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Migren bulantý, kusma, ýþýða ve sese duyarlýlýk gibi semptomlarýn eþlik ettiði tekrarlayan baþ aðrýsý ataklarý ile karakterize bir nörolojik bozukluktur. Global Hastalýk Yükü 2019 verilerine göre dünya genelinde 1,12 milyardan fazla kiþiyi etkilemektedir ve önemli bir engellilik nedenidir. Yüzyýllardýr bilinen bir hastalýk olmasýna raðmen, patofizyolojisi henüz tam olarak aydýnlatýlamamýþtýr. Bugüne dek çeþitli teoriler öne sürülmüþtür; en günceli nörovasküler teoridir. Nöroradyoloji ve immünohistokimya alanýndaki geliþmelerin de desteklediði bu teori trigeminovasküler (TGV) sistemin migren patofizyolojisindeki önemine vurgu yapmaktadýr. TGV sistemin kraniyal kanlanmayý düzenleyerek ve nosiseptif iletinin yayýlmasýna katký saðlayarak migrenle iliþkilendirilen bir dizi karmaþýk olayýn baþlamasýna ve sürdürülmesine katkýda bulunduðu açýktýr. Migren patofizyolojisinde rolü olduðu gösterilen vazoaktif nöropeptidlerin saptanmasý migren tedavisine yönelik yeni stratejilerin geliþtirilmesi için fýrsat yaratmýþtýr. KT gen ile iliþkili peptid (CGRP), TGV sistemde fazla miktarda bulunmasý ve migrenin vazodilatasyon, nörojenik enflamasyon, periferik ve santral sensitizasyon gibi farklý süreçlerinde rol oynamasý nedeniyle en fazla dikkat çeken nörotransmitterlerden biri olmuþtur. Son birkaç dekadda araþtýrmalarýn odaðý haline gelmiþ ve geniþ ölçüde çalýþýlmýþtýr. Gerek CGRP reseptörünü antagonize eden küçük moleküllü CGRP antagonistleri gerekse CGRP’nin kendisini veya reseptörünü hedef alan monoklonal antikorlar geliþtirilmiþ ve migren tedavisinde kullanýma girmiþtir. Bu derleme, CGRP’ye odaklý olarak TGV sistemin migren patofizyolojisindeki ve tedavisindeki rolünü gözden geçirmektedir.

Migraine is a neurological disorder characterized by recurrent attacks of headache usually accompanied by symptoms such as nausea, vomiting, photophobia and phonophobia. According to the Global Burden of Disease Study 2019 estimates, it affects more than 1.12 billion people worldwide and is a major cause of disability worldwide. Although migraine has been recognized for centuries, its pathophysiology has not been fully understood yet. Several theories have been proposed so far, the most recent being the neurovascular theory. Supported by the developments in neuroradiology and immunohistochemistry, the theory emphasizes the essential role of the trigeminovascular (TGV) system in migraine pathophysiology. It is obvious that the TGV system, regulating the cranial blood flow and nociceptive transmission, contributes to initiation and progression of serial complex events associated with migraine. The identification of vasoactive neuropeptides which had a role in migraine pathophysiology also created an opportunity for development of new treatment strategies in migraine. Calcitonin gene related peptide (CGRP) is one of the neurotransmitters that has attracted most attention since it is abundantly found in the TGV system and plays a significant role in different processes of migraine including vasodilation, neurogenic inflammation, peripheral and central sensitization. It became the focus of research in the last few decades and extensively investigated. Both small molecules antagonizing CGRP receptor and monoclonal antibodies targeting either CGRP or its receptor have been developed and used in migraine treatment. This article overviews the role of the TGV system in migraine pathophysiology and treatment with a specific focus on CGRP.

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Amaç: Nöromusküler hastalýklarda (NMH) ilerleyici kas kuvvet kaybýna baðlý olarak denge problemleri ve düþmeler, hastalarýn günlük yaþam aktivitelerini ve fonksiyonel baðýmsýzlýðýný olumsuz bir þekilde etkilemektedir. Zamanlý kalk ve yürü testi (ZKYT), uygulamasý kolay ve objektif bir denge deðerlendirmesidir. Bu çalýþmanýn amacý, NMH olan yetiþkin bireylerde ZKYT testinin kesme deðerini belirlemektir.
Gereç ve Yöntem: Retrospektif çalýþmaya 102 katýlýmcý dahil edildi. ZKYT testinin diagnostik geçerliliðini belirlemek için alýcý iþlem karakteristikleri analizi yapýlarak NMH’de kesme, duyarlýlýk ve özgüllük deðerleri hesaplandý.
Bulgular: Düþme öyküsü olan 55 hastanýn ve düþme öyküsü olmayan 47 hastanýn ortalama yaþlarý sýrasýyla 34,40±10,41 ve 31,87±10,11’dir. Bu bireylerin ZKYT puanlarýnýn ortalama deðerleri sýrasýyla 11,79±4,30 ve 7,33±1,51 saniye olarak hesaplanmýþtýr. NMH olan yetiþkin bireylerde ZKYT testinin kesme deðeri 8,9 saniye olarak belirlendi.
Sonuç: Mevcut çalýþmanýn sonuçlarý, ZKYT testini 8,9 saniyenin üzerinde tamamlayan NMH olan bireylerin düþme riskinin yüksek olduðunu göstermektedir. Düþme þikayetlerinin en sýk görüldüðü nörolojik hasta gruplarýndan biri olan NMH’de düþme riskinin belirlenmesi hastalarýn güvenliði ve rehabilitasyonun etkinliði açýsýndan son derece önemlidir.

Objective: Balance problems and falls due to a progressive loss of muscle strength in neuromuscular diseases (NMD) negatively affect the activities of daily living and functional independence of patients. The timed up and go (TUG) test is an easy-to-apply and objective measure of balance. This study aimed to determine the cut-off value of the TUG test in adult individuals with NMD.
Materials and Methods: This retrospective study included 102 patients. The receiver operating characteristic analysis was performed and cut-off, sensitivity, and specificity values were calculated in NMD to determine the diagnostic validity of the TUG test.
Results: The mean ages of 55 patients with a fall history and 47 patients without a fall history were 34.40±10.41 and 31.87±10.11 years, respectively. The mean values of the TUG scores of these individuals were calculated as 11.79±4.30 and 7.33±1.51 s, respectively. The cut-off value of the TUG test in adult individuals with the NMD was determined as 8.9 s.
Conclusion: The present study revealed that individuals with NMD who complete the TUG test over 8.9 s have a high risk of falling. Determining the risk of falling in NMD, which is one of the neurological patient groups where falling complaints are most common, is extremely important for patient safety and the effectiveness of rehabilitation.

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Amaç: Akatizi sýklýkla bir ilaç yan etkisi olarak görülür. Parkinson hastalýðýnda (PH) nispeten yetersiz çalýþýlmýþtýr. Akatizi araþtýran az sayýda çalýþma, deðerlendirme yöntemleri ve yaygýnlýk oranlarý açýsýndan farklýlýk göstermekte olup, objektif bir yaklaþýma ihtiyaç olduðunu göstermektedir. Amacýmýz, akatizi prevalansýný objektif bir deðerlendirme aracý ile belirlemek ve nöropsikiyatrik belirtiler ve intihar eðilimi ile iliþkisini araþtýrmaktýr.
Gereç ve Yöntem: PH olan 101 hasta ve yaþ ve cinsiyet açýsýndan eþleþen 75 kontrol deneði kaydedildi. Hastalar ve kontroller akatizi varlýðý açýsýndan karþýlaþtýrýldý. Ayrýca, akatizi olan ve olmayan hastalar, onaylanmýþ araçlar kullanýlarak hastalýk evresi, ciddiyeti, en yüksek doz diskinezi, intihar olasýlýðý, anksiyete varlýðý ve depresyon açýsýndan karþýlaþtýrýldý.
Bulgular: Akatizi parkinson hastalarýnda kontrollere göre daha sýktý (%6,9 0 p=0,02). Akatizi hastalarý, birleþik PH derecelendirme ölçeði-bölüm II’de (günlük yaþam deneyimleri) daha kötü puan aldý ve daha sýk anksiyete ve diskinezi bildirdiler. Akatizi olan veya olmayan hastalarda intihar olasýlýðý benzerdi.
Sonuç: Bulgularýmýz, akatizinin parkinson hastalarýnda kontrol grubuna göre daha sýk olduðunu ve anksiyete ile iliþkili olduðunu ortaya koymaktadýr.

Objective: Akathisia is frequently seen as a drug side-effect. In Parkinson’s disease (PD), it is relatively understudied. Moreover, few studies investigating akathisia differ concerning the assessment methods and prevalence rates, indicating a need for an objective approach. Our aim is to determine the prevalence of akathisia with an objective assessment tool and to investigate its relationship with neuropsychiatric symptoms and suicidal tendency.
Materials and Methods: One-hundred-one patients with PD and 75 age-and sex-matched control subjects were enrolled. Patients and controls were compared in terms of the presence of akathisia. Further, patients with and without akathisia were compared with regard to disease stage, severity, peak dose dyskinesia, suicide probability, presence of anxiety, and depression using validated tools.
Results: Akathisia was more frequent in patients with PD than in controls (6.9 vs. 0% p=0.02). Patients with akathisia scored worse in unified PD rating scalepart II (experiences of daily living) and reported anxiety and dyskinesia more frequently. The probability of suicidality was similar in patients with or without akathisia.
Conclusion: Our findings reveal that akathisia is more frequent in patients with PD than controls, and is associated with anxiety.

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Amaç: Ýskemik inme rekürrensi (ÝÝR), ÝÝ hastanýn karþý karþýya olduðu büyük bir tehdittir. Minör ÝÝ’si (MÝÝ) olan hastalarda ÝÝR riski ilk 3 ayda %10-13’tür. Hastalarýn ileri tetkik ve tedavisine raðmen, ÝÝR hala sýktýr. Hangi risk faktörlerinin ÝÝR’ye sebep olduðunu bilmek bazý önlemlerin alýnmasý açýsýndan önemlidir. Bu çalýþmanýn amacý MÝÝ’li hastalarda ÝÝR ile iliþkili demografik, klinik ve radyolojik özelliklerin saptanarak riskli grubun belirlenmesidir.
Gereç ve Yöntem: Bu çalýþmaya 01.01.2019-01.01.2020 tarihleri arasýnda Bursa Uludað Üniversitesi Týp Fakültesi Nöroloji Anabilim Dalý tarafýndan akut ÝÝ (AÝÝ) tanýsý konulan 310 hasta retrospektif olarak taranarak dahil edildi.
Bulgular: ÝR’si olan ve olmayan hastalarda klinik, radyolojik ve demografik özellikler analiz edildiðinde; koroner arter hastalýðý (KAH) varlýðý, aterosklerotik damar hastalýðý, anterior sirkülasyon inmesi, kraniyoservikal aterosklerotik stenoz, anterior sirkülasyonda aterosklerotik stenoz, semptomatik internal karotid arterde aterosklerotik stenoz, asemptomatik internal karotis arterde (ÝCA) aterosklerotik stenoz ve karotis arter stentleme iþleminin yapýlmasý açýsýndan istatistiksel olarak anlamlý farklýlýklar saptandý. MÝÝ’li hastalarda anlamlý deðiþkenler binary logistik regresyon ile analiz edildiðinde en anlamlý deðiþkenlerin KAH ve asemptomatik ÝCA stenozu olduðu saptandý.
Sonuç: Çalýþmamýzda MÝÝ’li hastalarda ÝÝR ile en iliþkili risk faktörleri KAH varlýðý ve asemptomatik ÝCA stenozu olarak saptanmýþtýr. Ateroskleroz sistemik bir hastalýktýr ve bu sebeble kraniyoservikal aterosklerotik stenoz multipl olabilir. Anjiyografik kanýtlar AÝÝ’li hastalarda etnik ve ýrksal farklýlýklarý da ortaya koymuþtur. Bu sebeple kendi popülasyonumuzda yapýlacak prospektif çalýþmalarla daha kesin bilgilere ulaþýlabilir.

Objective: Recurrent ischemic stroke (RIS) is a major threat to patients with IS. The risk of RIS in patients with minor IS (MIS) is 10-13% in the first 3 months. Despite the advanced examination and treatment of the patients, RIS is still common. It is important to know which risk factors cause RIS in order to take some precautions. The aim of this study is to determine the risky group by determining the demographic, clinical and radiological features associated with RIS in patients with MIS.
Materials and Methods: We included 310 patients diagnosed as having acute IS (AIS) by Bursa Uludag University Faculty of Medicine Department of Neurology between 01.01.2019 and 01.01.2020, retrospectively.
Results: When clinical, radiological and dermogrophic features were analyzed between patients with and without RIS, there were statistically significant differences between groups in terms of the presence of coronary artery disease (CAD), atherosclerotic vascular disease, anterior circulation stroke, craniocervical atherosclerotic stenosis, atherosclerotic stenosis in the anterior circulation, atherosclerotic stenosis of the symptomatic internal carotid artery (ICA), atherosclerotic stenosis in the asymptomatic ICA and performing carotid artery stenting. When significant variables were analyzed by using binary logistic regression in patients with MIS, it was found that the most significant variables were CAD and asymptomatic ICA stenosis.
Conclusion: In our study, the risk factors associated with RIS in patients with MIS were the presence of CAD and asymptomatic ICA stenosis. Atherosclerosis is a systemic disease and therefore craniocervical atherosclerotic stenosis may be multiple. Angiographic evidence has also revealed ethnic and racial differences in patients with AIS. For this reason, more precise information can be obtained with prospective studies to be conducted in our own population.

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Amaç: Migrenli hastalarda atak sýklýðýnýn ve aðrýlý gün sayýsýnýn artmasý ve hastalýðýn progrese olmasý kronik migren (KM) olarak adlandýrýlmaktadýr. Son zamanlarda birçok çalýþmada periferik sinir blokajýnýn özellikle migrende etkin olduðu gösterilmiþ ve büyük oksipital sinir [greater occipital nerve (GON)] blokajý tedaviye dirençli migren hastalarýnda kullanýlmaya baþlanmýþtýr. Çalýþmamýzda KM tanýsý ile takipte olan ve düzenli medikal profilaksi almakta iken dirençli aðrýlarý nedeniyle GON blokajý uygulanan hastalar ile sadece GON blokajý uygulanan hastalarda blokajýn etkinliðini araþtýrmayý amaçladýk.
Gereç ve Yöntem: Çalýþmaya 18-65 yaþ arasýnda olan, medikal tedavi ve GON blokajý uygulanan 60 KM hastasý ile sadece GON blokajý uygulanan 74 KM’li hasta dahil edildi. Hastalarýn vizuel analog skala (VAS) ve migren dizabilite deðerlendirme ölçeði (MIDAS) skorlarý, atak sýklýðý, atak süresi ve analjezik kullaným ihtiyacý iþlem öncesinde, 1. ayda ve 3. ayda kayýt edilerek tedavi öncesi dönem ve 1. ve 3. ay verileri karþýlaþtýrýldý.
Bulgular: Tekrarlayan GON blokajlarýnýn uygulandýðý hastalarýmýzda, profilaksi alan ve almayan her iki grupta 1 ve 3. ayda, tedavi öncesi döneme göre atak süresi, atak sýklýðý ve analjezik kullanýmýnda azalma; VAS ve MIDAS skorlarýnda belirgin iyileþme saptandý (p<0,001). Her iki grup arasýnda aðrý süresi, aðrý sýklýðý, analjezik alýmý, VAS ve MIDAS skorlarý bakýmýndan istatiksel olarak anlamlý fark saptanmadý.
Sonuç: Medikal tedavi alamayan veya uzun süre medikal tedavi almýþ ancak fayda görmemiþ olan KM’li hastalarda GON blokajýnýn etkin olduðu gözlenmiþtir. Uygulanmasý kolay, yan etkisi oldukça az ve tedavi maliyetlerine katkýsý yüksek olan bu yöntem uygun hastalarda tedavi seçeneði olarak düþünülebilir.

Objective: Chronic migraine (CM) refers to an increasing frequency of attacks and number of days with pain, and disease progression in patients with migraine. Recently, many studies have shown that peripheral nerve blockade is particularly effective in migraine, and greater occipital nerve (GON) blockade has been used in patients with treatment-resistant migraine. In our study, we aimed to investigate the effectiveness of the blockade performed in patients who were followed up with a diagnosis of migraine and underwent GON blockade due to persistent pain while receiving regular medical prophylaxis, and patients who only underwent GON blockade.
Materials and Methods: Sixty patients with CM aged 18-65 years who underwent medical treatment and GON blockade and 74 patients with CM who only underwent GON blockade were included in the study. The patients’ visual analogue scale (VAS) and migraine disability assessment scale (MIDAS) scores, attack frequency, duration of attack, and need for analgesic use were recorded before the procedure, and in the first and third months. Then, the data in the pre-treatment period were compared with the data in the first and third months.
Results: In our both groups who received and did not receive prophylaxis and in whom recurrent GON blockades were applied, the duration of attacks, frequency of attacks and analgesic use significantly decreased, and a significant improvement was found in VAS and MIDAS scores in the 1st and 3rd months compared to the pre-treatment period (p<0.001). There was no statistically significant difference between the two groups in terms of pain duration, pain frequency, analgesic intake, and VAS and MIDAS scores.
Conclusion: The GON blockade is effective in patients with CM who cannot receive medical treatment or who have received medical treatment for a long time but have not had benefit. This method, which is easy to apply, has few adverse effects and has a high contribution to reducing treatment costs, can be considered as a treatment option for suitable patients.

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Amaç: Depresyon ve anksiyete multipl skleroz (MS) hastalarýnda yaþam kalitesini düþüren, yaygýn görülen ve iyi tanýmlanmýþ komorbiditelerdir. Mizofoni, genellikle belirli çevresel seslere veya nadiren de görsel uyaranlara karþý anormal duygusal tepkiler oluþmasýna sebep olan ve hala yeteri kadar farkedilmeyen bir durumdur. Limbik sistem bozukluklarýnýn, hem MS’deki psikiyatrik bozukluklarýn hem de mizofoninin patofizyolojisinde sorumlu olabileceði düþünülmektedir. Mizofoni prevalansý, depresyon ve anksiyete ile iliþkisi MS popülasyonunda incelenmemiþtir. Bu çalýþmanýn amacý MS’de mizofoni sýklýðýný ve bunun depresyon ve anksiyete þiddetine etkilerini araþtýrmaktýr. Ýkincil amaç, MS ile iliþkili faktörlerin mizofoni þiddeti üzerindeki etkisini deðerlendirmektir.
Gereç ve Yöntem: Elli dokuz MS hastasý çalýþmaya dahil edildi. MS tipi, hastalýk süresi, yýllýk atak sýklýðý ve sigara içme alýþkanlýklarý deðerlendirildi. MS grubunda mizofoni, depresyon ve anksiyete varlýðý ve þiddeti 63 saðlýklý kontrol ile karþýlaþtýrýldý.
Bulgular: Mizofoni sýklýðý MS grubunda (%37,3) kontrollere (%19,4) göre anlamlý olarak daha yüksekti (p=0,046). MS grubunda þiddetli depresyon (%23,7) ve anksiyete (%28,8) kontrollere göre (%1,6 ve %11,1 p<0,001) daha sýktý. Mizofoni olan MS (MSwM) grubu, mizofoni olmayan MS (MSwoM) grubu ile karþýlaþtýrýldýðýnda þiddetli depresyon (p=0,004) ve anksiyete (p=0,019) anlamlý olarak daha sýktý. MS tipi, süresi, atak sýklýðý ve sigara içme alýþkanlýklarý MSwM ve MSwoM arasýnda benzerdi. MS’de mizofoni puaný ile Beck depresyon puaný (p=0,029) arasýnda anlamlý pozitif korelasyon vardý.
Sonuç: Misofoni MS popülasyonunda sýk karþýlaþýlan bir komorbidite olup depresyon ve anksiyete þiddetini arttýrabilmektedir.

Objective: Depression and anxiety are common and well defined psychiatric comorbidities in multiple sclerosis (MS), which decrease the quality of life. Misophonia is an underrecognized condition that consists of abnormal emotional responses to specific environmental sounds or rarely to images. Limbic system impairments can be the leading cause of both psychiatric disorders in MS and misophonia. The prevalence of misophonia and its relationship with depression and anxiety have not been studied in the MS population. This study aimed to investigate the frequency of misophonia in MS and its effects on depression and anxiety severity. A secondary aim was to evaluate the effect of the factors associated with MS on the misophonia severity.
Materials and Methods: Fifty-nine patients with MS were recruited for the study. MS type, disease duration, attack frequency per year and smoking habbits were evaluated. The presence and severity of misophonia, and depression and anxiety scores in MS group were compared with 63 healthy controls.
Results: The frequency of misophonia was significantly higher in MS group (37.3%) compared to controls (19.4%) (p=0.046). Severe depression (23.7%) and anxiety (28.8%) were more frequent in the MS group compared to controls (1.6% and 11.1% p<0.001). Patients with MS and misophonia (MSwM) had a significantly higher frequency of severe depression (p=0.004) and anxiety (p=0.019) than patients with MS without misophonia (MSwoM). MS type, duration, attack frequency and smoking habbits were comparable between MSwM and MSwoM. There was a significant positive correlation between the misophonia score and the Beck depression score (p=0.029) in patients with MS.
Conclusion: Misophonia is frequent in the MS population and increases the severity of depression and anxiety.

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Amaç: Çalýþmanýn amacý, nöroloji yoðun bakým ünitesi (YBÜ) hastalarýnda uygulanan perkütan ve cerrahi trakeostomi iþlemlerinin avantaj ve dezavantajlarý, komplikasyon ve ölüm oranlarýný deðerlendirmektir.
Gereç ve Yöntem: Çalýþma 3. basamak nöroloji YBÜ’de retrospektif olarak gerçekleþtirildi. Hastalarýn demografik özellikleri, komorbiditeleri, yatýþ nedenleri, YBÜ’ye giriþ skorlarý [Akut Fizyoloji ve Kronik Saðlýk Deðerlendirmesi 2 skoru (APACHE 2) ve Ardýþýk Organ Yetmezliði Deðerlendirme skoru (SOFA)], entübasyon süreleri (gün), yoðun bakýmda kalýþ süresi, iþlem komplikasyonu ve mortalite oranlarý, taburculuk durumu ve 3. ay modifiye Rankin skalasý (mRS) skorlarý deðerlendirildi. Cerrahi ve perkütan trakeostomi sonuçlarý karþýlaþtýrýldý. Ayný zamanda perkütan trakeostomide kullanýlan laringeal maske (LMA), bronkoskopi ve tüpü geri çekme yöntemleri karþýlaþtýrýldý.
Bulgular: Çalýþmaya 55 hasta dahil edildi. Hastalarýn 33’ü (%60,0) erkekti. Yaþ ortalamasý 71,4±11,8 yýldý. Komorbidite olarak hipertansiyon 35 (%63,6) hastada, diabetes mellitus 19 (%34,5) hastada ve inme 10 (%18,2) hastada mevcuttu. Yatýþ tanýlarý olarak; iskemik inme 37 (%67,3) hastada, hemorajik inme 7 (%12,7) hastada, amiyotrofik lateral skleroz 5 (%9,1) hastada, koronavirüs hastalýðý (COVID-19 pnömonisi) 2 (%3,6) hastada, miyastenia gravis 1 (%1,8) hastada, miyopati 1 (%1,8) hastada ve Guillain-Barré sendromu 1 (%1,8) hastada mevcuttu. Yoðun bakýma giriþ skorlarýndan APACHE 2 skoru ortalamasý 25,4±4,8 iken, SOFA skoru ortalamasý 8,1± 2,7 idi. Hastalarýn entübe kaldýðý gün sayýsý ortalama 20,7±11,8, yoðun bakýmda ortalama kalýþ süresi ise 33,1±13,0 gün olarak saptandý. Baþarýlý trakeostomi 53 (%96,4) hastada saðlandý. Baþarýlý ve baþarýsýz iþlemlerde toplam 5 (%9,1) hastada komplikasyon izlendi. Mortalite 23 (%41,8) hastada görüldü. Otuz iki (%58,2) hastada taburculuk mRS skoru 5 olarak saptandý. Cerrahi ve perkütan trakeostomi iþlemlerinin sonuçlarý karþýlaþtýrýldý. Cerrahi grubunda yoðun bakýmda kalýþ süresi, entübe gün sayýsý ve YBÜ yatýþý ile trakeostomi arasýnda geçen süre (gün) perkütan trakeostomi grubundan anlamlý olarak uzundu (p<0,05). Perkütan trakeostomi uygulanan hastalarda LMA, tüp geri çekme ve bronkoskopi gibi farklý yöntemlerin karþýlaþtýrýlmasýnda istatistiksel olarak anlamlý farklýlýk izlenmedi.
Sonuç: Cerrahi ve perkütan trakeostomi sonuçlarýný karþýlaþtýrdýðýmýz çalýþmada, iki grubun komplikasyon oranlarý ve taburculuk mRS skorlarý arasýnda istatistiksel olarak anlamlý farklýlýk görülmedi. Cerrahi trakeostomi uygulanan hastalarda mRS skoru 6 olarak belirtilen hastane içi ölüm oraný daha yüksek izlendi. Perkütan trakeostomi tercih edilen hastalarda iþlemin yatak baþý hýzlý uygulanmasý sonucu, nöroyoðun bakýmda yatýþ süresi ve entübe takip edilen gün sayýsýnýn azaldýðý görüldü.

Objective: The aim of the study is to evaluate the advantages and disadvantages,complication and mortality rates of percutaneous and surgical tracheostomy procedures performed in patients in neuro-intensive care unit (neuro-ICU).
Materials and Methods: The study was carried out retrospectively in neuro-ICU. Patients’ demographic characteristics, comorbidities, reasons for hospitalization, ICU scores at admission [Acute Physiology and Chronic Health Evluation 2 (APACHE 2) score and Sequential Organ Failure Assessment (SOFA) score], intubation period (days), length of stay in ICU, procedural complications, mortality rates, modified Rankin scale (mRS) scores at discharge and 3rd month were evaluated. Surgical and percutaneous tracheostomy results were compared. Laryngeal mask airway (LMA), bronchoscopy, and tube withdrawal procedures used in percutaneous tracheostomy were compared as well.
Results: Fifty five patients were included in the study. Of the patients, 60.0% were male. Mean age was 71.4±11.8 years. The APACHE 2 score was 25.4±4.8 and SOFA score was 8.1±2.7 at admission to ICU. Mean number of intubation days of the patients was 20.7±11.8, and mean length of stay in ICU was 33.1±13.0 days. Tracheostomy procedure was successful in 53 (96.4%) patients, complications were encountered in 5 (9.1%) patients among all (succesful and unsuccessful) intervention groups. Mortality was seen in 23 (41.8%) patients. Three-month mRS was 5 in 32 (%58.2) patients. Duration of stay in ICU, intubation period (days), and time between intensive care hospitalization and tracheostomy (days) in surgery group were significantly longer compared to percutaneous tracheostomy group. No statistically significant difference was observed in comparison of different groups such as LMA, tube withdrawal, bronchoscopy in patients undergoing percutaneous tracheostomy.
Conclusion: In the study in which we compared the surgical and percutaneous tracheostomy results, no statistically significant difference was found in the complication rates and mRS score at discharge of the two groups. In-hospital mortality rate, which was defined as mRS 6, was observed to be higher in patients who underwent surgical tracheostomy. Because of the rapid application of the procedure at the bedside in patients for whom percutaneous tracheostomy was preferred, it was observed that the length of stay in the neuro-ICU and the number of days followed up with intubation were reduced.

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Amaç: Parkinson hastalýðýnda (PH) bel aðrýsýný ve hastalarýn günlük yaþam aktiviteleri üzerindeki etkilerini deðerlendirmeyi amaçladýk. Bel aðrýsý ile spinal mobilite testleri arasýndaki iliþkiyi de gözlemledik.
Gereç ve Yöntem: Çalýþmaya, yaþ ortalamasý 63±5 yýl (38-82 yaþ aralýðýnda) olan 39 erkek ve 16 kadýndan oluþan, Hoehn Yahr evre I-IV, 55 idiopatik PH dahil edildi. Ortopedik hastalýðý olmayan ve ortalama yaþlarý 65±7 (35-87 yaþ aralýðýnda) yaþ-cinsiyeti uygun 20 saðlýklý kontrolü dahil ettik. Tüm katýlýmcýlara disk veya diðer dejeneratif patolojileri dýþlamak için lomber manyetik rezonans görüntüleme uygulandý. Spinal mobilite deðerlendirmesi için modifiye-modifiye schober testi (MMST), lomber fleksiyon ve ekstansiyon hareket açýklýðý (ROM) ölçümü uygulandý. Lomber fleksiyon ve ekstansiyon ROM universal bir gonyometri ile deðerlendirildi. Ayrýca hastalara Roland Morris dizabilite anketi (RMDQ), Oswestry dizabilite indeksi (ODI), aðrý için vizüel analog skalasý (VAS), birleþik Parkinson hastalýðý derecelendirme ölçeði (UPDRS), günlük yaþam aktiviteleri ölçeði, yorgunluk þiddeti ölçeði ve Beck’s depresyon envanteri uygulandý. Hasta ve kontrol gruplarýnýn spinal mobilite ve test sonuçlarý karþýlaþtýrýldý.
Bulgular: PH grubunda MMST skoru, fleksiyon ve ekstansiyon ROM deðerlerinin kontrol grubuna göre anlamlý olarak azaldýðýný bulduk (p<0,05). Bel aðrýlý hastalarda bel aðrýsý olmayanlara göre Hoenh Yahr evresi, UPDRS, RMDQ, ODI ve VAS deðerleri daha yüksek, MMST sonuçlarý daha düþüktü. Çok deðiþkenli analizde bel aðrýsýnýn varlýðý, yaþ, cinsiyet, hastalýk süresi, dominant semptom, günlük yaþam aktiviteleri, depresyon ve yorgunluk þiddeti dahil olmak üzere incelenen parametrelerin hiçbiriyle korele deðildi.
Sonuç: Bu çalýþma, klinik dizabilite kötüleþtikçe bel aðrýsý þikayetlerinin arttýðýný ve spinal mobilite test sonuçlarýnýn azaldýðýný göstermiþtir. Aðrýyý sorgulamak ve yeterince tedavi etmek, PH’ye daha iyi bir yaþam kalitesi saðlayabilir.

Objective: We aimed to evaluate the relationship between low back pain (LBP) in patients with Parkinson’s disease (PD) and its effects on the activities of daily living of the patients. We also observed the correlation between LBP and spinal mobility tests.
Materials and Methods: The study included 55 patients with PD, 39 males and 16 females, in Hoenh Yahr stage I-IV with an average age of 63±5 (range, 38- 82). We included age- and sex- matched 20 healthy controls who had no orthopedic disease, with a mean age of 65±7 (range, 35-87). All participants had lomber magnetic resonance imaging to exclude disc or other degenerative pathologies. The modified-modified schober test (MMST), lumbar flexion and extension range of motion (ROM) measurement were applied for assessment of spinal mobility. Lomber flexion and extension ROM was assessed by using a universal goniometry. In addition, Roland Morris disability questionnaire (RMDQ), the Oswestry disability index (ODI), visual analogue scale for pain (VAS), the unified Parkinson’s disease rating scale (UPDRS), activities of daily living scale (ADLs), fatigue severity scale and Beck’s depression inventory were applied to patients. Spinal mobility and test results of patients and controls were compared.
Results: We found that the values of MMST, and flexion and extension ROM were significantly decreased in the patient group compared to controls (p<0.05). The Hoehn Yahr stage, UPDRS, RMDQ, ODI and VAS values were higher and MMST results were lower in patients with LBP than patients without LBP. In the multivariate analysis, the presence of LBP did not correlate with any of the parameters including age, sex, duration of disease, dominant symptom, ADL, depression, and fatigue severity.
Conclusion: The current study showed that as the clinical disability worsened, the complaints of LBP increased and spinal mobility test results decreased. Questioning and adequately treating pain could permit a better quality of life to patients with PD.

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Amaç: Status epileptikus (SE), ciddi morbidite ve mortaliteye neden olan nörolojik acil durumlardan biridir. Çoðu zaman bu hastalarýn yoðun bakým ünitelerinde takibi gerekir. Özellikle non-konvülsif SE (NKSE) perspektifinden bakýldýðýnda, SE’nin ekonomik yükü ve maliyeti etkileyen potansiyel faktörler hakkýnda çok az bilgi vardýr.
Gereç ve Yöntem: 2009-2019 yýllarý arasýnda nöroloji yoðun bakým ünitemizde (NYBÜ) video- elektroensefalogram (EEG) monitörizasyonu ile NKSE tanýsý almýþ tüm hastalarý dahil ettik. Demografik ve klinik özellikler hasta dosyalarýndan tarandý. NYBÜ bakýmý sýrasýndaki toplam maliyet, hastanenin mali kayýtlarýndan elde edildi. Sonuçlar, ayný süre ve ayný kalýþ süresi boyunca takip edilen diðer NYBÜ hastalarý (kontrol grubu) ile karþýlaþtýrýldý. Maliyet üzerindeki potansiyel etkili olabilecek parametler gözden geçirildi.
Bulgular: Otuz iki NKSE hastasý ve 32 kontrol grubu hastasý dahil edildi. Çalýþmada hasta baþýna ortalama maliyet 11.831 Amerikan dolarý (USD), kontrol grubunda 11.240 USD idi (p=0,386). Artan yatýþ süresi (p<0,001), geliþte daha düþük Glasgow Koma skoru (p=0,003) ve NYBÜ takibi sýrasýnda NKSE geliþmesi (p=0,018) maliyetle anlamlý olarak iliþkili bulundu. SE ile ilgili doðrudan maliyet (anti-epileptik ilaçlar, anestetikler ve video-EEG monitörizasyonu) toplam NYBÜ bakým harcamalarýnýn yalnýzca %3’ünü oluþturuyordu.
Sonuç: NYBÜ’de NKSE yönetimi yüksek maliyete yol açmaktadýr. Toplam maliyetin diðer NYBÜ hastalarýna benzerliði, harcamalarýn çoðunun nöbet yönetiminden çok yoðun bakýmla iliþkili olduðunu göstermektedir. Hastalarla iliþkili bazý parametrelerin maliyeti önemli ölçüde etkileyebileceði gösterilmiþtir ancak bunlar deðiþtirilemez faktörlerdir.

Objective: Status epilepticus (SE) is one of the severe neurological emergencies with significant morbidity and mortality. Most of the time these patients require admission to intensive care units. There is little information about health-economy related burden of SE and potential factors affecting cost except for developed Western countries, especially from the perspective of non-convulsive SE (NCSE).
Materials and Methods: We included all consecutive patients diagnosed as having NCSE with continuous electroencephalogram (EEG) in our neurological intensive care unit (NICU) between 2009 and 2019. Demographic and clinical features were collected from patient files. Total cost during NICU care was obtained from hospital financial records. The results were compared with other NICU patients (control group) followed during the same period for the same length of stay. We also investigated the potential impact of several parameters on cost.
Results: Thirty two patients with NCSE and 32 controls were included. Mean cost per patient was 11,831 US dollars (USD) in the study and 11,240 USD in the control group (p=0.386). Increased length of stay (p<0.001), lower Glasgow Coma scale score at admission (p=0.003), and new diagnosis of NCSE after admission to NICU (p=0.018) were significantly associated with higher cost in study group. SE related direct costs (anti-seizure medicines, anesthetics and continuous EEG) comprised only 3% of total NICU care expenditures.
Conclusion: Management for NCSE in NICU leads to significant intensive care related cost. The similarity of the cost level to other NICU patients indicates that most of the expenditures are related to intensive care, rather than management of seizures. We found that a few patient-related parameters could significantly affect the cost, but they were all non-modifiable.

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Ýlk koronavirüs olgusu ortaya çýktýðýndan beri dünyanýn çeþitli bölgelerinden Koronavirüs hastalýðý-2019 (COVID-19) ile iliþkili nörolojik komplikasyonlar bildirilmektedir. Koronavirüs ile iliþkili Guillain-Barré sendromu (GBS) olgularý bildirilse de iliþki halen net deðildir ve kesin bir yargýya varmak için vaka sayýsý yeterli deðildir. Moleküler benzerlik GBS’deki istenmeyen immüniteyi ifade eden ilk hipotezlerdendir. Bu hipoteze göre immün sistemin patojenle veya baþka þekilde aktiflenmesi ile oluþan antikorlar periferik sinirler ve spinal kökleri hedef alýr. Patojenin doðrudan immün sistemi hedef aldýðý direkt viral nörotoksisite kavramý üzerinde de durulmuþtur. Burada Eylül-Aralýk 2020 tarihleri arasýnda merkezimizde takip ettiðimiz 4 olguyu sunuyoruz. Olgularýn ilki COVID-19 ile eþzamanlý demiyelinizan sensorimotor polinöropati iken diðer olgularda GBS, COVID-19 enfeksiyonu sonrasý saptanmýþtýr. Ýkinci olgu motor aksonal nöropati, üçüncü olgu sensorimotor aksonal nöropatidir. Dördüncü olguda Miller-Fisher sendromu-GBS birlikteliði söz konusudur.

Since the first case has emerged, different neurological complications associated with Coronavirus disease-2019 (COVID-19) have been reported all over the world. The association between coronavirus and Guillain-Barré syndrome (GBS) has also been reported before. Unfortunately, there is no certain mechanism about this association yet. Molecular mimicry is one of the first hypotheses to express the undesirable autoimmunity in GBS. According to this; the antibodies produced against virus may target peripheral nerves or spinal nerve roots. The entity of direct viral neurotoxicity has also been discussed. Here, we presented four variants of GBS associated with coronavirus that we followed up in our clinic between September-December 2020. While the first patient had demyelinating sensorimotor neuropathy concurrent with COVID-19, the other ones were postinfectious. The second patient had motor axonal neuropathy and the third one had sensorimotor axonal neuropathy. There was Miller-Fisher syndrome and GBS overlap in the fourth patient.

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