Pathological yawning in patients with acute middle cerebral artery infarction: Prognostic significance and association with the infarct location

Background: Pathological yawning is a compulsive, frequent, repetitive yawning triggered by a specific reason besides fatigue or boredom. It may be related to iatrogenic, neurologic, psychiatric, gastrointestinal, or metabolic disorders. Moreover, it could also be seen in the course of an ischemic stroke. Aims: To determine whether pathological yawning is a prognostic marker of middle cerebral artery stroke and evaluate its relationship with the infarct location. Study Design: Cross-sectional study. Methods: We examined 161 patients with acute middle cerebral artery stroke, consecutively admitted to emergency department. Demographic information, stroke risk factors, stroke type according to Trial of Org 10172 in Acute Stroke Treatment classification, blood oxygen saturation, body temperature, blood pressure, heart rate, glucose levels, daytime of stroke onset, National Institutes of Health Stroke Scale score (National Institutes of Health Stroke Scale score, at admission and 24 h), modified Rankin scale (at 3 months), and infarct locations were documented. Pathological yawning was defined as ?3 yawns/15 min. All patients were observed for 6 hours to detect pathological yawning. National Institutes of Health Stroke Scale score >10 was determined as severe stroke. The correlation between the presence of pathological yawning and stroke severity, infarct location, and the short-and long-term outcomes of the patients were evaluated. Results: Sixty-nine (42.9%) patients had pathological yawning and 112 (69.6%) had cortical infarcts. Insular and opercular infarcts were detected in 65 (40.4%) and 54 (33.5%) patients, respectively. Pathological yawning was more frequently observed in patients with cortical, insular, and opercular infarcts (p<0.05). Pathological yawning was related to higher National Institutes of Health Stroke Scale scores. Patients with severe stroke (National Institutes of Health Stroke Scale score ?10) presented with more pathological yawning than those with mild to moderate strokes (p<0.05). The clinical outcomes and mortality rates showed no significant relationship with the occurrence of pathological yawning. Conclusion: Pathological yawning in middle cerebral artery stroke was associated with stroke severity, presence of cortical involvement, and insular and opercular infarcts. However, no association was found with long-term outcome and mortality. ©Copyright 2020 by Trakya University Faculty of Medicine / The Balkan Medical Journal published by Galenos Publishing House

Demographic, Clinical and Electrophysiological Characteristics of the Hereditary Neuropathy Patients in Sakarya

Amaç Herediter nöropatiler; periferik sinir sisteminde, demyelinizasyon ve/veya akson kaybına yol açan, ilerleyici bir hastalık grubudur. Herediter nöropatiler genellikle aileselolmakla birlikte, sporadik olgular da nadiren görülebilir. Çalışmamızda Sakarya ilindeki herediter nöropatili olguların, demografik, klinik ve elektrofizyolojik özellikleriaraştırılmıştır. ( Sakarya Tıp Dergisi 2019, 9(1):120-124 )Gereç veYöntemBu çalışmaya, merkezimize 2011-2016 yılları arasında başvuran, herediter sensorimotor nöropati (HSMN) tanısı alan 26 hasta dahil edildi. Bu hastalara ait veriler; yaş,cinsiyet, hastalık başlangıç yaşı, başvuru yakınmaları, akraba evliliği, klinik ve elektrofizyolojik bulgular, ailesel ve genetik özellikler açısından retrospektif olarak incelendi.Bulgular Kliniğimizde takip edilen 26 hastanın 13’ü (%50) erkekti. Yaş ortalaması 41±12,29 iken hastalık bulgularının başlangıç yaş ortalaması 23,26±13,7 idi. Elektrofizyolojikincelemeler, 9 hastada aksonal, 12 hastada demiyelinizan ve 5 hastada mikst formda bir hasarı göstermekteydi. Genetik incelemelerde, 5 hastada heterezigot PMP 22delesyon ve 2 hastada PMP 22 duplikasyonu tespit edildi. Böylece, 5 hasta Charcot Marie Tooth (CMT)-1A, 2 hasta herediter basınca duyarlı polinöropati (HNPP) tanısıalırken, diğer 19 hasta ise tiplendirilemeyen herediter nöropati olarak değerlendirildi.Sonuç Son yıllarda moleküler biyoloji alanındaki yeni gelişmeler şimdiye kadar pek çok sınıflandırılamamış herediter nöropati tipinin tanınmasına yönelik önemli kazanımlarsağlamıştır. Çalışmamızda, Türkiye’de genotip değerlendirmesi yapılabilen demiyelinizan tip olguların Sakarya ilindeki fenotipik özellikleri değerlendirilmiş ve literatürle kıyaslanmıştır.Objective Hereditary neuropathies are a group of progressive disease that leads to demyelination and / or loss of axons in the peripheral nervous system. Although hereditary neuropathies frequently occurs in familial form, sporadic cases are rarely seen. In our study, demographic, clinical, and electrophysiological characteristics of hereditary neuropathy patients in Sakarya province were investigated. ( Sakarya Med J 2019, 9(1):120-124 ) Materials and Methods Totally 26 registered patients who were diagnosed as hereditary sensorimotor neuropathy (HSMN) between 2011 and 2016 were recruited for this study. The data of these patients were analyzed retrospectively in terms of age, gender, age at symptoms onset, referral complaints, consanguineous marriage, clinical and electrophysiological findings, familial and genetic features. Results Of the 26 patients followed up in our clinic, 13 (50%) were male. The mean age of the patients was 41±12,29, while the mean age of the symptoms onset was 23,26±13,7. Electrophysiological examinations showed axonal neuropathy in 9, demyelinating neuropathy in 12, and mixed neuropathy in 5 cases. Genetic studies revealed heterozygous PMP 22 deletion in 5 cases and PMP 22 duplication in 2 cases. Therefore, 5 cases were diagnosed as Charcot Marie Tooth (CMT)-1A, 2 cases were diagnosed as hereditary pressure sensitive polyneuropathy (HNPP), while other 19 cases were evaluated as unclassified hereditary neuropathy. Conclusion Recent advances in the field of molecular biology have provided significant development in recognition of many unclassified types of hereditary neuropathies. In our study, the phenotypic characteristics of demyelinating type cases which can be genotyped in Turkey of Sakarya province was evaluated and compared with the literature.

Evaluation of Interictal Electroencephalography Findings in Patients with Focal Epilepsy: Does Secondary Bilateral Synchrony Play a Role on Seizure Frequency?

Amaç: İnteriktal elektroensefalografi (EEG) epilepsi hastaları için günlük pratikte sıklıkla kullanılan, tanı ve tedavi sürecinde önemli olan elektrofizyolojik bir testtir. İnteriktal epileptiform deşarjların (İED) doğru değerlendirilmesi ve sekonder bilateral senkroninin (SBS) tanınması uygun tedavi seçeneklerinin değerlendirilmesi için önemlidir. Bu çalışmada, SBS varlığının nöbet sıklığı, lokalizasyon ve tedavi yanıtında rolü olup olmadığının araştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada, Namık Kemal Üniversitesi Uygulama ve Araştırma Hastanesi Nöroloji Polikliniği’nde epilepsi tanısı ile takip edilmekte olan 126 hastanın verileri geriye dönük olarak incelenmiştir. Hastaların demografik özellikleri, nöbet sıklığı, lokalizasyonu, tedavi yanıtı ve EEG özellikleri incelenmiş ve 122 hastanın sonuçlarına ulaşılmıştır. Bulgular: Olguların 58’i (%46) kadın, 68’i (%54) erkektir. Yaş ortalaması 36.5±16.4 (15–78) olarak saptanmıştır. On beş hastanın (%12.2) EEG’sinin SBS olarak raporlandığı tespit edilmiştir. Elli dört hastada (%44.2) fokal epileptiform anomali, 12 hastada (%9.8) fokal zemin ritmi düzensizliği (non-epileptik bulgular) saptanmıştır. Semiyolojik özellikler ve EEG bulguları ile birlikte değerlendirildiğinde 44 hasta (%34.9) frontal lob nöbet, 66 hasta (%52.4) temporal lob nöbet ve 16 hasta (%12.6) diğerleri olarak sınıflandırılmıştır. Yüz yirmi altı hastanın 46’sı (%36.5) nöbetsiz iken 15 hastada (%11.9) yılda bir nöbet, 46 hastada (%36.5) 1–6 ayda bir nöbet ve 19 hastada (%15.1) günlük ya da haftalık nöbetler olduğu saptanmıştır. Kırkaltı nöbetsiz hastanın 29’unda (%23) erken dönemde, 17’sinde (%13.5) tedavinin başlanmasından altı ay sonra nöbetsizlik elde edilebilmiştir. Sonuç: İnteriktal EEG’de, İED ve SBS varlığı nöbet sıklığı ve tedavi yanıtı açısından risk faktörü olmamakla birlikte frontal lob nöbetlerde SBS oranı daha yüksektir. Tedavi düzenlenmesinde, İED ve SBS varlığının göz önünde bulundurulması yanlış sonuçlara neden olabilirObjectives: Interictal electroencephalography (EEG) is an electrophysiological test used in daily practice and important in the diagnosis and treatment process for epileptic patients. Accurate assessment of the interictal epileptiform discharges (IEDs) and recognition of secondary bilateral synchrony (SBS) are important for the evaluation of appropriate treatment options. In this study, we investigated whether the presence of SBS is a risk factor for seizure frequency, treatment response, and localization. Methods: In this study, the data of 126 patients who were followed up with the diagnosis of epilepsy in the Neurology Outpatient Clinic of Namık Kemal University Education and Research Hospital were analyzed retrospectively. Demographic characteristics, seizure frequency, localization, treatment response and EEG characteristics of the patients were investigated and the results of 122 patients were obtained. Results: Fifty-eight (46%) of the patients were female, and 68 (54%) were male. The mean age was 36.5±16.4 (15–78) years. EEG of 15 patients (12.2%) was reported as SBS. Focal epileptiform abnormality was detected in 54 patients (44.2%) and focal irregular background activity (non-epileptic findings) was found in 12 patients (9.8%). When semiological features and EEG findings were evaluated together, 44 patients (34.9%) were classified as frontal lobe seizures, 66 patients (52.4%) as temporal lobe seizures, 16 patients (12.6%) as the others. Forty-six patients (36.5%) had no seizures, while 15 (11.9%) had one seizure per year, 46 (36.5%) had one seizure in one to six months, and 19 (15.1%) had daily or weekly seizures. Twenty-nine (23%) of the 46 seizure-free patients became seizure-free in an early stage, 17 patients (13.5%) became seizure-free after the sixth month of the treatment. Conclusion: Although the presence of IED and SBS in interictal EEG is not a risk factor for seizure frequency and treatment response, and the rate of SBS is higher in frontal lobe seizures. The presence of IED and SBS in the management of treatment may lead to false results

Patent Foramen Ovale in Young Patients with Ischemic Stroke

INTRODUCTION: The foramen ovale is a hole in the interatrial septum in prenatal period, which is closed after birth with the increase of left atrium pressure. If it does not close, stroke due to parodoxically embolism, local thrombosis, arrhythmia and hypercoagulability can be seen. In this article, the frequency of patent foramen ovale (PFO) and atrial septal aneurysm (ASA), treatment approaches and follow-up results have been reported in young stroke patients. METHODS: The files of 163 young stroke patients between 18 and 45 years of age who were followed up at our clinic were reviewed retrospectively. Transthoracic echocardiography (TTE) revealed PFO in 2 patients, ASA in 2 patients. Transeosophageal echocardiography (TEE) reported PFO in 5 patients. Age, gender, premorbid disease and antiaggregant-anticoagulant medical theraphy, routine tests, imaging, TTE and TEE findings, treatment protocols, stroke recurrence were recorded. RESULTS: PFO was detected in 5 of 163 young stroke patients (3.06%) (3K, 2E). The average age was 30.2 (18-42). One patient had transient ischemic attack and 4 patients had stroke. There was a 1 patient has a previous stroke and 2 patients were smokers. Carotis stenosis was not detected in patients. ANA was positive in recurrent stroke patient, another patient had recurrent abortion, heterozygote mutation of FVL, MTHFR C677T and A1298C and hyperhomocysteinemia. One patient had PFO and no other pathological result for etiological investigation. Endovascular closure was performed in 2 patients. 2 patients were treated with acetylsalicylic acid and 2 patients were treated with warfarin. No recurrent stroke was seen in 3-5 year follow-ups. DISCUSSION AND CONCLUSION: PFO investigation in young patients should be perform as a medical and surgically treatable factor against the risk of recurrence. In addition to the cryptogenic case, it is emphasized in all young stroke patients that TTE and TTE should be performed even in the presence of a known risk factor

Seizure Induced by Extended-Release Bupropion Used for Smoking Cessation at Early Term and Therapeutic Dose

Bupropion inhibits reuptakes of dopamine and noradrenaline. Since it is also a nicotine receptor antagonist, it acts as a drug used for smoking cessation. Bupropion is commonly preferred because of no side effects on weight, sexual function, and the lack of sedative effect. Immediate and sustained-release bupropion forms may trigger seizure activity. In the present article, we report a case of a 30-year-old man presenting with generalized tonic clonic seizures induced by extended-release bupropion. We also emphasized that extended-release bupropion, which is commonly used for smoking cessation therapy, may cause seizure at early term and therapeutic dose

Prevalence of carpal tunnel syndrome and its correlation with pain amongst female hairdressers

Objectives Carpal tunnel syndrome (CTS) may develop with repetitive and forced movements of the hands and wrists. In this study, we have aimed to evaluate whether the frequency of CTS is increased amongst female hairdressers as compared with unemployed women or not. Besides, we have also analyzed whether the functionality and pain intensity levels amongst female hairdressers with CTS are different from the ones of unemployed women with CTS or not. Material and Methods The consecutive female hairdressers and unemployed women who had referred to our electroneuromyography (ENMG) laboratory for the upper extremity nerve conduction studies were included. They were evaluated in terms of clinical and ENMG findings, socio-demographic characteristics, functionality and pain intensity levels determined with the Boston CTS Questionnaire and visual analog scale (VAS). Results In this study, 110 women (70 female hairdressers and 40 unemployed women) were included. The frequency of CTS among hairdressers (74.3%) was higher than the one of the unemployed control group (55%) (p = 0.032). We detected that as the time period of occupation in hairdressing increased, the risk of developing CTS also increased among hairdressers (p < 0.001). Additionally, pain intensity and functional loss levels were higher for hairdressers with CTS than those for the control group with CTS (p = 0.005, p < 0.001, p = 0.028, respectively). Conclusions The frequency of CTS is elevated for female hairdressers with respect to the unemployed women as in many other occupations requiring forced or repetitive hand movements. Besides, the occupational exposure in hairdressing also results in more elevated pain intensity and functional loss levels related with CTS as compared with the unemployed subjects. Int J Occup Med Environ Health 2018;31(3):333–33

Delayed diagnosis of a neuroBehçet patient with only brainstem and cerebellar atrophy: Literature review

We report a 34-year-old male neuroBehcet's Disease (NBD) patient with atypical magnetic resonance imaging (MRI) findings, whose behavioral problems were followed by progressive neurological symptoms. The patient was hospitalized due to forgetfulness, irritability, behavioral dyscontrol and a choking sensation. T2-weighted MRI showed prominent atrophy of cerebellar hemispheres, the cerebellar peduncle, the midbrain and the pons. He was diagnosed with NBD after an evaluation of his medical history together with neuropsychiatric and laboratory findings. There are few reports of NBD with only brainstem and cerebellar atrophy. We discuss our patient in the context of the four previously reported cases. In NBD without evident mucocutaneo-ocular symptoms, neurologists should always consider the medical and family history. Early diagnosis of NBD helps to initiate appropriate treatment, thereby modulating the course of the disease and preventing complications

The Evaluation of Botulinum Toxin Injection Effect for Poststroke Spasticity Treatment

Objective: In this study we aimed to evaluate the effectivity of treatment with the botulinum toxin-type A (BTX-A) on spasticity, spasticity-related pain, and the daily living activities in post-stroke patients with upper or lower limb spasticity. Materials and Methods: A total of 35 (23 right side, 12 left side) post-stroke patients who had upper and/or lower limb spasticity were enrolled to the study. BTX-A (249±41 U) was applied to their affected extremities. The degree of spasticity in the upper (elbow, wrists, and fingers) and lower (leg, knee and ankle) extremities was evaluated before treatment, 1 month, and 3 months after treatment using Modified Ashworth Scale (MAS). Daily life activities and severity of spasticity-related pain were also evaluated using the Barthel index and Visual Analogue Scale (VAS) at the same time points. Results: The average age of the patients in the study was 60±6 years. Both upper and lower extremities were affected in 69%, whereas upper or lower extremities were affected in 31% of patients. BTX-A provided improvement in severity of the spasticity, pain scale, functionality, and quality of life according to the MAS, VAS, and Barthel indexes.The benefits were sustained in the first 3 months of the post-treatment. Conclusion: BTX-A in the treatment of post-stroke spasticity is a reliable method in terms of adverse effects, pain reduction, its ability to provide long-term effectiveness, and increase functionality and quality of lif

Serum Fetuin-A Levels in Patients with Bilateral Basal Ganglia Calcification

Background and Purpose: The idiopathic basal ganglia calcification (Fahr syndrome) may occur due to senility. Fetuin-A is a negative acute phase reactant which inhibits calcium-phosphorus precipitation and vascular calcification. In this study, we aimed to evaluate whether serum fetuin-A levels correlate with bilateral basal ganglia calcification. Method: Forty-five patients who had bilateral basal ganglia calcification on brain CT were selected according to the inclusion and exclusion criteria, and 45 age and gender-matched subjects without basal ganglia calcification were included for the control group. Serum fetuin-A levels were measured from venous blood samples. All participants were divided into two groups; with and without basal ganglia calcification. These groups were divided into subgroups regarding age (18-32 and 33-45 years of age) and gender (male, female). Results: We detected lower levels of serum fetuin-A in patients with basal ganglia calcification compared with the subjects without basal ganglia calcification. In all subgroups (female, male, 18-32 years and 33-45 years), mean fetuin-A levels were significantly lower in patients with basal ganglia calcification (p = 0.017, p = 0.014, p = 0.024, p = 0.026, p = 0.01 respectively). And statistically significantly lower levels of fetuin-A was found to be correlated with the increasing densities of calcification in the calcified basal ganglia group (p-value: < 0.001). Conclusion: Considering the role of fetuin-A in tissue calcification and inflammation, higher serum fetuin-A levels should be measured in patients with basal ganglia calcification. We believe that the measurement of serum fetuin-A may play a role in the prediction of basal ganglia calcification as a biomarker

Comparison of VEP Parameters in NMOSD and MS Patients

Congress of the Pan-Asian-Committee-for-Treatment-and-Research-in-Multiple-Sclerosis (PACTRIMS) -- 2018 -- Sydney, AUSTRALIA[No Abstract Available]Pan Asian Comm Treatment & Res Multiple Sclerosi