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Lomber dar kanal ve intermittan nörojenik klodikasyon, 55 yaþýndan sonra sýk görülen ve 65 yaþýndan sonra klinik, radyolojik ve tedavi yönleriyle oldukça kompleks hale gelen bir hastalýktýr. Bu derlemede dejeneratif osteoartrite baðlý akkiz dar kanal ele alýnmýþtýr. Hastalýkta, bel ve bacak aðrýlarý, bacaklarda paresteziler sýk görülmekle beraber esas hastalýðý karakterize eden durum, ayakta durma ve yürüme ile bu bulgularýn ortaya çýkmasý ya da artýþ göstermesidir (intermittan nörojenik klodikasyon). Radyolojik görünüm tipik bir lomber dar kanal göstermesine karþýn olgularýn 1/4 ve 1/5’inde hiçbir yakýnma olmayabilir. Tanýya yardýmcý olmak bakýmýndan klinik nörofizyolojik testler hem istirahat hem de hasta aktif halde iken uygulanmýþtýr. Devinimi izledikten sonra elektrofizyolojik belirtilerin bazýlarýnda bozulmalar saptanmýþtýr. En yararlý görülen yöntemler paravertebral ve bacak kaslarýnda elektromiyografide denervasyon bulgularý saptanmasý ve H-refleks anormallikleri ile yeni radiküler uyarým teknikleriyle elde edilen bulgulardýr. Elektrofizyolojik bulgular kliniðe daha uyumlu bulunmuþtur. Hastalarýn yaþam kalitesini bozan ve konservatif tedaviden yarar görmeyen hastalarda çeþitli lomber cerrahi giriþim uygulamalarý söz konusudur.

Lumbar spinal stenosis and intermittent neurogenic claudication is a disease that occurs frequently after the age of 55 and becomes complicated after the age of 65 in clinical, radiological and therapeutic aspects. In this review, acquired spinal stenosis secondary to degenerative osteoarthritis is evaluated. In this disease, lumbar and extremity pain and paresthesia are frequent; however, the most characteristic feature of the disease is the occurrence and worsening of these findings with erect posture and walking (intermittent neurogenic claudication). Even though the radiological findings of spinal stenosis are apparent, 1/4-1/5 of the patients may be asymptomatic. In order to support the clinical findings, neurophysiological tests have been used at rest and motion. Certain electrophysiological signs have been found to change after motion. The most helpful signs are the denervation of paravertebral and leg muscles, H-reflex abnormalities, and the findings obtained with the recently used radicular excitation methods. Electrophysiological methods have been found to be more compatible with the clinical findings. Lumbar surgical approach is considered in patients with impaired life quality and in those unresponsive to conservative treatment.

AMAÇ: Çalýþmanýn amacý; farklý “Expanded Disability Status Scale (EDSS)” puanlarýna sahip multipl sklerozlu (MS) olgularýn tahmin ettikleri yürüme mesafesi ile gerçek yürüme mesafelerini karþýlaþtýrarak bu testi kullananlar için dikkat edilmesi gereken EDSS puan aralýðýný saptamaya çalýþmak, ayrýca yorgunluðun tahmini ve gerçek yürüme mesafesine olan etkilerini araþtýrmaktýr.
YÖNTEMLER: Çalýþmaya 30 MS hastasý, yaþ ve cinsiyet yönünden benzer 20 saðlýklý gönüllü alýnmýþtýr. MS’li olgular EDSS puanlarýna göre iki gruba ayrýlmýþtýr. Yorgunluk “Fatigue Severity Scale” kullanýlarak, motor yorgunluk ise 200 metrelik yürüyüþ testi ile ölçülmüþtür. Kaslardaki tonus artýþý “Modified Ashwort Scale” ile deðerlendirilmiþtir. Birinci grup MS hastalarý ve saðlýklý kontrol grubundaki olgulara altý dakikada dinlenmeden yürüyebilecekleri mesafe sorulmuþ ve kaydedilmiþ, ardýndan süre tutularak altý dakika boyunca yürüdükleri mesafe ölçülmüþtür. Ýkinci grup MS hastalarýna dinlenmeden yürüyebilecekleri mesafe sorulmuþ ve kaydedilmiþ, ardýndan yürüyebildikleri gerçek mesafe hasta yürütülerek ölçülmüþtür.
BULGULAR: “Fatigue Severity Scale” deðerleri yönünden iki MS grubunun yorgunluk þiddetlerinin birbirinden farklý olduðu görülmektedir (p< 0.05). Ýkinci MS grubunun yorgunluk þiddeti birinci gruptan daha fazladýr. Gruplarýn yürüyüþ yorgunluk indeks deðerleri farklý olup (p< 0.05), bu deðerin en yüksek olduðu olgularýn ikinci MS grubunda yer aldýðý görülmüþtür. Spastisite her iki kas için de ikinci grup MS olgularýnda birinci gruba göre anlamlý derecede yüksektir (p< 0.05). Birinci MS ve kontrol grubunun tahmin ettikleri ve yürüdükleri gerçek mesafe arasýnda istatistiksel olarak fark bulunmazken (p> 0.05), ikinci MS grubunun tahmin ettikleri ile yürüdükleri gerçek mesafeler farklýdýr (p< 0.05). “Fatigue Severity Scale” puanlarýyla birinci MS grubunun tahmin ettikleri yürüme mesafesi arasýnda ters iliþki mevcuttur (p< 0.05). Motor yorgunluk puanlarý ile sadece ikinci MS grubu olgularýnýn yürüdükleri gerçek mesafeler arasýnda ters yönlü bir iliþki saptanmýþtýr (p< 0.05).
SONUÇ: Özür düzeyi düþük hastalarda EDSS kullanýmý daha güvenilirdir. Sorun en yoðun þekilde EDSS puaný 4-5 arasýnda olan hastalarda görülmektedir. Ayrýca, bu olgularda yürüme mesafesi ile motor yorgunluk arasýnda önemli iliþki vardýr. Motor yorgunluk için spastisite önemli bir belirteçtir.

OBJECTIVE: This study aimed first to identify the range of the Expanded Disability Status Scale (EDSS) score by comparing the actual walking distance and the estimated walking distance of multiple sclerosis (MS) patients, and second, to investigate the effect of fatigue on walking distance.
METHODS: Thirty MS patients and 20 age -and gender- matched healthy volunteers were included in the study. MS patients were divided into two groups according to the EDSS score. Fatigue was measured using the Fatigue Severity Scale (FSS) and motor fatigue was measured using the 200 meter walking test. The increase in muscle tone was evaluated by Modified Ashworth Scale. The first group of MS patients and healthy control group patients were asked to estimate the distance they can walk without rest within six minutes. Then, their actual walking distance was measured for six minutes. The second group of MS patients was asked to estimate their most probable walking distance without rest; then, the actual walking distance of the patients was measured.
RESULTS: In terms of FSS values, fatigue severity was different in the two MS groups (p< 0.05). The fatigue severity of the second MS group was higher than of the first group. Walking fatigue index values were also different (p< 0.05), and the higher value was seen in the second MS group. The second group of MS patients had significantly higher spasticity for both muscles compared to the first group (p< 0.05). While estimated and actual walking distance was not found significantly different in the first MS group and control group (p> 0.05), the second MS group’s estimated and actual walking distances were significantly different (p< 0.05). A negative correlation was found between FSS scores and estimated walking distance in the second MS group (p< 0.05). A negative correlation was present between motor fatigue and actual walking distance only in the second MS group (p< 0.05).
CONCLUSION: EDSS evaluation is more reliable in patients with low level disability. The accuracy issues arise in patients with EDSS scores of 4-5. Additionally, there is an important correlation between motor fatigue and walking distance in these patients. For motor fatigue, spasticity is an important determinant.

AMAÇ: Çalýþmamýzda intrakraniyal hipotansiyonda manyetik rezonans görüntüleme (MRG) ve radyoizotop sisternografi bulgularý, klinik izlem ve tedavi sonuçlarýnýn deðerlendirilmesi amaçlanmýþtýr.
YÖNTEMLER: Merkezimizde intrakraniyal hipotansiyon tanýsý konulan 15 hasta geriye dönük olarak deðerlendirildi. Olgulara ait beyin omurilik sývýsý (BOS) açýlýþ basýncý ve BOS analizi sonuçlarý, beyin ve spinal MRG ve radyoizotop sisternografi bulgularý incelendi, klinik izlem ve tedavi sonuçlarý tartýþýldý.
BULGULAR: Yaþ ortalamasý 37 olan 15 olgunun (11’i kadýn, 4’ü erkek) 11’inde primer (spontan), dördünde sekonder intrakraniyal hipotansiyon saptandý. Olgularýn 14 (%93.3)’ünde postüral baþ aðrýsý izlendi. Bir (%6.6) olguda baþ aðrýsýnýn postüral özelliði yoktu. Baþ aðrýsýna ek olarak olgularýn 5 (%33.3)’inde bulantý-kusma, 1 (%6.6) olguda çift görme, 1 (%6.6) olguda boyun aðrýsý, 1 (%6.6) olguda baþ dönmesi mevcuttu. Beyin MRG’de 12 (%85.7) olguda dural kalýnlaþma, 5 (%35.7) olguda hipofiz bezinde geniþleme, 3 (%21.4) olguda beyinde aþaðýya doðru yer deðiþtirme, 2 (%14.2) olguda subdural hematom, 2 (%14.2) olguda subdural efüzyon saptandý. Spinal MRG altý olgunun 5 (%83.3)’inde normaldi, 1 (%16.6)’inde meningeal kalýnlaþma bulundu. Radyoizotop sisternografide dokuz olgunun 8 (%88.8)’inde BOS kaçaðý saptandý. Lomber ponksiyonda BOS açýlýþ basýncý dokuz olgunun 8 (%88.8)’inde ≤ 60 mmH2O bulundu. BOS proteini 3 (%33.3) olguda yüksek bulundu. Konservatif tedavi ile 8 (%53.3) olguda tam klinik düzelme saðlandý. Konservatif tedavi ile düzelmeyen 7 (%46.6) olguya kan yamasý uygulandý ve bunlardan altýsýnda tam klinik düzelme saðlandý.
SONUÇ: Postüral baþ aðrýsý, BOS açýlýþ basýncýnýn düþüklüðü ve karakteristik MRG bulgularý intrakraniyal hipotansiyon tanýsý için önemli kriterlerdir. Radyoizotop sisternografi BOS kaçaðýnýn saptanmasýnda faydalýdýr. Konservatif tedavi ile düzelmeyen olgularda otolog kan yamasý uygulanmalýdýr.

OBJECTIVE: It was aimed to evaluate the clinical features, magnetic resonance imaging (MRI) and radioisotope cisternography findings and results of the treatment in intracranial hypotension.
METHODS: Fifteen patients diagnosed with intracranial hypotension were evaluated retrospectively. The opening pressure and analysis of cerebrospinal fluid (CSF), cerebral and spinal MRI and radioisotope cisternography findings, clinical features, and results of the treatment are discussed.
RESULTS: The mean age of 15 patients, 11 women and 4 men, was 37 years. Eleven patients had spontaneous (primary) and 4 had secondary intracranial hypotension. Fourteen (93.3%) patients had orthostatic headache, and 1 (6.6%) patient’s headache did not have a postural feature. In addition to the headache, 5 (33.3%) patients had nausea and vomiting, 1 patient had diplopia, 1 had neck pain, and 1 had vertigo. Cerebral MRI revealed dural thickening in 12 (85.7%) patients, enlarged hypophysis in 5 (35.7%) patients, brain sagging in 3 (21.4%) patients, subdural hematoma in 2 (14.2%) patients, and subdural effusion in 2 (14.2%) patients. Spinal MRI was normal in 5 (83.3%) of 6 patients, and it showed meningeal thickening in 1 (16.6%). Radioisotope cisternography revealed CSF leak in 8 (88.8%) of 9 patients. CSF opening pressure was ≤ 60 mmH2O in 8 (88.8%) of 9 patients. CSF protein was increased in 3 patients. Complete improvement was obtained with conservative treatment in 8 (53.3%) patients. Seven (46.6%) patients who did not improve with conservative treatment were administered epidural blood patching, and 6 of these 7 patients improved completely.
CONCLUSION: Orthostatic headache, low CSF opening pressure and characteristic MRI findings are essential criteria for diagnosis of intracranial hypotension. Radioisotope cisternography is useful to detect CSF leak. In patients who do not improve with conservative treatment, autologous blood patch should be applied.

AMAÇ: Distimi hastalarýnda uyku bozukluklarý, genellikle hastalýðýn bir parçasý olarak deðerlendirilmekte, tedavi edilebilir farklý sebepleri çoðunlukla atlanmakta ve uyku sorunlarý distimi hastalarýnýn yaþamlarýnýn bir parçasý haline gelmektedir. Çalýþmamýzda bu amaçla, hastalarýn psikiyatrik semptomlarýný, uyku deðerlendirmesini ve eþlik eden bir uyku bozukluðu olup olmadýðýný gün içi uykululuk testleri ve polisomnografi ile belirlemeyi amaçladýk. Çalýþmamýzda kronik uykusuzluðu olan distimik kadýnlara, Epworth uykululuk testi (ESS) ve polisomnografik inceleme yaptýk.
YÖNTEMLER: Çalýþmamýza Uludað Üniversitesi Týp Fakültesi Psikiyatri Kliniðinde en az iki yýldýr distimi tanýsýyla takip edilen ve kronik uykusuzluðu olan 20 kadýn hasta ve kontrol grubu olarak 18-65 yaþ arasý 20 kadýn alýndý.
BULGULAR: Distimik hasta ve kontrol grubu arasýnda ESS ve uyku evreleri arasýnda anlamlý farklýlýklar gözlendi. Distimi hastalarýnda ESS deðerinin daha yüksek olduðu, uyku evrelerinden REM, non-REM-1 (evre 1), non-REM-2 (evre 2) daha yüksek oranda, non-REM-3-4 (evre 3-4) daha düþük oranda olduðu görüldü
SONUÇ: Bu çalýþma bulgularý, distimik hastalarda da yapýsal uyku deðiþikliklerinin olduðunu akla getirmekte olup, uyku deðiþkenlikleri ve depresif durumlarýnýn arasýnda hiçbir direkt baðlantý olmadýðýný göstermektedir.

OBJECTIVE: In patients with dysthymic disorder (DD), sleep problems are assessed as a part of their depressive state, and different treatable conditions, such as other primary sleep disorders, are often skipped. We aimed to determine symptoms related to daytime sleepiness and polysomnographic findings in dysthymic women with chronic insomnia and to find out whether or not there is an accompanying sleep disorder. We suggest that pathologies that can lead to sleep problems in dysthymic patients should be searched, and to this end, application of the Epworth sleepiness scale (ESS) and polysomnography examination should be used much more frequently
METHODS: We included 20 female dysthymic patients with complaints of chronic sleep problems who had been under follow-up at Uludag University Hospital Psychiatry Outpatient Clinic for at least the last two years. Twenty healthy female volunteers, aged 18-65 years, were included in the study as the control group. ESS and polysomnography examination were applied in all patients.
RESULTS: When patients with DD and healthy controls were compared, significant differences in ESS scores and ratios of sleep phases were determined between groups. DD patients had higher ESS scores and higher ratios of rapid eye movements (REM), non-REM-1 (Stage 1), non-REM-2 (Stage 2) phases and lower ratios of slow wave sleep (Stage 3 + Stage 4).
CONCLUSION: The findings of our study suggest that there are structural sleep changes in dysthymic patients, but no direct connection between sleep variables and depressive states is evident.

AMAÇ: Koroner arter hastalýðý olanlarda sessiz beyin infarktlarýnýn varlýðýný her yönü ile araþtýran birçok çalýþma varken, sessiz beyin infarktý olanlarda koroner arter hastalýðý ile ilgili çalýþma yoktur. Bu nedenle biz geçmiþinde inme ya da geçici iskemik atak öyküsü bulunmayan ve kraniyal manyetik rezonans görüntülemede sessiz serebral infarkt saptanan hastalarda noninvaziv yöntemlerle koroner arter hastalýðýnýn varlýðýný araþtýrmayý amaçladýk.
YÖNTEMLER: Hastalara rutin laboratuvar tetkikleri (açlýk kan þekeri, üre, kreatinin, total kolesterol, trigliserid, düþük dansiteli lipoprotein, yüksek dansiteli lipoprotein), elektrokardiyografi, karotis Doppler ultrasonografi, ekokardiyografi, treadmill efor testi ve incelemeler sonucunda gerekli olan olgularda miyokard perfüzyon sintigrafisi yapýlarak koroner arter hastalýðý araþtýrýldý. Hasta ve kontrol grubu koroner arter hastalýðý açýsýndan istatistiksel olarak karþýlaþtýrýldý.
BULGULAR: Çalýþmamýza kraniyal manyetik rezonans görüntülemede sessiz beyin infarktý olan 25’i erkek, 15’i kadýn toplam 40 olgu, kontrol grubu olarak sessiz beyin infarktý olmayan 15’i erkek, 10’u kadýn toplam 25 gönüllü alýndý. Hasta grubunda yaþ ortalamasý 66.7 kontrol grubunda 63.84 idi. Hasta grubunda 34 (%85) hastada çoðul, 6 (%15) hastada tek sessiz beyin infarktý saptanmýþtýr. Hasta grubunda yedi hastada koroner arter hastalýðý saptanmýþtýr. Bunlarýn biri kadýn, altýsý erkektir. Kontrol grubunda koroner arter hastalýðý saptanmamýþtýr (p= 0.03). Hasta grubu ile kontrol grubu arasýnda hipertansiyon, diabetes mellitus, hiperkolesterolemi, sol ventrikül hipertrofisi, hafif düzeyde karotis arter stenozu ve ailede koroner arter hastalýðý açýsýndan anlamlý fark saptanmýþtýr (sýrasýyla p< 0.01; p= 0.007; p= 0.01; p= 0.03; p= 0.02; p= 0.01).
SONUÇ: Çalýþmamýz sessiz beyin infarktlarý olan hastalarda koroner kalp hastalýðý için önemli bir riskin varlýðýný ortaya koymaktadýr. Baþka nedenlerle yapýlan görüntüleme çalýþmalarýnda saptanan sessiz infarktlar hastalarýn kardiyolojik açýdan da deðerlendirilmelerini ve tedavi edilmelerini saðlayabileceði için önemlidir.

OBJECTIVE: While there are many records of silent cerebral infarction in patients with coronary artery disease, there is no study about coronary artery disease in patients with silent cerebral infarction. Therefore, we intended to evaluate coronary artery disease in patients without history of stroke or transient ischemic attack but with silent cerebral infarction on cranial magnetic resonance imaging by noninvasive methods.
METHODS: Coronary artery disease was investigated by means of routine laboratory tests (glucose, urea, total cholesterol, low density lipoprotein, high density lipoprotein), electrocardiography, Carotid Doppler ultrasonography, echocardiography, treadmill effort test, and myocardial perfusion scintigraphy when needed. The patient and the control groups were compared for coronary artery disease statistically.
RESULTS: Twenty-five male and 15 female patients with silent cerebral infarction on cranial magnetic resonance imaging and 15 healthy male and 10 healthy female volunteers were recruited in this study. The mean age was 66.7 in the patient group and 63.84 in the control group. Silent cerebral infarction was established as multiple in 34 (85%) patients and single in 6 (15%) patients. Coronary artery disease was determined in 7 patients in the patient group (1 female, 6 males) and in none in the control group (p= 0.03).
CONCLUSION: Our study showed that coronary artery disease is an important risk factor in patients with silent cerebral infarction. Detection of silent cerebral infarcts are important, as they may lead to examination and treatment of the patients cardiologically.

AMAÇ: Mannitol intrakraniyal basýncý düþüren bir osmotik diüretiktir. En önemli yan etkisi böbrek fonksiyon bozukluðudur. Bu çalýþmada akut inme nedeniyle mannitol tedavisi alan hastalarda böbrek fonksiyonlarý deðerlendirildi.
YÖNTEMLER: Nöroloji yoðun bakým ünitesinde inme tanýsý ile izlenen ve beþ gün süreyle fraksiyone mannitol tedavisi verilen 122 hasta retrospektif olarak deðerlendirildi. Hastalarýn 96’sý iskemik, 26’sý hemorajik inme geçirmiþti. Hastalarýn 58’i erkek, 64’ü kadýn; yaþ ortalamasý 69.9 ± 11.8 (18-91) yýl idi. Tedavi baþlanmadan önce, tedavinin ikinci, üçüncü, dördüncü, beþinci ve onuncu günlerinde ölçülen serum üre, kreatinin ve elektrolit düzeyleri istatistiksel olarak baðýmlý iki örneklem t testi yöntemi ile karþýlaþtýrýldý.
BULGULAR: Tedavinin ikinci, üçüncü. dördüncü, beþinci gün ortalama üre ve kreatinin düzeyleri mannitol tedavisi öncesi ortalama üre ve kreatinin düzeylerine göre anlamlý olarak yüksek bulunurken (p< 0.05), ortalama sodyum, potasyum ve klor düzeylerinde deðiþme saptanmadý. Onuncu günde ise kreatinin düzeylerinin normale döndüðü ancak üre düzeyinde yüksekliðin azalmakla birlikte sürdüðü görüldü.
SONUÇ: Çalýþmamýz mannitol tedavisi verilen hastalarda böbrek fonksiyonlarýnýn yakýn izleminin gerekli olduðu görüþünü desteklemektedir.

OBJECTIVE: Mannitol is an osmotic diuretic agent and reduces intracranial pressure. The most serious side effect of mannitol is kidney dysfunction. In this study, renal functions in acute stroke patients treated with mannitol were evaluated.
METHODS: One hundred and twenty-two patients followed in the neurology intensive care unit with the diagnosis of stroke and treated with fractionated mannitol for 5 days were evaluated retrospectively. Ninety-six patients had ischemic and 26 had hemorrhagic stroke. Mean age was 69.9 ± 11.8 (18-91) years. Serum urea, creatinine and electrolyte levels measured before and on the second, third, fourth, fifth and tenth days of treatment were compared statistically with paired sample t test.
RESULTS: The average urea and creatinine levels on the second, third, fourth and fifth days of treatment were significantly higher than the baseline (p< 0.05). On the other hand, mannitol treatment did not change average sodium, potassium and chlorine levels. The creatinine levels had returned to the normal range on the tenth day of treatment, but the urea levels, although decreased, did not fall to the normal range.
CONCLUSION: Our results support the view that close monitoring of renal function is necessary in patients treated with mannitol.

Beyin sapý ve medulla spinalis tutulumu ve laktat yüksekliði ile seyreden lökoensefalopati (LBSL); altta yatan genetik defektin belirlenmiþ olduðu yeni tanýmlanmýþ bir lökoensefalopati tablosudur. Klinik özelliði yavaþ progresif piramidal, serebellar ve arka kordon disfonksiyonu bulgularýdýr. Hastalýk sýklýkla çocukluk döneminde baþlamakla beraber nadir olarak eriþkin baþlangýçlý olgular da bildirilmiþtir. Hastalýk ile iliþkili olarak mitokondriyal tRNA sentetazý kodlayan DARS2 geninde mutasyon yeni tanýmlanmýþtýr. Hastalýðýn manyetik rezonans görütüleme bulgularý spesifiktir, nonhomojen serebral ak madde tutulumu ile birlikte, selektif beyin sapý ve medulla spinalis traktuslarýnýn tutulumu taný koydurucudur. Manyetik rezonans spektroskopi (MRS)’de laktat piki sýk görülmekle beraber laktat yüksekliði saptanmayan olgular da bildirilmiþtir. Burada MRS’de laktat piki göstermeyen, genetik tanýsý teyit edilmiþ eriþkin bir LBSL hastasýnýn klinik ve radyolojik özellikleri tartýþýlmýþtýr.

Leukoencephalopathy with brain stem and spinal cord involvement and high lactate (LBSL) is a recently described leukoencephalopathy with a genetically proven underlying defect. Clinical features are slowly progressive pyramidal, cerebellar and dorsal column dysfunction with childhood or rarely adult onset. The genetic basis of the disease was recently identified, which concerned mutations in the DARS2 gene encoding mitochondrial aspartly-tRNA synthetase. The disease has distinct magnetic resonance imaging findings including inhomogeneous cerebral white matter abnormalities and selective brain stem and spinal cord tract involvement. Additionally, there are usually increased lactate levels on magnetic resonance spectroscopy (MRS) of the abnormal white matter. In this case report, we describe the clinical and radiological features of a patient with genetically proven adult-onset LBSL and normal lactate levels on MRS.

Erdheim-Chester hastalýðý etyolojisi bilinmeyen sistemik histiyositozisin nadir bir non-Langerhans formudur. Hastalýk, musküloskeletal sistem, kardiyak, pulmoner, gastrointestinal ve santral sinir sistemlerini de içeren multipl organ sistemini etkiler. Nörolojik belirtiler ise oldukça seyrektir. Bu yazýda, bilateral kavernöz sinüs infiltrasyonu ve bilateral karotis oklüzyonu bulunan 44 yaþýnda bir Erdheim- Chester hastasý sunulmuþtur.

Erdheim-Chester disease is a rare, non-Langerhans form of systemic histiocytosis of unknown etiology. The disease affects multiple organ systems, including musculoskeletal, cardiac, pulmonary, gastrointestinal, and central nervous systems, producing protean manifestations. Neurological manifestations are less frequent. We present a 44-year-old patient with Erdheim-Chester disease who had bilateral carotid artery occlusion and cavernous sinus infiltration.

Nöronal migrasyon bozukluklarýndan biri olan periventriküler nodüler heterotopi sýk olarak epilepsiye neden olmakta ve kraniyal manyetik rezonans görüntülemesi ile kolaylýkla tanýnabilmektedir. Bazen bu hastalarda psikiyatrik þikayetler de eþlik edebilmektedir. Yazýmýzda emosyonel stresle ortaya çýkan parsiyel nöbetleri somatizasyon olarak deðerlendirilerek psikiyatri tarafýndan 10 yýldýr takip edilen ve antidepresan kullanmakta olan 33 yaþýnda bir kadýn hasta sunulmuþtur. Elektroensefalografi incelemesi normal olarak bulunan hastanýn kraniyal manyetik rezonans incelemesinde bilateral periventriküler nodüler heterotopi saptanmýþtýr. Karbamazepin tedavisi ile nöbet kontrolü saðlanmýþtýr. Olgumuzda olduðu gibi beyinde bilateral lezyon olsa bile parsiyel nöbetler görülebilmekte ve nöbet kontrolü saðlanabilmektedir. Somatoform þikayetleri olan hastalardan öykü alýnýrken yakýnmalarýnýn epileptik nöbet olabileceði akýlda tutulmalý ve hastalar bu açýdan sorgulanmalýdýr.

Periventricular nodular heterotopia is a form of neuronal migration abnormality. Periventricular nodular heterotopia can easily be recognized by cranial magnetic resonance imaging. The most common clinical appearance is epileptic seizures. In some cases, symptoms are accompanied with psychiatric complaints. In this article, we report a 33-year-old female with complaints of left-sided paresthesia induced by emotional stress. She had been followed at an outpatient psychiatry clinic for about 10 years with the diagnosis of somatization disorder. Her electroencephalography recordings -awake as well as during sleep- were found to be normal. The cranial magnetic resonance imaging showed bilateral periventricular nodular heterotopia. Her seizures were controlled with carbamazepine treatment. Partial epileptic seizures might also be observed, even though the cerebral heterotopic lesions are bilateral. When a history is obtained from a patient with somatoform complaints, it should be kept in mind that these symptoms might be seizures, and the patient should be questioned accordingly.