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AMAÇ: Bu çalýþmada; yaþlý olgularda lökoaraiozis (LA) ile biliþsel durum, denge ve üriner disfonksiyon arasýndaki iliþki araþtýrýldý.
YÖNTEMLER: Nöroloji polikliniðine ayaktan baþvuran 91 olgu çalýþmaya dahil edildi. Manyetik Rezonans Görüntüleme (MRG) yapýlarak, LA varlýðý araþtýrýldý. LA, T2 ve Proton aðýrlýklý sekanslarda hiperintens ve T1 aðýrlýklý sekanslarda hipointens olarak görüldü. Tüm olgularýn MRG’leri daha önceden literatürde tanýmlandýðý gibi 0-4 arasýnda derecelendirildi. Olgularýn LA dereceleri, biliþsel durum, denge ve üriner disfonksiyonlarý kaydedildi.
BULGULAR: LA, biliþsel durum, denge ve üriner disfonksiyon arasýnda anlamlý iliþki saptandý (p<0.01). Serebral beyaz cevher lezyonlarýnýn oranýnda, bayan ve erkekte benzer olarak yaþ ile birlikte artýþ görüldü (p<0.05).
SONUÇ: Bu çalýþma, yaþlý olgulardaki serebral beyaz cevher anomalileri ile biliþsel fonksiyon bozukluðu, denge ve üriner fonksiyon bozukluklarý arasýnda anlamlý iliþki olduðunu göstermektedir. Yaþ ile beyaz cevher patolojilerinin derecesi artmaktadýr. Beyaz cevher hiperintensitelerinin varlýðý ve ciddiyetinin deðerlendirilmesi, tanýsal baðlamda dikkatlice yapýlmalýdýr.

OBJECTIVE: In present study, we aimed the relation between white matter lesions, and cognitive impairment, dysequilibrium and urinary dysfunctions in elderly people.
METHODS: In this study we recruited 91 patients attending our neurology outpatient department. We investigated the presence of leukoaraiosis (LA) on magnetic resonance imaging (MRI). Hyperintense lesions in T2 and proton weighted and non-hypotense lesions in T1 weighted sequences were considered as LA. MRIs of all cases were evaluated by means of a four grade scoring system -described previously in the literature. LA grades of patients with cognitive impairment, dysequilibrium and urinary dysfunctions were recorded.
RESULTS: There was significant associations between LA, and cognitive impairment, dysequilibrium and urinary dysfunctions (p<0.01). The proportion with white matter lesions increased with age, similarly for men and women (p<0.05).
CONCLUSION: This study demonstrated that white matter abnormalities are related to cognitive impairment, dysequilibrium or urinary dysfunctions in elderly people. The degree of cerebral white matter lesions increased with age. Interpretation of the presence and severity of white-matter hyperintensities in a diagnostic context must be done cautiously.

AMAÇ: Multipl myelom genellikle kemik iliðinde sýnýrlý kalmakta, nadiren ekstramedüller tutulumlar oluþturmaktadýr. Santral sinir sistemi tutulumu oldukça nadir olup tüm multipl myelom olgularýnýn %1'inde tanýmlanmýþtýr.
AMAÇLAR: Multipl myelomda santral sinir sistemi tutulumunun deðerlendirilmesi ve literatürün gözden geçirilmesi amaçlanmýþtýr.

YÖNTEMLER: Multipl myelom tanýsý almýþ ve nörolojik yakýnmalarý nedeniyle beyin MR tetkiki yapýlan 39 olgu geriye dönük olarak deðerlendirildi. Tüm olgulardan rutin beyin MR incelemesine ilave olarak kontrastlý görüntüler alýndý. Altý olguda BOS incelemesi gerçekleþtirildi.
BULGULAR: Olgularýn 8'i (%20.5) bilinç bozukluðu, 5'i (%12.8) konuþma bozukluðu, 6'sý (%15.3) baþaðrýsý, 4'ü (%10.2) baþ dönmesi, 4'ü (%10.2) oftalmopleji, 2'si (%5.1) hemiparezi, 2'si (%5.1) meningeal irritasyon bulgularý, 2'si (%5.1) oryantasyon bozukluðu, 2'si (%5.1) skalpte þiþlik, 2'si (%5.1) epilepsi ve 1'i (%2.5) görme bulanýklýðý ile baþvurdu. Kontrastlý beyin MR görüntülerde 14 olguda (%35.8) akut ve kronik iskemik lezyonlar, 14 olguda (%35.8) diploe lezyonu, 5 (%12.8) olguda kemik destrüksiyonuna eþlik eden dural kitle, 4 olguda (%10.2) dural kalýnlaþma, 3 olguda (%7.6) klivus kitlesi, 2 olguda (%5.1) paranazal sinüs kitlesi, 2 olguda (%5.1) leptomeningeal tutulum, 1 olguda (%2.5) orbital apeks ve kavernoz sinüs tutulumu, 1 olguda (%2.5) optik sinirde kontrastlanma, 1 olguda (%2.5) intraorbital kitle ve 1 olguda (%2.5) pontin myelinolizis saptandý. iki olgunun (%5.1) beyin MR'ý normaldi. Dural kalýnlaþma, leptomeningeal tutulum ve meningeal irritasyon bulgularý olan 6 olguya lomber ponksiyon yapýldý. Leptomeningeal tutulumu olan olgunun BOS analizinde plazma hücresi tespit edilirken dural kalýnlaþmasý olan olgularda tekrarlayan lomber ponksiyonlara raðmen hücre tespit edilmedi. BOS bulgularýna dayanarak iki olguya bakteriyel menenjit tanýsý kondu.
SONUÇ: Multipl myelomda santral sinir sistemi tutulumu nadirdir. Metabolik (hiperkalsemi, ilaç toksisitesi, üremi) nedenler, hiperviskozite ve spinal kord kompresyonlarýyla açýklanamayan nörolojik bulgular varlýðýnda santral sinir sistemi tutulumunun BOS analizi ve beyin MR tetkikiyle araþtýrýlmasý uygun olacaktýr.

OBJECTIVE: Multiple myeloma is usually restricted to the bone marrow. Central nervous system involvement is uncommon and can be observed in approximately 1% of the multiple myeloma patients. OBJECTIVES: We aimed to demonstrate brain magnetic resonance patterns in patients with multiple myeloma with neurologic symptoms and the literature is reviewed.
METHODS: We retrospectively studied 39 patients with multiple myeloma with neurologic symptoms. All the patients underwent classic and contrast enhanced brain MR examination.
RESULTS: Patients presented with the following symptoms: impaired consciousness (n=8, 20.5%), headache (n=6, 15.3%), hemiparesis (n=2, 5.1%), aphasia (n=6, 15.3%), scalp swelling (n=2, 5.1%), visual loss (n=1, 2.5%), seizure (n=2, 5.1%), vertigo (n=4, 10.2%), ophthalmoplegia (n=4, 10.2%), meningeal irritation findings (n=2, 5.1%), and orientation disorder (n=2, 5.1%). Among 39 patients with multiple myeloma, 14 (35.8%) had ischemic lesions, 14 (35.8%) had calvarial diploic metastases, 5 (12.8%) had dura mater mass, 4 (10.2%) had dura mater involvement, 2 (5.1%) had sinonasal mass, 1 had cavernous sinus and orbital apex mass, 1 (2.5%) had leptomeningeal involvement, 1 (2.5%) had intraorbital mass, 3 (7.6%) had clivus mass, 1 (2.5%) had optic neuritis, 1 (2.5%) had central pontine myelinolysis and 2 (5.1%) had meningitis. Examination of the cerebrospinal fluid was performed in 6 patients. Cerebrospinal fluid studies showed malignant plasma cells in 1 patient with leptomeningeal contrast enhancement. Despite serial cerebrospinal fluid examination, plasma cells in cerebrospinal fluid were not showed in 2 patients with dura mater involvement. Two patients had menengitis.
CONCLUSION: Involvement of the central nervous system in multiple myeloma is very uncommon. The occurrence of neurological symptoms in a patient with myeloma requires an accurate evaluation with MR and lumbar puncture to detect a possible meningeal or cerebral involvement, when metabolic factors (hypercalcemia,drug toxicity, uremia), hyperviscosity, or medullary compression can be excluded.

AMAÇ: Zamana yönelim ya da oryantasyon klinik açýdan deðerlendirilen ilk iþlevlerden biridir. Aðýr psikiyatrik bozukluklar, beyin patolojileri, ilaç veya toksik durumlarda zamana yönelim etkileneceðinden, doðru deðerlendirme klinik açýdan oldukça önemlidir. Ancak saðlýklý kiþilerde bile zaman oryantasyonunun özellikle eðitim seviyesi gibi çeþitli demografik deðiþkenlerden etkilenebileceði belirtilmektedir. AMAÇLAR: Bu çalýþma, saðlýklý kiþilerde demografik deðiþkenlerin (yaþ, eðitim, cinsiyet gibi) zamana yönelimi üzerindeki etkilerini incelemek amacýyla yapýlmýþtýr.
YÖNTEMLER: Çalýþmaya, 24-100 yaþ (x=50.74, std=17.46) aralýðýnda saðlýklý toplam 526 kiþi katýlmýþtýr. Katýlýmcýlar, SMMSE zaman oryantasyonu alt testi ile deðerlendirilmiþtir.
BULGULAR: Ki Kare testi ile yapýlan analizlerde, cinsiyet (K: 217/E: 309) ve yaþ gruplarý (24-29, 30-39, 40-49, 50-59, 60-69, 70-100) açýsýndan gruplar arasý farklarýn bulunmadýðý, ancak eðitim seviyesinin (okur-yazar-5 yýl; 6-11 yýl; 12 yýl ve üstü) anlamlý bir deðiþken olduðu görülmüþtür. Eðitim düzeyi düþtükçe zamana yönelim etkilenebilmektedir.
SONUÇ: Bu çalýþmadan elde edilen bulgular, ülkemizdeki özellikle düþük eðitim gruplarý ile çalýþan klinisyenlere yardýmcý olabilir.

OBJECTIVE: Time orientation is one of the cognitive functions that were first to be clinically assessed. Because time orientation is affected by severe psychiatric disturbance, brain pathologies, medication or toxicity, correct assessment is important in the clinical sense. However, it has been stated that, even healty people's time orientation may be affected by demographic variables, such as the level of education.
OBJECTIVES: This study has aimed at determining the effects of demoghraphic variables (such as age, education and gender) on time orientation.
METHODS: 526 healthy people between the ages of 24100 (x=50.74, std=17.46) participated in the study. Participants were assessed by SMMSE time orientation subtest.
RESULTS: According to Chi-Square analysis, there are no differences between the gender groups (F: 217/M: 309) and the age groups (24-29, 30-39, 40-49, 50-59, 60-69, 70-100), but the level of education (literate-5 years; 6-11 years; 12 years and above) has been found to be a significant variable. The lower the education level, the more time orientation is affected.
CONCLUSION: The results that were obtained from that study may be helpful especially for the clinicians who work with low education groups.

AMAÇ: Paraneoplastik etiyoloji beyin damar hastalýklarý içinde sýk deðildir. Farklý oluþum mekanizmalarý, klinik görünümleri ve tedavi süreçleri bu sýk görülmeyen tabloyu ilginç kýlmaktadýr. Sýk görülmemesi gözden kaçmasýna yol açabilmektedir. Kliniðimizde paraneoplastik iskemik inme tanýsý alan olgunun klinik ve görüntüleme bulgularý bu nadir görülen tabloyu anýmsatmak amacý ile gözden geçirilmiþtir. OLGU: Over ve kolon karsinomu ve karaciðer metastazý olan 60 yaþýndaki kadýn hasta, akut sol hemipleji ile kliniðimize baþvurdu. Manyetik rezonans görüntülemesinde ayný yaþta multipl infarktlarý saptandý. Laboratuar parametreleri kronik yaygýn damar içi pýhtýlaþma ile uyumlu idi. Antikoagüle edilen hastanýn klinik bulgularýnda deðiþiklik olmadý. Bir ay sonra evinde yaþamýný kaybettiði öðrenildi.
YORUMLAR: Nadir görülen paraneoplastik iskemik inme, iskemik inme ayýrýcý tanýsýnda yer alan, farklý oluþum mekanizmalarý, görüntüleme bulgularý ve tedavi yöntemleri ile bilinmesi gereken bir klinik tablodur. Prognoz, tablodan sorumlu tümörün özellikleri ile iliþkilidir.

OBJECTIVE: Paraneoplastic etiology is not frequent among cerebrovascular disorders. This rare disorder is interesting with different mechanisms, clinical manifestations and treatment options. Diagnosis may be overlooked for its rarity. We present a paraneoplastic ischemic stroke patient with its clinical and imaging characteristics for recalling this rare disease.
CASE: A sixty years old woman with a history of ovarian and colon cancer and liver metastasis admitted with acute left sided hemiplegia. Brain magnetic resonance imaging showed multiple ischemic lesions at the same age. Laboratory findings were compatible with chronic disseminated intravascular coagulopathy. She was anticoagulated but the clinical findings were not changed. She died one month after her discharge from the hospital.
CONCLUSIONS: Paraneoplastic ischemic stroke is rare and it should be recognized by the clinician to differentiate from other ischemic strokes by its different mechanisms, imaging characteristics and treatment modalities. Prognosis depends on the characteristics of the primary tumor.

Bilimsel zemin: istirahatte nötral pozisyona dönmeyen, hareketsiz distonik postür olarak tanýmlanan sabit distoninin ellerde görülen izole formu olan yumruk el sendromu (YES), fokal el distonisiyle karýþabilir. Sabit distoniler; sekonder distonilerde (akkiz bazal ganglion hastalýklarýnda, kortikobazal dejenerasyonda), kompleks bölgesel aðrý sendromunda, psikojen hareket bozukluðunda karþýmýza çýkabilir. Bu tip distonilerin taný aþamasý uzun, tedavisi de güç olmaktadýr. AMAÇ: Yumruk el sendromlu bir olguyu sunarak, ayýrýcý tanýsýný ve tedavisini literatür eþliðinde tartýþmayý amaçladýk. OLGU: Ellerini (saðý 5, solu 3 yýldýr) kullanamama þikâyeti ile gelen, 42 yaþýnda kadýn hastanýn fizik muayenesinde, iki elin dorsal yüzünde gode býrakan ödem, palmar yüzünde maserasyon, fissür ve kötü bir koku, týrnaklarda trofik deðiþiklikler gözlendi. Nörolojik muayenede bilateral üst ekstremitelerde yumruk yapýlmýþ el þeklinde fleksiyon postürü saptandý. Volenter ve zorlu ekstansiyona getirilemedi. Anestezi uygulandýktan sonra ellerde minimal pasif ekstansiyon saðlandý. Kranial ve spinal MR, biyokimya ve kan tetkikleri normal saptandý. EMG'de distonik aktivite gözlenmedi. Tedavide multidisipliner yaklaþým uygulandý.
YORUM: Sabit distonili ve dolayýsý ile yumruk el sendromlu hastalarda primer ve sekonder sebepler ekarte edildikten sonra tanýya ve tedaviye yönelik invazif yaklaþýmlardan kaçýnýlarak, fizyoterapi, iþ-uðraþý tedavisi, kognitif davranýþçý tedavi, psikoterapi, botulinum toksin uygulamasý, antikolinerjik, antiepileptik, benzodiazepinler gibi tedavileri içeren, nörolog, fizyoterapist, psikiyatrist, el cerrahý ve dermatoloðun katýlýmýyla multidisipliner bir yaklaþým gerçekleþtirilmelidir.

Scientific BACKGROUND: Fixed dystonia, is an immobile dystonic posture which could not return to neutral position at rest. Clenched fist syndrome, which is an isolated form of fixed dystonia of hands, could be confused with focal hand dystonia. Fixed dystonias could be seen in symptomatic dystonias (such as corticobasal degeneration, acquired basal ganglion disease), complex regional pain syndrome, and psychological movement disorder. The diagnosis of this kind of dystonias may be delayed and the treatment is difficult. OBJECTIVE: Our aim is to present a case with clenched fist syndrome, to discuss the differential diagnosis, treatment and to review of the literature.
CASE: The patient is a 42-year-old woman with inability to use her right hand for 5 and left hand for 3 years. In physical examination, dorsum of the hands were oedematous, palms of the hands were macerated with a bad odour, and unguis had a dystrophic appearence. In neurologic examination, clenched fists were observed. Voluntary and forced extension of the interphalangeal and metacarpophalangeal joints were impossible. After general anesthesia, passive extension of the hands were only minimal. Cranial, spinal magnetic resonance imaging and blood chemistry were within normal limits. In needle electromyographic study dystonic discharges were not observed. Multidisciplinary approach was performed in management.
CONCLUSION: In clenched fist syndrome or generally in fixed dystonias, invasive treatment modalities had to be avoided. Treatment modalities including physiotherapy, work-therapy, behavioural therapy, psychotherapy, botilinum toxin injection, medical treatment such as anticholinergics, benzodiazepine and antiepileptics should be performed by multidisciplinary approach after primary and secondary etiologies were eliminated. This means neurologist, physiotherapist, psychiatrist, dermatologist, and hand surgeon should work together when dealing such a patient.

Bilimsel zemin: Herpes zoster oftalmikus enfeksiyonlarý tüm zoster enfeksiyonlarýnýn %25 kadarýný oluþturur. Bununla birlikte herpes zoster enfeksiyonlarý ile birlikte ekstraoküler bakýþ paralizisi oldukça nadir bildirilmiþtir.
AMAÇ: Bu yazýda, herpes zoster oftalmikus enfeksiyonu ile birlikte altýncý kranial sinir paralizisi geliþen bir olgu sunulmuþtur. OLGU: Altmýþ yaþýnda bir bayan hasta sol retroorbital aðrý, konjuktival konjesyon, alýn ve burnun sol yarýsýnda döküntü ve altýncý kranial sinir paralizisi ile baþvurmuþtur.
SONUÇ: Herpes zoster virüs enfeksiyonu ekstraoküler bakýþ paralizisinin bir nedeni olarak göz önünde bulundurulmalýdýr ve erken tedavi ile bu tür komplikasyonlarýn geliþimi önlenebilir.

Scientific BACKGROUND: Herpes zoster ophthalmicus represents aproximately 25% of all zoster infections. However extraocular gaze palsy in association with herpes zoster infection is extremely rare. OBJECTIVE: We presented here a patient who had herpes zoster ophthalmicus with sixth cranial nerve palsy.
CASE: The sixty year old patient had suffered from left retroorbital pain, conjunctival congestion and rashes on the left forehead and the nose and developed ipsilateral sixth cranial nerve palsy. RESULT: Herpes zoster virus infection should be taken into consideration in patients with extraocular paralysis and early treatment may prevent such complications.

Eriþkin yaþta epileptik nöbet ile ortaya çýkan iki adet intrakranial iðne olgusu sunulmuþ, nöbetlerin mekanizmasý, hastalarýn tedavileri ve medikolegal durumlarý tartýþýlmýþtýr

We present two adult cases who presented with seizures and found to have intracranial sewing needles incidentally during their evaluation. The mechanism, treatment and medicolegal aspects are discussed.

Scientific BACKGROUND: Epileptic seizure could be induced by various drugs or agents administered for the treatment of other accompanying diseases in patients with controlled epileptic seizures. These drugs may lead to a stimulation in central nervous system and thereby reduce the seizure threshold.
CASE: A 13 years old girl presented with epileptic seizures when she took a drug including pseudoephedrine for sinusitis. She was known to have epilepsy which was well controlled by medication. Epileptic seizures were provoked by the cold medication and resolved on the cessation of drug. No seizure was observed during the long term follow-up period.
CONCLUSION: Administration of some drugs including pseudoephedrine to the patients with epilepsy may exacerbate the epileptic seizures as these agents have a stimulant effect on the central nervous system.

Bilimsel zemin: Nöbetleri kontrol altýnda olan epileptik hastalarda, baþka rahatsýzlýklar için verilen santral sinir sistemi stimülaný veya epileptik eþiði düþüren ilaçlar nöbetleri tekrar ortaya çýkarabilir.
OLGU: Jeneralize tonik-klonik nöbetleri antiepileptik ilaçla kontrol altýnda olan 13 yaþýnda bir kýz hastada, sinüzit tedavisi için psödoefedrin verilmesinin ardý sýra jeneralize tonik-klonik nöbetler ortaya çýktý. ilacýn kesilmesiyle tekrar nöbet görülmedi. Uzun süren izleminde hasta yakýnmasý olmadýðýný bildirdi.
YORUM: Santral sinir sistemi stimülaný olan efedra grubundan psödoefedrin içeren ilaçlar epileptik hastalara verilirken, nöbet ortaya çýkabileceði göz önünde bulundurulmalýdýr.