In this section, the brief information about secondary prevention of stroke by the recent develop... more In this section, the brief information about secondary prevention of stroke by the recent developments will be presented. Recommendation regarding the secondary risk factors including hypertension, diabetes, dyslipidemia, atrial fibrillation, symptomatic carotid occlusions, arterial dissections and patent foramen ovale and their treatment approaches will be offered.
Objective: Status epilepticus (SE) can cause life-threatening consequences. It is important to de... more Objective: Status epilepticus (SE) can cause life-threatening consequences. It is important to determine the etiologic factors of SE and treatment responses in elderly individuals, especially those with certain comorbidities. Based on our databank, these factors were evaluated in patients aged over 60 years. We reviewed the data of individuals aged over 60 years who were diagnosed clinically and electrophysiologically as having SE in the same databank. Demographic data of patients, SE subtypes, etiology, treatment responses, and survival of patients were noted. We evaluated 162 patients aged older than 60 years with SE episodes. The mean age of the patients was 73 years. Seventy-three percent of the patients were female. The types of SE episodes were: nonconvulsive (NCSE) (93 episodes), convulsive SE (56 episodes), and NCSE after convulsive SE (23 episodes). Stroke was the leading cause of the etiologies and accounted for 37% of the SE episodes. The NCSE subtype was more refractory to treatment (p=0.003). The longer duration and refractoriness of the episodes significantly predicted a worse outcome (p=0.0001, p=0.01). Prolonged SE duration and the refractoriness of SE episodes are risk factors for poor outcomes.
Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproducti... more Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results. The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34±9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cas...
To determine the electroencephalographic (EEG) response to intravenous bolus administration of di... more To determine the electroencephalographic (EEG) response to intravenous bolus administration of diazepam during status epilepticus (SE), we retrospectively evaluated the time to the disappearance of epileptiform activity in EEG recordings after 10 mg intravenous bolus administration of diazepam, and examined the relationship of this response time to the duration, etiology, and outcome of SE. Patients with SE who responded positively to diazepam administration (n = 53; 37 women, 16 men), aged 17-88 years were recruited from our SE registry. According to their response time to intravenous administration of diazepam, patients were divided into four subgroups: Group I response times ranged from 20 to 60 s, group II from 61 to 120 s, group III from 121-180 s, and group IV from 181 to 360 s. The duration of SE was 10.76 ± 3.46 h in the first group and 27.00 ± 12.57 h in the last group. According to the etiology, patients with central nervous system tumors and metabolic disorders were the fastest responders, whereas those with cerebrovascular diseases and withdrawal of antiepileptic drugs were the slowest responders. This study revealed a positive correlation between the response time to diazepam administration and seizure duration during status epilepticus. Response time may have a role in predicting outcome of status epilepticus treatment, in particular, the effects of diazepam. Thus, longer-duration EEGs are indicated.
Refractory status epilepticus (RSE) is known to constitute approximately 10-50% of all cases of s... more Refractory status epilepticus (RSE) is known to constitute approximately 10-50% of all cases of status epilepticus (SE) and is associated with significant morbidity and mortality. In the present study, data from a prospectively collected SE database were analyzed. Patients with RSE (defined as a SE episode requiring a second line of intravenous treatment following intravenous phenytoin) were compared with patients with nonrefractory SE (NRSE); 290 episodes of SE were identified, of which 108 (38%) were defined as RSE. Univariate analysis revealed that age, female gender, SE type, SE duration, and acute etiology were associated with refractoriness, whereas electroencephalographic patterns were not. Nonconvulsive SE, which is probably associated with delays in treatment initiation, was a predictor of RSE, although it was not retained as a predictor in multivariate analysis. In the latter analysis, female gender (odds ratio: 1.815, 95% CI: 1.053-3.126) and acute etiology (odds ratio: 0.619, 95% CI: 0.429-0.894) were shown to be the only significant independent predictors of refractoriness.
The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of sta... more The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of status epilepticus (SE) episodes, among patients aged 16-50 years. A total of 101 SE episodes in 88 young adult patients fulfilled our criteria. The mean age was 32 years. Status epilepticus episodes were most frequently observed in patients 21-30 years of age. A total of 53% of the patients were male, and 57% had pre-existing epilepsy. Seventy of the 101 episodes were convulsive SE. The most common etiology was withdrawal of or change in antiepileptic drugs (AEDs), seen in 31% of the SE episodes. This study included treatment of SE with traditional AEDs. Sixty-six episodes were treated successfully with intravenous infusion of 18-mg/kg phenytoin, and six episodes were treated with 10-mg/kg phenytoin. A total of 28% of the SE episodes remained refractory to first-line treatment, which was related to the duration of SE and mortality. The outcome was death in 14% of the patients due to underlying etiologies in the hospital.
Purpose: To evaluate gender, type and etiology of status epilepticus (SE), presence of epilepsy i... more Purpose: To evaluate gender, type and etiology of status epilepticus (SE), presence of epilepsy in history, treatment and outcome of SE in young patients who have been diagnosed SE below 50 years. Methods: We studied retrospectively in a total of 267 patients who had 288 SE episodes (111 women, 156 men), we analysed 72 patients (78 episodes) of SE with age below 50 years from SE registry data bank from 1997 to 2005. Results: SE most frequently observed in patients ranging from 21 to 30 years. There have been four recurrent SE episodes in one of the patients, three times in one patient and two times in one patient. Fourty-two of 78 SE episodes are convulsive SE (CSE), 16 of them are Nonconvulsive SE (NCSE) and 10 of them are first CSE then NCSE. Twenty-eight of 72 patients have previous history of epilepsy who also use antiepileptic drugs. In treatment of SE episodes in patients, intravenous infusion of diphenylhydantin (DPH) 18 mg/kg in 64 episodes, IV infusion of DPH 10 mg/kg in 22 episodes, IV infusion of phenobarbital (PB) 18 mg/kg in 18 episodes, IV infusion of PB 10 mg/kg in 6 episodes, clozepam in 1 episode, midazolam infusion in 7 episodes, propophol infusion in 2 SE episodes were given. Etiologies of SE consist of first infectious diseases, then withdrawal or change of antiepileptic drugs and then intracranial lesions according to order of frequency in young patients. The outcome of SE is poor in 7 out of 72 patients in spite of SE treatment. Conclusion: While different etiologies take place in epilepsy according to different age groups, etiologic factors and prognosis change according to age groups in SE. Convulsive SE is more frequently seen, recurring and resistant SE episodes are also encountered.
s of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008)... more s of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131 S81 P039 Analysis of EEG changes during stimulation using comprehensive similarity method Ewa Zalewska 1, Leszek Kowalczyk 1 , Jan Miszczak 2 1Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland; 2Military Institute of Aviation Medicine, Warsaw,
neuromuscular transmission disorder in 7 of 12 ADQ (58%), 3 of 4 (75%) trapezius and 2 of 6 OO (3... more neuromuscular transmission disorder in 7 of 12 ADQ (58%), 3 of 4 (75%) trapezius and 2 of 6 OO (33%) muscles. SFEMG was abnormal in all of 16 patients (100%). No correlation was found between serum AChR Ab titers and SFEMG (p≤ 0.05) and abnormal decremantal response on RNS testing (p≤ 0.05). Conclusion: AntiAChR Ab values are not associated with jitter and decrement abnormalities in myasthenia gravis patients.
Cerebral infarction is a presentation of systemic lupus erythematosus (SLE) and generally appears... more Cerebral infarction is a presentation of systemic lupus erythematosus (SLE) and generally appears during advanced, active phases of the disease. A thirty-two year old female was admitted to hospital with a history of diarrhea, agitation, headache and left hemiparesis. On physical examination her body temperature was high, lymphadenopathy and pretibial edema were noticed. Cranial diffusion weighted images were performed and acute bilateral disseminated multiple cortical and subcortical areas of high signal intensities on T2 and T1-weighted images compatible with vasculitis were detected. On laboratory tests, low complement levels, thrombocytopenia, neutropenia, lymphopenia, positive antinuclear antibodies (ANA) (1/320), persistently elevated anti-DNA titres and proteinuria were found. Renal biopsy confirmed lupus nephritis. Chest X-ray showed cardiomegaly and pleural effusion. This case presentation shows evidence of ischemia in patients with active SLE and also shows that the first symptom of SLE can be an acute ischemic stroke.
Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişims... more Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişimsel tedavilerin başarıyı yakalayabilmesi için iki uygulama ile desteklenmesi gerekir. Bunların ilki akut hastaların merkezlere zamanında ve güvenli triyajını sağlayacak olan "akut inme sevk ve idare sistemi", diğeri ise bu hastaların akut dönem hastane kalışındaki uygulamalarıdır. Hastane uygulamaları nöroloji yoğun bakım veya inme ünitelerinde başlayan bir süreç olup sonuçları hemşirelik uygulamalarının kalitesinden doğrudan etkilenir. Akut inme hemşireliği inme spesifik tedavilerin etkin ve güvenli uygulaması, kan basıncı, kan şekeri, yutma, nütrisyon ve hidrasyonun yönetimi; hastanın postür, mobilizasyon, erken dönem fizik tedavi ve rehabilitasyon planı; bilinç ve nörolojik muayenenin takibi; ayrıca venöz tromboembolizm, gastrik ve enfeksiyon proflaksisi; KIBAS, enfeksiyon, solunumsal yetmezlik ve kanama gibi komplikasyonların önlenmesi ile yoğun bakımda hasta takibi ve çok etkili hasta, hasta yakını ve takım etkileşimi ve iletişimini içerir. Bu derleme akut inme hemşireliğinin birçok güncel rehberinin ülkemiz için adapte edilmiş temel uygulama ve metriklerini sunar.
Many hypokinetic and hyperkinetic movement disorders (e.g. parkinsonism, chorea, myoclonus, dysto... more Many hypokinetic and hyperkinetic movement disorders (e.g. parkinsonism, chorea, myoclonus, dystonia) are associated with acquired immune deficiency syndrome (AIDS) and may sometimes represent the initial manifestation of the illness. We described a 37-year-old human immunodeficiency virus (HIV)-infected patient with generalized choreoathetoid movements associated with AIDS. Cranial MRI revealed multiple cerebral and cerebellar abscesses. The diagnosis of toxoplasmosis was established by brain biopsy. Hemichorea and hemiballismus in AIDS patients are pathognomonic findings of cerebral toxoplasmosis. Generalized choreiform movement is a rare condition and related to the bilateral cerebral involvement in toxoplasma disease affecting the subcortical structures.
Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in... more Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in females and usually in generalised form. We present a 66-year-old woman with acute onset hemichorea-ballism with no vascular pathology in the basal ganglia region. A clear relationship was observed between the onset of chorea and worsening of haematological parameters in the patient. After repeated phlebotomies the patient's clinical status was improved. Polycythaemic chorea must be considered, especially in the elderly, as early diagnosis leads to effective treatment and prevention of complications.
Herpes simplex encephalitis (HSE) is a serious viral infection with a high rate of mortality. The... more Herpes simplex encephalitis (HSE) is a serious viral infection with a high rate of mortality. The most commonly seen complications are behavioral changes, seizures and memory deficits. We report the case of a 37-year-old man with HSE in the right temporal lobe and a severe midline shift who was treated with acyclovir. The patient underwent anterior temporal lobe resection. Although HSE can cause permanent cognitive deficits, in this case, early surgical intervention minimized any deficit, as determined by detailed neuropsychological examination. Surgical decompression is indicated as early as possible in severe cases. This case report emphasizes the effect of surgical decompression for HSE on cognitive function, which has rarely been mentioned before.
Atriyal fibrilasyonu (AF) olan hastalarda başta iskemik olaylar olmak üzere, tromboembolik olayla... more Atriyal fibrilasyonu (AF) olan hastalarda başta iskemik olaylar olmak üzere, tromboembolik olaylar artma eğilimindedir. Epidemiyolojik veriler, AF'li hastalarda inmelerin sıklıkla kardiyoembolizmden kaynaklandığını göstermektedir. 1,2 Tromboembolik olay riskini azaltmak için oral antikoagülanların rolü
Changes in blood homocysteine, vitamin B12 and folic acid levels have been reported during multip... more Changes in blood homocysteine, vitamin B12 and folic acid levels have been reported during multiple sclerosis (MS) and treatment period; however, the exact mechanism has not been enlightened. We investigated the changes of serum B12, folic acid, and plasma homocysteine levels before and after high-dose IV methylprednisolone treatment and after interferon-β treatment in patients admitted with an acute attack of MS.31 patients followed for clinically definite MS (8 male, 23 female) and 10 control individuals were included in the study. 20 patients were admitted with an acute attack and were administered 1000 mg/day methylprednisolone for 7 days. 27 patients started interferon-β treatment. Serum B12, folic acid, and plasma Homocysteine levels measured before and after the 1 month after high dose steroid treatment and after 3-month interferon-β treatment were compared with pre-treatment levels and healthy controls. Baseline B12 levels were lower in patients with MS than in healthy contr...
Amaç: Bu çalışmanın amacı politerapi altındaki (birden fazla antiepileptik kullanan) epilepsi has... more Amaç: Bu çalışmanın amacı politerapi altındaki (birden fazla antiepileptik kullanan) epilepsi hastalarının demografik, klinik, nörolojik muayene ve görüntüleme sonuçlarının incelenerek politerapi ihtiyacına eşlik eden faktörlerin belirlenmesidir. Hastalar ve Yöntem: Marmara Üniversite Hastanesi Epilepsi polikliniğinde takipli 785 epileptik hastanın dosyası retrospektif olarak taranıp, hazırlanan formlar doldurulmuştur. Hastalar monoterapi ya da politerapi kullanmalarına göre gruplanmıştır. İki grup demografik veriler, klinik özellikler, nörolojik muayene ve görüntüleme sonuçları açısından Student-t ve ki-kare testleri ile karşılaştırılmıştır. Bulgular: Politerapi kullanan hasta grubunda öyküde kraniyotomi, intrakraniyal tümör, basit parsiyel nöbet ve konvülsif status epileptikus, nörolojik muayenede patolojik bulgu görülmesi, EEG, kranial görüntüleme (MR/BT) ve SPECT’de patoloji saptanması monoterapi kullanan hasta grubundan daha yüksek bulunmuştur. Sonuç: Politerapi epilepsi tedavi...
Objective: To assess the localizing value of interictal scalp EEG in epileptic focal cortical dys... more Objective: To assess the localizing value of interictal scalp EEG in epileptic focal cortical dysplasia (FCD) patients.Methods: A retrospective observational study of EEG records of epileptic patients seen at the Marmara University Hospital was performed. EEG and MRI findings were evaluated to detect a possible correlation. Results: EEG findings were consistent with MRI findings in 6 patients (37.5%).Conclusion: EEG findings were irrelevant in 62.5% (n:10) of patients. Additional imaging techniques such as ictal SPECT, MEG etc. will clearly augment the success of lesion localisation in FCD patients.
In this section, the brief information about secondary prevention of stroke by the recent develop... more In this section, the brief information about secondary prevention of stroke by the recent developments will be presented. Recommendation regarding the secondary risk factors including hypertension, diabetes, dyslipidemia, atrial fibrillation, symptomatic carotid occlusions, arterial dissections and patent foramen ovale and their treatment approaches will be offered.
Objective: Status epilepticus (SE) can cause life-threatening consequences. It is important to de... more Objective: Status epilepticus (SE) can cause life-threatening consequences. It is important to determine the etiologic factors of SE and treatment responses in elderly individuals, especially those with certain comorbidities. Based on our databank, these factors were evaluated in patients aged over 60 years. We reviewed the data of individuals aged over 60 years who were diagnosed clinically and electrophysiologically as having SE in the same databank. Demographic data of patients, SE subtypes, etiology, treatment responses, and survival of patients were noted. We evaluated 162 patients aged older than 60 years with SE episodes. The mean age of the patients was 73 years. Seventy-three percent of the patients were female. The types of SE episodes were: nonconvulsive (NCSE) (93 episodes), convulsive SE (56 episodes), and NCSE after convulsive SE (23 episodes). Stroke was the leading cause of the etiologies and accounted for 37% of the SE episodes. The NCSE subtype was more refractory to treatment (p=0.003). The longer duration and refractoriness of the episodes significantly predicted a worse outcome (p=0.0001, p=0.01). Prolonged SE duration and the refractoriness of SE episodes are risk factors for poor outcomes.
Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproducti... more Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results. The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34±9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cas...
To determine the electroencephalographic (EEG) response to intravenous bolus administration of di... more To determine the electroencephalographic (EEG) response to intravenous bolus administration of diazepam during status epilepticus (SE), we retrospectively evaluated the time to the disappearance of epileptiform activity in EEG recordings after 10 mg intravenous bolus administration of diazepam, and examined the relationship of this response time to the duration, etiology, and outcome of SE. Patients with SE who responded positively to diazepam administration (n = 53; 37 women, 16 men), aged 17-88 years were recruited from our SE registry. According to their response time to intravenous administration of diazepam, patients were divided into four subgroups: Group I response times ranged from 20 to 60 s, group II from 61 to 120 s, group III from 121-180 s, and group IV from 181 to 360 s. The duration of SE was 10.76 ± 3.46 h in the first group and 27.00 ± 12.57 h in the last group. According to the etiology, patients with central nervous system tumors and metabolic disorders were the fastest responders, whereas those with cerebrovascular diseases and withdrawal of antiepileptic drugs were the slowest responders. This study revealed a positive correlation between the response time to diazepam administration and seizure duration during status epilepticus. Response time may have a role in predicting outcome of status epilepticus treatment, in particular, the effects of diazepam. Thus, longer-duration EEGs are indicated.
Refractory status epilepticus (RSE) is known to constitute approximately 10-50% of all cases of s... more Refractory status epilepticus (RSE) is known to constitute approximately 10-50% of all cases of status epilepticus (SE) and is associated with significant morbidity and mortality. In the present study, data from a prospectively collected SE database were analyzed. Patients with RSE (defined as a SE episode requiring a second line of intravenous treatment following intravenous phenytoin) were compared with patients with nonrefractory SE (NRSE); 290 episodes of SE were identified, of which 108 (38%) were defined as RSE. Univariate analysis revealed that age, female gender, SE type, SE duration, and acute etiology were associated with refractoriness, whereas electroencephalographic patterns were not. Nonconvulsive SE, which is probably associated with delays in treatment initiation, was a predictor of RSE, although it was not retained as a predictor in multivariate analysis. In the latter analysis, female gender (odds ratio: 1.815, 95% CI: 1.053-3.126) and acute etiology (odds ratio: 0.619, 95% CI: 0.429-0.894) were shown to be the only significant independent predictors of refractoriness.
The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of sta... more The aim of this study was to evaluate the type, duration, etiology, treatment, and outcome of status epilepticus (SE) episodes, among patients aged 16-50 years. A total of 101 SE episodes in 88 young adult patients fulfilled our criteria. The mean age was 32 years. Status epilepticus episodes were most frequently observed in patients 21-30 years of age. A total of 53% of the patients were male, and 57% had pre-existing epilepsy. Seventy of the 101 episodes were convulsive SE. The most common etiology was withdrawal of or change in antiepileptic drugs (AEDs), seen in 31% of the SE episodes. This study included treatment of SE with traditional AEDs. Sixty-six episodes were treated successfully with intravenous infusion of 18-mg/kg phenytoin, and six episodes were treated with 10-mg/kg phenytoin. A total of 28% of the SE episodes remained refractory to first-line treatment, which was related to the duration of SE and mortality. The outcome was death in 14% of the patients due to underlying etiologies in the hospital.
Purpose: To evaluate gender, type and etiology of status epilepticus (SE), presence of epilepsy i... more Purpose: To evaluate gender, type and etiology of status epilepticus (SE), presence of epilepsy in history, treatment and outcome of SE in young patients who have been diagnosed SE below 50 years. Methods: We studied retrospectively in a total of 267 patients who had 288 SE episodes (111 women, 156 men), we analysed 72 patients (78 episodes) of SE with age below 50 years from SE registry data bank from 1997 to 2005. Results: SE most frequently observed in patients ranging from 21 to 30 years. There have been four recurrent SE episodes in one of the patients, three times in one patient and two times in one patient. Fourty-two of 78 SE episodes are convulsive SE (CSE), 16 of them are Nonconvulsive SE (NCSE) and 10 of them are first CSE then NCSE. Twenty-eight of 72 patients have previous history of epilepsy who also use antiepileptic drugs. In treatment of SE episodes in patients, intravenous infusion of diphenylhydantin (DPH) 18 mg/kg in 64 episodes, IV infusion of DPH 10 mg/kg in 22 episodes, IV infusion of phenobarbital (PB) 18 mg/kg in 18 episodes, IV infusion of PB 10 mg/kg in 6 episodes, clozepam in 1 episode, midazolam infusion in 7 episodes, propophol infusion in 2 SE episodes were given. Etiologies of SE consist of first infectious diseases, then withdrawal or change of antiepileptic drugs and then intracranial lesions according to order of frequency in young patients. The outcome of SE is poor in 7 out of 72 patients in spite of SE treatment. Conclusion: While different etiologies take place in epilepsy according to different age groups, etiologic factors and prognosis change according to age groups in SE. Convulsive SE is more frequently seen, recurring and resistant SE episodes are also encountered.
s of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008)... more s of the 13th European Congress of Clinical Neurophysiology / Clinical Neurophysiology 119 (2008), S1–S131 S81 P039 Analysis of EEG changes during stimulation using comprehensive similarity method Ewa Zalewska 1, Leszek Kowalczyk 1 , Jan Miszczak 2 1Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland; 2Military Institute of Aviation Medicine, Warsaw,
neuromuscular transmission disorder in 7 of 12 ADQ (58%), 3 of 4 (75%) trapezius and 2 of 6 OO (3... more neuromuscular transmission disorder in 7 of 12 ADQ (58%), 3 of 4 (75%) trapezius and 2 of 6 OO (33%) muscles. SFEMG was abnormal in all of 16 patients (100%). No correlation was found between serum AChR Ab titers and SFEMG (p≤ 0.05) and abnormal decremantal response on RNS testing (p≤ 0.05). Conclusion: AntiAChR Ab values are not associated with jitter and decrement abnormalities in myasthenia gravis patients.
Cerebral infarction is a presentation of systemic lupus erythematosus (SLE) and generally appears... more Cerebral infarction is a presentation of systemic lupus erythematosus (SLE) and generally appears during advanced, active phases of the disease. A thirty-two year old female was admitted to hospital with a history of diarrhea, agitation, headache and left hemiparesis. On physical examination her body temperature was high, lymphadenopathy and pretibial edema were noticed. Cranial diffusion weighted images were performed and acute bilateral disseminated multiple cortical and subcortical areas of high signal intensities on T2 and T1-weighted images compatible with vasculitis were detected. On laboratory tests, low complement levels, thrombocytopenia, neutropenia, lymphopenia, positive antinuclear antibodies (ANA) (1/320), persistently elevated anti-DNA titres and proteinuria were found. Renal biopsy confirmed lupus nephritis. Chest X-ray showed cardiomegaly and pleural effusion. This case presentation shows evidence of ischemia in patients with active SLE and also shows that the first symptom of SLE can be an acute ischemic stroke.
Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişims... more Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişimsel tedavilerin başarıyı yakalayabilmesi için iki uygulama ile desteklenmesi gerekir. Bunların ilki akut hastaların merkezlere zamanında ve güvenli triyajını sağlayacak olan "akut inme sevk ve idare sistemi", diğeri ise bu hastaların akut dönem hastane kalışındaki uygulamalarıdır. Hastane uygulamaları nöroloji yoğun bakım veya inme ünitelerinde başlayan bir süreç olup sonuçları hemşirelik uygulamalarının kalitesinden doğrudan etkilenir. Akut inme hemşireliği inme spesifik tedavilerin etkin ve güvenli uygulaması, kan basıncı, kan şekeri, yutma, nütrisyon ve hidrasyonun yönetimi; hastanın postür, mobilizasyon, erken dönem fizik tedavi ve rehabilitasyon planı; bilinç ve nörolojik muayenenin takibi; ayrıca venöz tromboembolizm, gastrik ve enfeksiyon proflaksisi; KIBAS, enfeksiyon, solunumsal yetmezlik ve kanama gibi komplikasyonların önlenmesi ile yoğun bakımda hasta takibi ve çok etkili hasta, hasta yakını ve takım etkileşimi ve iletişimini içerir. Bu derleme akut inme hemşireliğinin birçok güncel rehberinin ülkemiz için adapte edilmiş temel uygulama ve metriklerini sunar.
Many hypokinetic and hyperkinetic movement disorders (e.g. parkinsonism, chorea, myoclonus, dysto... more Many hypokinetic and hyperkinetic movement disorders (e.g. parkinsonism, chorea, myoclonus, dystonia) are associated with acquired immune deficiency syndrome (AIDS) and may sometimes represent the initial manifestation of the illness. We described a 37-year-old human immunodeficiency virus (HIV)-infected patient with generalized choreoathetoid movements associated with AIDS. Cranial MRI revealed multiple cerebral and cerebellar abscesses. The diagnosis of toxoplasmosis was established by brain biopsy. Hemichorea and hemiballismus in AIDS patients are pathognomonic findings of cerebral toxoplasmosis. Generalized choreiform movement is a rare condition and related to the bilateral cerebral involvement in toxoplasma disease affecting the subcortical structures.
Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in... more Chorea is a rare complication of polycythaemia vera. Polycythaemic chorea occurs predominantly in females and usually in generalised form. We present a 66-year-old woman with acute onset hemichorea-ballism with no vascular pathology in the basal ganglia region. A clear relationship was observed between the onset of chorea and worsening of haematological parameters in the patient. After repeated phlebotomies the patient's clinical status was improved. Polycythaemic chorea must be considered, especially in the elderly, as early diagnosis leads to effective treatment and prevention of complications.
Herpes simplex encephalitis (HSE) is a serious viral infection with a high rate of mortality. The... more Herpes simplex encephalitis (HSE) is a serious viral infection with a high rate of mortality. The most commonly seen complications are behavioral changes, seizures and memory deficits. We report the case of a 37-year-old man with HSE in the right temporal lobe and a severe midline shift who was treated with acyclovir. The patient underwent anterior temporal lobe resection. Although HSE can cause permanent cognitive deficits, in this case, early surgical intervention minimized any deficit, as determined by detailed neuropsychological examination. Surgical decompression is indicated as early as possible in severe cases. This case report emphasizes the effect of surgical decompression for HSE on cognitive function, which has rarely been mentioned before.
Atriyal fibrilasyonu (AF) olan hastalarda başta iskemik olaylar olmak üzere, tromboembolik olayla... more Atriyal fibrilasyonu (AF) olan hastalarda başta iskemik olaylar olmak üzere, tromboembolik olaylar artma eğilimindedir. Epidemiyolojik veriler, AF'li hastalarda inmelerin sıklıkla kardiyoembolizmden kaynaklandığını göstermektedir. 1,2 Tromboembolik olay riskini azaltmak için oral antikoagülanların rolü
Changes in blood homocysteine, vitamin B12 and folic acid levels have been reported during multip... more Changes in blood homocysteine, vitamin B12 and folic acid levels have been reported during multiple sclerosis (MS) and treatment period; however, the exact mechanism has not been enlightened. We investigated the changes of serum B12, folic acid, and plasma homocysteine levels before and after high-dose IV methylprednisolone treatment and after interferon-β treatment in patients admitted with an acute attack of MS.31 patients followed for clinically definite MS (8 male, 23 female) and 10 control individuals were included in the study. 20 patients were admitted with an acute attack and were administered 1000 mg/day methylprednisolone for 7 days. 27 patients started interferon-β treatment. Serum B12, folic acid, and plasma Homocysteine levels measured before and after the 1 month after high dose steroid treatment and after 3-month interferon-β treatment were compared with pre-treatment levels and healthy controls. Baseline B12 levels were lower in patients with MS than in healthy contr...
Amaç: Bu çalışmanın amacı politerapi altındaki (birden fazla antiepileptik kullanan) epilepsi has... more Amaç: Bu çalışmanın amacı politerapi altındaki (birden fazla antiepileptik kullanan) epilepsi hastalarının demografik, klinik, nörolojik muayene ve görüntüleme sonuçlarının incelenerek politerapi ihtiyacına eşlik eden faktörlerin belirlenmesidir. Hastalar ve Yöntem: Marmara Üniversite Hastanesi Epilepsi polikliniğinde takipli 785 epileptik hastanın dosyası retrospektif olarak taranıp, hazırlanan formlar doldurulmuştur. Hastalar monoterapi ya da politerapi kullanmalarına göre gruplanmıştır. İki grup demografik veriler, klinik özellikler, nörolojik muayene ve görüntüleme sonuçları açısından Student-t ve ki-kare testleri ile karşılaştırılmıştır. Bulgular: Politerapi kullanan hasta grubunda öyküde kraniyotomi, intrakraniyal tümör, basit parsiyel nöbet ve konvülsif status epileptikus, nörolojik muayenede patolojik bulgu görülmesi, EEG, kranial görüntüleme (MR/BT) ve SPECT’de patoloji saptanması monoterapi kullanan hasta grubundan daha yüksek bulunmuştur. Sonuç: Politerapi epilepsi tedavi...
Objective: To assess the localizing value of interictal scalp EEG in epileptic focal cortical dys... more Objective: To assess the localizing value of interictal scalp EEG in epileptic focal cortical dysplasia (FCD) patients.Methods: A retrospective observational study of EEG records of epileptic patients seen at the Marmara University Hospital was performed. EEG and MRI findings were evaluated to detect a possible correlation. Results: EEG findings were consistent with MRI findings in 6 patients (37.5%).Conclusion: EEG findings were irrelevant in 62.5% (n:10) of patients. Additional imaging techniques such as ictal SPECT, MEG etc. will clearly augment the success of lesion localisation in FCD patients.
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