Ideggyogyaszati Szemle-Clinical Neuroscience最新文献

Background and purpose:

Epidural fibrosis after all spinal surgeries is an important surgical issue. Various biological and non-biological materials have been tried to inhibit epidural fibrosis, which is deemed to be the most important cause of pain after spinal surgery. Olive oil, nigella sativa oil and soybean oil employed in oral nutrition in clinics involving liquid fatty acids, palmatic acid, linoleic acid, stearic acid and palmitoleic acid. The effectiveness of olive oil, nigella sativa oil and soybean oil on epidural fibrosis was researched on for the first time in laminectomy model.

Methods:

Fifty adult male Wistar albino rats weighing between 300 and 400 grams were used in the research. A total of 5 groups were formed: sham (Group I) (n = 10), no application was created; Group II (n = 10) 1 cc saline; Group III (n = 10) 1 cc olive oil; Group IV (n = 10) 1 cc nigella sativa oil; Group V (n = 10); 1 cc soybean oil was applied topically to the epidural region after laminectomy. The total spine of the rats was dissected, histopathological and immuno­chemical measurements were conducted. Neuro-histopathological results were scored semi-quantitatively in terms of vascular modification, neuron degeneration, gliosis and bleeding criteria.

Results:

The lowest level of fibrosis and connective tissue proliferation was observed in the group where nigella sativa oil was used after the operation, followed by the group treated with olive oil and lastly with the group given soybean oil.

Conclusion:

Nigella sativa oil and olive oil are very efficient for lowering the degree of epidural fibrosis and adhesions following laminectomy and can be employed as a simple, inexpensive and highly biocompatible material in clinical practice.

Background and purpose:

Hippocampi are the structures located in the medial depths of both temporal lobes, mainly responsible for memory, navigation and regulation of emotions, and activated during the processing of pain and the modification of nociceptive stimuli. Chronic pain is thought to have stress-like detrimental modulatory effects on the hippocampal neurogenesis, and adults with chronic pain have been showed to have lower hippocampal volumes. The present study aims to show the relationship between headaches and hippocampal volume by comparing the right, left and total hippocampal volumes of patients with Episodic Migraine (EM), Chronic Migraine (CM) and Medication Overuse Headache (MOH) to those of the healthy control group using the Magnetic Resonance Imaging (MRI) technique, also by looking into the correlation between the number of painful days and attacks and the current hippocampal volumes.

Methods:

A total of 30 patients (10 EM, 10 CM, 10 MOH) from 18 to 45 years of age diagnosed with migraine and also followed up by the neurology outpatient clinic from February to May 2022 and 30 healthy volunteers of similar ages and sexes to the patient group were included in the study. In addition to the routine cranial MRI protocols of all the participants, further cranial images were taken with the addition of the T1W 3D FSPGR sequence adjusted to the hippocampal body in the coronal plane and covering the whole brain. Hippocampal volumes were measured manually.

Results:

There were 27 females and 3 males in the patient group versus 28 females and 2 males in the control group, and no statistically significant differences in age and sex were found between the groups. The control group had higher average right, left and total hippocampal volumes than the whole patient group, but only the total hippocampal volume was significantly different between the groups. There was a negative correlation between the number of painful days and the measured right hippocampal and total hippocampal volumes; however, the measured values were not statistically significant. 

Conclusion:

It was concluded that the changes in the hippocampal volume in migraine might be associated with the pain characteristics of the disorder. 

Background and purpose:

Spinal surgery has an important place in neurosurgery practice. Surgical procedures on the lumbar spine include stabilization, discectomy, foraminotomy and decompression. Lumbar and lower thoracic spinal surgery can be safely performed under spinal anesthesia (SA). However, there are not many studies on the safety and efficacy of spinal anesthesia in patients who have undergone long segment stabilization surgery.

Methods:

Patients who underwent lumbar and lower thoracic spinal instrumentation operations with general anesthesia (GA) or spinal anesthesia were included in the study. Demographic characteristics and American Society of Anesthesiologists (ASA) physical status of the patients were all recorded. Visual analog scale and quality of life scores were obtained before and after the operation.

Results:

572 patients with SA and 598 patients with GA were included in the study, 352 / 347 had only-lumbar region and 220 / 251 had thoracolumbar region operations, respectively. All patients underwent short/long segment stabilization. Mean operating time was 106.1 / 156.7 minutes. Average blood loss was 375 / 390 mL. All patients were mobilized 16-24 / 24-36 hours after surgery. In our patient group, there were both high-risk and normal-risk subgroups in terms of ASA physical status. During the clinical follow-up, a statistically significant improvement was found for VAS and quality of life scores for both groups (p<0.05).

Conclusion:

Spinal anesthesia appears to be a very effective method in lumbar and thoracolumbar surgery. Along with careful patient selection, using this highly effective method provides a comfortable space for the surgeon.

Background and purpose:

Although headaches are often comorbid with psychological symptoms, the underlying psychological processes, e.g. the role of personality dimensions as headache determinants remains unclear. Studies found associations between headaches and various personality traits; according to the Big Five model of personality, persons suffering from headaches exhibit a higher rate in neuroticism, while a lower rate in extraversion, openness to experiences and positive emotions. This is the first study to clarify the associations among duration, intensity, and frequency of headaches and personality dimensions. Through this study we could get into the personality dimensions in the background of pain experience and that which personality dimensions bear a part in the behaviour of the persons, who suffered from headache, but do not seek treatment through this complaint. 

Methods:

Treated (Group1) and untreated (Group2) headache patients and healthy controls (Group3) were investigated (total of 360 participants). The main headache components of intensity, duration, and frequency were used as dependent variables with personality dimensions in the Big Five concept investigated by the NEO-PI-R Personality Inventory.

Results:

Employing multiple regression analysis, facets of personality described 14.7% of headache intensity, 10.9 % of duration, and 18.7 % of frequency variance. Group1 and Group2 reached significantly higher values on the dimension of anxiety, depression, and vulnerability to stress than Group3. Group1 showed a significantly higher value on trust personality dimension than Group3 and Group2. Group3 exhibited a significantly higher value in the trust dimension than Group2. Concerning vulnerability to stress, the highest value was yielded by the “treated and suffering from headaches” group and there was a significant difference also with the “untreated and suffering from headaches” group and with the control group. In this dimension, the “untreated and suffering from headaches” group’s point value was significantly higher than the control group’s (p<0.01, U=-4.501).

Conclusion:

Our study demonstrates that the three headache components are not independent from personality traits, and personality traits may interact with treatment seeking behavior even in the presence of significant headache complaints. The role of the personality traits are significant in the intensity, duration and frequency of headaches. 

Background and purpose:

The purpose of the present study was to evaluate ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), and brainstem auditory evoked potential (BAEP) response characteristics and to understand the pathophy­siology of vestibular dysfunction in female migraineurs with vertigo symptoms. We also aimed to assess the electrophysiological di­­agnostic significance of the VEMP respon­ses in vestibular migraine (VM). 

Methods:

23 patients with migraine without aura (MoA), 23 patients with VM, and 20 sex-and age-matched healthy controls, a total of 66 female participants were enrolled in this study. The outcome parameters were asymmetry ratios (ARs), amplitudes of oVEMP, cVEMP, N1P1, P13N23, and the respective latencies (mean ± SD). From the BAEP graphs, absolute and interpeak interval latencies of waves were analyzed. 

Results:

30.4% of the MoA group and 21.7% of the VM group had uni- or bilaterally absent cVEMP responses which were statistically significant only in the MoA group (p=0.035) in comparison to control group. Both groups displayed statistically insignificant absent or asymmetrical responses for oVEMP (13.1%). Cervical VEMP P13 and N23 latency, peak-to-peak amplitude, interaural latencies, and amplitude ARs did not show any significant difference between MoA and VM patients and healthy controls. No significant difference was detected among the three groups in the oVEMP and BAEP parameters.

Conclusion:

Although absent cVEMP responses were more common in MoA and VM patients than in healthy individuals, the VEMP and BAEP test results should not be used in the differential diagnosis of VM and MoA. 

Introduction - Immune-checkpoint inhibitors (ICI) are effective drugs in cancer treatment that block immune checkpoints and stimulate an attack on cancer cells. However, various side effects were reported with ICIs. Peripheral nervous system (PNS) side effects are three times more frequent than those in the central nervous system.
Case report - A 63-year-old male patient was admitted to our department with a 10-day history of dyspnea, diplopia, and generalized weakness. He had a diagnosis of non-small cell lung cancer, which was treated with pembrolizumab. His neurological symptoms appeared one week after the second course of pembrolizumab, and gradually worsened. His neurological examination showed nasal speech, bilateral ptosis, tongue and neck flexor weakness, prominent asymmetrical upper limb weakness, and mild lower limb weakness. Deep tendon reflexes and sensory examination were normal. He had an elevated creatine kinase level (4430 U/L). Needle electromyography (EMG) showed a myopathic pattern, and single fiber EMG demonstrated an increased jitter in the right frontal muscle. Pembrolizumab treatment was discontinued, and intravenous methylprednisolone followed by intravenous immunoglobulin (IVIg) were initiated. His symptoms gradually improved. However, his weakness began to worsen after a month, and repeated nerve conduction studies showed a predominantly motor axonal polyneuropathy. Thereafter, the patient was treated with IVIg infusions (0.4 g/every two weeks) to maintain his motor function.
Conclusion - Our case showed that ICIs could simultaneously or sequentially cause damage in multiple domains of the PNS. Early recognition of these adverse events is essential since the outcome is favorable with rapid cessation of the causative ICI and administration of immune-modulator treatment.

Airbag induced injuries such as skull and cervical spine fractures, epidural and subdural hematomas, atlantooccipital dislocations or brainstem lacerations are already documented in published literature, however, no previous case have been published about a penetrating foreign body of the skull base following airbag deployment. Removal of an intracranial foreign body is very dangerous and difficult, or even if it possible and necessary, requires open surgery in most of the cases. In this article we present the minimal invasive, transnasal removal of a coin from the intracranial, frontobasal region using high-resolution endoscopy combined with image-guided navigation.
We report the case of a 59-year-old male who was brought to the emergency department after a car accident. He suffered a penetrating injury by a coin that was placed on the car’s airbag at the moment of the accident. Upon the airbag being deployed the foreign body entered the skin through the right lower eyelid, crossing the orbital cavity, ethmoid cells, sphenoid sinus and the anterior part of the planum sphenoidale at an equal distance of 2mm from the two internal carotid arteries, extending into the intracranial space, without injuring the pituitary stalk and the chiasm. We proceeded to remove the coin endoscopically using a transnasal transseptal transsphenoidal approach under general anesthesia. The dura was closed with a multilayer skull base reconstruction technique using two layers of abdominal free fat and nasal septal mucoperiosteal flap. There were no postoperative complications, nor CSF rhinorrhea. The patient was discharged 10 days after the operation.
To our knowledge, this is the first publi­shed case of a penetrating foreign body of the skull base, extending into the intracranial cavity following airbag deployment. In some dedicated cases, a minimal invasive endoscopic approach should be considered as an alternative to anterior craniotomy if access is possible when foreign bodies from the skull base area need to be removed. This procedure is efficient, safe and minimally invasive. 

Background and purpose:

Neuropathic pain may appear as one of the first symptoms that take the patient to the physician in type 2 diabetes, which can be asymptomatic for years. Although it is accepted that diabetes is a trigger for vascular inflammation, it has been suggested that inflammation itself may trigger diabetes. In our study, we aimed to investigate the relationship between diabetic polyneuropathy and neuropathic pain and inflammatory markers.

Methods:

The study included 44 healthy controls, 46 diabetic patients with normal electroneuromyography (ENMG) and 44 diabetic patients with polyneuropathy detected in ENMG. Sedimentation, C-reactive protein (CRP), Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLO) and mean platelet volume (MPV) values were recorded in the sera of the patients. The Douleur Neuropathic 4 (DNP4) Questions was used to evaluate the presence of neuropathic pain in the patients, and the Visual Analogue Scale (VAS) was used to evaluate the severity of pain.

Results:

NLR, CRP, sedimentation levels were statistically significantly higher in the DMP+ and DMP– patient groups compared to the control group. PLO and MPV levels were significantly higher in the DMP+ patient group compared to both the DMP– patient group and the control group. 
The means of VAS and DN4 scores were statistically significantly higher in the DMP+ patient group than in the DMP– patient group. In the DMP– patient group, the NLR levels of those with neuropathic pain according to the DN4 scale were statistically significantly higher than those without neuropathic pain.

Conclusion:

Diabetic neuropathy is one of the common complications of diabetes, affecting about half of patients. Our study shows that NLR, PLO, MPV values can be used as parameters to help us make an easy and fast diagnosis in diabetic polyneuropathy. However, their reliability in the diagnosis of diabetic polyneuropathy should be evaluated with studies to be conducted with larger patient and control groups.

Background and purpose:

Although serum anti-neuronal antibodies are found in acute ischemic stroke (AIS) patients, it is not completely clear whether they are already present before the cerebrovascular event or emerge thereafter. 

Methods:

Sera of 21 consecutive first-ever AIS patients were collected within the first day of AIS (baseline), as well as 1 and 6 months after AIS. Well-characterized and novel anti-neuronal antibodies were investigated by cell-based assays, immunoblotting and indirect immunohistochemistry.

Results:

None of the AIS sera collected at different time points showed well-characterized antibodies. In 7 patients, 1- and 6-month sera (but not baseline sera) showed IgG mostly reacting with soma and dendrites of cerebellar Purkinje cells. Antibody-positive patients did not differ in terms of clinical and etiological features.

Conclusion:

Our results provide evidence for the antibody-triggering action of AIS. Although anti-cerebellar antibodies are not associated with the severity of stroke, they may potentially contribute to chronic post-stroke complications and disability.

Migraine as a common primary headache disorder has a significant negative effect on quality of life of the patients. Its pharmacotreatment includes acute and preventative therapies. Based on the shared therapeutic guideline of the European Headache Federation and the European Academy of Neurology for acute migraine treatment a combination of triptans and non-steroidal anti-inflammatory drugs is recommended for acute migraine treatment in triptan-nonresponders. In this short review we summarized the results of the randomized controlled clinical trials evaluating the effectiveness and safety of sumatriptan (85 mg)/naproxen sodium (500 mg) fix-dose combination. It was revealed that the fix-dose combination was better than placebo for the primary outcomes of exemption of pain and headache relief at 2 hours. Furthermore the combination showed beneficial effect on accompanying symptoms of migraine attack (i.e. nausea, photo- and phonophobia). Adverse events were mild or moderate in severity and rarely led to withdrawal of the drug.
It can be concluded that sumatriptan (85 mg)/naproxen sodium (500 mg) fix-dose combination is effective, safe and well-tolerated in the acute treatment of migraine.