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Göz hareketleri, hareket eden görsel hedeflerin izlenmesi ve foveal fiksasyonu saðlayarak net görmemizi saðlar. Bu hareketler oküler
motor sistem tarafýndan gerçekleþtirilir. Oküler motor sistem anatomik lokalizasyona göre infranükleer, nükleer, internükleer ve sup-
ranükleer olmak üzere bölümlere ayrýlarak irdelenir. internükleer liflerin oluþturduðu medial longitudinal fasikül lezyonu sonucu geli-
þen internükleer oftalmopleji, gençlerde sýklýkla multipl skleroz sonucu bilateral olarak görülür, yaþlýlarda ise vasküler hastalýklara bað-
lý geliþir. Supranükleer oküler motor bozukluklar; konjuge bakýþ felçleri, tonik deviasyonlar, sakkadik ve izleme göz hareket bozukluk-
larý, verjans anormallikleri, nistagmus ve oküler osilasyonlar olarak sýralanabilir. Supranükleer bozukluklar, oküler motor nükleuslarýn
üzerindeki lezyonlar sonucu ortaya çýkar ve tüm oküler motor hastalýklarýn yaklaþýk %10’unu oluþturur. Okülosefalik manevra ile göz
hareketleri yapýlabiliyorsa lezyon supranükleer; yapýlamýyorsa internükleer, nükleer ya da infranükleerdir.

Eye movements let us fixate on and follow a moving visual target. These movements are performed by the ocular motor system that
is divided according to anatomic location into infranuclear, nuclear, internuclear, and supranuclear components. It is important to
distinguish supranuclear and internuclear from nuclear and infranuclear disturbances. Internuclear ophthalmoplegia is due to a lesion of the medial longitudinal fasciculus, caused by multiple sclerosis in younger patients, particularly when the ophthalmoplegia is
bilateral, and usually of vascular origin in the elderly. Supranuclear disorders of eye movements are characterized by gaze palsies, tonic gaze deviation, saccadic and smooth pursuit disorders, vergence abnormalities, nystagmus, and ocular oscillations. Supranuclear
disorders result from lesions above the level of the ocular motor nerve nuclei, and they account for almost 10% of all patients with
disorders of eye movements. If oculocephalic maneuvers move the eyes appropriately, the lesion causing the gaze palsy is supranuc-
lear; if oculocephalic maneuvers do not move the eyes, the lesion may be internuclear, nuclear, or infranuclear.

AMAÇ: Merkezimizde mitoksantron endikasyon kriterleri çerçevesinde tedavi protokolüne alýnan erken progresif sürece geçiþ döne-
mindeki relaps ve remisyonlarla giden ve inflamasyon yanýtýnýn devam ettiði erken sekonder progresif multipl skleroz hastalarýnýn te-
davi yanýtlarý, izlemleri, ilaç yan etkileri ve manyetik rezonans görüntüleme (MRG) takibi olan hastalarýn sonuçlarýnýn aktarýlmasý amaç-
lanmýþtýr.

YÖNTEMLER: 2001-2008 yýllarý arasýnda tedavisini almýþ, halen almakta olan ve düzenli izlemi olan hastalar retrospektif ola-
rak deðerlendirilmiþtir. Hastalar progresif süreçte olup immünmodülatuar tedaviye yanýtsýzdýr ve immünsüpresif tedavi kontrendikas-
yonu taþýmamaktadýr. Aktif infeksiyonu ve kardiyak hastalýðý olmayan hastalara tam kan, karaciðer fonksiyon testleri, idrar tetkiki ve
transtorasik ekokardiyografinin ardýndan günlük tedaviyle; 3 ay indüksiyon, sonrasýnda 3 ayda bir 12 mg/m2 mitoksantron verilmiþ-
tir. Hastalar yan etkiler açýsýndan kontrolde tutulmuþtur.

BULGULAR: Deðerlendirmeye 33 kadýn ve 15 erkek hasta alýnmýþtýr. Tedavi protokolüne alýnan hastalarýn baþlangýç ortalama yaþlarý 36.6
± 7.8 yýl, hastalýk süreleri 9.38 ± 4.8 yýl, ortalama “expanded disease severity scale (EDSS)” 5.8, tedavi süreleri ortalama 11.16 ± 7.4
ay olarak deðerlendirilmiþtir. Tedavi sonunda 17 hastanýn özürlülük durumunda stabilizasyon, 10 hastada EDSS’de azalma, 14 hasta-
da ise EDSS’de tedaviye raðmen artýþ izlenmiþtir. On altý hastada tedavi iliþkili yan etki görülmemiþtir. ‹zlenen yan etkiler deðerlendi-
rildiðinde; 18 hastada bulantý, 1 hastada kalýcý lökopeni, 4 hastada geçici trombositopeni, 13 hastada alopesi, 1 hastada nötropenik
ateþ, 18 hastada amenore izlenmiþtir. MRG izlemleri olan bir alt grup hastanýn tedavi sonunda lezyon yükü artýþýnda duraklama göz-
lenmiþtir.

SONUÇ: Çalýþmamýz mitoksantron tedavisinin etkinliðini, klinik deðerlendirme ve izlem MRG bulgularý ile özetlemektedir. Tedavi etkin-
liðinde zamanlama ve doðru hasta seçimi önemli olup, ilk 3 kür sonunda yanýt verebilecek olan hastalarýn özürlülüklerinde sýnýrlanma-
nýn olmasý önemli klinik gözlemlerimizdendir.

OBJECTIVE: To report the clinical follow-up, side effects, and magnetic resonance imaging (MRI) findings of mitoxantrone treatment
in patients in the early phase of secondary progressive and exacerbating relapsing-remitting multiple sclerosis.
METHODS: Patients that completed and/or were undergoing treatment between 2001 and 2008 were included in the
study. All patients were definitive progressive multiple sclerosis patients and met ‘non-responder’ criteria for immunomodulatory the-
rapy. They did not have active infection, cardiac disease, or any contraindication for immunosuppressive treatment. Baseline comp-
lete blood count, liver function tests, and transthoracic echocardiography were performed. Mitoxantrone was given as induction the-
rapy (1 dose per month for 3 months) and then as maintenance therapy (with 3 month periods, 12 mg/m2 until to the cumulative
dose was reached). Patients were followed-up regularly for the appearance of any side effects.
RESULTS: The study included 33 female and 15 male patients. Mean age was 36.6 ± 7.8 years, mean disease duration was 9.38 ±
4.8 years, mean expanded disease severity scale (EDSS) score was 5.8, and mean treatment duration was 11.16 ± 7.4 months. Fol-
lowing the end of treatment, 17 patients were stabilized, 10 improved, and 14 progressed. There were no side effects observed du-
ring or after treatment in 16 patients. Among the other 32 patients, the observed side effects were as follows: nausea (n= 18), per-
manent leucopenia (n= 1), transient thrombocytopenia (n= 4), alopecia (n= 13), neutropenic fever (n= 1), and amenorrhea (n= 18).
MRI follow-up was performed in a subgroup of patients and showed that the lesion loads were stabilized.
CONCLUSION: We reported the efficacy, and clinical and MRI follow-up results of multiple sclerosis patients treated with mitoxantro-
ne. Patient selection and therapy timing was very important for maximum efficacy. Patients that responded to mitoxantrone treat-
ment benefited beginning with the induction phase and their disability was limited or improved.

AMAÇ: Son dönemdeki çalýþmalar incelendiðinde, epilepside alternatifsiz olarak kullanýlan klasik antiepileptik ilaçlar son 2 dekad içe-
risinde yerlerini yeni antiepileptik ilaçlara teslim ediyor görünmektedir. Bu çalýþmalarýn saha pratiðini yansýtýp yansýtmadýðýný deðerlen-
dirmek amacýyla bu çalýþma planlanmýþtýr.

YÖNTEMLER: 2001-2007 yýllarý arasýnda polikliniðimize epilepsi tanýsý ile baþvuran hastalarýn kayýtlarý retrospektif olarak ince-
lendi.

BULGULAR: : Toplam 1358 hasta verisi deðerlendirildi. Bin yüz yirmi (%82) hasta tekli, 238 (%18) hasta çoklu antiepileptik ilaç tedavisi
kullanmaktaydý. Tedavi baþlangýç tarihine göre gruplandýrýldýðýnda; 2000-2007 yýllarýnda ilaç baþlanan 603 hastanýn 552 (%86)’si kla-
sik, 92 (%14)’si yeni; 1995-1999 yýllarýnda ilaç baþlanan 483 hastanýn 467 (%95)’si klasik, 24 (%5)’ü yeni; 1994 ve öncesinde ilaç baþ-
lanan 272 hastanýn 270 (%99)’i klasik, 3 (%1)’ü yeni ilaç kullanmaktaydý.

SONUÇ: Tekli antiepileptik ilaç kullanan hastalarý, tedaviye baþlanma tarihlerine göre gruplandýrdýðýmýzda; yeni antiepileptik ilaçlarýn
kullaným oranlarýnýn %10’lara doðru artýþ gösterdiðini görmekteyiz, ancak yine de klasik antiepileptik ilaçlar tedavi seçiminde halen ilk
sýrada yer almaktadýr. Çoklu antiepileptik ilaç tedavisi altýnda olan hastalarda ise yeni antiepileptik ilaçlarýn son yýllarda kombine teda-
vide klasik ilaçlara ek olarak kullanýlmasýnda belirgin oranda artýþ izlenmektedir.
Anahtar Kelimeler: Antiepileptik ilaçlar, epilepsi, tedavi.

OBJECTIVE: According to recent studies old antiepileptic drugs used without alternative in the treatment of epilepsy, seems to leave
their place to new antiepileptic drugs during last two decades. The present study aimed to investigate whether the results of those
studies hold any truth in clinical practice.
METHODS: Medical records of patients that present to our clinic with the diagnosis of epilepsy between 2001 and 2007
were investigated retrospectively.
RESULTS: Data on 1358 patients were evaluated. Among them, 1120 (82%) patients had monotherapy and 238 (18%) patients had
polytherapy. The results were grouped by initial treatment dates: 552 of 603 (86%) patients used old antiepileptic drugs and 92
(14%) used new antiepileptic drugs between 2000 and 2007; 467 of 483 (95%) patients used old antiepileptic drugs and 24 (5%)
used new antiepileptic drugs between 1995 and 1999; 270 of 272 (99%) used old antiepileptic drugs and 3 (1%) used new antiepi-
leptic drugs prior to 1994.
CONCLUSION: When the patients that received monotherapy were grouped by initial treatment dates the rate of new antiepileptic
drug use was 10%, although old antiepileptic drugs were still the first choice. There was a significant increase in the use of new an-
tiepileptic drugs as adjuvant treatment in patients with polytherapy in the last years.

Sað hemiparezi ve dizartri ile merkezimize baþvuran 31 yaþýnda bir erkek hastada yapýlan tetkikler sonucunda yüksek dereceli baziler ar-
ter stenozu saptanmýþtýr. Yapýlan etyolojik araþtýrmalarda stenozun kesin nedeni bulunamamýþtýr. Medikal tedavi ile izlenmesi kararlaþtý-
rýlan hastanýn takip eden dönemde tekrarlayan bir þikayeti olmamýþtýr. Altý ay sonra kontrol amacýyla yapýlan anjiyografide stenozda dra-
matik bir düzelme gözlenmiþtir. Bu olgu, özellikle etyolojik nedeni tam aydýnlatýlamayan, klinik tablosu stabil olan ve yaþý genç olan bazi-
ler arter stenozu olgularýnda, endovasküler tedavi yöntemlerine baþvurmadan önce medikal tedavi ile izlemin önemini vurgulamaktadýr.

High-grade basilar artery stenosis was detected in a 31-year-old man that presented with right hemiparesis and dysarthria. The exact
etiology of the stenosis could not be determined. The patient was treated medically and remained asymptomatic during a 6-months
follow-up period, and follow-up angiograms showed a dramatic improvement in the high-grade stenosis. This report aimed to draw
attention to the importance of follow-up for high-grade basilar artery stenoses with medical therapy prior to using endovascular app-
roaches, especially in young patients with a stable clinical course and unknown etiology.

Altmýþ yaþýnda kadýn hasta sol üst kapaðýnda düþüklük þikayeti ile baþvurdu. Sekiz hafta önce herpes zoster oftalmikus nedeniyle te-
davi aldýðý öðrenildi. Nöro-oftalmolojik muayenesinde sol gözde miyozis ve sol kapakta pitozis saptandý. Apraklonidin ve hidroksiam-
fetamin testleri sonrasý postgangliyonik Horner sendromu tanýsý koyuldu. Herpes zoster oftalmikus nedeniyle geliþen Horner sendro-
munun nadir olmasý ve tanýda damla testlerinin önemini vurgulamak amacýyla olgunun sunulmasý uygun görüldü.

A 60-year-old woman presented with the complaint of left upper eyelid ptosis. Eight weeks earlier she was treated with antiviral
agents for herpes zoster ophthalmicus. Neuro-ophthalmic examination revealed pitozis and miyozis in her left eye. Based on aprac-
lonidine and hydroxyamphetamine test results the patient was diagnosed as postganglionic Horner’s syndrome. The rarity of Hor-
ner’s syndrome following herpes zoster ophthalmicus and the importance of topical agents in its diagnosis are emphasized.

Ýdiyopatik intrakraniyal hipertansiyon; hidrosefali ya da herhangi bir kitle lezyonu olmaksýzýn intrakraniyal basýncýn artýþý ile karakterize bir
sendromdur. Sýklýkla obez adölesan kýzlarda, genç kadýnlarda ve sýklýðý normal popülasyonla ayný olmak üzere gebelerde görülür. Gebe-
likte herhangi bir trimestýrda görülen idiyopatik intrakraniyal hipertansiyon ve tedavisinin gebeliðe etkisi, gebeliðin de hastalýða etkisini
deðerlendirmek, tedavi önerilerini gözden geçirmek amacýyla idiyopatik intrakraniyal hipertansiyonlu bir gebe olgusu sunulmuþtur.

Idiopathic intracranial hypertension is a syndrome characterized by an increase in intracranial pressure, without hydrocephaly or a mass
lesion. It is most commonly encountered in obese adolescent girls, young women, and pregnant women. Its prevalence rate in all 3
groups is the same. Herein we present a pregnancy case with idiopathic intracranial hypertension and an evaluation of the effects of
idiopathic intracranial hypertension during any trimester and the effects of its treatment on pregnancy, as well as the correlation bet-
ween idiopathic intracranial hypertension and pregnancy. Moreover, treatment options are assessed in light of the literature.

Mukormikoz, Mucorales Mucoraceae ailesinden, Rhizopus, Mucor ve Absidia’nýn oluþturduðu, birçok sistemi tutan hastalýklarýn ortak
ismidir. En sýk görülen klinik form rino-orbitoserebral tutulumdur. Mukormikoziste burun ve sinüsler infeksiyonun baþlangýç bölgeleri-
dir. Orbital aðrý, ani görme kaybý, kemozis, periorbital selülit, oftalmopleji ve propitoz görülebilir. Bu yazýda santral sinir sistemi tutu-
lumu olan ve bilateral oftalmopleji ile gelen bir olgunun klinik ve radyolojik görüntüleri sunulmuþtur.

Mucormycosis is the common name for diseases caused by fungi of the genera Rhizopus, Mucor, and Absidia of the family Mucora-
les: Mucoraceae, which affect many systems. Rhino-orbitocerebral infection is the most common form. In mucormycosis the nose
and sinuses are the initial regions of infection. Orbital pain, sudden loss of vision, chemosis, periorbital cellulitis, ophthalmoplegia,
and proptosis can be seen. We report the clinical and radiological findings of a mucormycosis case that presented with ophthalmop-
legia and central nervous system involvement

Wernicke ensefalopatisi, tiamin eksikliðine baðlý geliþen nörolojik bir sendromdur. Ciddi mortalite riski taþýmakla birlikte özellikle er-
ken dönemde tiamin tedavisine iyi yanýt vermektedir. Genellikle alkolizm ile iliþkili olduðu ve klinik triadýn hastalarýn %10-20 gibi az
bir kýsmýnda görüldüðü için özellikle alkolizm öyküsü olmayan olgularda tanýda güçlük yaratmaktadýr. Bu yazýda intihar amaçlý çama-
þýr suyu (sodyum karbonat) içen ve buna baðlý pilor stenozu geliþen, sonrasýnda konfüzyon, oftalmoparezi ve ataksi tablosuyla karþý-
mýza çýkan bir hastayý sunmayý amaçladýk.

Wernicke’s encephalopathy is a neurological syndrome that develops due to thiamine deficiency. Although it has a significantly high
mortality rate, it responds well to thiamine treatment, especially in its early stages. Because of its common association with alco-
holism and the fact that its clinical triad is seen in only a small portion of patients (10-20%), diagnosis is difficult, especially in cases
without a history of alcoholism. Herein we present a patient that drank bleach (sodium carbonate) in an effort to commit suicide and
developed pyloric stenosis, which was followed by confusion, ophthalmoparesis, and ataxia

Paraneoplastik ensefalit bulgularý olan ve anti-Ma2 antikorlarýnýn varlýðý saptanan 47 yaþýnda bir kadýn hastada hikaye ve toraks bilgi-
sayarlý tomografi bulgularýyla yüksek olasýlýklý malign mezotelyoma tanýsý koyulmuþtur. Plevral iðne biyopsisinde yüksek dereceli neop-
lastik infiltratif hücreler tespit edilen hasta immünoterapiye raðmen kaybedilmiþtir. Hücre tipi kesin ayýrt edilememesine raðmen, kö-
tü diferansiye akciðer kanseri ve mezotelyoma düþünülen bu hastada, anti-Ma2 pozitif paraneoplastik ensefalit ile mezotelyoma bir-
likteliðinin ilk kez görülmesi nedeniyle bildirilmesi uygun görülmüþtür.

We report a case of paraneoplastic encephalitis associated with anti-Ma2 antibodies. Medical history and thorax computed tomog-
raphy findings suggested malignant mesothelioma. Pleural biopsy results were compatible with high-grade neoplastic infiltration. Alt-
hough the biopsy could not differentiate the type of neoplasm, mesothelioma was considered a strong possibility in this poorly dif-
ferentiated lung carcinoma. To the best of our knowledge this is the first case report of paraneoplastic encephalitis associated with
anti-Ma2 antibodies and mesothelioma.