Canan Celik

Is 25(OH)D Associated with Cognitive Impairment and Functional Improvement in Stroke? A Retrospective Clinical Study

BACKGROUND In recent years, vitamin D deficiency has been suggested as a risk factor for ischemic stroke and stroke severity in both animal models and clinical studies. In this retrospective study, we investigated the relationship between 25-hydroxyvitamin D [25(OH)D] levels and functional outcomes in stroke patients during neurological rehabilitation program. We also investigated whether there is an association between 25(OH)D levels and cognitive impairment. METHODS The study included the medical records of 120 stroke patients who participated in a neurological rehabilitation program. The motor and cognitive components of the Functional Independence Measurements of all patients at admission and discharge were recorded. The Functional Ambulatory Scale was used to assess motor functional status, and the Turkish-validated version of the minimental state examination test was used to assess cognitive status. RESULTS A significant correlation was found between 25(OH)D level and cognitive impairment among patients who had ischemic strokes. High levels of 25(OH)D were associated with greater functional gain during the rehabilitation program in both ischemic stroke patients and hemorrhagic stroke patients. CONCLUSIONS High 25(OH)D levels might be associated with greater functional improvement and with less cognitive impairment in stroke patients.

Comparison of effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy

Abstract Objective: The aim of the study was to compare the effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy (CP). Methods: We included 48 children with CP using lower extremity orthosis. Energy expenditures determined based on heart rate, yielded an energy expenditure index (EEI) with and without orthosis during walking. Results were compared statistically between orthosis groups (solid polyethylene ankle foot orthosis (PAFO), articulated PAFO, ground reaction foot orthosis (GRAFO), plastic and metallic knee-ankle-foot-orthosis (KAFO), and metallic AFO). Results: It was found that an advancement in energy expenditure was seen with plastic orthoses which is more prominent by solid PAFO (p = 0.008). Conclusion: It was concluded that especially solid PAFO can be more beneficial in terms of energy consumption in CP patients. In rehabilitation phase, the EEI measurement was seen to be a useful and practical method for choosing the proper orthosis type.

Effect of cold application and tizanidine on clonus: clinical and electrophysiological assessment.

Abstract Background/Objectives: Clonus is an involuntary rhythmic muscle contraction after sudden muscle stretch that occurs as a result of a lesion in the upper motor neurons. The real mechanism behind clonus remains obscure. The objective of this study was to investigate the effects of central-acting tizanidine treatment and peripheral extremity cooling on clonus. Participants: Thirty-eight patients with upper motor neuron involvement and sustained clonus. Methods: The 38 patients were divided into 3 groups: cold group (n = 19), tizanidine group (n = 13), and patient control group (n = 6). A separate group of 21 able-bodied volunteers served as controls for the cold group. The physiologic effects of cold application were measured in the able-bodied group and compared with the effects in the patients in the cold group. All participants were evaluated by clinical and electrophysiologic measurements. Results: Changes in clinical and electrophysiologic measurements in the cold group were statistically significant compared with those of the tizanidine and patient control groups. Conclusions: Subsequent and long-term cold application induced prolonged inhibitory effects on clonus. Tizanidine had no significant effect on clonus. Suppression of clonus by cold highlights the importance of peripheral input in relation to central mechanisms.

Paraplegia associated with spinal hydatid cyst: a case report.

Study Design. Case report. Objectives. To report a case with paraplegia caused by spinal hydatid cyst. Summary of Background Data. Hydatid cyst is a disease caused by larval Echinococcus granulosus tapeworm. Spinal hydatid cyst rarely leads to severe neurologic problems. Methods. A 34-year-old male patient was referred to our outpatient clinic due to back and low back pain, progressive weakness and numbness in both lower extremities, and a prediagnosis of lumbar disc hernia. He had spastic paraplegia, and thorax magnetic resonance imaging revealed a lobulated cystic lesion with extradural intraspinal localization. Results. After surgery and following 2 months of rehabilitation program, the patient showed a dramatic clinical improvement. Conclusion. By this case, it is emphasized that spinal hydatid cyst should come to mind in the differential diagnosis of spinal cord compression, and the importance of prevention, early diagnosis, and treatment is highlighted because of high mortality and morbidity.

Temperament and Character Profile in Failed Back Surgery Syndrome: A Cross-Sectional Clinical Study

AIM Some psychometric properties may predict the development of failed back surgery syndrome (FBSS). The aim of this study was to determine the pain, disability, and depression severity in patients diagnosed with FBSS, and to determine the temperament and character subgroups in comparison with control group. MATERIAL AND METHODS Thirty-eight patients diagnosed with FBSS, and 35 patients with favourable outcome after lumbar spinal surgery were included to the study. Pain intensity, disability, depression scores, temperament and character profile were determined by the visual analogue scale (VAS), Roland Morris Disability Index, Beck Depression Inventory, and Temperament and Character Inventory. RESULTS Pain intensity, disability, and depression scores were higher in the FBSS group (p < 0.001). There were no significant differences between temperament and character subgroups between study groups except one of the temperament subgroup, reward dependence (p=0.05). There was a negative correlation between self-directedness and leg pain severity in the FBSS group (p=0.01, r=-0.400). CONCLUSION No significant differences were found between the FBSS and control groups with respect to temperament and character profile but FBSS was the cause of severe pain, disability, and higher depression scores. This group of patients must therefore be evaluated psychiatrically and should also be subjected to a clinical examination, and they should be managed using a multidisciplinary approach.

Pain in Patients with Traumatic Spinal Cord Injury

Objectives The aim of this study was to investigate the prevalence and characteristics of pain in patients with spinal cord injuries. Methods Patients with traumatic spinal cord injury [73 males, 17 females] who had taken part in a rehabilitation program in our inpatient clinic were included. The American Spinal Injury Association Impairment Scale, McGill Pain Questionairre, Numerical Rating Scale, and the Functional Independence Measure were used to evaluate the spinal cord level of the injury, the severity of injury, the resultant pain intensity and the functional state of the study subjects. Results The prevalence of pain was 86.7 percent in patients with spinal cord injury. The nature of the pain was neuropathic in 40 [44.4 percent] of these patients, musculoskeletal in 17 [18.9 percent] patients, and mixed origin in 21 [23.3 percent] patients. There was no apparent relationship between presence, or type of pain and level or severity of the injury [P > 0.05]. A positive relationship was observed between the extent of the injury and the severity of the pain [P = 0.012]. No relationship was found between the pain and the functional state of the patient [P > 0.05]. Conclusion Neuropathic pain is a common clinical manifestation in patients with traumatic spinal cord injury but some also exhibited a musculoskeletal component. The severity of the pain is related to the extent of the spinal cord injury but not to the functional state.

Critical illness polyneuropathy: a case report.

Critical illness polyneuropathy (CIP) is defined as a common complication of critically ilness patients who were admitted to the intensive care unit due to sepsis, multiple trauma and/or multi-organ failure. We aimed to present a patient who was diagnosed as CIP. He was admitted to our outpatient clinic due to weakness and pain in his lower extremities. He had been followed in an intensive care unit due to suicid five months ago. There were symmetrically and predominantly muscle weakness, sensory impairment, absence of deep tendon reflexes in his lower extremities. Electrophysiological evaluation demonstrated motor and sensory axonal distal polyneuropathy predominantly in lower extremities. At follow up, he had high fever, and elevated acute phase responses. Therefore source of infection was investigated and was suspected to a diagnosis of infective endocarditis. He was discharged to be hospitalized in cardiology clinic. With this case, we think that physiatrists should take into consideration a diagnosis of critical illness polyneuropathy in patients with symmetric motor weakness. In CIP, muscle weakness, sensory loss, neuropathic pain, and autonomic problems lengthened the rehabilitation period. Due to a diagnosis of infective endocarditis in our case, we point out that source of infection should be carefully investigated if there is acute phase responses in CIP patients even if during rehabilitation period.

Nocturnal hypoxia and functional outcome in stroke patients1

BACKGROUND Sleep disorders and nocturnal hypoxia are common in patients with cerebrovascular disease. Sleep-disordered breathing is associated with a poor functional outcome in stroke patients. OBJECTIVE We investigated the relationship between nocturnal hypoxia and functional outcome in the rehabilitation phase of stroke patients. METHODS Thirty patients with stroke and 20 controls were included. Functional status was evaluated with the Functional Independence Measure (FIM). Pulse oximetry was performed overnight from 21.00  h to 07.00  h. Baseline awake oxygen saturation, nocturnal oxygen saturation, the lowest nocturnal oxygen saturation, and the >4% Oxygen Desaturation Index (ODI) were calculated. RESULTS The mean oxygen saturation measurements were not significantly different among the groups (p >  0.05). There was no significant relationship between the FIM scores and the oxygen saturation measurements of the stroke patients (p >  0.05). The baseline oxygen saturation in patients with disease duration of 3 months or less was 94.67, and it was 96.56 (p = 0.016) in those with disease duration of more than 3 months. CONCLUSION This study showed that nocturnal oxygen saturation was not associated with functional outcome in therehabilitation phase of stroke patients.

Bilateral sacroiliitis and left hip arthritis secondary to isotretinoin treatment

cne vulgaris is a chronic inflammatory disease affecting the pilosebaceous unit in the skin [1]. Isotretinoin is a synthetic vitamin A derivative using in severe cystic acne treatment. Pain and arthralgia are observed in 20% of patients treated with isotretinoin [2]; however sacroiliitis is rare and hip arthritis is even more rare. There was no article in the literature about a patient with sacroiliitis and hip arthritis together. A 30-year-old male patient who was suffering from severe pain on his left hip and leg for two days admitted to our clinic. His pain was very intense in the evening and the Visual analog scale (VAS) pain score was 8. He experienced morning stiffness for two days and about an hour on his left lower extremity. The patient had no history of inflammatory low back pain, skin lesion, bowel problem or infection. No pathology was found in rheumatologic examination. Family history was normal, however the patient was taking isotretinoin 20 mg/day for acne vulgaris about two months. The patient resorted to the brain surgery department before our clinic, the lumbar magnetic resonance imaging (MRI) was taken and no pathology was detected. The inspection of left leg and other body parts were normal but there was a pronounced skin dryness around the mouth periphery and face. There was mild sensitivity with palpation on left hip but the movements were limited and so painful. Flexion, abduction, and external rotation (FABER), flexion, adduction, and internal rotation (FADIR), sacroiliac compression, Mennel and Gaenslen tests were bilateral positive but more painful on left side. Lumbar range of motion was normal and there was no neurological deficit. Erythrocyte sedimentation rate (ESR) (33 mm/hr) and C-reactive protein (CRP) (3.84 mg/L) values were higher in the laboratory tests. Complete blood count, routine biochemical tests and HLA-B27 were negative. Bilateral bone narrow edema on iliac sides of sacroiliac joints and increased joint fluid on left hip was found on MRI (Figures 1a and 2a). As a result of all tests, the patient was diagnosed as bilateral sacroiliitis and left hip arthritis due to isotretinoin. The isotretinoin was ceased and nimesulide 2×100 mg, methylprednisolone 1×16 mg and lansoprazole 1×30 mg was started. A dramatic clinical response was obtained. A significant decrease was observed in the laboratory parameters on the seventh day (CRP: 0.06 mg/L, ESR: 5 mm/hr) and the VAS score was 3. Methylprednisolone was reduced and ceased. A repeat MRI performed five months later showed no evidence of left hip arthritis and sacroiliitis (Figures 1b and 2b) and the examination was completely normal.

Bilateral obstetric brachial plexus paralysis: a case report

We aim to report a case with bilateral obstetric brachial plexus paralysis rarely seen after cesarean section. A 28-month-old girl was admitted to our outpatient clinic with weakness in both upper extremities. Shoulders were adduc ted and internally rotated, elbows were extended with flexion fingers. The 37-year-old mother, fetal breech presentation, premature birth and probably traction forces applied at birth were considered among the risk factors. With this case, it is emphasized that obstetric brachial plexus paralysis occurs rarely bilateral and after cesarean section.