-
[show abstract]
[hide abstract]
ABSTRACT: Neuropathy, one of the major reasons of morbidity in diabetes mellitus (DM), is associated with prediabetic conditions as well as DM. The present study aims to compare phrenic and peripheral nerves in prediabetic, diabetic patients and healthy controls. A total of 37 diabetic, 40 prediabetic patients and 18 healthy controls were enrolled in the study. All subjects underwent conventional sensory and motor nerve conduction studies. Bilateral phrenic and peripheric nerve conduction studies were performed. In both right and left phrenic nerves, the amplitudes were lower in prediabetic and diabetic patients than control subjects, respectively (p: 0.005 and p: 0.001). Both of the phrenic nerve conductions were altered similarly. The results of our study demonstrate that phrenic nerves are affected like peripheric nerves in prediabetic and diabetic patients. We suggest reminding phrenic neuropathy in newly onset respiratory failure in diabetic and prediabetic patients.
Acta Diabetologica 01/2012; · 2.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hypertension is the most important modifiable risk factor for intracerebral hemorrhage (ICH), but blood pressure (BP) management during the acute phase of ICH is still controversial. Approximately one-fourth of ICHs occur during treatment with warfarin or aspirin.
This study was designed to determine the effect of admission BP on the early prognosis of ICH patients by dividing them into three groups (warfarin, aspirin, and no drugs).
Three hundred and sixty-nine patients with supratentorial ICH were divided into three groups according to medication. Each group was evaluated in terms of prognosis and the risk for mortality based on the modified Rankin Scale (mRS) score at discharge (good prognosis: mRS ≤ 3; poor prognosis: mRS > 3). The effect of admission BP on prognosis was evaluated for each group.
The in-hospital mortality rate was 72% for ICH patients treated with warfarin, 41.6% for ICH patients treated with aspirin, and 35% for ICH patients treated with no drugs. Admission mean arterial blood pressure (MABP) values were higher in patients with poor prognosis compared with patients with good prognosis for the aspirin (P = .002) and no-drug (P = .001) groups, but not in the warfarin (P = .067) group.
A high MABP at admission was found to be an independent predictor of poor prognosis for ICH patients treated with aspirin or with no drugs, but not for ICH patients treated with warfarin.
Clinical and Experimental Hypertension 10/2011; 34(2):118-24. · 1.07 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Peripheral nerve neuropathies are more common in patients with cervical radiculopathy (CR) and a proximal lesion along an axon might predispose that nerve to injury at distal sites. To evaluate this hypothesis, the frequency of median nerve neuropathy at the wrist and the frequency of ulnar nerve neuropathy at the elbow were investigated in 80 patients with one-sided CR.
The symptomatic and asymptomatic extremities were compared for the electrophysiological parameters of ulnar and median nerve conduction studies. The patients were divided into three diagnostic subgroups (C5/C6 radiculopathy, C7 radiculopathy and C8/Th1 radiculopathy), and ulnar nerve conduction studies were compared between symptomatic and asymptomatic extremities in each subgroup.
Although, the median and ulnar nerves are mainly derived from C8/Th1 roots, we did not observe an increased frequency of ulnar nerve involvement at the elbow (3.7% in symptomatic, 2.5% in asymptomatic extremities) while increased median nerve involvement was present at the wrist (27.5% in symptomatic, 12.5% in asymptomatic extremities).
The electrophysiological data and the frequency of ulnar and median nerve neuropathy did not support an etiological association between CR and distal neuropathy. Significance: the association between CR and peripheral neuropathy is associational rather than causative.
European Neurology 01/2011; 66(1):53-8. · 1.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: ischemic strokes occurring in patients younger than 47 years is a relatively rare event and accounts for less than 5% of all ischemic strokes in western countries.
the etiologic spectrum in younger patients and older patients differs considerably.
in this hospital case series study, we enrolled 192 patients with ischemic stroke, aged 18 to 47 years, all of whom were submitted to a diagnostic protocol. The risk factors for stroke and the distribution of stroke subtype and prognosis were studied. Modified diagnostic criteria adopted from the Trial of ORG 10172 in Acute Stroke Treatment and the Baltimore-Washington Cooperative Young Stroke Study, were used for etiologic classification.
hypertension was found to be the main risk factor (45%) followed by cigarette smoking (37%), hyperlipidemia (35.4%), diabetes mellitus (17%), and family history of stroke (18%). Hypertension, diabetes mellitus, hypercholesterolemia, and smoking were present either alone or in combination in the majority of our patients. Oral contraceptives were being taken by 25% of the women. The etiology of stroke was as follows: atherothrombosis 26.5%, cardioembolism 20%, nonatherosclerotic vasculopathies 13%, other determined causes 10%, lacunar stroke 6%, migraine 3.6%, and undetermined causes 21%.
hypertension, diabetes mellitus, hypercholesterolemia, and smoking were the most common risk factors in our ischemic stroke patients between 18-47 years of age. Health care programs targeting the prevention and treatment of these factors will reduce the associated morbidity and mortality of stroke among this socioeconomically active age group.
The Neurologist 01/2011; 17(1):16-20. · 1.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study is to examine the direct medical costs and outcomes of patients with stroke.
The records of the patients admitted with ischemic and hemorrhagic stroke to the University of Trakya, School of Medicine, Department of Neurology were reviewed retrospectively in year 2007. Direct medical costs (total costs, radiological, laboratory, medicine, and other) were calculated, additionally cost per life saved and per life-year saved were calculated for stroke patients.
The study group consisted of 328 patients (169 male/159 female) and mean age was 66.5 ± 12.4 years. Length of hospital stay was 10.7 ± 7.5 days. Mortality rate was 20.4% and the mRS score of the patients was 3.2 ± 2.1. The average cost of stroke was US$ 1677 ± 2964 (29.9% medicine, 19.9% laboratory, 12.8% neuroimaging, and 38% beds and staff). Cost per life saved and per life-year saved were US$ 2108 and US$ 1070, respectively.
This is the first study in order to determine direct medical cost of stroke in Turkey, therefore, it may be guideline for disease-cost management of stroke.
Clinical neurology and neurosurgery 10/2010; 113(2):111-4. · 1.30 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Methanol is a clear, colorless, and highly toxic liquid with a similar smell and taste to ethanol, and is found in many commercial products such as solvents and cleaning fluids. Severe methanol intoxication occurs after suicidal or accidental oral ingestion of solvents. A few patients with methanol intoxication via the transdermal route have been reported. We present a 47-year-old woman with acute transdermal methanol intoxication admitted to the emergency department with weakness, blurred vision, bilateral areactive mydriasis, and deterioration of consciousness.
Journal of Clinical Neuroscience 08/2009; 16(11):1504-6. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although bee stings can cause local reactions, neurovascular complications are rare. A 60-year-old man developed a focal neurologic deficit 2 hours after multiple bee stings, which was confirmed to be acute cerebral infarctions on magnetic resonance imaging scan.
The Neurologist 02/2009; 15(1):42-3. · 1.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: With the advent of improved neuroradiological methods, it has been determined that frequency of traumatic carotid artery dissections is higher than previously observed. Since delayed neurological deficits may develop in some asymptomatic undiagnosed cases, it is essential to consider the possibility of the carotid artery dissection and evaluate it properly in suspicious cases. In this article, a case of internal carotid artery dissection and subsequent cerebral infarction following a motor vehicle accident is presented. Pathogenesis, clinical features, diagnostic method choices and treatments in this rare but severe condition are discussed in light of the relevant literature in order to convey current knowledge.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES 11/2008; 14(4):333-7. · 0.33 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Brucellosis is a zoonosis that is transmissible to humans. It is a disease with multi-systemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningo-encephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningo-vascular syndromes, are rarely encountered. We present a patient presenting with acute onset myositis. This kind of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neuro-brucellosis should be considered in patients presenting with muscle weakness.
Internal Medicine 02/2008; 47(23):2091-3. · 0.94 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant nerve disease usually caused by 1,5 Mb deletion on chromosome 17p11.2.2-p12, the region where the PMP-22 gene is located. The patients with HNPP usually have relapsing and remitting entrapment neuropathies due to compression. We present a 14-year-old male who had acute onset, right-sided ulnar nerve entrapment at the elbow. He had electrophysiological findings of bilateral ulnar nerve entrapments (more severe at the right side) at the elbow and bilateral median nerve entrapment at the wrist. Genetic tests of the patient demonstrated deletions in the 17p11.2 region. The patient underwent decompressive surgery for ulnar nerve entrapment at the elbow and completely recovered two months after the event. Although HNPP is extremely rare, it should be taken into consideration in young adults with entrapment neuropathies.
Turkish neurosurgery 02/2008; 18(1):82-4. · 0.62 Impact Factor
-
Journal of Neurosurgery 01/2008; 107(6):1276-7; author reply 1277-8. · 2.96 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Primary brain hemorrhage and infarction only very rarely occur simultaneously. We report a patient with the simultaneous onset of hemorrhagic and ischemic strokes who had uncontrolled hypertension and atrial fibrillation. Neuroradiologic investigations revealed a large right thalamic hematoma with ventricular extension and an infarct in the territory of the left internal carotid artery. The patient died at the end of the second day because of herniation in spite of anti-edema and antihypertensive medication.
The Neurologist 06/2007; 13(3):148-9. · 1.26 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In patients with large artery disease, determining the cerebral hemodynamic state and following its alterations may be a good marker for predicting long-term outcome. The aim of our study was to compare the changes in vasomotor reactivity (VMR) of patients with symptomatic intracranial and extracranial artery stenosis. We also examined whether VMR after stroke influences the long-term prognosis for these patients.
Forty-one patients were included in the study. To determine the cerebral hemodynamic state, transcranial Doppler ultrasound examinations and acetazolamide tests were performed after acute stroke and repeated after 6 months. We compared the VMR on admission and at 6 months, together with changes in VMR, of the patients with symptomatic intracranial and extracranial artery stenosis. By calculating the Barthel index at 6 months, we examined whether VMR had an effect on an improvement in their quality of life.
We observed a significantly higher initial VMR of the ipsilateral hemisphere in patients with intracranial stenosis (22.4 +/- 9.1 versus 13.4 +/- 12.8; P = .013). At 6 months, the VMR obtained from the ipsilateral hemisphere was better in patients with extracranial stenosis than in the patients with intracranial stenosis (P = .01). The ipsilateral VMR measured on admission showed a positive correlation with the Barthel index at 6 months (P = .007; r = 0.434).
Our study showed that VMR in patients with acute stroke who have extracranial and intracranial artery stenosis measured by using a transcranial Doppler examination may have value in predicting long-term outcome.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 03/2007; 26(2):179-85. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Cerebral venous thrombosis (CVT) is rare and has a wide spectrum of symptoms, therefore it is difficult to diagnose. Thrombosis of the deep cerebral veins occurs very rarely: it has been reported that approximately 6% of patients with CVT have deep CVT, and the prognosis for patients with this condition is poor. CVT has been reported in association with dehydration, a hypercoagulable state, mastoiditis, tumour invasion of a venous sinus, use of oral contraceptives, pregnancy, puerperium, head trauma, vasculitis, and intracranial and systemic infections. However, in the literature, there are few reported cases of CVT in association with iron deficiency anaemia, especially in adults. We present here two patients with bilateral thalamic and basal ganglionic lesions due to thrombosis of the deep cerebral veins. Both of our patients had severe hypochromic microcytic anaemia due to iron deficiency, and both had a good prognosis after 2 months.
Journal of Clinical Neuroscience 03/2007; 14(2):181-4. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Diabetes mellitus is an independent risk factor for poor prognosis in patients with ischemic stroke. It is known that diabetes mellitus directly affects cerebral vasculature as a secondary, long-term complication of cerebral circulation, and causes cerebral blood flow abnormalities. The abnormalities of cerebral autoregulation also poorly affects the prognosis of ischemic stroke. In this study, we aimed to show the cerebral autoregulation with transcranial Doppler (TCD) ultrasound in diabetic patients with autonomic nervous system abnormalities, determined with electrophysiological studies.
Twenty healthy controls and 39 patients, who had at least 2 years of diabetes mellitus, were evaluated (age ranges: 42-75 years). The patients were divided into two groups according to sympathetic skin response and R--R interval variation studies: (1) patients with autonomic neuropathy; (2) patients without autonomic neuropathy. Blood flow velocities were measured during supine position and after the patients were raised upright position on head up tilt table. Arterial blood pressures and heart rates were also evaluated.
Mean blood flow velocities of diabetic patients with autonomic neuropathy were found more decreased at 90s after the patients were raised upright position.
Autonomic neuropathy due to diabetes mellitus affects cerebral autoregulation, and by this way cerebral perfusion loses protection against hemodynamical changes.
Clinical Neurology and Neurosurgery 02/2007; 109(1):1-6. · 1.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Myoclonic tremor due to cortical lesions is a rare condition and must be distinguished from other causes of tremor. This is because the treatment strategies of tremor may differ due to the various etiologies. We present here two cases with myoclonic tremor caused by parietal cortical lesions showing tremulous finger movement provoked by action and posture. Clinical and electrophysiological features of the patients were reported and compared with the features of the patients with cortical tremor in association with cortical reflex myoclonus. Both of our patients responded well to anticonvulsants such as valproate and clonazepam. In patients with acute postural tremor, cortical lesions such as mass occupying lesions, ischemic lesions and arteriovenous malformations should be taken into consideration.
European Neurology 02/2007; 57(1):36-8. · 1.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Ischaemic stroke due to intracranial atherosclerosis is estimated to comprise 8-12% of all ischaemic strokes. It is known that the risk of recurrence is extremely high in patients with ischaemic stroke caused by intracranial stenosis. In the present study we aimed to evaluate the clinical and radiological findings over a 6-month follow-up period in patients with intracranial atherosclerosis. Prospective data for the ischaemic stroke patients admitted to our clinic between 2001 and 2004 were collected. The localization of stenosis/occlusion detected by magnetic resonance angiography (MRA) was recorded and patients were divided into two groups according to the presence of one or more arterial stenoses on MRA. The patients were followed up for 6 months at regular intervals and stroke recurrence and deaths were noted. Of the 47 patients, 11 had posterior circulation stenosis and 36 had anterior circulation stenosis. Thirty-three patients had only one intracranial artery stenosis, whereas 14 had more than one intracranial artery stenosis. Of the 38 patients who completed the 6-month follow-up period, 13 had recurrent stroke, and 10 died. The rate of stroke recurrence in patients with intracranial artery stenosis may be higher than in patients with stroke due to other aetiologies, and stenosis of multiple intracranial arteries increases the rate of recurrence.
Journal of Clinical Neuroscience 12/2006; 13(9):913-6. · 1.25 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Peripheral neuropathy is frequently observed in B(12) deficiency. In spite of this, there is little knowledge about peripheral neuropathy in B(12) deficiency because the severity of clinical involvement of the central nervous system clearly outweighs signs and symptoms due to peripheral nervous system involvement. We primarily investigated peripheral neuropathy with dorsal sural conduction study, which is a new method for detection of early peripheral neuropathy, in B(12) deficiency with megaloblastic anemia. Conventional nerve conduction studies and tibial sensory-evoked potential (SEP) recording were also performed. Twenty-eight B(12)-deficient patients (15 male, 13 female, mean age 65.8 years) with megaloblastic anemia and 18 age- and sex-matched controls were included in the study. Although dorsal sural sensory nerve action potentials (SNAPs) were not recorded in 15 (54%) of 28 patients, only 9 (32%) of them were found to have polyneuropathy by conventional conduction studies. Furthermore, patients with dorsal sural SNAP had mean lower amplitude, mean longer latency, and slower velocity response when compared with controls. Twenty patients (71%) were diagnosed as having myelopathy by the combination of tibial SEP and neurological findings. Two patients whose dorsal sural SNAPs were not recorded had normal tibial SEP responses; therefore, these patients were considered to have isolated peripheral neuropathy. As a result, we conclude that dorsal sural nerve conduction study is a reliable method for detection of early peripheral neuropathy in B(12) deficiency.
Journal of the Peripheral Nervous System 10/2006; 11(3):247-52. · 2.80 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This article evaluates diagnostic sensitivity of minimal F-wave latency, sural/radial amplitude ratio (SRAR), dorsal sural/radial amplitude ratio (DSRAR), sympathetic skin response (SSR), and R-R interval variability (RRIV) for detecting early polyneuropathy in patients with glucose intolerance and diabetic patients. F-wave latencies were more prolonged in diabetic patients with normal and abnormal nerve conduction studies than control subjects (p < .001). SRAR was lower, SSR latency was more prolonged, and RRIV was lower in diabetic patients with abnormal nerve conduction studies than healty controls (p < .001). SSR latency was more prolonged and RRIV was lower in diabetic patients with normal nerve conduction studies than healty controls (p < .01, p < .05, respectively). DSRAR was lower in diabetic patients with normal and abnormal nerve conduction studies than control subjects (p < .001). DSRAR was also lower in patients with glucose intolerance than control subjects (p < .01). DSRAR was the most sensitive and specific test in either of diabetic patients with normal nerve conduction studies (sensitivity 66%, specificity 90%) and diabetic patients with abnormal nerve conduction studies (sensitivity 100%, specificity 90%). DSRAR is the most reliable method for detection of early nerve pathology. Patients with glucose intolerance might have subclinical neuropathy that can be demonstrated with DSRAR analysis.
International Journal of Neuroscience 06/2006; 116(6):745-59. · 0.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although mental changes and cognitive disorders are seen frequently in myotonic dystrophy (MD) there are only three cases of MD associated with parkinsonism reported in the literature. We report another case of this extremely rare combination.
Journal of Clinical Neuroscience 03/2006; 13(2):275-6. · 1.25 Impact Factor
