A. Cetiz

Validity and Reliability of the Turkish Version of the Questionnaire for the Assessment of Dysphagia in Multiple Sclerosis

Introduction The aim of this study was to investigate the validity and reliability of the Turkish version of the Questionnaire for the Assessment of DYsphagia in MUltiple Sclerosis (DYMUS) that has been developed for evaluating dysphagia in patients with multiple sclerosis. Methods This methodological study was conducted in the neurology clinic and outpatient department of a training hospital between March 15 and September 15, 2015. The study included 117 patients aged 18 years and over who had a definite diagnosis of multiple sclerosis, could communicate in Turkish, and volunteered to be included. Data were collected using a descriptive information form, the DYMUS, and the Eating Assessment Tool (EAT-10). The scale was translated and back translated to determine the language validity, and a specialist was consulted to make sure the content was valid. We used the EAT-10 and Kurtzkes Expanded Disability Status Scale (EDSS) concurrently to test the criterion-related validity. The test-retest procedure was used at 1-week intervals for 37 patients in this study. Descriptive statistics, factor analysis, Kappa analysis, reliability analysis, and correlation analysis were used to analyze the data. Results Factor analysis revealed that the scale was bifactorial, and this was consistent with its original form. There were positive and statistically significant relationships between the DYMUS and EAT-10 (r=0.90, p<0.001) and the mean EDSS scores (r=0.49, p<0.001). The internal consistency of the total scale was high (Cronbachs alpha coefficient= 0.91). The Cronbachs alpha coefficients pertaining to dysphagia for solids and liquids were determined to be 0.88 and 0.83, respectively. The total scale and subscales demonstrated a high test-retest reliability (r=0.79-0.95, p<0.001). Conclusion In this study, the Turkish version of the DYMUS was found to be a valid and reliable tool for evaluating dysphagia in patients with multiple sclerosis.

Decreased cerebral vasomotor reactivity in patients with obstructive sleep apnea syndrome

OBJECTIVE In obstructive sleep apnea syndrome (OSAS), any of the activated neural, vascular, hemodynamic, metabolic, inflammatory, and thrombotic mechanisms may be related to increased cerebrovascular disease and risk of death; however, the possible pathophysiological process between obstructive sleep apnea syndrome and stroke has not been clearly explained. We hypothesize that alterations in vasomotor reactivity in patients may be responsible for their altered cerebral blood flow, and may contribute to the increased risk of ischemic stroke. METHODS A total of 30 untreated patients with severe obstructive sleep apnea and 26 control subjects were included in the study. The mean blood flow velocity and breath holding index were measured in middle cerebral artery bilaterally in both patient and control groups by using transcranial Doppler ultrasound. We compared the values between two groups. RESULTS The mean blood flow velocity and breath holding indexes were significantly decreased in the patient group when compared with the control group. There were no correlations between cerebral hemodynamic parameters and polysomnographic findings in patients. CONCLUSION Our findings suggest that there was a deteriorated vasodilator response to hypercapnia in patients with OSAS. This deterioration may stem from chemoreceptors or endothelial damages that lead to vascular relaxation and vasodilatation in cerebrovascular circulation. This impaired cerebral vascular regulation may contribute to the increased risk of stroke in patients with OSAS.

Post-surgical focal inflammatory neuropathy of the sciatic nerve

Post-operative neuropathies are frequently encountered, usually related to factors such as compression, injection, and lying position during operation. Post-operative neuropathies are not always due to mechanical causes, they can be caused by inflammatory mechanisms and present with pain and weakness in focal, multifocal and diffuse patterns [1–4]. These inflammatory neuropathies are observed temporally and spatially distant from the time and site of surgery. This case report discusses the neurophysiological and magnetic resonance imaging (MRI) findings of a patient with left foot drop 2 days after ear surgery. A 9-year-old female patient was admitted to our hospital with weakness of the left foot. Her complaints began the day after ear surgery (ventilation tube removal). The surgery had lasted 30 min. Propofol anesthesia was given during surgery. There was no complication during the wake-up phase, no injection into the gluteal region, no position nerve compression. The patient applied to our outpatient clinic the day after the operation. Her neurological examination revealed reduced dorsiflexion of the left foot (1/5 according to the Medical Research Council scale), sensory examination was normal, plantar flexion and other muscle strength examinations were within normal limits and there were no pathological reflexes. Whole blood test, routine biochemistry, sedimentation rate, C-reactive protein (CRP) was within normal limits. Segmental motor and sensory conduction studies of the left peroneal nerve were normal. Peroneal F response on the left could not be obtained (Table 1). No activity was observed in tibialis anterior muscle on needle EMG. MEP (motor evoked potentials) examination, of both tibialis anterior muscles showed similar response with thigh stimuli, while low latency potential was obtained from the left with lumbar root and cortical stimulation (Fig. 1). According to these findings magnetic resonance imaging (MRI) of the gluteal region was performed. It showed the left sciatic nerve begins to increase in thickness from the beginning to the middle of the thigh with increased T2 signal in fatsuppressed sequence (Fig. 2a, b). No external pressure or focal mass was detected. The imaging findings were consistent with an idiopathic inflammatory neuropathy. High dose methylprednisolone therapy (1000 mg/day) was given to the patient for 5 days. One month after the methylprednisolone therapy the patient showed full improvement. Post-operative inflammatory neuropathy is not often seen, but it can be reversible with appropriate

ID 408 – Meralgia paresthetica after the fragmentation of a renal stone using ESWL metod: A case report

Meralgia paresthetica (MP) is the painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN). LFCN originates from the root of the second and third lumbar nerves and innervates the skin on the anterolateral part of the thigh. MP is presented with burning, pain, numbness, tingling on this part of the thigh. Many different reasons are reported in the etiology. The most common reasons are positional mechanical compression, anterior hip surgery, thigh injury, disc herniation and the use of tight corset or tight belt. We reported a case about MP which occurred with a previously undefined reason in the literature. A 35 -year old- male patient presented with burning and pain on the anterolateral part of the right thigh after the fragmentation of a right renal stone using extracorporeal shock wave lithotripsy. The cortical somatosensory evoked potential (SEP) obtained by innervating of LFCN was longer in the right side than the left side. Lumbar MRI and abdominal computed tomography examination were normal. MP was diagnosed as a result of the clinical findings and the examination of the SEP. Drug was not given to patient due to the absence of severe pain. Symptoms were completely healed after 2 month. SEP was normal bilaterally.

Alien hand syndrome in a patient with corpus callosum ischemia associated with MTHFR mutation

diffusion MRI was undergone and acute lacuner infarct near the anterior horn of the right lateral ventricles was detected. The laboratory and cardiac tests were normal. So acetylsalicylicacid was given. Conclusion: Lacunar infarcts tend to cause restricted neurological signs due to their small sizes. Fisher CM stated that monoparesis does not ocur secondary to a lacunar infarct ,but some cases have been described despite the lack of clinical details or pathological confirmation. Clinicians should consider lacunar infarcts in patients presentingwithmonoparesis, so larger infarcts can be prevented.

Thyroid function abnormalities and cognitive decline

Dear Sir, We have read Granic et al.’s [1] study with great interest. In this study, they aimed to show a relationship between cognitive performance in the very old (85+) and 25-hydroxyvitamin D (25(OH) D). They reported that low and high season-specific 25(OH)D levels were associated with prevalent cognitive impairment and poorer overall performance in attention-specific tasks in the very old (85+). When we inspected the article, in the model of the study, sociodemographic factors (sex, education, income), health and morbidity [individual chronic diseases: cardiovascular diseases (includes hypertension, cardiac disease and peripheral vascular disease), cerebrovascular diseases, diabetes, osteoporosis, or total number of chronic diseases, renal impairment, depression, waist hip ratio, serum vitamin B12 and folate] and lifestyle factors (smoking, alcohol and physical activity) were considered for inclusion. Unfortunately, thyroid hormones were not considered for inclusion. Studies about thyroid function abnormalities showed that subclinical hyperthyroidism (a clinical condition with reduced serum thyroid stimulating hormone levels while free thyroxine and tri-iodothyronine levels stay within the reference ranges) was associated with lower cognitive performance [2–4]. Also, single photon emission computed tomography or magnetic resonance spectroscopy studies have shown similar abnormal findings in cognitively impaired patients with hyperthyroidism and in Alzheimer’s disease (AD) [5,6]. Thyroid hormones could also modulate the contents of b-amyloid precursor protein isoforms, which are important pathological processes for AD [7]. A few questions arise about the inclusion criteria for Granic et al.’s study. Did the authors evaluate thyroid functions in the study group? If yes, in our opinion this issue should be declared by the authors. If not, readers should keep in mind that thyroid function abnormalities might have an effect on cognitive impairment.

Horizontal gaze palsy due to an infarction of the frontal eye field

A 76-year-old man was admitted to the emergency department with a left gaze palsy, which started suddenly 6 h before admission. Prior medical history revealed hypertension for 7 years. The patient was a heavy smoker for 50 years. His neurological examination showed a horizontal gaze palsy to the left side (Fig. 1). Oculo-vestibular reflexes were normal. A cranial magnetic resonance imaging (MRI) showed an acute infarction of the right frontal eye field (FEF) (Fig. 2), as described in the literature [1, 2]. Electrocardiography and echocardiography were normal. Carotid artery Doppler-sonography revealed non-significant calcified plaques on both sides. The patient was treated by 300 mg/day acetylsalicylic acid. After 4 days, his gaze palsy fully recovered.