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Stroke 03/2013; 44(3):e18. · 5.73 Impact Factor
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Stroke 03/2013; 44(3):e17. · 5.73 Impact Factor
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Sleep Medicine 12/2012; · 3.40 Impact Factor
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Clinical neurology and neurosurgery 11/2012; · 1.30 Impact Factor
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ABSTRACT: The pathophysiology of periodic leg movements in sleep (PLMS) is complex, and still lacks a consensus. Consecutive 35 patients with the diagnosis of acute supratentorial ischemic stroke and 35 age- and sex-matched control subjects were prospectively investigated. Clinical and sociodemographic evaluation and a whole-night polysomnographic recording were performed. In patients with supratentorial ischemic stroke, 27 patients (77.2%) had PLMS-index more than 5/h, and 19 out of 35 patients (54.3%) had PLMS-index more than 15/h; while only 10 participants (28.5%) in control group had PLMS-index more than 5/h, and 6 participants (17.1%) had PLMS-index more than 15/h (p < 0.05). None of the demographic variables showed statistically significant relationship with PLMS, such as gender (p = 0.952) and age (p = 0.435). Territorial localization of ischemic lesions showed no relation with the presence of PLMS (p = 0.867), PLMS-index (p = 0.432), or restless legs syndrome (p = 0.833). All patients demonstrated PLMS contralateral to ischemic lesion except eight patients with bilateral PLMS; these were also more prominent contralaterally. Our study supports the hypothesis that destructive lesions causing the loss of cortical or subcortical inhibition exerting on the reticular formation on spinal pathways could lead to the development of PLMS.
Acta neurologica Belgica 03/2012; 112(1):27-32. · 0.54 Impact Factor
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ABSTRACT: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for ischemic cerebrovascular diseases, and results in worse prognosis and higher mortality. We aimed to investigate the effects of early treatment of OSAS on the prognosis of ischemic stroke. We prospectively evaluated patients with acute supratentorial ischemic stroke and OSAS on admission (acute stage), at second week (subacute stage) and at second month (chronic stage); 11 (73.3%) out of 15 patients put on the non-invasive mechanical ventilation treatment within 48 h of stroke constituted the treatment group, and 13 patients constituted the control group. Patients with OSAS treatment showed significantly better prognosis and better functioning in activities of daily living in both subacute and chronic stages. The rate of shrinkage of the ischemic lesion was higher in the treatment group, though not significant. The early and effective treatment of OSAS provides a better clinical prognosis in ischemic stroke. The beneficial effects on radiological parameters need to be further studied.
Neurological Sciences 11/2011; 33(4):811-8. · 1.32 Impact Factor
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ABSTRACT: The beneficial effects of antihypertensive drugs in secondary stroke prevention could not be based on their effects on lowering hypertension only.In this prospective study, the status of blood pressure, treatment regimens, new atherothrombotic event, blood sampling for hs-CRP and fibrinogen were asked at initial visit, 6th, and 12th months in 226 patients with atherothrombotic stroke.Eighty-seven percent of patients had an antihypertensive regimen, but hypertension control was achieved in 34.1% of patients.Neither use of six different antihypertensive drug regimens nor the change in blood pressure levels showed any difference on new atherothrombotic events, outcomes or survival rates.On the other hand, the higher levels of hs-CRP at baseline were found to be associated with higher mortality rates (p=0.020).Our findings emphasize the predictive role of inflammation in future cardiovascular mortality in patients with acute ischemic stroke, indicating that inflammatory mediators underlying the atherothrombotic process play a more important role than it is assumed.
Inflammation 01/2011; 35(1):65-73. · 1.75 Impact Factor
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ABSTRACT: Although seizures are rarely encountered in Wilson's disease (WD), seizures related to hypocupremia have not been reported before. We report a patient presenting with partial status epilepticus who was on strict low-copper diet and chelating therapy for WD. Despite other rare causes of seizures in WD including penicillamine-induced pyridoxine deficiency, cerebral copper deposition and metabolic encephalopathy, the most probable cause of resistant status epilepticus in this patient was found as hypocupremia from overzealous treatment. This case exemplifies that hypocupremic states should be kept in mind as a risk factor for resistant seizures.
Seizure 11/2010; 19(9):602-4. · 1.80 Impact Factor
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ABSTRACT: Unilateral cerebellar hypoplasia (UCH) is a rare pathological condition characterized by the loss of volume in cerebellar hemispheres ranging from mild asymptomatic to severe symptomatic cases. As the designation of UCH remains problematic, the underlying etiopathogenesis also lacks explanation. We investigated the patients admitted to Departments of Child Neurology, Neurology, and Genetics between the years 1992 and 2010 and detected 12 patients with unilateral cerebellar volume loss, with the exclusion of all other cerebellar pathologies. The ages of patients ranged between 6 months to 55 years. Five patients had a delay in developmental milestones, and one of these was diagnosed with neurofibromatosis type 1. Two patients had epileptic seizures, one patient had peripheral facial paralysis as a component of Moebius syndrome, and four patients were incidentally diagnosed during etiological work-up for headache. The clinical outcomes of patients varied from healthy subjects to marked developmental impairment. Radiologically, five patients had severe disproportionate UCH, six had moderate disproportionate, and one had mild proportionate UCH. Cerebellar peduncles were affected in all, and vermis was partly hypoplastic in eight patients. Brainstem was involved in four patients, and seven patients showed involvement of white matter and/or corpus callosum. Imaging features supported that patients with severe disproportionate UCH also displayed additional cerebral and commissural changes, which were related to ischemic or vascular injuries, implying a prenatally acquired disruption. In the presence of such a wide spectrum of clinical and radiological features, a prenatally acquired lesion and, thus, a disruption seem to be more explanatory rather than a primary developmental process or malformation in the etiopathogenesis of unilateral cerebellar hypoplasia.
The Cerebellum 10/2010; 10(1):49-60. · 3.21 Impact Factor
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ABSTRACT: We aimed to investigate auditory-evoked masseter inhibitory reflex and discuss possible auditory-trigeminal pathways in brainstem. Our study population consisted of 21 healthy volunteers (age-matched 7 males and 14 females). Bilateral electrical blink reflex (BR), auditory blink reflexes (ABR) and electrical MIR (MIR) were studied. After obtaining normal potentials, auditory MIR (AMIR) was studied. Electrical blink reflexes had two components as R1 and R2, and ABR had one evoked potential in all volunteers. There was no significant difference between gender, nor between right- and left-sided BR and ABR. The mean latency of ABR responses were shorter than latencies of R2 phase of BR (p=0.013 for left-sided responses, p=0.035 for right-sided responses). Electrical stimulation revealed two suppression periods (SP1 and SP2) in MIR responses bilaterally in all volunteers. Auditory stimulation evoked typical two suppression periods only in 11 subjects (5 males, 6 females). The mean latency of SP1 component of AMIR was significantly longer than those of MIR bilaterally in both males and females, while the SP2 component had a shorter onset. The durations of SP1, SP2 and total SP were always shorter than those obtained in MIR with smaller degree of suppressions. None of the MIR or AMIR responses showed significance difference between sexes. We assume that auditory-evoked MIR might share the similar interneurons as with other electrical or nociceptive stimulation, which connects cochlear-trigeminal neurons via pontine reticular system to premotor area for masseter muscle.
Neuroscience Letters 03/2010; 475(1):12-5. · 2.11 Impact Factor
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ABSTRACT: Panayiotopoulos syndrome is a common benign epilepsy affecting otherwise healthy children that present with autonomic seizures, in which nausea, retching, and vomiting are particularly common and prominent. Because of the unusual ictal symptoms and lengthy manifestations, misdiagnosis is a common major problem. We describe a young girl with intractable and lengthy vomiting attacks, several admissions to hospitals, and extensive gastroenterological workup for several years from early childhood. On all previous occasions the diagnosis varied from psychosomatic disease, to functional dyspepsia, to cyclic vomiting syndrome. The possibility of autonomic epileptic seizures and Panayiotopoulos syndrome, though likely, was not considered.
Epilepsy & Behavior 03/2009; 14(4):703-4. · 2.34 Impact Factor
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ABSTRACT: Osteopontin (OPN) was suggested to have a role in the pathophysiology of MS and in bone metabolism. However, we formerly reported increased presence of osteoporosis in MS patients independent of corticosteroid treatment, there is only limited information about the mechanism of bone loss. In this study, we investigated the role of OPN on bone mineral density in MS patients. Thirty-three relapsing-remitting (RR), 12 secondary progressive (SP), and 5 primary progressive (PP) MS patients and 30 healthy controls were prospectively enrolled. Students' t test, chi-square test, and Pearson correlations were used. The mean OPN level was 155.4+/-81.8 ng/ml in controls, and 15.9+/-36.2 ng/ml in MS patients (p<0.001).No statistical difference was observed among RR, SP and PPMS patients (p=0.162). No relationship was found between OPN levels and age at onset of disease (p=0.830), gender (p=0.785), MS subtypes (p=0.330), disease duration (p=0.744), or EDSS scores (p=0.633).About 34% of MS patients versus 10.3% of controls had osteoporosis (p=0.017).Osteopontin levels showed no significant correlation with osteoporosis in controls, but were lower in MS patients with osteoporosis in femur neck (r=0.85, p=0.010).The cumulative dose of corticosteroid treatment did not correlate with OPN levels (p=0.285).In conclusion, our results suggest that OPN may have a role as a shared cytokine in pathogenesis of MS and osteoporosis.
Journal of the Neurological Sciences 10/2008; 276(1-2):41-4. · 2.35 Impact Factor
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ABSTRACT: Catatonic state has been related to variable medical, neurological, and psychiatric disorders. Although it is commonly associated with schizophrenia, epilepsy presenting as catatonialike seizures or ictal catatonia was rarely reported. Moreover, the coexistence of schizophrenia and epilepsy in a patient complicates the diagnosis and management. Here we report a case of postictal catatonia in a patient with schizophrenia who was successfully treated by electroconvulsive treatment, and in this context, we aimed to review the therapeutic effect of electroconvulsive treatment in postictal catatonia.
Journal of Ect 07/2008; 24(2):166-7. · 1.54 Impact Factor
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Diabetes research and clinical practice 02/2008; 79(1):e17-8. · 2.16 Impact Factor
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ABSTRACT: About one in five patients with atrial fibrillation have significant carotid artery disease, but not all strokes are cardioembolic in origin in these patients.
We investigated stroke sub-types based mainly on clinical, carotid ultrasonographic, and neuroimaging findings in ischemic stroke patients with non-valvular atrial fibrillation (NVAF).
The etiology of stroke was classified as definite or probable cardioembolic, possible lacunar, or possible atherothrombotic, as proposed by Hart et al. and the TOAST criteria. Clinical features and risk factors (gender, age, diabetes mellitus, hypertension, hyperlipidemia, cigarette smoking, and alcohol consumption) were designated as clinical variables.
One hundred and six of 1938 patients (5.5%) had NVAF. In patients with and without NVAF, hyperlipidemia was more common in patients without NVAF (p<0.001), while the prevalence of other risk factors was not statistically different. On the basis of the TOAST criteria, none of the patients with NVAF could be classified as having had an atherothrombotic stroke. According to the classification by Hart et al., of the patients with NVAF, 49 patients (46.3%) had a definite embolic stroke, 17 (16.0%) had a probable embolic stroke, 12 (11.3%) had a possible atherothrombotic stroke, 17 (16.0%) had a possible lacunar infarction, and 11 (10.4%) had a stroke of undetermined etiology. Besides the presence of significant carotid stenosis (p<0.001), none of the variables related to stroke were different among the sub-groups.
Patients with significant carotid stenosis were more likely to develop atherothrombotic stroke, while other risk factors associated with stroke failed to point to an etiologic cause. It should also be emphasized that the conventional classification system failed to aid in the correct diagnosis and risk stratification in patients with multiple confounding risk factors.
Clinical Neurology and Neurosurgery 08/2007; 109(6):485-90. · 1.58 Impact Factor
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ABSTRACT: Deep-seated cavernoma or cavernous angioma is a very rare clinical entity, as is basal ganglia cavernoma presenting with Parkinsonism. The authors demonstrate a 56-year-old man with a cavernoma located in basal ganglion, who subsequently developed Parkinsonism. The patient refused the surgical intervention, and received L-dopa trial; however, no change in the tremor and bradykinesia was observed in spite of high doses of L-dopa. Our case indicates that chronic compression and continuous hemorrhage could cause Parkinsonism, which is uncommon symptom of cavernous angioma.
Parkinsonism & Related Disorders 01/2006; 11(8):517-9. · 3.80 Impact Factor
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ABSTRACT: Subacute sclerosing panencephalitis is a progressive disorder which also presents with various types of seizures, mainly myoclonic jerks, atonic attacks and tonic-clonic seizures. We report two cases, documented by video-EEG that during the course of the disease also presented with tonic seizures. The differential diagnosis of non-epileptic paroxysmal events might prove to be a problem.
Epileptic disorders: international epilepsy journal with videotape 10/2005; 7(3):221-5. · 1.50 Impact Factor
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ABSTRACT: Increased intima-media thickness (IMT) of the common carotid arteries (CCA) and elevated levels of highly sensitive C-reactive protein (hsCRP) are both shown to be associated with the occurrence of stroke. We investigated whether elevated hsCRP level is a risk factor for the increased IMT of the CCA independent of other proven risk factors for the ischemic stroke and studied the interaction between hsCRP level and the extent of carotid atherosclerosis.
We studied 104 patients aged between 30 to 92 years who were admitted to our neurology department with acute ischemic stroke. All patients underwent a clinical evaluation, laboratory investigations, and neuroultrasonographic examination. In 24 patients with normal ultrasonographic examination, mean hsCRP levels was 8.6 + 6.7 mg/L. Mean hsCRP level was 18.0 + 25.6 mg/L in patients having increased intima to media thickness (> 1.2 mm); 32.7 + 49.1 mg/L in patients who had atheromatous plaques without significant narrowing; and 23.9 + 27.3 mg/L in patients with internal carotid artery stenosis more than 50%. hsCRP levels and the extent of the atherosclerosis showed a significant relationship (p = 0.040). In multiple regression analyses, this relationship was found to be independent of other proven risk factors. The only variable that showed a significant relation with the level of hsCRP was the HDL level. A negative correlation was found between hsCRP and HDL levels.
We conclude that elevated hsCRP level is an indirect risk factor for the ischemic stroke through its relation with the extent of the carotid atherosclerosis, and this relation is independent of other known risk factors.
Acta neurologica Belgica 07/2005; 105(2):73-80. · 0.54 Impact Factor
