DOWNLOAD | English Full Text

Postüral stabilite çevresel koþullara uygun tepki verebilmek için farklý duyumsal girdilerin entegre edilmesini gerektiren karmaþýk bir denge görevidir. Vücudun stabiliteyi koruma becerisi bedenin içsel temsilinin mekandaki konumu gibi biyomekanik kýsýtlamalar ile sýnýrlandýrýlmýþtýr. Postürel stabilite, bedeni yönlendirmeye yarayan ve dengeyi korumaya yardým eden birden farklý beyin bölgesinin etkileþimini gerektirir, örneðin düþeyliðin vestibüler kortekste ve somatosensori korteksteki etkileþimi buna bir örnektir. Dahasý, denge sistemi duyumsal girdileri entegre etmek için biliþsel kaynaklarý kullanýr. Bradikinezi, rijidite, istirahat halinde izlenen tremor gibi birçok motor semptom ile karakterize edilen Parkinson hastalýðý (PH) genellikle tremor tipi ve postüral instabilite yürüyüþ güçlükleri (PÝYG) tipi olmak üzere iki alt kategoride sýnýflandýrýlýr. Önceki çalýþmalar PÝYG tipinin L-dopa içeren güncel tedavilere daha az yanýt verdiðini göstermiþtir. Dolayýsýyla PÝYG tipi Parkinson hastalarýný daha iyi tedavi etmek için denge sisteminin ve postüral eksikliklere neden olan etkilerinin daha iyi anlaþýlmasýna ihtiyaç vardýr. Bu derleme makalede, dengenin korunmasýna dahil olan nöral mekanizmalar gözden geçirilmekte ve bu denge aðlarýnýn PH tarafýndan nasýl etkilenebileceðine iliþkin çýkarýmlar sunulmuþtur.

Postural stability is a complex task that requires the integration of many sensory inputs to produce an appropriate response for every environmental situation. The balance systems employ both reactive and anticipatory strategies to maintain the body’s center of mass. The body’s ability to maintain stability is limited by biomechanical constraints, such as the bodies’ internal representation of position in space. The balance system has multiple internal representations of verticality including those in the vestibular and somatosensory cortexes that serve to orient the body and help to maintain balance. Moreover, the balance system uses cognitive resources to integrate sensory inputs. These cognitive resources are used to produce the appropriate motor responses in situations when the balance system is malfunctioning. Parkinson’s disease (PD) is characterized by many motor symptoms, such as resting tremors, bradykinesia, and rigidity. PD is generally characterized by two subcategories of symptoms: the tremor type and the postural instability gait difficulties type (PIGD). Previous studies showed that the PIGD type is less responsive to current treatments, which include L-dopa. Thus, a better understanding of the balance system and how it affects the production of postural deficits is needed to better treat individuals suffering from the PIGD type of PD. Here, we review the candidate neural mechanism involved in balance, and inferences are made on how these balance networks may be affected by PD.

Abstract | English Full Text

Amaç: Epilepsi, dünyada etnik köken, yaþ ve cinsiyete bakýlmaksýzýn önemli bir saðlýk sorunudur. Hastalýk ve hastalýkla iliþkili faktörleri tanýmlamada epidemiyolojik çalýþmalar önemlidir. Bizim bu çalýþmada amacýmýz Erzurum ilinde 15 yaþ ve üzeri insanlarda epilepsi prevalansýný tanýmlamaktýr.
Gereç ve Yöntem: Bu çalýþmamýz 4 kiþilik bir doktor ekibiyle yapýldý. Kapý kapý dolaþýlarak epilepsi ve sosyo-demografik bilgiler kaydedildi. Epilepsi prevalansý, yaþ ve cinsiyet, mezuniyet derecesi, aldýðý tedavi ve ailesel karakteristikleri kaydedildi. Bu çalýþmada 15 yaþ ve üzeri 4093 kiþi incelendi.
Bulgular: Çalýþmaya alýnan kiþilerin 2046’sý (%50) kadýn, 2047’si (%50) erkekti. Yirmi iki kiþide epilepsi tanýsý saptandý. Epilepsi prevalansý 5/1000 hesaplandý (kadýn prevalansý 4/1000, erkek prevalansý 6/1000). Epilepsi hastalarýnýn yarýsý jeneralize nöbet geçirirken, diðer yarýsý fokal nöbet geçiriyordu. Epilepsiye neden olan en önemli etiyolojik faktörler kraniyal travma ve geliþimsel nörolojik malformasyonlardý. Yirmi iki epilepsi hastasýnýn 20’si (%91) antiepileptik ilaç (AEÝ) kullanýyordu. Bunlarýn %75’i tek AEÝ kullanýrken, %25’i birden fazla AEÝ alýyordu.
Sonuç: Epilepsi prevalansý ve karakteristik özellikleri geliþmiþ ülkelerdeki oranlara benzerdi. Sonuç olarak çalýþmamýz epilepsi ile ilgili çalýþmalarda ve epilepsi prevalansý ile ilgili konularda yol göstereceði kanaatindeyiz.

Objective: Epilepsy is an important healthcare problem that occurs in every society across the world regardless of any difference in sex, age and ethnicity. Epidemiologic studies are important for providing a common ground and determining the factors associated with the disease. The objective of our study was to determine the prevalence of epilepsy for the population aged 15 years and over in the provincial center of Erzurum.
Materials and Methods: A questionnaire on epilepsy and a socio-demographic data form were administered to each patient by four assistant physicians who made door-to-door visits. The prevalence rate, distribution by age and sex, grading, treatment and familial characteristics of the disease were studied. We evaluated 4093 subjects aged 15 years and over.
Results: Of these subjects, 2046 (50%) were female, and 2047 (50%) were male. We identified 22 patients with active epilepsy with a point prevalence of 5/1000 (4/1000 in female and 6/1000 in male patients). Fifty percent of patients had partial-onset seizures, and 50% had generalized-onset seizures. The possible etiology was identified in 50% of patients. The most common identifiable etiology was cranial trauma and developmental brain malformation. Of these 22 patients, 20 (91%) were on antiepileptic drugs (AEDs), 75% on a single AED, and 25% on multiple AEDs.
Conclusion: In the present study, the prevalence of active epilepsy and other characteristics were similar to those found in developed countries and studies in Turkey. The results can be attributed to careful use of International League Against Epilepsy guidelines and to the urban cohort.

Abstract | English Full Text

Amaç: Yüksek prevalans oranýna raðmen migren patofizyolojisi halen anlaþýlamamýþtýr. Bu çalýþmada, yeni taný almýþ epizodik migren hastalarýnda endotel disfonksiyonunun araþtýrýlmasý, bulgularýn saðlýklý kontrollerle karþýlaþtýrýlmasý ve manyetik rezonans görüntülemede (MRG) beyaz cevher lezyonlarý (BCL) oluþmuþ ise bu lezyonlar ile endotel disfonksiyonu arasýnda bir korelasyon olup olmadýðýnýn deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntem: Bu çalýþma 2013 ve 2014 yýllarý arasýnda yürütülmüþtür. Çalýþmaya toplam 51 hasta ve 27 saðlýklý kontrol alýndý. Hasta grubunda MRG yapýldý. Hasta ve kontrol grubunda, kan lipitleri, tiroid hormonlarý, asimetrik dimetil arjinin ve endotelin seviyeleri için kan numuneleri toplandý. Her iki grupta insülin direnci = homeostasis model deðerlendirmesi ve brakiyal arter indeksi flow-aracýlý dilatasyon (FMD) araþtýrýldý.
Bulgular: Migrenli 40 hastada MRG’de BCL mevcuttu. Migren hastalarýnda FMD düþüktü (p=0,021). Migren baþ aðrýsý þiddeti ile FMD arasýnda negatif korelasyon bulundu. Baþ aðrýsý þiddeti ile BCL’ler arasýnda pozitif bir iliþki görüldü (p=0,001). Hasta ve kontrol grubunda belirtilen belirteçlerin konsantrasyonlarý arasýnda istatistiksel olarak anlamlý farklýlýk görülmedi. Kan parametreleri ile MRG lezyon yükü korelasyonuna bakýldýðýnda yaþ, kolesterol, düþük yoðunluklu lipoprotein, vücut kitle indeksi ve trigliserid düzeyi ile pozitif korelasyon saptandý ve beklenenin aksine homosistein düzeyi arasýnda iliþki yoktu. Bununla birlikte, insülin direnci ve lezyon yükü arasýnda anlamlý bir iliþki vardý (p<0,03).

Sonuç: Bu çalýþmada özellikle BCL’li epizodik migrenli hastalarda, endotel disfonksiyonu için bir belirteç olan FMD’nin istatistiksel olarak anlamlý olduðu bulunmuþtur. Bu bulgu migren patogenezine katkýda bulunabilir. Özellikle profilaksiye ihtiyaç duyan hastalarda endotel düzeyinde tedavi edici bir farmakoterapi seçenek olarak düþünülebilir.

Objective: Despite its high prevalence, the basic pathophysiologic mechanism of migraine is still poorly understood. Our aim was to research endothelial dysfunction in patients with recently diagnosed episodic migraine, and to determine whether there was a correlation between endothelial dysfunction and white matter lesions (WMLs) on magnetic resonance imaging (MRI).
Materials and Methods: This study was conducted between 2013 and 2014. A total of 51 patients and 27 healthy controls were included in the study. MRI was performed in the patient group. Blood samples were collected to investigate serum level of lipids, thyroid hormones, asymmetric dimethyl arginine, and endothelin levels in the patient and control groups. Homeostasis model assessment = insulin resistance factor and brachial artery index flow-mediated dilatation (FMD) were investigated in both groups.
Results: WMLs on MRI were present in 40 patients with migraine. FMD was low in patients with migraine (p=0.021). There was a negative correlation between the severity of migraine headache and FMD. A positive correlation was seen between severity of headache and WMLs (p=0.001). The other blood sample concentrations in both the case and control groups were not significantly different. When the blood parameters were evaluated with MRI lesion load, there was a positive correlation with age, cholesterol, low-density lipoprotein, body mass index and triglyceride, and contrary to expectations, there was no relationship with homocysteine. However, there was a significant correlation between insulin resistance and lesion load (p<0.03).
Conclusion: In this study, especially in patients with episodic migraine with WMLs, FMD as a marker for endothelial dysfunction was found to be statistically significant. This finding contributes to the pathogenesis of migraine. An endothelial therapeutic drug could be considered as an option, especially in patients who need prophylaxis.

Abstract | English Full Text

Amaç: Ýnme, Türkiye’de ölüme neden olan hastalýklar içerisinde ikinci sýrada ve özürlülüðe yol açan nedenler içerisinde üçüncü sýradadýr. Akut iskemik inmeye (AÝÝ) baðlý her geçen dakikada ortalama 1,9 milyon nöron ölmektedir ve bu nedenle “zaman beyindir”. Hýzlý bir þekilde intravenöz trombolitik tedaviye (ÝTT) ve mümkünse endovasküler tedaviye baþlanmalýdýr. Biz bu çalýþma ile Þanlýurfa’daki ÝTT deneyimimizi paylaþmayý amaçladýk.
Gereç ve Yöntem: Haziran 2015 ve Temmuz 2017 arasýnda baþvuran, AÝÝ tanýsý konarak ÝTT verilen 21 hastanýn klinik ve demografik özelliklerini, risk faktörlerini ve 3 aylýk izlemlerini kaydettik.
Bulgular: Çalýþmaya dahil edilen 21 hastanýn 12’si kadýn, 9’u erkekti ve yaþ ortalamalarý 72,1±11,8 (48-87) idi. Etiyolojik incelemede hastalarýn beþinde (%23,8) büyük damar hastalýðý, dokuzunda (%42,9) kardiyoembolizm, ikisinde (%9,5) küçük damar hastalýðý saptanýrken, beþinde (23,8%) neden bulunamadý. Hastalarýn %38,1’inde atrial fibrilasyon, %57,1’inde hipertansiyon, %23,8’inde diabetes mellitus, %33,3’ünde koroner arter hastalýðý, %19’unda hiperlipidemi ve %33,3’ünde sigara kullanýmý mevcuttu. Hastalarýn tedavi öncesi National Institutes of Health Stroke Scale (NIHSS) skoru 11,7±6,7 (2-24) idi. Semptom baþlangýcýndan tedaviye baþlanana kadar geçen süre 19 hasta deðerlendirildiðinde 185±55,8 dakika idi. Ýki hastada (%9,5) tedavi sonrasý intraserebral kanama gözlendi. Birisi asemptomatikti, semptomatik (%4,75) olan bir hasta ise dekompresif cerrahi uygulanmasýna raðmen kaybedildi. Üç aylýk takipte on hasta kaybedildi ve mortalite oraný (%47,6) olarak hesaplandý. Üçüncü ay modifiye Rankin skalasý skoru, sekiz hastada (%38,1) 0-2, yedi hastada (%33,3) 0-1 idi. Yedi hastada ≥80 yaþ, beþ hastada NIHSS <5 ve iki hastada 4,5 saatlik tedavi penceresi aþýlmýþ olmasýna raðmen, ruhsatlandýrma dýþý olarak ÝTT uygulanmýþtýr.
Sonuç: ÝTT etkili ve güvenlidir. Baðýmsýz yaþayan hasta sayýsýný anlamlý olarak arttýrýr. Bu tedavinin Türkiye’nin her yerinde uygulanmasýna gayret göstermeli ve meslektaþlarýmýzý cesaretlendirmeliyiz.

Objective: Stroke ranks second among the diseases that cause death and third among the causes of disability in Turkey. An average of 1.9 million neurons die every minute due to acute ischemic stroke and therefore ‘time is brain’. Intravenous thrombolytic treatment (ITT) and, if possible, endovascular treatment should be initiated quickly. We aimed to share our ITT experience in Sanliurfa with this study.
Materials and Methods: We recorded the clinical and demographic characteristics, risk factors, and three-month follow-up of 21 patients with acute ischemic stroke who were given ITT between June 2015 and July 2017.
Results: Of the 21 patients, nine were male and 12 were female, and the mean age was 72.1±11.8 (range, 48-87) years. Large vessel occlusion was found in five (23.8%) patients, cardioembolism in 9 (42.9%), and small vessel occlusion in 2 (9.5%) patients; etiology was not determined in five (23.8%) patients. Atrial fibrillation was found in 38.1%, hypertension in 57.1%, diabetes mellitus in 23.8%, coronary artery disease in 33.3%, hyperlipidemia in 19%, and smoking in 33.3% of the patients.The NIHSS score was 11.7±6.7 (range, 2-24) prior to treatment. The symptom-onset to needle time was 185±55.8 minutes when 19 patients were evaluated. Intracerebral hemorrhage was observed in two (9.5%) patients after treatment. One patient was asymptomatic and the symptomatic patient (4.75%) died despite decompression surgery. Ten patients died and the mortality rate was 47.6% at the end of the three-month follow-up period. The modified Rankin scale score was 0-2 in eight patients (38.1%) and was 0-1 in seven patients (33.3%). ITT was given to seven patients aged ≥80 years, five patients with NIHSS <5, and two patients in whom the treatment window was exceeded, which was non-adherent to the label.

Conclusion: ITT is effective and safe. It increases the number of independent living patients. We must strive to perform this treatment all over Turkey and encourage our colleagues.

Abstract | English Full Text

Amaç: Multipl skleroz (MS), nöromiyelitis optika spektrum bozukluklarý (NMOSB) ve saðlýklý kontrollerde, peripapiller retina sinir lifi tabakasý kalýnlýðý (pRSLT) ve maküla hacminin karþýlaþtýrýlmasýdýr.
Gereç ve Yöntem: Bu çalýþmada pRSLT ve maküla hacmini ölçmek için spektral optik koherans tomografi kullanýlmýþtýr. MS veya NMOSB nedeniyle izlenen 40 hasta ve 19 saðlýklý kontrol dahil edilmiþtir.
Bulgular: Tek bir optik nevrit sonrasý ortalama pRSLT’nin NMOSB olanlarda [60 µm (34-105)] ve MS’lerde [85 µm (41-109)], saðlýklý kontrollere göre [99 µm (88-109)] daha düþük olduðu görülmüþ ve bunun NMOSB olanlarda MS’lere göre anlamlý düþük olduðu saptanmýþtýr (p=0,002). Fovea hacmi NMOSB ve MS hastalarýnýn optik nevrit geçiren gözlerinde farklýlýk göstermemiþtir (NMOSB 1,18±0,3 mm3, MS 1,82±2,07 mm3). Ortalama pRSLT kalýnlýðý seronegatif NMOSB olan grupta [58 µm (47-111)] seropozitif gruba göre [76 µm (42-105)] daha ince olma eðilimde saptanmýþ olmakla birlikte, bu istatiksel olarak anlamlý bulunmamýþtýr.
Sonuç: Çalýþmamýzda saðlýklý kontrollere göre NMOSB ve MS’lilerde hem fovea (1,5 mm ETDRS halkasý) hem de maküla (6 mm ETDRS halkasý) hacminin azaldýðý gösterilmiþtir. NMOSB optik nevritinin MS ile karþýlaþtýrýldýðýnda, daha ince ortalama RSLT ile iliþkili olduðunu ve etkilenen optik sinirde daha erken aksonal hasar geliþtiðini desteklemektedir.

Objective: To compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular volume in patients with multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and healthy controls.
Materials and Methods: This study used spectral domain-optical coherence tomography to measure pRNFL and the volume of retinal layers at the macula. Forty patients with MS or NMOSD and 19 healthy controls were enrolled.
Results: After at least one clinical episode of optic neuritis, the average pRNFL for NMOSD [60 µm (34-105)] and patients with MS [85 µm (41-109)] were lower than in healthy controls [99 µm (88-109)], and patients with NMOSD had significantly lower pRNFL compared with patients with MS (p=0.002). Foveal volume did not differ between optic neuritis eyes of patients with NMOSD and MS (NMOSD 1.18±0.3 mm3, MS 1.82±2.07 mm3). The mean pRNFL values in seronegative NMOSD eyes [58 µm (range, 47-111)] tended to be thinner compared with seropositive NMOSD eyes [76 µm (range, 42-105)]. This finding was not considered to be statistically significant.
Conclusion: Our study revealed that both foveal (area in a 1.5 mm ETDRS ring) and total macular volume (area in a 6 mm ETDRS ring) were lower in both patients with MS and NMOSD compared with healthy controls. Optic neuritis of NMOSD is associated with a thinner average RNFL compared with MS, suggesting earlier axonal injury in the affected optic nerves.

Abstract | English Full Text

Amaç: Ýki farklý referans merkezin nöro-oftalmoloji polikliniklerinde izlenen, izole üçüncü, dördüncü ve altýncý kraniyal sinir felçlerinin etiyolojik faktörleri ve klinik profillerinin tespit edilmesidir.
Gereç ve Yöntem: Hasta kayýtlarýnýn geriye dönük olarak taranmasýdýr.
Bulgular: Toplamda 127 hasta (78 erkek, 49 kadýn) incelendi. Kýrk beþ hastanýn (%35,4) izole üçüncü sinir felci, 34 hastanýn (%26,8) izole dördüncü sinir felci ve 48 hastanýn (%37,8) izole altýncý sinir felci vardý. Ortalama yaþlar benzerdi, sýrasýyla: 58,87 (±13,6), 56,32 (±16,1) ve 54,9 (±14,4) olarak saptandý (p=0,4). Ana semptom çift görme olup, tüm hastalarda izlendi. Yirmi bir hastanýn anizokorisi vardý (20 üçüncü, 1 dördüncü sinir). Anizokorisi olan hastalardan 3 tanesi vaskülopatiye baðlý üçüncü sinir felciydi, diðerleri edinilmiþ non-travmatik grup olarak kabul edildi ve etiyolojilerinde anevrizma, Tolosa-Hunt sendromu, C karotiko-kavernöz fistül gibi tanýlar vardý. Tüm hasta gruplarýnda en sýk saptanan etiyoloji vaskülopati idi. Üç hasta pupilin korunduðu üçüncü sinir felci olmasýna raðmen Tolosa-Hunt sendromu tanýsý aldý. Tüm sinirler için düzelme zamaný benzerdi.
Sonuç: Her ne kadar üçüncü, dördüncü ve altýncý sinir felçlerinin en sýk etiyolojik sebebi vaskülopati olsa da, tedavi potansiyeli olan ve tehlikeli durumlarýn dýþlanabilmesi için nöro-görüntüleme çalýþmalarý önemlidir.

Objective: To determine the etiologic factors and clinical profile of isolated third, fourth, and sixth nerve palsies in neuro-ophthalmology outpatient clinics of two different reference centers.
Materials and Methods: Retrospective evaluation of medical records from the institutional database.
Results: A total of 127 (78 male, 49 female) patients were analyzed. Forty-five (35.4%) patients had isolated third nerve palsy, 34 (26.8%) had isolated fourth nerve palsy, and 48 (37.8%) patients had isolated sixth nerve palsy. The mean ages were similar; 58.87±13.6, 56.32±16.1, and 54.9±14.4 years, respectively (p=0.4). Diplopia was the main symptom seen in all patients. Twenty-one patients had anisocoria (20 third, 1 fourth). Among patients with anisocoria, 3 patients had final diagnoses of vasculopathy, the rest were diagnosed as having acquired non travmatic palsy with different etiologies such as aneurysm, Tolosa-Hunt syndrome, and carotico-cavernous fistula. The most common etiology for all groups was vasculopathy. Three patients with isolated oculomotor nerve palsy were diagnosed as having Tolosa-Hunt sydnrome despite pupillary sparing. The mean recovery time was similar for all cranial nerve palsies.
Conclusion: Although, the most common etiology of third, fourth, and sixth nerve palsies is vasculopathy, neuroimaging studies are crucial to exclude potentially treatable and dangerous conditions.

Abstract | English Full Text

Cockayne sendromu, karakteristik klinik özellikleri geliþme geriliði, erken yaþlanma, retinal ve yaygýn nörolojik anormallikler olan genetik bir hastalýktýr. Olgumuz, fizik tedavi ve rehabilitasyon polikliniðine sað üst ve alt ekstremitelerinde güçsüzlük ile baþvuran, baþvurusundan uzun zaman önce Cockayne sendromu tanýsý almýþ 29 yaþýnda bir erkek hastadýr. Sekiz ay önce, travmaya baðlý olmayan akut baþlangýçlý sað taraf güçsüzlüðü ve yürüme zorluðu ile acil servise baþvuran hastanýn kraniyal bilgisayarlý tomografisinde akut subdural hematom saptanmýþtýr. Olgu tarafýmýzca deðerlendirildiðinde kronik evre subdural hematomu mevcuttu. Kronik subdural hematom esas olarak yaþlý bireylerde görülen bir hastalýk olup, ileri yaþ majör risk faktörlerinden birisidir. Olgumuz, esasen yaþlý bireylerin bir hastalýðý olan kronik spontan subdural hematomun, erken yaþlanma sendromu olan genç bir bireyde de olabileceðini göstermektedir.

Cockayne syndrome is a rare genetic disease that presents with growth retardation, premature aging, retinal and generalized neurologic abnormalities. The presented case is a 29-year-old male patient, who was previously diagnosed as having Cockayne syndrome and who was admitted to the physical medicine and rehabilitation outpatient clinic with loss of strength in the right upper and lower extremity. The patient was detected to have acute-onset, non-traumatic rightsided muscle weakness secondary to acute subdural hematoma diagnosed in cranial computed tomography imaging at admission to emergency care department 8 months ago. When the patient was evaluated by us, he had a chronic stage subdural hematoma. Chronic subdural hematoma is a disease of elderly and aging is a well-known risk factor. Our case demonstrates that the disease of old age, chronic spontaneous subdural hematoma, can be seen in a very young age secondary to premature aging syndrome known as Cockayne syndrome.

Abstract | English Full Text

Abstract | English Full Text

Abstract | English Full Text

Abstract | English Full Text

Abstract | English Full Text | Video

Abstract | English Full Text

Abstract | English Full Text

Abstract | English Full Text