Aylin Bican Demir

Conditions that Mimic Stroke in Elderly Patients Admitted to the Emergency Department

BACKGROUND Stroke is the most common neurologic cause for patient admission to the emergency department (ED) and the risk of stroke increases with age. This study aimed to determine the clinical and demographical characteristics of stroke-mimicking patients 65 years or older who were admitted to the ED for stroke. METHODS After the retrospective file examination, patients 65 years and older who were admitted to the ED with an established final diagnosis of stroke as a result of history, physical examination, imaging, and required consultations were included in the study. RESULTS After scanning 671 records of patients 65 years or older, 87.3% (n=586) were diagnosed with stroke and 12.7% (n=85) received different diagnoses mimicking stroke. Of these 85 patients, 91.8% (n=78) and 8.2% (n=7) were prediagnosed with ischemic stroke and transient ischemic attack, respectively, by the ED physicians. After complete evaluations and consultations, the patients with stroke were typically diagnosed with vertebrobasilar insufficiency (n=16, 18.8%). Of the patients, 76.5% (n=65) were discharged after treatment and follow-up in the ED, and 21.1% (n=18) were hospitalized. CONCLUSIONS In older patients, stroke-mimicking conditions can cause signs and symptoms indistinguishable from true stroke, representing about 12.7% of elderly patients admitted to an ED with these diagnoses.

Nonconvulsive status epilepticus cases arising in connection with cephalosporins

Cephalosporins, particularly cefepime, exert neurotoxic side effects that can lead to status epilepticus. These neurotoxic side effects include myoclonus, dystonic movements, tremor, asterixis, seizure, status epilepticus, encephalopathy, and sometimes coma. Status epilepticus, particularly nonconvulsive status epilepticus (NCSE), is a well-known but unusual complication in patients with altered renal function who were receiving treatment with intravenous cephalosporins, especially cefepime. We reviewed the clinical and electroencephalographic (EEG) characteristics of 7 patients with renal failure who developed consciousness alterations with changes in EEG activity while being treated with cephalosporins. All patients developed renal failure: six patients had chronic renal failure, one patient had acute renal failure, and two patients were administered hemodialysis. Nonconvulsive status epilepticus was observed between 2 and 8 days (average of 5.6 days) after initiation of cephalosporins. Cephalosporins are epileptogenic drugs, especially when used in excessive doses or when renal function is impaired. Critically ill patients with chronic kidney disease are particularly susceptible to cefepime neurotoxicity. Clinical and electrophysiological results of patients guide the diagnosis of NCSE by healthcare providers.

Statistical shape analysis of temporal lobe in mesial temporal sclerosis patients

BackgroundSurgery is regarded as a common treatment option for patients with mesial temporal lobe epilepsy due to hippocampal sclerosis but sometimes deciding this diagnosis can be very difficult. We aim to investigate the shape differences in the temporal lobe of mesial temporal sclerosis epilepsy patients compared with healthy controls, investigating the side difference and, if present, assessing the clinical application of this situation.MethodThe MRI scans of mesial TLE patients and controls were retrospectively reviewed. Temporal lobe data were collected from the two-dimensional digital images. Standard anthropometric landmarks were selected and marked on each digital image using TPSDIG 2.04 software. Eight anatomic landmarks were marked on images. A generalized Procrustes analysis was used to evaluate the shape difference. The shape deformation of the temporal lobe from control to patient was evaluated using the TPS method.ResultsThere were statistically significant TL shape differences between groups. High level deformations for the left and right side from the control to patient group were seen in the TPS graphic. The highest deformation was determined at the inferior lateral temporal midpoint of the middle temporal gyri and superior temporal landmark points of both the right and left sides.ConclusionOur study for the first time demonstrated temporal shape differences in TLE patients using a landmark-based geometrical morphometric method by taking into consideration the topographic distribution of TL.

Togetherness of REM Behavior Disorder and Fahr Disease: A Case Report

Togetherness of REM Behavior Disorder and Fahr Disease: A Case Report REM Behavior Disorder (RBD) is seen in elderly population mostly. Its prevalence is unknown but the disease was reported in 0.38% of overall population and in 0.50% of elderly population. One third of newly diagnosed Parkinson’s patients, 47% of overall Parkinson’s patients and 90% of multiple system atrophy patients diagnosed as RBD. RBD is a chronic, progressive sleep disorder and its frequency or severity changes over time. Fahr disease (FD) most common clinical signs are Parkinsonism, dystonia, tremor, chore, ataxia, dementia and affective disorders. Etiopathogenesis of RBD and FD are still unknown. Our patient presented with FD with the calcification in basal ganglions before Parkinson’s disease manifested. We aimed to underline the importance of FD in the differential diagnosis of RBD and RBD must be considered and kept in mind during the clinical course of FD.

Ictal kissing: Electroclinical features of an unusual ictal phenomenon ☆

PURPOSE The study aimed to describe the electroclinical features of ictal kissing, an unusual behavior that may occur during focal seizures. METHOD Twenty-five patients collected from four epilepsy centers and previously published reports were reviewed for their demographic, clinical, and electrophysiological features. RESULTS Sixteen of 25 patients were female. The mean age was 32.9 years (9.9-51 years) and the average age at seizure onset was 14.5 years. All seizures were localized to the temporal lobe (TL) and lateralized to right side in 17 patients, left side in 2 patients, and unclear in 6 patients. A total of 55 ictal video electroencephalograms (EEGs) were analyzed. There were other symptoms such as speaking, spitting, hugging, and oral and upper-extremity automatisms along with different types of ictal kissing behavior during the seizures. The median duration of all seizures was 106.7±73.73s. Kissing occurred at a median time of 71s (1-95s) after the onset of seizure, and ictal epileptiform discharges usually involved TL during kissing episode. CONCLUSION Ictal kissing is mainly associated with right TL and female gender, although association with left TL may also occurs, possibly related to the circuits involving temporo-insular structures.

Paroxysmal Amnesia Attacks due to Hashimoto’s Encephalopathy

Hashimotos encephalopathy is a rare disease which is thought to be autoimmune and steroid responsive. The syndrome is characterized by cognitive impairment, encephalopathy, psychiatric symptoms, and seizures associated with increased level of anti-thyroid antibodies. The exact pathophysiology underlying cerebral involvement is still lesser known. Although symptoms suggest a nonlesional encephalopathy in most of the cases, sometimes the clinical appearance can be subtle and may not respond to immunosuppressants or immunomodulatory agents. Here we report a case who presented with drowsiness and amnestic complaints associated with paroxysmal electroencephalography (EEG) abnormalities which could be treated only with an antiepileptic drug.

The Role of Obstructive Sleep Apnea Syndrome as a Cause of Stroke

Uyku apne sendromu yüksek prevalansa sahip, sıklıkla gözden kaçan, obstrüktif, santral ve mikst Uyku apne sendromu olarak alt başlıklarda değerlendirilen bir uyku bozukluğudur. Solunumla ilişkili uyku bozuklukları arasında en sık saptanan Obstrüktif uyku apne sendromudur (OUAS) ve en önemli bulguları; horlama, tanıklı apne varlığı ve gün içi uykululuk halidir. İnme ise dünyada ölümlerin 2., özürlülüklerin 3. en sık nedenidir. İnmenin başlıca risk faktörleri hipertansiyon, sigara, obezite, diyabet ve kardiyak aritmiler olarak değerlendirilebilir. OUAS ve inme birlikte bulunabilen iki ayrı hastalıktır. İkisinin ortak risk faktörleri olduğu gibi özellikle arteryel kökenli inme olgularında OUAS’ın kendisinin başlı başına bağımsız bir risk oluşturduğu bilinmektedir. Bununla birlikte venöz sistem kökenli inme veya serebrovasküler olgularında da risk oluşturabileceğine dair yayınlar vardır (1). Olgu Sunumları

The Associations Between Epileptic Seizures, EEG and Radiologic Findings With Prognosis in Patients With Meningioma

Objectives: Meningiomas are majorly benign tumours which are most commonly occured in middle-advanced ages with predominance of women and extra-axial localization. In the literature;it was reported that 19-63% of the patients with meningioma are suffered from epilepsy in the pre-operative period, 35% of them experience the epileptic seizures as the initial symptom. Methods: A total of51 patients with a diagnosis of intracranial meningioma were retrospectively evaluated. Results: A total of 51 patients with a diagnosis of intracranial meningioma were retrospectively evaluated. 39 of the 51 patients were operated, whereas 12 patients were not. 3 of the not-operated patients had partial seizure. 7 (28%) of the 25 patients with both operation and seizure (25/39) were manageable without seizure with monotherapy; while 4 (16%) patients had a 50% reduction in frequency of seizure with monotherapy. 38 (76.9%) of our patients had EEG pathology in pre-operative period. Conclusion: In our study EEG pathology was detected 76.9% of the patients with predominance of meningiomas with convexity localization. In previous studies,it was shown that 40% of the patients had findings consistent with an intracranial lesion in EEG and the EEG abnormality was lateralized towards the lesion side. In conclusion, we aimed to evaluate whether EEG is an accessible, feasible, method for localization and/or lateralization of the lesion and to discuss its importance along neuroimaging techniques in patients with meningioma.

A case of mycosis fungoides-like lesions developing after levetiracetam therapy

Levetiracetam is a relatively new antiepileptic drug that has previously not been associated with severe dermatological side effects. We report the case of a 31-year-old male treated with levetiracetam for seizures who subsequently developed a mycosis fungoides-like drug reaction that resolved upon dosage reduction.