of Geriatric Patients In A Neuro-Ophthalmology Outpatient Clinic

Introduction: To determine the clinical profile of geriatric patients in a neuroophthalmology outpatient clinic of a tertiary center. Materials and Method: Retrospective evaluation of medical records from the institutional database, including patients aged >= 65 years who were treated by the same neuroophthalmologist, was performed. Results: A total of 99 (52 F, 47 M) geriatric patients were analyzed. Mean age was 72.14 +/- 5.26 years. The most frequent complaint was visual loss (48.9%), followed by oculomotor abnormalities (38.7%). Thirty-eight of 48 patients had permanent visual loss, whereas 10 had transient visual loss. Patients with permanent visual loss were older than those with transient visual loss (mean ages of 73.05 +/- 5.85 and 68.5 +/- 2.84 years, respectively (p=0.022)]. Diplopia was the primary symptom, followed by ptosis in the oculomotor group. Conclusion: Neuro-ophthalmological diseases have many manifestations in the aging population. Physiological changes and risk factors associated with aging may lead to different complaints from young adults. This study contributed to the neuro-ophthalmological profile of Turkish geriatric patients.Wo

Isolated Third, Fourth, And Sixth Cranial Nerve Palsies In The Turkish Population: Etiologic Factors And Clinical Course

Objective: To determine the etiologic factors and clinical profile of isolated third, fourth, and sixth nerve palsies in neuro-ophthalmology outpatient clinics of two different reference centers. Materials and Methods: Retrospective evaluation of medical records from the institutional database. Results: A total of 127 (78 male, 49 female) patients were analyzed. Forty-five (35.4%) patients had isolated third nerve palsy, 34 (26.8%) had isolated fourth nerve palsy, and 48 (37.8%) patients had isolated sixth nerve palsy. The mean ages were similar; 58.87 +/- 13.6, 56.32 +/- 16.1, and 54.9 +/- 14.4 years, respectively (p=0.4). Diplopia was the main symptom seen in all patients. Twenty-one patients had anisocoria (20 third, 1 fourth). Among patients with anisocoria, 3 patients had final diagnoses of vasculopathy, the rest were diagnosed as having acquired non travmatic palsy with different etiologies such as aneurysm, Tolosa-Hunt syndrome, and carotico-cavernous fistula. The most common etiology for all groups was vasculopathy. Three patients with isolated oculomotor nerve palsy were diagnosed as having Tolosa-Hunt sydnrome despite pupillary sparing. The mean recovery time was similar for all cranial nerve palsies. Conclusion: Although, the most common etiology of third, fourth, and sixth nerve palsies is vasculopathy, neuroimaging studies are crucial to exclude potentially treatable and dangerous conditions.WoSScopu

The Presence Of Autoantibodies Against Vascular And Nervous Tissue In Sera From Patients With Neuro-Behcet'S Disease

Introduction: Behcet's disease is a chronic inflammatory disease of unknown aetiology that affects multiple organ systems. Since the diagnosis of this disease mainly relies on clinical criteria, a diagnostic laboratory test is required especially for neuro-Behcet's patients without systemic involvement. Method: In this study, we searched for the presence of autoantibodies against brain tissue, by means of indirect immunofluorescent staining technique in sera obtained from patients with neuro-Behcet's disease, based on reports that humoral immune dysregulation may play a role in susceptibility to Behcet's disease. After pre-absorbtion of sera with guinea pig liver powder to reduce nonspecific staining, serum samples were applied to mouse brain sections and immunoreactivity was detected with fluorescein (FITC)-conjugated goat antibody against human IgG. Results: Ten sera from neuro-Behcet's patients and 10 age-matched control sera were screened for immunoreactivity. We detected specific immunoreactivity to both parenchymal and vascular brain structures in the patients' sera. Parenchymal vessel immunopositivity was detected in 8 of 10 patients, whereas only two of control sera showed no significant parenchymal vascular immunoreactivity (p=0.025). In addition to vascular immunoreactivity, filamentous and reticular immunopositive structures were detected in brain sections of 5 out of 10 patients. No such immunoreactivity was detected in sections incubated with control sera (p=0.016). Conclusion: We detected a specific immunoreactivity against vascular and parenchymal filamentous structures in neuro-Behcet patients' sera. Humoral autoimmunity may play a role in the pathogenesis of neuro-Behcet's disease in addition to cellular immune response. Findings of this preliminary study will be evaluated with a large number of patients and controls, to determine whether it is the cause or the result and, further studies are underway to disclose the nature of epitope to which the immunoreactivity was directed against and to develop a diagnostic laboratory method for investigating central nervous system involvement in Behcet's patients.Wo

Data Of Indirect Immunofluorescence Labeling Of The Mouse Brain Sections With Sera From Sle And Ms Patients

The data presented in this article are related to the research article entitled “Behcet Disease serum is immunoreactive to neurofilament medium which share common epitopes to bacterial HSP-65, a putative trigger” (Lule et a. 2017) . The immunoreactivity to self-antigens is well characterized for systemic lupus erythematosus (SLE) and multiple sclerosis (MS) (Magro Checa et al., 2013) . Indirect immunofluorescence labeling of the mouse tissue sections with patient sera has recently been popular to discover novel epitopes and gain mechanistic insight to diseases with dysregulated immunity (Lennon et al., 2004) . The present article demonstrates widespread labeling of cell nuclei with SLE patient sera and sporadic filamentous labeling along the axons with MS patient sera on mouse brain sections. The filamentous immunolabeling was sometimes associated with cytoplasmic staining of cells, which sent processes along the axon bundles, suggesting that they were oligodendrocytes. Since the mouse brain tissue has little autofluorescence and limited connective tissue causing non-specific immunolabeling, it appears superior to peripheral tissues for searching serum immunoreactivity.PubMe

Analysis Of Peripapillary Retinal Nerve Fiber Layer And Macular Volume In Patients With Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorders, And Healthy Controls Using Spectral Domain Optical Coherence Tomography In A Turkish Cohort

Objective: To compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular volume in patients with multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and healthy controls. Materials and Methods: This study used spectral domain-optical coherence tomography to measure pRNFL and the volume of retinal layers at the macula. Forty patients with MS or NMOSD and 19 healthy controls were enrolled. Results: After at least one clinical episode of optic neuritis, the average pRNFL for NMOSD [60 mu m (34-105)] and patients with MS [85 mu m (41-109)] were lower than in healthy controls [99 mu m (88-109)], and patients with NMOSD had significantly lower pRNFL compared with patients with MS (p=0.002). Foveal volume did not differ between optic neuritis eyes of patients with NMOSD and MS (NMOSD 1.18 +/- 0.3 mm(3), MS 1.82 +/- 2.07 mm(3)). The mean pRNFL values in seroneguive NMOSD eyes [58 mu m (range, 47-111)] tended to be thinner compared with seropositive NMOSD eyes [76 mu m (range, 42-105)]. This finding was not considered to he statistically significant. Conclusion: Our study revealed that both foveal (area in a 1.5 mm ETDRS ring) and coral macular volume (area in a 6 mm ETDRS ring) were lower in both patients with MS and NMOSD compared with healthy controls. Optic neuritis of NMOSD is associated with a thinner average RNFL compared with MS, suggesting earlier axonal injury in the affected optic nerves.WoSScopu

The Presence of Autoantibodies Against Vascular and Nervous Tissue in Sera From Patients with Neuro-Behçet's Disease

ABSTRACT Introduction: Behçet's disease is a chronic inflammatory disease of unknown aetiology that affects multiple organ systems. Since the diagnosis of this disease mainly relies on clinical criteria, a diagnostic laboratory test is required especially for neuro-Behçet's patients without systemic involvement

Factors determining the response to treatment in patients with vestibular migraine

Purpose To find out clinical features associated with poor response to treatment in vestibular migraine (VM) Methods VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. >= 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. Results The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 +/- 12.2 years (range: 17-74 years), were analyzed. Conclusion Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives

Can vestibular migraine development be predicted in patients with new onset migraine headaches?

Objective: This study aims to determine the clinical features associated with the development of vestibular migraine (VM) in patients with migraine headaches. Methods: A cross-sectional, multicenter study was performed in nine tertiary neurology clinics. Patients with migraine without vestibular symptoms were classified as having migraine only (MO) and compared with patients with VM to determine any differences in clinical features, associated disorders, past medical history, and family history of migraine headaches. Moreover, we investigated the features that might predict the development of VM. Results: Two hundred forty-four patients with MO and 461 patients with VM were included. The age of onset of headache attacks was later in life for patients with VM (p<0.001). Migraine without aura (MwoA) was significantly more common than migraine with aura (MwA) in patients with VM (p=0.016). All associated features of migraine headaches were significantly more frequent in patients with MO than patients with VM (p<0.005). The same was true for all triggers, including fasting, sleep disturbances, menstruation, stress, flickering lights, and smartphones/computer games (p<0.005). A family history of migraine headaches was more common in MO patients (p=0.002). However, a previous history of motion sickness was significantly more common in patients with VM (p<0.001), as was aural fullness/tinnitus accompanying attacks (p<0.001). Logistic regression analysis indicated that aural fullness/tinnitus accompanying attacks and a previous history of motion sickness were risk factors for the development of VM. Conclusion: Patients with migraine reporting aural symptoms accompanying attacks and motion sickness in their past medical history are at increased risk of vestibular attacks fulfilling the diagnosis of VM later in life

Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorder Patients in Turkish Cohort Demographic, Clinical, and Laboratory Features

Background: Neuromyelitis optica (NMO) is an immune-mediated, chronic relapsing, inflammatory disease characterized by severe attacks of optic neuritis and myelitis