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AMAÇ: Migren iskemik tip serebrovasküler olaylar için tek baþýna risk faktörü olarak kabul edilmiþtir. Migren iskemik inme birlikteliðinin fizyopatolojisi tam olarak anlaþýlamamýþtýr. Migren hastalarýnda tromboza eðilim yaratan genetik faktörler patogeneze ýþýk tutmasý amacýyla daha önce de araþtýrýlmýþtýr, fakat fikir birliðine varýlamamýþtýr. Bu çalýþmada migrenli hastalarda tromboza eðilim yaratan faktör V leiden (FVL), protrombin (Pt) G20210A ve metilentetrahidrofolat redüktaz (MTHFR) C677T mutasyonu sýklýðý araþtýrýlmýþtýr
YÖNTEMLER: Baþkent Üniversitesi Hastanesi Nöroloji Polikliniðine baþvuran 15-55 yaþ arasý Uluslararasý Baþ Aðrýsý Derneði (IHS) taný kriterlerine göre migren tanýsý konulan ve sistemik hastalýðý olmayan 160 hastadan izole edilen genomik DNA, FVL, Pt G20210A ve MTHFR C677T gen polimorfizmleri açýsýndan deðerlendirildi ve Türk popülasyonuna ait saðlýklý kontrol grubu ile kýyaslandý.
BULGULAR: FVL mutasyonu 160 migrenli hastanýn 155 (%96.9)’inde homozigot normal 5 (%3.1)’inde ise heterozigot olarak saptandý, hastalarýn hiçbiri homozigot mutant deðildi. Kontrol grubunda ise heterozigot birey oraný %9.8 olmasýna raðmen iki oran arasýndaki fark istatistiksel olarak anlamlý bulunmamýþtýr (p> 0.05). Normal Türk popülasyonu ile yapýlan çalýþmanýn sonucuna benzer þekilde bizim çalýþmamýzda da hiç homozigot mutant birey saptanmamýþtýr. MTHFR C677T mutasyonu için 160 migrenli hastada heterozigot hasta sayýsý 39 (%24.4), homozigot mutant hasta sayýsý ise 8 (%5) iken; kontrol grubunda 37 (%34.9) kiþi heterozigot ve 6 (%5.6) homozigot mutant bulunmuþtur. Oranlar arasýnda istatistiksel olarak anlamlý fark saptanmamýþtýr (p= 0.15). Pt G20210A mutasyonu için 160 migrenli hastadan 3 (%1.9)’ü heterozigot iken, kontrol grubunda heterozigot birey sayýsý 5 (%2.9) olarak saptanmýþtýr. Bu oranlar arasýnda da istatistiksel olarak anlamlý bir fark saptanmamýþtýr (p= 0.420).
SONUÇ: Çalýþmamýz trombotik risk faktörlerinden FVL, Pt G20210A ve MTHFR C677T gen mutasyonlarýnýn popülasyonumuzda migren patogenezi ile iliþkili olmadýðýný göstermektedir. Toplumlar arasý farklýlýk vardýr ve bu fark muhtemelen etnik köken ayrýlýðýna baðlýdýr.

OBJECTIVE: Migraine is an independent risk factor for ischemic stroke, but its pathophysiology is still unclear. Genetic factors that predispose patients to thrombosis have been studied in patients with migraine to highlight the pathogenesis, but the results remain controversial. In this study, the frequencies of factor V Leiden (FVL), prothrombin (Pt) G20210A and methylenetetrahydrofolate reductase (MTHFR) C677T mutations were investigated.
METHODS: One hundred and sixty patients aged of 15 to 55 years with no history of systemic disease and who had been diagnosed as migraine according to the International Headache Society (IHS) diagnostic criteria at Baskent University Hospital Neurology Outpatient Clinics were investigated for FVL, Pt G20210A and MTHFR C677T mutations from their genomic DNA, and the results were compared with those of healthy controls.
RESULTS: One hundred and fifty five (96.9%) of 160 migraine patients were homozygote normal, 5 (3.1%) were heterozygote and none of them were homozygote mutant for FVL. The control group had 9.8% heterozygote individuals but the difference between the percentages was not statistically significant (p> 0.05). There were no homozygote mutant individuals in the Turkish population study in normal subjects like our study. Thirty nine (24.4%) of 160 migraine patients were heterozygote and 8 (5%) were homozygote mutant for MTHFR C677T. The control group had 37 (34.9%) heterozygote and 6 (5.6%) homozygote mutant individuals. The difference between the percentages was not statistically significant (p= 0.15). Three (1.9%) of 160 migraine patients were heterozygote and 5 (2.9%) of the control group were heterozygote mutant for Pt G20210A mutation. The control group had 37 (34.9%) heterozygote and 6 (5.6%) homozygote mutant individuals. The difference between the percentages was not statistically significant (p= 0.420).
CONCLUSION: Our study indicates that FVL, Pt G20210A and MTHFR C677T gene mutations, which are considered as risk factors for thrombosis, were not found to be associated with migraine pathogenesis in our population. The differences between populations probably depend on variations in ethnic origin.

AMAÇ: Ýskemik inmede prognostik belirleyicilerle ilgili mevcut veriler deðerlendirildiðinde ciddi çeliþkilerle karþýlaþýlýr. Bu çalýþmada kendi hasta popülasyonumuzda, iskemik inmeden sonraki altý aylýk mortalite, rekürrens ve fonksiyonel iyileþme üzerine hangi klinik ve laboratuvar parametrelerin etki gösterdiði belirlenmeye çalýþýlmýþtýr.
YÖNTEMLER: Ýki yüz yirmi üç iskemik beyin damar hastasý için yaþ, cinsiyet, hipertansiyon, aterosklerotik kalp hastalýðý, atriyal fibrilasyon, diabetes mellitus, hiperlipidemi, eski inme varlýðý, inme alt tipi, baþvuru ortalama kan basýncý, baþvuru kan þekeri, hematokrit deðeri, sol ventrikül hipertrofisi varlýðý, ejeksiyon fraksiyonu kaydedildi. Hastalarýn baþlangýçtaki ve altýncý aydaki “National Institute of Health Stroke Scale (NIHSS)”, modifiye Rankin Skalasý (mRS) ve Barthel Ýndeksi (BÝ) skorlarý belirlendi. Ýnmeden sonraki ilk altý aydaki ölüm, rekürrens ve iyileþme düzeyi ile bu 14 parametrenin iliþkisi istatistik olarak araþtýrýldý.
BULGULAR: Hastalarýmýzdaki altý aylýk mortalite %33, rekürrens %3.8 idi. Mortalite ile iliþkili faktörler ileri yaþ, kadýn cinsiyet, inme alt tipi, eski inme öyküsü, eþlik eden aterosklerotik kalp hastalýðý ve atriyal fibrilasyon, ejeksiyon fraksiyonunun %40 altýnda, hematokridin %39 altýnda ve baþvuru kan þekerinin 180 mg/dL üzerinde olmasýydý (p< 0.05). Hiperlipidemisi olan hastalarda mortalite anlamlý düzeyde düþük bulundu (p< 0.05). Ýncelenen faktörlerden hiçbirisi ile rekürrens arasýnda istatistiksel anlamlý korelasyon saptanmadý (p> 0.05). Çok deðiþkenli analizde sadece yaþýn, baþvuru kan þekeri ve hiperlipideminin mortalite üzerine anlamlý etkisi devam ediyordu (p< 0.05). NIHSS skorlarý deðerlendirildiðinde baþvuru ortalama kan basýncý yüksek olanlarda, mRS ve BÝ deðerlendirildiðinde, gençlerde ve laküner infarktý olanlarda iyileþmenin en iyi, önceden inme geçirenlerde iyileþmenin en az olduðu görüldü (p< 0.05).
SONUÇ: Ýleri yaþ ve yüksek baþvuru kan þekeri iskemik inmeden sonraki mortaliteyi artýran en önemli faktörlerdir. Hiperlipidemi varlýðý, belki de kullanýlan antihiperlipidemik ilaçlarýn nöroprotektif etkisiyle, ölüm riskini azaltmaktadýr. Altýncý aydaki fonksiyonel iyileþme üzerine net etkisi olan bir faktör yoktur.

OBJECTIVE: If the present data defining the prognostic predictors is examined carefully, a serious contradiction is noticed. In this study, we tried to determine which factors affect the sixth month mortality, recurrence and functional recovery measured quantitatively after ischemic stroke, among our own patients followed in a tertiary health care center.
METHODS: Age, sex, the presence of hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus, hyperlipidemia, previous stroke, stroke subtype, admittance mean blood pressure, admittance blood sugar, hemotocrit, the presence of left ventricle hypertrophy and ejection fraction was recorded for 223 patients with ischemic stroke. The scores for National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) were recorded at the beginning and at the end of six months. The correlation of these 14 clinical and laboratory parameters with mortality, recurrence and recovery was examined statistically.
RESULTS: Mortality rate was 33%, recurrence rate was 3.8%. Factors related with mortality were age, female gender, coronary artery disease, atrial fibrillation, low ejection fraction, low hematocrit and high admittance blood glucose (p< 0.05). Mortality was significantly low among patients with hyperlipidemia (p< 0.05). There was no statistically significant correlation between stroke recurrence and any of parameters investigated (p> 0.05). In the multivariate analyses, only, the effect of age, gender and hyperlipidemia on mortality was persisting (p< 0.05). Considering NIHSS, patients with high mean admittance blood pressure, considering mRS and BI younger patients and patients with lacunar infarcts had better recovery levels, while patients with previous strokes had poorer recovery (p< 0.05).
CONCLUSION: Higher age and high admittance blood sugar were the most important determinants of mortality after ischemic stroke. Hyperlipidemia reduces the risk of death after stroke probably because of the neuroprotective effects of lipid lowering drugs. None of these parameters clearly affect functional recovery at the end of six month.

AMAÇ: Obezitenin karpal tünel sendromu (KTS) için önemli bir risk faktörü olduðu ileri sürülmektedir. KTS ile obezite iliþkisini araþtýran önceki çalýþmalarda genel olarak beden kitle indeksi (BKÝ) dikkate alýnmýþtýr. Abdominal obezitenin daha hassas göstergeleri olan bel çevresi ve bel-kalça oraný (BKO) ile KTS iliþkisi þu ana kadar araþtýrýlmamýþtýr. Bu çalýþmada KTS’lilerde BKÝ ve abdominal obezitenin rolünü araþtýrmak amaçlandý.
YÖNTEMLER: Çalýþmaya ellerde aðrý, uyuþma, parestezi veya dizestezi yakýnmasý ile nöroloji polikliniðine baþvuran kadýn olgular dahil edildi. Klinik deðerlendirme ile olgular KTS grubu ve non-KTS grubu olarak iki gruba ayrýldý. Kýrk dört olgunun KTS tanýsý elektrofizyolojik olarak doðrulandý. Elektrofizyolojik olarak KTS tanýsý almayan 31 kiþi kontrol grubu olarak alýndý. KTS’li olgularýn klinik bulgular, sinir iletileri ve antropometrik ölçümleri (boy, aðýrlýk, BKÝ, bel çevresi, kalça çevresi, BKO) kontrol grubuyla karþýlaþtýrýldý.
BULGULAR: KTS’li hastalarýnýn BKÝ, bel çevresi ve BKO kontrol grubuna göre istatistiksel olarak anlamlý þekilde yüksek bulundu (her bir karþýlaþtýrma için p< 0.0001). KTS grubu hastalar bel çevresine göre %55.8, BKÝ’yi göre %47.7, BKO’ya göre %34.9 oranlarýnda obez olarak belirlendi. BKÝ’ye göre obez olmayan KTS’lilerin %16’sý bel çevresine göre obezdi. KTS’lilerde BKO ve BKÝ ile 4. parmak median-ulnar tepe latans farký arasýnda anlamlý pozitif korelasyon saptandý (sýrasýyla; r= 0.26, p< 0.05; r= 0.25, p< 0.05).
SONUÇ: Abdominal obezitenin KTS için önemli bir risk faktörü olduðu; bel çevresi, BKÝ ve BKO sinir iletilerini etkileyebileceði bu çalýþmada belirlendi. Genel obezitenin yaný sýra abdominal obezite KTS’de bir risk faktörü olabilir.

OBJECTIVE: Obesity has been suggested as a risk factor for carpal tunnel syndrome (CTS). Previous studies on the association of CTS and obesity have generally considered body mass index (BMI). However, the relationships between CTS and waist circumference or waist-to-hip ratio (WHR), which are known as more sensitive measures for abdominal obesity, have not been studied previously. In this study, it was aimed to evaluate the role of BMI and abdominal obesity in patients with CTS.
METHODS: Female patients who applied to the neurology outpatient clinics with pain, numbness, paresthesia, or dysesthesia in the hands were included. The patients were divided into two groups, according to the clinical evaluation, as CTS or non-CTS. CTS diagnosis was electrophysiologically confirmed in 44 patients. Thirty-one subjects who were not diagnosed as CTS electrophysiologically were recruited as the control group. Clinical findings, nerve conduction studies and anthropometric measurements (height, weight, BMI, hip circumference, waist circumference and WHR) of CTS patients were compared with those of the control group.
RESULTS: The CTS group had significantly higher BMI, waist circumference and WHR values compared to the control group (for each parameter, p< 0.0001). The rates of obesity in the CTS group were 55.8%, 47.7% and 34.9%, respectively, according to waist circumference, BMI and WHR measurements. In the CTS group, 16% of the patients, who were defined as non-obese according to BMI, were determined as obese according to waist circumference. In the CTS group, significant positive correlations were found between BMI and WHR and median-ulnar sensory interpeak latency of the fourth digit (r= 0.26, p< 0.05; r= 0.25, p< 0.05, respectively).
CONCLUSION: In this study, it was found that abdominal obesity is an important risk factor for CTS, and nerve conduction may be affected by waist circumference, BMI and WHR. In addition to general obesity, abdominal obesity may be an important risk factor for CTS.

Herediter basýnca duyarlý nöropati (HBDN) minör bir travma veya basý sonrasý ortaya çýkan akut, aðrýsýz ve tekrarlayýcý mononöropati ataklarý ile karakterize otozomal dominant (baskýn) geçiþli ailevi bir hastalýktýr. HBDN tanýsý ayrýntýlý incelemenin yapýlmadýðý durumlarda kolaylýkla atlanabilmekte ve bu yüzden hastalar gereksiz medikal ve cerrahi giriþimlere maruz kalabilmektedir. Biz anamnez, nörolojik muayene ve elektrofizyolojik bulgularýn tanýdaki önemini vurgulamak amacýyla HBDN tanýlý dört hastamýz ve yakýnlarýnýn özelliklerini literatür eþliðinde tartýþtýk. Yedi olguda genetik inceleme yapýldý ve tümünde HBDN delesyonu gösterildi.

Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder characterized by acute, painless and recurrent mononeuropathies that are secondary to minor trauma or compression. Diagnosis is often overlooked when detailed examinations are not performed. We discuss the features of our four HNPP patients and their close relatives in order to emphasize the importance of clinical and electrophysiological findings in the diagnosis of HNPP. Four patients and three members of the family underwent genetic testing and HBDN deletion was shown in all.

Ayna hareketleri istemli hareket sýrasýnda vücudun karþý tarafýndaki homolog kaslarda meydana gelen istem dýþý hareketlerdir. Genellikle üst ekstremitelerin distalinde görülür ve hayatýn ilk 10 yýlýnda varlýðý normal olarak kabul edilmektedir. Ayna hareketi etyopatogenezinde en çok konjenital malformasyonlar sorumlu tutulmuþtur. Polimikrogri bir kortikal organizasyon defekti olup gri cevherde kalýnlaþma, giral paternin kaybolmasý ve gri-beyaz cevher sýnýrýnýn düzleþmesini ifade etmektedir. Polimikrogri kliniði lezyonun lokalizasyonu ve geniþliðine göre farklýlýklar göstermektedir. Kuvvetsizlik yakýnmasý ile gelen 21 yaþýndaki erkek hastada muayene esnasýnda tespit edilen ayna hareketi, manyetik rezonans görüntülemede tespit edilen polimikrogri ve korpus kallosum hipoplazisinin birlikteliði nadir görülmesi nedeniyle sunulmuþtur. Yapýlan elektrofizyolojik incelemeler sonucunda, polimikrogri ile etkilenen taraftaki transkallozal inhibisyonda bozulma ve karþý hemisferdeki ipsilateral kortikospinal yollarýn aktivitesinde artýþýn ayna hareketlerini oluþturabileceði sonucuna varýlmýþtýr.

Mirror movements are defined as involuntary movements of the contralateral homologous extremities during voluntary movements of one side. They are usually observed in the distal parts of the upper extremities and are not considered a pathological finding within the first decade. Congenital malformations are mostly responsible for mirror movements. Polymicrogyria is a cortical organization defect. It is defined as thickening of gray matter, loss of gyral pattern and flattened border of gray and white matter. Clinical findings of polymicrogyria vary according to the location and width of the lesion. We present a 21-year-old male patient with left-sided hemiparesis who also had mirror movements. Polymicrogyria and hypoplasia of the corpus callosum were observed in cerebral magnetic resonance imaging. Coexistence of polymicrogyria and mirror movements is seen only rarely. According to the electrophysiological studies, we suggest that polymicrogyria may lead to a decrease in transcallosal inhibition on the affected side and increased activity of the ipsilateral corticospinal pathway in the opposite hemisphere, causing the mirror movements.

Valproik aside (VPA) baðlý ensefalopati, VPA’nýn nadir bir komplikasyonudur. Valproata baðlý ensefalopatinin erken tanýnmasý, ölümle sonuçlanabilecek bu aðýr tablonun geri dönüþümünü saðlayabilmesi açýsýndan çok deðerlidir. Uykululuk halinden letarji ve komaya kadar uzanan bilinç deðiþikliði, fokal veya bilateral nörolojik bulgular, nöbet, kusma, elektroensefalografi (EEG)’de yavaþlama valproata baðlý ensefalopatide görülebilmekte ve valproatýn kesilmesi ile düzelebilmektedir. Hiperamonemi bu tabloya eþlik edebilir. Bazen de ensefalopati hiperamonemi olmadan ortaya çýkar. Bu yazýda valproata baðlý üç ensefalopati olgusu sunulmuþtur. Olgularýmýzda, bulantý, kusma, bilinç bulanýklýðý, EEG’de zemin ritmi yavaþlamasý, iki olguda serum amonyum seviyesinde yükselme gözlenmiþtir. Olgularýn karaciðer enzim seviyeleri ve serum VPA seviyeleri normal sýnýrlarda tespit edilmiþtir. Bütün semptomlar VPA kesimi sonrasý düzelmiþtir. Serum amonyum seviyesi bu nadir yan etkinin erken teþhisinde önemli bir parametredir. Serum amonyum seviyesinin normal olmasý durumunda klinik bulgular ve EEG bulgularý teþhis için büyük önem taþýmaktadýr.

Valproic acid-induced encephalopathy is a serious complication of valproate, rarely observed, and can lead to death if early diagnosis is not made. It is clinically presented as mental status changes that range from drowsiness to lethargy and coma, focal or bilateral neurological deficits, seizure, vomiting, and marked electroencephalography (EEG) background slowing, with or without hyperammonemia. It can also be properly managed by discontinuation of the drug. We present three cases who developed vomiting, disturbance in consciousness, EEG-slowing, and elevated serum ammonia levels. In all cases, symptoms resolved after termination of valproate. Most notably, these side effects occurred in the presence of normal liver enzymes and normal valproate concentrations. Development of unconsciousness and associated EEG slow waves are observed rarely in VPA-induced encephalopathy, and this is discussed together with a review of the literature. Serum ammonia level is an important parameter in the early diagnosis of this rare adverse event. The clinical symptomatology and EEG findings have significant importance in the differential diagnosis when encephalopathy occurs without hyperammonemia and with normal or slight increase in serum ammonia level.

Spontan bilateral intraserebral hemorajiler oldukça nadirdir. Biz bilateral subtalamik hemorajisi olan, sað üst ekstremite monoplejisi ve bilinç kaybý ile baþvuran 60 yaþýnda hipertansif hastayý literatürü de gözden geçirerek sunduk.

Spontaneous bilateral intracerebral hemorrhages are extremely rare. To further characterize this rare event, we report a 60-year-old man with chronic hypertension, who presented with bilateral subthalamic hemorrhages that consequently resulted in monoplegia in the right upper extremity and loss of consciousness. The literature is reviewed regarding this condition.

Herpes simpleks ensefaliti tipik olarak medial temporal ve inferior frontal loblarý etkilemekte, beyin sapý lezyonlarý oldukça nadir olarak izlenmektedir. Burada, 42 yaþýnda deliryum tablosu ile baþvuran ve herpes simpleks ensefaliti tanýsý alan bir kadýn hasta sunulmaktadýr. Hastanýn manyetik rezonans görüntülemesinde kontrast tutulumu gösteren inferior frontal ve pons lezyonlarý saptanmýþtýr. Hasta baþarýlý bir þekilde tedavi edilmiþ ve nörolojik sekel kalmamýþtýr, ancak lezyonlardaki kontrast tutulumunun devam ettiði dikkati çekmiþtir. Bu olgu herpes simpleks ensefalitinin de beyin sapý lezyonlarýnda ayýrýcý tanýda araþtýrýlmasýný vurgulamaktadýr. Ek olarak, kontrast tutulumunun klinik düzelme sonrasýnda birkaç ay daha sürebileceði akýlda tutulmalýdýr.

Herpes simplex encephalitis typically involves the medial temporal and inferior frontal lobes; brainstem lesions are very unusual. We present a 42-year-old woman admitted with delirium and diagnosed as herpes simplex encephalitis. The patient had gadolinium-enhancing inferior frontal and pontine lesions on magnetic resonance imagings. The patient was successfully treated without any neurologic sequelae, though contrast-enhancement was still present. This case report emphasizes that herpes simplex encephalitis should be investigated in the differential diagnosis of brainstem lesions. Moreover, contrast-enhancement may persist for some months even after clinical improvement.

Çok sayýda kraniyal sinirleri tutabilen ve nadir görülen bir konjenital sendrom olan Möbius sendromu baþlýca fasiyal ve abdusens sinirlerin bilateral veya unilateral paralizisi ile karakterizedir. Sendromun klinik belirtileri çoðunlukla yenidoðan döneminde ortaya çýkar. Möbius sendromunun diðer sistemlere ait anormalliklerle birlikteliði sýktýr. Bunlar içerisinde kas iskelet sistemine ait anormallikler ön planda olup çoðunlukla tek taraflýdýr. Burada bilateral pektoral kas hipoplazisinin eþlik ettiði Möbius sendromlu genç eriþkin bir hasta sunulmaktadýr.

Moebius syndrome, a rare congenital disorder of varying severity, involves multiple cranial nerves and is characterized predominantly with bilateral or unilateral paralysis of the facial and abducens nerves. Clinical signs and symptoms of the syndrome usually appear during the newborn period. Moebius syndrome is frequently associated with abnormalities of other systems. Of these, abnormalities of the musculoskeletal system predominate and they are usually unilateral. The current report presents a young male with Moebius syndrome, which was associated with bilateral pectoralis muscle hypoplasia.