Aysun Ünal

Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache

Background: Medication overuse headache (MOH) mostly evolves from migraine and episodic tension‐type headache (ETTH). Chronic tension‐type headache (CTTH) is another headache type that evolves over time from ETTH. It is well known that psychiatric comorbidity is high in MOH patients.

Evaluation of common mutations in the Mediterranean fever gene in Multiple Sclerosis patients: Is it a susceptibility gene?

PURPOSE Multiple Sclerosis (MS) is a disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the white matter of the brain and spinal cord. MEFV gene, which is the main factor in familial Mediterranean fever, is an intracellular regulator of inflammation. This study was designed to determine if known mutations in pyrin domain of MEFV gene are involved in MS and associated with MS morbidity. METHODS Fifty-three patients with MS and 66 healthy subjects, who were all Turkish, were included in this study. Five pyrin gene mutations (E148Q, M680I, M694V, M694I and V726A) were detected in the patients and controls by using the PRONTO FMF Basic Kit according to the manufacturers instructions. RESULTS Pyrin gene mutations were found in 20 of the 53 MS patients (38%) and in seven of the 66 healthy subjects (11%). The frequency of total pyrin domain mutations was significantly higher in the MS patients than in the healthy subjects (p<0.0001). The frequencies of M694V, E148Q and V726A mutations were significantly higher in the patients than in the healthy subjects (p=0.02, p=0.013, p=0.004 respectively). The mean time to reach EDSS score 3.0 was earlier in the patients with MEFV gene mutation (p=0.02) and the relapse rate was slightly higher among the MS patients carrying MEFV gene mutation (p=0.04). CONCLUSION The results of this study supported the hypothesis that MS patients with MEFV mutation seem to have the susceptibility to develop a more progressive disease. Moreover, these data suggest that MEFV mutations may increase the risk of MS development.

Low Income and Education Levels May Cause Medication Overuse and Chronicity in Migraine Patients

Background.—Frequent analgesic drug intake, especially in migraine patients, may induce the risk of medication overuse headache (MOH). The various conditions that may affect the development and the features of MOH have not been determined yet.

Peripheral nervous system involvement in patients with Behçet disease.

Background:Central nervous system involvement in Behçet disease (BD) has been well documented, but studies evaluating peripheral nervous system involvement are relatively uncommon. Objective:The aim of this study is to evaluate the frequency and characteristics of peripheral nervous system involvement in BD. Methods:Sixty-nine BD patients (36 women, 33 men) followed by neurology and dermatology outpatient clinics between October 1999 and October 2004 were enrolled into study. A careful history was taken and physical and neurologic examinations were done. All other medical causes that may be related to peripheral nervous system involvement were studied. All patients underwent nerve conduction studies using standard electrophysiologic procedures. Results:Peripheral nervous system involvement was detected in 13 patients. There was no sign and symptom related to peripheral nervous system involvement in these patients. Causes other than BD were found in 5 patients with polyneuropathy. Asymptomatic delay in conduction velocities of the median nerves was detected in 3 patients. In 5 patients with clinically evident peripheral nerve involvement due to BD, 3 had sensorimotor and 2 had sensory axonal neuropathies. Conclusion:Axonal type polyneuropathy may be seen in BD patients. Peripheral involvement may be detected by electrophysiological examinations in asymptomatic BD patients.

Frontal lobe epilepsy presented as ictal aggression

Aggressive behaviour is rarely observed as an ictal semiology. Ictal aggression can occur in lesions of frontal and limbic structures. In limbic structure lesions, the main mechanism of aggressive behaviour is hyperactivity; whereas frontal lesions may cause aggressive behaviour with an indirect mechanism in which the suppression on limbic system is lost. Here we present a patient with ictal aggression. In this case a right frontoparietal epileptiform focus was detected during the postictal period. Magnetic resonance imaging showed cortical dysplasia on the right inferior frontal gyrus. The seizures disappeared completely after pharmacological treatment.

Sympathetic Skin Response in Migraineurs and Patients With Medication Overuse Headache

Background.—Autonomic dysfunction has been reported in patients with migraine, and it may play a role in promoting attacks.

UNUSUAL COMBINATION OF REVERSIBLE SPLENIAL LESION AND MENINGITIS-RETENTION SYNDROME IN ASEPTIC MENINGOMYELITIS

A circumscribed lesion in the splenium of the corpus callosum (SCC) is a rare finding, and little is known about its etiology.1 Reversible splenial lesions in the CC are observed in various diseases (Table 1).1–33 Table 1 Etiologies of isolated reversible lesions in the splenium of the corpus callosum The combination of aseptic meningitis or meningomyelitis and acute urinary retention has been recently acknowledged and, in the absence of accompanying abnormalities, has been referred to as meningitis-retention syndrome (MRS) by some Japanese authors.34,35 Only a few reports of MRS are available to date.34–38 Although the term meningitis was used, some of the reported cases could in fact have been myelitis in view of the presence of fecal incontinence and brisk reflexes.34 To the best of our knowledge, the combination of neurogenic bladder and reversible splenial lesion due to meningomyelitis or to any other condition has not been reported previously. Here, we report a case of an isolated reversible splenial lesion and a neurogenic bladder in a woman with aseptic meningomyelitis.

Giant unruptured anterior communicating artery aneurysm presenting with seizure

Giant aneurysms of the anterior communicating artery (AComA) are rare. The clinical presentation of giant AComA aneurysms is usually associated with the mass effect of the space-occupying lesion or with subarachnoid haemorrhage. A giant AComA aneurysm presenting with a seizure has only been reported twice previously. We report a 70-year-old female patient, in whom a single seizure was the only symptom of a giant AcomA aneurysm, with no neurological deficit. The diagnosis of unruptured giant AComA aneurysm was made with cranial CT, MRI and angiography. The patient refused surgical intervention, was treated with anti-epileptic therapy and has been asymptomatic for 7 months. We suggest that elderly patients presenting with a first seizure need detailed evaluation and giant aneurysms, which may be confused with other intracranial space-occupying lesions, need to be considered in the differential diagnosis.

The co-incidence of multiple sclerosis in a patient with familial Mediterranean fever

Sir, Familial mediterranean fever (FMF) is an autosomal recessive inherited inflammatory disorder and in this disease central nervous system (CNS) involvement is uncommon. In 1997, three Turkish patients with FMF and multiple sclerosis (MS) were described,[1] this was followed by other reports from Israel and Turkey.[2-4] In this study, we report the fifth patient of FMF and MS. This patient was not on therapy for FMF, especially colchicine at the time of diagnosis this association.

Atypical retroauricular pain: a case report.

Retroauricular pain is rarely seen in clinical practice. We present a 29-year-old man who suffered from an intractable and atypical retroauricular pain. The pain was refractory to medications (anticonvulsant drugs, selective serotonin reuptake inhibitors, and amitriptyline). Therefore, a local anesthetic injection for nerve block was done, despite the fact that the causative nerve could not be identified. We believe that this case report is important as we could not find another patient reported in literature with regard to similar headache characteristics and treatment strategy.