Ideggyogyaszati Szemle-Clinical Neuroscience最新文献

Background and purpose:

To determine the risk of hemorrhagic transformation in patients with acute ischemic cerebrovascular disease, we investigated the relationship between Apparent Diffusion Coefficient Magnetic Resonance Imaging values measured within the infarct area and microbleeds observed on Gradient Echo Sequence Magnetic Resonance Imaging.

Methods:

A total of 172 patients who were hospitalized to the Neurology Clinic of the Istanbul Provincial Directorate of Health Erenkoy Mental and Nervous Diseases Training and Research Hospital between June 2019 and March 2020 were included in this cross-sectional study. The patients were classified according to their demographic and clinical characteristics, by age, gender, hypertension, diabetes mellitus, smoking, and alcohol use. In the Cranial Magnetic Resonance Imaging taken in the application for the diagnosis of acute ischemic cerebrovascular disease, the infarction area in Apparent Diffusion Coefficient sequences with the Region of Interest value and the relationship between microhemorrhage observed in Gradient Echo hemo-sequence was evaluated in Magnetic Resonance Imaging applied between 3-7 days. While calculating spherical Region of Interest values, 5 Region of Interest values were obtained for lesions larger than 1.5x1.5 cm, and their arithmetic mean was obtained, and single spherical Region of Interest value was taken for smaller ones. Apparent Diffusion Coefficient Magnetic Resonance Imaging Region of Interest mean values were divided into 2 groups as <500x10–6 mm2 /s and >500x10–6 mm2/s. 

Results:

Patients in the group with Apparent Diffusion Coefficient Region of Interest mean values below 500x10-6 mm2/s, had a significantly higher probability for microhemorrhage observes in Gradient Echo Sequence Magnetic Resonance Imaging (p: 0.001) and also more likely to experience microhemorrhage in other areas, which was statistically significant (p: 0.001).The probability of another micro-bleeding observed in patients with microhemorrhage Gradient Echo Sequence Magnetic Resonance Imaging was also statistically significant (p: 0,001). The risk of microbleeding in areas other than ischemia was also found to be significantly higher in patients with microbleeding in the ischemia area in Gradient Echo Sequence Magnetic Resonance Imaging.

Conclusion:

In our study, a statistically significant relationship was found between the microhemorrhage in the infarct area and the Apparent Diffusion Coefficient Region of Interest values. When the literature was reviewed, no such study was found to determine the risk of bleeding.

Background and purpose:

To evaluate the long-term effects of the COVID-19 pandemic on seizure frequency and levels of mental distress in individuals with epilepsy and identify potential risk factors associated with increased seizure frequency.

Methods:

This is a cross-sectional study conducted in Türkiye in May 2021 by phone. Information on epilepsy syndromes, antiseizure medications, average seizure frequency, and drug resistance was obtained from medical records. A questionnaire was completed that included demographic and clinical characteristics and Kessler Psychological Distress Scale 10 (K-10). From people with epilepsy (PWE), seizure control in the month before the pandemic and perceived stress, sleep changes, changes in adaptation during this period, and whether there were changes in seizure control after the pandemic were questioned.

Results:

A total of 227 patients were included, and the K-10 score of 81.9% (186/227) of PWE was found to be ≥30. An increase in seizure frequency was detected in 34 (15%) patients. The factors affecting the increase in seizure frequency were analyzed using logistic regression analysis. In the univariate model hesitate to go to the emergency room despite having seizures during the pandemic (OR= 8.325; 95% CI: [2.943 - 23.551], p=<0.001) was evaluated as the parameter with the highest risk of increased seizure frequency. In multivariate analyses (enter model) only polytherapy (OR= 2.945; 95% CI: [1.152 – 7.532], p=0.024) was detected as the parameter with increased seizure frequency. 

Conclusion:

One year after the declaration of the pandemic, we found that stress was still common, the frequency of seizures increased. In multivariate analyses, only polytherapy was detected as the parameter with increased seizure frequency. 

Background and purpose:

Face masks are crucial parts of personal protective equipment (PPE) to reduce the risk of respiratory infections. The COVID-19 outbreak has increased healthcare workers’ use of face masks. This study aimed to evaluate changes in cerebrovascular response among healthcare workers using surgical and N95 respirator masks. 

Methods:

90 healthcare workers: 30 wearing surgical masks, 30 wearing N95 respirators, and 30 without masks were included. After two-hour of face mask use, the baseline mean flow velocity (MFV) and the mean breath-holding index (BHI) of the bilateral middle cerebral arteries (MCAs) were evaluated with transcranial Doppler ultrasound. The presence of de-novo headache was recorded. BHI values ​​below 0.69 were evaluated as a sign of impaired cerebrovascular reactivity (CVR). 

Results:

The rate of de-novo headache was significantly higher in the N95 respirator mask group (p = 0.004). Compared to the control and surgical mask groups, the N95 respirator mask group had significantly lower values of the baseline MFV of the right MCA (p = 0.003 and p = 0.021, respectively) and mean BHI (p = 0.003 and p = 0.012, respectively). Still, only one N95 respirator mask user had a mean BHI value below 0.69.

Conclusion:

Surgical masks did not signi­fi­cantly affect cerebral hemodynamics. Although N95 respirator mask use significantly decreased BHI values, the CVR is still within normal limits, and the development of de-novo headache is not directly associated with low CVR. 

Background and purpose:

Posterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic edema, usually reversible, with the prominent involvement of the parietal and occipital lobes. The exact etiopathogenesis leading to PRES is unknown. Because signs of eclampsia and preeclampsia in neuroimaging often overlap and manifest as PRES, we aimed to evaluate whether demographic, clinical, and laboratory parameters predict PRES in patients with preeclampsia or eclampsia.

Methods:

213 pre-eclampsia or eclampsia patients with cranial imaging were retrospectively examined. We recorded the patients’ demographic information, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hemogram, biochemical indicators, clinical symptoms, and imaging features.

Results:

Of all patients, 69% (n = 147) had preeclampsia while 31% (n = 66) had eclampsia, and 24.4% (n = 53) were diagnosed with PRES. The mean age of patients who developed PRES was 25.81 ± 6.07 years and thus significantly less than that of patients who did not develop PRES (p = .000). Patients with PRES had significantly higher mean SBP (p = .015), DBP (p = .009), and MAP (p = .003) than patients without PRES, along with significantly higher aspartate aminotransferase (ASAT; p = .001), alanine aminotransferase (ALAT; p = .001) blood urea nitrogen (BUN; p = .001), white blood cell (WBC; p = .003), neutrophil (p = .001), and hemoglobin (Hb; p = .027) levels, but significantly lower albumin (p = .000) levels.

Conclusion:

Age, high blood pressure, and BUN, neutrophil, and WBC levels were predictors of the development of PRES in patients with preeclampsia and eclampsia. Early neuroimaging considering those predictors should be performed to diagnose PRES in patients with preeclampsia and eclampsia.

Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system with demyelination and neurodegeneration. In addition to the inflammatory immune processes that characterise the onset of the disease with relapses, chronic inflammation is also present from the onset of the disease. The catabolic processes induced by chronic inflammation are responsible for the axonal degeneration that causes the progression of the disease. The activity of the disease is well defined, an important prognostic factor, and a determining factor in the indication of disease-modifying therapies. It is important to establish disease activity at the time of diagnosis and to monitor it continuously during patient care, both clinically and radiologically, as it is the basis for deciding on the current treatment. If detected on the basis of the professional guideline, it is necessary to start or switch to a highly effective therapy. 

If severe cervical spinal cord injury or severe cervical vertebral fracture, subluxation or luxation is confirmed, 20-40% of the cases have vertebral artery dissection or occlusion. These can be asymptomatic, but can cause additional neurological damage in addition to cervical myelon and cervical nerve root symptoms. Vertebral artery dissection can be caused by direct injuries, stab wounds or gunshot wounds. Indirect vertebral artery dissection can occur at the same time as subluxation, luxation, or complex fractures of the cervical vertebra. CTA is the examination procedure of choice. In many cases, digital subtaction angiography examination and, if necessary, neurointerventional treatment must precede open neurosurgery. In our report, in the first patient, complete luxation of the C.VI vertebra caused unilateral vertebral artery 2-segment dissection-occlusion, while in our second patient, a stab injury caused direct vertebral artery compression and dissection. The occlusion of the vertebral artery did not cause neurological symptoms in any of the cases. In both of our cases, parent vessel occlusion was performed at the level of the vertebral artery injury before the neurosurgical operation.

Background - POEMS syndrome is a potentially well manageable disease with an ascendant therapeutic arsenal nowadays. The early recognition of the syndrome is key to prevent serious multiorgan damage, and that is still a big challenge for physicians. With the following two case reports the authors aimed to highlight the consequences of late recognition of the disease and summarize the potential therapeutic options for POEMS syndrome.

Results - We have presented two patients’ cases with a long history of examination and treatment because of uncleared polyneuropathy. Through these cases we could see how serious could be the consequences of late diagnosis and despite multiorgan impairment there are still therapeutic options which could improve the patient’s condition. Although the diagnosis of POEMS syndrome is not easy, it must raise our mind the thought and be prudent when we start a treatment in polyneuropathy.

Background and purpose:

The aim of this study is to comprehensively determine the types of affected fibers in Parkinson’s disease (PD) patients by employing nerve conduction studies (NCS), sympathetic skin response (SSR) examinations, and current perception threshold (CPT) testing and to analyze the correlation between levodopa use and nerve involvement.

Methods:

This retrospective study included 36 clinically diagnosed PD patients who were recruited between January 2018 and April 2019. All patients underwent NCS, SSR testing, and CPT sensory examinations. Additionally, the PD patients were assessed for disease staging using the Hoehn and Yahr (H-Y) scale. 

Results:

Fifteen patients were included in the tremor-dominant subtype, ten patients in the rigid-dominant subtype, and eleven patients in the mixed subtype. Eleven patients were using levodopa, while twenty-five patients had never used any anti-Parkinson’s medication. Ten patients (28%) showed abnormal sympathetic skin responses (SSR). The CPT examination revealed sensory abnormalities in twenty-four patients (67%), with eighteen patients (75%) experiencing sensory hypersensitivity and six patients (25%) experiencing sensory hypoesthesia. Twelve patients (33%) had normal CPT results. Among the patients with abnormal CPT findings, seven cases (29%) involved large myelinated fiber damage, twenty-two cases (92%) involved small myelinated fiber damage, and nineteen cases (79%) involved unmyelinated fiber damage. The rate of sensory abnormalities was 64% (7/11) in the levodopa group and 68% (17/25) in the non-levodopa group, with no statistically significant difference between the two groups. 

Conclusion:

The incidence of abnormal CPT findings in PD patients was higher than that of abnormal SSR responses, suggesting that nerve fiber damage primarily affects small fiber nerves (SFN).

Background and purpose:

Fibrinogen to albumin ratio (FAR) is thought to have a predictive effect in diseases such as cancer and myocardial infarction. We aimed to elucidate the prognostic value of FAR in ischemic stroke patients who underwent mechanical thrombectomy.

Methods:

A total of 103 patients hospita­lized for acute stroke who underwent me­cha­nical thrombectomy within 6 hours of symp­toms’ outset have been analyzed retro­spectively. Stroke severity was interpreted via the National Institutes of Health Stroke Scale (NIHSS) score during the neurological examination. Recanalization success after mechanical thrombectomy was evaluated with the TICI score (Thrombolysis in Cerebral Infarction scale), and 2b – 3 patients were recorded as those with recanalization. The patients’ modified Rankin scale (mRS) at discharge and at the end of the third month were recorded. 

Results:

 Statistically significant differen­ces were observed in age, admission blood glucose, glomerular filtration rate and FAR according to the mRS scores of the patients in the third month (p<0.05). Significant va­riab­les in the risk factor analysis were re-evaluated in the multivariate model. The best model was determined using the backward Wald method in the multivariate model, and it was determined that differences in age, admission blood glucose, and FAR were significant.

Conclusion:

FAR can be used as a novel, effective, economical, and practical biomarker in patient with acute ischemic stroke who underwent mechanical thrombectomy.

Background and purpose:

Parkinson’s disease (PD) is a heterogeneous neurodegenerative disorder characterized by contradictory clinical outcomes among its several subtypes. The disease can manifest with a tremor-dominant (TD) or a non-tremor-dominant (NTD) phenotype. Although the TD subtype may show a better prognosis, there is limited information on the phenotypic differences regarding the level of axial symptoms. For this reason, in this study it was aimed to make a quantitative comparison of axial posture and spinal mobility between PD with TD and NTD. 

Methods:

This case-control study was conducted on 94 patients with diagnosed PD. A group diagnosis approach was used in the study, such that the diagnosis of each patient was confirmed, and they were assig-ned to TD and NTD groups by a neurologist expert on movement disorders. Of the patients with PD, 61 were in the TD group, and 33 were in the NTD group. Spinal mouse was used to measure spinal posture and spinal mobility in both sagittal and frontal planes. 

Results:

Two groups of 61 patients (25 male + 36 female) with TD-PD (mean age: 64.49±10.37 years) and 33 patients (20 male +13 female) with NTD-PD (mean age: 63.45±9.11 years) were enrolled in the study. There were no significant differences bet­ween the patients with TD and NTD in terms of sagittal and frontal postures (p>0.05). In addition to this, anterior trunk tilt was found to significantly increase as the disease stage advanced in both groups. While the greatest anterior trunk tilt change in the TD-PD group was observed in the 3rd stage, NTD-PD group was in the 2.5th stage. Aside from this, the out­comes of the spinal mobility measurements in the frontal and sagittal planes were similar between the groups (p>0.05).

Conclusion:

It is widely acknowledged that many clinical aspects of the TD and NTD forms of PD differ; however, in our study, it was observed that there may be no difference in the axial symptoms of the patients with PD in terms of classification according to tremor dominance.