DOWNLOAD | English Full Text

AMAÇ: Dünyanýn farklý bölgelerinde kalýtsal trombofilik risk faktörlerinin görülme sýklýðý deðiþiklik göstermektedir. Bu çalýþma ile bölgemizde iskemik inme geçirmiþ hastalarda faktör V, metilentetrahidrofolat redüktaz (MTHFR), protrombin, β-Fibrinojen gen mutasyonlarý ve human platelet alloantigens (HPA), plazminojen aktivatör inhibitör 1 (PAI), Apolipoprotein E ( APO-E), Anjiyotensin dönüþtürücü enzim(ACE) gen polimorfizmlerinin görülme sýklýklarýnýn kontrol grubuna göre anlamlý olup olmadýðýnýn araþtýrýlmasý amaçlanmýþtýr.
YÖNTEMLER: Çalýþmamýza kliniðimizde takip edilen serebral enfarkt geçirmiþ 212 hasta ve inme geçirmemiþ yaþ ve cinsiyet özellikleri hasta grubuna benzer 238 birey alýndý. Tüm katýlýmcýlarýn demografik verileri ve beyin damar hastalýklarý için risk faktörleri sorgulandý. Serumlarýnda bazý biyokimyasal parametrelere bakýldý ve elektrokardiyografileri çektirildi. Faktör V, MTHFR, protrombin, β-Fibrinojen gen mutasyonlarý ve HPA, PAI, APO-E, ACE gen polimorfizmlerine bakýldý. Veriler SPSS 15.0 paket programýnda tanýmlayýcý istatistik, ki-kare, baðýmsýz iki grup t testi ve lojistik regresyon testleri ile analiz edildi. Ýnme ve kontrol grubunda karþýlaþtýrýlan baðýmsýz deðiþkenlerden istatistiksel olarak anlamlý bulunanlar lojistik regresyon analizine alýndý. P <0.05 anlamlý kabul edildi.
BULGULAR: Çalýþmamýzýn sonucunda inme ve kontrol gruplarý arasýnda HPA, PAI, APO, ACE gen polimorfizmlerinin görülme sýklýklarý arasýnda anlamlý bir fark görülmezken sadece faktör V H1299R, F V Leiden ve β Fibrinojen -455GA mutasyonlarýnýn görülme oranlarý inme geçirmiþ hasta grubunda Ki-kare testine göre anlamlý yükseklikte bulundu (p<0.05). Ancak lojistik regresyon analizine göre ise bu mutasyonlarýn istatistiksel olarak anlamlýlýklarý kayboldu (p>0.05).
SONUÇ: Çalýþmamýzdan elde edilen bulgular ýþýðýnda inme etiyopatogenezinin multifaktöriyel olduðunu ve protrombin gen mutasyonlarýnýn ancak diðer risk faktörleri ile birlikte olduklarýnda bu faktörlerin neden olabilecekleri riski artýrabilecekleri düþünülmektedir.

OBJECTIVE: The present study aimed to investigate whether the frequency of factor V, methylenetetrahydrofolate reductase (MTHFR), prothrombin, β-fibrinogen gene mutations, and human platelet alloantigens (HPA), plasminogen activator inhibitor 1 (PAI1), apolipoprotein E (APOE), and angiotensin converting enzyme (ACE) gene polymorphisms in stroke patients is higher than that in normal individuals.
METHODS: Two hundred twelve patients with cerebral infarction and 238 individuals of similar age and gender with no history of stroke were included. Demographics and risk factors for cerebrovascular disease of all individuals were determined. Biochemical parameters were analyzed in serum, and electrocardiography was performed. Factor V, MTHFR, prothrombin, β-fibrinogen mutations and HPA, PAI, APOE, and ACE polymorphisms were investigated. Data were analyzed with SPSS 15.0 software using descriptive statistics, chi-square, independent two-group t-test, and logistic regression tests. Statistically significant differences in independent variables were further analyzed by logistic regression. p < 0.05 was considered statistically significant.
RESULTS: HPA, PAI, APO, and ACE polymorphism frequency was not significantly different between the stroke and control groups. Factor V H1299R, factor V Leiden, and β fibrinogen -455GA mutation frequency was significantly higher in the stroke than the control group by the chi-square test, but not by logistic regression analysis.
CONCLUSION: Stroke etiopathogenesis is multifactorial, and prothrombin gene mutations increase the impact of existing risk factors when other risk factors are considered.

Abstract | English Full Text

AMAÇ: Çalýþmamýzda posterior serebral arterin (PCA) kortikal ve derin sulama alaný infarktlarýnda risk faktörleri, klinik özellikler ve inme mekanizmalarý arasýndaki iliþkiyi ortaya koymaya amaçladýk.
YÖNTEMLER: Çalýþmaya Þiþli Etfal Eðitim ve Araþtýrma Hastanesi Nöroloji Kliniðine Ocak 2002- Aðustos 2007 yýllarý arasýnda ilk kez inme geçiren saf PCA alanýnda infarktý olan 57 hasta alýndý. Olgular kortikal dal infarktý olanlar ile kortikal dal +derin dal(talamus) infarktý olanlar olmak üzere iki gruba ayrýldý. Bu iki grupta yapýlmýþ olan tetkikler ile hastalar dört etyolojik grupta incelendi. PCA ve dallarýndaki týkanýklýk, PCA proksimalindeki týkanýklar, kardioembolik nedenler, kriptojenik grup olarak sýnýflandýrýldý. Tüm hastalara kranial Bilgisayarlý Tomografi (BT) ve Manyetik Rezonans Görüntüleme (MRG), boyun doppler Ultrasonografi (dUSG), Manyetik Rezonans Anjiyografi (MRA) ya da Dijital Substraksiyon Anjiografi (DSA), transösofagial ya da transtorasik ekokardiyografi (TEE, TTE), hematolojik ve vaskülitik tetkik yapýldý.
BULGULAR: Otuz beþ hasta (%61) PCA kortikal dal infarktüs geçirirken, 22 hastada (%39) kortikal ve derin PCA besleme alanýnda infarkt saptandý. Etyolojiye bakýldýðýnda her iki grupta da kardioembolizmin(n=27,%47) daha sýk olduðu saptandý. Bunu sýrayla intrinsek PCA hastalýðý(n=12,%21), proksimal arter hastalýðý(n=10,%17), kriptojenik emboli(n=8,%15) izledi. Ýnme baþlangýcýnda hastalarýn %52 baþ aðrýsý gözlendi. Hastalarýn %78’inde görme alaný bozukluklarý, %54’ünde motor semptomlar, %24’ünde duysal semptomlar mevcuttu.
SONUÇ: Posterior serebral arterin kortikal ve derin sulama alanýndaki infarktlarda kardiyojenik emboli ve intrinsek PCA hastalýðýnýn daha sýk olduðu düþünüldü. PCA kortikal dal infarktý olanlar ile derin ve kortikal dal infarktý olanlar arasýnda etyoloji ve risk faktörleri açýsýndan anlamlý istatistiksel deðiþiklik saptanmadý.

OBJECTIVE: The objective of our study is to investigate the association between the infarcts in the cortical and deep posterior cerebral artery perfusion area and the mechanisms of stroke, clinical features and risk factors.
METHODS: For this purpose, 57 patients included in this study who suffered strokes first time and have infarcts in the posterior cerebral artery perfusion area and admitted to our Neurology Clinics between January 2002 and August 2007. Subjects were divided in two groups as cortical branch infarct group and deep (thalamus) + cortical branch group. Patients were evaluated in four etiologic clusters; 1.Occlusion in the posterior cerebral artery or its branches. 2. Occlusion proximal to the posterior cerebral artery. 3. Cardio-embolic reasons. 4. Cryptogenic embolism group. All patients had cranial CT, MRI, neck Doppler USG, MRA or DSA, trans-esophageal or trans-thoracic echocardiography, hematologic and vasculytic investigations. Risk factors in all patients were recorded.
RESULTS: Thirty-five (61%) patients had cortical branch infarct, 22 patients (39%) had infarcts in the cortical and deep PCA perfusion area. The cardio-embolism (n: 27; 47%) was the most frequently observed etiologic factor in both groups. This is followed by intrinsic PCA disease (n: 12; 21%), proximal artery disease (n: 10; 17%), cryptogenic embolism (n: 8, 15%), respectively. Headache was observed in 52% of the patients at the beginning of stroke. Seventy-eight of the patients had visual disturbances, 54% had motor symptoms, 24% had sensorial symptoms.
CONCLUSION: It is concluded that cardiogenic embolism and intrinsic PCA disease are more frequent etiologic factors in infarcts observed in the cortical and deep posterior cerebral artery perfusion area. There was no statistical difference in etiology and risk factors between the patients who had PCA cortical branch infarct group and deep (thalamus) + cortical branch group.

Abstract | English Full Text

AMAÇ: Akut spinal kord yaralanmasý (SKY) sonrasý nörolojik hasar, primer mekanik yaralanma ile olduðu kadar sekonder olarak doku hasarýna yol açan hücre ölümü aktivasyon kaskatlarýndan da kaynaklanmaktadýr. Bu çalýþmada vitamin D3’ün sýçanlarda oluþturulan deneysel SKY sonrasýnda motor fonksiyonlar üzerindeki iyileþtirici etkinliði araþtýrýldý.
YÖNTEMLER: Bu çalýþma Saðlýk Bakanlýðý Haydarpaþa Numune Eðitim ve Araþtýrma Hastanesinde yapýldý. Çalýþmada 3 grupta, 7’þer adet olmak üzere toplam 21 adet Spraque-Dawley cinsi sýçan kullanýldý. Ýlk gruba sadece laminektomi yapýldý (Kontrol grubu). Ýkinci gruba laminektomi yapýlýp omurilik yaralanmasý oluþturuldu (travma grubu). Üçüncü gruba laminektomi yapýlýp omurilik yaralanmasý oluþturuldu ve 1., 3., 5., 7. günlerde intraperitoneal olarak 1 mcg/kg/gün dozunda vitamin D3 enjeksiyonu yapýldý (Vitamin D3 grup). Deneklerin fonksiyonel iyileþmeleri cerrahi iþlem sonrasý 1., 7., 14. ve 21. günlerde eðik düzlem testi, Drummond ve Moore motor fonksiyon skoru ile deðerlendirildi. Kontrol, travma ve vitamin D3 uygulanan gruplardaki doku parçalarý hematoksilen-eozin (HE) boyasý ile boyanýp ýþýk mikroskobunda incelendi.
BULGULAR: Vitamin D3 grubunda eðik düzlem testi sonuçlarý ve motor fonksiyon skorlarý travma grubu ile karþýlaþtýrýldýðýnda 1., 2. ve 3. haftalarda anlamlý olarak daha yüksek bulundu.
SONUÇ: Bu çalýþmamýzda, sýçanlarda oluþturulan deneysel SKY’da vitamin D3’ün tedavi edici etkisi araþtýrýlmýþ olup klinik olarak iyileþme sürecine anlamlý etkinliði olduðu saptanmýþtýr.

OBJECTIVE: Spinal cord injuries are frequently encountered and is a major health problem because it causes severe disability. The neurological damage of acute spinal cord trauma includes primary mechanisms of injury and cell death activation cascades that causes damage of the tissue. The aim of this study is to investigate the therapeutic effects of vitamin D3 in a rat model of spinal cord injury.
METHODS: The study was performed at Haydarpasa Numune Training Hospital, Istanbul, Turkey. Twenty-one Spraque-Dawley rats were randomly assigned to the following study groups: the control group, undergoing laminectomy procedure; trauma group, undergoing spinal cord injury after laminectomy; and trauma plus vitamin D3 group, undergoing spinal cord injury after laminectomy and later administration of vitamin D3 on days 1., 3., 5., 7. intraperitoneally with a dosage of 1mcg/kg/day. The functional outcome was evaluated by using inclined plane test and Drummond and Moore motor function score on days 1, 7, 14, 21. Spinal cord samples of the control, trauma and trauma plus vitamin D3 groups were obtained for histopathologic evaluations after clinical examinations and was examined under light microscope.
RESULTS: Inclined plane test scores and motor function scores of vitamin D3 group were significantly higher than the trauma group at 1.,2. and 3. week.
CONCLUSION: In our study we have investigated the therapeutic effects of vitamin D3 and found out that it has a positive impact to the recovery process of the spinal cord injury..

Abstract | English Full Text

AMAÇ: Epilepsi yaþlýlarda sýk görülen bir hastalýktýr, ancak etiyolojisi, klinik sunum, eþlik eden hastalýklar ve prognozu genç hastalardan farklýdýr. Bu çalýþmada yaþlýlarda nöbet tipleri, EEG bulgularý ve epilepsi nedenleri araþtýrýldý.

YÖNTEMLER: Altmýþ beþ yaþ ve üzerinde ilk epileptik nöbetini geçiren 95 hasta retrospektif olarak deðerlendirildi. Epilepsi tipi, yaþ, EEG bulgularý, manyetik rezonans görüntüleme ve/veya kranial tomografi bulgularý, etyoloji, eþlik eden hastalýklar ve antiepileptik tedavi deðerlendirildi.

BULGULAR: Hastalarýmýzýn yaþ ortalamasý 75 idi ve 50(%56) hasta erkekti. Doksan beþ hastanýn 55’inde parsiyel tipte nöbet, 36’sýnda jeneralize tonik klonik nöbet ve 4’ünde jeneralize status epileptikus vardý. Ýnteriktal EEG'de fokal epileptiform aktivite sýklýðý %32,6 idi. Nöbetler hastalarýn %85'inde monoterapiyle %15'inde politerapiyle kontrol altýndaydý. Çalýþmamýz serebrovasküler hastalýklarýn, en sýk (% 63) etyolojik neden olduðunu gösterdi. Yaþ ve nöbet sýklýðý ve EEG anormallikleri arasýnda anlamlý bir iliþki saptanmadý. Ancak yaþ ve eþlik eden hastalýklar arasýnda anlamlý bir iliþki saptandý.

SONUÇ: Sonuçlarýmýz fokal nöbetlerin yaþlý epilepsinin en sýk belirtisi olduðunu desteklemektedir. Serebrovasküler hastalýklar yaþlýlarda epilepsinin en fazla rastlanan etyolojik nedenidir. Monoterapi hastalarýn çoðunluðunda yeterlidir. Yaþlý nüfusun devamlý büyümesi, doðru taný ve etkili tedavi gereksinimini arttýrmaktadýr.

OBJECTIVE: Epilepsy is a frequent disease in the elderly, but its aetiology, clinical presentation, comorbidities, and prognosis are different than younger patients. In this study, we investigated types of seizures, EEG findings and the cause of epilepsy in the elderly.

METHODS: We analyzed retrospectively 95 patients all of whom are 65 years old and over having an epileptic seizure fort the first time. Type of epilepsy, age, EEG findings, magnetic resonans imaging and/or cranial tomography findings, aetiology, comorbidities and antiepileptic medication were evaluated.

RESULTS: The average age of our patients was 75, and 50(56%) patients were males. In 95 patients, 55 (58%) had focal seizures, 36 (38%) had generalize tonic clonic seizures and 4(4%) had convulsive status epilepticus. The frequency of focal interictal epileptiform activity was 32,6% patients. Seizures were responsive to treatment as monotherapy in 81(%85) patients and as politherapy in 14(%15) patients. Our study showed that cerebrovascular disease was the most common (63%) aetiologic cause identified. There was no significant relationship between age and frequency of seizures and EEG abnormalities. However, a significant correlation was found between age and comorbidities.

CONCLUSION: Our results supported the focal seizure is the most common manifestation of epilepsy in the elderly. Cerebrovascular disease is the most common etiological cause of epilepsy in the elderly. Monotherapy is sufficient in the majority of patients. Continuous growth of the elderly population is increasing the need for accurate diagnosis and effective treatment.

Abstract | English Full Text

Bu yazý olaðan dýþý bir olgu sunumu çerçevesinde multipl skleroz, manik atak ve steroid kullanýmý iliþkisini irdelemektedir. Multipl sklerozda bipolar bozukluk görülme sýklýðý normal kiþilerle karþýlaþtýrýldýðýnda daha sýktýr. Yedi yýllýk multipl skleroz öyküsü bulunan 25 yaþýndaki kadýn hastamýz sað tarafýnda güçsüzlük yakýnmasý ile geldi. Muayene sýrasýnda manik içerikli davranýþlarý gözlendi ve psikiyatrik deðerlendirme sonrasý ‘bipolar bozukluk-manik atak’ tanýsý aldý. Atak tedavisi için yüksek doz steroid ve manik semptomlar açýsýndan antipsikotik kullanýmý önerilen hasta mani tedavisini reddetti. Beklenenin aksine steroid tedavisinin üçüncü gününde, manik ataðýn alevlenmesi bir yana semptomlar tama yakýn düzeldi. Olgumuz manik atakla gelen ve steroid uygulamasý sonrasý manik semptomlarý tama yakýn düzelen literatürdeki ilk multipl skleroz hastasýdýr.

This paper consists of an unusual case history and an overview of the relationship between multiple sclerosis, manic episode and corticosteroid treatment. Bipolar disorder and multiple sclerosis co-occur at a relatively higher rate. A 25-year old woman with a 7-year history of multiple sclerosis admitted to our hospital with right side weakness. During examination she showed some manic behavior patterns and diagnosed as ‘bipolar disorder-manic episode’ by psychiatrists. She was suggested to receive high dose steroids for her attack and antipsychotics for the manic episode but refused the latter. Unexpectedly at the third day of steroid treatment, instead of being triggered, almost all of the manic symptoms disappeared. This is the first report of a multiple sclerosis patient with bipolar disorder whose manic symptoms were cured after receiving steroids.

Abstract | English Full Text

Paroksismal hemikraniya (PH); sýk, kýsa süreli, þiddetli, tek taraflý baþ aðrýsýna kraniyal otonom bulgularýn eþlik etmesiyle karakterize bir aðrýdýr. Bu sendromun en belirgin özelliði ataklarýn nispeten kýsa süreli olmasý ve indometazin tedavisine tam olarak yanýt vermesidir.
PH, net olarak tek taraflý baþ aðrýsýna eþlik eden kraniyal otonom bulgulu bir baþ aðrýsý olarak sýnýflanmýþ olsa da, az sayýdaki olguda iki yanlý olabileceði bildirilmiþtir.
Biz bu sunumda iki yanlý lokalizasyon ve iki yanlý otonom bulgularýn gözlendiði bir PH olgusu sunucaðýz. PH, aslýnda farklý fenotipleri içeren bir klinik spektrumu yansýtýyor olabilir.

Paroxysmal hemicrania (PH) is characterized by frequent, short-lasting, severe, unilateral headaches that occur in association with cranial autonomic features. The hallmarks of this syndrome are relatively short attacks and a complete therapeutic response to indomethacin. Although PH has been classified as strictly unilateral headache in association with cranial autonomic features, a few cases have been reported that suggest bilateral PH. We report a case of PH with bilateral distribution and bilateral autonomic features. PH may actually represent a clinical spectrum including different phenotypes.

Abstract | English Full Text

Kaþýntý, çeþitli nörolojik ve dermatolojik hastalýklar sonrasýnda geliþen ciltte mekanik irritasyon için duyulan istektir. Kaþýntýnýn nörolojik nedenleri görece az bilinir ve çoðunlukla gözden kaçýrýlýr. Burada, baþlangýç semptomu olarak fasiyal kaþýntý ve çift görme olan olasý akut enflamatuvar poliradikülopati olgusu sunulacaktýr. Baþlangýç semptomu olan fasiyal kaþýntý ve çift görme özgün ve sinir sistemiyle baðlantýlý olmadýðý düþünüldüðünden hastamýzýn tanýsý gecikmiþtir. Kaþýntýnýn, özellikle diðer nörolojik belirtiler eþlik ettiðinde dikkate deðer bir nörolojik bulgu olabileceðini ileri sürmekteyiz.

Itch is the desire for mechanical irritation of skin which may result from various dermatological and sometimes neurological diseases. Neurological causes for itch is relatively unknown and frequently overlooked. Here, we report a case of possible acute inflammatory polyradiculopathy who had facial pruritus and diplopia as the initial symptoms. Diagnosis of our patient was delayed because initial diplopia and pruritus complaints were considered as nonspecific and unrelated to the nervous system. We suggest that pruritus may be a remarkable neurological finding especially when it is accompanied by other neurological symptoms.

Abstract | English Full Text

Neoplazi iliþkili spontan kronik subdural hematom nadir görülen bir rahatsýzlýktýr. Burada akut bifenotipik lösemi ile iliþkili nadir görülen bir kronik subdural hematom olgusu sunulmuþtur. Hematoloji bölümünden akut bifenotipik lösemi tanýsý almýþ 78 yaþýnda kadýn hastada geniþ, kronik subdural hematom meydana gelmiþ. Hasta sol tarafýnda güçsüzlük ile yakýnlarýnca hastanemiz acil servisimize getirilmiþtir. Çekilen kontrastsýz beyin bilgisayarlý tomografisinde travmatik olmayan, sað yerleþimli, geniþ, kronik subdural hematom gözlendi. Beyin cerrahi bölümünce deðerlendirildikten sonra acil olarak hematomu boþaltýlan hastanýn operasyon sonrasý nörolojik defisiti yoktu. Olgu; nadir görülen chronik subdural hematom geliþmiþ akut bifenotipik lösemi hastalarýnda subdural hematom gibi önemli komplikasyonlara dikkat çekmektedir.

Spontaneous chronic subdural hematoma associated with neoplasm is a rare disorder. A rare case of chronic subdural hematoma associated with acute biphenotypic leukemia presented here. A 78-year-old woman who diagnosed as acute biphenotypic leukemia by hematology was complicated with a large chronic subdural hematoma. She presented to our emergency medicine service of hospital with left-sided weakness. Her non-contrast brain computerized tomography scan showed a non-traumatic right-sided, large, chronic subdural hematoma. She was treated with urgent hematoma evacuation by neurosurgery and had no neurological deficits after that operation. The case highlights the importance of paying attention to acute biphenotypic leukemia patients for important complications such as subdural hematomas.

Abstract | English Full Text

Abstract | English Full Text