Turk J Neurol: 28 (3)

e-ISSN 1309-2545 ISSN 1301-062X

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Cilt : 29 Say� : 3 Y�l : 2023

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Turk J Neurol: 28 (3)

Cilt: 28 Say�: 3 - 2022

�zetleri Gizle \| << Geri
1.	Kapak Cover Sayfalar I - XIII DOWNLOAD \| Tam Metin PDF

DERLEMELER
2.	COVID-19�lu Hastalarda Potansiyel N�rolojik Sonu�lar: Pandeminin �lk Y�l�nda Literat�r�n Sistematik Olmayan Bir Derlemesi Potential Neurological Outcomes in COVID-19 Patients: A Nonsystematic Review of the Literature During the First Year of the COVID-19 Pandemic Khadija Asif, Farhat Abbas doi: 10.4274/tnd.2022.90248 Sayfalar 129 - 133 Sa�l�k otoriteleri ve bireyler i�in k�resel bir meydan okuma olan koronavir�s, �in�in Wuhan kentinde ortaya ��kt�. Hastalar, koronavir�s hastal��-2019�un (COVID-19) neden oldu�u n�rolojik semptomlarla veya vir�se yakalanma korkusuyla �nceden var olan n�rolojik bozukluklar�yla klinisyene ba�vurmaktad�r. Bu �al��ma sistematik bir derleme olmasa da, COVID-19�lu hastalardaki ve altta yatan n�rolojik bozukluklar� olan hastalardaki n�rolojik sonu�lar� ara�t�ran, Aral�k 2020 ile Mart 2021 aras�nda yap�lan bir literat�r derlemesidir. Koronavir�sten muzdarip hastalar�n n�rolojik belirtileri hakk�nda veriler i�in PubMed, Google Scholar, EBSCO, Semantic Scholar ve Wiley Online dahil olmak �zere birden fazla veritaban�n� tarad�k. Hastalar�n klinik verileri ve komorbiditeleri incelendi. Ba� a�r�s�, ba� d�nmesi, hipozmi ve inme bildirilen semptomlar aras�ndayd�. Geli�mekte olan literat�r, koronavir�s ile enfekte hastalar�n solunum semptomlar� ile birlikte n�rolojik semptomlar da ya�ad��n� g�zler �n�ne sermektedir. �nme gibi baz� t�bbi acil durumlar, hastalar� kurtarmak i�in acil tedavi gerektirir. N�rologlar�n ve klinisyenlerin, hastalar� zaman�nda y�netmek ve tedavi etmek i�in bu semptomlar� tan�mas� gerekir. Coronavirus emerged from Wuhan China, which has been a global challenge for healthcare authorities and individuals. Patients are presenting to clinicians with neurological symptoms caused by coronavirus disease-2019 (COVID-19) or with preexisting neurological conditions with fear of contracting the virus. This is a literature review of COVID-19 patients and patients with underlying neurological conditions affected by the pandemic encompassing December 2020 to March 2021. We searched multiple databases including PubMed, Google Scholar, EBSCO, Semantic Scholar, and Wiley Online for information on neurological manifestations of patients suffering from coronavirus. Clinical data and co-morbidities of the patients were examined. Headache, dizziness, hyposmia, and stroke symptoms were reported. According to recently published literature, some of the patients with coronavirus who have respiratory symptoms also develop neurological symptoms. Certain medical emergencies such as stroke require immediate treatment to ensure better clinical outcomes for the patients. Neurologists and clinicians need to recognize these acute symptoms in order to timely manage and treat the affected patients. Makale �zeti \| Tam Metin PDF

�ZG�N ARA�TIRMALAR
3.	Hastanede Yatan Akut �nmeli Hastalarda Gastrostomi: �N�roTek� T�rkiye Nokta Prevalans �al��mas� Alt Grup Analizi Gastrostomy in Hospitalized Patients with Acute Stroke: �N�roTek� Turkey Point Prevalence Study Subgroup Analysis Mehmet Akif Top�uo�lu, Atilla �zcan �zdemir, �zlem Ayka�, Aysel Milano�lu, Mustafa G�k�e, Song�l Bavli, Murat �abalar, Vildan Yayla, Hac� Ali Erdo�an, Ay�a �zkul, Ayg�l G�ne�, Bahar De�irmenci, Ufuk Alu�lu, Hasan H�seyin Kozak, Levent G�ng�r, M�cahid Erdo�an, Zeynep �zdemir Acar, Utku Cenikli, Y�ksel Kablan, Arda Y�lmaz, Hamit Gen�, Bijen Nazliel, Hale Batur �a�layan, Elif Sar��nder Gencer, Halil Ay, Hayri Demirba�, �zlem Akdo�an, Ufuk Emre, �zlem Kay�m Y�ld�z, Asl� Bolay�r, Turgay Demir, Zeynep Tanr�verdi, �lgen Yalaz Tekan, �etin K�r�ad Akp�nar, Esra �zkan, Faik �lik, Hadiye �irin, Ay�e G�ler, Halil �nder, Hesna Bekta�, Levent �cek, Mustafa Bakar, Nedim Ongun, Yakup Krespi, Canan Togay I��kay, Eda Aslanbaba, Mine Sorgun, Erdem G�rka�, Hasan H�seyin Karadereli, �pek Midi, �rem �lgezdi, Adnan Burak Bilgi�, �ener Akyol, M. Tuncay Ep�eliden, Murat Mert Atmaca, O�uzhan Kur�un, Onur Keskin, P�nar Bekdik �irinocak, Recep Baydemir, Merve Ak�akoyunlu, �erefnur �zt�rk, Tu�ba �zel, Ali �nal, Bab�r Dora, Vedat Ali Y�rekli, Z�lfikar Arl�er, Alper Eren, Ay�e Y�lmaz, Ay�in K�sabay, Bilgehan Acar, Birg�l Ba�tan, Zeynep Acar, Buket Niflio�lu, B�lent G�ven, Dilaver Kaya, Nazire Af�ar, Duran Yaz�c�, Emrah Ayta�, Erdem Yaka, Eren Topluta�, Eylem De�irmenci, Fatma Birsen �nce, G�lseren B�y�k�erbet�i, �sa Ayd�n, Mustafa �etiner, Mustafa �en, Nilda Turgut, Nil�fer Kale, Eda �oban, Nil�fer Ye�ilot, Esme Ekizo�lu, �zg� Kizek, �zlem Birgili, Recep Yevgi, Refik Kunt, Semih Giray, Sinem Yaz�c� Akka�, Song�l �enad�m, Tahir Yolda�, Talip Asil, Ta�k�n Duman, Tu�rul Atasoy, Bilge Piri ��nar, T�lin Demir, Ufuk Can, Yaprak �z�m �nsal, Neslihan E�kut, Y�ld�z Aslan, Demet Funda Ba�, Ufuk �ener, Zahide Y�lmaz, Zehra Bozdo�an, Zekeriya Alio�lu, Ethem Murat Arsava doi: 10.4274/tnd.2022.52460 Sayfalar 134 - 141 Ama�: Akut n�rovask�ler hastal�klarda n�trisyonel durum ve disfaji de�erlendirmesi ve enteral beslenme karar� �nemli prognoz belirleyicilerindendir. Gere� ve Y�ntem: N�roTek, 10 May�s 2018�de (D�nya �nme Fark�ndal�k G�n�) T�rkiye�nin t�m sa�l�k alt b�lgelerine yay�lm�� 87 hastanenin kat�l�m�yla ger�ekle�tirilen bir nokta prevalans �al��mas�d�r. Hastanede yatan ve bu alt �al��ma i�in toplanan verisi tam olan toplam 972 n�rovask�ler hasta (kad�n: %53, ya�: 69�14 y�l; 845�i akut iskemik inme; 119�u intraserebral hematom ve 8�i post-res�sitasyon ensefalopatisi) analiz edildi. Bulgular: Gastrostomi iskemik inmeli hastalar�n %10,7, intraserebral kanamal�lar�n %10,1 ve post-resusitasyon ensefalopatisi olanlar�n %50�sine uygulanm��t�r. Perk�tan endoskopik gastrostomi (PEG) gereksiniminin ba��ms�z belirleyicileri, iskemik inme grubunda kabul NIHSS [exp (β): 1,09, %95 g�ven aral�� (GA): 1,05-1,14, puan ba��na] ile hem iskemik hem de hemorajik inmelerde mekanik ventilasyon uygulanm�� olmas�d�r [iskemik i�in: exp (β): 6,18, %95 GA: 3,16- 12,09] ve hemorajik inme i�in: [exp (β): 26,48, 95% GA: 1,36-515,8]. �nme olgular�nda PEG uygulamas� hastane i�i mortalite i�in ba��ms�z belirleyici de�ildi [exp (β): 1,731, 95% GA: 0,785-3,829]. Ancak, PEG uygulanm�� olmas� taburculuk esnas�nda iyi prognoza (modifiye Rankin skoru 0-2) sahip olabilme i�in anlaml� bir negatif etmen olarak bulundu [exp (β): 0,032, %95 GA: 0,004-0,251]. Hastanede yatan n�rovask�ler hastalar�n yakla��k ��te ikisinde maln�trisyon ve yutma bozuklu�u a��s�ndan de�erlendirme yap�lm��t�. Nutrisyonel status de�erlendirmesinin %69�u ve disfaji de�erlendirmesinin %76�s� ilk 48 saat i�inde ger�ekle�tirilmi�ti. T�ple enteral n�trisyon uygulama oran� %39�du. Beslenme t�plerinin %83,5�i ilk 2 g�n i�inde yerle�tirilirken beslenme t�p� olan hastalar�n %28�ine daha sonra PEG a��lm��t�. Sonu�: N�roTek �al��mas� ile T�rkiye�de hastanede yatan akut inme hastalar�nda nutrisyonel uygulamalar�n temel kalite �l��tlerine ili�kin ilk g�venilir ve b�y�k �l�ekli veri sa�lanm��t�r. Ekonomik olmas� ve do�rulu�u a��s�ndan nokta yayg�nl�k y�nteminin bu tip verilerin temini i�in daha fazla kullan�lmas� mant�kl�d�r. Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: N�roTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69�14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin�s scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The N�roTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method. Makale �zeti \| Tam Metin PDF

4.	Akut �skemik �nmede �iddetin ve Prognozun �ng�r�c�s� Olarak D Vitamini Vitamin D as a Predictor of Severity and Prognosis of Acute Ischemic Stroke Hari Krishan Aggarwal, Deepak Jain, Taruna Pahuja, Jasminder Singh, Shaveta Dahiya doi: 10.4274/tnd.2022.24434 Sayfalar 142 - 147 Ama�: Bir steroid hormonu olan D vitamininin kemik sa�l�� zerindeki etkisi uzun zamand�r bilinmektedir. D vitamininin diyabet, hipertansiyon, kronik b�brek hastal��, koroner arter hastal��, kanser gibi �e�itli hastal�klarla da ili�kili oldu�u g�sterilmi�tir. D vitamininin n�roprotektif etkisi, onu bili�sel bozukluk, demans ve Alzheimer hastal�� gibi n�rolojik hastal�klar�n klinik seyrinde �nemli bir belirte� haline getirir. D vitamini eksikli�i ayr�ca inme riskinde art��la ili�kilidir. Bu �al��mada, D vitamini d�zeylerinin inme �iddeti ve prognozu �zerindeki etkisinin �l��lmesi ama�lanm��t�r. Gere� ve Y�ntem: Bu prospektif ve g�zlemsel �al��ma, Rohak�ta ��nc� basamak bir sa�l�k merkezinde serviste yat�r�larak izlenen 200 inme hastas� ile ger�ekle�tirilmi�tir. National Institute of Health Stroke scale (NIHSS) ve modifiye Rankin �l�ekleri, s�ras�yla ba�vuruda inme �iddetini ve 3. ayda fonksiyonel sonlan�m� de�erlendirmek i�in kullan�lm��t�r. Hastalar D vitamini d�zeylerine g�re d�rt gruba ayr�lm��t�r. Bulgular: Vitamin D eksikli�i, daha y�ksek NIHSS skoruyla ve ba��ms�z olarak k�t� fonksiyonel sonlan�m ile ili�kiliydi. �iddetli D vitamini eksikli�i, hafif D vitamini eksikli�i ve D vitamini yetersizli�i olan hastalar; ya�a, cinsiyete, alkol ve sigara kullan�m�na, v�cut kitle indeksi de�erine, NIHSS skoruna ve komorbiditelere g�re d�zeltildi�inde, D vitamini d�zeyleri normal olan hastalara k�yasla 3. ayda s�ras�yla 9, 6,7 ve 3,9 kat daha fazla k�t� fonksiyonel sonlan�m oranlar�na sahipti (p<0,01). Sonu�: D vitamini d�zeyleri 3. ayda �iddetli inme ve k�t� fonksiyonel sonlan�m ile ili�kilidir. Bununla birlikte, D vitamini takviyesinin inmeyi veya ili�kili morbiditeyi ve mortaliteyi �nlemeye katk�s�n� de�erlendirmek i�in ileri �al��malar�n yap�lmas� gerekmektedir. Objective: The effect of vitamin D, which is a steroid hormone, on bone health has long been known. Vitamin D is also found to be associated with various diseases such as diabetes, hypertension, chronic kidney disease, coronary artery disease, and cancer. Neuroprotective effect of vitamin D makes it an important marker in clinical course of neurological diseases such as cognitive impairment, dementia and Alzheimer�s disease. Vitamin D deficiency is also associated with increased risk of stroke. In this study, we aimed to show the effect of vitamin D levels on severity and prognosis of stroke. Materials and Methods: This was a prospective, observational study conducted in a tertiary medical center in Rohtak on 200 stroke patients admitted in Medicine ward. The National Institute of Health Stroke scale (NIHSS) and modified Rankin Scale were used to assess the severity of stroke at admission and functional outcome at 3 months, respectively. The patients were divided into 4 groups on the basis of vitamin D levels. Results: Vitamin D deficiency was associated with higher NIHSS score and independently associated with poor functional outcome. Patients with severe and mild vitamin D deficiency, and vitamin D insufficiency had 9, 6.7, and 3.9 times higher adjusted odds of poorer functional outcomes at 3 months in comparison to the patients with normal vitamin D levels (p<0.01) when adjusted for age, sex, alcohol, smoking, body mass index, NIHSS score, and co-morbidities. Conclusion: Vitamin D is associated with severe stroke and poor functional outcome at 3 months. However, further studies need to be carried out to evaluate whether supplementation of vitamin D can help prevent stroke or associated morbidity and mortality. Makale �zeti \| Tam Metin PDF

5.	�nmede K�t� Prognozu G�r�nt�leme Yapmadan Tahmin Edebilir miyiz? �nmeli Hastalarda Karar A�ac� Analizi Can We Predict Poor Outcome in Stroke Patients Without Imaging Data? A Decision Tree Analysis of Stroke Patients Mine Sezgin, Mehmet G�ven G�nver, Nil�fer Ye�ilot doi: 10.4274/tnd.2022.39024 Sayfalar 148 - 151 Ama�: Ya�lanan d�nya n�fusu ve artan kardiyovask�ler risk fakt�rleri nedeniyle inme s�kl�� ve inmeye ba�l� morbidite giderek artmaktad�r. Bu �al��mada, inme �nitemizdeki iskemik inmeli hastalarda morbidite oranlar�n� y�kselten belirleyicilerin analizi ama�lanm��t�r. Gere� ve Y�ntem: �stanbul �niversitesi �nme Veri Bankas��na 2014-2020 y�llar� aras�nda kaydedilmi� iskemik inmeli hastalar �al��maya dahil edilmi�tir. Cinsiyet, diyabet, hipertansiyon, ge�irilmi� inme �yk�s�, iskemik kalp hastal��, hiperlipidemi, inme �nitesinde yat�� s�ras�nda pn�moni tan�s� ve atriyal fibrilasyon, k�t� klinik sonlan�m�n olas� g�stergeleri olarak belirlenmi�tir ve karar a�ac� analizi (CHAID) y�ntemi uygulanm��t�r. Bulgular: �al��maya dahil etme ve �al��madan d��lama kriterlerine g�re iskemik inme tan�s� alan 881 hasta dahil edilmi�tir. �skemik inmeli hastalar�n ya� ortalamalar� 66,5�14,4 y�l idi ve hastalar�n %59�u erkekti. CHAID analizi ile pn�moninin modifiye Rankin Skalas� (mRS) skoru >3 olan hastalarda en s�k g�r�len risk fakt�r� oldu�u ortaya konmu�tur. Pn�monisi olmayan ve mRS skoru 3��n �zerinde olan hastalarda ise hipertansiyon ve hiperlipidemi k�t� prognoz i�in risk fakt�rleri olarak ortaya ��kmaktad�r. Sonu�: �nmeli hastalarda �nleyici tedbirler sadece ikincil profilaksi ile s�n�rl� kalmamal�d�r. �nmenin akut d�neminde hastane enfeksiyonlar�n�n �nlenmesi iyi klinik sonlan�m ile ili�kilidir. Objective: The aging world population and increased cardiovascular risk factors contribute to stroke and stroke related morbidity. In this study, we aimed to analyze predictors of increased morbidity of ischemic stroke patients in a single stroke unit. Materials and Methods: Stroke patients recorded in the Istanbul University Stroke Registry between 2014 and 2020 were included and decision tree analyses [chi-squared automatic interaction detection (CHAID) method] were conducted. Gender, diabetes, hypertension, previous stroke, ischemic heart disease, hyperlipidemia, diagnosis of pneumonia during hospitalization in the stroke unit, and atrial fibrillation were determined as possible indicators for poor clinical outcomes. Results: We included 881 patients with ischemic stroke in the study according to the inclusion and exclusion criteria. The mean age of patients was 66.5�14.4 years and 59% of the patients were male. CHAID analysis revealed that the most important factor for predicting modified Rankin Scale (mRS) score >3 is pneumonia. In patients with mRS score >3 and without pneumonia; hypertension and hyperlipidemia were found to be risk factors for poor functional outcome. Conclusion: Preventative measures in stroke patients should not be limited to secondary prophylaxis of stroke. Avoiding infections in the acute phase plays an essential role in achieving favorable clinical outcomes. Makale �zeti \| Tam Metin PDF

6.	Tan�sal Ultrason Dalgalar�n�n, Hipokampal N�ronlarda Pentilentetrazol Taraf�ndan �nd�klenen Uyar�labilirlik E�i�i ve H�cresel Apoptoz �zerine Etkileri The Effects of Diagnostic Ultrasound Waves on Excitability Threshold and Cellular Apoptosis Induced by Pentylenetetrazole in Hippocampal Neurons Faezeh Shokri, Ardeshir Moayeri, Naser Abbasi, Maryam Maleki, Mina Kafashi, Mohammadreza Kaffashian doi: 10.4274/tnd.2022.58295 Sayfalar 152 - 157 Ama�: Ultrason (US), �e�itli terap�tik ve tan�sal uygulamalarda kullan�lan bir t�bbi g�r�nt�leme tekni�idir. Bu �al��mada, s��anlarda 3,5 MHz frekans ve 65 mW/cm2 yo�unluktaki tan�sal US dalgalar�n�n n�ronlar�n uyar�labilirlik e�i�i ve pentilentetrazol (PTZ) taraf�ndan ind�klenen apoptoz �zerindeki etkilerinin ara�t�r�lmas� ama�lad�. Gere� ve Y�ntem: K�rk yedi g�nl�k Wistar s��anlar� rastgele be� gruba ayr�ld�. Birinci grup kontrol grubuydu, ikinci gruba intraperitoneal PTZ enjeksiyonu ile n�bet ge�irtildi, ��nc�, d�rd�nc� ve be�inci gruplara s�ras�yla 5, 10 ve 15 dakika US dalgalar� uyguland� ve ard�ndan intraperitoneal PTZ enjeksiyonu ile bu gruplara n�bet ge�irtildi. Hayvanlar g�zlemlendi ve n�bet s�resi, n�bet say�s� ve n�bet biti� zaman� dahil olmak �zere davran��lar� 30 dakika boyunca kaydedildi. Daha sonra, Western blot teknikleri ile B-h�cresi lenfoma proteini 2 (BCL-2) ve BCL-2-ili�kili X (BAX) d�zeylerini �l�mek i�in hayvanlar�n hipokampuslar� ��kar�ld�. Bulgular: Sonu�lar, 5, 10 ve 15 dakikal�k s�relerle tan�sal frekans aral��ndaki US dalgalar�n�n hedef gruplarda n�bet s�resini �nemli �l��de art�rd��n� g�stermi�tir. Ayr�ca US�nin istenilen s�relerle e� zamanl� kullan�lmas� PTZ�nin neden oldu�u n�bet say�s�n� art�rm��t�r ve n�bet biti� s�resini uzatm��t�r. PTZ, BAX/BCL-2 protein oran�n� art�rm��t�r ve US ve PTZ�nin birlikte kullan�m� bozulmay� art�rm��t�r. Sonu�: Bu �al��ma, s��an hipokampal h�crelerinde US�ye maruz kalman�n n�ronlar�n uyar�labilirli�ini art�rd��n� ve PTZ�nin n�bet etkilerini ve ayr�ca PTZ ile ind�klenen apoptozu �iddetlendirdi�ini g�stermi�tir. Objective: Ultrasound (US) is a medical imaging technique with various therapeutic and diagnostic applications. This study aimed to investigate the effects of diagnostic US waves with a frequency of 3.5 MHz and intensity of 65 mW/cm2 on the threshold of neurons� excitability and the apoptosis induced by pentylenetetrazole (PTZ) in rats. Materials and Methods: Forty-seven-day-old Wistar rats were randomly divided into five groups. The first group was assigned as the control group, the second group was seized by intraperitoneal injection of PTZ, the third, fourth, and fifth groups were given US waves for 5, 10, and 15 minutes, respectively, followed by intraperitoneal PTZ injection. The animals were observed and their behavior, including the seizure duration, the number of seizures, and the seizure cessation time were recorded for 30 minutes. Subsequently, animals� hippocampi were removed in order to measure B-cell lymphoma protein 2 (BCL-2) and BCL-2-associated X (BAX) by using Western blotting techniques. Results: The results showed that US waves in the diagnostic frequency range with a duration of 5, 10, and 15 minutes significantly increased the seizure duration in the target groups. Furthermore, the simultaneous use of US with the desired times with PTZ increased the number of seizures and prolonged the seizure cessation time. PTZ increased the BAX/BCL-2 proteins ratio, and the concomitant use of US and PTZ intensified the impairment. Conclusion: This study showed that exposure to US increased the excitability of neurons and exacerbated the seizure effects of PTZ as well as PTZ-induced apoptosis in the rat hippocampal cells. Makale �zeti \| Tam Metin PDF

7.	Sinsi Bir Klinik Tablo: COVID-19�lu Hastalarda Optik Sinir Tutulumu An Insidious Clinical Picture: Optic Nerve Involvement in Patients with COVID-19 �zg�l Ocak, Erkan Melih �ahin, Alper �ener, Bar�� Ocak doi: 10.4274/tnd.2022.67026 Sayfalar 158 - 161 Ama�: Merkezi sinir sistemi, periferik sinir sistemi ve kas-iskelet sistem hasar�na ba�l� n�rolojik semptomlar koronavir�s hastal��-2019�lu (COVID-19) hastalar�n ��te birinden fazlas�nda bildirilmi�tir. COVID-19�da optik n�ritli olgular bildirilse de olduk�a nadirdir. Bu �al��man�n amac�, bilinen g�rme bozuklu�u olmayan asemptomatik hastalarda g�rsel uyar�lm�� potansiyel (VEP) ile COVID-19�lu hastalarda optik sinir tutulumunu taramakt�r. Gere� ve Y�ntem: Bilinen g�rme bozuklu�u olmayan 101 yeti�kin COVID-19�lu hastada tedavileri ve karantina s�recini tamamlad�ktan sonra pattern reversal VEP �l��mleri yap�ld�. VEP analizi karanl�k bir odada 4 kanall� elektromiyografi cihaz� ile kaydedilmi�, ayn� n�rolog taraf�ndan P100 latanslar� ve amplit�dleri incelenmi�tir. Bulgular: Toplam 34 (%33,7) hastada P100 latans uzamas� vard�. Cinsiyet, ya� veya ayaktan/yatarak tedavi durumu a��s�ndan anlaml� bir fark yoktu. Polimeraz zincir reaksiyonu tan�s� ile VEP �ekim zaman� aras�ndaki s�re ile elde edilen de�erler aras�nda anlaml� bir ili�ki yoktu. Sonu�: Daha �nceki �al��malar�n aksine, VEP �l��mleri ile COVID-19 sonras� asemptomatik optik sinir tutulumu tespit edildi. P100 latans uzamas�, insan g�z�ndeki COVID-19 vir�s� ile anjiyotensin d�n��t�r�c� enzim 2 resept�rleri aras�ndaki olas� ba�lant�y� g�steriyor olabilir. Objective: Many neurological symptoms due to central nervous system, peripheral nervous system and musculoskeletal system damage have been reported in more than a third of patients with coronavirus disease-2019 (COVID-19). Although optic neuritis has been reported in patients with COVID-19, they are extremely rare. The aim of this study was screening optic nerve involvement in COVID-19 with visual evoked potential (VEP) in asymptomatic patients without a history of visual impairment. Materials and Methods: Pattern reversal VEP measurements were made in 101 adult patients with COVID-19 without a history of visual impairment after they completed COVID-19 treatments and the quarantine period. VEPs were recorded with the 4-channel electromyography-evoked device in a dark room. P100 latencies and amplitudes were analyzed by the same neurologist. Results: A total of 34 (33.7%) patients had P100 latency prolongation. There was no significant difference in terms of gender, age or outpatient/inpatient treatment status. There was no significant correlation between the time of polymerase chain reaction diagnosis and VEP values. Conclusion: Contrary to previous studies, asymptomatic optic nerve involvement after COVID-19 was detected by VEP measurements. Prolongation of P100 latency shows the probable linkage between COVID-19 virus and angiotensin converting enzyme 2 receptors in human eyes. Makale �zeti \| Tam Metin PDF

8.	Relapsing-remitting Multipl Sklerozlu Hastalar�n K�sa S�reli Bellek, �al��ma Belle�i ve Y�netici ��levlerinin De�erlendirilmesi Evaluation of Short-term Memory, Working Memory, and Executive Functions in Patients with Relapsing-remitting Multiple Sclerosis Furkan Duman, Handan Can, Alev Levento�lu doi: 10.4274/tnd.2022.24992 Sayfalar 162 - 168 Ama�: Relapsing-remitting multipl sklerozlu (RRMS) hastalar ile sa�l�kl� bireyleri k�sa s�reli bellek, �al��ma belle�i ve y�netici i�levler a��s�ndan kar��la�t�rmakt�r. Gere� ve Y�ntem: Ara�t�rmaya RRMS tan�s� alan 33 hasta (RRMS grubu) ile ya�, cinsiyet, e�itim d�zeyi ve el tercihi bak�m�ndan e�le�tirilen 26 sa�l�kl� kat�l�mc� (kontrol grubu) dahil edilmi�tir. Kat�l�mc�lar�n sosyo-demografik �zellikleri kaydedilmi�tir ve kat�l�mc�lara Beck depresyon envanteri ile durumluk/ s�rekli kayg� envanteri uygulanm��t�r. Kat�l�mc�lar bili�sel i�levler g�rsel-i�itsel say� dizisi testi B formu (G�SD-B), Wisconsin kart e�leme testi (WKET), geriye do�ru say� dizisi g�revi (GDSD), stroop testi T-BAG formu, Wechsler bellek �l�e�i geli�tirilmi� formunun (WB�GF) alt testlerinden biri olan g�rsel bellek uzam� alt testi (GBU) ve iz s�rme testi (�ST) kullan�larak de�erlendirilmi�tir. Bulgular: Gruplar aras�nda depresyon ve kayg� puanlar� a��s�ndan istatistiksel olarak anlaml� bir fark bulunmam��t�r (p>0,05). RRMS grubunun WB�GF�nin GBU alt testinden hesaplanan ters g�rsel bellek uzam� daha d��kt�r (p<0,05). Gruplar aras�nda G�SD-B, WKET, GDSD, WB�GF�nin GBU alt testinden hesaplanan d�z g�rsel bellek uzam� ve �ST puanlar� a��s�ndan anlaml� bir fark bulunmam��t�r (p>0,05). Sonu�: Mevcut ara�t�rmada RRMS�li hastalar�n �al��ma belle�indeki g�rsel-mekansal kopyalama (s�zel olmayan bilgi) kapasitesinin d��k oldu�u saptanm��t�r. S�zel olan ve olmayan k�sa s�reli bellek kapasitesi, �al��ma belle�indeki fonolojik d�ng� (s�zel bilgi) kapasitesi ile y�netici i�levlerden perseverasyon yapma e�ilimi, kavramsalla�t�rma/irdeleme, inhibisyon (bozucu etkiye kar�� koyma) ve set de�i�tirme becerileri a��s�ndan RRMS grubu ile kontrol grubu aras�nda istatistiksel olarak anlaml� bir farkl�l�k olmad�� saptanm��t�r. Objective: To compare patients with relapsing-remitting multiple sclerosis (RRMS) and healthy individuals in terms of short-term memory (STM), working memory (WM) and executive functions. Materials and Methods: The sample consisted of 33 patients with RRMS and 26 healthy participants. The groups were matched in terms of age, gender, level of education and hand dominance. The socio-demographic characteristics of the participants were recorded; and they were evaluated with Beck depression inventory and state/trait anxiety inventory. Visual aural digit span test B form, Wisconsin card sorting test, backward digit span task, stroop test T-BAG form, Wechsler memory scale: Revised form visual memory span subtest (WMS-R/VMS) and trail making test (TMT) for cognitive functions. Results: There was no statistically significant difference between groups in terms of depression and anxiety scores (p>0.05). Backward visual memory span calculated from WMS-R/VMS was significantly lower (p<0.05) in the RRMS group. However, there was no significant difference between groups in WMS-R/ VMS and TMT scores (p>0.05). Conclusion: Results of this study indicate that patients with RRMS have lower visuo-spatial sketchpad capacity in their WM. However, there was no significant difference between patients with RRMS and healthy controls in terms of verbal and visuo-spatial STM capacity, phonological loop capacity in WM, perseveration, conceptualization, inhibition and set shifting skills. Makale �zeti \| Tam Metin PDF

9.	Optik N�riti Olan ve Olmayan Multipl Sklerozlu Hastalarda Stereokeskinli�in Retinal Sinir Lifi Tabakas� Kal�nl�� ve P100 Dalgas� ile �li�kisinin �ncelenmesi Investigation of Relationship of Stereoacuity with Retinal Nerve Fiber Layer Thickness and P100 Latency in Patients with Multiple Sclerosis with and Without Optic Neuritis Belk�s Ko�tekin, Burcu Y�ksel, Do�an Durmaz, Mert Abdullah �illi, Mustafa Agah Tekindal, Deniz Turgut �oban doi: 10.4274/tnd.2022.88555 Sayfalar 169 - 175 Ama�: Optik n�riti (ON) olan ve olmayan multipl sklerozlu (MS) hastalarda stereokeskinli�in P100 dalgas� ve retinal sinir lif tabakas� kal�nl�� (RSLTK) ile ili�kisinin ara�t�r�lmas� ama�lanm��t�r. Gere� ve Y�ntem: Bu prospektif �al��maya klinik MS tan�s� alm��, hikayesinde ON olan ve olmayan 29 hasta dahil edildi. ON olmayan hastalar tekrarlayand�zelen MS (TDMS) ve tek atak MS (TAMS) alt gruplar�nda incelendi. �al��mada ON�li TDMS (ON-TDMS) grubunda 11 hasta, ON olmayan MS grubunda 11 TDMS�li ve 7 TAMS�li hasta ve ��nc� grup olarak kontrol grubunda 16 sa�l�kl� g�n�ll� yer ald�. Stereokeskinlik TNO ve Titmus testleri ile belirlendi. RSLTK, spektral-domain optik koherens tomografi ve P100 dalgas�, patern g�rsel uyar�lm�� potansiyeller ile �l��ld�. Sonu�lar, SPSS 20 istatistik program� ile analiz edildi. P<0,05 anlaml� kabul edildi. Bulgular: ON-TDMS, TDMS, TAMS ve kontrol gruplar�nda s�ras�yla TNO test skorlar� 151,5�175,85, 117,27�67,00, 197,14�141,62 ve 49,29�29,00; Titmus test skorlar� 89�111,20, 59,09�48,26, 68,57�39,76 ve 40,00�0,00 saptand�. TNO test skorlar� ON-TDMS ve TAMS gruplar�nda kontrol grubundan anlaml� derecede daha y�ksek idi (s�ras�yla; p=0,03 ve p=0,006). Titmus test skorlar� MS gruplar�nda kontrol grubundan farkl�l�k g�stermedi. ON-TDMS grubunda Titmus test skorlar� artt�k�a nasal-RSLTK azalmaktayd� ve TAMS grubunda TNO test skorlar� artt�k�a P100 latans� uzamaktayd� (s�ras�yla r=-0,795, p=0,018 ve r=0,761, p=0,047). Sonu�: �al��man�n sonu�lar�na g�re, ON olan ve olmayan MS gruplar�nda stereokeskinlik azalmaktad�r. MS�li hastalarda stereokeskinli�in �l��lmesi tan� ve takipte yard�mc� olabilir. Objective: It was aimed to investigate the relationship of stereoacuity with retinal nerve fiber layer thickness (RNFLT) and P100 latency in multiple sclerosis (MS) patients with and without optic neuritis (ON). Materials and Methods: Twenty-nine patients diagnosed with clinically definite MS with and without a history of ON were included in this prospective study. Patients without ON were classified into relapsing-remitting MS (RRMS) and single-attack MS (SAMS) subgroups. There were 11 patients in the RRMS group with ON (ON-RRMS), 11 patients with RRMS and 7 patients with SAMS in the MS group without ON, and 16 healthy subjects in the control group. Stereoacuity was determined by the TNO and Titmus tests. RNFLT was measured by spectral domain-optical coherence tomography and P100 latency was measured in pattern visual evoked potential recordings. The results were analyzed with the SPSS 20 statistical program. P<0.05 was considered significant. Results: In ON-RRMS, RRMS, SAMS, and control groups, the TNO test scores were 151.5�175.8, 117.2�67.0, 197.1�141.6, and 49.2�29.0, respectively and Titmus test scores were 89�111.2, 59.0�48.2, 68.5�39.7 and 40.0�0.0, respectively. TNO test scores were significantly higher in ON-RRMS and SAMS groups than in controls (p=0.03 and p=0.006, respectively). There was no difference between the MS groups and the control group in terms of the Titmus test. Nasal-RNFLT decreased as Titmus test scores increased in the ON-RRMS group, and P100 latency was prolonged as TNO test scores increased in the SAMS group (r=-0.795, p=0.018 and r=0.761, p=0.047, respectively). Conclusion: Stereoacuity was decreased in patients with MS with and without ON. Measurement of stereoacuity in patients with MS may be useful for diagnosis and monitoring. Makale �zeti \| Tam Metin PDF

10.	Akut �skemik �nmeli Hastalarda Tromboliz Sonras� Erken N�rolojik K�t�le�menin Risk Fakt�rlerinin Belirlenmesi Identifying the Risk Factors of Early Neurological Deterioration After Thrombolysis in Patients with Acute Ischemic Stroke Yasemin Din�, R�fat �zpar, Bahattin Hakyemez, Mustafa Bakar doi: 10.4274/tnd.2022.55531 Sayfalar 176 - 181 Ama�: Akut iskemik inme (A��) tedavisinde intraven�z (�V) rekombinant doku plazminojen aktivat�r� (rt-PA) tedavisinin etkinli�i bir�ok �al��mada g�sterilmi� ve �V rt-PA tedavisi t�m d�nyada giderek artan bir �ekilde kullan�lmaya ba�lanm��t�r. A�ݒde erken n�rolojik k�t�le�me (ENK) yayg�n bir durumdur ve potansiyel olarak k�t� klinik sonlan�m ile ili�kilidir. A�ݒde ENK prevalans� yap�lan �al��malarda %13 ile %37 aras�nda de�i�mektedir. Bu �al��man�n amac� �V rt-PA tedavisi alan A�ݒli hastalarda ENK prevalans�n�n ve risk fakt�rlerinin belirlenmesidir. Gere� ve Y�ntem: Bu �al��maya 01.01.2020-01.01.2021 tarihleri aras�nda Bursa Uluda� �niversitesi T�p Fak�ltesi, N�roloji Anabilim Dal� taraf�ndan �V rt-PA tedavisi verilmi� 157 hasta retrospektif olarak dahil edildi. ENK olan hastalar, olmayanlar ile k�yaslanarak riskli grubun belirlenmesi planland�. Bulgular: ENK ile ili�kili klinik, radyolojik ve demografik veriler de�erlendirildi�inde ya� (p=0,023), serum glukoz d�zeyi (p=0,045), taburculuktaki The National Institutes of Health Stroke skoru (p<0,01), Alberta Stroke Program Early CT (ASPECT) skoru (p<0,01), maj�r damar okl�zyonu varl�� (p=0,012), kardiyoembolizme ba�l� iskemik inme (p=0,002), klinik sonlan�m (p<0,001) ve semptomatik intraserebral kanama (p<0,001) ile anlaml� istatistiksel ili�ki saptand�. ENK ile ili�kili anlaml� de�i�kenler binary lojistik regresyon ile de�erlendirildi�inde en anlaml� de�i�kenlerin ya� (p=0,006) ve ASPECT skoru (p<0,001) oldu�u saptand�. Sonu�: ENK sebepleri multifakt�riyeldir. Risk fakt�rlerinden en ili�kili olanlar� ileri ya� ve d��k ASPECT skoru olarak saptanm��t�r. ENK�n�n en s�k sebebinin ise maj�r damar okl�zyonuna mekanik trombektomi yap�lamamas� oldu�u anla��ld�. San�lan�n aksine �V rt-PA tedavisi alan A�ݒli hastalarda ENK�n�n en s�k sebebi semptomatik intrakraniyal kanama de�il yetersiz rekanalizasyon ya da ge� rekanalizasyon olarak de�erlendirildi. Objective: The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) therapy in the treatment of acute ischemic stroke (AIS) has been demonstrated in many studies and IV rt-PA therapy has been increasingly used all over the world. Early neurological deterioration (END) in AIS is common and potentially associated with a poor clinical outcome. The prevalence of END in AIS ranges from 13% to 37% in studies. The aim of this study is to determine the prevalence and risk factors of END in patients with AIS receiving IV rt-PA therapy. Materials and Methods: One hundred fifty seven patients who were given IV rt-PA treatment by Bursa Uludag University Faculty of Medicine, Department of Neurology between 01.01.2020 and 01.01.2021 were retrospectively included in this study. It was planned to determine the risk group by comparing patients with END with those without. Results: Age (p=0.023), serum glucose level (p=0.045), The National Institutes of Health Stroke score at discharge (p<0.01), Alberta Stroke Program Early CT (ASPECT) score (p<0.01) when clinical, radiological and demographic data associated with END were evaluated and, statistically significant correlation was found with the presence of major vessel occlusion (p=0.012), ischemic stroke due to cardioembolism (p=0.002), clinical outcome (p<0.001) and symptomatic intracerebral hemorrhage (p<0.001). When the significant variables associated with END were evaluated with binary logistic regression, the most significant variables were found to be age (p=0.006) and ASPECT score (p<0.001). Conclusion: The causes of END are multifactorial. The most associated risk factors were found to be advanced age and low ASPECT score. It was understood that the most common cause of END was the inability to perform mechanical thrombectomy for major vessel occlusion. Contrary to popular belief, the most common cause of END in patients with AIS who received IV rt-PA treatment was not considered to be symptomatic intracranial hemorrhage but to inadequate recanalization or late recanalization. Makale �zeti \| Tam Metin PDF

11.	Parkinson Hastal�� Olan Hastalara Bak�m Verenlerin Ya�ad�� Psikolojik Stresin SCL- 90-R De�erlendirme �l�e�i Kullan�larak De�erlendirilmesi Psychological Distress Among Caregivers of Patients with Parkinson�s Disease Assessed with SCL-90-R Self-reported Questionnaire Bet�l �zdilek, Selma Bozkurt, Dilek G�nal doi: 10.4274/tnd.2022.27813 Sayfalar 182 - 187 Ama�: Parkinson hastal�� (PH) olan hastalara bak�m verenler yo�un psikolojik stres ya�arlar. Bu �al��mada Belirti Tarama �l�e�i 90 (SCL-90-R) formu kullan�larak, PH�li hastalara bakman�n, bak�m verenlerin psikiyatrik durumlar� �zerindeki etkisi ara�t�r�lm�� ve de�i�ik sosyo-demografik ve klinik �zellikler ile bak�m verenin ya�ad�� psikolojik stres aras�ndaki ili�ki a��klanmaya �al��lm��t�r. Gere� ve Y�ntem: SCL-90-R anketi PH�li hastaya bak�m veren 60 ki�iye ve 50 sa�l�kl� kontrole uygulanm��t�r. Hastalar�n motor ve motor olmayan bulgular�; birle�ik PH de�erlendirme �l�e�i, Hoehn & Yahr �l�e�i, Schwab-�ngiltere g�nl�k ya�am aktiviteleri �l�e�i ve mini-mental test gibi farkl� testler kullan�larak de�erlendirilmi�tir. Hastalardaki uyku bozukluklar� ise PH uyku skalas� ve Epworth uykululuk skalas� kullan�larak de�erlendirildi. Bulgular: Bak�m vericilerin t�m� aile �yeleriydi. Bak�m vericiler SCL-90-R�nin anksiyete b�l�m�nden kontrol grubuna g�re daha y�ksek puan alm��t�r. On �� (%22) bak�m vericide genel semptom indeks puan� patolojik bulunmu�tur. Hastalar�n ya�� ve uyku �l�ek skorlar�, bak�m vericinin ki�iler aras� duyarl�l�k, fobik anksiyete, psikoz, obsesyon-komp�lsiyon, anksiyete, depresyon ve ek madde b�l�mlerinde artm�� psikolojik stresi anlaml� �ekilde �ng�rebilmi�tir. Hastal��n �iddeti ve di�er PH bulgular� bak�m vericideki psikolojik strese anlaml� etkide bulunmam��t�r. Sonu�: Bu �al��ma, PH�li hastalar�n aile �yesi olan bak�m vericilerinin psikolojik stres olarak daha y�ksek anksiyete d�zeyine sahip oldu�unu g�stermektedir. PH�li hastalar�n uyku ile ilgili semptomlar� bak�m vericilerin psikolojik stres seviyelerini etkilemektedir. Objective: Caregivers of patients with Parkinson�s disease (PD) experience increased levels of psychological distress. This study investigated the impact of caring for patients with PD on the psychiatric health status of the caregivers by using Symptom Checklist 90 Revised (SCL-90-R) and described the relationship between various socio-demographic and clinical characteristics and psychological distress of caregivers. Materials and Methods: The SCL-90-R self-reported questionnaire was administered to 60 caregivers of PD patients and 50 healthy controls. Sixty patients underwent different scales including unified PD rating scale, Hoehn & Yahr scale, the Schwab-England activities of daily living scale and mini-mental state examination for the assessment of their motor and non-motor symptoms. Sleep disturbances in patients were assessed using the PD sleep scale and Epworth sleepiness scale. Results: All caregivers were family members. They got higher scores from the anxiety (ANX) of the SCL-90-R than the control group. Of the caregivers, 13 (22%) had a pathological score in the global severity index. Age and sleep scales scores significantly predicted psychological distress in interpersonal sensitivity, phobic ANX, psychoticism and obsessive - compulsive symptoms, ANX, depression and additional items dimensions in caregivers. Disease severity and other clinical findings did not affect psychological distress in caregivers. Conclusion: Our findings suggest that caregivers of patients with PD who are family members have higher ANX level as psychological distress. Sleep symptoms of patients with PD affect distress level of caregivers of patients with PD. Makale �zeti \| Tam Metin PDF

OLGU SUNUMLARI
12.	Nadir Bir Ataksi Nedeni: SPG7 Mutasyonu A Rare Cause of Ataxia: SPG7 Mutation Afra �elik, Banu �zen Barut, Rahsan �nan doi: 10.4274/tnd.2021.22804 Sayfalar 188 - 190 Herediter spastik paraplejiler (HSP) alt ekstremitelerde ilerleyici g��s�zl�k ve spastisite ile karakterize n�rodejeneratif nat�rde klinik ve genetik olarak heterojen bir grup hastal�kt�r. Klinik olarak p�r ve komplike formlar� bulunmaktad�r. Genetik olarak da otozomal dominant, otozomal resesif, X�e ba�l� ve mitokondriyal olarak kal�t�labilir. Olgumuz 61 ya��nda erkek hasta olup bacaklarda ilerleyici g��s�zl�k, sertlik ve dengesizlik, konu�mada bozukluk ve g�z kapa��nda d��me ile ba�vurdu. Ailesinde benzer bir �yk� bulunmayan hastan�n beyin manyetik rezonans g�r�nt�lemesinde serebellar atrofi izlendi. T�m ekzom dizileme ile SPG7 geninde homozigot p.Ala572Val (c.1715C>T) mutasyonu saptand�. SPG7 mutasyonu eri�kin ba�lang��l� tan� koyulamayan ataksinin �nemli sebeplerindendir. Her ne kadar t�m ekzom dizileme gibi yeni nesil dizileme y�ntemleri ile molek�ler olarak daha kolay tan� koyulabilse de eri�kin ba�lang��l� ataksilerin ay�r�c� tan�s�nda SPG7�yi d��nmek gerekir. Bu yaz�da SPG7 mutasyonlu komplike HSP formu tan�s� alan bir hastay� sunuyoruz. Hereditary spastic paraplegias (HSPs) are neurodegenerative disorders characterized by progressive weakness and spasticity in the lower limbs and are clinically and genetically heterogeneous. They are clinically classified as pure and complicated forms. HSP may be inherited as autosomal dominant, autosomal recessive, X-linked, or mitochondrial disorders. A 61-year-old man presented with progressive stiffness, weakness, ataxia in the lower limbs, dysarthria and asymmetric ptosis. None of the family members had such neurological symptoms. Brain magnetic resonance imaging showed cerebellar atrophy. Genetic analysis with whole exome sequencing revealed a homozygous p.Ala572Val (c.1715C>T) exchange mutation in SGP7 gene. SPG 7 mutation is an important cause of adult-onset undiagnosed ataxia. Although the availability of exome sequencing with targeted analysis helps molecular diagnosis of SPG7 easier, it is important to consider SPG7 in the differential diagnosis of adult onset ataxias. In this paper we report a patient with complicated form of HSP with SPG7 mutation. Makale �zeti \| Tam Metin PDF

KLINIK G�R�N�MLER
13.	Siringomiyeliye Ba�l� Unilateral Hiperhidrosis ve Kontralateral Horner Sendromu Unilateral Hyperhidrosis and Contralateral Horner�s Syndrome Due to Syringomyelia Ne�e Dericio�lu, Sel�uk Palao�lu doi: 10.4274/tnd.2021.45077 Sayfalar 191 - 192 Makale �zeti \| Tam Metin PDF

14.	Ataksi ile Seyreden Edinilmi� Hepatoserebral Dejenerasyon ve Orta Serebellar Pedink�lde Simetrik T2 Hiperintensiteler Acquired Hepatocerebral Degeneration with Ataxia and Symmetric Middle Cerebellar Peduncle T2 Hyperintensities Ayg�l Tantik Pak, Sebahat Nacar Do�an, Y�ld�zhan �eng�l doi: 10.4274/tnd.2022.95002 Sayfalar 193 - 194 Makale �zeti \| Tam Metin PDF

EDIT�RE MEKTUPLAR
15.	Primer Hipereozinofilik Sendrom ve �nme: Mekanizma ve Tan� Primary Hypereosinophilic Syndrome and Stroke: Mechanisms and Diagnosis Melike �akan, Mehmet Akif Top�uo�lu doi: 10.4274/tnd.2021.07448 Sayfalar 195 - 196 Makale �zeti \| Tam Metin PDF

16.	Sodyum Valproat Kullan�m� ile Tetiklenen Eri�kin Ba�lang��l� Tip 2 Sitr�llinemi Sodium Valproate-induced Adult-onset Type 2 Citrullinemia Ba�ak El�in Ate�, Turgay Demir, Deniz Kor, Remzi Emre �ahin, �ebnem B��ak�� doi: 10.4274/tnd.2022.37539 Sayfalar 197 - 199 Makale �zeti \| Tam Metin PDF

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